Single Incision Laparoscopic Surgery (SILS) is also known as LaparoEndoscopic Single Site surgery (LESS). A further extension of this sort of approach is Natural Orifice Transluminal Endoscopic Surgery (NOTES), whereby instruments are introduced though the gut, via the mouth, or through the top of the vagina into the abdomen, in order to perform operations such as cholecystectomy and appendicectomy. These (NOTES) approaches leave no visible scars, but remain very much experimental at this stage. SILS, however, has gained some traction, particularly with laparoscopic cholecystectomy and bowel resection. Single incision laparoscopic cholecystectomy Using a specially adapted access port, laparoscopic cholecystectomy can be reduced to a single 1.5-2.0 cm incision tucked into the umbilicus. This avoids the usual 3 extra ports that are placed across the upper abdomen during “conventional” laparoscopic cholecystectomy. The operation is technically more demanding using the SILS approach and usually takes a little longer. It seems that the main advantage is cosmetic; recovery times following single incision laparoscopic cholecystectomy are very similar to the conventional laparoscopic approach. Andrew Bowker’s experience with single incision laparoscopic cholecystectomy Andrew introduced this procedure to New Zealand in 2012. He has now done over 75 cholecystectomies in this manner (March 2017), without need to convert to the standard 4-port approach.  The operation can be considered for those in whom cosmesis is a concern. He has found that this is not restricted to his (prejudiced) preconception of the 25 year old female model; the oldest in his series has been 68 and the largest BMI 34.6