Robotic distal gastrectomy for gastric cancer in a patient with situs inversus totalis and a vascular anomaly

• Published in: International cancer conference journal 2022-10, Vol.11 (4), p.253-260
• Main Authors: Sagawa, Hiroyuki, Ito, Sunao, Hayakawa, Shunsuke, Ueno, Shuhei, Okubo, Tomotaka, Tanaka, Tatsuya, Ogawa, Ryo, Takahashi, Hiroki, Matsuo, Yoichi, Mitsui, Akira, Kimura, Masahiro, Takiguchi, Shuji
• Format: Article
• Language: English
• Subjects: Abdomen; Antigens; Case Report; Complications; Dissection; Endoscopy; Gastrectomy; Gastric cancer; Gastrointestinal surgery; Inversion; Laparoscopy; Lymph nodes; Lymphatic system; Medical imaging; Medicine; Medicine & Public Health; Metastasis; Oncology; Patients; Postoperative; Robotic surgery; Surgeons; Surgical anastomosis; Surgical Oncology; Thorax; Tomography; Transposition; Ulcers; Veins & arteries; Viscera
• ISSN: 2192-3183; 2192-3183
• DOI: 10.1007/s13691-022-00554-x

Situs inversus totalis is defined as a complete mirror-image transposition of the thoracic and abdominal viscera. Cancer surgery in patients with situs inversus totalis can be more difficult than in patients without situs inversus totalis; however, robotic surgery using the da Vinci Surgical System allows for intuitive operation with its multi-articular function and stereopsis effect. In addition, prevention of shaking and the motion scale allows for efficient surgical procedures. We evaluated a 64-year-old man who had gastric cancer, and situs inversus totalis and a blood-vessel variation. To facilitate intuitive handling of the robot in this patient with organs reversed from the norm, we arranged the instruments and ports in such a way that the Maryland bipolar forceps could be used with the surgeon’s right hand. We performed a successful robotic distal gastrectomy with lymph node dissection. The operative time was 286 min, and the blood loss was 44 mL. There were no intra- or post-operative complications. The patient was discharged on postoperative day 7 and has had no evidence of a recurrence for 18 months. We conclude that robotic surgery is an efficient tool for operating on patients with gastric cancer, and situs inversus totalis and vessel variations.