In 2008, we presented our initial experience with application of our Single Port Access (SPA) surgery technique to cholecystectomy. We now follow this up with 18 months experience using the SPA technique for cholecystectomy and other procedures of the alimentary tract.Maintaining our entry technique through a single incision, 1.5 to 2.5 cm in length, and often times hidden within the umbilicus, we have successfully performed over 45 cholecystectomies, 10 colon resections, 20 procedures involving the small bowel and omentum, 8 gastric procedures and liver biopsy. Only two procedures has required additional port sites and none have required transabdominal sutures. In addition, we have performed these procedures with standard "very low profile" trocars and access devices, instruments and techniques. Although early development included articulating instruments, < 5% of all procedures done to date have required the use of articulation.The SPA technique has allowed us to access all quadrants of the abdomen through a single point of entry. In addition, it has maintained “independence of movement” of each instrument and scope. We demonstrate range of motion up to 1800 for individual instrument movement and 1600 for separation of two instruments. This “independence of movement” is maintained in both the horizontal and vertical direction. In addition, this property not afforded by multi-trocared access devices, also allows dissection to be maintained virtually identical to multiport laparoscopic procedures. In cholecystectomy, we are able to maintain dynamic retraction of the gallbladder and obtain the “critical view’ throughout dissection. In colon surgery, it allows both “medial to lateral” and “lateral to medial dissection”.Immediate follow-up demonstrated similar outcomes in terms or blood loss, hospital stay and pain, with slight increases in operative time. Follow up of patients up to two years has resulted in comparable results to multiport laparoscopy. To date, one hernia has been identified in a patients SPA incision which was used for colon extraction.With initial procedures performed in April 2007, we are now able to report 18 month follow-up of a novel laparoscopic approach utilizing standard instrumentation. We demonstrate that Single Port Access (SPA) surgery is a comparable alternative to multiport procedures with the benefit being decreased number of incisions and improved cosmesis for the patient. Long term and large series will be necessary to assess pain, recovery and hernia formation.