Single-incision laparoscopic cholecystectomy in situs inversus totalis

Situs inversus totalis (SIT) is a rare congenital anomaly that can cause difficulties during standard laparoscopic cholecystectomy due to its mirror-image anatomy. These cases require more technically demanding procedures, and handedness of the surgeon may influence performance of these operations. Single-incision laparoscopic surgery (SILS) has been proposed as a less-invasive alternative to conventional laparoscopic surgery. We report the first case of successful SILS cholecystectomy in a patient with SIT and discuss technical aspects of the operation related to the handedness of the surgeon.

A 49-year-old man who was known to have situs inversus totalis presented with symptomatic cholelithiasis. This patient was operated on by a right-handed surgeon. The surgeon and camera assistant were positioned on the right and left side respectively with the video monitor above the patient's left shoulder. The SILS port (Covidien), which has 3 operating channels, was placed in the abdomen via a 2-cm intraumbilical incision. SILS cholecystectomy was performed successfully. Dissection of Calot's triangle and the gallbladder bed was performed using a dissector and hook in the right hand without any technical problems.

SIT may confer an advantage over the orthotopic position for right-handed surgeons. SILS cholecystectomy can be performed safely in SIT.