The choice of a laparoscope for single-incision laparoscopic colorectal surgery should be based on operator preference and clinical application. When deciding upon a camera system for SILCS the following attributes should be considered. A 5 mm diameter scope takes up less space inside the access port and leaves a 10–12 mm port free for larger instruments such as a reticulating endoscopic stapling device. Secondly, it is advisable to use a laparoscope with a cable connection on the posterior rather than lateral aspect allowing rotation without interfering with instruments. The problem of the lateral light cable of regular telescopes and the bulky camera heads clashing with the instruments can be done away with by the use of a telescope with a coaxial light cable. In addition, using an extra-long or bariatric laparoscope staggered with regular-sized instruments may allow the free movement of the camera head away from the surgeon’s hands. Some surgeons prefer the assistant to sit so that the assistant’s hands move in a different plane, reducing the external interference. Integrated digital cameras also minimize external bulk and give more space.

Manufacturers have now developed a full range of laparoscopes that include 5 and 10 mm versions with 0°, 30°, or 45° direction of views in standard and high definition (720p). The newest advancements of laparoscopes to facilitate SILCS are the deflecting or articulating scopes, such as the EndoEYE™ by Olympus (Fig. 1.1). These laparoscopes are equipped with an advanced flexible tip design that provides a 100° view in all directions that can be fixed at any angle with a toggle switch. These articulating scopes are ideal for SILCS as they eliminate the need to exchange 0° scopes with angled scopes. They can also eliminate the crossing interference with parallel instruments while still providing a head-on directional view. It must however be noted that use of this instrument has a learning curve. If an internally flexible scope is not available, then an externally flexible scope will at least remove the assistant’s hands from the surgeon’s field.

Regardless of which platform is used, most SILCS begin with a vertical midline incision at umbilicus for entry into the peritoneum. The midline linea-alba is void of muscles and vascular structures and therefore minimizes postoperative pain and the potential for inadvertent vascular injuries. It is our practice to use a vertical midline incision and sharp dissection to enter the peritoneum under direction vision with the use of S-retractors. Entry is confirmed with a blunt hemostat or finger to minimize the risk of injury to intra-abdominal organs and vessels. Depending on the particular procedure, point of entry anywhere in abdomen may be utilized with this technique. For example, if a protective stoma is planned, one should consider the stoma site for entry and extraction. The size of the particular incision is based on the specific device used. Most ports should utilize at least one 10–12 mm trocar and two to three 5 mm trocars with side ports for CO₂ insufflation and smoke evacuation. There are several single-incision platforms at your disposal (Fig. 1.2) and four of them will be discussed in detail in this chapter. They all have similarities in function with only minor deviations.

When choosing a platform one should consider the following technical considerations:

The glove-port technique emerged as a means to perform single-incision laparoscopic surgery in a simple, low-cost, and easily reproducible manner. The access device was made by a standard wound protector (a small size or extra small size wound protector and a size 6, non-latex, sterile glove. The wound protector is introduced through the small umbilical incision. The surgical glove was fixed to the outer ring of the wound protector. Access ports are utilized through the glove’s finger tips (Fig. 1.3).