This detailed surgical demonstration focuses on the laparoscopic management of a pedunculated uterine myoma, highlighting controlled myoma excision and effective pedicle management using the Mishra’s Knot technique. The procedure demonstrates important principles of minimally invasive gynecological surgery, including identification of the myoma, assessment of its attachment, precise tissue handling, hemostatic control, and secure ligation.

Pedunculated fibroids are characterized by their attachment to the uterus through a narrow or relatively defined stalk. Although their anatomy may appear straightforward, careful surgical planning is essential to identify the pedicle correctly and minimize unnecessary bleeding or injury to surrounding structures. A systematic laparoscopic approach allows the surgeon to obtain excellent visualization while maintaining precise control throughout the procedure.

The demonstration emphasizes the importance of establishing an appropriate operative field before beginning myoma excision. Adequate exposure and clear identification of the uterine surface and pedicle help the surgeon determine the safest point for intervention. Controlled traction and counter-traction can facilitate visualization and improve the precision of dissection.

A key component of this procedure is Mishra’s Knot, a laparoscopic knotting technique used to achieve secure tissue ligation. Proper placement, tightening, and confirmation of the knot are important steps when managing vascular pedicles during minimally invasive surgery. The technique also provides valuable training in intracorporeal laparoscopic suturing and knot-tying skills.

Following pedicle control, the myoma can be separated from its attachment with careful attention to hemostasis and preservation of healthy surrounding tissue. The operative field is inspected after excision to ensure adequate control of bleeding and appropriate management of the remaining uterine surface.

This surgical teaching session is particularly valuable for gynecologists, laparoscopic surgeons, fellows, postgraduate trainees, and medical professionals developing advanced minimally invasive surgical skills. It demonstrates how anatomical knowledge, controlled dissection, effective knotting, and disciplined laparoscopic technique can be integrated into the management of pedunculated myomas.

The procedure also highlights the educational philosophy of World Laparoscopy Hospital, where surgeons are trained to understand not only the sequence of an operation but also the reasoning behind each surgical maneuver. Mastering techniques such as Mishra’s Knot can improve confidence in laparoscopic pedicle management and contribute to more controlled operative procedures.

This demonstration serves as an educational resource for surgeons interested in laparoscopic myomectomy, pedunculated fibroid excision, laparoscopic suturing, intracorporeal knotting, pedicle ligation, and advanced gynecological laparoscopy.