Professor R K Mishra has been invited on 29th of December 2010 to London to receive Lifetime achievement award during the World Association of Laparoscopic Surgeons general body meeting of Europe this is a two days function who gave Professor Mishra its most prestigious Award for the accomplishment of his surgical masterpiece and dedication as laparoscopic trainer.

This Award truly represents an outstanding recognition in the field of minimal access surgery since this uppermost distinction had been given only to 4 surgeons in 20 years time. A grand and befitting function will jointly be organised in collaboration of Ethicon endosurgery and covidean in London.

The decision to organise the function was taken in a meeting, held on 14th of October in London, in which prominent leaders from the WALS, who was made convener of the organising committee of the programme Dr. Ray Green will be present.

Prof. Mishra also serves as the scientific coordinator for several minimal access surgical European projects: “related to robotics and single incision laparoscopic surgery”, He is at present and involved in 12 international and national projects covering several application areas of laparoscopy. He has served as a scientific expert for numerous international Journal and the European Commission as well as French journals. He is also the chief editor of World Journal of Laparoscopic Surgery.

As an innovative surgeon and researcher this award and prize of Gold medal was given to Prof. Dr. R.K. Mishra He is also recipient of Global Medical Education Award by vice-chancellors of eight apex universitiesduring National Open and Distance Education Summit 2007 in the presence of Honorable Shri P.R. Kyndiah, Union Minister for tribal affairs, Government of India. He is recipient of Lord Ashdown award for his valuable teaching contribution in the field of Minimal Access Surgery. For his dedicated service in the field of laparoscopic surgery LIONS CLUB ANNAMAMALAINAGARhas honoured Prof. Mishra with “THE LIFE TIME ACHIEVEMENT AWARD” in July 2010, but this award in Europe is definitely going to be a real life time achievement.

Laparoscopic or “minimal Access Surgery” is a highly specialized technique for performing surgery of abdomen. In the past, this surgical technique was commonly used only for gynaecologic surgery, for diagnostic laparoscopy in cases of infertility and for gall bladder surgery. Over the last 10 years the use of this specialized surgical technique has expanded into intestinal surgery. In traditional “open” surgery the surgeon uses a single incision to enter into the abdomen. Laparoscopic surgery uses several 0.5-1cm incisions. Each incision is called a “port.”  At each port a tubular instrument known as a trochar and cannulla is inserted.  Specialized instruments and a special telescope known as a laparoscope are passed through the port during the procedure. At the beginning of the procedure, the patient’s abdomen is inflated with carbon dioxide gas to provide a working and viewing space for the laparoscopic surgeon. The laparoscope transmits images from the abdominal cavity to high-resolution video monitors through a digitally advanced camera system in the operating room. During the operation the surgeon watches detailed images of the abdomen on the high resolution monitor. This system allows the surgeon to perform the same operations as traditional surgery but with smaller multiple incisions.However recently single incision laparoscopic surgery is also evolved.

In certain situations a minimal access surgeon may choose to use a special type of port that is large enough to insert a hand known as Hand Port. When a hand port is used the surgical technique is called “hand assisted laparoscopic surgery". The incision required for the hand port is generally 5.5 cm and hence larger than the other laparoscopic incisions, but is usually smaller than the incision required for traditional surgery.

Advantages of laparoscopic surgery?

Compared to traditional open surgery, patients often experience less pain, an earlier recovery, and less scarring with laparoscopic surgery.

Operations which can be performed using laparoscopic surgery?

Most of the abdominal advanced surgeries can be performed using the laparoscopic technique in experienced hand. These include surgery for gallbladder, duodenal perforation, appendicitis, Crohn’s disease, ulcerative colitis, diverticulitis, cancer, rectal prolapse and severe constipation.

In the past there had been concern raised about the safety of laparoscopic surgery for radical cancer operations. But recently several studies involving hundreds of patients have shown that laparoscopic surgery is safe for certain ­colorectal cancers.

How safe is laparoscopic surgery?

Laparoscopic surgery is as very safe as traditional open surgery. At the beginning of a laparoscopic operation the laparoscope is inserted through a small incision near the umbilicus, Either superior crease or inferior crease of umbilicus. The laparoscopic surgeon initially inspects the abdomen by doing diagnostic laparoscopy to determine whether laparoscopic surgery may be safely performed.  If there is a large amount of inflammation or if the surgeon encounters other factors that is risky and prevent a clear view of the structures the surgeon may need to make a larger incision in order to complete the operation safely by converting laparoscopic surgery into open surgery.

Any intestinal or abdominal laparoscopic surgery is associated with certain risks such as complications related anaesthesia and bleeding or infectious complications. The risk of any operation is determined in part by the nature of the specific operation and hidden risk factor within the patient itself. An individual’s general health and other medical conditions are also factors that affect the risk of any operation. Patient should discuss with your surgeon your individual risk for any operation. World Laparoscopy Hospital, Gurgaon is very reach in this concern because for poor and needy patient surgery is completely free at World Laparoscopy Hospital.

Single incision laparoscopic surgery (SILS) or Single port access (SPA) surgery, also known as laparoscopic endoscopic single-site surgery (LESS), umbilical surgery (OPUS) or single port incisionless conventional equipment-utilizing surgery (SPICES) or natural orifice transumbilical surgery (NOTUS), or Embryonic Natural Orifice transumbilical surgery (E-NOTES) is an advanced minimally invasive surgical procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient’s navel. SPA surgical procedures are like many laparoscopic surgeries in that the patient is under general anaesthesia, insufflated and laparoscopic visualization is utilized.The World Laparoscopy Hospital in NCR Delhi is the first hospital in Haryana and only the third in the India to perform a single-port, natural orifice gallbladder surgery through the navel for gallbladder stone disease. During the procedure, surgeons use a single opening in the umbilicus as they manipulate a camera and two laparoscopic instruments to separate the gallbladder from its attachments in the abdomen. The gallbladder is then removed through that same opening. Only a tiny bandage is required to close the navel, and there are no scars.

Single-incision laparoscopic surgery employs the same tools and techniques as conventional laparoscopic surgery and can be used in both men and women. The only difference is a specially-designed port that accommodates the tools.

World Laparoscopy Hospital surgeons have always been leaders in minimally invasive surgery,” says Dr R K Mishra, Director of the World Laparoscopy Hospital and professor of TGO University. “This procedure signals another step forward for our nationally single incision surgery and elevates our efforts to provide the best surgical care while improving patient recovery.”

Dr. Mishra says that single incision laparoscopic surgery should not only for simple surgery like cholecystectomy but should also be used for surgery like donor nephrectomy and for donor who have already decided to give the gift of life and are willing to go through surgery to help a person in need, the possibility of coming through the surgery without scars is a secondary benefit.

This Hospital, “WORLD LAPAROSCOPY HOSPITAL” is situated in Gurgaon at Haryana near Delhi. Managing Director - Dr. R.K. Mishra one of the renowned laparoscopic surgeons of India and Prominent Citizen Delhi with the effort of World Association of Laparoscopic Surgeons has decided to perform free laparoscopic surgery for poor and needy. During the meeting with Honorable Mr. Harish Rawat Union Minister of Labor and Employment Government of India this decision was taken. Minister was the chief guest during the convocation of 120th batch of World Laparoscopy Hospital. Function was organized at India Habitat Center, New Delhi.

World Laparoscopy Hospital is the first hospital in the whole World who has taken decision to perform all the laparoscopic surgery for poor people completely free of cost. Only the cost of medicine will be taken from the patient.  World Laparoscopy Hospital is at present, 50 bed hospital with all facilities. Because this hospital is only dedicated for laparoscopic surgery and the patient need to stay in hospital only for one day so even this 50 bed only for laparoscopy is biggest bed strength dedicated for laparoscopy by any hospital in Asia.

“We are being treated with laparoscopy by the doctors here. It is being done free. In other hospitals treatment costs rupees 40,000. They ask for 3,500 rupees only for medicine. I could not work on my daily ways laborious job and hard work due to gallbladder stone earlier but now I can do” said Pritpal Singh, Patient.

Patients belonging to the below poverty line category will be treated by laparoscopic surgery now free of cost and others can avail the treatment at nominal price here at World Laparoscopy Hospital. At World Laparoscopy Hospital, financial assistance is provided to the patients living below poverty line, who are suffering from major life threatening diseases to receive laparoscopic treatment who could not receive their treatment at Govt. hospitals. The financial assistance to such patients is released in the form of ‘one time grant’ to the Medical Superintendent of the hospital in which the treatment is being received by World Association of Laparoscopic Surgeons.
Number of applications received and no. of patients to whom dree surgery have been provided under the above schemes during the last five years are now more than 950. And many hundreds has already been registered for other few month.

Any poor patient who is interested to get this free laparoscopic surgery can contact at address below:

World Laparoscopy Hospital
Cyber City, DLF Phase II, Gurgaon, NCR Delhi, 122 002, India
PHONES:
For Training: +91(0)9811416838, 9999677788, (attended in English)
For Treatment: +91(0)9811912768 (attended in English)
For General Enquiry: +91(0)12- 42351555 (attended by person speaking Hindi)
Email:contact@laparoscopyhospital.com
Website: http://www.laparoscopyhospital.com

Union Minister of India at World Laparoscopy Hospital

Convocation of batch July 2010 with Mr. Harsh Rawat Union Minister of Labour and Employment, Government of India. Mr. Rawat has congratulate Prof. R.K. Mishra for being Pioneer in the field of Laparoscopic Training.

Convocation of 120th batch at World Laparoscopy Hospital

Honorable Minister Mr. Harish Rawat has given certificate and Momento and Certificate to the surgeons and gynecologists of 12 Countries who participated in July batch of World Laparoscopy Hospital.

Dr. R.K. Mishra Director and Chief Surgeon of Laparoscopy Hospital have removed a 20-kg retroperitoneal tumour occupying entire abdominal cavity.

Mr. Chandeshwar Prasad Rai is a police inspector in Jharkhand. Surprisingly he never suffered any pain. He visited a doctor only after friends commented that his abdomen was getting unusually big and he was loosing weight. He was having protruded abdomen and ultimately he could not walk also due to heavy weight of tumor. Initially he visited many doctors and was treated for tuberculosis. Later one of the renowned surgeon of Jharkhand has examined his and referred him to All India Institute of Medical Sciences.

Retroperitoneal Tumor

Surgeon of All India Institute of Medical Sciences has done all the necessary investigation and Biopsy was performed two times to confirm type of tumour. Even after that dilemma was there. Ultimately the called the patient on 20th May to decide for surgery. Meanwhile patient came to Dr. R.K. Mishra in his Laparoscopy Hospital, New Delhi. Dr. Mishra has performed surgery without delay and life of the patient was saved.
Mr. was admitted in the hospital on 26th April and, same day surgery was performed. It was a two-and-a-half-hour complicated surgery; the mass was successfully removed by a team of Dr. R.K. Mishra, Dr. Sanjay Sharma and Dr. Anil Arora.

“It was a complicated surgery considering his age and the fact that his haemoglobin count was low,” said Dr Mishra. “Also, the tumour was retroperitoneal and surrounding aorta and both the kidney.

‘It pushed everything aside and was pressing the aorta and kidney, creating vascular and respiratory problems,’ surgeon Dr. Mishra stated. ‘The operation was complicated by the size of the tumour and during this the patient received four packages of blood transfusion.’
Tumours of that size are almost always benign, but can kill by severing circulation or increasing pressure on sensitive parts of the body.

Retroperitoneal Tumor

“It was removed from the Retroperitoneum after separating the Kidney, Spleen, Large intestine, Aorta and Vena Cava. We also repaired the bowel and other surrounding structure,” said Dr. Mishra. “We will send the tumour to the histopathology to find out if it was cancerous.”

Honorable Dr. Akhilesh Prasad Singh, Union Minister, Government of India as chief guest and Prof. Dr. P.R. Trivedi as Guest of Honour of certification ceremony of 100th batch of Laparoscopy Hospital on 13th of September 2008

Speech of Honourable Minister on the occasion of celebration of 100 th batch of Laparoscopic Training Programme of Laparoscopy Hospital on 13 th Evening at India Habitat Centre, Casurina Hall.

“I am very happy to see the Galaxy of super specialist surgeons and gynaecologists who came here from different part of India and abroad - Dr.A.P.Singh.

Laparoscopic surgery is one of the fastest growing areas in surgery today. Combining advanced technology with patient care has allowed surgeons to do more advanced surgery with less trauma to patient. Patients are experiencing less pain, shorter hospital stays, and faster recovery times than were ever imaginable 20 years ago - Dr.A.P.Singh.

Laparoscopy was previously considered as surgery of rich people but in my opinion laparoscopic surgery should be available for every citizen of India specially the poor who earn their money by hard physical work and they need more rapid recovery then rich and affluent section of society - Dr.A.P.Singh.

I am happy to know from Dr. R. K. Mishra that today Laparoscopy Hospital is celebrating the convocation of their 100 th batch of laparoscopic training course. Within last 8 year 2500 surgeons and gynaecologists has been trained in art and science of laparoscopic surgery by laparoscopy hospital. Among these 2500 surgeons 1150 surgeon are from overseas country - Dr.A.P.Singh.

Prof. Dr. R.K. Mishra Presenting the Momento to Honorable Minister of Govt. of India. Dr. A.P. Singh

It is a hard fact that only rich and middle class people can afford Laparoscopic surgery. I am very happy to know that for the poor and needy, Laparoscopy Hospital provides once a month laparoscopic surgery completely free of cost. For these patients medicines are also dispensed absolutely free of charge. There is no charge attached to any service at our hospital for these categories of patients. T his free service is provided to economically disadvantaged people irrespective of race , colour, language, class , creed, religion or region. Laparoscopy Hospital is providing these services in collaboration with World Association of Laparoscopic Surgeons - Dr.A.P.Singh.

I wish all the surgeons and gynaecologist who are present here a great success in their professional life. Much work is being done by many organizations, particularly in private-public partnerships, to ensure that lives are saved and health improved worldwide and I request all the doctors present in this gathering also to serve the poor and needy with their advanced surgical skill - Dr.A.P.Singh.

“Skilled Surgeon Safer Surgery “

Two-port laparoscopic cholecystectomy has been reported to be safe and feasible. At laparoscopy hospital New Delhi we have performed 200 cases of laparoscopic cholecystectomy within 5 years. Fist two port laparoscopic cholecystectomy was performed by Dr. R.K. Mishra in November 2002 at Laparoscopy Hospital, New Delhi. Laparoscopic two port cholecystectomy offers additional advantages over four port cholecystectomy or not remains controversial. During five year time we compared the clinical outcomes of two-port laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Two-port laparoscopic cholecystectomy resulted in less port-site pain and similar clinical outcomes as four port cholecystectomy. Two port laparoscopic cholecystectomy also offer fewer surgical scars compared to four-port laparoscopic cholecystectomy. Thus, it can be recommended as a routine procedure in elective laparoscopic cholecystectomy.

We have sent this trial to get published in World Journal of Laparoscopic Surgery. We report a prospective randomized controlled trial that compared the clinical outcomes of two-port laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy. In many previous study of the world Laparoctor were used perform two port cholecysctectomy and retraction of gallbladder was done by the long grasping forceps through the operating telescope, whereas dissection was accomplished through the 5-mm subxyphoid port. Additional 5-mm sub costal ports was used when it was found necessary.

The cystic duct and cystic artery were clipped by a 5-mm multiple clip applicator in previous studies. In our study we have used specially designed Mishra knot to perform two port cholecystectomy. The detail of this technique of performing two port can be seen at http://www.laparoscopyhospital.com/two_port_cholecystectomy.htm . Most of our patients reported high satisfaction for the surgery of two port laparoscopic cholecystectomy and the surgical scars was very much satisfactory. Compared to four port cholecystectomy there was a higher observed satisfaction score for the two-port laparoscopic cholecystectomy group, although this did not reach statistical significance? In the era of laparoscopic surgery, less postoperative pain and early recovery are major goals in order to achieve better patient care and cost-effectiveness. Several studies demonstrated that less postoperative pain was associated with reduction in either size or number of ports.

To conclude, we demonstrated in this study that two-port laparoscopic cholecystectomy is safe and has similar clinical outcomes compared to the conventional four-port laparoscopic cholecystectomy in selective cases. Since two-port laparoscopic cholecystectomy has less surgical scars, it can be recommended as a routine technique.

Laparoscopic management of early ovarian cancer is safe and effective and survival outcome is acceptable. At Laparoscopy Hospital, New Delhi Laparoscopic management of malignant ovarian tumour was performed for a Nigerian patient on 30th of August 2008. This giant ovarian tumors can be safely removed laparoscopically only by experienced laparoscopic surgeons.  According to Prof. Dr. R.K. Mishra, Director, Laparoscopy Hospital, the laparoscopic removal of giant ovarian tumors in  patient’s is preferable to removal by laparotomy. Surgical procedures for these malignant tumors of the ovary can be performed by open surgery (laparotomy) or keyhole surgery (laparoscopy) techniques. Historically, open surgery has been used, but new keyhole surgery seems attractive in that it appears to require a shorter hospital stay and there is a quicker return to normal activities for women.

The patient Mrs. Benedette I. Nwoye-Okorie With her husband  came from Nigeria to laparoscopy Hospital, New Delhi to get operated for this disease. She was having raised CA 125 marker and deranged hormonal essay. The CT findings were also towards the malignant change. One of the big proglem in dealing with the big tumour size is extraction of the tissue which is extremely difficult. The good quality commercially available endo-bag is required to extract the tumour without the risk of metastasis. The use of morcellator is also not possible in these cases because of risk of metastasis in other part of body. For extraction of the tumour of this patient Lap disc was used. This a hand port used to prevent metastasis

The practice of laparoscopic surgery for ovarian tumour is associated with benefits and harms. The minimal access surgical management of ovarian tumours is similar to that of open surgery. The procedures include resection of the tumour (enucleation), removal of an ovary or ovaries (oophorectomy), or surgical excision of the fallopian tube and ovary (salpingo-oophorectomy). The procedure can be done by open surgery (laparotomy) or keyhole surgery (laparoscopy) technique. The benefits of laparoscopic surgery include shorter hospital stay, earlier return to normal activity, and reduced postoperative pain. However, conventional laparoscopic surgery techniques required the infusion of gas carbon dioxide in the peritoneum to distend the abdomen and displace the bowel upward to create the room for surgical manipulation. Serious complications such as abnormally high levels of carbon dioxide in the circulating blood (hypercarbia) and perforation of internal organs have also been reported. These serious complications may be harmful to the patients especially if she is terminally ill.

New Delhi, India (PRnine - August 4, 2008) - This was a unique case of Mrs. Narender Kaur age about 29 years, resident of Tilak Nagar New Delhi. She was suffering from secondary infertility because of the huge fibroid inside her uterus. The huge intramural fibroid was 25cms big and 2.8 Kg in weight. It was successfully removed laparoscopically at Laparoscopy Hospital, New Delhi. There was hardly any space in abdomen to operate the same through Laparoscopy and most of the institution has refused the case of Mrs. Narender Kaur. Her husband Sardar Kultar Singh was helpless. He contacted Prof. Dr. R.K. Mishra and requested him to perform surgery. The main challenge is surgery was the bad adhesion, small built of the patient and lack of working space inside the abdominal cavity.

Dr.R.K.Mishra accepted this complicated case as a challenge and her operation was performed at Laparoscopy hospital, New Delhi on 3rd August 2008. Surgery continues for 3 hour and it was a very successful surgery. All the family members of this young women were waiting outside the operation theatre just thinking that may be surgeon will remove the uterus if something goes wrong, but surgery was a big success and without opening the abdomen and without disturbing the anatomy of uterus this fibroid was successfully removed. It requires unique skill, lot of Intracorporeal suturing skill snd experience to perform this kind of surgery. The patient is resident of L2/47 New Mahavir Nagar, Tilak Nagar, New Delhi 110018. Still today patient does not believe that this miracle was done she is cured now. News reporters from all over Delhi are coming to Laparoscopy Hospital, New Delhi to see the patient and to see her morcellated uterus that how it was removed without harming the uterus.

This was a unique case where a fibroid was 25cms big. Usually fibroids are detected 4-6 cms in size and easily removed by laparoscopy. When it is 25 cms big & intramural there is hardly any space in abdomen to operate through laparoscopy. It requires unique skill, lot of experience and expertise, instruments and equipments, setup and complete team effort. Patient ‘s husband Sardar kultarr singh had searched on internet & communicated with many Laparoscopic surgeons all over world and found Laparoscopy hospital as only institute suitable for her patient.

The tumour was removed in multiple strips with help of a unique instrument known as morcellator from a 12 millimeter cut only. The weight of tumour was 2.6 kgs. Laparoscopy Hospital is new Delhi, India based Advanced Laparoscopic Training & Treatment Institute for Excellence for most of the Gynecological Endoscopic Surgeries. Prof. Dr. R.K. Mishra is world renowned master laparoscopic surgeon. He has experience of most of the advanced Laparoscopic Surgeries with world class infrastructure at laparoscopy hospital, New Delhi, he perform many difficult & complicated laparoscopic surgeries.

Prof. Dr. R.K. Mishra is a well renowned surgeon who has made gesticulation in the field of Laparoscopic Surgery with his exceptional and unique laparoscopic skills, innovative & cost effective procedures and research. Prof. Mishra has trained more than 2500 surgeons and gynaecologists in his home country India , as well as from more than 100 countries.

Prof. Mishra is a prolific author who has published his research findings in journal articles, abstracts, textbooks, book chapters, and in editorials. Prof. Mishra is editor in chief of World Journal of Laparoscopic Surgery, an international peer reviewed publication of minimal access surgery.

Fibroid is the one of the common problems in female. Previously it was removed by a “Laparotomy” operation (cutting open the abdomen). Now, fibroids can be removed very easily and safely by laparoscopic surgery by the experienced surgeon like Dr. Mishra.