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WJOLS

Role of Mishra’s Knots in Various Surgeries in Laparoscopy
Wrapping limb: The free portion of the suture limb that compound sliding knots. They can be used in situations
wraps around the postlimb. where the suture slides smoothly and freely through the
Effective knot: Possesses the attributes of both knot secu­ tissue and anchoring device. They are advantageous since
rity and loop security. compound sliding knots can be made to slide down the
Knot security: The effectiveness of a knot to resist slippage postlimb without unraveling or jamming prematurely.
when load is applied. Theoretical disadvantages include abrasion of suture
Loop security: The ability of a knot to maintain a tight against the anchor eyelet, and suture cutting through
suture loop as a knot is tied. 3,7,8 tissue as it slides. 4,9,10
Mishra’s knot is one important extracorporeal knot
that combines the loop and knot securities of many other
TECHNIQUE
extracorporeal knot that is fast gaining wide acceptance by
More than one turn of the wrapping limb around the post many laparoscopic surgeons. The steps in tying Mishra’s
(i.e., any sliding knot other than a half hitch) is there for knot is highlighted in Figures 1 to 10.

Fig. 1: Use assistants finger to form a knot Fig. 2: Shorter hand to be placed over longer hand

Fig. 3: Take half hitch on the right side Fig. 4: Take one wind

Fig. 5: Complete the wind Fig. 6: Take second half lock
World Journal of Laparoscopic Surgery, September-December 2016;9(3):114-117 115