A case of rectal cancer in a patient with situs inversus totalis treated by laparoscopic-assisted low anterior resection

Abstract

We report a case of rectal cancer in a patient with situs inversus totalis who was treated by laparoscopic-assisted low anterior resection. A 53-year-old man was admitted to our hospital for treatment of rectal cancer. During childhood, he was diagnosed with situs inversus totalis. Pathological examination performed after endoscopic submucosal dissection of the rectal cancer revealed submucosal invasion and lymphatic vessel invasion ; we performed laparoscopic-assisted low anterior resection. Before the operation, we simulated a mirror image by watching a movie of a patient with a normal anatomy undergoing a similar operation played in inverse enantiomorph. During the operation, the operator and the endoscopist stood in opposite locations compared to those for standard operations in orthotopic patients. The trocars were also placed in mirror-image positions. The operation was successful, demonstrating that laparoscopic surgery can be performed safely in patients with situs inversus totalis provided the surgery is preceded by sound preoperative preparation.