The surgical treatment of disorders of the visceral organs in the abdominal cavity have evolved from traditional open surgery to laparoscopic surgery [
8] and in recent years to the new minimally invasive techniques of robotic surgery [
9]. The first published case of a situs inversus patient with gastric cancer, who had been treated with laparoscopy-assisted gastrectomy was in 2003 [
2]. Later, other case reports followed, [
3‐
6,
10] with most surgeons experiencing difficulties due to the abnormal position of the stomach. For example, Futawatari et al. [
10] noted that during surgery, the surgical field was difficult to see, and thus, confirmation of anatomy was impeded. Therefore, two monitors were used to show the left and right sides, which were shifted throughout the operation [
10]. Seo et al. reported that the first assistant had difficulties in the orientation of the entire anatomy, and the operators’ hand was confused [
5]; Min et al. noted that the first assistant is expected to do more, as some of the structures that are easily approached in normal patients are more conveniently accessed by the first assistant in patients with situs inversus totalis [
4]. In 2012, Kim et al. published a case report of a partly robot-assisted gastrectomy of a situs inversus patient, but the Billroth II gastrojejunostomy procedure was carried out extra corporally [
7]. There are only few case reports about situs inversus gastric cancer patient treatments in China, but all of the patients received open surgery [
11‐
13].
In gastric cancer surgery for mirror-image patients, a common problem is that the surgeon has to stand close to one side of the patient. The position has to be changed compared to the routine position adopted during the procedure, no matter if the intervention is open or laparoscopic surgery. However, when performing robotic surgery, neither the robotic system nor the surgeon’s position needs to be changed. The robotic system remains on the left side of the patient’s head for both normal and mirror-image patients. Moreover, the mechanical arms in the abdominal cavity are much more flexible with more dimensions of activity, and the sewing process is particularly fast compared with human hands. The dimensions of activity make it easier to remove lymph nodes located in the deep side of the abdomen or behind the viscera [
14]. A minor drawback of the robotic maneuver is the lack of tactile or haptic feedback during the procedure. In our hospital, robotic surgery for patients with gastric cancer usually takes about 2.5 h, with the mirror-image patient only taking another 30 min. Although our patient was weakened by a neo-adjuvant chemotherapy cycle, he was well enough to leave the hospital 5 days after the minimally invasive intervention.
In conclusion, a minimally invasive surgery completely performed with a Da Vinci surgical robot is a feasible, safe, and accurate method to treat a situs inversus totalis advanced gastric cancer patient who had previously received neo-adjuvant chemotherapy.