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