Robot-assisted surgery for rectal cancer in situs inversus totalis: a case report

Situs inversus totalis (SIT) is a relatively rare congenital malformation; and particular emphasis should be placed on its anatomical recognition during surgery. Here, we report a rare case of rectal cancer in SIT, treated with robot-assisted surgery (RAS). A 71-year-old man with SIT was referred to our department with advanced rectal cancer. Robot-assisted anterior resection, using the DaVinci Xi surgical system, was performed. The ports were arranged in a normal mirror image with the camera port (2nd arm) inside the lower left abdomen. The robotic procedure of total mesenteric excision with D3 lymph node dissection was achieved, and re-roll-in of the robotic arms was implemented for anastomosis, using the double-stapling technique and additional suture reinforcement at the anastomotic site. RAS was conducted with safety and efficiency; his postoperative course was uneventful and no adverse event was observed.