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Introduction Recent interest in improving cosmetic outcomes has led to single-incision laparoscopic surgery ( SILS) being performed in a variety of organs. However, this innovative technique has rarely been introduced in pancreatic surgery, as it is considered to be a challenging procedure. We report herein our technique of single-incision laparoscopic distal pancreatectomy with or without splenic preservation. Materials and Surgical Technique A 2.5-cm intraumbilical mini-laparotomy was made for the placement of a SILS Port as a single access site. The overall procedures were similar to those performed in the standard laparoscopic distal pancreatectomy with multiple trocars. To obtain better exposure of the operative field, we made technical refinements by employing gastric suspension with sutures, the tug-exposure technique, a balloon retractor, and gravity by changing the patient's position. The pancreas was transected with a linear stapler, and the specimen was extracted through the umbilical wound. Discussion Patients were discharged without any complications. The umbilical wounds were almost invisible 1 month after surgery. We believe that SILS, with some technical refinements, can be safely applied for distal pancreatectomy. Although the cosmetic benefits of single-incision laparoscopic distal pancreatectomy are obvious, several issues such as the extent of invasiveness, cost, indications, and learning curve need to be investigated. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Recent advances in single‐incision laparoscopic surgery (SILS) have caused increased difficulties when tying knots because of the limited working space. Although extracorporeal knot‐tying techniques may be a practical alternative choice in SILS, it is not always appropriate. For example, sliding resistance may be encountered when tying knots for a Z‐shaped suture, and it could damage the sutured tissue. Materials and Surgical Technique: The clinch knot is a kind of slipknot that has been historically used by fishermen. We modified it for SILS so that it has a locking mechanism caused by knot deformation. We apply pre‐tied modified clinch (MC) knots in the peritoneal cavity with a needle driver. After the suture, the needle is pulled through the knot and exits out the trocar. After the MC knot has been tightened, locking is achieved by pulling the other end of the axial thread and folding the thread in an acute angle. Because both ends of the suture thread leave the trocar together, every step can be carried out quickly through a single trocar. The MC knot can also be used to tie knots for Z‐shaped sutures because of its short sliding distance. Twelve simple interrupted sutures and 55 Z‐shaped sutures were tied by MC knot in SILS. All knots were successfully tied, and the mean required time to tie a knot was 27 s. Discussion: The MC knot is feasible knot‐tying procedure especially for a Z‐shaped suture during SILS. [ABSTRACT FROM AUTHOR]