In this video, we will discuss that In laparoscopic surgery, achieving reliable and secure knotting is essential for controlling bleeding, closing pedicles, and maintaining tissue approximation. The Extra Corporeal Mishra's Knot, developed by Prof. Dr. R.K. Mishra, is a highly effective technique that combines simplicity, strength, and safety, making it a preferred choice among minimal access surgeons worldwide. This video, titled "Extra Corporeal Mishra's Knot: A Strong and Secure Ligature Technique in Laparoscopic Surgery," provides a step-by-step guide to mastering this knot and understanding its practical applications.

What is the Mishra's Knot?

The Mishra's Knot is an extracorporeal knot designed for laparoscopic use. It is tied outside the body and introduced into the peritoneal cavity using a knot pusher. The knot features a unique configuration of locking throws that prevents loosening and ensures firm ligature even under traction or in moist environments. Its robust locking mechanism offers enhanced security, particularly for high-tension tissue ligation, such as vascular pedicles and organ bases.

Key Highlights Demonstrated in the Video

Knot Construction

The video clearly illustrates how to form the Mishra's Knot using a long suture. The knot typically consists of two half hitches in opposite directions, followed by additional locking throws to ensure security.

Knot Deployment Technique

Using a standard laparoscopic knot pusher, the completed knot is guided down the trocar into the abdominal cavity and cinched tightly over the targeted structure.

Application on Surgical Structures

The video demonstrates its use on appendiceal stumps, cystic ducts, mesenteric vessels, and tubal structures, showing its versatility and reliability across various laparoscopic procedures.

Clinical Applications of the Mishra's Knot

Laparoscopic appendectomy for base closure
Tubal ligation in sterilization procedures
Cystic duct or artery ligation in cholecystectomy
Mesenteric vessel control in bowel surgery
Hernia sac ligation and other general surgical ligatures

Advantages of the Extra Corporeal Mishra’s Knot

Strong and secure under high tension
Easy to learn and replicate, ideal for training
Cost-effective alternative to endoloops or staplers
Minimally invasive with a 5mm port

Suitable for resource-limited settings where advanced devices may not be available

Conclusion

The Extra Corporeal Mishra's Knot is a tried-and-tested knotting technique that enhances the surgeon’s ability to manage tissue securely and safely during laparoscopic surgery. Its simplicity, reproducibility, and reliability make it a critical component of the laparoscopic surgeon's skillset. Whether you are a trainee or an experienced surgeon, mastering this knot can greatly enhance your procedural confidence and outcome.

Watch the full video to learn the technique step by step and add the Extra Corporeal Mishra’s Knot to your laparoscopic toolbox. Don’t forget to like, comment, and subscribe for more surgical education from World Laparoscopy Hospital.