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Task analysis of Laparoscopic Sacrouteropexy

Gynecology / May 26th, 2019 4:42 am     A⁺ | a^-

TASK ANALYSIS OF SACROUTEROPEXY
Dr. Ashwin Rao (D.MAS May 2019)
 

PREOPERATIVE STEPS:
 

1. History taking and clinical examination of the patient.

2. Any medical co-morbidities and absolute or relative contraindications.

3. Informed consent.

4. Pre-Surgical checklist.

 

INTRA-OPERATIVE STEPS:
 

1. Prophylactic antibiotics half an hour prior to surgery after test dose.

2. Connect patient for vital signs monitoring and EtCo2 monitor.

3. Induction with general anesthesia.

4. Patient in Trendelenburg position.

5. Preparation of surgical site.

6. Speculum and per vaginal examination.

7. Monitors for vision should be placed appropriately for the surgeon and assistants.

8. Second assistant between the legs for uterine manipulation if required.

9. Make sure that all the cables and patient return plate are properly connected and the

required energy sources are in working condition.

10. Pre operative checklist is reconfirmed.

 

PNEUMOPERITONEUM AND ENTRY:

1. The mode of entry is decided by the operating surgeon based on ergonomics and previous surgical history.

2. The target of dissection is taken as the fundus of the uterus in the prolapsed position.

3. Ports placement: Telescope is ideally at the Supra umbilical port position, accessory ports (5mm ports) are placed according to the baseball diamond principle.

 

 

PROCEDURE STEPS:

1. The mesh is sutured to the posterior uterocervical junction at the level of the uterosacral ligaments.

2. Dissection of the peritoneum over the sacral promontory.

3. Attaching the mesh to the anterior longitudinal ligament over the sacral promontory.

TASK ANALYSIS OF THE PROCEDURE:

1. First a diagnostic laparoscopy is performed in order to identify the different structures and look for other pathologies as well.

2. Bowel is swept out of the pelvis if needed. And the uterus is identified.

3. A polypropylene mesh of size 15*3 cms is prepared. 

4. The uterus is held in the anteverted position with the manipulator. 

5. The mesh is brought posterior to the uterus. An endoski needle with 1- silk or Dacron is introduced. 

6. The first bite is taken on the medial part of the left/right uterosacral ligament and the mesh is attached. The knot is secured by an extracorporeal square knot with a Clark's knot pusher.

7. Similarly, the same step is performed on the other uterosacral ligament. Hence one end of the mesh is fixed.

8. Then the assistant is asked to lift the mesh towards the anterior abdominal wall.

9. Then 2 cms above the previous stitch above the left uterosacral ligament, the next bite is taken at a depth of 1cm which includes the mesh and the posterior wall of the uterus and secured with an extracorporeal square knot.

10. Similarly a stitch is placed 2cm above the right uterosacral ligament.

11. The idea behind placing 4 knots is to create fibrosis along that path to create a neo uterosacral ligament.

12. Now the peritoneum over the right border of the sacral promontory is lifted and dissected with harmonic scalpel/ monopolar scissors. Care should be taken to cut only the peritoneum and avoid the rectum and the medial sacral artery to the left. Hence a para rectal pouch is created.

13. The para rectal pouch is approximately 6-7 cms.

14. The fascia over the sacral promontory is dissected until the anterior longitudinal ligament is seen as a pearly white structure.

15. Now the assistant again lifts the uterus by about 9cms.

16. The mesh is brought to the sacral promontory and anchored to the anterior longitudinal ligament with a tacker. Care should be taken to stabilize the tacker with both hands in order to avoid injury to the medial sacral artery.

17. Alternately an intracorporeal surgeons knot may also be taken to secure the mesh to the anterior longitudinal ligament. Note that the bite is taken longitudinally and not transversely in order to avoid injuring the medial sacral artery. The excess mesh is cut.

18. The mesh is then buried into the pouch and the peritoneum has to be sutured over it to avoid internal hernia and small bowel adhesions.

19. The suture is initiated by a Dundee jamming knot followed by continuous locking sutures. After completely covering the mesh, the suture is terminated by an Aberdeen knot. During the entire process of suturing, the peritoneum is lifted up to prevent injury to the underlying structures.

20. Hemostasis is secured and wash is given.

21. Ports are withdrawn under direct visualization, optical port is withdrawn and closed.

22. Desufflation of abdomen is done.

23. Skin incisions are sutured.

5 COMMENTS

Dr. Binita Jain

#1

May 22nd, 2020 11:08 am

Thank you! I've been looking for a compiled video of Laparoscopic Sacrouteropexy. Thank you for your detailed teaching! step of Task analysis of Laparoscopic Sacrouteropexy. Help a lot! Thanks for Posting.

Dr Vikash kumar

#2

May 22nd, 2020 11:20 am

Thank you sir for sharing such an amazing article by showing us the whole process of Task analysis of Laparoscopic Sacrouteropexy. Thanks for sharing this Article.

Dr. Chiranjeev Dev

#3

May 22nd, 2020 11:28 am

This is very educative and informative Article on Task analysis of Laparoscopic Sacrouteropexy with a clear description it's very useful for me. Thanks for sharing.

Dr. Salim Ahmed

#4

May 22nd, 2020 11:31 am

This article helps me a lot in my career, Thank you for sharing Task analysis of Task analysis of Laparoscopic Sacrouteropexy is very good too to understand. It was very interesting and educative.

De. Rakesh

#5

Apr 29th, 2021 12:56 pm

. I have learned a lot in under 10 minutes. Thanks for sharing

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How to Perform and Implement Task Analysis of Laparoscopic and Robotic Procedures

Task analysis is a critical component of any complex surgical procedure, including laparoscopic and robotic surgeries. It involves breaking down the procedure into its constituent tasks, identifying the steps, skills, and cognitive processes required. Task analysis not only enhances the understanding of these intricate surgeries but also serves as a foundation for training, skill assessment, and continuous improvement in healthcare. In this essay, we will delve into how to conduct and implement task analysis for laparoscopic and robotic procedures.

Understanding the Significance of Task Analysis

Before we explore the procedure for task analysis, it's essential to recognize why it is of paramount importance in the realm of surgery, particularly for laparoscopic and robotic procedures.

1. Enhanced Learning and Training: Task analysis helps in developing structured training programs. It breaks down complex procedures into manageable components, making it easier for trainees to learn and practice each step methodically.

2. Skill Assessment: By understanding the tasks and sub-tasks involved, it becomes possible to assess the competence of surgeons and surgical teams. This is crucial for ensuring patient safety and quality care.

3. Workflow Optimization: Task analysis can reveal inefficiencies in surgical workflows. Identifying these bottlenecks allows for process improvements, potentially reducing surgical times and enhancing outcomes.

4. Error Reduction: Recognizing potential points of error is vital for preventing surgical complications. Task analysis can highlight critical steps where errors are more likely to occur, leading to proactive measures to mitigate risks.

Procedure for Task Analysis of Laparoscopic and Robotic Procedures:

Task analysis for laparoscopic and robotic procedures involves several steps:

Step 1: Define the Surgical Procedure

Begin by clearly defining the surgical procedure you wish to analyze. Whether it's a laparoscopic cholecystectomy or a robotic prostatectomy, having a specific procedure in mind is essential.

Step 2: Gather Expert Input

Engage experts in the field, including experienced surgeons, nurses, and other surgical team members. Their input is invaluable in identifying and detailing the tasks involved.

Step 3: Identify the Tasks and Sub-Tasks

Break down the surgical procedure into tasks and sub-tasks. For instance, in a laparoscopic cholecystectomy, tasks could include trocar placement, camera insertion, gallbladder dissection, and suturing. Sub-tasks under "trocar placement" might involve choosing trocar sizes, making incisions, and inserting trocars.

Step 4: Sequence the Tasks

Establish the chronological order of tasks. Determine which tasks are dependent on others and identify any parallel processes. Sequencing tasks is essential for understanding the flow of the procedure.

Step 5: Define Task Goals and Objectives

For each task and sub-task, define the goals and objectives. What should be achieved in each step? For instance, in gallbladder dissection, the goal might be to safely detach the gallbladder from the liver while preserving nearby structures.

Step 6: Skill and Equipment Requirements

Specify the skills and equipment required for each task. Consider the level of expertise needed, such as basic laparoscopic skills or advanced robotic manipulation. Document the instruments and technology involved.

Step 7: Cognitive Processes

Identify the cognitive processes involved, such as decision-making, spatial orientation, and problem-solving. Understanding the mental aspects of surgery is critical for training and error prevention.

Step 8: Consider Variations and Complications

Acknowledge potential variations in the procedure and anticipate complications. How would the surgical team adapt if unexpected issues arise? Task analysis should encompass both the standard procedure and potential deviations.

Step 9: Develop Training and Assessment Tools

Use the task analysis results to create structured training modules. These modules should align with the identified tasks, objectives, and skill requirements. Additionally, design assessment tools to evaluate the competence of trainees and surgical teams.

Step 10: Continuous Improvement

Task analysis is not a one-time endeavor. Regularly revisit the analysis to incorporate new techniques, technology, and best practices. Continuous improvement is vital for staying at the forefront of surgical care.

Implementing Task Analysis Results:

Once task analysis is complete, it's crucial to implement the findings effectively:

1. Training Programs: Develop and deliver training programs based on the task analysis. These programs should encompass both simulation-based training and real-life surgical experience.

2. Skill Assessment: Use the assessment tools developed during task analysis to evaluate the skills of surgical teams. This can be done through structured evaluations and objective metrics.

3. Quality Improvement: Task analysis can reveal areas for process improvement. Work with the surgical team to implement changes that enhance efficiency and patient outcomes.

4. Error Prevention: Utilize the identified points of error to develop strategies for error prevention. This might involve checklists, preoperative briefings, and enhanced communication protocols.

5. Research and Innovation: Task analysis can also guide research efforts, leading to the development of new techniques and technologies that improve surgical procedures.

In conclusion, task analysis is an indispensable tool in understanding, teaching, and advancing complex surgical procedures such as laparoscopic and robotic surgeries. By meticulously dissecting each task and sub-task, identifying skill requirements, and considering cognitive processes, healthcare professionals can enhance patient safety, optimize surgical workflows, and continually improve the quality of surgical care. Task analysis is not merely an analytical exercise; it is a pathway to excellence in surgical practice.