The management of esophageal cancer with situs inversus totalis by simultaneous hand-assisted laparoscopic gastric mobilization and thoracoscopic esophagectomy

Situs inversus is a rare disorder. We present a case of esophageal cancer with situs inversus totalis, which was successfully managed by laparoscopic gastric mobilization and thoracoscopic esophagectomy. A 57-year-old man presented to our hospital with intermittent epigastric and retrosternal pains. X-ray and computed tomography demonstrated situs inversus totalis. Upper gastrointestinal endoscopy and barium swallow showed esophageal cancer of the lower thoracic esophagus. After neoadjuvant chemotherapy, he underwent surgical intervention. Under general anesthesia, laparoscopic gastric mobilization using hand-assisted laparoscopic surgery technique was performed. The locations of the port sites were all the mirror image of the regular fashion, and the right hand of the surgeon was inserted into the peritoneal cavity. Reconstruction of the digestive tract using a gastric tube via the retrosternal route was then achieved. Finally, thoracoscopic esophagectomy with the patient in the right decubitus position was successfully completed. Postoperative recovery was uneventful.