Situs inversus totalis (SIT) is a rare anatomic anomaly, occurring once in every 3000-5000 births in Japan. A 72-year-old woman with SIT visited our hospital for the investigation of fecal occult blood. Colonoscopy revealed a type-2 tumor in the ascending colon, and the preoperative diagnosis based on the 8th UICC TNM classification was cT3N0M0 cStage IIA. We planned a laparoscopic right colectomy procedure with medial approach. The surgery was performed using five ports. The main surgeon stood between the patient's legs, while the assistants stood on the right side of the patient as opposed to the usual positioning where they stand on the left side. The operating time was 163 min. and the blood loss was 18 g. She was discharged on the 9th postoperative day, without postoperative complications. Histopathological examination revealed moderately differentiated adenocarcinoma, pT4bN0M0 pStage IIC. Preoperative assessment of the anatomical position and vascular malformations, using three-dimensional computed tomography, was essential for our safe surgical intervention. Furthermore, our co-axial technique and positioning the surgeon between the patient's legs enabled us to perform the procedure in the same way as a normal right-sided colectomy with a medial approach.