Rationale: Congenital thoracoabdominal visceral heterotaxy (CTVH) is a rare congenital anomaly characterized by complete reversal of thoracic and abdominal organ positions. This condition poses significant challenges in surgical planning due to altered anatomical landmarks, particularly in the Calot triangle region, which is critical for cholecystectomy. Laparoscopic surgery, particularly single-port laparoscopy combined with indocyanine green (ICG) fluorescence navigation, has emerged as a promising approach to address these anatomical complexities while offering the advantages of minimally invasive surgery and improved cosmesis. Patient concerns: A 67-year-old Asian Chinese male patient with a history of hypertension, type 2 diabetes mellitus, and cerebral infarction presented for management of gallbladder calculus. The patient had been aware of his CTVH since childhood, characterized by the liver being on the left side and the spleen on the right. Over the past 3 years, regular follow-up ultrasound examinations revealed progressive enlargement of gallbladder calculus, accompanied by intermittent episodes of upper abdominal pain and inflammatory symptoms. Diagnoses: The patient was diagnosed with gallbladder calculus based on ultrasound findings. Imaging also confirmed the presence of CTVH, with reversed thoracic and abdominal organ positions, further complicating surgical planning. Interventions: The patient underwent a single-port laparoscopic cholecystectomy with ICG fluorescence navigation. The fluorescence imaging provided enhanced visualization of the Calot triangle, enabling precise identification of the cystic duct and artery, thereby improving surgical safety and reducing the risk of complications. The single-port approach, utilizing a single small umbilical incision, minimized surgical trauma and ensured an aesthetic outcome. Outcomes: The surgical procedure was smoothly and successfully completed, with no notable postoperative adverse reactions observed during the patient’s hospital stay. Upon a one-week follow-up, the patient reported no postoperative complications. Lessons: This case demonstrates the successful combined application of single-port laparoscopic surgery and ICG fluorescence navigation to manage gallbladder calculus in a patient with CTVH. The fluorescence navigation enhanced safety by improving identification of critical structures, while the single-port approach provided a minimally invasive and cosmetically favorable option. This highlights the potential of advanced imaging and minimally invasive techniques in addressing complex congenital anomalies.
Liu et al. (Fri,) studied this question.