# Intraoperative Diagnosis of Situs Inversus Totalis in Laparoscopic Cholecystectomy: Taking Into Consideration Patient-Centered Care in a Limited-Resource Case

## TL;DR

This paper discusses the intraoperative diagnosis and management of a rare condition during a routine surgical procedure, emphasizing the importance of adaptability and accurate diagnosis for patient safety.

## Contribution

The paper highlights the challenges and considerations in performing laparoscopic cholecystectomy in a patient with situs inversus totalis.

## Key findings

- Situs inversus was confirmed intraoperatively during a scheduled laparoscopic cholecystectomy.
- Trocar placement was adjusted to the left side to accommodate the mirrored anatomy.
- Accurate preoperative diagnosis is essential for safe surgical planning in such cases.

## Abstract

Situs inversus (SI) is a rare congenital disorder in which the abdominal and thoracic organs create a mirror image orientation of their typical anatomical positions. In this article, we present the case of a 49-year-old female individual who underwent a scheduled laparoscopic cholecystectomy (LC) due to postprandial colic pain in the epigastrium. A prior ultrasound examination, conducted a year earlier, revealed the presence of small gallstones within the gallbladder, and a follow-up preoperative ultrasound suggested the possibility of SI, though the diagnosis was ruled out by a third ultrasound. Standard LC was commenced with umbilical trocar placement; however, SI was confirmed, and trocar placement was mirrored to the left side. Accurate preoperative diagnosis is crucial for surgical planning and to ensure patient safety. Performing an LC on a patient with SI poses unique challenges and requires heightened surgical skills and adaptability by the operating surgeon with extensive anatomical knowledge to mitigate risks and optimize patient outcomes.