Alternative Port Site Selection (APSS) for Improved Cosmesis in Laparoscopic Surgery

• Dr. de la Cruz-Muñoz developed a technique that moves surgical incision sites to less visible areas of the body so that scars from laparoscopic surgery are easier to conceal.
• The paper describes how to arrange the ports and standard laparoscopic instruments for gallbladder removal and gastric banding. It is a technique description and does not report outcome statistics compared with conventional port placement.
• The approach is intended for select patients; body habitus and the type of operation determine whether it is feasible.
• This study was published in the Journal of Gastrointestinal Surgery, and Dr. de la Cruz-Muñoz is the lead author who originated the technique.
• For patients concerned about visible scarring after surgery, this research shows a commitment to the complete patient experience, not just the medical outcome.

Why This Paper Was Written

Laparoscopy replaced long incisions with several small ones, but those small scars still sit on the upper abdomen, where they are visible in a swimsuit or crop top. Single-incision surgery through the belly button promised fewer scars but made operations technically harder and was associated with more incisional hernias. Dr. de la Cruz-Muñoz and Dr. Leonidas Koniaris proposed a middle path: keep standard laparoscopic instruments, but move the ports to places where scars are hidden.

What the Technique Involves

Alternative port site selection (APSS) places the working ports in less visible areas, chiefly the belly button and the bikini (pubic hairline) area, instead of the upper abdomen. The paper describes APSS setups for two common operations:

• Laparoscopic cholecystectomy (gallbladder removal), with ports concealed in the umbilicus and the bikini line.
• Laparoscopic gastric banding, adapting port positions to reduce visible upper-abdominal scarring.

The authors explain how to arrange the ports and instruments to overcome the longer reach and different angles, and note that the approach is less technically demanding than single-site surgery while preserving conventional triangulation.

What This Means for Patients

For many patients, especially younger women, how a scar looks matters. APSS shows that minimally invasive surgery can be planned with appearance in mind without compromising the safety of a standard operation. This work became the foundation of Dr. de la Cruz-Muñoz’s Supermodel Lap Chole, a hidden-incision gallbladder operation with the largest incision inside the belly button and two small incisions in the pubic hairline. If you have gallbladder disease, read Do I need my gallbladder removed? and our overview of gallbladder and bile duct disease.

Clinical Pearls

• Port placement can be moved to the umbilicus and bikini line for many routine laparoscopic operations.
• APSS preserves standard laparoscopic instruments and triangulation.
• It is less technically challenging than single-incision laparoscopic surgery.
• Not every patient is a candidate; body habitus and the operation determine feasibility.

Strengths and Limitations

This is a technique paper describing an approach and its practical setup rather than a comparative trial. It does not report outcome statistics against conventional port placement, and the authors note that APSS is intended for select patients.

Expert Commentary

Patients care about where their scars end up, and laparoscopic scars do not have to sit in the middle of the abdomen. APSS was my answer early in my career, and I have continued to refine it for about 20 years. The Supermodel Lap Chole is the direct descendant of this paper: the same safe gallbladder operation, with incisions you cannot see in a bathing suit.

— Dr. Nestor de la Cruz-Muñoz