Thoracoscopic Lung Lobectomy for a Lung Cancer Patient with Situs Inversus Totalis.

Situs inversus totalis is a rare clinical condition that represents a complete mirror image of the normal arrangement of the thoracic and abdominal viscera. There are very few reported cases of lung cancer patients with situs inversus totalis, but this condition requires particular care during surgery. A 61-year-old woman presented to our hospital with an abnormal shadow on chest radiography. Computed tomography revealed a 25×12 mm solitary pulmonary nodule in the left upper lobe (S2) and a complete mirror image of the normal organ arrangement, which findings met the criteria of situs inversus totalis. Preoperative examination revealed left upper lobe lung cancer (c-T1bN0M0 Stage IA), and surgery was planned for diagnosis and treatment. Before the surgery, three-dimensional CT images were reconstructed for a precise evaluation of the pulmonary vessels and bronchi. The nodule was microscopically diagnosed as adenocarcinoma from a frozen section obtained by wedge resection. We performed a left upper lobectomy with lymph node dissection using video-assisted thoracic surgery. The aortic arch was absent from the left thoracic cavity and the left lung was well lobulated into three lobes. Although it revealed a mirror image of the usual arrangement, we could accomplished in the usual procedure and process. Careful preoperative anatomical evaluation and perioperative handling are essential for the prevention of intraoperative injuries and complications in patients with situs inversus totalis.