Single-incision laparoscopic surgery with transabdominal retroperitoneal approach (SILS-TRPA): a novel surgical strategy for sigmoid colon/upper rectal cancer

Background: Single-incision laparoscopic surgery (SILS) is an established minimally invasive option for radical colorectal cancer resection, but its wider adoption is limited by technical challenges.This study introduces an innovative SILS technique with a transabdominal retroperitoneal approach (TRPA) to enhance its feasibility. Objective: This study aimed to evaluate the feasibility and safety of single-incision laparoscopic surgery with transabdominal retroperitoneal approach (SILS-TRPA) for the treatment of patients with sigmoid colon/rectal cancer. Materials and Methods: This prospective IDEAL stage 1 study included 36 patients at the affiliated hospital of North Sichuan Medical College from 12 October 2022 to 31 December 2024. All procedures were performed by the same surgical team. The short-term efficacy and safety of this surgical strategy were preliminarily studied by collecting and analyzing the demographic information, clinical characteristics, surgical outcomes and postoperative recovery indicators of this group of patients. Results: The median age of patients was 70.6 years (IQR 61–77), with a median body mass index of 24.8 kg/m 2 (IQR 21.0–28.2). Twenty-four patients had underlying respiratory conditions of chronic obstructive pulmonary disease (COPD). All patients successfully completed the SILS without conversion to laparotomy. The median total operating time was 118.75 minutes. The mean arterial carbon dioxide pressure during the extraperitoneal phase was significantly lower (32.7 mmHg) compared to the intraperitoneal phase (45.3 mmHg). The median estimated blood loss was 19.20 mL, with no blood transfusions required and no significant operative complications reported. Pathological analysis revealed that 77.78% of patients had advanced disease (stage III), and the average number of harvested lymph nodes was 21.32. Postoperatively, patients experienced a mean time to ambulation of 1.38 days and a mean hospital stay of 6.17 days. Complications occurred in 11patients (30.56%), which were 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 SILS-TRPA for sigmoid colon/upper rectal 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 sigmoid colon/upper rectal cancer, particularly in those with significant comorbidities.