Single-port Cholecystectomy in a Patient with Situs Inversus Totalis Presenting With Cholelithiasis

A Case Report

Marcus VD de Campos Martins; José L Pantaleão Falcão; James Skinovsky; Guilherme MSS de Faria

Disclosures

J Med Case Reports. 2012;6(96) 

In This Article

Discussion

Situs inversus totalis may affect the intra-abdominal viscera as well as the intrathoracic organs.[2] It can be associated with many other anatomical variations, including heart malformations and Kartagener's syndrome (bronchiectasis and sinusitis coexistence).[2,3] There is no evidence to suggest that gallstones are more common in people with this condition. However, left upper quadrant pain may delay the diagnosis. An ultrasound scan can confirm the presence of gallstones and the left-sided gallbladder. Some authors suggest that it would be very useful to perform a magnetic resonance cholangio-pancreatography (MRCP) procedure in order to reveal the exact anatomy of the biliary tract,[3] thus decreasing intra-operative complications and enabling better planning of the surgical procedure. Pre-operative knowledge of the presence of malrotation and its details is of prime importance, even more so when performing laparoscopic or minimally invasive surgery.

Since a great variety of patterns of malrotation have been described, the pre-operative knowledge of the presence of malrotation is of prime importance because the surgeon can then plan the operation better and minimize the possibility of intra-operative complications, especially when performing laparoscopic or minimally invasive surgery.[10]

In 1991, Campos and Sipes were the first to report a successful laparoscopic cholecystectomy in a patient with situs inversus totalis.[7] Since then, many other cases have been published,[2–5] even including cases of acute cholecystitis. Some technical difficulties, such as the mirror image, for example, should be considered. It requires the surgeon to stand on the right side with the monitor above the patient's left shoulder. This disposition requires mental adaptability and manual dexterity. The orientation and ergonomic challenges may result in an increased operative time.

In recent years, interest in performing new minimally invasive approaches has increased worldwide. Some reports have been published for abdominal access performed only through the umbilicus. This technique was named single port access (SPA) surgery. In a meeting held in July of 2008, the Single Port Consensus reviewed all the terminology for laparoscopic or endoscopic procedures performed through a single incision in the abdomen and proposed that laparoendoscopic single-site surgery (LESS) be used as the common term to define this procedure. LESS techniques basically include two different types of surgery. In the first one a single incision is made to place multiple trocars. In the second, a single incision is made to place a single trocar designed to contain all instruments. There are many models of single-port devices from many industries. SITRACC (Edlo, Porto Alegre, Brazil), Tri-port (Advanced Surgical Concepts, Wicklow, Ireland), X-Cone (Karl Storz, Tuttlingen, Germany) and SILS (Covidien, Mansfield, USA) are some of them.

Han et al. first published a single-incision multiport laparoscopic cholecystectomy in a patient with situs inversus totalis in 2011[11] but there are no data published regarding the single-port technique.

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