title: Thoracoscopic surgery in the prone position for esophageal cancer in patients with situs inversus totalis: A report of two cases.
abstract: BACKGROUND
  Situs inversus totalis (SIT) is a rare congenital condition characterized by a complete transposition of thoracic and abdominal organs. Here, we present two successful cases of left thoracoscopic esophagectomy in the prone position for SIT-associated esophageal cancer.
  
  
  METHODS
  Our first case was of an 82-year-old man who underwent a left thoracoscopic esophagectomy in the prone position, followed by hand-assisted laparoscopic gastric mobilization. Surgical duration and blood loss were 661min and 165g, respectively. His postoperative course was uneventful. The second case was of a 66-year-old man who underwent a left thoracoscopic esophagectomy in the prone position, followed by gastric mobilization via laparotomy owing to a concomitant intestinal malrotation and polysplenia. Surgical duration and blood loss were 637min and 220g, respectively. We trained for the surgical procedures preoperatively using left-inverted and right-inverted thoracoscopic surgical videos of patients with normal anatomy.
  
  
  CONCLUSIONS
  Surgical procedures in SIT patients are challenging owing to their mirrored anatomy. Recognition　of their　variations　is　thus important to　avoid　intraoperative accidental injuries. Left-inverted and right-inverted thoracoscopic surgical videos of patients with normal anatomy were found to be useful for image training prior to the actual surgery.
  
  
  CONCLUSIONS
  Thoracoscopic surgical treatment for esophageal cancer associated with SIT in the prone position can be performed safely, similar to the manner performed for thoracoscopic surgery in the right decubitus position, or surgery via an open thoracotomy. Gastric mobilization via laparotomy should be considered in patients associated other anatomic variations.
authors.affiliation: Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan. Electronic address: torun@med.tohoku.ac.jp.
authors.forename: Toru
authors.initials: T
authors.lastname: Nakano
authors.affiliation: Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kamei
authors.affiliation: Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Onodera
authors.affiliation: Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Ujiie
authors.affiliation: Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Ohuchi
keywords: Intestinal malrotation; Laparoscopy; Polysplenia; Thoracoscopy; Video