IMR Press / EJGO / Volume 42 / Issue 1 / DOI: 10.31083/j.ejgo.2021.01.2294
Open Access Case Report
Robotic hysterectomy with pelvic lymphadenectomy for early endometrial cancer in a patient with situs inversus totalis using 3D-CT analysis: a case report
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1 Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, 2-174 Edobashi, Tsu City, 514-8507 Mie, Japan
2 Department of Obstetrics and Gynecology, Mie-chuo, Medical Center Hisaimyoujinchou, Tsu City, 2158-5, 514-1101 Mie, Japan
Eur. J. Gynaecol. Oncol. 2021 , 42(1), 189–192; https://doi.org/10.31083/j.ejgo.2021.01.2294
Submitted: 2 October 2020 | Revised: 16 December 2020 | Accepted: 28 December 2020 | Published: 15 February 2021
Abstract

Background: Pelvic lymphadenectomy should be considered the standard of care for endometrial cancer patients with intermediate-risk. In such cases, lymph node assessment may be performed via a minimally invasive approach. Situs inversus totalis is a congenital condition wherein the major visceral organs are reversed or mirrored from their normal anatomical positions. Reports state that performing surgery on patients with this condition is difficult due to the anatomical abnormality. However, few clinical studies have been conducted to evaluate the efficacy of robotic surgery for endometrial cancer patients with situs inversus totalis because it is technically challenging. Case presentation: A 69-year-old woman with situs inversus totalis (gravida 2 para 2) was brought to our hospital due to a uterine tumor. Endometrial biopsy showed grade 1 endometrioid carcinoma. Using 3 dimensional -computed tomography reconstruction, her common iliac arteries and veins were found to be reversed or mirrored from their normal positions. She underwent hysterectomy with pelvic lymphadenectomy using the multi-articulated arms or 3 dimensional high-definite vision of the da Vinci® surgical system, and 19 lymph nodes were harvested. She was followed up for 24 months without signs of recurrence. Conclusion: The multi-articulated arms or 3 dimensional high-definite vision of the da Vinci® surgical system may be a feasible and safe approach for performing a pelvic lymphadenectomy on patients with situs inversus totalis using 3 dimensional computed tomography analysis.

Keywords
Situs inversus totalis
Robotic hysterectomy
Pelvic lymphadenectomy
Early endometrial cancer
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