Trans-Umbilical Single Incision Laparoscopic Sleeve Gastrectomy in a Patient with Situs Inversus Totalis and Kartagener Syndrome: Video Report
Single incision laparoscopic sleeve gastrectomy (SILSG) has proven to be a safe minimal invasive procedure. The umbilicus placement of the device allows the avoidance of any visible scars. Kartagener syndrome is a rare genetic disorder (1:15 000) accompanied by the combination of chronic sinusitis/bronchiectasis leading to respiratory insufficiency and situs inversus totalis (SIT) in half of the patients. SIT is a transposition of organs to the opposite side of the body and can lead to difficulties in laparoscopic surgery because of mirror image anatomy modification. We present the case of a 52-year-old woman (122 kg; 1.58 m) with a body mass index of 49 kg/m(2) presenting SIT with chronic respiratory insufficiency as part of Kartagener syndrome. In this multimedia video, we present a step-by-step trans-umbilical SILSG completed in SIT condition. Single site approach allows several technical advantages such as single-port placement, surgeon position as well as surgical instruments manipulation that are unchanged compared to "normal anatomy patients." These resulted in limited intra-operative difficulties. No adverse outcomes occurred during the post-operative period. Trans-umbilical SILSG in patients with SIT can be performed safely and in comparable conditions than in normal anatomy patients.