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Task Analysis Of Laparoscopy Port Site Closure Using Veress Needle.

Gynecology / Jul 25th, 2019 3:47 am     A⁺ | a^-

Task Analysis Of Laparoscopy Port Site Closure Using Veress Needle

Shilpa Kulkarni

Laparoscopic port site closure is recommended to prevent port site hernias. The incidence of port-site hernia is 0.02% to 5 % with an average of 1%. For 5mm port the incidence of hernia is 0.25%, 10 mm is 0.5%-2%, 12mm is 5%, 15mm is 20%. Thus, the recommendation is all ports greater than 10mm midline or lateral should be closed at a fascial level under laparoscopic vision.

There are many methods of port closure, the choice of method will depend on the individual patient characteristics, number, and size of ports and the surgeon’s preference. Closure using veress needle is quick, easy to perform, safe, inexpensive and provide adequate closure of fascia and peritoneum. 
 

Parts of veress needle: Veress needle consists of an outer cannula with beveled needlepoint for cutting through the tissue and inner stylet loaded with spring. For port site closure we use the outer cannula of the veress needle. Suture material used are delayed absorbable or non-absorbable monofilament like proline.
 

Steps are as follows:
 

1. Remove the stylet from the cannula of veress needle.

2. Pass a suture material through the cannula from the tip to get it out from the other end.

3. Tie both the ends together to form a loop and hide the knot in the cannula.

4. Take another suture material which will be used to close the port site, pass about 2cms of this suture through the same cannula tip.

5. Now hold the veress needle with both suture materials like a dart, now verees needle is ready to be used for closure. 

6. Occlude the port site with a gloved finger or keep the cannula in situ to maintain the pneumoperitoneum.

7. Now take the prepared veress needle, hold it like a dart and pierce at 30-450 angle beside the gloved finger or the cannula, within the upper edge of the incision, from subcutaneous tissue through layers of the abdomen into the peritoneal cavity under laparoscopic vision.

8. Once the tip is inside the peritoneal cavity, the suture is released by retracting the verees needle with a finger pressed over the suture on the abdominal wall, so that suture does not retract with veress.

9. Next veress needle is passed similarly through the opposite side of incision 1800 from the initial insertion site. Entangle the suture left in the abdomen in the loop of veress needle.

10. Tighten the loop of verses and retract the veress needle along with the suture. 

11. So, the two ends of the suture are outside the abdominal cavity now.

12. A gloved finger from the port site is removed, pneumoperitoneum is released completely, then the suture ends are tied.

13. Thus, the port site incision is closed including peritoneum and fascia.

5 COMMENTS

Dr. Ganshyam Purkayastya

#1

May 22nd, 2020 9:42 am

I'm Amazed! Everything is clearly discussed with this article, your way of teaching is just excellent. Thanks for uploading of Amazing and informative Task Analysis of Laparoscopy Port Site Closure Using Veress Needle.

Dr. Susmita Tripati

#2

May 22nd, 2020 9:46 am

Very enthusiastic teacher with good presentation skills. This is a very educative and informative Article of Task Analysis of Laparoscopy Port Site Closure Using Veress Needle. Thanks for uploading.

Dr. Sumona Chakravarti

#3

May 22nd, 2020 9:55 am

Thank you for changing my mindset. it's amazing, and i really appreciate such a teaching skills..very useful. Thanks for the Task Analysis of Laparoscopy Port Site Closure Using Veress Needle.

Dr. Kushal Punjabi

#4

May 22nd, 2020 9:58 am

Very nice article sir.Thanks for sharing this Task Analysis of Laparoscopy Port Site Closure Using Veress Needle. It's very helpful.

Dr. Jitender Singh Chowhan

#5

May 22nd, 2020 10:05 am

Wonderful Task Analysis of Laparoscopy Port Site Closure Using Veress Needle.It's very useful for Laparoscopic Surgeon's and Gynaecologist. This is a very educative and informative Article.
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.