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

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.