Since SPA surgical technique requires a consistent effort in terms of development of new technology and surgeon's adaptation, we consider this definition of primary relevance. As a matter of fact, a concrete introduction of SPA Surgery into daily practice is not possible without a concrete advantage for patients. Except one single trial comparing only postoperative pain (by Tsimoviannis et al. in G. Hatzikosta General Hospital, Ioannina Greece), at present there are no similar studies posted on USA and European trials databanks.