CasE REpORT Total Laparoscopic Donor Nephrectomy In Situs Inversus Totalis: A Case Report Ibrahim Berber, Nazim Gures, Ercument Gurluler, Altan Alim, Ulkem Cakir, Alihan Gurkan Abstract Situs inversus totalis is a rare anomaly characterized by the total inversion of all abdominal and thoracic organs. For the first time, we report a case of a donor nephrectomy in a patient with situs inversus totalis, completed with a full laparoscopic approach. At the time of this writing, the donor and the recipient are doing well after 6 month’s follow-up. Our experience shows that patients with situs inversus totalis may be eligible candidates for laparoscopic donor nephrectomy, provided that detailed preoperative imaging studies as well as precise preoperative planning are performed before the transplant. Key words: Situs inversus, Laparoscopy, Donor Introduction Situs inversus totalis (SIT) is a rare congenital malformation characterized by transposition of organs to the opposite side of the body in a mirror image of the usual. 1 The term situs inversus is a short form of the Latin phrase situs inversus viscerum, meaning inverted position of the internal organs. Situs inversus is generally an autosomal recessive genetic condition, although it can be a cross-linked genetic disorder with an incidence of 1 in 10 000. 2 Fabricius, in 1600, reported the first case of situs inversus in humans. Since Aristotle’s time, this condition of abnormal visceral rotation has been known in animals. 3 It describes an anatomy that is a perfect mirror image of the usual physiologic positions of the visceral organs with preservation of anteroposterior relations. 4 Yet because this arrangement is a perfect mirror image, the relation between the organs is not changed, so functional problems rarely occur. Generally, patients with SIT are asymptomatic and have a normal life expectancy. 5 Situs inversus totalis may pose several technical difficulties during operative procedures, especially during laparoscopic operations. The mirror image of laparoscopic view creates unfamiliarity for the surgeon and his usual maneuvers. Additionally, all instrument designs are for right-handed surgeons. 6 We present the first reported case of laparoscopic donor nephrectomy via totally laparoscopic approach in a patient with SIT. Case Report A 37-year-old man was admitted for a voluntary kidney donation to his 38-year-old wife who had end-stage renal disease for 5 years. He had no history of hypertension, anemia, renal diseases, diabetes, or prior surgical operations. His body mass index was 29.7 kg/m 2 . During preoperative investigation, radiologic imaging studies showed the presence of complete SIT. The results of blood biochemistry and urine tests were in normal ranges with a preoperative creatinine level of 80.44 μmol/L. A chest radiograph showed no signs of active pulmonary disease (Figure 1). Grade 1 hepatosteatosis was the only abnormality detected in abdominal ultrasonography. Renal computed tomography-angiography demonstrated From the Acibadem University, International Hospital Organ Transplantation Center, Istanbul Cad. No:82 Yesilkoy 34149 Istanbul, Turkey Acknowledgements: Ibrahim Berber performed the operation and wrote the paper; Nazim Gures wrote the paper; Ercument Gurluler collected data; Altan Alim collected data; Ulkem Yakupoglu contributed important reagents; and Alihan Gurkan designed study. The authors have no conflicts of interest to declare. Corresponding author: Dr. Nazim Gures, International Hospital. Istanbul Cad. No:82, Yesilkoy 34149 Istanbul, Turkey Phone: +90 212 468 4238 Fax: +90 212 662 0795 E-mail: guresnazim@yahoo.com Experimental and Clinical Transplantation (2013) 2: 195-198 Copyright © Başkent University 2013 Printed in Turkey. All Rights Reserved. DOI: 10.6002/ect.2012.0098