In this video, we will discuss that Continuous suturing is a fundamental technique in laparoscopic surgery, especially in procedures involving bowel anastomosis, peritoneal closure, and uterine repair. Achieving a secure start and finish to a continuous suture line is critical for maintaining tissue approximation and preventing complications such as dehiscence or bleeding. In this video, we demonstrate the use of two highly effective laparoscopic knotting techniques—the Meltzer Knot and the Mishra Knot—specifically in the context of continuous suturing. These knots offer the surgeon confidence in suture security while optimizing efficiency and minimizing intraoperative time.

What is the Meltzer Knot?

The Meltzer Knot is a reliable intracorporeal knot that offers excellent holding strength and is particularly suitable for deep spaces where direct access is limited. It is constructed within the abdominal cavity using standard laparoscopic instruments and allows the surgeon to anchor the suture line firmly at the beginning or end of a continuous suture. The locking nature of the knot helps maintain tension throughout the suture line, reducing the risk of loosening during peristalsis or tissue manipulation.

What is the Mishra Knot?

The Mishra Knot, developed by Dr. R.K. Mishra, is an advanced extracorporeal sliding knot that is delivered through a port and tightened precisely at the tissue site. It is easy to tie outside the body and slides smoothly along the suture, locking firmly once it reaches the target. In continuous suturing, the Mishra Knot is particularly useful for securing the initial bite or terminating the suture with minimal instrument exchange and without excessive force, reducing the chance of tissue trauma.

Applications in Continuous Suturing
Both knots serve critical roles in laparoscopic procedures such as:

Bowel anastomosis – to start and end the continuous suture line securely
Peritoneal closure in TAPP hernia repairs
Uterine repair post-myomectomy or cesarean section
Vaginal vault closure in TLH
Gastrointestinal suturing, especially in bariatric and colorectal surgery
Advantages of Using These Knots in Continuous Suturing
Time-saving compared to multiple interrupted sutures
Uniform tension along the entire suture line
Secure anchoring at the beginning and end of the suture
Reduced knot bulk, improving healing and reducing foreign body reaction
Adaptability in confined spaces or complex angles

Step-by-Step Demonstration in the Video In this video, we provide a side-by-side demonstration of:

How to initiate a continuous suture using the Meltzer Knot
How to secure a continuous suture using the Mishra Knot
Proper needle handling and tissue traction
Tips to avoid loosening, slippage, or knot failure
Ergonomic instrument usage to ensure precision and control

Conclusion
The Meltzer Knot and Mishra Knot are powerful tools in the laparoscopic surgeon’s skill set, especially when performing continuous suturing. Their correct application ensures suture integrity, optimizes surgical workflow, and enhances overall outcomes. Mastering these techniques is essential for surgeons aiming to perform advanced laparoscopic procedures with confidence and precision.

Watch the full video to learn the correct technique, indications, and practical applications of the Meltzer and Mishra knots in continuous laparoscopic suturing. Don’t forget to like, share, and subscribe for more educational content in Minimal Access Surgery.