Background An important aspect of a new surgical technique is whether it can be performed by other surgeons in other institutions. The authors report the first 297 cases in a multi-institutional and multinational review of laparoscopic cholecystectomy performed via a single portal of entry. Methods Data were collected retrospectively for the initial patients undergoing single-port cholecystectomy by 13 surgeons who performed these procedures in their institutions after training by the authors. The review included operative time, blood loss, incision length, length of hospital stay (LOS), necessary additional trocars, and other parameters important to cholecystectomy. A database of all the single-port-access (SPA) surgeries performed by the surgeons included demographic and procedural details, LOS, complications, and initial follow-up data. Results To date, 297 single-port cholecystectomies have been performed for a variety of diagnoses, primarily cholelithiasis. The average operative time was 71 min, and the average LOS was 1-2 days. The average blood loss was minimal. The use of additional port sites outside the umbilicus occurred in 34 of the cases. Of the 35 intraoperative cholangiograms performed, 34 were successful. No significant complications occurred except for seromas and minor postoperative wound infections. These results are comparable with those for standard multiport cholecystectomy. In addition, no access site hernias (ASH) occurred. SPATM is a Trademark

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Reduction in mortality from ruptured abdominal aortic aneurysm can be achieved by prompt recognition of established clinical manifestations. In addi tion to the classic symptoms and signs, incarceration of a previously reducible groin hernia has occasionally led to the diagnosis of aneurysmal rupture. This report details the first known case of acute incarceration of an epigastric (inci sional) hernia secondary to ruptured abdominal aortic aneurysm. It serves to underscore the necessity of maintaining a high index of suspicion for occult aneurysmal rupture when a patient presents with incarceration of any previ ously reducible abdominal wall hernia.