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

Abstract

Situs Viscerum Inversus (SVI) is a rare autosomal recessive disease. Because of this particular anatomy, it could be challenging for the surgeon to perform any abdominal procedure, including laparoscopic cholecystectomy. In these situations, indocyanine green fluorescence cholangiography can be essential. A 29-year-old female with documented situs viscerum inversus totalis underwent laparoscopic cholecystectomy with a four-trocar technique. Switching the vision to the near-infrared camera, which elicited the indocyanine green molecules, the surgeon could easily identify the common bile duct and the cystic duct. Switching back to the normal vision, the operator completed the dissection. The described procedure is still challenging due to the "mirror effect" and the uncommon position of the surgical instruments, especially for right-handed surgeons. Indocyanine green fluorescence angiography can help the surgeon identify the structures in cases of non-regular anatomy such as this.

Two Surgeons' Technique for Laparoscopic Cholecystectomy in Situs Inversus for a Right-Handed Surgeon: Technical and Ergonomic Considerations

“…This technique's advantages include using the surgeon's dominant hand, preventing abnormal postures when the surgeon is standing to the patient's left, and simplifying the procedure ergonomically. Bile duct injuries following laparoscopic cholecystectomy have been rarely reported and can be prevented using similar techniques described when the gall bladder is on the right side [19,20].…”