Rare AIIMS Surgery Offers New Hope To 98-cm, 22-kg Woman

For severe short stature, 44-year-old Meera (name changed), even the prospect of relief from nearly a year of severe pelvic pain came with its own risks. Standing just 98 cm tall and weighing 22 kg, she was living with conditions that made both her daily life and the possibility of surgery more challenging.

Medication was no longer enough to manage her suffering. But an operation was far from straightforward. Meera had deep endometriosis and adenomyosis, conditions that can cause persistent pelvic pain. She also had severe osteoporosis, which had left her bones extremely fragile and increased the risk of fractures during surgery.

However, when she approached the doctors at the All India Institute of Medical Sciences (AIIMS), New Delhi, doctors offered her a new ray of hope as they took up the challenge, carefully planning a procedure around her individual needs.

A multidisciplinary team performed a laparoscopic hysterectomy, a minimally invasive operation to remove the uterus, in about 90 minutes. She recovered well and was discharged on the third day.

“The patient had severe osteoporosis, making her bones extremely fragile,” said Professor Dr Reeta Mahey, who led the gynaecology team along with Dr Swati Tomar.

Osteoporosis reduces bone density and makes bones more susceptible to fractures. In a patient with severe disease, even routine movements and positioning during an operation require special care. Meera's height and weight added to the complexity, requiring doctors to ensure that her body was adequately supported without putting undue pressure on her bones.

The anaesthesia team also had to account for her low body weight while planning medication doses and managing her airway. The operation therefore required close coordination between the surgical and anaesthesia teams, with precautions tailored to her physical condition.

Instead of using the conventional position often adopted for gynaecological surgery, the doctors placed her flat to minimise the risk of fractures. Pain management and other aspects of anaesthesia were also planned according to her needs.

The team opted for laparoscopic surgery, in which surgeons operate through small abdominal incisions using a camera and specialised instruments rather than making a large incision. In suitable patients, this approach can reduce surgical trauma and support recovery.

The gynaecology team included Professor Mahey and Dr Tomar, while the anaesthesia team comprised Dr Parin Lalwani and Dr Choro Athiphro Kayina. The operation was carried out under the guidance of Professor Neena Malhotra, Head of the Department of Obstetrics and Gynaecology, and Professor K Aparna Sharma.

Meera's condition involved two gynaecological disorders that can substantially affect a woman's daily life, said the doctors.

Endometriosis occurs when tissue similar to the lining of the uterus grows outside it. In deep endometriosis, this tissue can affect structures within the pelvis and cause persistent pain. At the same time, adenomyosis occurs when similar tissue grows into the muscular wall of the uterus and can lead to painful periods, heavy bleeding and pelvic discomfort.

Symptoms and their severity vary. “Treatment depends on the nature of the disease, the patient's overall health, age, symptoms and reproductive goals. Hysterectomy may be considered in selected cases when other treatments are unsuitable or have not provided adequate relief. The procedure permanently ends the possibility of carrying a pregnancy,” said Professor Dr Mahey.

Meera's recovery was encouraging. Her discharge on the third day showed that, despite the unusual challenges, carefully planned minimally invasive surgery could be undertaken successfully in a medically complex case.