A 44-year-old woman weighing just 22 kg underwent successful laparoscopic hysterectomy despite severe osteoporosis, hypertension, and complex pelvic disease, highlighting the importance of individualized surgical planning in patients with unusual anatomical and physiological challenges. The patient from Delhi, who stands 98 cm tall, had experienced severe dysmenorrhea for nearly a year, significantly affecting her daily activities and prompting frequent use of painkillers. Investigations revealed deep pelvic endometriosis and adenomyosis.

Given her age and comorbidities, hormonal therapy was considered unsuitable, leading the treating team to opt for hysterectomy. A multidisciplinary team involving obstetrics and gynecology, endocrinology, and anesthesiology evaluated the feasibility of minimally invasive surgery. Severe osteoporosis presented a major concern, particularly during…