Simultaneous Robot-Assisted Distal Gastrectomy and Radical Cystectomy With a Shared Port Configuration in Situs Inversus Totalis

Abstract

Introduction

Situs inversus totalis complicates minimally invasive surgery, and simultaneous robotic surgery for tumors of different organs is particularly challenging.

Case Presentation

A 72-year-old man with situs inversus totalis receiving androgen blockade for prostate cancer developed a 40-mm muscle-invasive bladder tumor undetected on magnetic resonance imaging 7 months earlier; synchronous gastric cancer was also diagnosed. After four chemotherapy cycles, robot-assisted distal gastrectomy and radical cystectomy with an ileal conduit were performed in one session, sharing four of eight ports and lasting 10 h 27 min. The bladder showed no residual carcinoma (ypT0N0) and the gastric cancer ypT2N3aM0; he died 27 months postoperatively.

Conclusion

Two major robotic resections were completed in one session, to our knowledge for the first time. Port sharing avoided a second set of incisions and a second port map, although the robot was undocked and redocked. The surgery was prolonged and followed by suspected non-occlusive mesenteric ischemia.