title: Trans-Umbilical Single Incision Laparoscopic Sleeve Gastrectomy in a Patient with Situs Inversus Totalis and Kartagener Syndrome: Video Report.
abstract: BACKGROUND
  Single incision laparoscopic sleeve gastrectomy (SILSG) has proven to be a safe minimal invasive procedure. The umbilicus placement of the device allows the avoidance of any visible scars. Kartagener syndrome is a rare genetic disorder (1:15 000) accompanied by the combination of chronic sinusitis/bronchiectasis leading to respiratory insufficiency and situs inversus totalis (SIT) in half of the patients. SIT is a transposition of organs to the opposite side of the body and can lead to difficulties in laparoscopic surgery because of mirror image anatomy modification.
  
  
  METHODS
  We present the case of a 52-year-old woman (122 kg; 1.58 m) with a body mass index of 49 kg/m(2) presenting SIT with chronic respiratory insufficiency as part of Kartagener syndrome.
  
  
  RESULTS
  In this multimedia video, we present a step-by-step trans-umbilical SILSG completed in SIT condition. Single site approach allows several technical advantages such as single-port placement, surgeon position as well as surgical instruments manipulation that are unchanged compared to "normal anatomy patients." These resulted in limited intra-operative difficulties. No adverse outcomes occurred during the post-operative period.
  
  
  CONCLUSIONS
  Trans-umbilical SILSG in patients with SIT can be performed safely and in comparable conditions than in normal anatomy patients.
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Department of General and Hepatobiliary Surgery, Henri Mondor University Hospital, Créteil Cedex, France, laurent.genser@gmail.com.
authors.forename: Laurent
authors.initials: L
authors.lastname: Genser
authors.forename: Claude
authors.initials: C
authors.lastname: Tayar
authors.forename: Imad Kamal
authors.initials: IK
authors.lastname: Eddine
mesh_terms: D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007619:Kartagener Syndrome / Q000150:complications*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D012857:Situs Inversus / Q000150:complications; D014472:Umbilicus / Q000601:surgery