Description

Performing Total Laparoscopic Hysterectomy (TLH) and Laparoscopic Cholecystectomy in the same surgical setting is a rare but highly beneficial approach for selected patients who present with both gynecological and gallbladder pathology. This combined minimally invasive procedure offers significant clinical and economic advantages while minimizing surgical trauma. Why Combine the Procedures? Patients, especially women in their middle age, may often present with symptomatic uterine pathology such as fibroids, abnormal uterine bleeding, or adenomyosis, along with gallbladder diseases like cholelithiasis or chronic cholecystitis. Traditionally, these conditions would require two separate surgeries, leading to: Multiple hospital admissions Repeated anesthesia exposure Longer overall recovery period By performing both procedures together via laparoscopy, surgeons can achieve better patient outcomes with reduced healthcare burden. Surgical Approach Patient Positioning: The patient is placed in lithotomy position with adequate preparation for both pelvic and upper abdominal access. Port Placement: A modified port placement strategy is adopted so that the same trocars can be used efficiently for both hysterectomy and gallbladder removal. Sequence of Surgery: Many surgeons prefer completing the cholecystectomy first (as it involves the upper abdomen and may have the risk of spillage or contamination). The laparoscopic hysterectomy is then carried out, ensuring safe dissection of uterine vessels, adnexae, and vault closure. Specimen Retrieval: The gallbladder is retrieved via an endobag, while the uterus can be removed vaginally or morcellated, depending on the size. Advantages of Combined TLH and Cholecystectomy Single anesthesia and hospital stay Lower cost compared to two separate surgeries Faster recovery and shorter convalescence Cosmetic benefit with fewer incisions Psychological relief for the patient by resolving two surgical conditions at once Challenges and Considerations Longer operative time compared to a single procedure Requires a skilled surgical team experienced in both advanced gynecological and general laparoscopic surgery Proper patient selection is essential – patients should be fit for prolonged anesthesia and not have severe comorbidities Meticulous infection control is necessary to avoid cross-contamination between gallbladder and pelvic procedures Clinical Outcome Studies and case reports have shown that performing TLH with laparoscopic cholecystectomy in the same sitting is safe, feasible, and highly effective when done by experienced laparoscopic surgeons. With modern energy devices, advanced imaging, and multidisciplinary collaboration, this combined approach is gaining acceptance in specialized centers. Conclusion Total Laparoscopic Hysterectomy and Cholecystectomy together in the same patient represent the true spirit of minimally invasive surgery—treating multiple conditions with minimal trauma. For carefully selected patients, it reduces surgical risks, recovery time, and healthcare costs while ensuring optimal clinical outcomes. This combined procedure highlights the importance of multidisciplinary expertise and the continuous evolution of laparoscopic surgery in modern medicine.