Minimally invasive surgery has transformed modern medicine, offering patients the benefits of smaller incisions, reduced pain, faster recovery, and fewer complications. Among the pioneers in this field, Dr. R. K. Mishra stands out for his groundbreaking contributions. Recently, at the World Laparoscopy Hospital, Dr. Mishra achieved a world-first surgical feat by removing a massive 3.5 kg fibroid along with an ovarian cyst, gallbladder, and appendix—all through laparoscopic surgery. This extraordinary case highlights the pinnacle of surgical expertise, innovation, and patient-centered care.

Patient Presentation

The patient, a woman in her 40s, presented with abdominal distension, pain, and digestive discomfort. Imaging studies revealed a large uterine fibroid weighing approximately 3.5 kg, an ovarian cyst, gallstones, and an inflamed appendix. Traditionally, such a complex combination of pathologies would require open surgery with a large abdominal incision, prolonged hospital stay, and considerable postoperative morbidity.

However, Dr. Mishra and his team opted for a completely laparoscopic approach, demonstrating the capability of advanced minimally invasive surgery even in highly complex cases.

Preoperative Planning

Dr. Mishra emphasizes that meticulous preoperative planning is critical for complex laparoscopic procedures:

Detailed Imaging – Ultrasound and MRI were used to assess the size, location, and relation of the fibroid, ovarian cyst, gallbladder, and appendix.

Patient Assessment – Comprehensive evaluation of cardiovascular, respiratory, and metabolic status to ensure anesthesia safety.

Surgical Strategy – Careful sequencing of procedures: removal of the fibroid first, followed by ovarian cystectomy, cholecystectomy, and appendectomy.

Team Coordination – Multidisciplinary planning including anesthesiologists, nurses, and surgical assistants for efficient workflow.

Surgical Technique

The procedure, performed entirely laparoscopically, involved the following steps:

Laparoscopic Myomectomy

A small incision at the umbilicus was used for the laparoscope, with additional ports for instruments.

The 3.5 kg fibroid was carefully dissected from the uterine wall.

Advanced laparoscopic techniques, including enucleation and morcellation, were employed to remove the massive fibroid without enlarging incisions.

Ovarian Cyst Removal

The ovarian cyst was identified and dissected from the ovary while preserving healthy ovarian tissue.

The cyst was carefully extracted using laparoscopic retrieval bags to prevent spillage and minimize contamination.

Laparoscopic Cholecystectomy

The gallbladder containing stones was dissected from the liver bed.

The cystic duct and artery were clipped and divided.

The gallbladder was removed through a port using a retrieval bag to maintain sterility.

Laparoscopic Appendectomy

The appendix, inflamed and prone to infection, was isolated and excised.

The base was secured using laparoscopic sutures, and the appendix removed through a port.

Key Considerations:

Maintaining a clear operative field despite multiple pathologies.

Preventing cross-contamination between procedures.

Minimizing blood loss and maintaining hemodynamic stability.

Ensuring safety and precision at every step to avoid complications.

Challenges Overcome

Dr. Mishra highlighted several challenges in this case:

Massive Fibroid Size: Manipulating and removing a 3.5 kg fibroid laparoscopically required expert morcellation and careful tissue handling.

Multiple Organs: Operating on the uterus, ovary, gallbladder, and appendix sequentially demanded meticulous planning and surgical dexterity.

Time Management: Completing all four procedures in a single session without prolonging anesthesia time.

Safety: Avoiding injury to adjacent organs, controlling bleeding, and preventing postoperative infection.

Postoperative Outcome

The surgery was completed successfully without conversion to open surgery. Key postoperative outcomes included:

Minimal Pain – Managed with standard analgesics.

Early Mobilization – Patient was ambulating within 24 hours.

Rapid Recovery – Discharged within 3–4 days, significantly shorter than conventional open surgery.

Excellent Cosmetic Results – Only small laparoscopic port scars, preserving body image.

Significance of the Surgery

This procedure represents a world-first achievement, demonstrating that even extremely large fibroids and multiple coexisting pathologies can be managed laparoscopically. It showcases:

Innovation in minimally invasive surgery

Safety and feasibility of complex multi-organ laparoscopic procedures

Potential to reduce hospital stay, postoperative pain, and complications

Enhanced patient satisfaction due to faster recovery and minimal scarring

Dr. R. K. Mishra’s expertise emphasizes that surgical innovation combined with meticulous planning can redefine the limits of laparoscopy, benefitting patients with complex conditions who would traditionally face major open surgeries.

Conclusion

The removal of a 3.5 kg fibroid, ovarian cyst, gallbladder, and appendix through laparoscopy at the World Laparoscopy Hospital represents a landmark in minimally invasive surgery. This case highlights the skills, precision, and innovation of Dr. R. K. Mishra, proving that complex multi-organ pathologies can be safely managed with laparoscopic techniques. Such pioneering procedures set new standards in patient care, demonstrating that minimally invasive surgery can achieve outcomes once thought possible only with open surgery, transforming the future of gynecological and general surgery worldwide.