Task Analysis of Laparoscopic and Robotic Procedures

Task Analysis of Laparoscopic Fallopian Tubal Recanalization
Gynecology / Nov 30th, 2019 7:36 am     A+ | a-

Task Analysis of Laparoscopic Fallopian Tubal Recanalisation

DR.LAKSHMI SREE ATMURI  [ MS OBGY, F.MAS, D.MAS]


TUBAL RECANALISATION:
Surgical approximation of tubal segment after tubal sterilization or excision of an occluded or diseased portion of the fallopian tube

INDICATIONS: Desire for fertility

REQUIREMENTS:

Normal semen analysis
Age more than 40yrs
Tubal sterilization previously by modified Pomeroy, fallopian rings, Filshie Clips
HSG to assess the length of the fallopian tube

CONTRAINDICATIONS:

Age more than 40 yrs
Decreased ovarian reserve 
Ovarian failure
Extensive tubal damage 
Tubal length less than 3cm
Severe male factor infertility

IMPORTANCE:

Respect to the delicate nature of the tissue
Minimum use of energy sources
Irrigate abdominal cavity with normal saline to minimum drying or adhesion 

PROCEDURE:
  1. Patient in lithotomy position under general anesthesia
  2. Foleys catheterization
  3. Check veress needle for its spring action and patency
  4. Take 2allis forceps to evert and hold each side of umbilicus
  5. Use number 11 blade to place small horizontal stab wound on the inferior crease of umbilicus
  6. Mosquito artery to dissect subcutaneous adipose tissue and expose rectus sheath
  7. Measure abdominal wall thickness and add 4cm for distance to hold veress needle
  8. Veress needle should be held like a dart
  9. Lift suprapubic part of abdominal wall with the left hand
  10. Insert veress needle in stab incision with 45-degree elevation angle and distal end pointed towards anus and perpendicular to the abdominal wall
  11. The surgeon can hear 2 click sound and maintain the 45-degree angle
  12. Confirm correct veress needle placement by irrigation test, aspiration test, and hanging drop test
  13. Connect carbon dioxide gas tube to veress needle 
  14. Check quadromanometry for intraperitoneal placement of veress needle
  15. Ideal preset pressure of 12mmhg, maximum of 15mmhg
  16. The flow rate of 1lit/min
  17. Check uniform distension of abdomen and obliteration of liver dullness
  18. Once pneumoperitoneum is achieved remove veress needle
  19. Take cannula of 10mm and mark its impression on the skin
  20. Extend incision to the size of cannula impression
  21. Introduce 10mm port by holding it like a piston,  perpendicular to the abdomen
  22. Confirm intraabdominal placement of port by escaping air sound and audible click
  23. Take out trocar
  24. Set flow rate increased to 6lit/min
  25. Connect gas tubing to the primary port
  26. Insert telescope
  27. Inspect entry point to exclude any bowel or vessel injury
  28. Request for Trendelenburg of 30-degree position
  29. Perform diagnostic laparoscopy with special attention to tubes
  30. Insert uterine manipulator to aid ease of suturing fallopian tubes
  31. Secondary and tertiary port placement with help of baseball diamond principle
  32. Ipsilateral port placement may be desired
  33. Vasopressin 5IU diluted in 20ml normal saline is injected into mesosalpinx with help of aspiration needle
  34. Dissecting scissors in the dominant hand
  35. Maryland forceps on another hand
  36. Excise occluded area of the tube
  37. Freshen up the ends of the fallopian tube
  38. Minimize injury to mesosalpinx
  39. Preferred suture 4-0 vicryl cutting edge needle
  40. First Mesosalpinx is to be approximated, to prevent tension over the tube and also anastomosis becomes easy
  41. Surgeon knots to be applied
  42. Avoid torsion of tube
  43. Avoid catching tube directly with a grasper or any other instrument
  44. Seromuscular sutures are placed at 6, 10, 2* clock position on right fallopian tube 
  45. Seromuscular sutures are placed at 6, 10, 2* clock position on left fallopian tube
  46. Patency of the tube can be checked
  47. stop insufflation
  48. remove all ports under the vision
  49. close port sites 10mm port with help of veress needle, or port closure devices

  
 
2 COMMENTS
Dr. Monika Sen
#1
May 21st, 2020 2:58 am
This article is well organized and presented, which helped me to learn new knowledge quickly. Thanks for published Laparoscopic Fallopian Tubal Recanalization task analysis.
Dr. Jamie Enannuel
#2
May 22nd, 2020 4:40 am
Wow really i like this fascinating explanation well presented Article. Which help me a lot's. Thanks for uploading Laparoscopic Fallopian Tubal Recanalization task analysis.
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