Laparoscopic Cholecystectomy in Situs Inversus Totalis

Abstract

Situs inversus is a rare condition. It is characterised by reverse handed positioning of the internal viscera. Laparoscopic cholecystectomy is the standard procedure for cholelithiasis, but it may lead to technical difficulties in case of situs inversus, especially to right-handed surgeons. A 40-year female presented to the department with epigastric pain and bloating usually after fatty meals. Diagnosis of symptomatic gall bladder stone was made. She was a known case of situs inversus. Laparoscopic cholecystectomy was performed by right-handed surgeon with uneventful recovery.

The first case of balloon-occluded retrograde transvenous obliteration and partial splenic embolization for gastric varices in situs inversus abdominus

“…In this case, the patient had polysplenia and a complex vascular anatomy associated with vascular malformations. As mentioned, there are no reports of BRTO for GVs in SIA; however, there are some reports of surgical procedures (especially cholecystectomy) for SIT or SIA patients [ 14 – 16 ]. In those reports, the following three points were important for the success of the procedure: (i) sufficient preoperative discussion about the anatomy; (ii) reversal positioning of the surgeon, assistants, instruments, and monitors; and (iii) operation with care to avoid misidentification of the anatomy.…”

Laparoscopic cholecystectomy with indocyanine green fluorescence in patient with situs inversus totalis

“…Some authors described a simple mirror trocar's position to perform this surgery [6] , but we suggest reconsidering this simplification for right-handed surgeons and rethinking the use of the instruments. As described in a recent review [7] , there is no standard technique to approach this uncommon orientation. Differently from what is described in other papers [3,7,8] , our equipment was composed by a surgeon and an assistant, and they decided the best port placement that allows the surgeon to perform the dissection with the right hand, having full control of the instrument and completely relying on the assistant for the necessary tractions on the gallbladder to reach the critical view of safety.…”

“…As described in a recent review [7] , there is no standard technique to approach this uncommon orientation. Differently from what is described in other papers [3,7,8] , our equipment was composed by a surgeon and an assistant, and they decided the best port placement that allows the surgeon to perform the dissection with the right hand, having full control of the instrument and completely relying on the assistant for the necessary tractions on the gallbladder to reach the critical view of safety. By this, we tried to avoid the risk of vascular or biliary injury possibly due to the uncommon anatomy.…”

Colecistitis aguda en un situs inversus total. Reporte de caso

“…Otra técnica perioperatoria es la realización de una colangiografía con verde indocianina, pero se necesita un sistema óptico con lente que transmita luz infrarroja 16 . Se ha descrito la realización de colecistectomía laparoscópica mediante tres puertos, en posición de Lloyd Davis, colocando un puerto umbilical de 10 mm, otro puerto en el cuadrante superior derecho de 10 mm y otro en el flanco izquierdo de 5 mm, realizándola sin incidentes y de forma segura 17,[20][21][22] . Se ha descrito, aunque rara vez, la colecistectomía laparoscópica por puerto único en SIT, reportando mejores resultados cosméticos y disminución del dolor posquirúrgico 23,24 .…”