New frontiers in mini-invasive biliary surgery: Single incision laparoscopic surgery, natural orifice transluminal endoscopic surgery, and robotics

During the last 2 decades, technological advances as high-definition cameras along with three-dimensional vision systems, vessel sealing devices, and articulating instruments have added safety, efficacy, and precision to laparoscopic procedures. The need to develop even more minimally invasive surgical techniques has led laparoscopic surgeons to try to reduce the number of skin incisions or to avoid them altogether, and change the way to approach peritoneal cavity. Natural orifice transluminal endoscopic surgery and single incision laparoscopic surgery represent the surgeon's attempt to reduce invasiveness and body image trauma perception and improved esthetics in comparison with conventional laparoscopic surgery. All these innovations have been successfully applied to laparoscopic cholecystectomy. However, it is still debated when and how to use them instead of conventional procedures.