Jasmine Agarwal, Ajay Bhandarwar, MS, Amol Wagh, MS, Saurabh Gandhi, MS, Shubham Gupta, MS, Eham Arora, MS. Grant Government Medical College & Sir J.J. Group of Hospitals, Mumbai, India
INTRODUCTION: Situs Inversus Totalis (SIT) is inherited in an autosomalrecessive fashion with complete abnormal transposition of thoracic & abdominal viscera. Its incidence varies from 1 in 1400 to 35000 live births. For those undergoing surgery, laparoscopic approach is preferred as it avoids inappropriate incisions. However, due to mirroring of the viscera, the surgeon faces constant visio-spatial disorientation during laparoscopy.
Our objective is to devise methods for proper port placement to overcome the ergonomic challenges.
PROCEDURE: 3 patients with SIT were operated laparoscopically in our hospital in the period of May 2016 to November 2017, 2 males suffering from cholelithiasis without cholecystitis and 1 female with acute appendicitis. After thorough review of literature and proper planning, the patients were posted for surgery.
For laparoscopic appendectomy, a thorough initial diagnostic survey is performed on introducing a scope through the umbilical port and confirming the exact location of the appendix. The two working ports are introduced accordingly, which is usually a mirror image of the standard port sites. The appendix was visualised in the left iliac fossa and after meticulous dissection, the appendix and mesoappendix were divided using an endostapler. The operative time was 43 minutes and there were no intraoperative or postoperative complications..jpg)
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The port placement for laparoscopic cholecystectomy in such a case is trickier as the anatomical variation and the contralateral disposition of the biliary tree demand an accurate dissection and exposure of the biliary structures to avoid iatrogenic injuries. It is important to conform to the principles of triangulation during port placement. The mirror image of 4-port placement is convenient for left-handed surgeons. Whereas, to make the procedure comfortable for right-handed surgeons, the working ports need to be shifted caudally with the surgeon standing between the patient’s legs. The mean operative time was 54 minutes and there were no minor or major intraoperative or postoperative complications.
CONCLUSION: Ergonomic comfort is vital to a smooth procedure. While mirroring ports suffices for appendectomy, all other procedures require forethought for port placement. It should be noted that ambidexterity is a desirable skill in the operating room for a laparoscopic surgeon.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87269
Program Number: P763
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster