Melnikov N.V., Head of the Short-Term Stay Department, Nizhny Novgorod Regional Clinical Diagnostic Center; Zubeev P.S., MD, PhD, Professor, Department of Hospital Surgery, Nizhny Novgorod State Medical Academy. According to the generally accepted technique, the gallbladder is removed through an incision at the site of a 10 mm trocar in the umbilical area. This method has the following disadvantages. — To remove the gallbladder, the wound, as a rule, must be somewhat widened, which causes additional trauma. — To manipulate the aponeurosis, the skin wound must be larger than required for insertion of a 10 mm trocar, so it must be widened and the fatty tissue along the edge of the aponeurosis wound must be separated. This also causes additional trauma. — The fibers of the aponeurotic tissue are practically impossible to separate, therefore, the wound widening is performed by dissecting the aponeurosis. After removing the gallbladder, the wound in the aponeurosis must be sutured. Patients undergoing cholecystectomy are typically overweight, with a stretched and weakened linea alba, which reduces suture reliability. In cases of purulent wound complications, suppuration of the aponeurosis sutures leads to a 100% chance of developing a postoperative hernia. We remove the gallbladder through an extended puncture at the right trocar site, inserted almost along the midaxillary line. The advantages of this method, from our perspective, are: Only the skin is incised. All other muscle layers are simply separated. The closure of three opposing muscle layers virtually guarantees the prevention of hernias, a fact well known to surgeons from their experience with packing and drain placement. Therefore, after gallbladder removal, only the skin wound is sutured down to the drain, which is inserted under the liver through this opening. If a purulent complication arises from the wound, usually only fatty tissue and connective tissue are suppurated. Muscle layers are rarely affected by suppuration, therefore, wound suppuration also rarely leads to a hernia. In the absence of transected muscle layers, even if a hernia develops, its suturing is incomparably simpler and more reliable than that of a periumbilical hernia. After creating carboxyperitoneum, we use a Veress needle to blindly insert a 10 mm trocar into the periumbilical region through a small skin incision large enough to pass a ten-point slit. No further widening of the skin incision or exposure of the aponeurosis is performed. The puncture is not made along the abdominal midline, but slightly to the right of it, with the expectation that the trocar will successively pass through the two aponeurotic layers of the rectus sheath. A slight upward tilt of the puncture channel results in a puncture of both layers of the aponeurosis at different levels. We do not perform 10 mm fascial puncture suturing. We do not use clip applicators. The cystic artery is coagulated using a bipolar coagulation technique called BBC (a variation of the bipolar coagulation technique performed using two monopolar instruments) or, very rarely, ligated. An endoloop is placed on the cystic duct stump. Therefore, during cholecystectomy, we use only one 10 mm trocar for the optics and three 5 mm trocars for the instruments. Recently released powerful illuminators and high-quality optics allow cholecystectomy with 7 mm diameter optics. This further reduces trauma to the linea alba during insertion of the main optic trocar and the risk of postoperative hernia. Based on 244 cholecystectomies in which the gallbladder was removed using this technique, we are not aware of a single case of postoperative hernia. These techniques may not be new. But we have not seen them in use or read about them in literature.