**2. Limitations of SIPES**

SIPES is not a new technique. It is actually a modification of current laparoscopic technique with some modified instruments and approach used successfully for multiple laparoscopic procedures. Almost all cases which could be done by conventional laparoscopy are amenable to be done by SIPES like splenectomy, appendectomy, cholecystectomy, colectomy, anterior resection, hernia repair, splenectomy, Nissen fundoplication, and sleeve gastrectomy. The approach failed to gain momentum for several years, due to technical limitations with conventional instrumentation. These limitations did not prevent surgeons from using SIPES in pediatric age group. Barbaros and Dinccag [6] published the first two adult cases of SILS splenectomy in 2009. Later Dutta reported the first SIPES splenectomy in 2012 [7]. Recently still few centers worldwide have advanced pediatric SIPES [7–13].
