Ergonomic modified port placement for laparoscopic cholecystectomy in situs inversus totalis: a case report and...

Situs inversus is a rare congenital condition characterized by the mirror-image reversal of organ placement. Performing laparoscopic cholecystectomy in patients with situs inversus poses unique ergonomic challenges due to altered anatomical orientation. This case report presents a successful laparoscopic cholecystectomy in a patient with situs inversus, highlighting technical considerations and ergonomic modified port placement.

A 57-year-old male was a known case of situs inversus totalis (STT) for 15 years. Preoperative evaluation confirmed cholelithiasis, necessitating surgical intervention. Laparoscopic cholecystectomy was performed using a modified technique to accommodate the reversed anatomy and improve ergonomics for right-handed surgeons. The procedure was completed successfully without conversion. Intraoperatively, the gallbladder and biliary anatomy were mirror-imaged, and the gallbladder was hidden beneath a dense omental wrap due to inflammatory adhesions. Postoperative recovery was uneventful, and the patient was discharged on postoperative day 2 after drain removal.

Laparoscopic cholecystectomy in situs inversus requires understanding of reversed anatomy and adaptation of trocar placement and instrument handling. In this case, surgery was completed without complications, demonstrating the feasibility and safety of laparoscopic cholecystectomy using modified port placement. However, individual patient factors and surgeon expertise should be considered when selecting the optimal approach.

Laparoscopic cholecystectomy can be safely performed in situs inversus with careful planning and modified technique. Although rare, situs inversus should be considered in patients with gallstone disease. This case highlights the need for individualized management, and further accumulation of experience may help refine ergonomic port strategies in SIT.