I am please to review the manuscript on creative surgical technique.

Although single port surgery have many advantages & superiority, single port surgery has hurdles to overcome.

Especially, repair step is the most troublesome due to characteristics of single port surgery.

Single port surgery does not mean only number of incision and overall length of incision.

The most important point of single port surgery mean that the fundamental principles of laparoscopic surgery may be lost.

“Triangulation & leverage effect”

These principle enable to dissect the tissue and repair through laparoscopy.

But these principle may be lost or incapitated in sinlge port surgery.

So paradigm must be converted “to and pro movements” instead of “angular movements” to minimize the instrumental fighting and crowding.

To overcome these limitations, authors propose the extracorporeal one hand repair technique.

The idea is very creative.

But I will point out several supplement points.

1. This manuscript is not adequate review article category but categorized to case report.

Authors presented only one case experience.

More cases should be presented to prove the usefulness especially such as intramural myoma.

2. The technique may be possible with only special suture material with unidirectional barbs such as V-Loc^TM _.

The technique may be difficult and cannot ensure the adequate tissue repair with conventional suture materials.

But idea is very creative and the technique contribute to overcome hurdles for single port repairs.

3. The essential points of this manuscript is not on all-round single port technique but suture technique.

So descriptions and photographs on suture techniques and after repair (before application of adhesion barrier) should be presented instead of less essential descriptions and photographs.

YS Choi MD, PhD

yschoimd@yahoo.co.kr

Her Women’s clinic

1080-9, unam-dong, buk-gu, Kwang-ju metropolitan city, South Korea