Complete laparoscopic sigmoid colectomy for obese patient with sigmoid colon cancer

Abstract

Abstract (Clinical practice points) What is already known about this subject? After nearly 20 years of development, laparoscopic surgery for colon cancer has emerged as the standard procedure compared to open surgery with similar oncologic outcomes and superior perioperative results. Usually, an abdominal incision is required for anastomosis and specimen extraction for laparoscopic colon surgery. Recently, natural orifice specimen extraction (NOSE) and intracorporeal anastomosis have been proposed to improve the quality of laparoscopic colon resections. This approach can eliminate a larger abdominal incision other than that for trocar placement. However, intracorporeal anastomosis is the major challenge in laparoscopic surgery. Technique of delta-shaped anastomosis which was used for the gastric cancer surgery was reported firstly in 2002. and there was no report on the feasibility and safety of totally laparoscopic resection with delta-shaped anastomosis for colon cancer surgery till now. we describe this simple and safe technique of intracorporeally delta-shaped anastomosis in sigmoid colectomy combined with transvaginal extraction of the specimen. What are the new findings? Natural orifice specimen extraction and intracorporeal anastomosis have been proposed to improve the quality of laparoscopic colon resections. This case report demonstrates that the technical innovations of transvaginal specimen extraction and an intracorporeal delta-shaped anastomosis is considered a more feasible and safer procedure, and obesity does not adversely affect the outcomes of this technique with respect to postoperative recovery. How might it impact on clinical practice in the foreseeable future? This case report describes the feasibility, safety and shortterm outcome of an intracorporeal delta-shaped anastomosis technique for laparoscopic sigmoid colectomy combined with transvaginal extraction of the specimen in an obese patient. Our findings suggest that this technique is more feasible and safer for patients with sigmoid colon cancer than other natural orifice specimen extraction approaches and that obesity does not adversely affect the outcome of this technique with respect to postoperative recovery. We suggest that intracorporeal deltashaped anastomosis and transvaginal specimen extraction may be an appropriate technique for sigmoid colectomy without complications in suitable patients.