The safety, postoperative pain, and costs associated with a newly developed, radially expanding access (REA) system for laparoscopic surgery were evaluated. This prospective, patient-blinded, self-controlled study was conducted at a free-standing surgicenter. Nineteen women underwent various outpatient laparoscopic surgical procedures consecutively between November 1994 and February 1995. In each patient an REA system was placed laterally as an ancillary port, and a size-matched contralateral ancillary port was placed using a conventional cannula. In 8 patients 5-mm bilateral access devices were placed, and in 11 patients, 12-mm devices. All five complications and device-related adverse events were associated with conventional cannulas. At 1 day, 1 week, and 1 month after laparoscopic surgery, patients were asked on which side incisional pain was greater or whether there was no difference between the sides. A significantly higher proportion of patients rated pain on the REA system side lower at all three evaluations. This was the case for recipients of both 5- and 12-mm access devices. The REA system is safer, better tolerated, and more cost effective than conventional cannulas for a range of laparoscopic surgical procedures.