Pure laparoscopic right hepatectomy in a patient with situs inversus totalis

RATIONALE Hepatectomy in a patient with situs inversus totalis (SIT) is technically challenging, and pure laparoscopic major hepatectomy has not been previously described. PATIENT CONCERNS A 70-year-old male with SIT was referred to our hospital for investigation and treatment of a liver mass in segment 5/6. DIAGNOSIS Computed tomography (CT) and magnetic resonance imaging (MRI) showed features of chronic liver disease and a 5-cm sized mass with a bulging contour at segment 5/6. INTERVENTIONS Pure laparoscopic right hepatectomy was performed. OUTCOMES There was no intraoperative complication and the procedure was completed without a transfusion. The patient recovered well and was discharged on postoperative day 8. LESSONS Considering the position of the port sites and the assistant, and the operator's hand for the working port, a pure laparoscopic right hepatectomy can be a feasible procedure, even in a patient with SIT.