Watch this detailed video on Laparoscopic Surgery for Pedunculated Myoma using Mishra's Knot technique. Learn step-by-step how Dr. R.K. Mishra performs this minimally invasive procedure with precision and expertise. This surgical video is perfect for medical professionals, students, and anyone interested in advanced laparoscopic techniques.

Not all laparoscopic surgeons are trained in laparoscopic myomectomy surgery. Laparoscopic myomectomy is Gold Standard because of the small size of the incisions, removing uterine fibroids with laparoscopic myomectomy requires special training of knotting and suturing. Fibroids that are attached to the outside of the uterus by a stalk (pedunculated fibroids) are the easiest to remove laparoscopically my Mishra's Knot.

Pedunculated myomas, a type of uterine fibroid attached to the uterus via a thin stalk (peduncle), can cause significant symptoms including heavy menstrual bleeding, pelvic pain, and pressure effects on adjacent organs. Surgical intervention is often required when these fibroids cause discomfort, infertility, or rapid growth. Laparoscopic surgery, a minimally invasive technique, has revolutionized the management of such cases, and the use of Mishra's Knot technique has further enhanced surgical safety and efficiency.

What is a Pedunculated Myoma?

A pedunculated myoma is a benign tumor of the uterine smooth muscle that protrudes into the uterine cavity or outside the uterus on a stalk-like structure. Unlike sessile fibroids, pedunculated fibroids are mobile and can sometimes twist, leading to acute pain known as torsion.

Laparoscopic Approach

Laparoscopic surgery offers numerous advantages over traditional open surgery, including:

• Smaller incisions

• Reduced postoperative pain

• Faster recovery and shorter hospital stay

• Better cosmetic outcomes

• Lower risk of adhesions

During laparoscopy, a camera and specialized instruments are inserted through small abdominal incisions, allowing the surgeon to visualize and excise the fibroid with precision.

Mishra's Knot Technique

Mishra’s Knot is a specialized suturing technique developed by Dr. R.K. Mishra to secure pedunculated myomas during laparoscopic removal. This knot provides:

• Secure hemostasis, minimizing bleeding

• Efficient closure of the uterine wall

• Reduced operative time

• Enhanced safety for minimally invasive procedures

The technique involves careful placement of laparoscopic sutures around the pedicle of the myoma, followed by precise tying of the knot, ensuring the fibroid is safely detached without causing excessive bleeding or damage to surrounding tissue.

Step-by-Step Surgical Overview

1. Patient Preparation: Under general anesthesia, the patient is positioned, and the abdomen is prepped for laparoscopic entry.

2. Port Placement: Small incisions are made, typically at the umbilicus and lower abdomen, for the camera and instruments.

3. Fibroid Identification: The pedunculated myoma is visualized, and its stalk is carefully assessed.

4. Application of Mishra’s Knot: A laparoscopic suture is placed at the base of the pedicle, and Mishra's Knot is tied to secure hemostasis.

5. Fibroid Removal: The fibroid is excised and retrieved, sometimes using a morcellator or contained extraction bag.

6. Closure and Hemostasis: The uterine defect is inspected, additional sutures are applied if needed, and the laparoscopic ports are closed.

Benefits of the Technique

• Reduced intraoperative bleeding

• Minimal risk of pedicle torsion during surgery

• Faster recovery and return to normal activity

• Minimally invasive with better postoperative outcomes

Conclusion

Laparoscopic surgery for pedunculated myoma using Mishra's Knot represents a significant advancement in gynecological surgery. It combines the benefits of minimally invasive surgery with a reliable and safe method of controlling the myoma pedicle. Patients benefit from less pain, quicker recovery, and excellent surgical outcomes, making this approach a preferred choice in modern gynecological practice.