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      Laparoscopic sigmoidectomy in a case of sigmoid colon cancer with situs inversus totalis

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          Abstract

          Situs inversus totalis (SIT) is a rare anatomic anomaly in which organs in the chest and abdomen exist in a mirror image reversal of their normal positions. SIT can complicate surgical procedures, and few reports have described laparoscopic surgery for colorectal cancer in patients with SIT. Here, we report a case of successful laparoscopic surgery in a patient with SIT and sigmoid colon cancer. Laparoscopic sigmoidectomy involved colonic mobilization with high ligation of the inferior mesenteric vessels and complete mesocolic excision. The operating surgeon stood on the patient's left side, opposite the normal location for sigmoidectomy. By placing a 12‐mm trocar in the left iliac fossa and using an automatic endoscopic linear stapler, the operating surgeon was able to perform left‐handed colon resection without having to change position or move the laparoscopic monitor mid‐procedure. An automatic endoscopic linear stapler is useful for laparoscopic left‐side colon surgery in a patient with SIT.

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          Laparoscopic cholecystectomy in situs inversus totalis: The importance of being left-handed.

          Since laparoscopic cholecystectomy has become the standard procedure for the treatment of gallstone disease, several cases have been reported in patients with situs inversus. These cases require more technically demanding procedures due to the symmetrical disposition of the anatomy. Thus, handedness could influence the performance of these operations. The two of us (L.M.O.) and (J.M.B.), a right-handed and a left-handed surgeon, respectively, placed the instruments in reverse mode from that used in orthotopic patients. The right-handed surgeon felt more impairment when dissecting with his left hand and decided to cross the instruments within the abdomen. The left-handed surgeon was able to alternate the performance of the dissection maneuvers between the right and left hands. Surgical procedures are apparently designed for right-handed surgeons and can be approached by the left-handed in alternative ways. In fact, the accommodation of laparoscopic cholecystectomy to left-handedness has been described in the literature. The rare opportunity to operate in a symmetrical way allows the right-handed surgeon to understand the absence of comfort and ergonomy often experienced by left-handed colleagues.
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            Advanced cancer with situs inversus totalis associated with KIF3 complex deficiency: report of two cases.

            Situs inversus totalis (SIT) is a relatively rare congenital anomaly, occurring at an incidence of 1 in 10 000-50 000 live births. Although there are some case reports of SIT with the presence of cancer, there are few reports on the relationship between SIT and cancer. However, the recent phylogenetic investigations of this condition suggest that this may be linked to the development and progression of cancer on the molecular level. The key elements are one of the intracellular motor proteins, the KIF3 complex, and the cell-adhesion factors N-cadherin and beta-catenin. We herein present the cases of advanced gastric cancer and lung cancer with SIT, and review the relationship between SIT and the development and progression of cancer.
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              Laparoscopic Sigmoidectomy for a Patient With Situs Inversus Totalis: Effect of Changing Operator Position

              Situs inversus totalis (SIT) is a rare congenital condition in which the abdominal and thoracic organs are on the opposite sides to their normal anatomic positions. Reports of laparoscopic surgery for colorectal cancer with SIT are very few. Due to the mirror-image transposition of organs and vascular abnormalities, laparoscopic surgery for patients with SIT is technically complicated. Therefore, it has been reported as easier for left-handed surgeons. This report presents that operative procedures can be conducted as usual by changing the positions of the operator and assistants, even if the operator is right-handed. A 71-year-old woman visited our hospital with a 2-month history of hematochezia. Colonoscopy revealed an ulcerative tumor in the sigmoid colon and biopsy confirmed well-differentiated adenocarcinoma. Laparoscopic sigmoidectomy radical lymphadenectomy was performed. The operating time was 189 minutes and blood loss was 13 mL. The patient was discharged on postoperative day 7, without any complications. We report that complicated surgical procedures for patients with SIT can be simplified by changing viewpoints. Due to the altered anatomy in SIT, the positions of the operator and assistants are very important. Location of the pelvis is almost the same as in orthotopic patients, by moving the operator from the left side to the right side of the patient. Changing the position of the operator to the right side seems to be effective for patients with SIT during pelvic procedures.
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                Author and article information

                Contributors
                nharaguchi@gesurg.med.osaka-u.ac.jp
                Journal
                Asian J Endosc Surg
                Asian J Endosc Surg
                10.1111/(ISSN)1758-5910
                ASES
                Asian Journal of Endoscopic Surgery
                John Wiley & Sons Australia, Ltd (Kyoto, Japan )
                1758-5902
                1758-5910
                30 March 2018
                January 2019
                : 12
                : 1 ( doiID: 10.1111/ases.2019.12.issue-1 )
                : 111-113
                Affiliations
                [ 1 ] Department of Surgery National Hospital Organization Osaka National Hospital Osaka Japan
                [ 2 ] Department of Gastroenterological Surgery Graduate School of Medicine, Osaka University Osaka Japan
                Author notes
                [*] [* ] Correspondence

                Naotsugu Haraguchi, Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Adress: 2‐2 Yamadaoka, Suita, Osaka 565‐0871, Japan.

                Tel: +81 6 6279 3251

                Fax: +81 6 6879 3259

                Email: nharaguchi@ 123456gesurg.med.osaka-u.ac.jp

                Article
                ASES12483 ASES-2018-0035
                10.1111/ases.12483
                6585653
                29601667
                7f283ffe-c831-466e-bd49-82889fb2d430
                © 2018 The Authors Asian Journal of Endoscopic Surgery published by Asia Endosurgery Task Force and Japan Society of Endoscopic Surgery and John Wiley & Sons Australia, Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 February 2018
                : 25 February 2018
                Page count
                Figures: 4, Tables: 0, Pages: 3, Words: 1589
                Categories
                Case Report
                Case Reports
                Custom metadata
                2.0
                ases12483
                January 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.4 mode:remove_FC converted:20.06.2019

                laparoscopic sigmoidectomy,sigmoid colon cancer,situs inversus totalis

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