Innovations in technology has changed the traditional laparoscopy to be less invasive. Singleport transumbilical laparoscopy has emerged to enhance the cosmetic benefits and to decrease the morbidity of the minimally invasive surgery. It has further minimized the minimally invasive surgery. However, this technique requires a specialized multichannel port (for introducing laparoscope and instruments) which is very costly and in fact, is not affordable by the majority of the population in a developing country like India. We have improvised a single-port access system using readily available materials like surgical gloves, towel ring, inner flexible ring and conventional laparoscopic trocars with no added cost burden to the patient. We have performed 40 single port surgeries using this method without any complications.

Laparoscopic cholecystectomy has become the standard treatment for symptomatic cholelithiasis in patients with situs inversus totalis (SIT). In an effort to reduce morbidity and improve the cosmesis single-port laparoscopic cholecystectomy has recently emerged, where the surgery is done through a single port, typically the patient's navel. This improves the cosmesis, lessens post-operative pain and ensures virtually a “scar less” surgery. We report a case of successful single-port laparoscopic cholecystectomy for a patient with SIT, and describe its technical advantages and review of literature.

Management of complications in patients with Roux-en-Y reconstruction is still today an important surgical and endoscopic challenge. Various techniques have been employed to manage biliary strictures and intrahepatic calculi in patients with Roux-en-Y hepaticojejunostomy (RYHJ). We report the case of a 24-year-old female who had undergone RYHJ reconstruction 3 years back for choledochal cyst, admitted with the diagnosis of obstructive jaundice due to anastomotic stricture and multiple hepatic duct calculi. She was successfully treated with laparoscopic-assisted transjejunal endoscopic management of intrahepatic calculi and anastomotic stricture, which appears to be safe and useful procedure for anastomotic stricture and hepatic duct calculi in patients with surgically altered anatomy.

Laparoscopic surgery has come to replace many conventional abdominal surgeries because of its outstanding advantages, including a better cosmetic result, faster recovery, and lesser postoperative pain. We present a case of laparoscopic-assisted total excision of Todani type I(B) choledochal cyst and biliary reconstruction in a 24-yearold female patient. Dissection of the cyst was done laparoscopically using the monopolar diathermy energy source. An end-to-side hepaticojejunostomy was created intracorporeally using 3-0 Vicryl suture, and end-to-side enteroenterostomy was completed outside the abdominal cavity using the E.K. glove port as wound protector. A new pair of gloves was then used to construct the glove port that served as the optical port. Additional instruments for retraction and suturing were deployed through the port whenever necessary. The use of the glove port also eliminated the need to suture the umbilical port before the completion of surgery. No intraoperative complications or technical problems were encountered using this technique. The use of the E.K. glove port makes it more a convenient and cost-effective procedure in a country like India.