title: Laparoscopic nephroureterectomy in renal pelvic urothelial carcinoma with situs inversus totalis: preoperative training using a patient-specific simulator.
abstract: OBJECTIVE
  To report the first case of preoperative training using a patient-specific laparoscopic simulator for a patient with situs inversus totalis (SIT).
  
  
  METHODS
  A 61-year-old man presented with gross hematuria and was diagnosed with right renal pelvic cancer T1N0M0. A whole-body computed tomography (CT) scan also revealed his organs showed a mirror image, with left-to-right reversal, and SIT was diagnosed. A laparoscopic right nephroureterectomy through a retroperitoneal approach was scheduled. Before the operation, we practiced the operation using a patient-specific laparoscopic surgical simulator that we have developed. The patient's CT data were used to reproduce the retroperitoneal space in the simulator, and the surgeon trained and became familiar with his SIT anatomy.
  
  
  RESULTS
  The insufflation time was 182 minutes, and the estimated blood loss was 50 mL. The surgeon was able to complete the right retroperitoneoscopic nephroureterectomy safely, without any problems.
  
  
  CONCLUSIONS
  To our knowledge, we report the first case of preoperative training using a patient-specific simulator for a patient with SIT. Preoperative training was useful, and retroperitoneoscopic nephroureterectomy was successfully performed in a patient with renal pelvic urothelial carcinoma and SIT.
authors.affiliation: Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan. makiya@yokohama-cu.ac.jp
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Makiyama
authors.forename: Ryoko
authors.initials: R
authors.lastname: Sakata
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamanaka
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Tatenuma
authors.forename: Futoshi
authors.initials: F
authors.lastname: Sano
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kubota
mesh_terms: D002983:Clinical Competence; D015897:Comorbidity; D003198:Computer Simulation; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000601:surgery*; D007682:Kidney Pelvis; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D012857:Situs Inversus / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed; D014513:Ureter / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000193:education / Q000379:methods*