Laparoscopic Sigmoidectomy for a Patient With Situs Inversus Totalis: Effect of Changing Operator Position

Abstract

Situs inversus totalis (SIT) is a rare congenital condition in which the abdominal and thoracic organs are on the opposite sides to their normal anatomic positions. Reports of laparoscopic surgery for colorectal cancer with SIT are very few. Due to the mirror-image transposition of organs and vascular abnormalities, laparoscopic surgery for patients with SIT is technically complicated. Therefore, it has been reported as easier for left-handed surgeons. This report presents that operative procedures can be conducted as usual by changing the positions of the operator and assistants, even if the operator is right-handed. A 71-year-old woman visited our hospital with a 2-month history of hematochezia. Colonoscopy revealed an ulcerative tumor in the sigmoid colon and biopsy confirmed well-differentiated adenocarcinoma. Laparoscopic sigmoidectomy radical lymphadenectomy was performed. The operating time was 189 minutes and blood loss was 13 mL. The patient was discharged on postoperative day 7, without any complications. We report that complicated surgical procedures for patients with SIT can be simplified by changing viewpoints. Due to the altered anatomy in SIT, the positions of the operator and assistants are very important. Location of the pelvis is almost the same as in orthotopic patients, by moving the operator from the left side to the right side of the patient. Changing the position of the operator to the right side seems to be effective for patients with SIT during pelvic procedures.

Laparoscopic hemicolectomy for a patient with situs inversus totalis: A case report

“…Due to the different anatomical positions of the organs, surgical procedures in patients with SIT are considered more difficult than those in others, particularly laparoscopic surgery. While, laparoscopic colorectal surgery (LCS) is currently the standard procedure for colorectal cancers (CRC), including the present case, only eight cases of LCS for colorectal cancer in patients with SIT have been reported [3] , [4] , [5] , [6] , [7] , [8] , [9] .…”

Single-Site Laparoscopic Colectomy in a Patient With Situs Inversus Totalis

“…9 We found only 8 cases of laparoscopic surgery for colorectal malignancy complicated by SIT reported in the English literature, and only one of them involved treatment with single-site laparoscopic surgery. [1][2][3][4][5][6][7][8] Laparoscopic surgery is considered to be more difficult in patients with SIT than in other patients because of the mirror-image anatomy. It is therefore important for the safe and effective performance of laparoscopic surgery in patients with SIT to first undertake a preoperative examination, because the frequency of abnormal vascularization of arteries and veins is high, in addition to the problems posed by the mirror-image presentation of the viscera.…”

“…Although the use of this surgery for colorectal cancer is rapidly becoming widespread, we found only 8 case reports in patients with SIT. [1][2][3][4][5][6][7][8] To our knowledge, thus far, there is only 1 case report of single-site laparoscopic surgery in SIT. 8 We present another case.…”

Laparoscopy‐assisted distal gastrectomy in a case of gastric cancer with situs inversus totalis: a case report

“…Surgeons in these past cases in Japan performed surgery while standing opposite to their normal positions, whereas surgeons in the Korean cases stood in a normal position. Yaegashi et al reported that changing surgeons’ standing positions during surgery in patients with SIT is effective in laparoscopic surgery . We selected the opposite port locations and standing positions and used a second monitor to recognize the normal images during surgery.…”