Concomitant Laparoscopic Surgery: A Step Ahead

Abstract

With the development of laparoscopy and refinement of the surgical instruments and technology, multiple surgeries, in the same sitting, can be safely handled which needs evaluation in the terms of feasibility and validation. The study is a case series analysis of prospectively collected data on concomitant (≥ 2) laparoscopic procedures done, over 7 years (2016–2023) at the Department of General Surgery, of two tertiary medical care institutes, by a single surgeon. All such 139 patients on accrual with coexisting benign surgical pathologies amenable to laparoscopy were included after formal consent. The data were analysed in terms of operative time, visual analogue scale (VAS) for pain at 24 h, hospital stay, surgical feasibility, post-operative complications and cost. The outcomes were compared against the single procedures (as component of concomitant surgeries) done by same surgeon/or other modalities possible, in the same duration. A total of 139 registered cases underwent surgery, of which 61 were different procedures combined with laparoscopic cholecystectomy. Rest 78 cases included single incision bilateral TAPP, TEP for bilateral inguinal hernias, bilateral transperitoneal pyelolithotomy, laparoscopic pyelolithotomy with pyeloplasty and Meckel’s diverticulectomy with appendectomy. The results of concomitant surgeries, i.e. operative time and hospital stay, were significantly less, and the respective VAS values were nearly equal to the VAS in a single procedure, with no significant difference. With the developed expertise of surgeon, skill enhancement and establishment of a good infrastructure and surgical team, it is well feasible to carry concomitant laparoscopic surgeries with early return to activity and sufficient cost saving. It saves both out-of-pocket expenses of the patient, trouble of second anaesthesia and surgery and reduces provider’s cost and burden as well.