1. Authors replyes the same phrases to <introduction> and <patients method>.
2. All patients with Acute Cholecystitis and ASA II-III, were excluded from this study. Never the less, there is 2 patints out of 18 in the group of 3-port L.C. suffering from acute cholecystitis (ac), while there is 5 more patients out of 33 (4-port LC), with A.C; mean that 7 patients out of 33 (13% approximatelly)!!! Authors believes that preoperative selection of the patients was accurated?
3. In nine patients(1 in 3-port LC and 8 in 4-port LC group), operation was converted to the open laparotomy (23%). Conversion rate is much higher that median. Non the less, is too small the number of patients selective for 3-port and 4-port LC.
4. In male patients and in 3-port LC group, operative time was similar, longer, or much longer than  in male patients of 4-port group?
Authors don't mentioned anythink regardind the details of the operation and especially during preparation and division of the Callot triangl elements.
5. Ombelicus is a normal scar of the human body. Is any specificate reason to create others, new scars?
In summary, there is some specific thinks that authors must reevaluate in the article.
Once again,thank you for your's consideration.

Many regards,
Koulas Spyridon
Consultant in General Surgeon

this article does not add much to the field of laparoscopic cholecystectomy.

the article is writen in an acceptalbe way but ....

first the idea of the work is not of importance. adding a 5-mm port does not cause any problem. on contraray it helps much for safe exposure and dissection.

the number of cases is few.

the study is not randomized.

i think it is a weak article....

i work in the field of laparoscopic biliary surgery (cholecystectomy and bile duct exploration) with many publications 

The authors decribe a series of patients operated on two different techniques, 3-port or 4-port laparoscopic cholecystectomy. The study is not randomised or controlled. However, no difference in the patient characteristics appears between the two groups.

The main finding of the study is that 3-port LC seems to be as safe as 4-P LC. The study is nicely written and the reviewed literature is well chosen. 

Corrections and suggestions:

1. Patients and methods: the authors should describe how they chose one of the two techniques for each patient.

2. Results: the conversion rate with acute cholecystitis patients was very high, with 3-port LC 50% of acute cholecystitis and with 4-port LC 60% of acute cholecystitis patients. The authors should comment this in discussion.

3. Results: To me it does not sound correct to exclude bleeding complications from the final analysis (as was done with the patients that had a conversion to open cholecystectomy). At least the data should be shown, even separately

4. Results and Discussion and Conclusion: there was no STATISTICALLY significant difference in the requirement on analgesia between the two groups. Thus I would suggest that this conclusion is removed from discussion, as well as the last sentence in discussion-section modified by leaving "better post-operative recovery" out.

GI surgeon.

Some own publications related to gall stone disease.

This is a retrospective non-randomized study comparing 3-Port (n=18) and 4-Port (n=37) cholecystectomy. There was a high conversion rate (22% in the 4-Port-Group), however, converted patients were not included in the analyses. The fact, that none of the outcome parameters were signifantly different is probable due to a very low sample size.

More to the point, I do not understand why it is of advantage to avoid a scar in or around the umbilicus. The recent experience with Single-Port and NOTES-surgery has demonstrated that a incision in the umbilicus is not associated with increased morbidity. Moreover, the scar in the umbilicus is hidden and the cosmesis of such scars is excellent.

The present study is weak due to its low sample size. The high conversion rate raises questions on the used technique. I do not see why the umbilicus should be saved from incisions and why the proposed technique is of advantage.

Single-Port and 4-Port lap. Cholecystectomy