Robotic Assisted Distal Gastrectomy for Gastric Cancer in a Patient with Situs Inversus Totalis: with Video.

Situs inversus totalis (SIT) is a relatively rare condition where the abdominal and/or thoracic organ is positioned as a "mirror image" of the normal position. We are presenting a video of robotic distal gastrectomy performed in a 52-year-old female known to have SIT. Preoperative investigations revealed the patient has an early gastric cancer at the antrum. Ports were placed as mirror image to our usual port placement and upon exploration, the liver is visualized on the left side of the abdomen and the spleen is on the right. Lymph node dissection was performed in a similar approach to conventional robotic distal gastrectomy. After gastric resection, gastroduodenostomy was performed intracorporeally using a linear stapler. The operation took 195 min without intraoperative complications and minimal blood loss of 30 ml. The patient was discharged on postoperative day 5, uneventfully. The final pathology confirmed moderately differentiated adenocarcinoma confined to the mucosa without metastasis in 74 lymph nodes. Robotic distal gastrectomy can be safely performed in patients with situs inversus totalis and has similar surgical outcomes as usual robotic gastrectomy. Robotic technique can help surgeon's ambidexterity in performing such complex procedures.