Article Data

  • Views 771
  • Dowloads 118

Case Reports

Open Access Special Issue

Robotic hysterectomy with pelvic lymphadenectomy for early endometrial cancer in a patient with situs inversus totalis using 3D-CT analysis: a case report

  • Hideaki Yajima1,2
  • Eiji Kondo1,*,
  • Masafumi Nii1
  • Michiko Kaneda1
  • Kenta Yoshida1
  • Tomoaki Ikeda1

1Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, 2-174 Edobashi, Tsu City, 514-8507 Mie, Japan

2Department of Obstetrics and Gynecology, Mie-chuo, Medical Center Hisaimyoujinchou, Tsu City, 2158-5, 514-1101 Mie, Japan

DOI: 10.31083/j.ejgo.2021.01.2294 Vol.42,Issue 1,February 2021 pp.189-192

Submitted: 02 October 2020 Accepted: 28 December 2020

Published: 15 February 2021

(This article belongs to the Special Issue Minimally Invasive Surgery in Gynecologic Oncology)

*Corresponding Author(s): Eiji Kondo E-mail:


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.


Situs inversus totalis; Robotic hysterectomy; Pelvic lymphadenectomy; Early endometrial cancer

Cite and Share

Hideaki Yajima,Eiji Kondo,Masafumi Nii,Michiko Kaneda,Kenta Yoshida,Tomoaki Ikeda. Robotic hysterectomy with pelvic lymphadenectomy for early endometrial cancer in a patient with situs inversus totalis using 3D-CT analysis: a case report. European Journal of Gynaecological Oncology. 2021. 42(1);189-192.


[1] Mayo CW. Situs inversus totalis. Archives of Surgery. 1949; 58: 724.

[2] Varano NR, Merklin RJ. Situs inversus: review of the literature, report of four cases and analysis of the clinical implications. The Journal of the International College of Surgeons. 1960; 33: 131-148.

[3] Cao Y, Li J, Shen L, Wang J, Xia Z, Tao K, et al. Gastric cancer in a situs inversus totalis patient with multiple intestinal and vessel variations related to gastrectomy surgery. Medicine. 2017; 96: e8209.

[4] Dai H, Wang Z, Feng X, Wang G, Li W, Hang C, et al. Case report about a successful full robotic radical gastric cancer surgery with intracorporeal robotsewn anastomosis in a patient with situs inversus totalis and a two-and-a-half-year follow-up study. World Journal of Surgical Oncology. 2018; 16: 41.

[5] Atwez A, Keilani Z. Laparoscopic Roux-en-Y gastric bypass in a patient with situs inversus totalis: case report, technical tips and review of the literature. International Journal of Surgery Case Reports. 2018; 45: 56-62.

[6] Yaegashi M, Kimura T, Sakamoto T, Sato T, Kawasaki Y, Otsuka K, et al. Laparoscopic sigmoidectomy for a patient with situs in-versus totalis: effect of changing operator position. International Surgery. 2015; 100: 638-642.

[7] Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, et al. ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Annals of Oncology. 2016; 27: 16-41.

[8] Park DA, Lee DH, Kim SW, Lee SH. Comparative safety and effectiveness of robot-assisted laparoscopic hysterectomy versus conventional laparoscopy and laparotomy for endometrial cancer: a systematic review and meta-analysis. European Journal of Surgical Oncology. 2016; 42: 1303-1314.

[9] Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO, et al. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecologic Oncology. 2008; 109: 11-18.

[10] Gilani S, Anderson I, Fathallah L, Mazzara P. Factors predicting nodal metastasis in endometrial cancer. Archives of Gynecology and Obstetrics. 2014; 290: 1187-1193.

[11] Kim T, Yoon G, Lee Y, Choi CH, Lee J, Bae D, et al. Robotic high paraaortic lymph node dissection with high port placement using same port for pelvic surgery in gynecologic cancer patients. Journal of Gynecologic Oncology. 2015; 26: 222-226.

[12] Cui B, Lei S, Liu K, Yao H. Robotic low anterior resection plus transanal natural orifice specimen extraction in a patient with situs inversus totalis. BMC Surgery. 2018; 18: 64.

[13] Mäenpää MM, Nieminen K, Tomá s EI, Laurila M, Luukkaala TH, Mäenpää JU. Robotic-assisted vs traditional laparoscopic surgery for endometrial cancer: a randomized controlled trial. American Journal of Obstetrics and Gynecology. 2016; 215: 588.e1-588.e7.

[14] Westhofen S, Conradi L, Deuse T, Detter C, Vettorazzi E, Treede H, et al. A matched pairs analysis of non-rib-spreading, fully endoscopic, mini-incision technique versus conventional mini-thoracotomy for mitral valve repair. European Journal of Cardio-Thoracic Surgery. 2016; 50: 1181-1187.

[15] Ustunyurt E, Cift T. Staging laparotomy for endometrial cancer in a patient with situs inversus totalis: a case report. Oncology Letters. 2014; 8: 1765-1767.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time