title: Simplified technique of laparoscopic cholecystectomy in a patient with situs inversus: a case report and review of techniques.
abstract: BACKGROUND
  Situs inversus is a rare and silent autosomal recessive disorder occurring in 1:5,000 to 1:20,000 individuals. Laparoscopic cholecystectomy, a standard treatment for gallbladder disease in the general population, is very challenging in patients with situs inversus, especially for right-handed surgeons. We herein report a case involving our modified laparoscopic cholecystectomy technique for right-handed surgeons in a Thai patient with situs inversus who developed a symptomatic gallstone. We also include a short review of the literature.
  
  
  METHODS
  A 39-year-old female patient with dextrocardia presented with a 5-month history of episodic biliary colic. Abdominal ultrasonography revealed a left-sided gallbladder with gallstones. We performed laparoscopic cholecystectomy with our modified technique including port relocation. The operation went well, and our patient recovered satisfactorily.
  
  
  CONCLUSIONS
  Laparoscopic cholecystectomy in patients with a left-sided gallbladder is not often confidently performed by right-handed surgeons. However, some modifications of "mirror image" ports focused on the more ergonomic port position are the keys to successful completion of this operation. The patient will thus still obtain benefits from this standard minimally invasive technique.
authors.affiliation: Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand.
authors.forename: Natthawut
authors.initials: N
authors.lastname: Phothong
authors.affiliation: Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Thawatchai
authors.initials: T
authors.lastname: Akaraviputh
authors.affiliation: Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Vitoon
authors.initials: V
authors.lastname: Chinswangwatanakul
authors.affiliation: Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. atthaphorn.tra@mahidol.ac.th.
authors.forename: Atthaphorn
authors.initials: A
authors.lastname: Trakarnsanga
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D005704:Gallbladder / Q000002:abnormalities*; D005705:Gallbladder Diseases / Q000150:complications*; D042882:Gallstones / Q000150:complications / Q000601:surgery*; D006801:Humans; D012857:Situs Inversus / Q000150:complications*