Description

Performing multiple laparoscopic procedures in a single surgical session is an advanced approach in minimally invasive surgery. Combining laparoscopic appendicectomy with total laparoscopic hysterectomy (TLH) in the same patient can be highly beneficial in selected cases, offering advantages in terms of recovery, hospital stay, and overall patient comfort. Indications This combined approach may be considered in patients who present with: Coexisting pathologies: For example, a patient with acute or chronic appendicitis and a symptomatic uterine condition such as fibroid, adenomyosis, or abnormal uterine bleeding. Incidental findings: During laparoscopic evaluation, an inflamed appendix may be detected alongside gynecological pathology requiring surgery. Desire for single-stage surgery: Minimizes repeated anesthesia exposure and hospital admissions. Preoperative Evaluation A thorough preoperative assessment is crucial: Clinical examination to evaluate abdominal and pelvic pathology. Imaging: Ultrasound, CT scan, or MRI as needed to confirm appendiceal inflammation and gynecological pathology. Laboratory tests: Complete blood count, coagulation profile, renal and liver function tests. Anesthetic assessment for suitability of prolonged laparoscopic procedure under general anesthesia. Surgical Technique 1. Patient Positioning: The patient is placed in a supine position with a slight Trendelenburg tilt for gynecologic access. Pneumoperitoneum is established using a Veress needle or Hasson technique. 2. Port Placement: Standard laparoscopic ports are placed to allow access to both the pelvic organs and the right lower quadrant. Typically, a 10 mm umbilical camera port and three 5 mm accessory ports are sufficient. 3. Laparoscopic Appendicectomy: The appendix is visualized, mobilized, and mesoappendix is divided using bipolar cautery or ultrasonic energy device. The appendix is ligated at its base and removed through the umbilical port in an endoscopic bag to prevent contamination. 4. Total Laparoscopic Hysterectomy (TLH): The procedure proceeds with mobilization of the uterus, ligation of the uterine vessels, and dissection of the bladder and adnexal structures if required. The uterus is detached from the vaginal vault laparoscopically and removed through the vagina or via morcellation if large. Vaginal cuff closure is performed laparoscopically. Advantages of Combined Surgery Single anesthesia exposure reduces risks associated with multiple operations. Shorter overall hospital stay and faster return to normal activity. Reduced cumulative surgical trauma compared to performing procedures separately. Cost-effective by combining operative and hospital resources. Challenges and Considerations Longer operative time: Requires surgical expertise and careful patient selection. Risk of infection: Proper technique and appendiceal specimen retrieval are critical to prevent pelvic contamination. Anesthesia management: Prolonged laparoscopy requires careful monitoring of ventilation and hemodynamics. Postoperative care: Early mobilization, pain management, and monitoring for complications such as infection or bleeding. Conclusion Performing laparoscopic appendicectomy and total laparoscopic hysterectomy in the same patient is a feasible and safe approach in carefully selected cases. With meticulous planning, advanced laparoscopic skills, and proper perioperative care, patients can benefit from the efficiency, reduced recovery time, and minimal invasiveness of a single combined procedure.