This video demonstrate Laparoscopic Hysterectomy and Cholecystectomy together with Removal of Gallbladder though Vagina. The average surgical time was 45 min for laparoscopic cholecystectomy and 15 min for hysterectomy and 30 min for hysterectomy. Total blood loss was approximately less than 50ml. Lesson for both, gynecologists and the surgeons, is to combine these two when required and possible. This provides maximum advantages through minimizing risk of anesthesia and time duration, hospital stay, cost-effectiveness.

Advances in minimally invasive surgery have revolutionized the way complex procedures are performed, allowing patients to undergo multiple surgeries simultaneously with reduced pain, quicker recovery, and minimal scarring. One such innovative approach is the combination of laparoscopic hysterectomy and cholecystectomy (gallbladder removal), with the added benefit of transvaginal extraction of the gallbladder.

What is Laparoscopic Hysterectomy?

Laparoscopic hysterectomy is a minimally invasive surgical procedure to remove the uterus. Instead of a large abdominal incision, small keyhole incisions are used to insert a camera (laparoscope) and specialized surgical instruments. This method offers:

• Faster recovery

• Less postoperative pain

• Minimal scarring

• Reduced risk of infection

What is Laparoscopic Cholecystectomy?

Laparoscopic cholecystectomy is the standard minimally invasive procedure to remove the gallbladder, usually due to gallstones or gallbladder disease. Small incisions are made in the abdomen to allow surgical instruments to remove the gallbladder safely.

Combining Both Procedures

In select patients, it is possible to perform a laparoscopic hysterectomy and cholecystectomy in a single surgery. This approach has several advantages:

• Single anesthesia session, reducing risks

• Shorter total hospital stay

• Reduced overall recovery time

• Less overall surgical trauma

Transvaginal Gallbladder Removal

One of the most innovative aspects of this combined procedure is removal of the gallbladder through the vagina, also known as Natural Orifice Transluminal Endoscopic Surgery (NOTES). This technique eliminates the need for a larger abdominal incision to extract the gallbladder, offering benefits such as:

• Completely scarless abdomen

• Reduced postoperative pain

• Faster return to normal activities

• Lower risk of wound-related complications

Step-by-Step Overview of the Procedure

1. Anesthesia and Positioning: The patient is placed under general anesthesia in a supine position.

2. Port Placement: Small laparoscopic ports are placed in the abdomen for hysterectomy and cholecystectomy instruments.

3. Hysterectomy: The uterus is carefully detached using laparoscopic instruments.

4. Cholecystectomy: The gallbladder is dissected from the liver using standard laparoscopic techniques.

5. Transvaginal Extraction: Both the uterus (if needed) and gallbladder are removed through the vaginal canal, avoiding additional abdominal incisions.

6. Closure and Recovery: Small port sites are closed, and the patient is monitored in recovery with faster mobilization compared to traditional open surgeries.

Who Can Benefit from This Procedure?

This combined approach is ideal for patients who require both hysterectomy and gallbladder removal and are medically fit for minimally invasive surgery. Preoperative evaluation, including imaging and lab tests, is essential to ensure safety.

Recovery and Outcomes

Patients typically experience:

• Minimal postoperative pain

• Rapid recovery, often resuming daily activities within 1–2 weeks

• Excellent cosmetic results with no visible scars

• Short hospital stay, sometimes same-day discharge depending on the case

Conclusion

The combination of laparoscopic hysterectomy and cholecystectomy with transvaginal gallbladder removal represents a significant advancement in minimally invasive surgery. By reducing surgical trauma, improving recovery, and achieving superior cosmetic outcomes, this approach demonstrates how modern surgical techniques are enhancing patient care and comfort.