title: Mirror image hepatectomy in a patient with situs inversus totalis.
abstract: BACKGROUND
  Hepatectomy in a patient with situs inversus patient is technically challenging because of its complete mirror image anatomy, especially for a tumor located deep in the liver. Incorrectly identifying intrahepatic vessels and biliary system would lead to serious complications. We experienced a hepatectomy for a tumor in a patient with situs inversus totalis with referring to computer-generated mirror images.
  
  
  METHODS
  A 66-year-old female patient with situs inversus totalis was diagnosed with hepatocellular carcinoma, 5 cm in diameter, centrally located just above the hepatic hilum compressing the right and left hepatic duct. The liver infected with hepatitis C was cirrhotic with a moderate amount of ascites. We preoperatively created several diagrams of the mirror image anatomy and made plans for how to resect this tumor, presupposing the patient had an ordinary anatomy. The tumor was successfully enucleated with referring to these diagrams.
  
  
  RESULTS
  The operation time was 454 minutes. Five units of fresh frozen plasma was transfused intraoperatively. Although she suffered refractory ascites which needed repeated paracentesis, she managed to leave the hospital two months after the operation.
  
  
  CONCLUSIONS
  Creating a mirror image anatomy enables surgeons to safely perform a complex hepatectomy in a patient with situs inversus totalis.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ikeda
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawanaka
authors.forename: Yo-Ichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Masaru
authors.initials: M
authors.lastname: Morita
authors.forename: Eiji
authors.initials: E
authors.lastname: Oki
authors.forename: Koushi
authors.initials: K
authors.lastname: Mimori
authors.forename: Keishi
authors.initials: K
authors.lastname: Sugimachi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Saeki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Watanabe
authors.forename: Kenji
authors.initials: K
authors.lastname: Takenaka
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D019990:Perioperative Care; D012857:Situs Inversus / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome