Task Analysis of Laparoscopic and Robotic Procedures

Task Analysis for Intracorpeal Surgeons knot
General Surgery / Mar 20th, 2017 2:17 am     A+ | a-

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. Emmanuel Ashaulu
May 27th, 2020 2:52 pm
Thank you so much Dr. R. K. Mishra for this wonderful class. I am a Nigerian, I thank god for showing your lecture and videos. I was really frustrated because I watched many video s but by this video it was so clear to me. Thanks for posting.
Dr. Guo Heng (Vietnam)
May 27th, 2020 2:58 pm
Wonderful video presentation Laparoscopic Intracorporeal surgeon's knot. i don't know about others but for me your style of teaching was really wonderful in this video & you have explained it so easily & smoothly....it's really helped me...
Dr. Khaleed Nawaz
May 27th, 2020 3:14 pm
Dr. Mishra your video was very helpful and i hope sir, hear more video from u. about other's Laparoscopic Extracorporeal knot. I have watched your all video's. Really you are very amazing teacher i never seen. Thanks a lot.
Dr. Alexandru (Romania)
May 27th, 2020 3:28 pm
Thank you so much sir... I'm Romanian..Sir your explaining power is incredible..
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.
Dr. Mohammed Al- Zahrani
May 27th, 2020 3:59 pm
Excellent - studying to be a personal trainer and though these thing made sense to me in medical Field - 25 years later I really needed this lecture. Thanks so much...even your Explaining was so excellent in making the points clear. Thanks for posting this Laparoscopic Intracorporeal surgeon's knot.
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