Robotic-Assisted Sigmoidectomy with D3 Lymphadenectomy for Sigmoid Colon Cancer in a Patient with Situs Inversus Totalis: A Case Report

TL;DR

A robotic-assisted surgery successfully treated sigmoid colon cancer in a patient with mirrored organ positions, showing the procedure's effectiveness in rare anatomical cases.

Contribution

Demonstrates robotic-assisted colectomy as a feasible and advantageous approach for patients with situs inversus totalis.

Findings

Robotic-assisted sigmoidectomy with D3 lymphadenectomy was successfully performed in a patient with situs inversus totalis.

Patient-specific port configuration based on preoperative imaging minimized technical challenges and optimized instrument mobility.

The procedure was completed with minimal blood loss and no complications, supporting robotic surgery as a viable option for such rare cases.

Abstract

Situs inversus totalis (SIT) is a rare congenital anomaly characterized by complete mirror-image transposition of thoracic and abdominal organs. Although laparoscopic colectomy in SIT has been increasingly reported, the reversed anatomy and inherent limitations of laparoscopy make such procedures technically demanding. Robotic-assisted surgery may overcome these issues by providing enhanced ergonomics and intuitive instrument control, yet reports in SIT remain scarce.

A 51-year-old man with SIT presented with anal bleeding and was diagnosed with sigmoid colon cancer. Preoperative CT confirmed complete visceral inversion without distant metastasis. Robotic-assisted sigmoidectomy with D3 lymphadenectomy was performed using the da Vinci Xi surgical system. A patient-specific port configuration was designed based on preoperative imaging, minimized arm collisions, and optimized instrument mobility. The procedure was uneventful, with an operative time of 232 minutes and minimal blood loss. The patient was discharged on POD 7 without complications. Histopathological examination revealed pT3, pN1a, cM0, Stage IIIB adenocarcinoma.

This case demonstrates that robotic-assisted colectomy can effectively overcome the ergonomic and technical challenges posed by SIT. Patient-specific port mapping, guided by preoperative imaging, is essential to maximize the benefits of robotic technology. Furthermore, this report contributes to the limited evidence supporting robotic colectomy as a feasible and advantageous approach for patients with SIT.

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