Laparoscopic Cholecystectomy in Situs Inversus Totalis With Combined Indocyanine Green Fluorescence and Conventional...

Situs inversus totalis (SIT), a complete form of situs inversus of the viscera, is a rare congenital anomaly that presents technical challenges during laparoscopic cholecystectomy (LC) due to mirror-image anatomy. We report a case of a 75-year-old female with known SIT and symptomatic cholelithiasis. After initial conservative management and endoscopic retrograde cholangiopancreatography (ERCP) for biliary sludge, elective LC was performed. A modified mirrored American-style port configuration was used, including a caudally placed left mid-clavicular port for right-hand dissection. Biliary navigation was enhanced by combining indocyanine green fluorescence cholangiography (ICG-FC) with conventional intraoperative cholangiography (IOC). ICG-FC allowed real-time identification of the cystic and common bile ducts, while IOC clearly delineated the common hepatic duct and confirmed the absence of residual stones. The operation was completed uneventfully in 108 minutes with 5 mL blood loss, and the patient was discharged on postoperative day three without complications. This case demonstrates that LC in SIT can be performed safely with meticulous preoperative planning, adapted port placement, and complementary imaging strategies. The integration of ICG-FC and IOC contributed to surgical safety by improving biliary visualization and minimizing the risk of injury.