The right-handed surgeon might experience technical difficulties while performing the laparoscopic cholecystectomy in situs inversus totalis patients. The difficulty might be due to a) difficult adhesiolysis with the non-dominant hand, b) constant mental orientation of the anatomy c) crossover of the hands while dissecting the calot’s triangle [12-16]. Dissection of the calot’s triangle would be easier for a left-handed surgeon than a right-handed surgeon [17-20].

Many techniques are described to decrease the difficulty, like the four-port technique, the French position of the operating surgeon, frequent changes in instruments between two arms, retracting infundibulum through the sub-xiphoid port, and port relocation [21-26]. These techniques, even though useful, could not prevent crossover of the arms leading to an abnormal posture for the surgeon.

To avoid difficult dissection, two surgeon’s techniques can be followed, where the primary and the first assistant use the dominant right hand [6,25,27,28]. However, the problem with this technique is it requires good coordination among the operating surgeons, preventing abnormal posture for the operating surgeon [29]. In this technique, the primary surgeon dissects the calot’s triangle with his dominant hand while the infundibulum is retracted by the first assistant and the fundus by the third assistant [30-32]. The first assistant carries out posterior dissection while the operating surgeon retracts the infundibulum. Dissection by the left hand from the sub-xiphoid port makes the instrument lose its perpendicular and narrow angles, making dissection difficult [32]. However, this problem can be overcome by doing anterior dissection alone from the dominant right hand of the right-handed surgeon and posterior dissection by the first assistant through the mid-clavicular port [33]. Advantages of this technique include using the dominant hand by the surgeons, preventing abnormal postures when the surgeon is standing to the patient's left, and simplifying the procedure ergonomically. Bile duct injuries following laparoscopic cholecystectomy have been rarely reported and can be prevented using similar techniques described when the gall bladder is on the right side [34,35].