Gynecological Surgery
DR CHISOKO ERNEST CHIPAMPE
MMed OBGY, FMAS, DMAS
PROCEDURE STEPS
- The client is identified and make sure that consent is obtained.
- The client should not have taken solid food the night before and laxatives were given.
- Check the equipment is in good working condition, the insufflators, light source, HD camera,10 mm, 30degrees telescope, 7 parameter monitor, LCD monitor, energy source, 10 mm trocar, 5 mm trocar, ring applicator, rings, cone and ring pusher.
- General or local anesthesia can be given depending on the anesthetist.
- Insert number 14 folys catheter or you could have told the client to void before.
- The surgeon scrub and wear sterile surgical gloves.
- The client is put is supine position ( lithotomy) with 15 degrees head down.
- Antiseptic is applied on clients abdominal wall from nipple level to pubic symphysis and draped.
- The surgeon stands on the left side of the patient in coaxial alignment with the target organ (tubes) and monitor, which is at a distance of 5 times its diameter. The table height is 4.9 times the height of the surgeon in cms.
- The assistant stands on the right side of the surgeon and the scrub nurse stands at the left side of the surgeon.
- Infiltrate 5-10mls of xylocain around the umbilicus.
- Make a 2mm incision with blade number 11 in the lower crease of umbilicus.
- Check the verse needle for patency and spring action.
- Hold the verse needle like a dart in the right hand; add 4 cms to the thickness of the abdominal wall for needle tenting.
- Lift the abdominal wall with left fingers and punch the abdominal wall at the incision at 90 degrees and 45 degrees to clients body , directing the needle towards the anus.
- 2 click sounds is heard for perforating the rectus sheath and peritoneum.
- Check the irrigation , sucking and hanging drop test for correct needle positioning.
- Switch the insufflator on and connect to the verse needle.
- Check flow rate not to exceed 1.5L/min and that the actual pressure is parallel to the gas used.
- When actual pressure is equal to preset pressure, remove the verse needle.
- Increase the verse needle punch site by making a smiling incision in the lower crease.
- Dissect with a mosquito artery forceps to separate the rectus sheath and dilate the vitalointestinal duct.
- Hold the 10 mm trocar like a pistol in the right hand with the index finger pointing forwards half way the trocar and make screwing movement’s perpendicular to the abdominal wall. 1 click sound will be heard with the whooshing sounds.
- Connect to the insufflator and close the valve for continuous pneumoperitonuem.
- Focusing the telescope at 10 cm distance and do white balancing.
- Insert the 10 mm 30 degrees telescope through the 10 mm port.
- Make a 2 mm incision, 7.5 cm to lateral left side of telescope and insert through a 5 mm trocar according to the baseball diamond theory under vision.
- Do diagnostic laparoscopy , starting from the caecum going clockwise up to the right hepatic flexure, the reverse trendelenbege position for inspection from the right lobe of liver to the pelvic organs.
- Put the ring cone over the ring applicator.
- Put the ring over the tip of the cone and push it with the ring pusher.
- Insert the ring applicator through the 5 mm port with the jaws inside.
- Move the applicator to the posterior of the uterus and move laterally to hang the tube.
- Drop the tube and open the jaws of the applicator.
- Hang the tube 2 cm lateral to the uterus in the lower jaw.
- Close the jaws of the applicator closer to the tube and not stretching the tube.
- Fire the applicator and wait for 5 seconds.
- Rotate the applicator slightly to release it from the tube.
- Check the ring placement.
- Do the same on the other side.
- Remove the applicator from the port and the 5 mm trocar.
- Inspect the abdominal cavity with the telescope.
- Deflate the abdomen gradually after disconnecting the insufflator.
- Remove the 10 mm trocar with the telescope.
- Document the all procedure.
Sterilization.
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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.
