Performing multiple laparoscopic procedures simultaneously, such as cholecystectomy, sterilization, and appendectomy, in the same patient has become increasingly feasible due to advances in minimally invasive surgery. This approach offers several advantages, including reduced overall operative time, faster recovery, minimal postoperative pain, and a single anesthesia exposure. However, careful patient selection, meticulous surgical planning, and adherence to sterilization protocols are crucial to ensure safety and optimal outcomes.

Indications and Patient Selection

The ideal candidate for combined laparoscopic procedures is a patient with symptomatic gallstones, who desires permanent sterilization, and has either a history of appendicular issues or incidental appendicular pathology detected during preoperative evaluation. Patients should have no contraindications to general anesthesia, laparoscopic surgery, or pneumoperitoneum, such as severe cardiopulmonary disease or uncontrolled coagulopathy. Preoperative evaluation includes a thorough history, physical examination, laboratory investigations, and imaging studies like ultrasound of the abdomen to assess the gallbladder, appendix, and reproductive organs. Counseling the patient about the benefits, risks, and potential complications of combined procedures is essential, and informed consent must be obtained.

Surgical Preparation and Sterilization Protocols

Proper preparation for multiple procedures begins in the operating room with strict adherence to aseptic techniques. Laparoscopic instruments are sterilized using autoclaving or other validated sterilization methods to ensure complete elimination of microorganisms, including spores. The patient is placed under general anesthesia, and the abdomen is prepped and draped following standard surgical protocols. A prophylactic antibiotic may be administered to reduce the risk of postoperative infections.

Port Placement and Access

A standard laparoscopic cholecystectomy typically requires four ports: an umbilical port for the camera, epigastric port for the surgeon’s right hand, and two lateral ports for retracting and dissecting instruments. For sterilization, usually a tubal ligation or salpingectomy is performed through the same laparoscopic access with minor adjustments in port manipulation. An appendectomy can also be performed using the same port sites, although sometimes an additional port is required for optimal visualization and dissection. Using a single set of ports efficiently reduces additional trauma and minimizes postoperative pain.

Laparoscopic Cholecystectomy

The first step involves performing the laparoscopic cholecystectomy. The gallbladder is mobilized using standard techniques, and careful dissection of Calot’s triangle is performed to identify the cystic duct and artery. These structures are clipped and divided safely to avoid injury to the common bile duct. The gallbladder is then separated from the liver bed using electrocautery and extracted through the umbilical port in a retrieval bag to prevent spillage of bile or stones into the peritoneal cavity.

Laparoscopic Sterilization

After cholecystectomy, attention is turned to sterilization. Depending on the patient’s preference and surgical feasibility, either bilateral tubal ligation or salpingectomy is performed. The fallopian tubes are identified and securely occluded using clips, rings, or cautery. Care is taken to maintain strict asepsis during this portion of the procedure to prevent any contamination from bile or appendicular contents.

Laparoscopic Appendectomy

Finally, the appendix is addressed. The cecum and appendix are visualized, and the mesoappendix is carefully dissected to control the appendicular artery. The appendix is then ligated at its base and removed through the existing port, preferably in a retrieval bag to prevent contamination. In cases of appendicitis with minimal contamination, this combined approach avoids the need for a separate surgery and promotes faster recovery.

Advantages of Combined Procedures

Performing these procedures together provides several benefits. Patients undergo a single anesthesia event, resulting in reduced perioperative risks. Hospital stay and overall healthcare costs are minimized. Recovery time is shortened, and patients can return to normal activities sooner compared to undergoing separate surgeries. Furthermore, combining procedures can be psychologically advantageous, as patients address multiple health concerns simultaneously.

Postoperative Care

Postoperatively, patients are monitored for pain, signs of infection, or complications such as bile leak, bleeding, or injury to adjacent organs. Early ambulation and oral intake are encouraged. Pain management typically involves oral analgesics, and most patients can be discharged within 24–48 hours, depending on their clinical status. Follow-up includes wound inspection, evaluation of recovery, and counseling on long-term care after sterilization.

Conclusion
Laparoscopic cholecystectomy, sterilization, and appendectomy in the same patient are safe and effective when performed by experienced surgeons with strict adherence to sterilization protocols and careful patient selection. This combined approach offers significant benefits in terms of recovery, cost, and patient convenience while maintaining the safety and efficacy of each individual procedure. With meticulous planning and surgical expertise, these simultaneous laparoscopic interventions can provide excellent clinical outcomes and improved patient satisfaction.