Task Analysis of Laparoscopic and Robotic Procedures

Task Analysis of Total Laparoscopic Hysterectomy
Gynecology / Apr 3rd, 2018 12:22 pm     A+ | a-

The first hysterectomy was done in 1843 by Charles clay in Manchester England. The first laparoscopic hysterectomy was done in 1988 by Reich. Hysterectomy is among the most common surgeries done in women outside pregnancy in the United States.
 Among the indications for TLH are:

1. Abnormal uterine bleeding especially menorrhagia
2. Uterine fibroids
3. Endometriosis
4. Uterine size greater than 12 weeks
5. Endometrial malignancy.



1) Patient clerkship and physical examination.
2) Review all investigations, ultrasound, MRI, pap smear, complete blood count, urea creatinine and electrolytes
3) Informed consent from patient.
4)Laxatives two days preoperatively
5) Surgical safety checklist 

• Prophylactic antibiotics on induction
• General anaesthesia
• Patient in Trendelenburg position
• Abdominal shaving
• Speculum exam
• Tenaculum application to cervix
• Monitors in position 15 to surgeon’s eye axis surgeon on left assistant on the right
• Second assistant between the legs,
• Ensure all cables in order
Introduce Verres needle and carbon dioxide gas to pressures of 15 mmhg, flow of 25 l /min
7.  Ports placement
Depends on size of uterus. 
The laparoscope is placed at umbilicus or palmers point. For a large uterus midpoint between xiphisternum and umbilicus.11mm trochar
Accessory ports are placed at least 7.5 cm from central trocar lateral to umbilicus. Trocar size 7.5mm
Eye instrument axis must be maintained. the target is the uterine vessels
8.The uterine manipulator
Allows mobilization of uterus (lateral, retroversion anteversion, on axis rotation).
Visualization of vaginal cuff and sealing.
9. division of round ligament and broad ligament
Coagulation and division of round ligament, open vesicouterine space and dissection of bladder. Coagulate round ligament at centre between two posterior and anterior broad ligaments.
Dissection of bladder by blunt dissection.
The broad ligaments are fenestrated on the right and left.
10.division of adnexa
The opening is extended towards uterosacral ligament, and suspensory ligament of ovary. The adnexa are coagulated and divided where it merges with the uterus by bipolar coagulations followed by division.
11.Uterine vessels.
Posterior dissection, uterus is pushed upwards and to the right
The posterior peritoneum is and base of parametrium, then toward cardinal and uterosacral ligaments. The peritoneum is divided, the cardinal ligament is coagulated and cut, releasing arch of the artery, the uterosacral is sectioned in turn, the ureter is now visible .the uterine artery is coagulated taking care not to injure bladder. The uterine can be tied with surgeons extracorporeal Mishra knot ligatures 
12.opening and division of vagina
The uterine manipulator can be turned 360 degrees, the cylinder is advanced to the into vagina, the vagina is opened all round with monopolar hook starting from anterior vaginal wall.
13.extraction of uterus and closure
Extraction via colpotomy, assistant draws uterus into vagina.
If it is large it can be morcellated.
Closure is carried out with vicryl0 or 1 the vagina is transfixed completely to produce complete haemostasis.
14. A final lavage completes the surgery, followed by closure of the ports
Dr. Kalpana jain
May 23rd, 2020 11:40 am
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 Total Laparoscopic Hysterectomy.
Dr. Nishanthini
May 23rd, 2020 12:13 pm
Thanks for your Task Analysis of Total Laparoscopic Hysterectomy ! Really good course! I am so grateful and very happy. You explain things clearly and make hard concept easier to understand. Thanks for posting.
Dr. Adhitya Langthasa
May 23rd, 2020 12:21 pm
Much appreciated, As you explain all the step of Task Analysis of Total Laparoscopic Hysterectomy it is really !!Amazing!! Thanks for posting.
Dr. Krishna Muthuswamy. N
May 23rd, 2020 12:30 pm
Dr. R. K. Mishra you are the best teacher in the world and your explaining all subject is very very simple and interesting. Thanks for posting this Task Analysis of Total Laparoscopic Hysterectomy..
Dr. Marifah Yasmin (Baksa)
May 23rd, 2020 12:42 pm
Awesome.. I tried to understand though textbook, well it left me exhausted, Thanks you sir now everything became clear. God bless you. You're really a great teacher. After reading this Task Analysis of Total Laparoscopic Hysterectomy. seriously changed my practice. Thank you.

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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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