Cholecystectomy in situs inversus totalis: a laparoscopic approach

PURPOSE To report and describe a safe approach to laparoscopic cholecystectomy in patients with situs inversus totalis. METHODS We present the case of a 61-year-old male who was diagnosed with gallstones and situs inversus totalis during work-up for epigastric pain. Laparoscopic cholecystectomy was performed in mirror-image to the standard approach, with the surgeon standing on the patient's right side. In order to maintain orientation and safety during the operation, anatomical structures were spatially related to each other in a "medial" and "lateral" manner, which are preserved in situs inversus; rather than "left" and "right" which are reversed. RESULTS The duration of the operation was 85 minutes, which is slightly longer than our standard laparoscopic cholecystectomy. Nonetheless, the patient was discharged on the morning following surgery, which is comparable to other patients undergoing laparoscopic cholecystectomy. He was seen in follow-up on postoperative day 14 and was doing very well. There were no postoperative complications. CONCLUSION Laparoscopic cholecystectomy can be performed safely in patients with situs inversus totalis. Careful attention to unfamiliar anatomic relationships is important. Approaching the anatomy in terms of medial and lateral structures, a relationship that is preserved, is helpful to complete the procedure safely.