This video demonstrate For the surgeon to develop the same level of proficiency and dexterity in the endoscopic environment as he may possess in open surgery is not a simple matter. The use of proper Mishra's Knot, are essential.  Participating in an in-depth, systematic training program in a laboratory setting is essential before applying endoscopic Mishra's Knot techniques to humans. Successful acquisition of these Mishra's Knot skill requires that the surgeon be motivated to succeed and willing to invest the time and effort necessary to do so.