1) Cutting the suture 20 cm
2) Inserting the Maryland in the reducer
3) Holding the suture in the middle
4) Hiding in the reducer
5) Inserting in the abdomen with the reducer
6) Dropping over the tissue in a way that tip should be left and the tail should be right
7) Align the needle by the following three techniques
a) Pressing the needle by upper jaw of the needle holder at the junction of one third and two third.
b) Holding the needle by left hand at the curvature and pulling the suture up near the needle by the right hand
c) Hang the needle by left hand like a pendulum and go with the open jaw of the needle holder keeping the moving jaw to the left and dragging it to the right
8) Stabilize the tissue by the left hand and prick the tissue by the needle and by rotating the tip of needle to keep it perpendicular to the tissue.
9) Bringing the tip of the needle 1/3rd out and catch it with left hand instrument and keeping the convex end of the instrument towards the tissue.
10) Guard the tissue by the needle holder keeping concave part towards the tissue and pulling the needle by left hand instrument
11) Hold the suture by the needle holder as soon as needle is out
12) Guard the suture by the Maryland and pull the suture by needle holder to make a tail of 2cm
13) A “C” shape will form and keep the left hand instrument above and in the centre of the “C”.
14) Bring the tip of the needle holder near the tip of the Maryland and rotate the needle holder to make a loop.
15) Keep the Maryland static and take two loose wrap by the needle holder.
16) Move both the instrument together, to catch the tail by the Maryland.
17) After catching the tail don’t pull the tail but move the needle holder towards the tip of the Maryland
18) Drop the suture away from the Maryland and come again to catch the needle end of the suture near the knot and tie the first knot.
19) Catch the suture now with left hand to make a reverse “C”.
20) Now keep the needle holder static in the centre and above of the reverse “C”.
21) Hold the suture with Maryland and bring the tip of the Maryland near the tip of needle holder
22) Rotate the Maryland to make a loop
23) Needle holder will be static and Maryland will take a single wrap
24) Needle holder will catch the tail but the tail should not be pulled.
25) Maryland will slide the loop in direction of the tip of the needle holder
26) Maryland will drop the suture away from the knot and will come again to hold the suture near the knot.
27) Needle holder and Maryland will move away from each other in tissue plane to tie the second knot.
28) Suture will be held again by the needle holder to make a “C”.
29) Maryland will be static in the centre and above of the “C”
30) Needle holder will come near the tip of the Maryland with the suture and will be rotated to make a loop.
31) Needle holder will move around the tip of Maryland to take a single wrap.
32) Maryland will hold the tail and needle holder will slide the wrap in the direction of the tip of the Maryland.
33) Needle holder will leave the suture away from the knot and come again to catch the suture near the knot.
34) Needle holder and Maryland by holding the suture will move in the opposite direction to tight the last knot in the tissue plane.
35) Hold the needle end of the suture with the Maryland and remove the needle holder.
36) Introduce the scissor in the right port and cut the suture.
37) Hide the suture in the reducer by pulling the Maryland and pull Maryland and the reducer together out.
38) Push the Maryland to eject the needle.
Dr. Mishra I’m trying to learn knoting again. I learned it. I watched many other videos so confusing, I came across your videos. Your are wonderful teacher so clear speaking your hand writing your drawing and the video itself clear. All I want to say thank you so much may God bless you for this wonderful work you do It is so beautiful you passing your knowledge to us. I thank you and ask God to give you long healthy happy life.
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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.
