Advancements in Single-Port Surgery: The Integration of Mishra's Knot and ICG for Dual Procedures

Introduction:
Single-port surgery, also known as laparoendoscopic single-site surgery (LESS), has emerged as a promising approach in the field of minimally invasive surgery. It offers the advantages of reduced scarring, decreased postoperative pain, and faster recovery times compared to traditional multi-port laparoscopic techniques. In recent years, the integration of innovative techniques such as Mishra's Knot and indocyanine green (ICG) fluorescence imaging has further enhanced the efficacy and safety of single-port procedures, allowing for dual procedures to be performed with greater precision and efficiency.

Mishra's Knot Technique:
Mishra's Knot, developed by Dr. R.K. Mishra, is a novel technique that facilitates the secure approximation and ligation of tissues during laparoscopic surgery. Unlike conventional knot-tying methods, Mishra's Knot employs a series of loops and twists to create a secure knot within the confined space of a single port. This technique enables surgeons to perform intricate procedures with improved dexterity and maneuverability, thereby reducing the risk of complications such as bleeding and tissue damage.

The key advantages of Mishra's Knot technique include:

1. Enhanced precision: Mishra's Knot allows for precise control over knot placement and tension, ensuring optimal tissue approximation and hemostasis.
2. Reduced operative time: By streamlining the knot-tying process, Mishra's Knot helps to minimize surgical time, leading to shorter overall procedure durations.
3. Minimized tissue trauma: The gentle handling of tissues afforded by Mishra's Knot reduces the risk of tissue trauma and postoperative complications, promoting faster recovery for patients.

Integration of ICG Fluorescence Imaging:
Indocyanine green (ICG) fluorescence imaging is a cutting-edge technology that utilizes the near-infrared fluorescence properties of ICG dye to visualize vascular structures and tissue perfusion in real-time. By injecting ICG dye intravenously, surgeons can accurately identify blood vessels, lymphatic channels, and tissue perfusion patterns during surgery, thereby enhancing surgical precision and reducing the risk of inadvertent injury.

The integration of Mishra's Knot and ICG fluorescence imaging in single-port surgery offers several synergistic benefits:

1. Enhanced visualization: ICG fluorescence imaging provides surgeons with real-time visual feedback on tissue perfusion and vascular anatomy, complementing the precise tissue approximation achieved with Mishra's Knot.
2. Improved safety: By identifying vital structures such as blood vessels and bile ducts, ICG fluorescence imaging helps to minimize the risk of intraoperative complications, such as vascular injury or bile duct damage.
3. Facilitated dual procedures: The combination of Mishra's Knot and ICG fluorescence imaging enables surgeons to perform complex dual procedures, such as cholecystectomy and hepatectomy, with greater confidence and efficiency.

Clinical Applications and Future Directions:
The integration of Mishra's Knot and ICG fluorescence imaging has broadened the scope of single-port surgery, enabling the performance of increasingly complex procedures with minimally invasive techniques. From gastrointestinal surgeries to gynecological procedures, the synergistic benefits of these innovative techniques hold promise for improving patient outcomes and advancing the field of minimally invasive surgery.

In the future, further refinements in instrumentation and imaging technology may enhance the applicability and efficacy of single-port surgery with Mishra's Knot and ICG fluorescence imaging. Additionally, ongoing research efforts aimed at optimizing surgical techniques and patient selection criteria will continue to drive innovation in the field, ultimately improving the accessibility and outcomes of minimally invasive procedures.

Conclusion:
Single-port surgery with Mishra's Knot and ICG fluorescence imaging represents a significant advancement in the field of minimally invasive surgery, offering enhanced precision, safety, and efficiency for a wide range of surgical procedures. By integrating innovative techniques and technologies, surgeons can perform dual procedures with greater confidence and effectiveness, ultimately improving patient outcomes and advancing the standard of care in modern surgical practice.