M Venu Bhargava, Vaddavalli Venkata Vineeth, Abuji Kishore, Palle Pranay, Ramavath Krishna
Department of Surgical Gastroenterology, Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Hyderabad, IND.
Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND.
Cureus. 2023 Apr 26;15(4):e38161. doi: 10.7759/cureus.38161. eCollection 2023 Apr.
Laparoscopic cholecystectomy can be technically challenging in patients with situs inversus totalis. A middle-aged gentleman presented with pain in the left upper abdomen. His cardiac workup showed dextrocardia, and ultrasonography showed a gall bladder on the left side. He was diagnosed with acute cholecystitis and was planned for laparoscopic cholecystectomy. We used the four-port technique, where anterior dissection was carried out by the dominant right hand of the primary surgeon, and the infundibulum was retracted by the first assistant from the mid-clavicular port. The first assistant carried out the posterior dissection through a midclavicular port, whereas the primary surgeon did a retraction. To conclude, this technique done by two surgeons decreases the ergonomic difficulty faced by right-handed surgeons while performing laparoscopic cholecystectomy.
对于全内脏转位的患者，腹腔镜胆囊切除术在技术上可能具有挑战性。一位中年男性因左上腹疼痛就诊。他的心脏检查显示右位心，超声检查显示左侧有胆囊。他被诊断为急性胆囊炎，并计划进行腹腔镜胆囊切除术。我们采用了四孔技术，主刀医生用优势右手进行前侧分离，第一助手通过锁骨中线端口牵拉胆囊漏斗部。第一助手通过锁骨中线端口进行后侧分离，而主刀医生进行牵拉。总之，由两位外科医生完成的这项技术降低了右利手外科医生在进行腹腔镜胆囊切除术时面临的人体工程学困难。
