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Miyasaka M, Teramura K, Kitashiro S, Okawa Y, Sekiya S, Saikawa D, Hayashi S, Suzuki Y, Kawada M, Kawarada Y, Kaga K, Okushiba S, Hirano S. Two Cases of Single-Incision Laparoscopic Surgery for Sigmoid Colon and Rectal Cancer in Situs Inversus Totalis. Surg Case Rep 2025; 11:24-0016. [PMID: 40151336 PMCID: PMC11946454 DOI: 10.70352/scrj.cr.24-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Accepted: 03/04/2025] [Indexed: 03/29/2025] Open
Abstract
INTRODUCTION Situs inversus totalis (SIT) is a rare congenital disorder characterized by the complete inverted transposition of the thoracic and abdominal viscera. This anatomical variation complicates laparoscopic surgery, and there are currently no reports of single-incision laparoscopic surgery (SILS) for patients with sigmoid colon cancer or rectal cancer with SIT. CASE PRESENTATION We performed SILS on 2 patients with sigmoid colon and rectal cancers who also had SIT. The first case involved a 64-year-old woman with sigmoid colon cancer. A 3.5 cm umbilical incision was made, and SILS was performed using a single-port surgical device with three 5 mm trocars placed in the incision. The sigmoid colon was resected with a linear stapler, which required switching from a 5 mm trocar to a 12 mm trocar. Laparoscopic anastomosis was performed using the double-stapling technique. The second case involved an 81-year-old man with dual cancers located in the sigmoid colon and lower rectum, 8 cm from the anal verge. The abdominal approach was performed using SILS, similar to the first case, along with a transanal total mesorectal excision (TaTME) from the perineum by 2 teams. Anastomosis was performed laparoscopically using a single-stapling technique. Neither patient experienced postoperative complications, and both remained free of recurrence at 42 and 7 months, respectively. CONCLUSIONS SILS is a feasible approach for patients with sigmoid colon cancer or rectal cancer and SIT.
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Affiliation(s)
- Mamoru Miyasaka
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Koichi Teramura
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Shuji Kitashiro
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Yuki Okawa
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Sho Sekiya
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Daisuke Saikawa
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Satoshi Hayashi
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | | | - Masaya Kawada
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Yo Kawarada
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Kichizo Kaga
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | | | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Hokkaido, Japan
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Chen Y, Ma M, Huang X, Wan J, Huang H. Enteral nutritional support for an elderly critically ill patient with gastroesophageal reflux disease and situs inversus totalis: a case report. Front Nutr 2025; 12:1514980. [PMID: 40078418 PMCID: PMC11896863 DOI: 10.3389/fnut.2025.1514980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 02/07/2025] [Indexed: 03/14/2025] Open
Abstract
Herein, we present a case of serious protein-energy malnutrition in an elderly critically ill patient with situs inversus totalis. It was difficult to implement enteral nutrition in this patient for more than 2 months of hospitalisation in another hospital, and we applied electromagnetic navigation guidance to implement enteral nutrition after successful placement of nasojejunal tubes. We reviewed the management of enteral nutrition support.
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Affiliation(s)
| | | | | | - Jia Wan
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haiyan Huang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Yokoi R, Tajima JY, Kiyama S, Fukada M, Asai R, Sato Y, Yasufuku I, Tanaka Y, Okumura N, Murase K, Takahashi T, Matsuhashi N. Usefulness of an intraoperative flipped monitor in laparoscopic surgery with situs inversus totalis: a case report of laparoscopic-assisted ileocecal resection. Surg Case Rep 2024; 10:6. [PMID: 38190089 PMCID: PMC10774461 DOI: 10.1186/s40792-023-01806-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Situs inversus totalis (SIT) is a rare congenital condition that involves complete transposition (right to left reversal) of the visceral organs. Laparoscopic surgery can be challenging because of the mirror-image anatomy. We describe a surgical innovation in laparoscopic surgery for SIT. CASE PRESENTATION A 41-year-old man with SIT was diagnosed with an appendiceal tumor and underwent laparoscopic-assisted ileocecal resection. Preoperatively, we evaluated anatomical variations using 3D-computed tomography and simulated mirror images by watching flipped videos of patients with normal anatomy undergoing similar operations. During the operation, port placement and the surgeons' standing positions were reversed. Additionally, two monitors were placed at the patient's head, with one monitor showing original images, and the other showing flipped images that looked the same as the normal anatomy. We checked the range of the mobilized region and important anatomical structures by watching the flipped monitor as needed. The patient's postoperative course was uneventful. CONCLUSIONS Due to the complexities of laparoscopic surgery for SIT, preoperative preparation and surgical innovation are necessary for safe surgery. Several suggestions have been made to understand anatomical anomalies and improve operability; however, surgeons must focus on the mirror-image anatomy throughout the operation. Therefore, the use of intraoperative flipped monitor will be helpful for surgeons in reducing the risk of anatomical misidentification.
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Affiliation(s)
- Ryoma Yokoi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Jesse Yu Tajima
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Shigeru Kiyama
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Masahiro Fukada
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Ryuichi Asai
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Yuta Sato
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Itaru Yasufuku
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Yoshihiro Tanaka
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Naoki Okumura
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Katsutoshi Murase
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Takao Takahashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Nobuhisa Matsuhashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan.
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Hu JL, Li QY, Wu K. Ascending colon cancer and situs inversus totalis – altered surgeon position for successful laparoscopic hemicolectomy: A case report. World J Clin Oncol 2022; 13:848-852. [PMID: 36337311 PMCID: PMC9630992 DOI: 10.5306/wjco.v13.i10.848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/08/2022] [Accepted: 09/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Situs inversus totalis (SIT) is a rare congenital condition in which the structure of the abdominal and thoracic cavities is the mirror image of normal. This anatomic reversal makes laparoscopic surgery difficult when treating colorectal cancer.
CASE SUMMARY We describe the successful laparoscopic hemicolectomy of a 68-year-old Chinese woman with SIT and ascending colon cancer. Based on preoperative imaging and careful consideration of the patient’s anatomy, the position of the surgeon was modified such that the surgeon stood between her legs, while the surgical assistant and endoscopist stood to the surgeon’s left. Trocar position was also adjusted appropriately. The surgery lasted 178 min, during which the patient lost 50 mL of blood. Pathology analysis of the resected tumor confirmed an adenocarcinoma in clinical stage pT3N0M0, without lymph node involvement. The patient experienced no postoperative complications and was discharged 10 d after surgery.
CONCLUSION This case illustrates that careful positioning of the surgeon can facilitate laparoscopic surgery of SIT patients.
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Affiliation(s)
- Ji-Long Hu
- Department of Abdominal Tumor Surgery, Jiangxi Cancer Hospital, Nanchang 330000, Jiangxi Province, China
| | - Qi-Yun Li
- Department of Abdominal Tumor Surgery, Jiangxi Cancer Hospital, Nanchang 330000, Jiangxi Province, China
| | - Kun Wu
- Department of Abdominal Tumor Surgery, Jiangxi Cancer Hospital, Nanchang 330000, Jiangxi Province, China
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Zheng ZL, Zhang SR, Sun H, Tang MC, Shang JK. Laparoscopic radical resection for situs inversus totalis with colonic splenic flexure carcinoma: A case report. World J Clin Cases 2022; 10:5435-5440. [PMID: 35812688 PMCID: PMC9210886 DOI: 10.12998/wjcc.v10.i16.5435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/22/2021] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Situs inversus totalis (SIT) is a rare group of congenital developmental malformations in the clinical setting, with all organs in the chest and abdomen existing in a mirror image reversal of their normal positions. Few reports have described laparoscopic surgery for colorectal cancer in patients with SIT, and it is considered difficult even for an experienced surgeon because of the mirror positioning. We present a case report of laparoscopic radical resection of a colonic splenic flexure carcinoma in a patient with SIT.
CASE SUMMARY A 72-year-old male was referred to our hospital with colonic splenic flexure carcinoma, and computed tomography showed that all the organs in the chest and abdomen were inverted. Laparoscopic hemicolectomy with complete mesocolic excision was safely performed. The operating surgeon stood on the patient’s left side, which is opposite of the normal location.
CONCLUSION Abdominal computed tomography is an effective method for diagnosing SIT preoperatively in patients with colonic splenic flexure carcinomas. Laparoscopic radical resection is difficult, but it is well established and safe. The surgeon should stand in the opposite position and perform backhand operations.
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Affiliation(s)
- Zi-Ling Zheng
- Department of Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Shou-Ru Zhang
- Department of Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Hao Sun
- Department of Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Mao-Cai Tang
- Department of Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Jing-Kun Shang
- Department of Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing 400030, China
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Arita T, Kuriu Y, Shimizu H, Kiuchi J, Otsuji E. Laparoscopic anterior resection for patients with rectosigmoid cancer in situs inversus totalis - a video vignette. Colorectal Dis 2022; 24:797. [PMID: 35068038 DOI: 10.1111/codi.16063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/12/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Tomohiro Arita
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshiaki Kuriu
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroki Shimizu
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jun Kiuchi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Eitler K, Bibok A, Telkes G. Situs Inversus Totalis: A Clinical Review. Int J Gen Med 2022; 15:2437-2449. [PMID: 35264880 PMCID: PMC8901252 DOI: 10.2147/ijgm.s295444] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/17/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Katalin Eitler
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - András Bibok
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Gábor Telkes
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
- Correspondence: Gábor Telkes, Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, VIII. Baross u.23., Budapest, H-1082, Hungary, Tel +36 20 825 8593, Email
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