1. How is traditional “open” surgery performed for multiple pathology.
2. What is “minimally invasive multiorgan surgery”?
3. A description of the minimally invasive surgery techniques available
4. The benefits and risks of mutiple minimally invasive surgery at the same time
5. The types of operations and diseases for which minimally invasive surgery is appropriate
6. Individual patient factors that must be considered
7. Questions to discuss with the surgeon and his experience of performing multiple surgery

At World Laparoscopy Hospital he have started doing multiple surgery at the same time in same patients and the results were very encouraging. In the video above you can see that laparoscopic myomectomy, Ovarian cystectomy and cholecystectomy was performed in same patients.

The result of this surgery was following:

1. Mean operating time was 90 minute
2. Hospital stay was one day 24 hour
3. Number of Ports were four
4. One colpotomy was just additional wound to remove the myoma
5. Pain of the patient was same as cholecystectomy alone
6. The cost of surgery was very less compare to the cost of all these three surgery seperately

In order to perform mutiple operations inside the abdomen, surgeons must make an incision large enough to offer adequate visibility of all the area including pelvis to upper abdomen, provide access to the abdominal organs and allow the use of hand-held surgical instruments during traditional open surgery. These incisions may be placed in different parts of the abdominal wall.  Depending on the size of the patient and the type of operation and the organs which will be envolved in the surgery, the incision may be 12 to 24 inches in length if multiple open surgery will be performed together. 

There is a significant amount of discomfort associated with these multiple incisions that can prolong the time spent in the hospital after surgery and can limit how quickly a patient can resume normal daily activities.  Because traditional techniques have long been used and taught to generations of general surgeons and gynecologists, they are widely available and are considered the standard treatment to which newer techniques must be compared.

Because the incisions are much smaller than those used in traditional mutiorgan surgery, there is usually less discomfort following minimally invasive surgery.  This has been shown to result in a shorter hospital stay, less need for prescription pain medications, an earlier return to normal activities and less visible scarring.  While some experts have suggested a long-term benefit to minimally invasive surgery, it is generally accepted that the primary benefits are seen in the initial recovery from surgery.

Conclusion:

In properly selected women, combined myomectomy, cholecystectomy and ovarian cystectomy are safe, feasible and cost-effective procedures and can be considered by both gynaecologist and general surgeon. However if hysterectomy is complicated, gall bladder can be left for removal later on.