Laparoscopic cholecystectomy in situs inversus totalis: A case report

Situs inversus totalis represents a rare autosomal recessive morphological anomaly of the internal viscera, equally affecting both genders. The genetic defect occurs in the 2nd week of embryonic life, when a 270-degree clockwise rotation of the primitive digestive tube occurs. The incidence of calculosis of gallbladder in patients with situs inversus is the same as in the general population. A 61-year-old female patient with a history of four episodes of colicky, left hypochondrium and epigastric pain, without fever and jaundice, was admitted for elective laparoscopic cholecystectomy. CT of abdomen confirmed situs inversus totalis that was previously known to the patient. The patient was positioned in supine position and a mirror image configuration of the operating room was obtained, with surgeon and scrub nurse on the right side and assistant on the left side of the patient. Four trocars were introduced mirroring the standard position of the 5 mm trocars. During the dissection, second assistant was introduced for the laparoscope, due to the surgeon's limited motor skills in his left hand for delicate dissection, rendering him inapt to perform precise and safe dissection. The total operating time amounted to 110 minutes, which is three times longer than the standard operating time at our institution. The most critical point of the operation in constellation of situs inversus totalis is applying the clips, which requires precision and strength in the same moment. In the available literature, 40 open cholecystectomies before introduction of laparoscopy and 92 laparoscopic cholecystectomies were reported. To our knowledge, this is the first and the only reported laparoscopic cholecystectomy for situs inversus in North Macedonia.

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Case Report of Situs Inversus Totalis and Laparoscopic Cholecystectomy

International Surgery ◽

10.9738/intsurg-d-16-00109.1 ◽

2016 ◽

Vol 101 (7-8) ◽

pp. 347-351 ◽

Cited By ~ 1

Author(s):

Thomas K. Duncan ◽

Kenneth Waxman

Keyword(s):

Laparoscopic Cholecystectomy ◽

Situs Inversus ◽

Epigastric Pain ◽

Signs And Symptoms ◽

Technical Difficulty ◽

Situs Inversus Totalis ◽

Mirror Image ◽

The Body ◽

Critical View Of Safety ◽

The Right

Laparoscopic cholecystectomy (LC) in patients with situs inversus totalis (SIT) characterized by transposition of organs to the opposite side of the body can be technically challenging. A 43-year-old Hispanic woman presented with epigastric pain radiating to the chest and back, intermittently over 3 months, but worse on day of admission. During the cardiac workup, she was noted to have dextrocardia. The patient had a left-sided Murphy's sign, propagating a workup that confirmed SIT, including an ultrasound showing cholelithiasis and normal ducts. The patient underwent an LC and was found to have choledocholithiasis. An endoscopic retrograde cholangiopancreatography cleared the common bile duct of a choledocholith. LC is the gold standard for cholecystitis. It is the second most common laparoscopic procedure conducted worldwide. When SIT is encountered, feasibility and technical difficulty in diagnosis and treatment of such cases pose challenges due to contralateral transposition of the visceral organs. Difficulty is encountered when exposing the triangle of Calot/critical view of safety and especially when conducting a cholangiogram. As such, added time is usually required to conduct the procedure. Conducting an LC in a patient with SIT is feasible when performed by an experienced laparoscopic surgeon. The diagnosis and initial presenting signs and symptoms are different from the patient with a normal anatomy. The surgical skills of the surgeon are challenged, especially in the right hand–dominant individual. The mindset of the surgeon requires changing the critical thinking when conducting a mirror image dissection.

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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.

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Laparoscopic Sigmoidectomy for a Patient With Situs Inversus Totalis: Effect of Changing Operator Position

International Surgery ◽

10.9738/intsurg-d-14-00217.1 ◽

2015 ◽

Vol 100 (4) ◽

pp. 638-642 ◽

Cited By ~ 7

Author(s):

Mizunori Yaegashi ◽

Toshimoto Kimura ◽

Takashi Sakamoto ◽

Tadao Sato ◽

Yuichiro Kawasaki ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Situs Inversus ◽

Operating Time ◽

Situs Inversus Totalis ◽

Mirror Image ◽

Laparoscopic Sigmoidectomy ◽

Vascular Abnormalities ◽

Congenital Condition ◽

Well Differentiated ◽

The Right

Situs inversus totalis (SIT) is a rare congenital condition in which the abdominal and thoracic organs are on the opposite sides to their normal anatomic positions. Reports of laparoscopic surgery for colorectal cancer with SIT are very few. Due to the mirror-image transposition of organs and vascular abnormalities, laparoscopic surgery for patients with SIT is technically complicated. Therefore, it has been reported as easier for left-handed surgeons. This report presents that operative procedures can be conducted as usual by changing the positions of the operator and assistants, even if the operator is right-handed. A 71-year-old woman visited our hospital with a 2-month history of hematochezia. Colonoscopy revealed an ulcerative tumor in the sigmoid colon and biopsy confirmed well-differentiated adenocarcinoma. Laparoscopic sigmoidectomy radical lymphadenectomy was performed. The operating time was 189 minutes and blood loss was 13 mL. The patient was discharged on postoperative day 7, without any complications. We report that complicated surgical procedures for patients with SIT can be simplified by changing viewpoints. Due to the altered anatomy in SIT, the positions of the operator and assistants are very important. Location of the pelvis is almost the same as in orthotopic patients, by moving the operator from the left side to the right side of the patient. Changing the position of the operator to the right side seems to be effective for patients with SIT during pelvic procedures.

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Laparoscopic Cholecystectomy in Kartagener Syndrome

Journal of Postgraduate Medicine Education and Research ◽

10.5005/jp-journals-10028-1262 ◽

2017 ◽

Vol 51 (4) ◽

pp. 192-194

Author(s):

Rahul Gupta ◽

Harjeet Singh ◽

Ganga R Verma

Keyword(s):

Laparoscopic Cholecystectomy ◽

Laparoscopic Surgery ◽

Magnetic Resonance ◽

Situs Inversus ◽

Autosomal Recessive ◽

Epigastric Pain ◽

Autosomal Recessive Disorder ◽

Situs Inversus Totalis ◽

Kartagener Syndrome ◽

Abdominal Organs

ABSTRACT Kartagener syndrome is a rare autosomal recessive disorder in which there is situs inversus involving abdominal or thoracic viscera or both. Anatomy of the abdominal organs in such a patient is distorted making laparoscopic surgery very difficult. A 45-year-old lady, a known case of Kartagener syndrome, presented with epigastric pain. Ultrasound of abdomen revealed situs inversus with mild hepatomegaly and multiple gallbladder calculi. Magnetic resonance pancreatocholangiography (MRCP) confirmed situs inversus totalis with cholelithiasis and mild central intrahepatic biliary dilatation. Patient was treated successfully with laparoscopic cholecystectomy. How to cite this article Gupta R, Singh H, Verma GR. Laparoscopic Cholecystectomy in Kartagener Syndrome. J Postgrad Med Edu Res 2017;51(4):192-194.

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Laparoscopic cholecystectomy in situs inversus totalis: is it safe?

Annals of The Royal College of Surgeons of England ◽

10.1308/147870810x12699662980277 ◽

2010 ◽

Vol 92 (5) ◽

pp. e30-e32 ◽

Cited By ~ 7

Author(s):

TC Hall ◽

J Barandiaran ◽

EP Perry

Keyword(s):

Laparoscopic Cholecystectomy ◽

Surgical Technique ◽

Genetic Predisposition ◽

Situs Inversus ◽

Situs Inversus Totalis ◽

Mirror Image ◽

Therapeutic Management ◽

Review Of The Literature ◽

Symptomatic Cholelithiasis

Situs inversus totalis (SIT) is a rare defect of genetic predisposition. It may cause difficulties in the diagnostic and therapeutic management of abdominal pathology due to the mirror-image anatomy. We report the management of a case of symptomatic cholelithiasis with emphasis on its surgical technique combined with a review of the literature.

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Laparoscopic Cholecystectomy in Situs Inversus, a Novel Port Placement Technique, Two Case Reports, and Review of Literature

10.32592/ircmj.2021.23.10.1168 ◽

2021 ◽

Keyword(s):

Laparoscopic Cholecystectomy ◽

Situs Inversus ◽

Epigastric Pain ◽

Case Reports ◽

Abdominal Ultrasound ◽

Situs Inversus Totalis ◽

Port Placement ◽

Technical Problems ◽

Anatomical Changes ◽

Gallbladder Diseases

Background: Situs Inversus Totalis (SIT) is a rare and silent autosomal recessive disease in which all organs are on the opposite side. Diagnosis of gallbladder diseases will be difficult due to these anatomical changes. Laparoscopic cholecystectomy is the standard treatment for gallbladder diseases but is technically challenging for patients. Case presentation: Two 52- and 64-year-old women with known SIT who complained of intermittent epigastric pain and nausea after eating fatty and bulky meals were examined. With the help of abdominal ultrasound, a gallbladder on the left side of the abdomen with multiple gallstones was shown. Conclusion: Since the successful primary cholecystectomy was performed on a patient with SIT in 1991, several modifications have been made for port insertion. Surgeons try to overcome technical problems by making various adjustments compared to conventional laparoscopic cholecystectomy. Laparoscopic cholecystectomy in patients with SIT is safe. However, laparoscopic cholecystectomy is challenging due to anatomical changes in the SIT. Our proposed method of port placement helps right-handed surgeons for safer and easier dissection.

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Laparoscopic cholecystectomy in situs inversus totalis: case report

International Surgery Journal ◽

10.18203/2349-2902.isj20192396 ◽

2019 ◽

Vol 6 (6) ◽

pp. 2210

Author(s):

Sreedhar Rao Kota ◽

Abhilash Gundala ◽

Srikanth Sirikonda ◽

Jayachandra Reddy Metta ◽

Mayur Kumar Jinde

Keyword(s):

Laparoscopic Cholecystectomy ◽

Situs Inversus ◽

Situs Inversus Totalis ◽

Mirror Image ◽

Uneventful Recovery ◽

Rare Entity ◽

Review Of Literature ◽

Technical Approach ◽

Set Up ◽

Calculous Cholecystitis

Laparoscopic cholecystectomy is one of the commonest surgical procedures carried out in the world today. Occasionally, few undiagnosed situs inversus patients present with calculous cholecystitis. One such case is being discussed here on how the diagnosis was made and focuses on the technical approach to the operation along with review of literature. A 52 year old female presented to our department with right hypochondrial pain which was diagnosed as choledocholithiasis and calculous cholecystitis with situs inversus totalis following clinical and radiological evaluation. Patient underwent ERCP and CBD, PD stenting, following which laparoscopic cholecystectomy was performed and the patient made uneventful recovery. Situs inversus with calculous cholecystitis is a rare entity. The surgeon must appreciate that care should be taken to set up the operating theatre in the mirror image of the normal set up for cholecystectomy. Surgerons must also modify their technique to adapt mirror image anatomy.

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