Task Analysis of Laparoscopic Procedures

TASK ANALYSIS FOR LAPAROSCOPIC BILATERAL TUBAL STERILIZATION
Gynecology / Oct 5th, 2017 11:51 am     A+ | a-
 
Gynecological Surgery
DR CHISOKO ERNEST CHIPAMPE
MMed OBGY, FMAS, DMAS
 
PROCEDURE STEPS
  1. The client is identified and make sure that consent is obtained.
  2. The client should not have taken solid food the night before and laxatives were given.
  3. 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.
  4. General or local anesthesia can be given depending on the anesthetist.
  5. Insert  number 14 folys catheter or you could have told the client to void before.
  6. The surgeon scrub and wear sterile surgical gloves.
  7. The client is put is supine position ( lithotomy) with 15 degrees head down.
  8. Antiseptic is applied on clients abdominal wall from nipple level to pubic symphysis and draped.
  9. 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.
  10. The assistant stands on the right side of the surgeon and the scrub nurse stands at the left side of the surgeon.
  11. Infiltrate 5-10mls of xylocain around the umbilicus.
  12. Make a 2mm incision with blade number  11 in the lower crease of umbilicus.
  13. Check the verse needle for patency and spring action.
  14. Hold the verse needle like a dart in the right hand; add 4 cms to the thickness of the abdominal wall for needle tenting.
  15. 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.
  16. 2 click sounds is heard for perforating the rectus sheath and peritoneum.
  17. Check the irrigation , sucking and hanging drop test for correct needle positioning.
  18. Switch the insufflator on and connect to the verse needle.
  19. Check flow rate not to exceed 1.5L/min and that the actual pressure is parallel to the gas used.
  20. When actual pressure is equal to preset pressure, remove the verse needle.
  21. Increase the  verse needle punch site by making a smiling incision in the lower crease.
  22. Dissect with a mosquito artery forceps to separate the rectus sheath and dilate the vitalointestinal duct.
  23. 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.
  24. Connect to the insufflator and close the valve for continuous pneumoperitonuem.
  25.  Focusing the telescope at 10 cm distance and do white balancing.
  26. Insert the 10 mm 30 degrees telescope through the 10 mm port.
  27. 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.
  28. 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.
  29. Put the ring cone over the ring applicator.
  30. Put the ring over the tip of the cone and push it with the ring pusher.
  31. Insert the ring applicator through the 5 mm port with the jaws inside.
  32. Move the applicator to the posterior of the uterus and move laterally to hang the tube.
  33. Drop the tube and open the jaws of the applicator.
  34. Hang the tube 2 cm lateral to the uterus in the lower jaw.
  35. Close the jaws of the applicator closer to the tube and not stretching the tube.
  36. Fire the applicator and wait for 5 seconds.
  37. Rotate the applicator slightly to release it from the tube.
  38. Check the ring placement.
  39. Do the same on the other side.
  40. Remove the applicator from the port and the 5 mm trocar.
  41. Inspect the abdominal cavity with the telescope.
  42. Deflate the abdomen gradually after disconnecting the insufflator.
  43. Remove the 10 mm trocar with the telescope.
  44. Document the all procedure.   
 
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