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Knotting and suturing is a must-learn skill for any laparoscopic surgeon, gynecologist, or urologist. Without knotting skills, one can not expect to perform advanced surgery. Prof. Mishra's Mishra Knot was published in the World Journal of Laparoscopic Surgery in 2007 and since then hundreds of surgeons all over the world is using this knot. CONCLUSION: Extracorporeal Mishra's Knot and Tayside Knot can tolerate better distraction forces and thus have higher median Knot Quality Score scores compared with Roeder's knots.

Laparoscopic myomectomy is an advanced minimally invasive surgical procedure performed to remove uterine fibroids while preserving the uterus. At World Laparoscopy Hospital, surgeons are trained in innovative suturing and hemostatic techniques that improve surgical safety and outcomes. One such technique is Mishra’s Knot, developed and popularized by Dr. R. K. Mishra, which is widely used for secure intracorporeal knotting and bleeding control.

Understanding Pedunculated Myoma

A pedunculated myoma is a type of fibroid attached to the uterus by a thin stalk (pedicle). These fibroids can cause symptoms such as pelvic pain, abnormal bleeding, pressure symptoms, and sometimes infertility. Because of their stalk-like attachment, pedunculated fibroids are often ideal candidates for laparoscopic removal.

Surgical Technique Overview

During laparoscopic myomectomy for pedunculated myoma, small incisions are made in the abdomen to insert a laparoscope and specialized instruments. The fibroid stalk is carefully identified, coagulated, and then cut. The main challenge in such cases is achieving secure hemostasis at the base of the pedicle to prevent bleeding.

This is where Mishra’s Knot plays a vital role. It is a modified extracorporeal sliding knot technique that allows surgeons to:

• Achieve strong tissue approximation

• Maintain excellent tension control

• Reduce operative bleeding

• Decrease suturing time

Advantages of Mishra’s Knot in Laparoscopic Myomectomy

The application of Mishra’s Knot offers several clinical advantages:

• Reliable hemostasis at the pedicle base

• Easy learning curve for laparoscopic surgeons

• Reduced need for excessive electrocautery

• Preservation of surrounding healthy uterine tissue

• Better postoperative healing

Patient Benefits

Patients undergoing laparoscopic myomectomy with advanced knotting techniques experience:

• Minimal postoperative pain

• Smaller scars

• Faster recovery and early return to daily activities

• Lower risk of adhesions compared to open surgery

Training and Excellence at WLH

At World Laparoscopy Hospital, surgeons receive structured hands-on training in advanced laparoscopic suturing and knotting techniques, including Mishra’s Knot. The institution focuses on evidence-based surgical practice combined with innovative teaching methods to produce globally competent laparoscopic surgeons.

Conclusion

Laparoscopic myomectomy for pedunculated myoma using Mishra’s Knot represents a significant advancement in minimally invasive gynecological surgery. With precise surgical technique, reliable knot security, and excellent hemostatic control, this approach ensures safer surgery and better patient outcomes. The continued teaching and refinement of such techniques at leading training centers help raise global surgical standards.