Uterine fibroids, also known as leiomyomas, are the most common benign tumors in women of reproductive age. They vary in size, number, and location, and may lead to symptoms such as heavy menstrual bleeding, pelvic pain, infertility, or recurrent miscarriage. While hysterectomy provides definitive treatment, many women of childbearing age desire uterine preservation. Laparoscopic myomectomy has therefore emerged as a highly effective and fertility-preserving surgical option. Among the pioneers of advanced laparoscopic surgery, Dr. R. K. Mishra, a globally renowned laparoscopic surgeon and educator, has significantly contributed to refining and teaching this procedure.

Philosophy and Approach of Dr. R. K. Mishra

Dr. Mishra advocates for the philosophy of “minimal access, maximal results.” His teaching emphasizes that laparoscopic myomectomy should not only remove fibroids but also restore normal uterine anatomy with minimal trauma. For him, the success of the procedure lies in three essential principles:

Precise Enucleation – removing the fibroid completely while safeguarding the pseudocapsule to protect the uterine vasculature.

Meticulous Hemostasis – ensuring minimal blood loss through vasopressin infiltration, energy devices, and skillful dissection.

Secure Uterine Reconstruction – closing the myometrial defect in multiple layers with advanced laparoscopic suturing techniques.

These steps, when mastered, make laparoscopic myomectomy safe and feasible even for large and multiple fibroids.

Indications for Surgery

According to Dr. Mishra, laparoscopic myomectomy is particularly indicated in the following situations:

Symptomatic fibroids causing menorrhagia, pelvic pain, or pressure effects

Fibroids contributing to infertility or recurrent pregnancy loss

Rapidly growing fibroids raising concern for sarcomatous change (though rare)

Large intramural, subserosal, or broad ligament fibroids affecting quality of life

While hysteroscopic resection is ideal for small submucosal fibroids, large intramural and multiple fibroids are best approached laparoscopically.

Preoperative Preparation

Dr. Mishra emphasizes careful preparation before surgery. Patients undergo detailed imaging with ultrasound or MRI to map fibroid number and location. Hemoglobin levels are corrected preoperatively. In select cases, GnRH analogs are used to reduce fibroid vascularity and size. Importantly, patients are counseled about the potential for conversion to laparotomy in rare circumstances of uncontrolled bleeding or distorted anatomy.

Stepwise Surgical Technique

Dr. Mishra teaches laparoscopic myomectomy as a structured, step-by-step procedure:

Anesthesia and Positioning

General anesthesia with endotracheal intubation.

Lithotomy position with Trendelenburg tilt for pelvic visualization.

Port Placement

A 10 mm umbilical port for the laparoscope.

Two or three accessory ports in the lower quadrants, ergonomically aligned for instrument triangulation.

Vasopressin Injection

Dilute vasopressin solution injected into the myometrium overlying the fibroid to minimize intraoperative bleeding.

Uterine Incision

A vertical or transverse incision made with harmonic scalpel or monopolar scissors.

Fibroid Enucleation

The fibroid is separated from its pseudocapsule using blunt and sharp dissection.

Bipolar energy is used judiciously to maintain hemostasis.

Uterine Closure

The myometrial defect is closed in multiple layers using intracorporeal suturing.

Dr. Mishra emphasizes this as the most critical step, ensuring uterine strength for future pregnancies.

Specimen Retrieval

Removed by contained morcellation or mini-laparotomy, depending on fibroid size and safety considerations.

Teaching Focus

As Director of World Laparoscopy Hospital, Dr. R. K. Mishra has trained thousands of surgeons in laparoscopic myomectomy. His lectures stress the importance of ergonomics, instrument handling, and advanced suturing skills. He demonstrates live surgeries, video tutorials, and hands-on simulation training, ensuring that surgeons master both the technical and decision-making aspects of the procedure.

Advantages of the Procedure

Dr. Mishra highlights the numerous benefits of laparoscopic myomectomy over open surgery:

Less blood loss due to precise dissection

Small incisions with better cosmetic results

Reduced pain and faster recovery

Shorter hospital stay, often 24–48 hours

Lower adhesion formation, preserving fertility

High patient satisfaction and improved reproductive outcomes

Outcomes and Results

Patients undergoing laparoscopic myomectomy under Dr. Mishra’s technique typically experience excellent outcomes. Most return to daily activities within one to two weeks. Women desiring pregnancy are advised to wait at least six months before conception, ensuring adequate uterine healing. The recurrence of fibroids is possible, but the procedure offers long-lasting relief of symptoms and improved fertility rates.

Conclusion

Laparoscopic myomectomy by Dr. R. K. Mishra embodies the highest standards of minimally invasive gynecologic surgery. His expertise, teaching, and philosophy have made this procedure accessible and safe for women across the globe. By combining meticulous surgical technique with innovative teaching methods, Dr. Mishra has transformed laparoscopic myomectomy from a challenging operation into a reproducible, standardized, and highly effective solution for symptomatic uterine fibroids. For women seeking relief from fibroid symptoms while preserving fertility, his approach represents not only surgical excellence but also a beacon of hope.