Task Analysis of Laparoscopic and Robotic Procedures

Task Analysis of Laparoscopic Splenectomy
General Surgery / Sep 1st, 2017 2:03 am     A+ | a-
Dr.Tejasvi Kumar.C
Assistant Professor/Lecturer
KIMS, Bangalore
Task Analysis of Laparoscopic Splenectomy
  • Idiopathic Thrombocyotopenic Purport
  • Autoimmune Haemolytic Anemia
  • Microspherocytosis
  • Benign tumours and cysts
  • AIDS-related thrombocytopenia
  • Massive Splenomegaly
  • Portal Hypertension
 Preoperative Preparation 
  • Vaccines - Pneumococcal , Haemophilus influenza, Neisseria meningitidis ideally two weeks prior to surgery or post operatively. 
  • Blood and platelet transfusion if needed and arrange blood.
  • General anaesthesia with endotracheal intubation is required.
  • Two large IV catheters.
  • Foleys catheter and Nasogastric tube. 
Patient Position  
  • Patient placed in right lateral position and left arm crossing chest and lying on right arm.
  • Left hip and chest are elevated with pillows, leaving the flank area open and the left knee flexed, with a padding o blankets between the legs. 
  • The patients secured across the chest and hips to the table with wide adhesive tape,as the operating room table will be tilted.
Operation room check list
  • Monopolar cautery check done along with patient end plate and Hormonic scalpel checks done. 
  •  Coaxial alignment of surgeon, target and monitor checked. 
  • Camera connected, white balancing and focusing done. 
  • Co2 cylinder checked for sufficient insuflation. 
  •  Working status of all the lap instruments along with insulation check is     properly made. 
Operative Preparation

The skin is prepared from the lower chest to pubis.

Port placement
  • A 10 mm camera port is inserted at the level of the umbilicus over the left mid clavicular line. 
  • A 2mm stab incision is placed and verses needle is inserted perpendicular to abdominal wall. 
  • Intrabdominal position if verses is confirmed by the suction, irrigation, hanging drop and plunger test. 
  • Pneumoperitoneum is created by setting the insufflator at 14 mm hg. 
  • Camera inserted and abdomen inspected noting the size of the spleen for working port placement. 
  • Two additional 5mm ports are inserted on either side of camera port at 7.5 cms according to base ball diamond concept. 
  • Additional epigastric port can be inserted for liver retraction in case of hepatomegaly.
Details of procedure
Dissecting free from ligaments
Splenectomy Laparoscopic

  • After inspection of the abdomen the splenocolic ligament is visualised along with greater omentum. 
  • Splenic end of the ligament is identified and elevated with traction identifying a plane above the splenic flexure and entered using harmonic scalpel. 
  • Dissection continued medial to spleen to reach the gastrosplenic ligament containing short gastric vessels. 
  • By giving traction over the greater curvature of stomach lesser sac is entered using blunt dissection and short gastric vessels are divided 1 cm away from the gastric wall. 
  • The pancreas,splenic artery and vein running at the base of lesser sac are visualized. 
  • Short gastric are divided upto gastro oesophageal junction.
  • Spleen is elevated medially and the splenorenal ligament is divided and continued till the top of spleen is free. 
Laparoscopic Spleenectomy
Dissection of splenic pedicle
  • Dissection of the medial part of spleen continued to reach the splenic pedicle. 
  • The area chosen should be distal to the tail of the pancreas but proximal to the trifurcation of the splenic vessels.
  • A 12 mm port is required for Endo GIA Vascular stapler for the splenic pedicle.
  • Dissection is performed until vessels an be safely encompassed within the  jaws of the Vascular stapler.
  • Care is taken to include the pedicle having splenic artery and vein in the arms of the stapler and fired . 
  • Alternatively artery and vein can be dissected and fired with stapler separately. 
  • Reinforced plastic bag is introduced and the organ is carefully placed into the bag. 
  • Bag is closed and partially withdrawn through the abdominal wall until the open rim of the bag is under control outside the abdomen. 
  • Bag is cut free from the carrier using drawstring in the end of instrument handle. 
  • Spleen is morcellated and extracted 
  • Post extraction the right upper quadrant lavaged with suction irrigator and a careful inspection is made of all cut surfaces and vessels. 
  • Tail of the pancreas is examined for possible injury. 
  • A silastic catheter drain is placed. 
  • All ports are closed under vision.
 Laparoscopic Splenectomy
Post operative care  
  • The NG tube is removed post operatively.
  • Foleys catheter is discontinued when the patient is alert enough to void.
  • Clear liquids can be started within a day and diet is advanced as tolerated.
Dr. Abdulla Al-Abu Huraira
May 26th, 2020 12:21 pm
A brilliant and clear and fully understood. Great explanation, we all appreciate your work. professor Dr. R. K. Mishra ! Thank you for these Task Analysis of Laparoscopic Splenectomy ! I have studying Maser in Minimal access surgery Perfectly under sir your Guidance. Thanks for Posting.

Dr. Mahmud Al-Magdy (Cairo)
May 26th, 2020 12:59 pm
You are a blessing to people. You are a blessing to Doctor's they want to learn Laparoscopy and Robotic surgery. I have watched similar videos but will always come back to yours video's because of your well Explaining, as well as your wonderful style of in depth teaching. Undoubtedly, the knowledge and insight from your videos. Thanks for posting these for Task Analysis of Laparoscopic Splenectomy.
Dr. Adrian Arne
May 26th, 2020 2:20 pm
Congratulation to your mastery of education in Laparoscopy & Robotic Surgery super excellent and thanks a million. Dr. Mishra thank you so much your
beautifully explained and well presented lecture, video presentation and Task Analysis help me so much! Thank you!!
Dr. Isaac Kane
May 26th, 2020 2:35 pm
Thank you for that motivational article. It's really interesting and educative. Thanks for sharing your experience and knowledge.
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