LAP. CHOLE IN SITUS INVERSUS TOTALIS

1. LAP. CHOLE IN
SITUS INVERSUS
TOTALIS
DR. ASHOK DHONDE,
MS; FMAS.; FIAGES
DR.VILAS JOSHI
MS; FMAS.; FIAGES
DHONDE HOSPITAL, SANGLI[MS]
LAPAROSCOPIC SURGERY CENTRE.

2. AIMS AND OBEJECTIVES
 To study the presentation of cholelithiasis in S.I.
Totalis
 To study the re-orientation of ports and modification
of O.R. Set-up.
 To highlight the modification in operative technique.

3. CASE HISTORY
 45 Y, F – [L] Upper Quadrant Pain -1 M.
 No H/O Nausea, Vomiting, Jaundice
 Past H/O hysterectomy
 O/E Vitals-[N]. Apex beat in [R] 5th I.C.S.
 P/A- Tenderness in [L] H.C. area.

4. INVESTIGATIONS
 Blood-[N]
 CXR[PA]
 ECG

5. INVESTIGATIONS
 U S G.

6. OPERATING ROOM
 RE-ARRANGEMENT

7. VDO -SURGERY

8. DISCUSSION
 Extremely rare with mirror image anatomy.
 Crossing of hand [ to hold the dissector with [Rt.]
hand and grasper with [Lt.] hand done.
 Skeletonsing calot’s took more time.
 Took 1.5 h. completed successfully.
 Easy for [Lt.] handed surgeons.
 Difficulty encountered - puncture of G.B wall.

9. CONCLUSION
 Unusual orientation – requires mental adaptability
and manual dexterity.
 Crossing of hand may increase chances of biliary
system injury due to coupling of current – not
advisable.
 Modification of surgical technique is reqd. to
comfortably and safely carry out the procedure.