Thoracoscopic esophagectomy and hand-assisted laparoscopic gastric mobilization for esophageal cancer with situs inversus totalis

Minimally invasive Ivor Lewis esophagectomy in a patient with situs inversus totalis through a total of five ports

Situs inversus totalis is inverse placement of intra-thoracic and abdominal organs identical with a mirror image. Herein, we present a rare case of situs inversus totalis and gastroesophageal junction carcinoma treated with minimally invasive Ivor Lewis esophagectomy. A 73-year-old male patient presented with dysphagia and a diagnosis of adenocarcinoma was made. He underwent three-port laparoscopic gastric conduit preparation without using a liver retractor. Esophageal mobilization in the chest was completed with biportal video-assisted thoracoscopic surgery technique and a completely side-to-side stapled anastomosis. The patient is still alive without recurrence four years after surgery. Minimally invasive Ivor Lewis esophagectomy can be performed in these cases; however, a careful planning and rethinking of the anatomy for correct intraoperative orientation are needed. Similar surgical and oncological outcomes are expected in this patient population.

Total minimally invasive McKeown esophagectomy in an esophageal cancer patient with situs inversus totalis: A case report

Situs inversus totalis (SIT) is an extremely rare anomaly characterized by a left‐to‐right reversal of all the thoracic and abdominal organs. Only 11 cases of esophageal cancer with SIT have been reported worldwide, most of which underwent hybrid minimally invasive esophagectomy (MIE) but not total MIE. Here, we report a case of esophageal cancer with SIT successfully treated by total MIE, with a right lateral‐prone position adopted during the thoracic procedure. The relevant literature is also discussed and reviewed.

Multiple stab wounds on the left side of the chest in a patient with Situs Inversus Totalis: A lifesaving coincidence

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Reports of surgery in patients with SIT.

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Outcomes of emergency surgeries in patients with SituS Inversus Totalis can be different than those expected in the general population due to anatomical differences.

Introduction

Situs Inversus Totalis (SIT) is a rare finding of complete reversal of the thoracic and abdominal organs with an estimated incidence of 0.005%–0.01% in the population. Severe trauma has not been reported in this population. We present a case of multiple chest stab wounds in a patient with previously unknown SIT.

Presentation of case

A 39-year-old male was admitted to the emergency room with multiple stab wounds on the left side of the chest. Upon admission the patient was hypotensive, with miosis and intubated. Significant ECG findings were an inverted P wave, inverted QRS complex and inverted T wave in V1. A chest CT scan showed SIT, hemopneumothorax on the left side and, despite multiple stab wounds on the left side of the chest, no cardiac damage. The surgical team decided for a conservative approach and the patient remained in the ICU for two days. After five days he was discharged in good clinical conditions.

Discussion

SIT generally does not have a clinical relevance throughout the patients life and most diagnoses are coincidental. However, when discovered in acute surgical cases, it requires an accurate evaluation by the surgical team due to anatomical differences that may produce undesirable outcomes in emergency cases such as appendicitis and general trauma.

Conclusion

There have been very few reports of SIT and trauma in the medical literature. This might be the first ever reported case of a patient with SIT who suffered multiple stab wounds on the left side of the chest and was saved because of his condition.

Operative Challenges with Minimally Invasive McKeown Esophagostomy with Two-Field Lymphadenectomy in a Case of Situs Inversus Totalis with Carcinoma Esophagus: A Case Report with Review of the Literature

Situs inversus totalis is an uncommon anatomical congenital anomaly characterized by complete transposition of viscera with right-to-left reversal across the sagittal plane. Consequently, surgery in such cases is more technically challenging and requires a complete reorientation of visual-motor coordination skills. We describe a case of a 50-year-old gentleman with locally advanced lower esophagus carcinoma post-neoadjuvant chemoradiotherapy with situs inversus totalis and treated with minimally invasive McKeown esophagectomy using a left thoracoscopic, laparoscopic-assisted and right cervical approach. The operative procedure and difficulties during surgery are highlighted. Minimal invasive esophagectomy is safe and feasible in situs inversus totalis. Recognition of the anatomy with a meticulous preoperative planning is advocated for an uneventful operative intervention.

Video-assisted thoracic surgery and jejunal reconstruction in a case of situs inversus totalis with esophageal cancer

A 78-year-old man with situs inversus totalis who had a previous history of distal gastrectomy for gastric cancer was referred to our hospital for treatment of esophageal cancer. He was diagnosed as cT2N0M0 and underwent video-assisted thoracic surgery and open completion gastrectomy with jejunal reconstruction via the ante-thoracic route. The postoperative period was uneventful except for transient palsy of the right recurrent laryngeal nerve. Based on a preoperative assessment of anatomical abnormality and an intraoperative adaptation to the mirror image of the standard procedure, video-assisted esophagectomy was considered safe and feasible. It can be recommended for patients with esophageal cancer complicated by situs inversus totalis. This is the first case report of a patient with situs inversus totalis who underwent video-assisted esophagectomy with jejunal reconstruction. Relevant literature is also discussed and reviewed.

Thoracoscopic surgery in the prone position for esophageal cancer in patients with situs inversus totalis: A report of two cases

Introduction

Situs inversus totalis (SIT) is a rare congenital condition characterized by a complete transposition of thoracic and abdominal organs. Here, we present two successful cases of left thoracoscopic esophagectomy in the prone position for SIT-associated esophageal cancer.

Presentation of case

Our first case was of an 82-year-old man who underwent a left thoracoscopic esophagectomy in the prone position, followed by hand-assisted laparoscopic gastric mobilization. Surgical duration and blood loss were 661 min and 165 g, respectively. His postoperative course was uneventful. The second case was of a 66-year-old man who underwent a left thoracoscopic esophagectomy in the prone position, followed by gastric mobilization via laparotomy owing to a concomitant intestinal malrotation and polysplenia. Surgical duration and blood loss were 637 min and 220 g, respectively. We trained for the surgical procedures preoperatively using left-inverted and right-inverted thoracoscopic surgical videos of patients with normal anatomy.

Discussion

Surgical procedures in SIT patients are challenging owing to their mirrored anatomy. Recognition　of their　variations　is　thus important to　avoid　intraoperative accidental injuries. Left-inverted and right-inverted thoracoscopic surgical videos of patients with normal anatomy were found to be useful for image training prior to the actual surgery.

Conclusion

Thoracoscopic surgical treatment for esophageal cancer associated with SIT in the prone position can be performed safely, similar to the manner performed for thoracoscopic surgery in the right decubitus position, or surgery via an open thoracotomy. Gastric mobilization via laparotomy should be considered in patients associated other anatomic variations.

Thoracoscopic esophagectomy for esophageal cancer with situs inversus totalis: a case report and literature review

A 63-year-old male visited our hospital, complaining of discomfort when swallowing. Upper gastrointestinal endoscopy revealed a type 2 tumor in the middle thoracic esophagus, which was diagnosed as squamous cell carcinoma by endoscopic biopsy. Computed tomography revealed situs inversus totalis (SIT). We assessed the relationship of the esophagus with neighboring organs using preoperative three-dimensional imaging. We performed thoracoscopic esophagectomy with radical lymph node dissection in the right decubitus position and hand-assisted laparoscopic gastric mobilization in the supine position. The definitive diagnosis was squamous cell carcinoma, pT2N1M0, pStage IIB according to the Union for International Cancer Control. The patient's postoperative course was uneventful, and 5 years post-operation, he is alive without recurrence. In SIT patients, surgical procedures are difficult because of anatomic transposition. Three-dimensional imaging effectively assesses the anatomical structure and contributes to safer thoracoscopic esophagectomy for esophageal cancer patients with SIT. Relevant literature is also discussed and reviewed.

Minimally invasive Mckeown esophagectomy with modified three-field lymphadenectomy in case of situs inversus totalis with carcinoma mid esophagus

Performing complex surgical procedures in patients with situs inversus totalis is a challenge because of the need to orient to the completely mirror transposed abdominal and thoracic viscera. We report our experience in performing a three phase minimally invasive (thoracoscopic and laparoscopic) esophagectomy for carcinoma of the mid esophagus in a patient with situs inversus totalis. We believe that this is the first reported case of this kind.