Robotic-assisted pulmonary lobectomy with lung cancer in a patient with situs inversus totalis

Abstract

Background Situs inversus totalis (SIT) is a relatively rare congenital abnormality in which the major thoracic and abdominal visceral organs are reversed from their usual positions. In patients with SIT and bronchial carcinoma, surgical difficulty increases sharply. It has been reported that the video-assisted thoracic surgery (VATS) still poses the operator to a challenge situation. The similarity of surgical positions and the flexibility of the mechanical arm in robotic surgery, may be beneficial to SIT patients due to reducing technical difficulties. Here, we present a first case of SIT patient with lung cancer, in which Da Vinci robot-assisted thoracic surgery (RATS) was performed successfully. Case presentation A 66-year old patient, previously diagnosed with SIT since childhood, came to our hospital with two pulmonary nodules in his left lung field. The bigger one had increased somewhat for the last 2 years of follow-up. Software Mimics was preoperatively carried out to analyze anatomical variations. RATS was conducted to complete left upper lobectomy and left middle wedge resection. The patient had no intraoperative complications and was discharged day 5 after the operation. Conclusions This is the first report of a successful robot-assisted lung cancer resection in a patient with SIT. In such challenging cases as lung cancer and rare anomaly as SIT, RATS is more advantageous and suitable than VATS with the help of software Mimics utilized for 3D reconstruction, which can identify the anatomical abnormalities and facilitate the surgical procedures.

Presentation and management of delayed bronchopleural fistula after pulmonary lobectomy: a case report

“…This lady was the first patient to undergo a robotic-assisted lobectomy in Jordan. According to Yang et al, robotic-assisted thoracic surgery was advantageous in a case of lobectomy in a cancer patient with situs inversus totalis as it helped in identifying the anatomical abnormalities and facilitated the surgery [7]. In addition, Nomori et al concluded that a largely fused fissure is not a limiting factor for the performance of VATS lobectomy [8].…”

Surgical Treatment of Lung Cancer in Situs Inversus Totalis—A Case Report

“…Only eight studies reported a follow-up (6 months-2 years). The majority of cases were described in the eastern part of the world [15,18,19,21,22,[24][25][26][28][29][30][31]33,34]. Surprisingly, the presence of as many as three such cases was observed in Szczecin, in Europe.…”

“…The complex anatomy in SIT is a difficulty in the preoperative planning of thoracic procedures. Therefore, 3D-CT images were described in several included articles [28,29,33,34]. It is important to remember potential metastasis.…”