177 SILS for Gastric SMT SILS procedure with lower time requirement and better maneuver- ability.(24) Adopting right-angle light cable adaptor which makes light cable run parallel with laparoscope and a long-shaft camera would further reduce external collisions.(25) Nevertheless, a learn- ing curve for these instruments is expected before their practical use, and further development of instrumentation is required for the widespread use of this new technique in more complicated procedures. It should be noted that SILS can be easily converted into conventional laparoscopic surgery by adding a few extra ports. Some investigators introduced 2~3 mm instruments, which serves as atraumatic retractors to secure a better surgical view and still leaves no scar after surgery(9); this could be an alternative solution for better surgical performance during SILS. A small extension of the transumbilical incision can be consid- ered for difficult-to-access tumors. Transumbilical incision with slight extension in SILS can be used to exteriorize the lesion for resection when the tumor is hard to access or manipulate in the abdominal cavity; this would further facilitate SILS in many cases. This study has several limitations. The number of patients in- cluded in the present study was small, and the comparative data between SILS and conventional laparoscopic approach were not presented. Additional prospective randomized controlled trials are needed to examine its feasibility and safety. The participating two surgeons utilized different types of platform to perform single- incisional wedge resection in the present study; this would have influenced the surgical performance and serve as a limitation of the present study. In conclusion, gastric wedge resection using SILS for gastric SMTs is safe and feasible when performed by experienced laparo- scopic surgeons. This scar-free abdominal procedure is a promis- ing alternative method for the treatment of gastric SMTs, especially those located at the anterior wall or along the greater curvature of the stomach. However, careful selection of patients based on tumor location and a standardized method for tumor localization should precede the widespread use of this new technique. Although the immediate benefit appears to be cosmetic, potential benefits and disadvantages require further evaluation. Prospective randomized studies comparing SILS and conventional laparoscopic surgery for gastric wedge resection are necessary to confirm the benefits of this new technique. References 1. Allori AC, Leitman IM, Heitman E. Natural orifice translumi- nal endoscopic surgery: lessons learned from the laparoscopic revolution. Arch Surg 2008;143:333-334. 2. de la Fuente SG, Demaria EJ, Reynolds JD, Portenier DD, Pry- or AD. New developments in surgery: Natural Orifice Translu- minal Endoscopic Surgery (NOTES). Arch Surg 2007;142:295- 297. 3. Flora ED, Wilson TG, Martin IJ, O'Rourke NA, Maddern GJ. A review of natural orifice translumenal endoscopic surgery (NOTES) for intra-abdominal surgery: experimental models, techniques, and applicability to the clinical setting. Ann Surg 2008;247:583-602. 4. Bessler M, Stevens PD, Milone L, Parikh M, Fowler D. Trans- vaginal laparoscopically assisted endoscopic cholecystectomy: a hybrid approach to natural orifice surgery. Gastrointest En- dosc 2007;66:1243-1245. 5. Hong TH, You YK, Lee KH. Transumbilical single-port laparo- scopic cholecystectomy: scarless cholecystectomy. Surg Endosc 2009;23:1393-1397. 6. Reavis KM, Hinojosa MW, Smith BR, Nguyen NT. Single-lap- aroscopic incision transabdominal surgery sleeve gastrectomy. Obes Surg 2008;18:1492-1494. 7. Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I. One-wound laparoscopic cholecystectomy. Br J Surg 1997; 84:695. 8. Podolsky ER, Curcillo PG 2nd. Single port access (SPA) sur- gery--a 24-month experience. J Gastrointest Surg 2010;14:759- 767. 9. Omori T, Oyama T, Akamatsu H, Tori M, Ueshima S, Nishida T. Transumbilical single-incision laparoscopic distal gastrectomy for early gastric cancer. Surg Endosc 2011;25:2400-2404. 10. Lee YS, Kim JH, Moon EJ, Kim JJ, Lee KH, Oh SJ, et al. Com- parative study on surgical outcomes and operative costs of transumbilical single-port laparoscopic appendectomy versus conventional laparoscopic appendectomy in adult patients. Surg Laparosc Endosc Percutan Tech 2009;19:493-496. 11. Blay JY, Bonvalot S, Casali P, Choi H, Debiec-Richter M, Dei Tos AP, et al; GIST consensus meeting panelists. Consensus meeting for the management of gastrointestinal stromal tu- mors. Report of the GIST Consensus Conference of 20-21 March 2004, under the auspices of ESMO. Ann Oncol 2005; 16:566-578. 12. Kinoshita K, Isozaki K, Tsutsui S, Kitamura S, Hiraoka S, Wa- tabe K, et al. Endoscopic ultrasonography-guided fine needle aspiration biopsy in follow-up patients with gastrointestinal