This educational video demonstrates the advanced technique of Skin-to-Skin Laparoscopic Myomectomy for the management of intramural fibroids. Performed by Dr. R.K. Mishra at World Laparoscopy Hospital, this video provides a detailed step-by-step approach to minimally invasive fibroid removal, focusing on precision, safety, and optimal patient outcomes.

In this video, surgeons and gynecologists can learn key aspects such as patient positioning, port placement, enucleation of fibroid, suturing techniques, and strategies to minimize blood loss. This video is highly beneficial for medical professionals seeking to enhance their laparoscopic skills and understand modern approaches to myomectomy.

Comprehensive Approach to Skin-to-Skin Laparoscopic Myomectomy for Intramural Fibroid | Minimally Invasive Surgical Technique by Dr. R.K. Mishra at World Laparoscopy Hospital

Laparoscopic myomectomy has revolutionized the management of uterine fibroids, particularly intramural fibroids, by offering a fertility-preserving and minimally invasive alternative to open surgery. Intramural fibroids, located within the muscular wall of the uterus, are among the most challenging to treat due to their depth and impact on uterine architecture and reproductive outcomes . The “skin-to-skin” laparoscopic myomectomy approach, as practiced by Dr. R.K. Mishra at World Laparoscopy Hospital, represents a highly refined, patient-centered technique emphasizing precision, minimal trauma, and rapid recovery.

Understanding Intramural Fibroids and Surgical Need

Intramural fibroids develop within the myometrium and may distort the uterine cavity, leading to symptoms such as heavy menstrual bleeding, pelvic pain, infertility, and recurrent pregnancy loss. Surgical removal is often indicated when symptoms are severe or fertility is compromised. Myomectomy, unlike hysterectomy, preserves the uterus and enhances reproductive potential .

Concept of Skin-to-Skin Laparoscopic Myomectomy

The term “skin-to-skin” refers to the complete surgical journey—from the initial incision to final closure—being performed using minimally invasive laparoscopic techniques. This approach ensures:

• Minimal incision size (5–12 mm ports)
• Reduced tissue trauma
• Enhanced cosmetic outcomes
• Faster postoperative recovery

Compared to open surgery, laparoscopic myomectomy significantly reduces blood loss, postoperative pain, and hospital stay .

Preoperative Evaluation and Planning

A comprehensive preoperative assessment is crucial for successful outcomes. This includes:

• Detailed imaging such as MRI for fibroid mapping
• Assessment of size, number, and location of fibroids
• Evaluation of uterine cavity involvement

Advanced imaging helps surgeons plan port placement, anticipate challenges, and strategize uterine reconstruction .

Surgical Technique: Step-by-Step Approach

1. Patient Positioning and Port Placement

The patient is placed in a lithotomy position with Trendelenburg tilt. Typically, four laparoscopic ports are inserted to allow optimal instrument triangulation.

2. Vasoconstriction and Hemostasis

Diluted vasopressin may be injected into the myometrium to minimize intraoperative bleeding.

3. Myoma Enucleation

A precise incision is made over the fibroid, followed by careful dissection to enucleate the myoma from surrounding myometrial tissue. This step requires advanced laparoscopic skills to maintain tissue planes.

4. Uterine Reconstruction

Reconstruction of the uterine wall is the most critical step. It involves:

• Multi-layer suturing of the myometrium
• Intracorporeal knotting techniques
• Restoration of uterine integrity

Studies emphasize three-layer closure to ensure strength and reduce risk of uterine rupture in future pregnancies .

5. Specimen Retrieval

The fibroid is removed using morcellation or contained extraction techniques, ensuring minimal contamination.

6. Final Inspection and Closure

Hemostasis is confirmed, and ports are closed, completing the “skin-to-skin” minimally invasive cycle.

Advantages of the Technique

The skin-to-skin laparoscopic approach offers multiple benefits:

• Fertility preservation: Maintains uterine structure
• Minimal adhesions: Reduced risk compared to open surgery
• Short hospital stay: Often same-day discharge
• Faster recovery: Return to normal activity within 2–3 weeks
• Cosmetic benefits: Smaller scars

Additionally, laparoscopic techniques reduce postoperative complications and improve patient satisfaction.

Challenges and Surgical Expertise

Laparoscopic myomectomy is technically demanding. Key challenges include:

• Control of intraoperative bleeding
• Precise suturing in a confined space
• Removal of large or multiple fibroids

Mastery of intracorporeal suturing and advanced laparoscopic skills is essential. Surgeons trained at centers like World Laparoscopy Hospital are equipped with these competencies.

Postoperative Care and Outcomes

Patients typically experience:

• Minimal pain
• Early ambulation
• Quick return to daily activities

Long-term outcomes are favorable, with improved fertility and symptom relief. However, careful follow-up is necessary due to the possibility of fibroid recurrence.

Conclusion

The comprehensive skin-to-skin laparoscopic myomectomy technique represents a significant advancement in the management of intramural fibroids. Under the expertise of surgeons like Dr. R.K. Mishra, this minimally invasive approach ensures optimal surgical precision, uterine preservation, and enhanced patient recovery. As laparoscopic technology and surgical training continue to evolve, such techniques are setting new standards in gynecological surgery, offering patients safer and more effective treatment options.