In the present era of laparoscopy and its everexpanding application to various different types of surgeries, the art of suturing and knotting still plays a pivotal role in determining the success of any surgery as in case of open surgeries. Despite the introduction of various energy sources as an alternative to suturing and knotting, the various complications associated with them and the cost limitations have to be considered.

Extracorporeal and intracorporeal knotting in laparoscopic surgery can be used in various situations and though it can be technically demanding, it can be overcome with repeated practice. Here we describe a new technique of knot which is simple, easy, and a safe extracorporeal knotting technique which can be used for any continuous tubular structure up to a maximum diameter of 22 mm. This technique was introduced by Professor and Doctor Mishra who has himself worked upon it in the last 2 years after trying various other knots and modifying them to achieve better security.

Mishra's knot is a modification of the Roeder's knot or the Meltzer's knot. It's a relative simple technique where we use 3 hitches and 3 loops alternating each other. The modification aims to achieve better knot security by application of a lock after every wind.

A literature review was performed using PubMed, SpringerLink, HighWire Press and search engines like Google and Yahoo. The following search terms were used: Extracorporeal knot, Roeder's knot, Meltzer's knot, Mishra's knot. A total of more than 300 citations were found. Selected papers were screened for further references according to our requirements.

A list of 280 surgeries where Mishra's knot was successfully used was given to us for study purpose by Professor Dr RK Mishra.

“This is a very simple and safe technique and has been successfully followed in more than 300 cases for tying an extracorporeal knot. It's a very safe and reliable knot even for the critical structures like cystic duct, uterine artery, and various arteries and we observed it to be very secure.”

Mishra RK, Koruth S, Reshme N. Role of Mishra's Knots in Various Surgeries in Laparoscopy. World J Lap Surg 2016;9(3):114-117.