Laparoscopic myomectomy has emerged as one of the most advanced and effective minimally invasive techniques for the management of uterine fibroids. Large myomas, once considered a contraindication for laparoscopic surgery, can now be removed safely and efficiently with modern laparoscopic skills, instruments, and techniques. Under the expertise of Dr. R. K. Mishra, a pioneer in the field of minimal access surgery, laparoscopic myomectomy for large fibroids has been performed with excellent outcomes, proving that even giant myomas can be managed without resorting to traditional open surgery.

Understanding Large Myomas

Uterine fibroids, also called leiomyomas or myomas, are benign tumors of the smooth muscle of the uterus. While many women have small, asymptomatic fibroids, some develop very large fibroids that can enlarge the uterus to the size of a 16–20-week pregnancy. Large fibroids often cause significant symptoms such as:

Heavy and prolonged menstrual bleeding leading to anemia

Pelvic pain and pressure

Abdominal distension

Frequent urination or constipation due to pressure on bladder or rectum

Infertility and recurrent miscarriages

Traditionally, women with large fibroids were advised to undergo open myomectomy or even hysterectomy. However, with the refinement of laparoscopic techniques, large myomas can now be removed while preserving the uterus and ensuring minimal postoperative discomfort.

Philosophy of Dr. R. K. Mishra

Dr. R. K. Mishra, world-renowned laparoscopic surgeon and director of World Laparoscopy Hospital, emphasizes the philosophy that size alone should not be a barrier to minimally invasive surgery. His extensive experience demonstrates that with proper case selection, skillful dissection, and advanced suturing techniques, laparoscopic myomectomy for even the largest fibroids can be performed safely. His contributions in training thousands of surgeons worldwide have made laparoscopic management of large myomas a practical and reproducible reality.

Preoperative Preparation

Performing laparoscopic myomectomy for a large fibroid requires meticulous planning. Dr. Mishra advocates the following steps:

Imaging (Ultrasound/MRI): To map the location, size, and number of fibroids.

Hemoglobin Correction: Patients with anemia due to heavy bleeding are optimized with iron therapy or blood transfusion if necessary.

GnRH Agonists (Optional): In selected cases, preoperative use can shrink fibroids slightly and reduce vascularity, although Dr. Mishra often prefers to deal with the fibroid in its natural state to avoid tissue plane distortion.

Informed Consent: Patients are counseled regarding possible conversion to laparotomy, blood transfusion, and fertility implications.

Surgical Technique by Dr. R. K. Mishra

Anesthesia and Positioning
The patient is placed in lithotomy position under general anesthesia. After creating pneumoperitoneum, trocars are inserted strategically to allow optimal instrument mobility, especially important when dealing with a bulky uterus.

Exploration and Mapping
The uterus is inspected, and the exact site of the large myoma is identified. Associated fibroids are also noted.

Uterine Incision
A vertical or transverse incision is made on the uterus overlying the myoma using monopolar energy or harmonic scalpel.

Myoma Enucleation
Dr. Mishra skillfully enucleates the fibroid by applying traction with a myoma screw while dissecting with precise countertraction. Even with giant fibroids, the pseudocapsule is carefully preserved to protect uterine integrity.

Suturing the Myoma Bed
One of Dr. Mishra’s hallmarks is his advanced laparoscopic suturing technique. The defect is closed in multiple layers with delayed absorbable sutures. This meticulous closure restores uterine anatomy and ensures strong healing, critical for women desiring future pregnancy.

Specimen Retrieval
Large fibroids are morcellated and removed piecemeal through the laparoscopic ports. Dr. Mishra ensures the safe use of morcellation techniques, preventing spillage and maintaining oncological safety.

Hemostasis and Adhesion Prevention
Careful inspection is carried out to ensure hemostasis. Anti-adhesion barriers may be applied in fertility-preserving cases.

Postoperative Care and Recovery

Thanks to minimally invasive techniques, recovery after laparoscopic myomectomy for large myomas is remarkably quick. Most patients are mobilized within hours, and oral intake is resumed the same day. Hospital stay is usually limited to 24–48 hours. Postoperative pain is minimal, and patients can return to normal activities within a week. For women planning pregnancy, Dr. Mishra advises waiting for 3–6 months to allow complete uterine healing.

Advantages of Laparoscopic Myomectomy for Large Fibroids

Avoidance of large abdominal incision

Minimal blood loss due to precise dissection and energy devices

Faster recovery and shorter hospital stay

Better cosmetic outcomes

Preservation of fertility and uterine function

Reduced risk of postoperative adhesions compared to open surgery

Dr. R. K. Mishra’s Contribution

Through his expertise and training programs at World Laparoscopy Hospital, Dr. R. K. Mishra has made laparoscopic myomectomy for large fibroids accessible to gynecologists across the globe. His lectures, surgical demonstrations, and training modules emphasize safe surgical steps, advanced suturing, and patient-centered care. By breaking the myth that large fibroids require open surgery, he has redefined the standard of care in gynecological surgery.

Conclusion

Laparoscopic myomectomy for large myomas, once considered a surgical challenge, is now a safe and effective procedure in the hands of experts like Dr. R. K. Mishra. His refined techniques, vast experience, and dedication to teaching have empowered surgeons worldwide to treat large fibroids laparoscopically, preserving fertility and improving women’s quality of life. With continuing advances in laparoscopy, even the most complex gynecological surgeries can now be performed with minimal invasiveness, making Dr. Mishra’s approach a true milestone in modern surgery.