Task Analysis of Laparoscopic and Robotic Procedures

Task Analysis of Laparoscopic Cholecystectomy
General Surgery / Aug 27th, 2017 4:42 pm     A+ | a-


1.      Laparoscopic cholecystectomy must be performed under general anesthesia
2.      checking the all devices
3.      Before starting operation surgeon must be sure all devices (insufflator, camera, light source, monitor, telescope and energy devices set up) are working.
4.      Surgeons position
5.      Operation table height must be 0.49 X surgeons height
6.      Surgeon stands left side of the table
7.      Camera assistant stands left side of the surgeon
8.      Other assistant stands opposite side for traction of fundus
9.      Surgeon, target organ and monitor should be in coaxial alignment
10.   Monitor should be placed 5 times far from the surgeon of its diagonal diameter and height should be 20 cm lower than surgeon’s eyes.
Preparation :

1.The skin is initially prepared with betadine solution from just below   the nipple line to the inguinal ligaments and laterally to the anterior superior iliac spine. The operative field is then draped with sterile drapes.


1.      One of the most important step of all laparoscopic procedures is correct and enough insufflation the abdomen with CO2.
2.      Evert umbilicus with two Alley’s  forceps  both side
3.      Make an 3 mm skin incision with no :11 blade over the lower inferior crease of umbilicus.
4.      Hold up the abdominal wall 
5.      Hold the Veress needle( 4cm + thickmess) as a dart and put on the incision
6.      Veress needle must be perpendicular  to abdominal wall
7.      Tip of the veress needle should be inserted towards rectum
8.      Push the Veress needle and pass two layers of abdominal wall( realizes 2 prick)
9.       3  confirmatory tests to be done ;a) flushing  and  aspiration b) hanging drop c) plunging . when all these confirmatory tests shows positive it indicates entered into pneumoperitoneum.
10.   Connect the CO2 tube.
11.   Enlarge the incision( 1cm) to become smiley incision for optical port
12.   Insert 10 mm trocar with screwing movements slowly
13.   Connect the gas tube to the trocar
14.   Be sure your camera’s white balance is OK 
15.   Insert the camera through the 10mm trocar
16.   30 degree camera is recommended
17.   After entering the abdominal cavity inspect all abdomen possible bleeding, injury, adhesions or other pathologies which are undefined before.


1.      A 1 cm incision approximately in the junction of upper third minimizing 2/3rd of the line between your xiphisternum and umbilicus.
2.      A 5 mm incision within the right mid-axillary line about5 - 8 cm below the rib margin.
3.      A 5 mm incision in the right mid-clavicular line about 2 cm. below the costal margin.
1.      The lateral port  is applied to the fundus and used to hold it cephalad over the dome of the liver.
2.      If  gallbladder distended extremely it must be drained with a needle.Hold the Hartman’s pouch with the medial grasper and make a traction to caudolateral.
3.      With this maneuver straighten the cystic duct (ie, retracts it at 90° from the common bile duct [CBD]) and helps protect the CBD injury. 
4.       Any adhesions are between the gallbladder and the omentum or duodenum must be dissected with energy devices.( momopolar, bipolar, harmonic).
5.      On the area of the hilum of the gallbladder it must be avoided over-dissection.
6.      All movement are must be controlled and towards down to up.
7.      After dissecting adhesions by retracting the infundibulum to the left side anterior peritoneum of gallbladder must be dissected at the level of Hartman’s pouch.
8.      Then by retracting the infundibulum to the right side dissect the posterior peritoneum.
9.      After opening both side of peritoneum there will be a window behind the infundibulum.
10.   In this bundle there is cystic duct and artery.
11.   Exposure them with meticulous dissection.
12.   After having enough space put 3 clips to the cystic duct or ligate it with extracorporeal suture
13.   Then apply 2 clips to the artery.
14.   Cut both of them with scissor or with energy device such as harmonic
15.   Hold the infundibulum again.
16.   With monopolar hook or harmonic device start the dissection to gallbladder from hepatic surface.
17.   Subsequently cut  both side of peritoneum .
18.   Make some traction to upper side.
19.   In this step be careful about some aberrant bile duct or artery.
20.   Dissect the gallbladder towards the fundus.
21.   Small oozing is controlled by fulguration.
22.   Try to avoid perforation of bladder.
23.   Before the cutting last attachment of fundus  look for bleeding of liver and clip area.
24.   If there is some clots irrigate and aspirate for better view.

Mobilization and removal of gallbladder
  • With 5-mm graspers are applied to the gallbladder and used to hold it over the right upper quadrant. . 
  • Bed of bladder and sub and suprahepatic spaces are irrigated and suctioned to ensure adequate hemostasis and removal of any debris or bile that may have spilled.
  • Gall bladder is retrieved by using endobag through epigastric port .
Port removal and closure

1.       The epigastric port   and the two 5-mm ports are removed under direct vision.
2.       The fascia is closed at the umbilical port.
3.       All of the skin incisions are closed with skin staples .
Dr. Jalal Sulaiman
May 27th, 2020 12:45 pm
Very interesting wonderful, inspiring Task Analysis of Laparoscopic Cholecystectomy surgery. It is highly educative. Thank you for sharing this expensive wealth of knowledge with us. I really really appreciate.
Dr. Phelan Reuel
May 27th, 2020 1:01 pm
I love you so much I am a medical student. Living in Russia. I got lot's of knowledge watching your videos, Lecture and reading very impressive Task ANALYSIS. You are the best Doctor ever you my best ever. Thank you so much for posting this Task Analysis of Laparoscopic Cholecystectomy.
Dr. Chang Chao
May 27th, 2020 1:08 pm
Thank you, Dr. Mishra, you saved my time such a great Task Analysis of Laparoscopic Cholecystectomy I can't express how helpful that was. It's very informative.Thank you so much . God bless you...
Dr. Daquan DA
May 27th, 2020 1:14 pm
Thank you very much for this Task Analysis of Laparoscopic Cholecystectomy! Your explanation is very clear and contains most vital knowledge about the understanding of the Cholecystectomy surgery step and you have delivered the information effectively !
Leave a Comment
Play CAPTCHA Audio
Refresh Image
* - Required fields
Older Post Home Newer Post

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.

Task Analysis of Laparoscopic Surgery

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.

In case of any problem in viewing task analysis please contact | RSS

World Laparoscopy Hospital
Cyber City
Gurugram, NCR Delhi, 122002

All Enquiries

Tel: +91 124 2351555, +91 9811416838, +91 9811912768, +91 9999677788

Need Help? Chat with us
Click one of our representatives below
Hospital Representative
I'm Online