There is no discussion that the technique has a number of drawbacks. The major one regards the concept of "triangulation" to which laparoscopic surgeons have grown accustomed in terms of both the instruments and scope, which is now lacking. Although this seems to be overshadowed by the increasing acceptability of in-line viewing, it has to be said that industries concentrate on developing and marketing a number of curved instrument with different characteristics with the aim of restoring standard triangulation as under laparoscopic environment. Nevertheless, personal experience gained by conducing a trial on a virtual reality simulator designed for the purpose, demonstrated that only very experienced surgeons performed surgical tasks with safety and effectiveness and requiring a short learning curve, while for all other surgeons technique acquisition was challenging7 .