Description

The fundus-first, or top-down approach of cholecystectomy, is an important alternative technique in laparoscopic gallbladder surgery, particularly when conventional dissection from Calot’s triangle is difficult or unsafe. In this educational surgical video from World Laparoscopy Hospital (WLH), the technique of performing cholecystectomy using the fundus-first approach is demonstrated with special emphasis on Mishra’s Knot and controlled laparoscopic tissue handling. In the fundus-first technique, the surgeon begins dissection at the gallbladder fundus and progresses gradually toward the neck of the gallbladder. This top-down direction can provide an alternative surgical strategy in selected difficult cases where inflammation, adhesions, distorted anatomy, or dense fibrosis makes initial dissection around the hepatocystic triangle challenging. Careful identification of anatomical structures remains essential throughout the procedure. The video also highlights the application of Mishra’s Knot, an intracorporeal laparoscopic knotting technique associated with secure tissue approximation and ligation. Proper knot construction, instrument coordination, traction, counter-traction, and precise laparoscopic movements are important components of advanced minimally invasive surgery. This educational demonstration is valuable for surgeons, gynecologists, trainees, and medical professionals interested in improving their understanding of advanced laparoscopic techniques. The procedure emphasizes systematic dissection, anatomical orientation, safe energy use, effective tissue handling, and appropriate surgical decision-making. At World Laparoscopy Hospital, surgeons receive structured exposure to minimally invasive surgery through lectures, demonstrations, hands-on training, and advanced laparoscopic surgical education. This video provides an opportunity to observe the principles of the fundus-first approach and the practical use of Mishra’s Knot in laparoscopic cholecystectomy.