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      Modified laparoscopic cholecystectomy technique for treatment of situs inversus totalis: A case report

      case-report

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          Abstract

          Laparoscopic cholecystectomy is a broadly used technique for gallbladder treatment. However, situs inversus, a rare anomaly, is reportedly difficult to treat by conventional laparoscopic cholecystectomy. A 36-year-old woman with chronic cholecystitis and multiple gallstones was found to have dextrocardia on a chest X-ray. Magnetic resonance imaging demonstrated situs inversus, cholecystitis, and cholelithiasis. We successfully performed laparoscopic cholecystectomy using our modified technique, which mainly involved a left-handed operation and adjustment of the port positions. This case will be very instructive for right-handed surgeons in the management of cholelithiasis by laparoscopic cholecystectomy in patients with situs inversus.

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

          C L Ronchera-Oms, J Badia (2003)
          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.
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            Laparoscopic cholecystectomy in a 39-year-old female with situs inversus.

            Antonio C L Campos, E Sipes (1990)
            Kartagener syndrome consists of situs inversus, chronic sinusitis, and bronchiectasis. A 39-year-old woman known to have Kartagener syndrome presented with complaints of left upper abdominal quadrant pain. Suspicion of cholelithiasis was confirmed with ultrasound and oral cholecystogram. The patient underwent a laparoscopic cholecystectomy. Standard techniques were modified in mirror image fashion to provide access to the left upper quadrant. This unusual presentation of chronic calculus cholecystitis in a patient with Kartagener syndrome demonstrates the adaptability of laparoscopic cholecystectomy technique.
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              Laparoscopic cholecystectomy in situs inversus totalis: a case report

              Damian McKay, Geoffrey Blake (2005)
              Background Laparoscopic cholecystectomy is one of the commonest surgical procedures carried out in the world today. Occasionally patients present with undiagnosed situs inversus and acute cholecystitis. We discuss one such case and outline how the diagnosis was made and the pitfalls encountered during surgery and how they were overcome. Case presentation A 32 year old female presented to our department with epigastric pain radiating through to the back. A diagnosis of acute cholecystitis in a patient with situs inversus totalis was made following clinical examination and radiological investigation. Laparoscopic cholecystectomy was subsequently performed and the patient made an uneventful recovery. Conclusion Situs inversus presenting with acute cholecystitis is very rare. 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, and that right handed surgeons must modify their technique to adapt to the mirror image anatomy.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Int Med Res
                Journal ID (iso-abbrev): J. Int. Med. Res
                Journal ID (publisher-id): IMR
                Journal ID (hwp): spimr
                Title: The Journal of International Medical Research
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Print): 0300-0605
                ISSN (Electronic): 1473-2300
                Publication date (Electronic): 18 April 2017
                Publication date (Print): June 2017
                Volume: 45
                Issue: 3
                Pages: 1261-1267
                Affiliations
                [1 ]Department of General Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot, PR China
                [2 ]Key Laboratory of Molecular Pathology, Inner Mongolia Medical University, Huhhot, PR China
                Author notes
                [*]Rui Xiao, Key Laboratory of Molecular Pathology, Inner Mongolia Medical University, #5 Xin Hua Street, Huhhot 010059, PR China. Email: xiaorui79@ 123456hotmail.com
                Article
                Publisher ID: 10.1177_0300060517703258
                DOI: 10.1177/0300060517703258
                PMC ID: 5536415
                PubMed ID: 28417652
                SO-VID: 9bb1fdc4-2a16-4d60-b30e-325848edc098
                Copyright © © The Author(s) 2017
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License ( http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 16 December 2016
                Date accepted : 15 March 2017
                Funding
                Funded by: the Grassland Talents Program of Inner Mongolia Autonomous Region, FundRef ;
                Award ID: Year 2013
                Award ID: 2015
                Funded by: the talents team funds from Inner Mongolia Medical University, FundRef ;
                Award ID: NYTD-2015001
                Funded by: the talents team funds from Inner Mongolia Medical University, FundRef ;
                Award ID: NYTD-2015101
                Categories
                Subject: Case Reports

                Keywords: situs inversus,laparoscopic cholecystectomy,left hand
                Data availability:
                Keywords: situs inversus, laparoscopic cholecystectomy, left hand

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