During the past 10 years, the minimally invasive technique has become the standard approach for many thoracic, abdominal, and pelvic procedures in adults and children. We now know there are well-defined benefits to this approach. However, when it was introduced, the laparoscopic technique was quickly adopted without appropriate clinical evidence to justify its advantages over open surgery. With continued efforts to increase the benefits of minimally invasive surgery for their patients, surgeons have developed new techniques to further decrease the trauma of the operation and improve the postoperative cosmetic appearance for the patient. These innovations range from decreasing the size of the ports and instruments to the current group of techniques termed "scarless" surgery. In today's era of evidence-based medicine, it is important to scientifically evaluate the benefits of a new approach or technique. This article seeks to review the history of laparoscopic surgery, apply lessons learned during the past 10 years to the evolution of single incision laparoscopic surgery, and urge for sound prospective evaluation for the use of laparoscopic surgery using a single umbilical incision.
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