Department of Thoracic Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China.
Department of Hepatobiliary Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China.
J Cardiothorac Surg. 2022 Sep 1;17(1):221. doi: 10.1186/s13019-022-01983-8.
Situs inversus totalis (SIT) is a relatively rare congenital abnormality in which the major thoracic and abdominal visceral organs are reversed from their usual positions. In patients with SIT and bronchial carcinoma, surgical difficulty increases sharply. It has been reported that the video-assisted thoracic surgery (VATS) still poses the operator to a challenge situation. The similarity of surgical positions and the flexibility of the mechanical arm in robotic surgery, may be beneficial to SIT patients due to reducing technical difficulties. Here, we present a first case of SIT patient with lung cancer, in which Da Vinci robot-assisted thoracic surgery (RATS) was performed successfully.
A 66-year old patient, previously diagnosed with SIT since childhood, came to our hospital with two pulmonary nodules in his left lung field. The bigger one had increased somewhat for the last 2 years of follow-up. Software Mimics was preoperatively carried out to analyze anatomical variations. RATS was conducted to complete left upper lobectomy and left middle wedge resection. The patient had no intraoperative complications and was discharged day 5 after the operation.
This is the first report of a successful robot-assisted lung cancer resection in a patient with SIT. In such challenging cases as lung cancer and rare anomaly as SIT, RATS is more advantageous and suitable than VATS with the help of software Mimics utilized for 3D reconstruction, which can identify the anatomical abnormalities and facilitate the surgical procedures.
全内脏反位（SIT）是一种相对罕见的先天性异常，其中主要的胸腹腔内脏器官与通常的位置相反。在 SIT 合并支气管癌的患者中，手术难度急剧增加。据报道，电视辅助胸腔镜手术（VATS）仍然对操作者构成挑战。由于减少了技术难度，机器人手术中手术位置的相似性和机械臂的灵活性可能对 SIT 患者有益。在这里，我们报告了首例 SIT 合并肺癌患者，成功地进行了达芬奇机器人辅助胸腔手术（RATS）。
一名 66 岁患者，自幼被诊断为 SIT，因左肺野有两个肺结节来我院就诊。其中较大的一个在过去 2 年的随访中有所增大。术前进行了软件 Mimics 分析解剖学变异。进行 RATS 以完成左上肺叶切除术和左肺中叶楔形切除术。患者术中无并发症，术后第 5 天出院。
这是首例 SIT 患者成功接受机器人辅助肺癌切除术的报道。在肺癌和 SIT 等罕见异常等具有挑战性的情况下，RATS 比 VATS 更有利且更适合，借助用于 3D 重建的软件 Mimics 可以识别解剖学异常并简化手术过程。
