New Delhi, Oct 16 (PTI) Doctors at AIIMS Delhi have successfully removed the uterus of a 44-year-old woman, who stands just 98 cm tall and weighs 22 kg, through laparoscopic surgery despite severe osteoporosis and other medical complications.
The woman, who has severe short stature and fragile bones, had been suffering from extremely painful menstrual periods for nearly a year, disrupting her daily life and forcing her to frequently rely on painkillers, according to the hospital.
Medical investigations revealed deep pelvic endometriosis and adenomyosis, conditions in which tissue similar to the uterine lining grows outside the uterus or within its muscular wall respectively.
Considering her age, severe osteoporosis and hypertension, hormonal treatment was not considered feasible, and doctors decided to remove her uterus to provide relief from the symptoms, the statement said.
The case was assessed by a multidisciplinary team comprising specialists from gynaecology, endocrinology and anaesthesia to determine the feasibility of performing the procedure through a minimally invasive approach.
“Minimally invasive surgery is now routine for most hysterectomies, but operating on an adult woman of this size with severe bone weakness and hypertension poses unusual challenges,” said Dr Aparna Sharma, professor in the Department of Obstetrics and Gynaecology at AIIMS, Delhi.
Doctors said positioning the patient for surgery was particularly challenging as the standard lithotomy position used for hysterectomy could have put her at risk of fractures in the lower back and thigh bones.
“Due to short stature along with severely fragile bones, standard lithotomy position for hysterectomy could have put her at risk of lower back and thigh bone fractures. There was a need for utmost care in proper positioning and cushioning during surgery,” said Dr Rajesh Khadgawat, professor in the Department of Endocrinology.
The patient and her family opted for the laparoscopic approach, and the surgery was performed with her lying flat on her back.
“Her uterus was enlarged due to adenomyosis, and the uterus and ovaries were stuck to the adjacent intestines, while the space in her abdomen was very limited. We were able to complete the hysterectomy successfully through laparoscopic route in around 90 minutes,” said Dr Reeta Mahey, professor in the Department of Obstetrics and Gynaecology, who performed the surgery.
The anaesthesia team also faced several challenges due to the patient’s severely weakened bones, short neck and low body weight. There were risks associated with positioning, airway management, intravenous cannulation and epidural catheter insertion.
“All drug doses and permissible blood loss were calculated according to her weight, and blood was arranged in advance. We avoided an epidural for post-operative pain and gave an ultrasound-guided abdominal block instead,” said Dr Parin Lalwani from the Department of Anaesthesia.
The patient recovered well and was discharged on the third day after surgery.
“The case shows that with careful planning, even patients with severe short stature and fragile bones can benefit from minimally invasive surgery, which means less pain and faster recovery,” said Dr Neena Malhotra, Head of the Department of Obstetrics and Gynaecology. PTI PLB KSS
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