Task Analysis of Laparoscopic and Robotic Procedures

Laparoscopic Radical Hysterectomy Task Analysis
Gynecology / Apr 3rd, 2018 12:00 pm     A+ | a-
Laparoscopic radical hysterectomy in Gynecologic cancer. task analysis 
Dr Maliheh Arab, MD
1- Select the patient : Early stage cervical cancer- endometrial cancer with cervical involvement. 
2- Put the patient in lithotomy position. 
3- Telescope port position: 4cm above umbilicus ( supra umblical).
4- Working port position : Two 5mm right: ipslateral, and two 5mm left: ipslateral.
5- Open Peritoneum between round lig and infundibulopelvic ligament (IP) and cut downward towards iliac vessels .
6- Use harmonic for cutting ( metal part is open and cut with upward hanging and cutting of Peritoneum) or monopolar.
7- Find int iliac vessel by opening the peritoneum lateral to ureter just in junction of ureter and iliac vessels. cut uterine artery in its origin.
8- Dissect pararectal space lateral: to ureter and IP ligament : 
  • Anterior: uterine artery and lateral parametrium 
  • Lateral: posterior division of hypogastric artery  
  • Posterior: lateral surface of the sacrum
  • Medial: rectum
9- Dissect paravesical passa by cutting peritoneum downwards:
  • Lateral: ext. iliac and obturator fossa
  • Posterior: uterine artery and lateral parametrium 
  • Anterior: obturator muscle
  • Medial: bladder and vagina
10- Cut the uterine vein below ureter tp prevent bleeding in parametrial resection.
11- Cut parametrium which is located in front of pararectal space, near pevic.
12- Medial to ureter and IP ligament, cut the peritoneum towards down and medial to posterior cul de sac.
13- Expose rectovaginal space by dissecting denonvilie ligament and going down between uterosacral ligaments into the space.
14- Cut uterosacral ligaments in half of its length.
15- Open vagina circular by removing at least 2 centimeters of vagina.
16- Cut infundibulopelvic or utero. Ovarian ligament ( this step is postponed for better traction).
17- Vaginal cuff is closed by 3 extra corporal knots.
18- Ovaries might remain in young women 
19- Ophoropexis is considered in young women for protection of ovarian function if irradiation is needed ( probably not very effective)
20- Do pelvic lymphadenectomy at first part or second part of the surgery.
Dr. Appolina Tooppo
May 23rd, 2020 1:06 pm
Thank you so much for the Article. It's really awesome Task Analysis of Laparoscopic Radical Hysterectomy , very informative and educative and lot's of information. Keep it up the good work!
Thanks for posting.
Dr. Monalisa Kurmi
May 23rd, 2020 1:13 pm
Thanks for posting this Task Analysis of Laparoscopic Radical Hysterectomy !! Dr. Mishra is so helpful and he make it so much easier to understand than the textbook! Keep it up!!

Dr. Suryakumar Yadav
May 23rd, 2020 1:24 pm
Thank yous so much sir! I'm a final year PG student. Your videos are the reason I am doing laparoscopic Hysterectomy surgery. I am reading your all task analysis for butter understanding. Thanks for posting great Task Analysis for Laparoscopic Radical Hysterectomy.
Dr. Sulaiman Habib
May 23rd, 2020 1:39 pm
Amazing explanation of the step surgery's. all step are very clearly understand and very interesting. Thanks uploading the Task analysis of Laparoscopic Radical Hysterectomy. you are the Great Example for our Nation.
Dr. khairul Hassan Khan
May 23rd, 2020 2:18 pm
Thank you, so much, for your time and consideration in forming this Task Analysis of Laparoscopic Radical Hysterectomy. Thank u for this amazing explanation keep going.
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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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