Laparoscopic mesohepatectomy with situs inversus totalis: A case report

ABSTRACT: Situs inversus totalis (SIT) is a rare congenital anomaly characterised by a mirror-image transposition of intra-abdominal and intrathoracic organs. SIT renders surgical procedures more complicated, but few studies have described laparoscopic surgery for hepatocellular carcinoma (HCC) in such patients, especially the resection of centralised HCC involving intrahepatic vessels. In this report, we present the case of a 55-year-old male who experienced recurring pain in the right upper abdomen. Radiological investigations unveiled intriguing inversions of thoracoabdominal organs and the presence of a centrally located liver tumour, measuring 5 cm × 7 cm × 6 cm. The patient underwent laparoscopic mesohepatectomy (LMH) treatment, leading to the successful resection of the tumour. Subsequent follow-ups showed no signs of recurrence. Our article delves into a comprehensive analysis of the surgical approach employed, alongside an exploration of the anatomical abnormalities associated with SIT. Furthermore, we review similar literature to summarise the challenges and risks of LMH and share experiences and methods aimed at reducing the difficulty of the procedure. LMH can be considered as a feasible and effective surgical alternative to centralised HCC in patients with SIT if appropriate imaging techniques and careful perioperative strategies are employed.