Task Analysis of Laparoscopic and Robotic Procedures

Task Analysis of Tumble Square Knot
Urology / Mar 13th, 2018 3:40 pm     A+ | a-
1) Cutting the suture 24 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 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 leftand 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 needle by the needle holder as soon as needle is out and take bite at the other side of tissue to be approximated and then pull the needle with Maryland while supporting the tissue with needle holder and once the needle is out hold the suture with needle holder.
12) Guard the suture by the Maryland and pull the suture by the needle holder to make a tail. The length of the tail should be defect plus 2 cm
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 Marryland and rotate the needle holder clockwise  to make a loop 
15) Keep the Maryland static and take one loose wrap by the needle holder 
16) Move both the instruments 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. The Knot should be placed towards the  left side with tail facing upwards. The knot should not be placed in the middle neither in the right side.
18) Drop the suture away from the Maryland and keeping the loop loose hold the suture with the Maryland and make a reverse ‘C’
19) Now keep the needle holder static in the centre and above the reverse ‘C’
20) Hold the suture with Maryland and bring the tip of Maryland near the tip of needle holder
21) Rotate the Maryland anti-clockwise to make a loop
22) Keeping the needle holder static, take a single wrap with Maryland 
23) Needle holder will catch the tail but tail should not be pulled.
24) Maryland will slide the loop in the direction of the tip of the needle holder 
25) Maryland will drop the suture and then tighten the knot. It will be a square knot.
26) Now pull the needle end and the limb on the same side as the needle end in the opposite direction to convert square knot into slip knot i.e tumbling.
27) Now slip the knot with the help of marryland to tighten the tissue and bring them together till buttock sign is formed. The knot should be hold with 3rd or 4th serrated  jaw of the marryland. It should not be hold with the tip neither with the base.
28) Now hold the long end with Maryland and tail with needle holder and pull the tail to untumble the slip knot to square knot and lock the knot.
29) Keep the Maryland steady and hold the needle end with needle holder and pull it to make ‘C’.
30) Now hold the suture with needle holder and keep the Maryland steady and in the centre of ‘C’.
31) Rotate the needle holder clockwise to make a loop and take one wrap over the Maryland with the needle holder.
32) Both the instruments move together to hold the tail with the Maryland 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.
Dr. Sumayra Parveen
May 23rd, 2020 3:15 pm
Thanks for the content is extremely interesting and useful. The professor is excellent in conveying knowledge and inducing thought. Thanks for sharing this Task Analysis of Laparoscopic intracorporeal Tumble Square Knot.

Dr. Krishna Reddy
May 23rd, 2020 3:19 pm
Thanks Dr. R.K. Mishra!! This is the best Task Analysis to learn all the step of Laparoscopic Intracorporeal Tumble Square Knot suture techniques!! The content is extremely interesting and useful.Thanks for sharing.
Dr. Sumona Chakravarti
May 23rd, 2020 3:25 pm
Thanks for posting this Task Analysis of Laparoscopic Intracorporeal Tumble square knot.This is a very informative Task analysis for Laparoscopic Surgeon's. I have benefited from reading this.
Dr Vikash kumar
May 23rd, 2020 3:29 pm
Thank you very much for all your Article! It's really amazing. This helped me out so much!, Thanks for posting this Task Analysis of Laparoscopic Intracorporeal Tumble square knot.
Dr. Rashid Mahmud Abbasi
May 23rd, 2020 3:33 pm
You're so Awesome sir .. so clear so easy .. you have a great quality of teaching in Laparoscopy surgery. very interesting and full of information and very Impressive with your training .Thanks for posting Knoting step of Laparoscopic Intracorporeal Tumble Square knot.
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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.

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