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Cited 6 time in webofscience Cited 6 time in scopus
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Robot-assisted Low Anterior Resection for Situs Inversus Totalis: A Novel Technical Approach for an Uncommon Condition

Authors
Leong, Quor MengSon, Dong-NyungCho, Jae-SungAmar, Azali Hafiz-YazeeKim, Seon-Hahn
Issue Date
Apr-2012
Publisher
LIPPINCOTT WILLIAMS & WILKINS
Keywords
robot-assisted low anterior resection; rectal cancer; situs inversus totalis
Citation
SURGICAL LAPAROSCOPY ENDOSCOPY & PERCUTANEOUS TECHNIQUES, v.22, no.2, pp E87 - E90
Indexed
SCI
SCIE
SCOPUS
Journal Title
SURGICAL LAPAROSCOPY ENDOSCOPY & PERCUTANEOUS TECHNIQUES
Volume
22
Number
2
Start Page
E87
End Page
E90
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/12230
DOI
10.1097/SLE.0b013e3182447ebc
ISSN
1530-4515
1534-4908
Abstract
Introduction: Situs inversus totalis (SIT) is an uncommon condition, with an incidence of 1 in 10,000. Surgery for SIT patients is more difficult because of the uncommon anatomy. Experience in laparoscopic surgery for patients with SIT is very limited. Only a few cases of laparoscopic colorectal resections have been reported in the literature. We present the first robot-assisted low anterior resection for rectal cancer in a patient with SIT. Patient: A 70-year-old woman with SIT who presented with rectal bleeding underwent a colonoscopy and barium enema. This workup revealed a rectal cancer 10 cm from the anal verge. The magnetic resonance imaging scan revealed a T3/4 tumor in the rectum with perirectal lymph node involvement, whereas the computed tomography positron emission tomography scan did not reveal any distal metastasis. She underwent neoadjuvant chemoradiotherapy 6 weeks before surgery. Postoperatively, she made an uneventful recovery and was discharged on day 6. Surgical Technique: After laparoscopic examination and displacement of the small bowel, 4 robot trocars were inserted into 4 quadrants of the abdomen. A fifth port was inserted and used by the assistant. The robot cart was docked from the right side with arms 1, 2, and 3 in the right upper quadrant (Cadiere grasper), left lower quadrant (bipolar Maryland grasper), and left upper quadrant (monopolar scissors), respectively, for colonic mobilization without splenic flexure takedown. For pelvic dissection, arms 1 and 3 were moved to the right upper quadrant and right lower quadrant, respectively. After adequate pelvic dissection, the robot cart was undocked, and a laparoscopic articulating linear stapler was used to transect the rectum from the left lower quadrant port. Bowel continuity was restored with a circular stapler. A loop ileostomy was created through the extraction site in the right lower quadrant. Conclusions: Robot-assisted low anterior resection for SIT patients can be performed safely and confers the benefits of laparoscopic low anterior resection with additional advantages unique to the da Vinci system.
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