Thoracoscopic surgery in the prone position for esophageal cancer in patients with situs inversus totalis: A report of two cases

Abstract

IntroductionSitus inversus totalis (SIT) is a rare congenital condition characterized by a complete transposition of thoracic and abdominal organs. Here, we present two successful cases of left thoracoscopic esophagectomy in the prone position for SIT-associated esophageal cancer.Presentation of caseOur first case was of an 82-year-old man who underwent a left thoracoscopic esophagectomy in the prone position, followed by hand-assisted laparoscopic gastric mobilization. Surgical duration and blood loss were 661 min and 165 g, respectively. His postoperative course was uneventful. The second case was of a 66-year-old man who underwent a left thoracoscopic esophagectomy in the prone position, followed by gastric mobilization via laparotomy owing to a concomitant intestinal malrotation and polysplenia. Surgical duration and blood loss were 637 min and 220 g, respectively. We trained for the surgical procedures preoperatively using left-inverted and right-inverted thoracoscopic surgical videos of patients with normal anatomy.DiscussionSurgical procedures in SIT patients are challenging owing to their mirrored anatomy. Recognition of their variations is thus important to avoid intraoperative accidental injuries. Left-inverted and right-inverted thoracoscopic surgical videos of patients with normal anatomy were found to be useful for image training prior to the actual surgery.ConclusionThoracoscopic surgical treatment for esophageal cancer associated with SIT in the prone position can be performed safely, similar to the manner performed for thoracoscopic surgery in the right decubitus position, or surgery via an open thoracotomy. Gastric mobilization via laparotomy should be considered in patients associated other anatomic variations.

Total minimally invasive McKeown esophagectomy in an esophageal cancer patient with situs inversus totalis: A case report

“…To the best of our knowledge, only 11 cases of esophagectomy for esophageal cancer with SIT have been previously reported globally (Table 1). [2][3][4][5][6][7][8][9][10][11] Along with advances in endoscopic technology, MIE has gradually emerged as an effective alternative to open surgery. 12 MIE mainly consists of total MIE (combined thoracoscopic-laparoscopic esophagectomy) and hybrid MIE (thoracoscopic-assisted esophagectomy or laparoscopicassisted esophagectomy).…”

“…To the best of our knowledge, only 11 cases of esophagectomy for esophageal cancer with SIT have been previously reported globally (Table 1). 2–11 …”

“…1 To the best of our knowledge, there have only been 11 cases of esophagectomies for esophageal cancer with SIT reported worldwide so far, most of which underwent hybrid minimally invasive esophagectomy (MIE) and a right decubitus or prone position was adopted during the thoracic procedure. [2][3][4][5][6][7][8][9][10][11] Here, we report a case of esophageal cancer with SIT successfully treated by total MIE, with a right lateral-prone position adopted during the thoracic procedure.…”

Minimally invasive esophagectomy with intrathoracic anastomosis in a situs inversus totalis patient

“…Yoshida et al rst reported a patient with SIT underwent simultaneous hand-assisted laparoscopic gastric mobilization and thoracoscopic esophagectomy in 2004 [8]. Later, other case reports followed, with cervical anastomosis used in most of cases [2,[9][10][11]. Intrathoracic anastomosis was reported only once [4].…”

Video‐assisted thoracic surgery and jejunal reconstruction in a case of situs inversus totalis with esophageal cancer

“…Prior image training with right–left inverted videos has been reported to be helpful to ensure surgical safety . In our case, the surgeon underwent image training before surgery using horizontally inverted thoracoscopic surgical videos of patients with normal anatomy in order to recognize the mirror image anatomy.…”