the first recorded synchronous laparoscopic surgery was in zurich , switzerland last 2006 where breitenstein et al .
, transvaginal extraction of the spleen and uterus was done in a community hospital in arizona , usa last 2013 . meanwhile , fistarol et al . from brazil used a single trocar access port through the umbilicus for an adnexal mass excision and cholecystectomy in 2014 .
this case report hopes to shift paradigms encouraging multidisciplinary approach through minimally invasive surgery in a single incision port .
this is a case of a 48-year - old female clerk with 3 months of fatigue getting worse with occasional diarrhea .
there was no exertional dyspnea , dizziness , loss of consciousness , rectal bleeding and abdominal pain .
physical examination reveals body mass index of 31.8 kg / m , pallor , without abdominal masses or tenderness .
pelvic exam showed parous introitus , atrophy of vaginal mucosa , multiparous cervix , 10-week size uterus , no adnexal masses or tenderness , no discharges . on initial evaluation ,
she was transfused 2 units of packed red blood cells due to hemoglobin of 6 g / dl .
other pertinent laboratory findings include carcinoembryonic antigen 6.6 mg / ml , calcium 10.4 mg / dl and fasting blood sugar 202 mg / dl .
colonoscopy done showed an ascending colon mass in the hepatic flexure and a rectal polyp .
computerized axial tomography scan of the abdomen revealed wall thickening or mass involving the proximal ascending colon with multiple subcentimeter lymph nodes within mesentery adjacent to this portion ( fig .
1 ) . there was no evidence of metastatic disease . a 3.8  3.3 cm hypodense mass located in the central portion of the uterus
a vertical 2 cm incision was made above the umbilicus to facilitate extraction of the mass .
the omentum was then dissected off the transverse colon , and hepatic flexure was subsequently taken down .
next , the right branch of the middle colic artery and the ileocolic pedicle was isolated and doubly ligated with the laparoscopic blunt tip vessel sealer and divider .
the large bowel including the tumor was brought out through the opening in the anterior abdominal wall ( fig .
a side - to - side functional end - to - end ileotransverse colic anastomosis was performed with reloadable surgical staplers ( fig .
an enterotomy was made on the terminal ileum and a colostomy was made on the right transverse colon .
vicryl 3 - 0 sutures were used to bury the corners of the staple line .
the anastomosis and staple line was sprayed with fibrin glue and reduced back into the abdomen . 

vaginal examination was then done to place the speculum into the vagina and put a single tooth tenaculum on the anterior lip of her cervix and an acorn uterine manipulator at the cervix to use for manipulation of the uterus during the laparoscopic portion .
repositioning the patient for the laparoscopic approach through the spa , the infundibulopelvic ligament , round ligament , fallopian tubes and ovaries were first divided .
the broad ligaments were dissected down to the level of the uterine arteries to mobilize the structures .
hysterectomy and bilateral salpingo - oophorectomy were then completed vaginally ( figs 6 and 7 ) .
the vaginal cuff was closed by baseball stitches first then with running interlocking stitch of chromic .
the cuff was closed from the superior angle to inferior angle and the uterosacral ligaments were approximated to help with vaginal vault support . 

the single access port was removed from the umbilicus , and the stay sutures were approximated from 9 o'clock to 3 o'clock and from 12 o'clock to 6 o'clock .
individual figure of eight sutures were placed at the fascia to avoid gaps and herniation .
gross examination of the ascending colon showed a fungating , friable , centrally ulcerated mass 3.5 cm from the distal surgical margin that is almost circumferential and 7.5  4.8  2.1 cm in greatest dimensions .
histopathologic examination revealed infiltrating well to moderately differentiated , mucous producing adenocarcinoma , extending through the muscle wall and microscopically into the pericolonic adipose tissue with metastasis to 1/34 regional lymph nodes ( fig .
gross examination of the uterus revealed 273 g measuring 7.5  5.5  5 cm with a posterior myometrial white whorled nodule .
final diagnosis was ascending colon adenocarcinoma stage iiib ( t4a , n1,m0 ) and uterine fibroids .
this is the first time , a synchronous right hemicolectomy , hysterectomy and bilateral salpingo - oophorectomy was performed through a spa laparoscopic route . the first reported case of single incision right hemicolectomy ( sirh ) was in july 2008 . in 2009 , ramos - valadez et al .
recorded the first series of sirh in consecutive unselected 13 patients with benign or malignant pathology .
. showed satisfactory lymph node harvest and resection margin and reduction in conversion rate to laparotomy with single incision laparoscopic colectomy compared with multiport conventional laparoscopic colectomy .
however , there were no significant differences in short - term clinical outcomes . since the first laparoscopic hysterectomy was described in 1989 by reich et al .
, initial experiences with spa laparoscopic - assisted vaginal hysterectomy ( spa - lavh ) were documented in different countries with good postoperative outcomes [ 68 ] .
showed decreased blood loss and visual analog scale  based pain scores 24 and 36 h after surgery with spa - lavh compared with multiport access . despite the numerous advantages of spa laparoscopic surgery , more studies are needed to determine its safety and applicability to other surgical entities especially when performing synchronous procedures .
spa laparoscopic surgery is feasible for multidisciplinary approach in resectable tumors and achieving good postoperative outcomes .
 laparoscopic surgery through a single incision is gaining popularity with different stakeholders . 
 the advantages of improved cosmetics , decreased postoperative pain and blood loss continue to attract patients from different surgical fields . 
 multidisciplinary approach to different surgical entities through a single incision has just been introduced . 
 we report the first case of a synchronous single - port access ( spa ) laparoscopic right hemicolectomy and laparoscopic - assisted vaginal hysterectomy with bilateral salpingo - oophorectomy through a single incision above the umbilicus in a 48-year - old female with ascending colon mass and uterine mass with good postoperative outcomes . 
 spa laparoscopic surgery is feasible for multidisciplinary approach in resectable tumors . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION