This video demonstrate Laparoscopic Cholecystectomy with Laparoscopic Ovarian Drilling in same patient by Dr R K Mishra at World Laparoscopy Hospital. Laparoscopic ovarian drilling is a surgical treatment that can trigger ovulation in women who have polycystic ovary syndrome (PCOS).

Minimally invasive surgery has transformed modern surgical practice by enabling surgeons to treat multiple pathologies in a single operative session with faster recovery, less postoperative pain, and superior cosmetic results. At World Laparoscopy Hospital, advanced laparoscopic procedures such as laparoscopic cholecystectomy and laparoscopic ovarian drilling (LOD) are performed using evidence-based surgical techniques and standardized safety protocols. The combination of these procedures may be considered in selected patients who present simultaneously with gallbladder disease and polycystic ovarian syndrome (PCOS) requiring surgical intervention.

Laparoscopic surgery represents the gold standard approach for many abdominal and pelvic diseases. Laparoscopic cholecystectomy is widely accepted as the preferred treatment for symptomatic gallstone disease, while laparoscopic ovarian drilling is an established surgical option for ovulation induction in selected PCOS patients resistant to medical therapy.

Combining procedures during one anesthesia session can reduce hospital stay, anesthesia exposure, and overall cost, especially in high-volume laparoscopic centers such as World Laparoscopy Hospital where multidisciplinary minimally invasive expertise is available.

Laparoscopic Cholecystectomy: Overview

Laparoscopic cholecystectomy is performed for several gallbladder conditions including:

• Symptomatic gallstones

• Acute or chronic cholecystitis

• Gallstone pancreatitis

• Gallbladder polyps or biliary dyskinesia

The procedure involves creating pneumoperitoneum, placement of 3–4 ports, dissection of Calot’s triangle, achievement of the critical view of safety, clipping and division of the cystic duct and artery, and removal of the gallbladder. The laparoscopic approach offers faster recovery and better cosmetic results compared to open surgery.

Laparoscopic Ovarian Drilling: Overview

Laparoscopic ovarian drilling is primarily indicated in PCOS patients who fail ovulation induction with medications such as clomiphene citrate. Ideal candidates often have ovulatory resistance, elevated LH levels, and appropriate BMI selection.

The standard technique involves creating multiple punctures (typically 5–10) on each ovary using monopolar energy to reduce androgen-producing tissue and restore ovulatory cycles.

Clinical studies show that LOD can:

• Reduce testosterone and LH levels

• Improve menstrual regularity (reported up to ~82%)

• Improve ovulation and fertility outcomes

Other clinical data demonstrate improved menstrual regularity and measurable pregnancy rates following the procedure in selected PCOS patients.

Rationale for Combined Procedure

Performing laparoscopic cholecystectomy with ovarian drilling in one session may be beneficial when both pathologies coexist. Advantages include:

1. Single anesthesia exposure

2. Reduced hospital stay and cost

3. Faster overall recovery

4. Reduced psychological stress for patient

However, patient selection is critical, and procedures should only be combined when both surgeries are clearly indicated.

Step-by-Step Surgical Approach (Combined Procedure)

1. Preoperative Preparation

• Complete clinical evaluation

• Hormonal profile and ultrasound pelvis for PCOS

• Liver function tests and imaging for gallbladder disease

• Anesthesia fitness assessment

2. Patient Position and Port Placement

Ports are placed considering access to both upper abdomen and pelvis. Typically:

• Umbilical camera port

• Right upper quadrant ports for gallbladder surgery

• Additional pelvic working ports if required

3. Laparoscopic Cholecystectomy Phase

• Creation of pneumoperitoneum

• Gallbladder retraction

• Dissection of Calot’s triangle

• Achievement of critical view of safety

• Clipping and division of cystic duct and artery

• Gallbladder removal

4. Laparoscopic Ovarian Drilling Phase

• Pelvic inspection

• Identification of ovaries

• Controlled monopolar cautery punctures (5–10 per ovary)

• Hemostasis confirmation

5. Closure

• Port closure

• Recovery and postoperative monitoring

Postoperative Care

Patients usually experience rapid recovery after minimally invasive surgery. Postoperative care includes:

• Early ambulation

• Pain control

• Monitoring for bleeding or infection

• Fertility follow-up in PCOS patients

Clinical Outcomes and Evidence

LOD has shown favorable hormonal and reproductive outcomes in PCOS patients, including improved ovulation and reduction in androgen levels.

Similarly, laparoscopic cholecystectomy remains the standard surgical management for symptomatic gallbladder disease due to its safety and effectiveness.

Training and Expertise at World Laparoscopy Hospital

World Laparoscopy Hospital is internationally recognized for advanced laparoscopic training. Surgeons are trained in:

• Safe laparoscopic entry techniques

• Energy-based surgical precision

• Evidence-based surgical decision making

• Combined laparoscopic procedures

The hospital emphasizes patient safety, surgical ergonomics, and standardized protocols.

Conclusion

Laparoscopic cholecystectomy combined with laparoscopic ovarian drilling is a safe and effective surgical strategy in carefully selected patients suffering from both gallbladder disease and PCOS with ovulatory dysfunction. With advances in minimally invasive surgery and specialized training at World Laparoscopy Hospital, such combined procedures can be performed efficiently with excellent clinical outcomes, minimal complications, and rapid postoperative recovery.