Laparoscopic cholecystectomy in situs inversus totalis

Situs inversus totalis is a rare congenital anomaly in which the thoracic and abdominal viscera are transposed in mirror image, placing the gallbladder in the left upper quadrant. Laparoscopic cholecystectomy is consequently demanding for the right-hand-dominant surgeon, who, using a conventionally mirrored setup, would be required to dissect with the non-dominant hand, accept crossing of the operating instruments, or delegate retraction to an additional assistant. We describe a woman in her 40s with situs inversus totalis and symptomatic cholelithiasis who underwent an elective laparoscopic cholecystectomy using a configuration in which the surgeon operated from the patient's left with both working ports placed subcostally. This allowed dominant-hand dissection while the surgeon retained infundibular retraction, enabling the procedure to be completed safely with a single assistant. The critical view of safety was achieved and the patient's recovery was uneventful. An annotated operative video accompanies this report as a teaching resource.