Task Analysis for Intracorpeal Surgeons knot
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.
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