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The advancements in minimal access surgery have enabled surgeons to perform multiple procedures through a single laparoscopic port, reducing trauma, improving cosmetic outcomes, and enhancing recovery. In select cases, laparoscopic cholecystectomy, appendectomy, and tubal ligation can be successfully performed using the same port, offering significant benefits to the patient.
Patient Selection Criteria
Not all patients are candidates for this approach. Ideal candidates include:
• Female patients of reproductive age who have completed their family.
• Patients presenting with symptomatic gallstones and chronic or recurrent appendicitis.
• Patients with a normal body mass index (BMI) and without extensive adhesions from prior surgeries.
Surgical Technique
Port Placement and Instrumentation
A supraumbilical or transumbilical incision is made for the single-port access. A specialized single-incision laparoscopic surgery (SILS) port or a conventional multiport trocar arrangement can be used. The working instruments (5 mm) and the laparoscope are inserted through this access point.
1. Laparoscopic Cholecystectomy:
• Standard dissection of the Calot’s triangle is performed using a harmonic scalpel or LigaSure.
• The cystic duct and artery are clipped and divided.
• The gallbladder is dissected from the liver bed and extracted through the port site.
2. Laparoscopic Appendectomy:
• The appendix is identified and mobilized.
• The mesoappendix is coagulated and divided.
• The base of the appendix is ligated with an endoloop and excised.
• The specimen is removed via the same port.
3. Laparoscopic Tubal Ligation:
• The fallopian tubes are grasped and coagulated at the mid-segment using bipolar diathermy or Filshie clips.
• Both tubes are occluded to ensure permanent sterilization.
Postoperative Advantages
• Single incision results in minimal scarring.
• Reduced postoperative pain compared to multiple-port techniques.
• Shorter hospital stay and faster recovery.
• Cost-effectiveness by combining procedures in a single surgical session.
Challenges and Limitations
• Requires expertise in single-port laparoscopic surgery.
• Instrument crowding can make dissection challenging.
• Not suitable for patients with severe intra-abdominal adhesions.
Conclusion
Performing laparoscopic cholecystectomy, appendectomy, and tubal ligation through a single port is a feasible and effective approach in selected patients. It optimizes surgical outcomes, enhances patient recovery, and reflects the growing trend toward scarless and minimally invasive surgery. With proper patient selection and surgeon expertise, this technique can be a valuable addition to the armamentarium of laparoscopic procedures.
