Enciu Octavian, Toma Elena Adelina, Tulin Adrian, Georgescu Dragos Eugen, Miron Adrian
Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.
General Surgery Department, Elias Emergency University Hospital, 011461 Bucharest, Romania.
Diagnostics (Basel). 2022 May 19;12(5):1265. doi: 10.3390/diagnostics12051265.
Laparoscopic cholecystectomy in situs inversus totalis (SIT) is a technically and physically demanding procedure for surgeons and there is still a lack of consensus regarding the best technical approach in such cases. We conducted a systematic review and meta-analysis to evaluate port placement, the dominant hand of the surgeon, preoperative imaging, morbidity, and mortality.
We searched MEDLINE, SCOPUS, Web of Science, and the Cochrane Library for studies of patients with SIT that underwent laparoscopic cholecystectomy. Of 387 identified records, 101 met our inclusion criteria, all of them case reports or case series of maximum of 6 patients.
Out of the 121 patients included in the analysis, 94 were operated on using a "mirrored American" technique, 12 using the "Mirrored French", 9 employed single-port techniques, and 6 described novel port placements. Even though most surgeries were conducted by a right-handed surgeon (93 cases), surgeries performed by the seven left-handed surgeons yielded shorter intervention times ( = 0.024). Preoperative imaging (CT, MRI, MRCP, ERCP) also correlated with a lower duration of surgery ( = 0.038. Length of stay was associated with the type of disease, but not with other studied endpoints. Morbidity was less than 1%, and conversion rates and mortality were nil.
Cholecystectomy in SIT is a safe but challenging procedure and surgeons should prepare in advance for the unfamiliar aspects of completing such a task. While preoperative imaging and a left-handed surgeon are beneficial in terms of surgery length, when these are not available surgeons should focus on achieving the most comfortable setting based on their experience and tailor their approach to the patient at hand. Further studies are needed in order to properly describe and evaluate intraoperative findings as well as surgeon-dependent factors that could improve future recommendations.
全内脏反位（SIT）患者的腹腔镜胆囊切除术对外科医生来说在技术和体力上都要求很高，对于此类病例的最佳技术方法仍缺乏共识。我们进行了一项系统评价和荟萃分析，以评估端口放置、术者优势手、术前影像学检查、发病率和死亡率。
我们在MEDLINE、SCOPUS、科学网和考克兰图书馆中检索了接受腹腔镜胆囊切除术的SIT患者的研究。在387条检索到的记录中，101条符合我们的纳入标准，所有这些都是病例报告或最多6例患者的病例系列。
在纳入分析的121例患者中，94例采用“镜像美式”技术进行手术，12例采用“镜像法式”技术，9例采用单端口技术，6例描述了新颖的端口放置方法。尽管大多数手术由右手优势的外科医生进行（93例），但由7名左手优势的外科医生进行的手术干预时间更短（P = 0.024）。术前影像学检查（CT、MRI、MRCP、ERCP）也与较短的手术时间相关（P = 0.038）。住院时间与疾病类型有关，但与其他研究终点无关。发病率低于1%，中转率和死亡率为零。
SIT患者的胆囊切除术是一种安全但具有挑战性的手术，外科医生应提前为完成此类任务中不熟悉的方面做好准备。虽然术前影像学检查和左手优势的外科医生在手术时长方面有益，但当无法获得这些条件时，外科医生应根据经验专注于实现最舒适的手术环境，并根据手头患者的情况调整手术方法。需要进一步研究以正确描述和评估术中发现以及可能改善未来建议的术者相关因素。
