Table 3.
Common challenges and solutions during single incision laparoscopic surgery
| Challenges |
| Clashing of instruments |
| Lack of ideal operative ports |
| Interference and deflection of laparoscope’s light source by operating instruments |
| Interference of wires or tubing that connect perpendicularly to instruments (i.e., cautery) |
| Difficulty with retraction of organs or structures |
| Change of surgeon’s mindset |
| Lack of time and patience to learn |
| Loss of propioception due to crossed instrument |
| Solutions |
| Use of curved, reticulating, or flexible instruments |
| Use of very-low-profile trocars |
| Staggering heights and heads of trocars |
| Use of novel multichannel ports |
| Use of a laparoscope with a light source on the back of the camera |
| Use of a flexible-tip endoscope |
| Use of an extra-long 5-mm angled laparoscope (50 cm) |
| Use of a 90º adaptor for the light source (for sharp change in its direction parallel to the laparoscope) |
| Use of instruments that connect at their distal ends any necessary wires or tubing (i.e., cautery) |
| Use of extra-long bariatric size instruments |
| Use of retracting sutures |
| Continuous medical education |
| Potential solutions |
| Design of innovative retracting platforms |
| Implementation of magnetically anchored instruments deployed though a single incision |
| Implementation of robotic platforms |
| Design of sigmoid-shaped instruments |
| Additional basic surgical principles |
| Sound surgical judgment |
| Maintenance of equivalent operative exposure |
| Low threshold for use of additional ports at the initial incision site or prompt conversion to conventional laparoscopy or to open surgery |