Uludag Mehmet, Yetkin Gurkan, Kartal Abdulcabbar
Sisli Etfal Training and Research Hospital 2nd General Surgery, Sisli, Istanbul, Turkey; Atakent Mah. Manolya cikmazi No: 2E, D:1, Kucukcekmece, Istanbul, TURKEY (34303).
JSLS. 2011 Apr-Jun;15(2):239-43. doi: 10.4293/108680811X13071180407032.
Situs inversus totalis (SIT) is a rare congenital anomaly that can cause difficulties during standard laparoscopic cholecystectomy due to its mirror-image anatomy. These cases require more technically demanding procedures, and handedness of the surgeon may influence performance of these operations. Single-incision laparoscopic surgery (SILS) has been proposed as a less-invasive alternative to conventional laparoscopic surgery. We report the first case of successful SILS cholecystectomy in a patient with SIT and discuss technical aspects of the operation related to the handedness of the surgeon.
A 49-year-old man who was known to have situs inversus totalis presented with symptomatic cholelithiasis. This patient was operated on by a right-handed surgeon. The surgeon and camera assistant were positioned on the right and left side respectively with the video monitor above the patient's left shoulder. The SILS port (Covidien), which has 3 operating channels, was placed in the abdomen via a 2-cm intraumbilical incision. SILS cholecystectomy was performed successfully. Dissection of Calot's triangle and the gallbladder bed was performed using a dissector and hook in the right hand without any technical problems.
SIT may confer an advantage over the orthotopic position for right-handed surgeons. SILS cholecystectomy can be performed safely in SIT.
全内脏转位（SIT）是一种罕见的先天性异常，因其镜像解剖结构，在标准腹腔镜胆囊切除术中可能会造成困难。这些病例需要技术要求更高的手术操作，并且外科医生的用手习惯可能会影响这些手术的实施。单孔腹腔镜手术（SILS）已被提议作为传统腹腔镜手术的一种侵入性较小的替代方法。我们报告了首例成功对全内脏转位患者实施SILS胆囊切除术的病例，并讨论了与外科医生用手习惯相关的手术技术要点。
一名49岁已知患有全内脏转位的男性因有症状的胆结石前来就诊。该患者由一名右利手外科医生进行手术。外科医生和摄像助手分别位于患者右侧和左侧，视频监视器位于患者左肩上方。通过脐部2厘米切口将具有3个操作通道的SILS端口（柯惠公司）置入腹腔。成功实施了SILS胆囊切除术。使用右手持有的分离器和钩子对胆囊三角和胆囊床进行解剖，未出现任何技术问题。
对于右利手外科医生而言，全内脏转位可能比正常解剖位置具有优势。SILS胆囊切除术可在全内脏转位患者中安全实施。
