Single-port laparoscopic surgery for sigmoid colon cancer: a novel surgical strategy based on “peritoneal dome”

Abstract

Aims: This study aimed to introduce a novel 'peritoneal dome' strategy for single port laparoscopic surgery in patients with sigmoid colon cancer and to evaluate the feasibility and safety of this approach. Methods: A total of 12 patients at the affiliated hospital of North Sichuan Medical College from January 2022 to August 2024 were enrolled. All procedures were performed by the same surgical team. By collecting and analyzing the demographic information, clinical characteristics, surgical outcomes and postoperative recovery indicators of this group of patients, the short term efficacy and safety of this surgical strategy were preliminarily studied. Results: The median age of patients was 72 years (range, 58-81), with a median body mass index (BMI) of 25.8 kg/m2 (range, 22-31.2). Most patients had underlying respiratory conditions, particularly chronic obstructive pulmonary disease (COPD) (80%). All patients successfully completed the single-port laparoscopic surgery without conversion to laparotomy. The median of the total operating time was 98.80 minutes. The mean arterial carbon dioxide pressure (PaCO2) during the extraperitoneal phase was significantly lower (32.5 mmHg) compared to the intraperitoneal phase (47.1 mmHg). The median estimated blood loss was 19.20 ml, with no transfusions required and no significant operative complications reported. Pathological analysis revealed that 83.3% of patients had advanced disease (stage III), and the average number of harvested lymph nodes was 18.92. Postoperatively, patients experienced a mean time to ambulation of 1.25 days and a mean hospital stay of 6.17 days. Complications occurred in 33.3% of patients, primarily classified as grade I and II according to the Clavien-Dindo classification. Notably, there were no cases of anastomotic leakage or severe complications. Conclusion: The single port laparoscopic surgery based on a "peritoneal dome" supported strategy for sigmoid colon cancer demonstrates effective oncological management with minimal complications and a favorable recovery profile. The results suggest that this technique is a viable option for patients with advanced sigmoid colon cancer, particularly in those with significant comorbidities.