Laparoscopy has transformed the field of minimally invasive surgery by allowing surgeons to treat multiple conditions during a single operative session. Among the combinations performed in selected cases, laparoscopic cholecystectomy with laparoscopic ovarian drilling (LOD) stands out as a procedure that addresses both gallbladder disease and polycystic ovarian syndrome (PCOS)-related infertility. This dual surgery provides the benefits of reduced anesthesia exposure, shorter hospital stay, quicker recovery, and improved cost-effectiveness, especially in women who require treatment for both conditions simultaneously.

Understanding the Procedures
Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is the gold-standard treatment for symptomatic gallstones and gallbladder disease. Through small abdominal incisions, a laparoscope and specialized instruments are introduced to visualize and remove the gallbladder. The procedure offers minimal postoperative pain, faster return to normal activities, and smaller scars compared to open surgery. Common indications include recurrent biliary colic, acute or chronic cholecystitis, gallbladder polyps, and gallstone pancreatitis.

Laparoscopic Ovarian Drilling (LOD)

LOD is a fertility-enhancing procedure performed in women with polycystic ovarian syndrome (PCOS) who fail to respond to first-line treatments like ovulation-inducing medications. During the procedure, a laparoscope is inserted into the abdomen, and small punctures are made in the thickened ovarian capsule using diathermy or laser energy. This reduces androgen production, restores normal hormonal balance, and induces ovulation. LOD is particularly beneficial for women resistant to clomiphene citrate, improving spontaneous conception rates without the risks of multiple pregnancies associated with gonadotropin therapy.

Why Combine the Procedures?

Certain women present with both symptomatic gallbladder disease and infertility due to PCOS. Performing laparoscopic cholecystectomy and ovarian drilling in the same sitting has several advantages:

Single anesthesia exposure – Reduces anesthesia-related risks, especially in young women of reproductive age.

Shorter hospital stay – A combined surgery prevents two separate admissions, saving time and resources.

Cost-effectiveness – Patients avoid expenses associated with separate operations and hospitalizations.

Enhanced recovery – The patient undergoes one healing period instead of two, minimizing disruption to personal and professional life.

Patient convenience – Women planning conception can promptly address infertility after treating gallbladder disease.

Surgical Technique
Anesthesia and Positioning

The patient is placed under general anesthesia and positioned in the supine position with a slight Trendelenburg tilt to facilitate pelvic access after gallbladder removal. Proper port placement is essential to allow smooth transition from cholecystectomy to ovarian drilling.

Laparoscopic Cholecystectomy

A standard four-port technique is used.

Pneumoperitoneum is created, and the laparoscope is introduced.

The gallbladder is retracted to expose Calot’s triangle.

The cystic duct and cystic artery are carefully dissected, clipped, and divided.

The gallbladder is separated from the liver bed using electrocautery and retrieved through the umbilical port.

Hemostasis is ensured before proceeding to the gynecological procedure.

Laparoscopic Ovarian Drilling

The uterus is manipulated to visualize the ovaries.

A monopolar needle or diathermy probe is applied to create 4–10 punctures on each ovary, avoiding excessive thermal damage.

Each puncture is approximately 4 mm deep and applied for 4 seconds at 40 watts of current.

Care is taken to preserve ovarian tissue and prevent adhesion formation.

Once drilling is completed, the pelvis is irrigated with saline to reduce postoperative adhesions.

Postoperative Care

Patients typically recover quickly after combined surgery. Key aspects include:

Pain management with NSAIDs or mild analgesics.

Early mobilization to reduce thromboembolic risks.

Diet progression from liquids to solids within 24 hours.

Fertility guidance – Patients are counseled regarding the expected improvement in ovulation and conception rates within 3–6 months after LOD.

Follow-up to monitor liver function, wound healing, and reproductive outcomes.

Benefits and Outcomes

Studies and clinical experience suggest that combining these procedures is safe and effective when performed by skilled surgeons. Reported benefits include:

Comparable complication rates to performing each surgery separately.

High patient satisfaction due to convenience and reduced recovery periods.

Significant improvement in menstrual regularity and ovulation after LOD.

Resolution of gallbladder-related symptoms with negligible recurrence.

For women with PCOS-related infertility, conception rates after LOD may reach 50–60% within a year, offering a promising alternative to prolonged medical therapy.

Risks and Considerations

Despite its advantages, combined laparoscopic surgery requires careful patient selection. Risks include:

General surgical risks – bleeding, infection, injury to surrounding structures.

Adhesion formation in the pelvis post-LOD.

Reduced ovarian reserve if excessive drilling is performed.

Longer operative time, which may increase anesthesia exposure in high-risk patients.

Therefore, a multidisciplinary team involving both general surgeons and gynecologists is essential for optimal outcomes.

Conclusion

Laparoscopic cholecystectomy with laparoscopic ovarian drilling represents an innovative, patient-centered approach for women suffering from gallbladder disease and infertility due to PCOS. By addressing two distinct pathologies in a single minimally invasive session, the procedure minimizes surgical trauma, lowers healthcare costs, and enhances patient satisfaction. With proper patient selection, meticulous surgical technique, and multidisciplinary collaboration, this combined approach is both safe and effective, marking another advancement in modern laparoscopic surgery.