Robot-assisted low anterior resection for situs inversus totalis

A novel technical approach for an uncommon condition

Quor Meng Leong, Dong Nyung Son, Jae Sung Cho, Azali Hafiz Yazee Amar, Seon Hahn Kim

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

INTRODUCTION: Situs inversus totalis (SIT) is an uncommon condition, with an incidence of 1 in 10,000. Surgery for SIT patients is more difficult because of the uncommon anatomy. Experience in laparoscopic surgery for patients with SIT is very limited. Only a few cases of laparoscopic colorectal resections have been reported in the literature. We present the first robot-assisted low anterior resection for rectal cancer in a patient with SIT. PATIENT: A 70-year-old woman with SIT who presented with rectal bleeding underwent a colonoscopy and barium enema. This workup revealed a rectal cancer 10 cm from the anal verge. The magnetic resonance imaging scan revealed a T3/4 tumor in the rectum with perirectal lymph node involvement, whereas the computed tomography positron emission tomography scan did not reveal any distal metastasis. She underwent neoadjuvant chemoradiotherapy 6 weeks before surgery. Postoperatively, she made an uneventful recovery and was discharged on day 6. SURGICAL TECHNIQUE: After laparoscopic examination and displacement of the small bowel, 4 robot trocars were inserted into 4 quadrants of the abdomen. A fifth port was inserted and used by the assistant. The robot cart was docked from the right side with arms 1, 2, and 3 in the right upper quadrant (Cadiere grasper), left lower quadrant (bipolar Maryland grasper), and left upper quadrant (monopolar scissors), respectively, for colonic mobilization without splenic flexure takedown. For pelvic dissection, arms 1 and 3 were moved to the right upper quadrant and right lower quadrant, respectively. After adequate pelvic dissection, the robot cart was undocked, and a laparoscopic articulating linear stapler was used to transect the rectum from the left lower quadrant port. Bowel continuity was restored with a circular stapler. A loop ileostomy was created through the extraction site in the right lower quadrant. CONCLUSIONS: Robot-assisted low anterior resection for SIT patients can be performed safely and confers the benefits of laparoscopic low anterior resection with additional advantages unique to the da Vinci system.

Original languageEnglish
JournalSurgical Laparoscopy, Endoscopy and Percutaneous Techniques
Volume22
Issue number2
DOIs
Publication statusPublished - 2012 Apr 1

Fingerprint

Situs Inversus
Rectal Neoplasms
Rectum
Dissection
Arm
Transverse Colon
Ileostomy
Chemoradiotherapy
Colonoscopy
Surgical Instruments
Abdomen
Laparoscopy
Anatomy
Lymph Nodes
Magnetic Resonance Imaging
Hemorrhage
Neoplasm Metastasis
Incidence
Neoplasms

Keywords

  • rectal cancer
  • robot-assisted low anterior resection
  • situs inversus totalis

ASJC Scopus subject areas

  • Surgery

Cite this

Robot-assisted low anterior resection for situs inversus totalis : A novel technical approach for an uncommon condition. / Leong, Quor Meng; Son, Dong Nyung; Cho, Jae Sung; Amar, Azali Hafiz Yazee; Kim, Seon Hahn.

In: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques, Vol. 22, No. 2, 01.04.2012.

Research output: Contribution to journalArticle

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AB - INTRODUCTION: Situs inversus totalis (SIT) is an uncommon condition, with an incidence of 1 in 10,000. Surgery for SIT patients is more difficult because of the uncommon anatomy. Experience in laparoscopic surgery for patients with SIT is very limited. Only a few cases of laparoscopic colorectal resections have been reported in the literature. We present the first robot-assisted low anterior resection for rectal cancer in a patient with SIT. PATIENT: A 70-year-old woman with SIT who presented with rectal bleeding underwent a colonoscopy and barium enema. This workup revealed a rectal cancer 10 cm from the anal verge. The magnetic resonance imaging scan revealed a T3/4 tumor in the rectum with perirectal lymph node involvement, whereas the computed tomography positron emission tomography scan did not reveal any distal metastasis. She underwent neoadjuvant chemoradiotherapy 6 weeks before surgery. Postoperatively, she made an uneventful recovery and was discharged on day 6. SURGICAL TECHNIQUE: After laparoscopic examination and displacement of the small bowel, 4 robot trocars were inserted into 4 quadrants of the abdomen. A fifth port was inserted and used by the assistant. The robot cart was docked from the right side with arms 1, 2, and 3 in the right upper quadrant (Cadiere grasper), left lower quadrant (bipolar Maryland grasper), and left upper quadrant (monopolar scissors), respectively, for colonic mobilization without splenic flexure takedown. For pelvic dissection, arms 1 and 3 were moved to the right upper quadrant and right lower quadrant, respectively. After adequate pelvic dissection, the robot cart was undocked, and a laparoscopic articulating linear stapler was used to transect the rectum from the left lower quadrant port. Bowel continuity was restored with a circular stapler. A loop ileostomy was created through the extraction site in the right lower quadrant. CONCLUSIONS: Robot-assisted low anterior resection for SIT patients can be performed safely and confers the benefits of laparoscopic low anterior resection with additional advantages unique to the da Vinci system.

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