Task Analysis of Laparoscopic and Robotic Procedures

Task Analysis of Weston Knot
Urology / Mar 13th, 2018 4:54 pm     A+ | a-
1) Cutting suture 75-90cm with Endoski needle which is proximal 2/3rd straight & distal 1/3rd curved.
2) Insert Maryland in the reducer.
3) Hold the suture with Maryland at the tail end & pull it out through the reducer & then hold it near the needle and hide it in the reducer.
4)Insert the Maryland with the reducer into the abdomen.
5) Drop the needle over the tissue in such a way that the tip should be in the left & the tail in the right side.
6) Align the needle by the following 3 techniques:
     a) Pressing the needle by the upper jaw of the needle holder at the junction of 1/3rd & 2/3rd.
     b) Holding the needle by the left hand at the curvature & pulling the suture up near the needle by the right hand.
     c) Hang the needle by the left hand like a pendulum & go with the open jaw of the needle holder keeping the moving jaw to the left & dragging it to the right. 
7) Stabilize the tissue by the left hand & take a bite by keeping the needle at 90 degree angle to the tissue & rotating the tip of the needle to bring it to the other side.
8) Bring the tip of the needle 1/3rd out& catch it with the left instrument, keeping the convex end towards the tissue.
9) Guard the tissue by the needle holder, keeping the concave part of the instrument towards the tissue & pulling the needle by the left hand instrument.
Feed the suture 4 times inside abdomen .
10) Hold the suture by the needle holder as soon as the needle is out.
11) The configuration of WESTON KNOT is 1-1-1.
12) WESTON KNOT is a self locking sliding knot, which has one hitch, one reverse hitch & one final wrap and lock.

The Step of Weston Knot are:
Step 1: The index finger of the assistant may be used to make Weston knot. The left hand should be used to hold the short limb and the right hand long limb of thread.
Step 2: The short limb of the thread is crossed over the long limb.
Step 3: The intersection point of thread should be pinched by left hand index finger and thumb. At the time of making intersection, surgeon should keep sufficient length of short limb, to make it comfortably. It is important to remember that left hand is used only to hold the intersection point while the right hand will make the necessary hitches and loops.
Step 4:The short limb is passed between the thread upward.
Step 5:The short limb should be pulled from up by right hand to make first hitch.
Step 6:The short limb is placed towards the left side and is passed between the two limb upward to make a reverse hitch.
Step 7:The short limb should encircle the thread from below upward and should be put in the first loop to lock it. 
13) Now hide the knot in the reducer with or without Maryland & push the knot sliding downwards to the desired place where you want to tie by keeping the suture in the left hand t & pulling the suture with the right hand.
14) After tightening the knot, you can take a final square knot to secure.
15) Introduce the scissors from the right port and cut the suture.
16) You can again reuse the same suture needle to tie another knot.
17) Weston knot is used in gynecological surgeries & also in arthroscopic surgeries. It can be used in situations where suture slides smoothly & freely through tissue & the anchoring device. 
Advantages of Weston knot:    
    a) It is a relatively easy knot which can be tied outside, can slip easily into place & tightly secured.
   b) It locks readily & is not bulky.
   c)  No knot pusher needed.
   e) The suture needle is maintained, so it can be re used for taking another bite.
Dr. Mamtashree .K
May 23rd, 2020 2:20 pm
This article is very well presented, which helped me to learn new knoting knowledge quickly. Thanks for published Task Analysis of Laparoscopic Extracorporeal Weston Knot.
Dr. Shagarika Mohan
May 23rd, 2020 2:45 pm
Dr. R. K. Mishra, Thank you for your amazing content of Laparoscopic extracorporeal Western Knot.
It's really interesting. Thanks for sharing.
Dr Nitish Kumar Yadav
May 23rd, 2020 2:59 pm
I love your lessons, Dr. Mishra Mind Maps, in other words the best way to retain and learn. Fantastic, Very Easy way to Learn Laparoscopy surgery! your explanations make it look super easy! You’re the best! Thanks for posting Laparoscopy Extracorporeal Western Knot.
Dr. Kum Kum Saini
May 23rd, 2020 3:06 pm
This is great explanation of Laparoscopic Extracorporeal Western knot. This Task Analysis is very good for me to understand. You're doing a great job. Thanks for Posting.
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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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