This video demonstrates Laparoscopic Myomectomy for Large Fibroid Uterus and Cholecystectomy in the same patient by Three Port. With advancements in minimal access surgery, combined laparoscopic procedures are now being performed for treating coexisting abdominal pathologies at the same surgery. In our center, we performed 245 combined surgical procedures from January 2001to December 2020. The combination included laparoscopic cholecystectomy, various hernia repairs, and gynecological procedures like hysterectomy, salpingectomy, ovarian cystectomy, tubal ligation, urological procedures, fundoplication, splenectomy. The most common procedure was laparoscopic cholecystectomy with another endoscopic procedure. As long as the basic surgical principles and indications for combined procedures are adhered to, more patients with concomitant pathologies can enjoy the benefit of minimal access surgery. Minimal access surgery is feasible and appears to have several advantages in the simultaneous management of two different coexisting pathologies without significant addition in postoperative morbidity and hospital stay.

Minimally invasive surgery has revolutionized modern surgical practice by allowing complex procedures to be performed with minimal trauma, faster recovery, and better cosmetic outcomes. At advanced centers such as World Laparoscopy Hospital, surgeons increasingly perform combined procedures safely in selected patients. One such advanced approach is performing laparoscopic myomectomy for large fibroid uterus along with laparoscopic cholecystectomy using a three-port technique in the same surgical sitting. This combined minimally invasive strategy reduces overall hospital stay, anesthesia exposure, and recovery time while maintaining excellent surgical outcomes.

Laparoscopic myomectomy is a fertility-preserving procedure used to remove uterine fibroids while preserving the uterus. Large fibroids can cause heavy menstrual bleeding, pelvic pressure, infertility, and chronic pelvic pain. Compared to open surgery, laparoscopic myomectomy offers advantages such as smaller incisions, less blood loss, reduced postoperative pain, and faster recovery. However, removal of large fibroids requires advanced laparoscopic skill because visualization, suturing, and bleeding control are technically demanding. Studies and clinical experience indicate that minimally invasive removal of fibroids can result in shorter hospital stay and quicker return to daily activities when performed by experienced surgeons. Patients undergoing laparoscopic procedures often benefit from reduced adhesion formation and faster healing compared to open surgery.

In cases of large fibroid uterus, preoperative planning is crucial. Proper imaging helps determine size, number, and location of fibroids. During surgery, vasopressin injection, advanced energy devices, and meticulous suturing techniques help reduce blood loss and maintain uterine integrity. The goal is complete removal of fibroids while ensuring strong uterine repair, which is especially important for future pregnancy outcomes.

Cholecystectomy, the surgical removal of the gallbladder, is one of the most commonly performed laparoscopic procedures. Traditionally, it is done using four ports. However, the three-port laparoscopic cholecystectomy technique has emerged as an effective alternative in experienced hands. Evidence suggests that three-port cholecystectomy is technically feasible and can provide benefits such as reduced postoperative pain, shorter hospital stay, and earlier return to routine activity compared to the conventional four-port method.

Further comparative studies have shown that three-port cholecystectomy can offer advantages including reduced analgesic requirement, early ambulation, and better cosmetic results, while maintaining safety similar to standard techniques. Some modified three-port techniques also demonstrate less postoperative pain and improved cosmetic satisfaction without increasing complication rates.

Performing laparoscopic myomectomy and three-port cholecystectomy in the same patient requires careful patient selection. The patient should be medically fit for longer anesthesia duration, and both pathologies should be suitable for minimally invasive surgery. The usual sequence is to perform the more complex procedure first, often the myomectomy, followed by cholecystectomy. This approach ensures optimal concentration and reduces contamination risk.

The advantages of combined surgery are significant. The patient undergoes anesthesia only once, which reduces anesthesia-related risks. Hospital stay is shortened, overall treatment cost may be reduced, and recovery is faster compared to two separate surgeries. Cosmetically, minimal scars are achieved because both procedures are done laparoscopically. Additionally, early mobilization reduces the risk of postoperative complications such as deep vein thrombosis.

However, combined laparoscopic procedures require highly trained surgeons, advanced instrumentation, and proper operative planning. Large fibroid myomectomy itself can be technically demanding, and when combined with another procedure, surgical expertise becomes even more important. Safety should always be prioritized, and conversion to open surgery should be considered if required.

At advanced laparoscopic training centers like World Laparoscopy Hospital, surgeons are trained in complex minimally invasive procedures, including combined surgeries. With modern laparoscopic technology and standardized surgical protocols, such procedures can be performed safely with excellent patient outcomes.

In conclusion, laparoscopic myomectomy for large fibroid uterus combined with three-port laparoscopic cholecystectomy represents an advanced minimally invasive surgical approach. When performed in experienced centers, it offers excellent clinical outcomes, faster recovery, reduced pain, and improved cosmetic results. This combined surgical strategy reflects the evolution of modern surgery toward safer, patient-friendly, and highly efficient treatment methods.

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