Laparoscopic cholecystectomy in case of complete situs inversus: an ergonomic challenge

Abstract

Situs inversus totalis (SIT) is an uncommon congenital condition in which the thoracic and abdominal organs are arranged in a complete mirror image configuration. To date, roughly 60 cases of laparoscopic cholecystectomy(LC) performed in patients with situs inversus have been documented. Performing laparoscopic cholecystectomy in these patients is technically more challenging, as it requires surgeons to adapt their visuomotar coordination and operative orientation to the left upper abdominal quadrant. We report a case of a 46 years old lady with pain in left upper abdomen for last 6 months. Diagnosis of situs inversus totalis was confirmed with ultrasound with presence of multiple gall bladder stones with no intra or extrabiliary duct dilatation. The patient underwent laparoscopic cholecystectomy by a right-handed surgeon standing at the right side of patient with the other ports in mirror image of the standard procedure. The duration of surgery was around 90 minutes and the patient was discharged uneventfully in 48 hours and was well on one-week follow-up.  It requires an experienced surgeon, re-training of visual-motor coordination and modification of surgical steps.