Background <p>Autogenous rib cartilage is a common material for rhinoplasty, especially for nose extension and revision. At present, open surgery is the most mature method for rib extraction. However, it has many disadvantages, such as long recovery and visible incision. Our previous study reported a TUSILS method, leaving&#xa0;invisible incisions in the&#xa0;umbilical folds. Recently, we made a further optimization to avoid abdominal cavity intrusion: the trans-umbilical single-incision laparoscopic surgery through the sheath of rectus abdominis for costal cartilage harvest (TUSILS-SRA).</p> Objectives <p>This study aims to test the efficacy and safety of TUSILS-SRA.</p> Methods <p>We reviewed 40 patients who underwent costal cartilage harvest in our department from 2020 to 2023, with 20 in the TUSILS-SRA group and 20 in the open harvest group as control. The pain scores [visual analog scale (VAS)] 1/2/3/7 day after surgery, satisfaction assessments, operation time, and complications were compared as measurements.</p> Results <p>By repeated measures&#xa0;ANOVA, the VAS values in 1/2/3/7 days after surgeries were significantly (<i>P</i> &lt; 0.05) lower in the TUSILS-SRA group. Surgical time is a little longer (<i>P </i>&lt; 0.05) in the TUSILS-SRA group (33.5 ± 4.9&#xa0;min), compared with the traditional group (27.0 ± 4.7&#xa0;min). TUSILS-SRA did a better job in satisfaction assessment (<i>P</i> &lt; 0.05). Complications were rare during our 6-month follow-up.</p> Conclusions <p>Overall, TUSILS-SRA is a safe, effective, and promising surgical method of costal cartilage harvest for rhinoplasty.</p> Level of Evidence III <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p> Graphical Abstract <p></p>