Single Incision Laparoscopic Cholecystectomy in situs Inversus Totalis
A 49-year-old man who was known to have SIT, was admitted for elective cholecystectomy due to cholelithiasis. He presented to the department of surgery with complaints of left sided pain in the hypochondrium accompanied with nausea and vomiting after meals. The electrocardiogram and chest X-rays shows signs of dextrocardia []. On ultrasonographic evaluation, the right lobe of the liver and gallbladder were found on the left side; the spleen was visualized on the right. The gallbladder was filled with several gallstones. The common bile duct was normal in diameter. In the operating room, the surgeon and camera assistant were positioned on the right and the laparoscopy tower on the left. A single intra-umbilical 20 mm vertical incision was made by pulling out the umbilicus. After exposing the fascia, a single port trocar (Ethicon® Single Port) was applied just through the umbilicus and pneumoperitoneum was maintained stable at 12 mm Hg with carbon dioxide. The patient was put in a reverse trendelenburg position and rotated to the right. An initial laparoscopy inspected the reversed position of all intraperitoneal viscera []. The gallbladder was retracted with a suture placed along the gallbladder through the left side of the abdominal wall. Reticulating devices were entered through the port. Dissection was performed using an electric cautery hook (Ethicon® Endopath® Hook Electrode) and reticulating dissector (Covidien Articulating SILSTM Dissector and SILSTM Grasper). Before clipping, meticulous dissection and complete clearance of cystic duct and cystic artery represent an essential step for a safe procedure []. The cystic duct and artery were separately clipped with a standard 5-mm clip applier (Ethicon® Ligaclip®) and divided []. The specimen was retrieved through the umbilical incision. Finally, the 20 mm trocar site was closed with an absorbable suture and the umbilicus was restored to its physiological position. The operating time was 90 min and the procedure was completed without technical problems and complication. Patient received per os at 6 h postoperatively and was mobilized. The patient was discharged on the first day in a nice condition.