Laparoscopic cholecystectomy in situs inversus totalis: The importance of being left-handed

Abstract

Since laparoscopic cholecystectomy has become the standard procedure for the treatment of gallstone disease, several cases have been reported in patients with situs inversus. These cases require more technically demanding procedures due to the symmetrical disposition of the anatomy. Thus, handedness could influence the performance of these operations. The two of us (L.M.O.) and (J.M.B.), a right-handed and a left-handed surgeon, respectively, placed the instruments in reverse mode from that used in orthotopic patients. The right-handed surgeon felt more impairment when dissecting with his left hand and decided to cross the instruments within the abdomen. The left-handed surgeon was able to alternate the performance of the dissection maneuvers between the right and left hands. Surgical procedures are apparently designed for right-handed surgeons and can be approached by the left-handed in alternative ways. In fact, the accommodation of laparoscopic cholecystectomy to left-handedness has been described in the literature. The rare opportunity to operate in a symmetrical way allows the right-handed surgeon to understand the absence of comfort and ergonomy often experienced by left-handed colleagues.

Retrograde ( Fundus First ) Laparoscopic Cholecystectomy in Situs Inversus Totalis = إستئصال المرارة العكسي بالمنظار الجراحي في حالة إنعكاس وضع الأحشاء الكلي

“…In the reports described previously, the surgeon dissected with his left hand, or asked for assistance to grasp the neck of the gall bladder while he dissected the Calot's triangle. 7,8 In our case, both surgeons were right-handed; therefore the technique had to be adjusted. It is much easier for a left-handed surgeon to perform laparoscopic cholecystectomy in such patients.…”

Laparoscopic cholecystectomy in situs inversus totalis with left-sided gall bladder

“…Positioning of the surgical team and port placements described in the literature are often a mirror image of the protocols used for conventional laparoscopic cholecystectomy. However, the ergonomics of a right-handed surgeon standing on the right side of the patient demand that either he crosses hands so as to allow the right hand to operate through the epigastric port 4 or use the assistant to retract the Hartmann's pouch from the left side 5 or as we have described here, use the epigastric port to retract with the left hand and operate with the right hand through the lateral subcostal port. The surgeon standing at the foot end, in between the legs of the patient while the patient is in a Lloyd-Davis position, is an alternative, as is delegating to a left-handed surgeon!…”

Colorectal Carcinoma in a Patient with Situs Inversus Totalis

“…Some authors report the advantage of a left-handed surgeon, but a right-handed specialist can also perform the procedure by changing his position [4,5,6,7]. Young Wan Kim et al reported two cases of SIT.…”