Robot-Assisted Radical Cystectomy with Intracorporeal Ileal Conduit in a Patient with Situs Inversus Totalis

Abstract

Background: Situs invesus totalis is a rare congenital anomaly characterized by the mirror-image transposition of abdominal and thoracic organs. Although feasible, operating on patients with situs inversus offers unique technical challenges to the surgeon because of its rarity and the contralateral disposition of the viscera. Urologists in particular need to be aware of the genitourinary abnormalities associated with situs inversus when planning to operate. Case Presentation: We report the case of a 67-year-old man with invasive bladder cancer in the presence of situs inversus totalis (SIT) and associated bilateral duplicated ureters. This is only the second case of bladder cancer in the context of situs inversus reported in the literature and the first one managed with robot-assisted radical cystectomy and urinary diversion with an intracorporeal ileal conduit. Conclusion: In this unique case, robot-assisted radical cystectomy with intracorporeal ileal conduit in a patient with muscle-invasive bladder cancer and SIT was safely performed and we suggest to others to consider our technique of "mirror-image port placement and surgical technique" if they encounter such a patient.

Keywords: bladder cancer; intracorporeal ileal conduit; robotic urinary diversion; situs inversus.

FIG. 1.

Preoperative CT showing large bladder wall thickening suspicious for tumor: (a) axial image and (b) coronal image.

FIG. 2.

Wallace type anastomosis of right duplicated ureter.

FIG. 3.

Stoma of ileal conduit on patient's left lower abdomen.

FIG. 4.

Postoperative CT, coronal image.