**4. Conclusions**

The current evidence shows that LESS upper GI surgery is feasible, and its adoption is expanding worldwide. A successful LESS procedure requires proper instrumentation, adequate laparoscopic experience, and careful patient selection. The demonstration of a significant and consistent increase in the adverse events associated with certain LESS applications in upper GI surgery should represent a word of caution in performing these procedures. While cosmetic improvement is a natural corollary to LESS, real advantages of the approach in upper GI surgery are still controversial. Prospective randomized studies are largely awaited to further explore the benefits of this technique for patients as well as to elucidate the costeffectiveness of the approach. The advent of new instruments and platforms may significantly counteract technical issues associated with LESS surgery and facilitates the current steep learning curve.
