Totally Laparoscopic Total Gastrectomy in a Patient With Situs Inversus Totalis

Abstract

Situs inversus totalis (SIT) is a rare congenital anomaly in which the organs are transposed from the normal to the opposite side. Occasionally, we encounter a patient with a combination of this condition and gastric cancer. Several cases of laparoscopic distal gastrectomy for gastric cancer in such patients have been reported. However, there is no report of totally laparoscopic total gastrectomy (TLTG) for such patients. We present a case of advanced gastric cancer with SIT that was successfully treated by TLTG involving radical lymph node dissection. A 63-year-old woman who presented with hematemesis was admitted to our hospital. She was diagnosed with advanced gastric cancer. Endoscopic findings revealed that tumor invasion was to the depth of the muscularis propria. Computed tomography (CT) showed a lack of lymph node swelling or distant metastasis. She was also diagnosed with SIT (a characteristic of Kartagener syndrome). Total gastrectomy was deemed necessary and we planned laparoscopic surgery. We carefully analyzed the location of abdominal organs from a preoperative examination, including three-dimensional reconstruction images from CT. In this operation, we reversed the normal positions of the surgeon, assistant, nurse, and trocar sites to accommodate the inverted abdominal locations of organs. TLTG was completed safely without any postoperative complications. Three-dimensional reconstruction images from CT and the inverse transposition of our usual intraoperative positions led to a smooth operation. TLTG may be not only a minimally invasive, but also a useful option for gastric cancer cases exhibiting SIT.