Introduction

Advancements in minimally invasive surgery have enabled surgeons to safely perform multiple complex procedures during a single operative session. Combining laparoscopic myomectomy and laparoscopic cholecystectomy in one sitting offers significant benefits to selected patients by reducing anesthesia exposure, shortening hospital stay, minimizing postoperative pain, and accelerating recovery. This approach becomes particularly remarkable when treating a large fibroid uterus through only three laparoscopic ports while simultaneously addressing symptomatic gallbladder disease.

The successful management of both conditions in a single surgical intervention demonstrates the versatility and efficiency of advanced laparoscopic techniques and highlights the growing trend toward patient-centered, minimally invasive care.

Understanding the Clinical Scenario

Uterine fibroids, also known as leiomyomas, are the most common benign tumors affecting women of reproductive age. Large fibroids may cause symptoms such as:

• Heavy menstrual bleeding
• Pelvic pain and pressure
• Infertility
• Urinary frequency
• Abdominal distension

At the same time, gallstones can lead to recurrent biliary colic, nausea, dyspepsia, and episodes of acute cholecystitis. When both conditions coexist, patients traditionally undergo separate surgeries at different times, resulting in multiple hospital admissions and repeated recovery periods.

With modern laparoscopic expertise, both pathologies can be addressed simultaneously through a carefully planned surgical strategy.

Preoperative Evaluation

A thorough preoperative assessment is essential before undertaking combined procedures. Evaluation typically includes:

• Detailed gynecological examination
• Pelvic ultrasonography or MRI for fibroid mapping
• Abdominal ultrasonography for gallbladder pathology
• Complete blood count and coagulation profile
• Liver function tests
• Anesthetic fitness assessment

Careful patient selection plays a crucial role in ensuring safety and optimal outcomes.

Surgical Technique

Port Placement Strategy

The procedure is performed using a three-port laparoscopic approach, significantly reducing abdominal wall trauma compared to conventional multi-port surgery.

Typical port configuration includes:

1. Umbilical camera port
2. Left lower abdominal working port
3. Right lower abdominal working port

The same ports can be utilized efficiently for both gynecological and upper abdominal procedures with appropriate patient positioning and instrument handling.

Step 1: Laparoscopic Myomectomy

After establishing pneumoperitoneum, the pelvic cavity is inspected. The enlarged fibroid uterus is carefully evaluated.

Key surgical steps include:

• Injection of vasoconstrictive agents to minimize bleeding
• Serosal incision over the fibroid
• Careful enucleation of the fibroid
• Meticulous hemostasis
• Layered reconstruction of the uterine wall using intracorporeal suturing techniques

Despite the large size of the fibroid, advanced laparoscopic suturing allows precise restoration of uterine anatomy while preserving future fertility potential.

Step 2: Laparoscopic Cholecystectomy

Following completion of the myomectomy, patient positioning is modified to facilitate access to the upper abdomen.

The gallbladder is identified and dissected according to the principles of the Critical View of Safety.

The procedure includes:

• Dissection of Calot’s triangle
• Identification of cystic duct and cystic artery
• Secure clipping and division
• Separation of the gallbladder from the liver bed
• Retrieval of the specimen through one of the existing ports

The ability to complete both procedures through the same port sites represents a significant achievement in minimally invasive surgery.

Advantages of Combined Surgery

Reduced Exposure to Anesthesia

Performing two surgeries during one operative session eliminates the need for a second hospitalization and another exposure to general anesthesia.

Faster Recovery

Patients recover from both conditions simultaneously, reducing overall downtime and enabling a quicker return to normal activities.

Lower Healthcare Costs

A single admission, one operating room session, and one recovery period significantly decrease overall treatment expenses.

Improved Cosmetic Results

The three-port approach minimizes visible scars while maintaining excellent surgical outcomes.

Enhanced Patient Satisfaction

Patients appreciate avoiding multiple procedures, repeated investigations, and separate recovery periods.

Technical Challenges

Combined laparoscopic surgery for a large fibroid uterus and gallbladder disease is technically demanding.

Challenges may include:

• Limited working space due to enlarged uterus
• Increased operative complexity
• Requirement for advanced laparoscopic suturing skills
• Management of potential blood loss
• Coordination between gynecologic and general surgical principles

Therefore, such procedures should be undertaken by surgeons with extensive experience in advanced laparoscopic surgery.

Postoperative Care

Postoperative management includes:

• Early ambulation
• Pain control using multimodal analgesia
• Monitoring for bleeding and infection
• Gradual advancement of diet
• Follow-up assessment of wound healing

Most patients can be discharged within 24 to 48 hours, depending on individual recovery.

Clinical Outcomes

Studies and clinical experiences have demonstrated excellent outcomes following combined minimally invasive procedures. Benefits include:

• Reduced postoperative pain
• Minimal blood loss
• Short hospital stay
• Faster return to work
• Low complication rates
• High patient satisfaction

When performed by skilled laparoscopic surgeons, the procedure offers outcomes comparable to separate operations while providing significant additional advantages.

Conclusion

Three-port laparoscopic myomectomy for a large fibroid uterus combined with laparoscopic cholecystectomy in the same patient represents a remarkable advancement in minimally invasive surgery. This innovative approach demonstrates how modern laparoscopy can successfully address complex gynecological and general surgical conditions during a single operative session. By reducing surgical trauma, shortening recovery time, minimizing healthcare costs, and improving patient comfort, combined laparoscopic surgery continues to redefine the standards of contemporary surgical care and highlights the expanding possibilities of advanced minimally invasive techniques.