Description

Total laparoscopic hysterectomy (TLH) has transformed gynecologic surgery by offering minimally invasive options with reduced pain, shorter hospital stays, and faster recovery. A critical component of TLH is secure tissue approximation and hemostasis, which ensures patient safety and surgical efficiency. In this context, Mishra's Knot has emerged as a highly effective and reliable knotting technique, specifically designed for laparoscopic procedures. What is Mishra's Knot? Mishra's Knot is a specialized laparoscopic knot technique developed by Dr. R. K. Mishra, a pioneer in minimally invasive gynecologic surgery. Unlike conventional laparoscopic knots, Mishra's Knot is designed for ease of application, superior tensile strength, and secure ligation of vascular and uterine pedicles. Advantages in Total Laparoscopic Hysterectomy: Enhanced Security: The knot ensures minimal slippage, reducing the risk of postoperative bleeding. This is particularly important for securing the uterine arteries and supporting ligaments during TLH. Time Efficiency: Mishra's Knot is easier and quicker to tie compared to traditional intracorporeal or extracorporeal knots, reducing overall operative time. Reduced Instrument Manipulation: The technique minimizes unnecessary handling of tissue and instruments, decreasing the risk of trauma and adhesions. Versatility: It can be applied to a variety of tissue types including vascular pedicles, ligaments, and soft tissues, making it ideal for complex hysterectomies. Learning Curve: The method is designed for simplicity, making it accessible for both experienced laparoscopic surgeons and trainees under supervision, thereby standardizing safe knotting practices. Clinical Impact: Incorporating Mishra's Knot in TLH has demonstrated improved hemostasis, reduced operative complications, and enhanced overall surgical outcomes. Surgeons at centers specializing in minimally invasive gynecology, such as the World Laparoscopy Hospital, have successfully adopted this knot in routine hysterectomy procedures with excellent results. Conclusion: Mishra's Knot represents a significant advancement in laparoscopic suturing techniques. Its security, simplicity, and versatility make it the ideal choice for total laparoscopic hysterectomy, offering both surgeons and patients greater confidence in surgical outcomes. Mastery of this knot is now considered an essential skill for gynecologic surgeons specializing in minimally invasive procedures.