This detailed surgical video from World Laparoscopy Hospital (WLH) presents the principles of the top-down or fundus-first approach to laparoscopic cholecystectomy, demonstrating an alternative direction of gallbladder dissection along with the use of Mishra’s Knot. The technique is an important part of advanced laparoscopic surgery and can be considered in appropriately selected cases where standard dissection may be technically challenging.

The fundus-first approach involves mobilizing the gallbladder beginning from its fundus and continuing progressively toward the gallbladder neck. This approach changes the direction of dissection and may be particularly useful when severe inflammation, adhesions, fibrosis, or difficult anatomy makes early dissection in the Calot’s triangle region problematic. As with any laparoscopic procedure, the surgeon must maintain continuous awareness of anatomy and use careful dissection to avoid injury to surrounding structures.

A key educational component of this demonstration is Mishra’s Knot, showcasing laparoscopic knot-tying skills and controlled intracorporeal suturing techniques. Mastery of laparoscopic knots requires precise manipulation, appropriate tension, coordinated movements, and consistent visualization. These skills are essential for surgeons developing advanced minimally invasive surgical expertise.

The video provides valuable learning material for laparoscopic surgeons and surgical trainees who want to understand different approaches to gallbladder surgery. It demonstrates how surgical strategy can be adapted according to operative findings while maintaining the fundamental principles of anatomical identification, safe dissection, hemostasis, and controlled tissue handling.

Through its surgical training programs and academic activities, World Laparoscopy Hospital provides opportunities for doctors to study and practice advanced minimally invasive surgical techniques. This demonstration of fundus-first cholecystectomy and Mishra’s Knot can serve as an educational reference for understanding alternative dissection strategies and laparoscopic knotting principles.