Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2022; 14(7): 1363-1371
Published online Jul 15, 2022. doi: 10.4251/wjgo.v14.i7.1363
Da Vinci robot-assisted pancreato-duodenectomy in a patient with situs inversus totalis: A case report and review of literature
Bai-Bei Li, Shi-Liu Lu, Xiang He, Biao Lei, Jian-Ni Yao, Si-Chen Feng, Shui-Ping Yu
Bai-Bei Li, Shi-Liu Lu, Xiang He, Biao Lei, Jian-Ni Yao, Si-Chen Feng, Shui-Ping Yu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Author contributions: Li BB and Lu SL reviewed the literature, designed the case report presentation, and wrote the manuscript; He X and Lei B participated in manuscript preparation, revision, patient investigation and treatment; Yao JN and Feng SC participated in patient investigation and treatment and provided the gross and pathology images; Yu SP designed the case report presentation and revised the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shui-Ping Yu, PhD, Doctor, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. 478517575@qq.com
Received: March 20, 2022
Peer-review started: March 20, 2022
First decision: April 17, 2022
Revised: April 30, 2022
Accepted: June 26, 2022
Article in press: June 26, 2022
Published online: July 15, 2022
Abstract
BACKGROUND

Situs inversus totalis (SIT) is an extremely rare congenital malformation characterized by mirror displacement of the thoracoabdominal organs such as the heart, liver, spleen, and stomach. Herein, we describe a patient with SIT complicated with cholangiocarcinoma who underwent successful pancreaticoduodenectomy with the assistance of a da Vinci robot.

CASE SUMMARY

A 58-year-old female presented to the hospital with paroxysmal pain in her left upper abdomen, accompanied by jaundice and staining of the sclera as chief complaints. Imaging examination detected a mass at the distal end of the common bile duct, with inverted thoracic and abdominal organs. Endoscopic retrograde cholangiopancreatography forceps biopsy revealed the presence of a well-differentiated adenocarcinoma. The patient successfully underwent robotic-assisted pancreaticoduodenectomy; the operation lasted 300 min, the intraoperative blood loss was 500 mL, and there were no intraoperative and postoperative complications.

CONCLUSION

SIT is not directly related to the formation of cholangiocarcinoma. Detailed preoperative imaging examination is conducive to disease diagnosis and also convenient for determining the feasibility of tumor resection. Robot-assisted pancreaticoduodenectomy for SIT complicated with cholangiocarcinoma provides a safe, feasible, minimally invasive, and complication-free alternative with adequate preoperative planning combined with meticulous intraoperative procedures.

Keywords: Situs inversus totalis, Cholangiocarcinoma, Da Vinci robot, Whipple, Surgery, Case report

Core Tip: Situs inversus totalis (SIT) is an extremely rare congenital malformation characterized by a mirror image displacement of the thoracoabdominal organs such as the heart, liver, spleen and stomach. SIT combined with choledochal cancer is even rarer, and da Vinci robot-assisted pancreaticoduodenectomy in patients with SIT combined with choledochal cancer has not been reported. This case demonstrates that preoperative thorough planning, intraoperative precise anatomical knowledge, effective teamwork, meticulous treatment, and postoperative care are feasible with the aid of the da Vinci robot for pancreaticoduodenectomy in patients with SIT.