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.

Laparoscopic surgery has revolutionized gynecological and general surgical procedures by offering minimally invasive approaches that reduce postoperative pain, hospital stay, and recovery time. Performing multiple surgeries in the same session is becoming increasingly feasible with advances in laparoscopic techniques. One such approach is the simultaneous laparoscopic myomectomy for a large fibroid uterus and cholecystectomy using a three-port technique, which exemplifies efficiency and patient-centered care.

Patient Selection

Simultaneous procedures are considered in patients who require treatment for both large uterine fibroids and gallbladder pathology such as cholelithiasis or symptomatic gallstones. Ideal candidates should have:

Good overall health with no major comorbidities

Adequate anatomical feasibility for laparoscopic access

No severe adhesions or prior complex abdominal surgeries

Preoperative imaging with ultrasound or MRI is crucial for mapping the fibroid size, location, and gallbladder status.

Surgical Technique

Three-Port Laparoscopy is employed for both procedures, minimizing the number of incisions while maintaining optimal visualization and instrument maneuverability.

Patient Positioning:

Supine with slight Trendelenburg for pelvic access.

Reverse Trendelenburg may be used during gallbladder dissection.

Port Placement:

Umbilical port (10mm): Camera and primary access

Left lower abdominal port (5mm): Manipulation and dissection

Right lower abdominal port (5mm): Assistant port for instruments and suction

Laparoscopic Myomectomy:

Uterine fibroid is localized and excised using minimal electrocautery to preserve myometrial integrity.

Hemostasis is ensured with careful suturing of the myometrium.

Specimen retrieval is done via morcellation or mini-laparotomy, depending on fibroid size.

Laparoscopic Cholecystectomy:

After completing the myomectomy, the table is adjusted for gallbladder exposure.

Standard dissection of Calot’s triangle is performed, followed by clipping of the cystic duct and artery.

Gallbladder is removed through the umbilical port, minimizing additional incisions.

Advantages of Single-Session Surgery

Reduced total anesthesia exposure: One procedure under a single anesthesia instead of two separate operations.

Shorter total hospital stay: Patients recover faster with fewer interruptions to daily life.

Cost-effective: Reduces hospitalization and procedural costs.

Enhanced patient satisfaction: Less overall trauma and faster return to normal activities.

Challenges and Considerations

Requires an experienced laparoscopic surgeon comfortable with dual procedures.

Adequate planning for instrument handling and port placement is critical to avoid collisions.

Careful hemostasis during myomectomy is essential to prevent intraoperative bleeding, which could complicate the cholecystectomy.

Postoperative Care

Early mobilization and pain management are key to recovery.

Monitoring for signs of bleeding or infection at both surgical sites is essential.

Follow-up imaging may be done to assess uterine healing and gallbladder status.

Conclusion

Simultaneous laparoscopic myomectomy for large fibroid uterus and cholecystectomy via a three-port technique is a safe, effective, and patient-friendly approach in selected cases. It combines the benefits of minimally invasive surgery with the efficiency of treating two pathologies in a single session. With careful preoperative planning and surgical expertise, patients can experience excellent outcomes, minimal postoperative discomfort, and faster return to daily life.