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Task Analysis of Laparoscopic Jejunostomy

General Surgery / Apr 3rd, 2018 12:29 pm     A⁺ | a^-

Task Analysis of Laparoscopic Jejunostomy

Dr Ismail Alnjadat

Feeding jejunostomy is done when nutritional support is needed in cases such as gastric outlet obstruction and gastric trauma.

 

Procedural steps:

1. Patient preparation

2. Abdominal access and port placement

3. Identifying the proper jejunostomy site

4. Transabdominal sutures insertion

5. Jejunostomy tube insertion

6. Jejunum and jejunostomy tube fixation

7. Ending the procedure

 

 

Patient preparation:

1. Patient is put on supine position

2. Prophylactic antibiotics are given 

3. Antithrombotic measures are provided according to the protocol

4. scrubbing with antiseptic solution and toweling

 

 

Abdominal access and port placement:

1. Veress needle is inserted in Palmer's point

2. Checking the position of Veress needle with suction, irrigation and drop test

3. Insufflation of the abdomen at rate 1L/minute to a pressure of 14mmHg

4. A 10 mm trocar is inserted at a point of crossing between the level of umbilicus and right anterior clavicular line

5. A 5 mm trocar is inserted 7 cm above the 10 mm trocar at same vertical line

6. A 5 mm trocar is inserted 7 cm below the 10 mm trocar at same vertical line

 

 

Identifying the proper jejunostomy site:

1. Identify Treitz ligament

2. Follow the jejunum distally for 30 cm

3. Mark the antimesentric border at this site(30 cm) with small stitch or methylene blue

 

 Transabdominal sutures insertion:

1. Mark a point at abdominal wall that located at left midclavicular line

at level of umbilicus. This point will be the exit of jejunostomy Tube.

2. Using No. 11 blade put 4 small skin stab incisions at 3, 6, 9 and 12 o’clock positions in relation to the proposed jejunostomy tube exit site.

3. PDS 2.0 on a straight needle is passed from the stab wound to the abdominal cavity the take a seromuscular bite from jejuna wall at the corresponding site around the mark on jejunal wall.

4. The suture then exit the abdomen from the stab wound and both ends held in hemostat (but not tied).

5. This step is repeated for all the 4 sutures at 3, 6, 9 and 12 positions.

 

 

Jejunostomy tube insertion:

1. A small stab incision is made on the skin at the mark in the middle of sutures

2. NO. 15 Cystocath with its introducer is inserted through this stab incision into abdominal cavity

3. The introducer pierces the jejunal wall at the marked area on the antimesenteric side

4. The Cystocth is advanced for 30 cm in jejunal lumen distally with the help of atraumatic grasper and pushing of the tube

5. The introducer is withdrawn from abdominal cavity 

 

 

Jejunum and jejunostomy tube fixation:

1. The previously untied 4 sutures are now tied in a way that the knots will be buried in the subcutaneous tissue

2. Two additional PDS 2.0 sutures are used to fix the jejunal wall to the surface of peritoneum 4 and 8 cm distal to jejunostomy opening

3. One stitch of PDS 2.0 is used to fix Cystocath at its exit on the surface of the abdomen 

 

 

Ending the procedure:

1. 20 cc of normal saline or diluted methylene blue is irrigated in the cystocath to check patency of the tube

2. 5 mm telescope is inserted in one of 5mm trocars and the 10mm camera port is closed under vision using suture passer

3. Ports are checked for bleeding

4. Abdomen desufflated

5. Stab incisions are closed with suture, skin stapler or glue

6. Small pieces of Airstrip are used for dressing

2 COMMENTS

Dr. Khaleed al Hashimi

#1

May 23rd, 2020 11:16 am

Thank you for the clear, concise explanation of Task Analysis of Laparoscopic Jejunostomy. You'r really good teacher: Sir your lectures always leave me breathless, thank you! Thanks for posting.

Dr. Susmita Das

#2

May 23rd, 2020 11:28 am

Thank you so much for making these Article, Thank you for the clear, concise explanation. You are really good teacher!!! I would like to join the course. Thanks for uploading this Task Analysis of Laparoscopic Jejunostomy.

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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.