The history of single-port surgery may date back to its early use in laparoscopic gynecologic surgery when Wheeless and Thompson described more than 1000 tubal ligations using a single puncture laparoscope with an offset eye piece.⁷ However, purists within the contemporary single-port arena argue that operative laparoscopy differs significantly from modern day single-port surgery, and the origins of the single-port surgical revolution were developed more recently. The first use of separate instruments and ports through a single incision was initially described in 1997 by Navarra et al., when they published their “one wound cholecystectomy” using two transumbilical trocars. At that time, single-port surgery seemed as if it was not ready to emerge as a viable access platform for the mainstream and even Navarra himself questioned the ­validity of that approach in terms of its safety, efficacy, and operative time.⁸ It was not until 2007 when Curcillo revisited ­Navarra’s work and described a stepwise approach for the reduction of port sites and consolidation of trocars, resulting in one umbilical incision for laparoscopic cholecystectomy named single-port access (SPA).⁹ Since 2007, a massive emergence of single-port procedures has been successfully adapted to many common multiport laparoscopic abdominal procedures in both children and adults with the ultimate goal of reducing overall surgical invasiveness. The single-port platform evolved rapidly with the objectives of minimizing overall surgical trauma, reducing postoperative pain, shortening convalescence, and improving cosmesis.⁹ In humans, it is speculated that the potential advantages that single-port surgery has over conventional multiport laparoscopy include superior cosmesis from a relatively hidden umbilical scar; a possible decrease in morbidity related to visceral and vascular injury during trocar placement; and risk reduction of postoperative wound infection, hernia formation, and elimination of multiple trocar site closures.¹⁰ Although single-port surgery may seem to have potential benefits, comparative trials in humans have yet to find significant differences between single-port and conventional multiport laparoscopy in postoperative complications, postoperative pain, hospital stay, and cosmetic results.^11,12 It should also be noted that within the human literature, including both clinical case series and laboratory-based skill acquisition studies, evidence has demonstrated unique requirements of single-port surgery, with skill sets and ergonomic demands that cannot be directly adapted from existing laparoscopic experience, and the implementation of an evidence- and competency-based single-port training curriculum is necessary to ensure appropriate training of future single-port surgeons.¹³

Within veterinary laparoscopic surgery, reducing the number of portals of entry has been a concept embraced by many veterinarians for a number of common techniques. In 2009, Dupre et al. described the one portal operating laparoscopic ovariectomy (OVE) using a 10-mm telescope that incorporates a working channel that can accommodate 5-mm instruments.¹⁴ An array of two-port laparoscopic-assisted techniques, including gastropexy,¹⁵ cystopexy,¹⁶ urinary calculi removal,¹⁷ and cryptorchidectomy,¹⁸ have also been described. These two-port techniques enabled many common elective procedures to be done routinely by veterinary laparoscopic surgeons. It was only recently that many of the two-port procedures in veterinary laparoscopy took a leap toward the single-port platform in which multiple instruments as well as the telescope are consolidated to one point of entry for completion of the entire procedure. The earliest abstract reports on laparoscopic single-port veterinary techniques that did not use an operating laparoscope emerged in 2011.^19,20 The single-port platform gained rapid popularity among veterinary laparoscopic surgeons. Shortly after the initial single-port abstracts, a total laparoscopic ovariectomy using standard rigid instrumentation was described²¹ using a commercially available single-port device (SILS [single-incision laparoscopic surgery] port, Covidien, Mansfield, MA). Shortly after, the SPA ovariectomy technique was reported.²² Other single-port devices as well as novel bent and articulating instruments emerged as feasible instrumentation that could be used in veterinary single-port laparoscopy.²³ More recently, other techniques using the single-port approach were reported, including single-incision laparoscopic-assisted intestinal surgery (SILAIS) in dogs and cats using the EndoCone (Karl Storz Endoscopy, Goleta, CA) and the SILS port²⁴; the single incision laparoscopic ovariectomy in cats²⁵; the SPA gastropexy and ovariectomy (SPAGO) with the SILS port²⁶; and the single-port laparoscopic cryptorchidectomy (SPLC), which was described using the EndoCone, SILS, and Triports (Olympus, Center Valley, PA).²⁷ An evaluation of the learning curve for the single-port ovariectomy using the SILS port has also been reported.²⁸ A study has also been published within the veterinary literature evaluating the effect of standard decontamination and sterilization methods on sterility after reuse of the SILS device.²⁹

The principles of single-port surgery are very similar to those of conventional multiport laparoscopy, although differences exist associated with the way triangulation is achieved. Having one point of entry inherently prevents the traditional principles of instrument triangulation. The close proximity of the instruments and optics both intraabdominally and extraabdominally causes the surgeon to perform the procedure without a lot of surgical working space intraabdominally. This ultimately causes increased technical ­complexity for any procedures because of inadequate triangulation, a compromised field of view, inadequate exposure, and frequent instrument collisions, which all occur as a result of the common entry point for the camera and instruments.³⁰ Single-port laparoscopy has been able to somewhat overcome this lack of triangulation by using angled optical telescopes, crossing instruments, or bent and articulating instruments. This novel arrangement of both the optics and instruments creates more internal and external working space, allowing for some triangulation which prevents instrument crowding. Although standard instruments can be used for single-port surgery, numerous instruments and devices have been developed to simplify and make single-port surgery more user friendly.

The devices and equipment used for single-port surgery can be broadly classified as (1) specifically manufactured devices for ­single-port surgery, (2) standard instruments and trocar–cannula assemblies used for conventional laparoscopy inserted through one skin incision, or (3) innovative adoptions of existing equipment not primarily intended for laparoscopy.