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Case Reports
. 2015 Apr;100(4):638-42.
doi: 10.9738/INTSURG-D-14-00217.1.

Laparoscopic sigmoidectomy for a patient with situs inversus totalis: effect of changing operator position

Mizunori Yaegashi  1 , Toshimoto Kimura, Takashi Sakamoto, Tadao Sato, Yuichiro Kawasaki, Koki Otsuka, Go Wakabayashi
Affiliations
Case Reports

Laparoscopic sigmoidectomy for a patient with situs inversus totalis: effect of changing operator position

Mizunori Yaegashi et al. Int Surg. 2015 Apr.

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.

Keywords: Colon cancer; Laparoscopic sigmoidectomy; Laparoscopic surgery; Situs inversus totalis.

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Figures

Fig. 1
Fig. 1
Chest radiography showing dextrocardia.
Fig. 2
Fig. 2
Preoperative images. (a) Abdominal computed tomography (CT) shows inversion of the abdominal viscera, with the liver on the left and spleen on the right. (b) Three-dimensional CT angiography shows the inferior mesenteric artery located on the right side. (c) CT colonography shows an ulcerated lesion in the sigmoid colon.
Fig. 3
Fig. 3
Trocar placement for laparoscopic sigmoidectomy in patients with situs inversus totalis (SIT).
Fig. 4
Fig. 4
Intraoperative findings. (a) Division of the inferior mesenteric artery at its origin. (b) The distal rectosigmoid is divided using an articulating endoscopic linear stapler. (c) Intracorporeal anastomosis using the end-to-end anastomotic stapler.
See this image and copyright information in PMC

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