The cooling of enthusiasm related to EA-NOS procedures has naturally forced surgeons to concentrate on techniques which could be more easily reproduced in clinical environments. This brought the interest towards what we would call Surgical Access Natural Orifice Surgery (SA-NOS)2 . In fact, an analysis of the literature would unveil that the vast majority of human studies can be ascribed to SA-NOS. A wider vision of what can be considered a SA-NOS approach, includes in this group not only transvaginal, thoroughly described in literature, but also trans-umbilical surgery. Although both approaches have the advantage of not being burdened by problems related to endoscopic defect's closure in terms of infection, safety, consistent technological research and time-consumption, there is no discussion that trans-umbilical techniques encountered more appreciation among surgeons. We have observed a rapid clinical diffusion driven by a technology development supported by all the different major surgical companies. Thus, it has to be said that single-port laparoscopic surgery is nothing new. It was 1992 when Marco Pelosi first described a laparoscopic appendectomy using a single umbilical puncture5 . Even multi-port single-incision trans-umbilical laparoscopic cholecystectomy was first described by Giuseppe Navarra already in 19977 . Despite this, interest towards single-port surgery grew-up only very recently. This might be on one side explained with the better establishment of laparoscopic techniques and skills over the years, but rises doubts about a possible industry driven interest.