This video demonstrate How to do Safe Laparoscopic Hysteropexy - Lecture by Dr R K Mishra. Laparoscopic hysteropexy involves a lifting up and reinforcing the support structures of a uterus. It is a surgical procedure for women who are troubled by prolapse (a feeling of falling down or heaviness in the vagina) of their womb. When performing a hysteropexy, we wrap a special reinforcement mesh / netting around the neck of the womb (the cervix) and fix this to some strong tough areas (ligaments) on the base of the spine. This is what keeps the womb in place and we hope that by using this special mesh material, that the womb will be unable to fall down or prolapse again. In younger women or those who may desire future pregnancies we use a tape (uterine sling – images) to support the uterus as this does not wrap around the cervix and may be better in these situations. The principles of the operation are the same for both methods. Hysteropexy is used as a treatment for women with prolapse of their uterus. It is a womb-sparing procedure, as it does not involve removing the womb (hysterectomy). It is chosen by those women who for whatever reason are keen to not have their uterus removed. We hope that by not subjecting woman to much of the necessary surgical cutting involved in performing a hysterectomy, that also a woman’s recovery will be quicker, and that she will be able to return to daily activities sooner than is normally the case with hysterectomy. If your preference is to have your womb removed, a hysterectomy would be a more appropriate operation. If you have any doubts regarding surgery we would advocate trying non-surgical treatments first. Laparoscopic hysteropexy is safe and very effective, but as with any surgical procedure there are risks attached. Some women have such dense scarring because of their previous surgery that preclude us from performing the procedure safely with keyhole surgery, and we may need to perform the prolapse repair via the vagina. This is very rare. The risks common to all operations include anaesthetic risks, infection, bleeding, recurrence of symptoms and formation of a blood clot in the legs/lungs.

How to Do Safe Laparoscopic Hysteropexy – Lecture by Dr. R. K. Mishra at World Laparoscopy Hospital

Laparoscopic hysteropexy is a modern, uterus-preserving surgical procedure used to treat uterine prolapse. In an educational lecture at World Laparoscopy Hospital, renowned minimal access surgeon Dr. R. K. Mishra explains the principles, techniques, and safety considerations required to perform this advanced procedure effectively. His lecture emphasizes meticulous surgical technique, proper anatomical understanding, and adherence to safety protocols to ensure optimal patient outcomes.

Uterine prolapse occurs when the pelvic floor muscles and supporting ligaments weaken, allowing the uterus to descend into the vaginal canal. Traditionally, hysterectomy was the common treatment option, but many patients prefer to preserve their uterus for physiological or personal reasons. Laparoscopic hysteropexy offers a minimally invasive alternative that restores the normal position of the uterus while maintaining reproductive anatomy. According to Dr. Mishra, the key goal of hysteropexy is to suspend the uterus securely to strong pelvic ligaments using mesh or sutures, thereby restoring pelvic support without removing the uterus.

During the lecture, Dr. Mishra highlights the importance of proper patient selection and preoperative evaluation. Detailed clinical examination, imaging when necessary, and assessment of associated pelvic floor defects help determine whether laparoscopic hysteropexy is the appropriate surgical approach. Patients with symptomatic uterine prolapse who wish to retain their uterus and do not have uterine pathology are ideal candidates for this procedure.

The surgical procedure begins with standard laparoscopic port placement and careful exploration of the pelvic cavity. After identifying important anatomical landmarks, the surgeon dissects the peritoneum and prepares the area for mesh fixation. In many cases, the mesh is attached from the posterior cervix to the sacral promontory, providing durable support and repositioning the uterus into its normal anatomical location. Dr. Mishra emphasizes the importance of gentle tissue handling, precise dissection, and avoiding injury to surrounding structures such as the ureters, bladder, and rectum.

Another key aspect discussed in the lecture is mesh placement and fixation. Proper sizing and positioning of the mesh are essential to avoid complications such as mesh erosion or recurrence of prolapse. Dr. Mishra advises surgeons to ensure tension-free placement and secure fixation with non-absorbable sutures. Peritoneal closure over the mesh is also recommended to reduce the risk of bowel adhesions.

Safety remains a central theme throughout the lecture. Dr. Mishra stresses adherence to the fundamental principles of laparoscopic surgery, including clear visualization, controlled energy use, and careful identification of vital structures. He also encourages surgeons to develop strong laparoscopic skills through structured training programs before attempting advanced pelvic reconstructive procedures.

Postoperative care and patient follow-up are also crucial components of successful outcomes. Patients typically experience less pain, shorter hospital stay, and faster recovery compared with traditional open surgery. Regular follow-up helps ensure proper healing and early detection of any complications.

In conclusion, the lecture by Dr. R. K. Mishra at World Laparoscopy Hospital provides valuable insights into performing safe laparoscopic hysteropexy. By combining advanced laparoscopic techniques with strict safety principles, surgeons can effectively treat uterine prolapse while preserving the uterus. This approach not only improves patient outcomes but also reflects the evolution of modern minimally invasive gynecologic surgery.