This video demonstrate Single-incision laparoscopic combined cholecystectomy and appendectomy appear to be a technically feasible alternative to the standard laparoscopic procedure in simultaneous management of coexisting benign gallbladder and appendix pathologies. Larger studies are required to confirm these findings.

Laparoscopic surgery has revolutionized modern surgical practice by allowing complex intra-abdominal procedures to be performed through small incisions with minimal trauma. One of the advanced applications of minimally invasive surgery is the simultaneous laparoscopic cholecystectomy and appendectomy performed through a single port, also known as single-incision or single-site combined laparoscopic surgery. This approach is increasingly being explored to manage patients presenting with coexisting gallbladder and appendix pathology in a single operative session.

Gallbladder diseases such as cholelithiasis and cholecystitis are among the most common abdominal surgical conditions, while appendicitis remains one of the most frequent surgical emergencies. Traditionally, these conditions are treated separately. However, with advancements in laparoscopic technology, it has become possible to remove both organs in the same sitting and, in selected cases, through a single umbilical port.

Studies show that performing laparoscopic cholecystectomy and appendectomy concurrently is feasible and can yield favorable outcomes in suitable patients, especially when both pathologies coexist.

Concept of Same-Port (Single-Incision) Surgery

Single-port laparoscopic surgery involves introducing a specialized port device through the umbilicus containing multiple channels for instruments and camera. This allows surgeons to operate inside the abdomen through one incision instead of multiple trocar sites.

Single-incision combined cholecystectomy and appendectomy has been shown to be technically achievable, with successful completion of surgeries without conversion to open procedures and with good cosmetic satisfaction among patients.

Indications

Combined same-port cholecystectomy and appendectomy may be considered in:

• Concurrent acute appendicitis and gallbladder disease

• Symptomatic gallstones with incidental appendiceal pathology

• Chronic gallbladder disease with planned appendectomy

• Selected incidental appendectomy during cholecystectomy

Earlier reports have also suggested that incidental appendectomy using the same laparoscopic incisions during cholecystectomy is technically possible and safe in selected patients.

Surgical Technique Overview

1. Patient Positioning

• Supine position

• Surgeon stands on patient’s left side

2. Port Placement

• Single multi-channel port placed through umbilicus

• Allows insertion of laparoscope and working instruments

3. Cholecystectomy Steps

• Exposure of Calot’s triangle

• Achievement of critical view of safety

• Clipping and division of cystic duct and artery

• Gallbladder dissection from liver bed

4. Appendectomy Steps

• Table tilt to access right iliac fossa

• Identification of appendix

• Mesoappendix division

• Base ligation and division

5. Specimen Retrieval

• Both organs retrieved via endobag through umbilical port

Single-incision combined procedures have demonstrated operative times ranging roughly from 30–120 minutes with minimal blood loss and early postoperative recovery.

Advantages of Same-Port Combined Surgery

1. Single Anesthesia Exposure
Reduces risk associated with multiple surgeries.

2. Single Hospital Admission
Decreases healthcare cost and hospital stay.

3. Faster Overall Recovery
Patients recover from both pathologies simultaneously.

4. Better Cosmetic Outcome
Only one hidden umbilical scar.

5. Reduced Overall Treatment Time
Avoids delay between two separate surgeries.

Combined laparoscopic procedures also allow patients to benefit from a single recovery period and absence from work.

Potential Risks and Challenges

Despite advantages, combined same-port surgery has limitations:

• Instrument crowding and loss of triangulation

• Longer operative time in difficult cases

• Risk of infection or adhesion formation

• Possibility of bile duct injury or bile leak

• Technical difficulty requiring advanced laparoscopic skill

Some large database analyses suggest combined procedures may show higher morbidity rates, though this may be influenced by patient selection and emergency presentations.

Patient Selection Criteria

Ideal candidates include:

• Hemodynamically stable patients

• Confirmed pathology in both organs

• Non-complicated inflammation

• Surgeon experienced in advanced laparoscopy

Careful selection is essential because performing two procedures increases operative complexity.

Clinical Outcomes

Available literature suggests:

• High technical success rate

• Low conversion rate to open surgery

• Good patient satisfaction

• Acceptable complication profile

Combined surgery is considered safe and effective in properly selected patients, though larger studies are still needed.

Future Perspectives

Advancements in:

• Articulating instruments

• High-definition 3D laparoscopy

• Robotic single-site surgery

are expected to further improve safety and feasibility of same-port combined procedures.

Conclusion

Laparoscopic cholecystectomy and appendectomy performed through the same port represents an evolution in minimally invasive surgery. It offers the benefits of single anesthesia exposure, shorter hospital stay, faster recovery, and superior cosmetic results. While technically demanding, it is a safe and feasible option in selected patients when performed by experienced laparoscopic surgeons. Future research and technological innovation will likely expand its indications and improve outcomes further.