Abstract
Introduction:
Situs inversus totalis is a rare congenital condition of mirror-image transposition of the major visceral organs with an incidence of 1:5,000 to 1:20,000 in adults. 1,2 Hepatic resection in situs inversus totalis was reported in only seven cases with malignant tumors and open surgery was performed. 3 Due to the rare incidence and left-to-right transposition of the visceral organs, laparoscopic surgery is a challenging procedure. We report on a patient who received laparoscopic left hepatectomy for intrahepatic duct stones with situs inversus totalis.
Materials and Methods:
A 66-year-old woman with situs inversus totalis was diagnosed with intrahepatic duct stones in the left lateral segment of the liver. Four ports were used: a 12-mm camera port into supraumbilicus, a 12-mm and a 5-mm working port in the left and right upper quadrant respectively, and a 5 mm working port in the left flank area. The surgeon was standing in the right side of the patient. The patient was placed supine in 15 degree reverse Trendelenburg position. Left hepatectomy was conducted by the following orders: liver mobilization, cholecystectomy, hilum dissection, division of the left hepatic artery and portal vein, intraoperative ultrasonography, parenchymal transection, division of left intrahepatic duct, division of the left hepatic vein and retrieval of the specimen. During parenchymal transection, the rubber band retraction method was used to expose parenchymal transection plane.
Results and Conclusion:
The operation time was 386 minutes and estimated blood loss was 150 mL. There were no abnormal findings in the abdominal CT image on the fifth post-operative day. The patient was discharged on the sixth post-operative day without any complications. In conclusion, laparoscopic left hepatectomy seems to be a feasible and safe procedure for a patient with situs inversus totalis.
No competing financial interests exist.
Runtime of video: 4 mins 54 secs
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Supplementary Material
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