Laparoscopic total mesorectal excision in a rectal cancer patient with situs inversus totalis

Abstract

Situs inversus totalis is a rare anomaly in which the abdominal and thoracic cavity structures are opposite their usual positions. A 41-yr-old woman, who had an ulcerating cancer on the rectum, was found as a case of situs inversus totalis. We present an overview of the operative technique for the first documented laparoscopic total mesorectal excision of a rectal cancer in the patient with situs inversus totalis. Careful consideration of the mirror-image anatomy permitted a safe operation using techniques not otherwise different from those used for the general population. Therefore, curative laparoscopic surgery for rectal cancer in this patient is feasible and safe.

Keywords: Laparoscopy; Rectal Neoplasms; Situs Inversus.

Fig. 1

Chest X-ray showing dextrocardia and a right subphrenic gastric bubble.

Fig. 2

Computed tomography disclosing complete transposition of the abdominal viscera: (A) coronal view and (B) axial view.

Fig. 3

Origin of the inferior mesenteric artery (IMA) from the right side of the abdominal aorta. CIA, common iliac artery.

Fig. 4

Division of the inferior mesenteric artery at its origin.

Fig. 5

Division of the inferior mesenteric vein and left (actually right side) colic artery.

Fig. 6

Full mobilization of the splenic flexure.

Fig. 7

Extracorporeal extraction of the specimen through a 12-mm port in the right lower quadrant of the abdomen.

Fig. 8

Intracorporeal anastomosis using the EEA stapler (CDH29®; Ethicon Endo-Surgery Inc., Cincinnati, OH, USA).

Fig. 9

The rectal cancer specimen.