Table 1.

Some of the technical challenges involved in a SILS cholecystectomy¹⁵

Challenge	Solution	Problems
1. Restricted number of working instruments	Single, large device with multiple ports or multiple ports through a single incision	Restricted movements and clashing of instruments
		Increased potential for development of fascial defects
		Difficulty maintaining pneumoperitoneum
		No escape for smoke created by tissue cauterisation
2. Introduction of single, large or multiple ports	Development of circumferential skin flaps	Potential for subcutaneous haematoma or seroma formation
3. Loss of triangulation with straight instruments	Angulated instruments	Requires training and adjustment
	Semirigid instruments	‘Bending’ during retraction/dissection
4. Suboptimal exposure of Calot's triangle	Retraction with hooks, stay sutures and/or percutaneous gallbladder drainage	Potential for bactobilia and biliary leaks with bile peritonitis