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Knotting and suturing is a must-learn skills 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.

Laparoscopic Myomectomy for Pedunculated Myoma Using Mishra's Knot

Laparoscopic myomectomy is a minimally invasive surgical procedure used to remove uterine fibroids (myomas) while preserving the uterus. Among the various types of fibroids, pedunculated myomas, which are attached to the uterus via a stalk (pedicle), present a unique surgical challenge. One of the most effective techniques for securing and excising pedunculated myomas laparoscopically is the Mishra's Knot—a specialized extracorporeal knot used for secure hemostasis.

Understanding Pedunculated Myomas

Pedunculated myomas are fibroids that grow on a stalk either inside the uterine cavity (submucosal) or outside the uterus (subserosal). They may cause symptoms such as pelvic pain, abnormal bleeding, or pressure effects on surrounding organs. Laparoscopic removal is preferred due to its minimal invasiveness, shorter recovery time, and reduced risk of complications compared to open surgery.

Mishra’s Knot: A Reliable Hemostatic Technique

Mishra’s Knot is a type of extracorporeal slip knot that provides strong and reliable hemostasis during laparoscopic procedures. It is particularly advantageous in laparoscopic myomectomy for pedunculated fibroids because:

1. Secure Ligation: The knot effectively seals the vascular pedicle, minimizing the risk of bleeding.
2. Ease of Application: It can be tied with a single hand and adjusted to achieve optimal tension.
3. Reduced Operative Time: Quick and efficient knot-tying reduces surgery duration.
4. Lower Risk of Recurrence: Proper ligation of the pedicle prevents regrowth or residual fibroid tissue.

Laparoscopic Myomectomy Procedure Using Mishra’s Knot

1. Patient Preparation: The patient undergoes general anesthesia, and the abdomen is insufflated with CO₂ for optimal visualization.
2. Trocar Placement: A standard laparoscopic setup is used with ports for a camera and surgical instruments.
3. Identification of the Myoma: The pedunculated fibroid is located, and its vascular supply is assessed.
4. Application of Mishra’s Knot:
   • A suture loop is introduced through a trocar.
   • The knot is positioned around the fibroid’s pedicle and tightened extracorporeally.
   • The suture is securely locked to prevent slippage.
5. Excision of the Myoma: After ensuring hemostasis, the fibroid is excised using laparoscopic scissors or an energy device.
6. Extraction: The fibroid is removed through a small incision using a morcellator or an endoscopic bag.
7. Hemostasis and Closure: The pedicle is checked for any bleeding, and the abdomen is closed in layers.

Advantages of Using Mishra’s Knot in Laparoscopic Myomectomy

• Reduced Blood Loss: Effective vessel sealing reduces intraoperative bleeding.
• Enhanced Safety: Minimizes the risk of delayed hemorrhage or stump necrosis.
• Faster Recovery: Smaller incisions and precise hemostasis promote quicker healing.
• Minimal Scarring: Compared to open surgery, laparoscopic techniques leave minimal scars.

Conclusion

Laparoscopic myomectomy for pedunculated myomas using Mishra’s Knot is an efficient and safe surgical approach. The technique provides superior hemostasis, shortens operative time, and enhances patient recovery. As laparoscopic skills continue to evolve, incorporating reliable knot-tying techniques like Mishra’s Knot can further refine the precision and safety of myomectomy procedures. 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.

For more information please contact:
World Laparoscopy Hospital
Cyber City, Gurugram, NCR DELHI
 INDIA 122002
Phone & WhatsApp: +919811416838, + 91 9999677788