ACTA FAC MED NAISS 2021;38(2): 183-1880

UDC:616.366‑007.45‑089.832
DOI: 10.5937/afmnai38-30172

Case report

Laparoscopic Cholecystectomy in Situs Inversus Totalis:
A Case Report

Radomir Gelevski¹, Gjorgji Jota², Lazar Todorović³, Gjorgji Trajkovski²,
Vladimir Joksimović², Bojan Trenčić¹

¹General Hospital Kumanovo, Kumanovo, North Macedonia
²University Clinic for Digestive Surgery Skopje, Skopje, North Macedonia
³University Clinic for Paediatric Surgery Skopje, Skopje, North Macedonia

 SUMMARY

                            Situs inversus totalis represents a rare autosomal recessive morphological anomaly of the internal viscera, equally affecting both genders. The genetic defect occurs in the 2^nd week of embryonic life, when a 270-degree clockwise rotation of the primitive digestive tube occurs. The incidence of calculosis of gallbladder in patients with situs inversus is the same as in the general population. A 61-year-old female patient with a history of four episodes of colicky, left hypochondrium and epigastric pain, without fever and jaundice, was admitted for elective laparoscopic cholecystectomy. CT of abdomen confirmed situs inversus totalis that was previously known to the patient. The patient was positioned in supine position and a mirror image configuration of the operating room was obtained, with surgeon and scrub nurse on the right side and assistant on the left side of the patient. Four trocars were introduced mirroring the standard position of the 5 mm trocars. During the dissection, second assistant was introduced for the laparoscope, due to the surgeon’s limited motor skills in his left hand for delicate dissection, rendering him inapt to perform precise and safe dissection. The total operating time amounted to 110 minutes, which is three times longer than the standard operating time at our institution. The most critical point of the operation in constellation of situs inversus totalis is applying the clips, which requires precision and strength in the same moment. In the available literature, 40 open cholecystectomies before introduction of laparoscopy and 92 laparoscopic cholecystectomies were reported. To our knowledge, this is the first and the only reported laparoscopic cholecystectomy for situs inversus in North Macedonia.

Key words: situs inversus totalis, laparoscopic cholecystectomy, critical view of safety