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

Abstract Situs inversus totalis (SIT) is a rare congenital condition, which is characterized by abnormal placement of the thoracic and abdominal organs. The incidence of this condition is estimated to be from 1/8000 to 1/25,000. There have been minimal reports on SIT patients with esophageal cancer. In this report, we discuss a patient with SIT complicated by middle and lower esophageal cancer who underwent laparoscopic and thoracoscopic esophagectomy with intrathoracic anastomosis, and provide useful information with regards to treatment of this rare condition.

Download Full-text

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

10.21203/rs.3.rs-34893/v1 ◽

2020 ◽

Author(s):

Yunchong Meng ◽

Zheng Zhang ◽

Kuo Li ◽

Quanfu Huang ◽

Wenlin Qiu ◽

...

Keyword(s):

Esophageal Cancer ◽

Situs Inversus ◽

Minimally Invasive Esophagectomy ◽

Operation Time ◽

Situs Inversus Totalis ◽

Thoracoscopic Esophagectomy ◽

Cancer Case ◽

Intrathoracic Anastomosis ◽

Invasive Esophagectomy ◽

Estimated Blood Loss

Abstract Background Situs inversus totalis (SIT) is a rare congenital condition which is characterized by abnormal placement of the thoracic and abdominal organs. Laparoscopic and thoracoscopic esophagectomy with intrathoracic anastomosis is technically difficult and has rarely been reported in SIT patients with esophageal cancer. Case presentation: We report a SIT patient whose condition is complicated by middle and lower esophageal cancer. This 55-year-old patient underwent total laparoscopic and thoracoscopic esophagectomy with intrathoracic anastomosis. The overall operation time was 270 minutes. Estimated blood loss was 150 mL and the patient was discharged after 20 days. Conclusions Laparoscopic and thoracoscopic esophagectomy with intrathoracic anastomosis is technically feasible and secure in SIT patients with esophageal cancer.

Download Full-text

End to side circular stapled anastomosis during robotic-assisted Ivor Lewis minimally invasive esophagectomy (RAMIE)

Diseases of the Esophagus ◽

10.1093/dote/doab088 ◽

2022 ◽

Author(s):

Giovanni Capovilla ◽

Edin Hadzijusufovic ◽

Evangelos Tagkalos ◽

Caterina Froiio ◽

Felix Berlth ◽

...

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Primary Outcome ◽

Minimally Invasive Esophagectomy ◽

Postoperative Mortality ◽

The Other ◽

Ivor Lewis ◽

Robotic Assisted ◽

Intrathoracic Anastomosis ◽

Invasive Esophagectomy

Abstract Robotic-assisted minimally invasive esophagectomy (RAMIE) represents an established approach for the treatment of esophageal cancer. Aim of this study is to evaluate the feasibility and safety of our technique for performing the intrathoracic anastomosis during RAMIE.All the procedures were performed by the same surgeon using the same technique for performing the intrathoracic anastomosis. Intraoperative and postoperative outcomes were recorded. Postoperative complications were classified according to the Esophagectomy Complications Consensus Group (ECCG); the primary outcome was the evaluation of the feasibility and safety of our technique. From 2016 to 2021, 204 patients underwent Ivor Lewis RAMIE at our Center. Two patients (0.9%) were converted during the thoracic phase. The anastomosis was completed in all the other patients forming complete anastomotic rings. The median duration for the robotic-assisted thoracoscopic phase was 224 minutes. Twenty-two of the RAMIE-Ivor Lewis patients had an anastomotic leakage (10.3%). The overall 90-day postoperative mortality was 1.9%. The procedure resulted to be feasible and safe in our cohort of patients.

Download Full-text

P123 ROBOT ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY (RAMIE4) WITH INTRATHORACIC ANASTOMOSIS: PROMISING RESULTS AND LESSONS LEARNED IN 100 PATIENTS

Diseases of the Esophagus ◽

10.1093/dote/doz092.123 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

E Tagkalos ◽

der Sluis P C van ◽

E Hadzijusufovic ◽

B Babic ◽

E Uzun ◽

...

Keyword(s):

Esophageal Cancer ◽

Postoperative Complications ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Case Series ◽

Oncologic Outcomes ◽

Robot Assisted ◽

Short Term ◽

Intrathoracic Anastomosis ◽

Invasive Esophagectomy

Abstract Aim The aim of this study was to describe postoperative complications and short-term oncologic outcomes for RAMIE4 with intrathoracic anastomosis for esophageal cancer within our case series of 100 consecutive patients. Background & Methods Robot assisted minimally-invasive esophagectomy (RAMIE) with intrathoracic anastomosis is gaining popularity as a treatment for esophageal cancer. In this study, we present the results of 100 RAMIE procedures using the da Vinci Xi robotic system (RAMIE4). The aim of this study was to describe postoperative complications and short-term oncologic outcomes for RAMIE4 within our case series of 100 consecutive patients. Between January 2017 and February 2019, data of 100 consecutive patients with esophageal carcinoma undergoing modified Ivor-Lewis esophagectomy were prospectively collected. All operations were performed by the same surgeon using an identical intrathoracic anastomotic reconstruction technique with the same perioperative management and pain control regimen. Intra-operatively and post operatively complications were graded according to definitions stated by the Esophagectomy Complications Consensus Group (ECCG). Results Mean duration of the surgical procedure was 416 min (± 80). In total, 70 patients (70%) had an uncomplicated operative procedure and postoperative recovery. Pulmonary complications were most common and were observed in 17 patients (17 %). Anastomotic leakage was observed in 8 patients (8%). Median ICU stay was 1 day and median overall postoperative hospital stay was 11 days. 30 day mortality was 1%. A R0 resection was reached in 92% of patients with a median number of 29 dissected lymph nodes. Conclusion RAMIE4 with intrathoracic anastomosis for esophageal cancer or cancer located in the esophagus was technically feasible and safe. Postoperative complications and short term oncologic results were comparable to the highest international standards nowadays. These results could only be obtained due to a structured RAMIE training pathway. The superiority of RAMIE compared to conventional minimally invasive esophagus is currently investigated in multiple randomized controlled trials. Results of these trials will define the role for RAMIE for patients with esophageal cancer in the future.

Download Full-text

Situs Inversus Totalis in a Dog With a Chronic Diaphragmatic Hernia

Journal of the American Animal Hospital Association ◽

10.5326/0450245 ◽

2009 ◽

Vol 45 (5) ◽

pp. 245-248 ◽

Cited By ~ 3

Author(s):

Tige H. Witsberger ◽

David I. Dismukes ◽

Efrat Y. Kelmer

Keyword(s):

Case Report ◽

Diaphragmatic Hernia ◽

Situs Inversus ◽

Situs Inversus Totalis ◽

Mirror Image ◽

Doberman Pinscher ◽

Clinically Normal ◽

Normal Orientation ◽

Congenital Condition ◽

Thoracic And Abdominal

Situs inversus totalis is a rare, congenital condition that is characterized by the development of the thoracic and abdominal viscera in a mirror image to their normal orientation. This case report describes the condition in a 4-year-old, spayed female Doberman pinscher that was evaluated for dyspnea following sedation. Radiography confirmed a diaphragmatic hernia. Situs inversus was discovered during surgical correction. The diaphragmatic rent was repaired, and the dog was clinically normal at recheck 13 months after surgery.

Download Full-text

Intrathoracic hand-sewn esophagogastric anastomosis in prone position during totally minimally invasive two-stage esophagectomy for esophageal cancer

Diseases of the Esophagus ◽

10.1093/dote/doaa106 ◽

2020 ◽

Author(s):

Alexandros Charalabopoulos ◽

Spyridon Davakis ◽

Athanasios Syllaios ◽

Bruno Lorenzi

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Anastomotic Leak ◽

Prone Position ◽

Minimally Invasive Esophagectomy ◽

Esophagogastric Anastomosis ◽

Two Stage ◽

End Points ◽

Intrathoracic Anastomosis ◽

Invasive Esophagectomy

Summary Utilization of totally minimally invasive esophagectomy for cancer is on the rise. Esophagogastric anastomosis is mechanically or robotically performed routinely; little report exists of hand-sewn esophagogastric anastomosis. This is the largest so far study with thoracoscopic hand-sewn esophagogastric anastomosis during fully minimally invasive two-stage esophagectomy for esophageal cancer in prone position. Consecutive two-stage totally minimally invasive esophagectomies for cancer were performed by one surgical team, from September 2016 to March 2019. All operations were technically identical in terms of patient positioning, surgical approach, extend of lymphadenectomy and type of anastomosis formed. Primary end points were anastomotic leak and anastomotic stricture rate, while secondary end points were 30-day and 90-day mortality rates. From the overall n = 80 patients, n = 67 were males, while n = 13 were females. Mean age was 64.6 years. Mean length of stay was n = 14 days. There were no conversions to open. Mean operating time was 420 minutes with no blood loss over 200 mL noted. Pulmonary and cardiac complication rate was 23.75% and 2.5%, respectively. Anastomotic leak rate was 2.5%. Anastomotic strictures were seen in 12.5% of cases. 30-day and 90-day mortality rate was 2.5% and 5%, respectively, with none accounted for ischemic conduit complications. Intrathoracic anastomosis in totally minimally invasive esophagectomy is challenging and accountable for most of the mortality associated with the procedure. In thoracoscopic two-stage esophagectomy, a mechanical anastomosis is usually preferred; this is believed to be due to the complexity of manual anastomosis associated with the thoracoscopic approach. We aim to present our series of completely hand-sewn intrathoracic anastomosis utilizing a totally minimally invasive approach with favorable outcomes. With this study, reproducibility of the anastomosis is shown that can potentially favor a change in the practice of esophageal surgeons worldwide.

Download Full-text

Laparoscopic Cholecystectomy for Severe Acute Cholecystitis in a Patient with Situs Inversus Totalis and Posterior Cystic Artery

Diagnostic and Therapeutic Endoscopy ◽

10.1155/2008/465272 ◽

2008 ◽

Vol 2008 ◽

pp. 1-3 ◽

Cited By ~ 9

Author(s):

Theodoros E. Pavlidis ◽

Kyriakos Psarras ◽

Apostolos Triantafyllou ◽

Georgios N. Marakis ◽

Athanasios K. Sakantamis

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Situs Inversus ◽

Anatomical Variations ◽

Situs Inversus Totalis ◽

Mirror Image ◽

Cystic Artery ◽

Quadrant Pain ◽

Abdominal Organs ◽

Thoracic And Abdominal

Situs inversus totalis is an inherited condition characterized by a mirror-image transposition of thoracic and abdominal organs. It often coexists with other anatomical variations. Transposition of the organs imposes special demands on the diagnostic and surgical skills of the surgeon. We report a case of a 34-year-old female patient presented with left upper quadrant pain, signs of acute abdomen, and unknown situs inversus totalis. Severe acute cholecystitis was diagnosed, and an uneventful laparoscopic cholecystectomy was performed. A posterior cystic artery was identified and ligated. Laparoscopic cholecystectomy is feasible in patients with severe acute calculus cholecystitis and situs inversus totalis; however, the surgeon should be alert of possible anatomic variations.

Download Full-text

Living donor hand-assisted laparoscopic nephrectomy in a healthy individual with situs inversus totalis: no need to turn down the donor

BMJ Case Reports ◽

10.1136/bcr-2019-233523 ◽

2020 ◽

Vol 13 (1) ◽

pp. e233523

Author(s):

Stan Benjamens ◽

Tamar Alice Johanne van den Berg ◽

Johan Frédéric Michel Lange ◽

Robert Alexander Pol

Keyword(s):

Situs Inversus ◽

Living Donor ◽

Sagittal Plane ◽

High Volume ◽

Situs Inversus Totalis ◽

Laparoscopic Nephrectomy ◽

Close Relative ◽

Living Kidney Donors ◽

Abdominal Organs ◽

Thoracic And Abdominal

A 70-year-old healthy male individual offered to undergo a living donor hand-assisted laparoscopic nephrectomy to enable kidney transplantation for a close relative. As required for all living transplant donor candidates, extensive screening was performed to exclude potential contraindications for donation. Tests revealed a situs inversus totalis, meaning a complete transposition of the thoracic and abdominal organs in the sagittal plane. As other contraindications for living kidney donation were absent, the feasibility of this procedure was determined multidisciplinary. A successful donation procedure was performed without surgical complications for the donor and good short-term transplant outcomes. In line with current developments that have resulted in more liberal criteria for potential living kidney donors, major anatomical deviations should not automatically be a contraindication. With multidisciplinary efforts and thorough surgical preparation at a high-volume transplant centre, this procedure is feasible and safe.

Download Full-text

Laparoscopic simple nephrectomy patient wıth situs inversus totalis and left renal hypoplasia: A case report

Canadian Urological Association Journal ◽

10.5489/cuaj.2824 ◽

2015 ◽

Vol 9 (7-8) ◽

pp. 521 ◽

Cited By ~ 1

Author(s):

Haci Ibrahim Cimen ◽

Yavuz Tarik Atik ◽

Oztug Adsan

Keyword(s):

Case Report ◽

Situs Inversus ◽

Situs Inversus Totalis ◽

Renal Hypoplasia ◽

Normal Side ◽

Laparoscopic Procedures ◽

Abdominal Organs ◽

Opposite Position ◽

Thoracic And Abdominal

Situs inversus totalis (SIT) is a relatively rare anatomical condition characterized by the transposition of thoracic and abdominal organs from the normal side to the opposite position. Most reports of laparoscopic procedures in patients with SIT cite technical difficulties and longer operative times due to disorientation because of the reversed abdominal organs and necessary modification of the surgeon’s movements and techniques. We present a case of a patient with SIT in whom a transperitoneal laparoscopic simple nephrectomy was performed.

Download Full-text

A Rare Anatomical Variation Complicating A Diffuse Abdominal Pain Presentation: Colonic Perforation in Situs inversus totalis

10.22541/au.162575272.27940045/v1 ◽

2021 ◽

Author(s):

Omar Elfanagely ◽

Yousef Elfanagely ◽

Abimbol Pratt

Keyword(s):

Abdominal Pain ◽

Situs Inversus ◽

Anatomical Variation ◽

Situs Inversus Totalis ◽

Colonic Perforation ◽

Diffuse Abdominal Pain ◽

Abdominal Organs ◽

Thoracic And Abdominal

Situs inversus totalis (SIT) is a rare anatomical variation of the thoracic and abdominal organs. We report a case of a 93-year-old woman who presented with pneumoperitoneum secondary to stercoral colonic perforation requiring emergent Hartman’s procedure.

Download Full-text