Hideki Hayashi, MD, PhD1, Toshiyuki Natsume, MD, PhD2, Masayuki Kano, MD, PhD3, Koichi Hayano, MD, PhD3, Takeshi Toyozumi, MD, PhD3, Hisahiro Matsubara, MD, PhD3. 1Center for Frontier Medical Engineering, Chiba Univeristy, 2Department of Surgery, Funabashi Municipal Medical Center, 3Department of Frontier Surgery, Chiba Univerisity
Background: Situs inversus totalis (SIT) is a rare congenital anatomy and a challenging condition for laparoscopic surgeries because standardized strategy to overcome such anatomical difficulties. Mirror-reversed video images of laparoscopic surgeries for patients with normal anatomy could help to develop surgical strategies for patients with SIT. We had a chance to evaluate this idea with a treatment of a patient of early gastric cancer, and describe the surgical results of the case.
Patient and methods: Seventy-two-year-old women with a history of SIT was referred to our department for the treatment of early gastric cancer, and laparoscopic distal gastrectomy with D1+ lymphadenectomy was scheduled. A video record of the same surgery for a patient with similar physical attribute performed before then was retrieved, and was edited with a computer into full length, totally mirror-reversed images of the surgery. Designated operator and assistant simulated the operation using the video several times before surgery.
Results: Laparoscopic distal gastrectomy was performed with D1+ lymphadenectomy while the operator was on the left side of the patient and the assistant on the other side, being opposite positions as usual. Laparoscopic B-1 reconstruction was followed using “Delta anastomosis” technique reported by Kanaya et al. Total laparoscopic procedures were completed with the operation time of 250 minutes and the blood loss below measurable limits. No appreciable complications were observed after surgery and the patient was discharged on postoperative day 12. No recurrence of the disease was detected until 5 years after surgery,
Conclusion: Although further validation is unlikely because of a rare incidence of this anatomy, the same technique would be recommended for one of the preoperative preparations for similar cases.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86766
Program Number: P299
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster