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Purpose. Total abdominal colectomy (TAC) with end ileostomy is the procedure of choice for patients with medically refractory ulcerative colitis (UC). A laparoscopic approach has been shown to be safe and effective and has become the preferred strategy in our practice. We report the evolved experience of a single colorectal surgeon (AF) and compare results of laparoscopic-assisted (LA) TAC, hand-assisted (HA) TAC and single incision laparoscopy (SIL) TAC.Methods. Since May 2010 ten consecutive patients with medically refractory UC underwent SIL TAC and were case matched by age, gender, BMI and smoking history to 10 LA TAC (from Feb 2003 to Jan 2007) and 10 HA TAC (from Feb 2006 to Apr 2010). Patient, disease and surgery-related factors were analysed and short-term outcomes were compared.Results. There were no statistical differences in age, gender, BMI and smoking history between the groups per the case match design. Disease duration, histologic disease activity, Mayo score for ulcerative colitis, nutritional and inflammatory parameters, steroid and anti-TNF therapies did not differ between groups. SIL TAC patients were more likely to have received immunosuppressive therapy within 30 days of the surgery (p=0.016) than the other groups. There were no conversion or intraoperative complications noted. The estimated blood loss did not differ between groups. The length of surgery was significantly shorter for SIL TAC (139.0+23.7 minutes) when compared with LA (270.9+45.4) and HA (182.8+31.6) (p<0.001). SIL TAC patients tolerated solid diet intake sooner (3.0+0.5 days) than the other groups (3.7+0.5) (p=0.019). Postoperative length of stay and short-term complication rates did not differ between groups.Conclusions. In this experience of a single surgeon, SIL TAC was associated with shorter procedure time, faster time to solid diet and was equally safe to traditional LA TAC and HA TAC. Additional study and experience will solidify this approach for future patients and surgeons.