INTRODUCTION:
Situs Inversus is a rare congenital recessive autosomal malformation, which is characterized by the viscera’s transposition which may be thoracic, abdominal or both (1, 2). Worldwide prevalence of this anomaly varies from 0.04% to 0.30% (3). Situs inversus is divided into two types: situs inversus partialis, which involves the thoracic organs (dextrocardia) or abdominal viscera, and situs inversus totalis, which involves both the thoracic organs and abdominal viscera (4).
Though situs inversus on its own is not pathological, it may be associated with cardiorespiratory, hepatopancreaticobiliary, gastrointestinal, neurological, orthopedic and urological anomalies, some of which may be life-threatening (2). Surgeons must be aware …show more content…
In 1991, Campos and Sipes reported the first successful laparoscopic cholecystectomy in a patient with situs inversus with a symptomatic gallstone (5). In literature there are fifty cases of laparoscopic cholecystectomy in patients with situs inversus totalis are reported. To deal with this eccentric anatomy of gall bladder, it is required to highlight the importance of a new pre-operatory planning, which involves a repositioning of the surgical team and the trocars in the left side of the abdomen. The standard four port technique was used in our case as recommended and reported in other studies (3.4,5,6). In order to optimize the surgical procedure in our operation, the operative equipment, surgeon’s position, and port placement were prepared as a “mirror image” to the routine laparoscopic cholecystectomy. In fact, the most crucial step of the operation is to achieve the critical level for safety of Calot,s Triangle (9). In our case the dissection of the cholecystic pedicle in left sided gall bladder was not time-consuming, but was uncomfortable and difficult. The operating surgeon was right handed and the dissection of Calot,s triangle and cholecystic pedicle was done by epigastric port and left subcostal port. Lochman et al. (6) and Arya et al. (10) performed the operation with an assistant surgeon grasping the infundibulum. The principal surgeon performed the dissection with only his dominant right hand via the epigastric port. Another technique to improve the operative ergonomics is to place the patient in lithotomy position and operating surgeon stands between patient legs with dissection of Calot,s triangle done with right subcostal port. Patle et al (11) performed five cases via
Situs Inversus is a rare congenital recessive autosomal malformation, which is characterized by the viscera’s transposition which may be thoracic, abdominal or both (1, 2). Worldwide prevalence of this anomaly varies from 0.04% to 0.30% (3). Situs inversus is divided into two types: situs inversus partialis, which involves the thoracic organs (dextrocardia) or abdominal viscera, and situs inversus totalis, which involves both the thoracic organs and abdominal viscera (4).
Though situs inversus on its own is not pathological, it may be associated with cardiorespiratory, hepatopancreaticobiliary, gastrointestinal, neurological, orthopedic and urological anomalies, some of which may be life-threatening (2). Surgeons must be aware …show more content…
In 1991, Campos and Sipes reported the first successful laparoscopic cholecystectomy in a patient with situs inversus with a symptomatic gallstone (5). In literature there are fifty cases of laparoscopic cholecystectomy in patients with situs inversus totalis are reported. To deal with this eccentric anatomy of gall bladder, it is required to highlight the importance of a new pre-operatory planning, which involves a repositioning of the surgical team and the trocars in the left side of the abdomen. The standard four port technique was used in our case as recommended and reported in other studies (3.4,5,6). In order to optimize the surgical procedure in our operation, the operative equipment, surgeon’s position, and port placement were prepared as a “mirror image” to the routine laparoscopic cholecystectomy. In fact, the most crucial step of the operation is to achieve the critical level for safety of Calot,s Triangle (9). In our case the dissection of the cholecystic pedicle in left sided gall bladder was not time-consuming, but was uncomfortable and difficult. The operating surgeon was right handed and the dissection of Calot,s triangle and cholecystic pedicle was done by epigastric port and left subcostal port. Lochman et al. (6) and Arya et al. (10) performed the operation with an assistant surgeon grasping the infundibulum. The principal surgeon performed the dissection with only his dominant right hand via the epigastric port. Another technique to improve the operative ergonomics is to place the patient in lithotomy position and operating surgeon stands between patient legs with dissection of Calot,s triangle done with right subcostal port. Patle et al (11) performed five cases via