Introduction: Situs inversus totalis (SIT) is the sagittal inversion of thoracoabdominal organs, affecting less than 0.01% of the population (1). Patients with SIT can complicate acute abdominal presentations with misleading diagnosis and require more technical spatial awareness to carry out surgery effectively (2). In the case of acute calculus cholecystitis, we aim to describe our surgical approach and experiences to trouble shoot the technical demands, analogous to reversing a trailer. Case Description: 49-year-old female with a body mass index (BMI) of 44 presents with 5 days of severe left upper quadrant pain, CRP 450 and a computed tomography (CT) confirming acute calculus cholecystitis SIT. Laparoscopic cholecystectomy (LC) with intra-operative cholangiography (IOC) was performed successfully. Discussion: LC in severe cholecystitis is inherently challenging; SIT introduces an additional layer of complexity, making pre-operative planning essential. There are several surgical approaches described but we simplified our approach to mirror the anatomy; sagittal inversion of port placement, surgeon, assistant, nurse and monitor. Despite recurrent spatial disorientation, safe dissection of the hepatocystic triangle was achieved through frequent anatomical verification, aided by IOC, given higher incidence aberrant biliary anatomy in SIT (1). Conclusions: SIT combined with acute calculus cholecystitis is rare, and technical guidance remains limited. Success hinges on meticulous planning, spatial awareness, patience and adaptability – much like reversing a trailer.