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Introduction: Besides improved cosmesis, transumbilical Laparo-Endoscopic Single Site (LESS) surgery promises quick recovery, reduced pain, and shorter length of stay. As well, because only an umbilical incision is used, (LESS) surgery lends itself well to epidural anesthesia and, thereby, avoidance of the adverse affects and cost of general anesthesia. The purpose of this study was to evaluate our evolving technique of LESS cholecystectomy with epidural anesthesia to determine safety, cost, and morbidity.Methods: Beginning in August 2009, we began to undertake LESS cholecystectomy with epidural anesthesia. We approached patients with chronic cholecystitis without previous abdominal surgery and body mass index (BMI) <35kg/m2. Exclusion criteria included pregnancy, or documented contraindications for epidural catheter placement. Among many measures, blood loss, operative time, complications, and length of stay were evaluated. Patients were seen in clinic 14 days postoperatively; using a Likert scale from 1 (worst)-10 (best), their pain, satisfaction, cosmesis, and symptom resolution was scored. Data are presented as median, mean ± SD, where appropriate.Results: From August to November 2009, 7 patients underwent LESS cholecystectomy with epidural anesthesia. Anesthetic costs for laparoscopic cholecystectomy were approximately $1,750 less with epidural anesthesia than with general anesthesia. In the recovery room and through discharge, all patients denied nausea or vomiting, hypotension, neurologic deficits, pruritis, palpitations, drowsiness, or “hangover” from anesthesia. Immediate postoperative pain and discomfort were minimal. The umbilical incisions healed with no apparent scar. The patients scored “Satisfaction” as 10, 10± 0.6, “Cosmesis” as 10, 10 ± 0.8, and perioperative “Pain” as 5, 5 ± 3.1. All patients returned to full activities by 2 weeks.Conclusion: In well selected patients, LESS cholecystectomy with epidural anesthesia can be undertaken safely with clinical outcomes at least equivalent to LESS cholecystectomy with general anesthesia. Anesthetic cost savings are notable. Patient satisfaction and cosmesis are particularly prominent. We recommend LESS cholecystectomy with epidural anesthesia for select patients.

Gender	Male (3) : Female (4)
Age:	55 years , 53 years +/- 9.9
BMI:	27 kg/m^2, 26 kg/m^2 +/- 7.0
Operative Time:	95 minutes, 84 minutes +/- 37.4
Estimated Blood Loss:	Minimal for all (<30 ml)
Conversion to multiple ports / open operation:	None
Length of hospital stay:	<24 hours for all
Complications:	None