During the testing, the camera and trocar locations need to be adjusted for each task. For saving time, two FLS simulators should be used for testing.
Instructional videos for testing can be downloaded from https://www.dropbox.com/sh/1y2c0m2gfdfycla/AABjWAL3rEiUGqUeWNMZh8-_a?dl=0
1. Needle Handling (Cutoff= 5mins)
Summary: This task requires passing a needle through 6 standardized holes oriented at different angles on a circular task platform.
Equipment: 2 needle drivers and 1 forceps and a 15cm 2-0 silk suture. Participants may select which of these instruments you would like to use for completion of the task. They will also be provided with one 15cm 2-0 Silk suture. Rules: The holes should be penetrated from outside to inside in a sequential, counter-clockwise fashion starting from the top right hole. When the last hole is reached, the string should be removed completely as this will mark the end of the timing period. If the needle is dropped outside of the field of view, you will be given a new suture and will be asked to continue from the hole where you dropped the needle. Assessment: Performance will be assessed on time, needle’s dropped outside of the field of view. Timing: The timing will start when any instrument is seen on the monitor and will stop when the needle string is removed from the last hole. Cutoff time: Maximum time for task completion is 5 minutes. If the task is not completed within the allotted time, you will be asked to stop. |
Task placement and camera adjustment:
Place the task block on the base of the FLS Trainer as shown below. Make sure the task is centered within the FLS Trainer video camera’s field of view by adjusting the camera. |
2. Offset Forehand Suturing (Cutoff= 10 mins)
Summary: This task requires inserting the needle through the two marked dots on the penrose drain and then tying a knot intracorporeally.
Equipment: 2 needle drivers, 1 forceps, 1 pair of laparoscopic scissors, and 1 15cm 2-0 Silk suture. Participants may select which of these instruments you would like to use for completion of the task. Rules: The first throw must be a Surgeon’s knot or double throw, followed by two single throws. You will then cut both ends of your stitch inside the box. You should not load the needle in your needle driver when introducing the suture into the box. Please use a righthanded forehand suturing technique when pushing the needle through the penrose drain from the side of the drain that is visible to the camera and then out the far side. Timing: The timing will start when any instrument is seen on the monitor and will stop when both ends of the suture are cut. Assessment: Performance will be assessed on time, quality of the closure. Cutoff time: Maximum time for task completion is 10 minutes. If the task is not completed within the allotted time or the penrose train will be avulsed from the suture block (fail), participants will be asked to stop. |
Place the camera post in front right corner of, trocars in front left corner of the base of the FLS trainer using velcro.
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3. Offset Backhand Suturing (Cutoff= 10 mins)
Summary: This task requires inserting the needle through the two marked dots on the penrose drain and then tying a knot intracorporeally.
Equipment: 2 needle drivers, 1 forceps, 1 pair of laparoscopic scissors, and 1 15cm 2-0 Silk suture. Participants may select which of these instruments you would like to use for completion of the task. Rules: The first throw must be a Surgeon’s knot or double throw, followed by two single throws. You will then cut both ends of your stitch inside the box. You should not load the needle in your needle driver when introducing the suture into the box. Please use a righthanded backhand suturing technique when pushing the needle through the penrose drain from the far side (not visible to the camera) and then out the near side (visible to the camera). Timing: The timing will start when any instrument is seen on the monitor and will stop when both ends of the suture are cut. Assessment: Performance will be assessed on time, quality of the closure. Cutoff time: Maximum time for task completion is 10 minutes. If the task is not completed within the allotted time or the penrose train will be avulsed from the suture block (fail), participants will be asked to stop. |
Same as the Offset Forehand Suturing task. Place the camera post in front right corner of, trocars in front left corner of the base of the FLS trainer using velcro.
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4. Confined Space Suturing (Cutoff= 10 mins)
Summary: This task requires inserting the needle through the two marked dots on the penrose drain and then tying a knot intracorporeally.
Equipment: 2 needle drivers, 1 forceps, 1 pair of laparoscopic scissors, and 1 15cm 2-0 Silk suture. Participants may select which of these instruments you would like to use for completion of the task. Rules: The first throw must be a Surgeon’s knot or double throw, followed by two single throws. You will then cut both ends of your stitch inside the box. You should not load the needle in your needle driver when introducing the suture into the box. Please use a right-handed forehand suturing technique when pushing the needle through the penrose drain from right to left. Although it is fine for instruments to touch the edges of the cup, it is not OK to exert so much force on the cup that the cup stand moves Timing: The timing will start when any instrument is seen on the monitor and will stop when both ends of the suture are cut. Assessment: Performance will be assessed on time, quality of the closure. Cutoff time: Maximum time for task completion is 10 minutes. If the task is not completed within the allotted time or the penrose train will be avulsed from the suture block (fail), participants will be asked to stop. |
Coming soon...
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5. Suturing Under Tension (Cutoff= 15 mins)
Summary: This task requires closure of a gap using 3 interrupted sutures.
Equipment: 2 needle drivers, 1 forceps, 1 knot pusher (open or closed), 1 pair of laparoscopic scissors and three 75 cm 2-0 Silk sutures. Participants will be allowed to use any of the instruments provided and can decide on the suture length. Rules: Participants may also decide whether to perform intra- or extracorporeal ties; there is no rule regarding the knot type. For each interrupted knot, the needle should pass precisely through two black dots on either side of the opening. Participants should perform a minimum of 3 ties per knot. Assessment: Performance will be assessed on time, quality of the closure. Timing: The timing will start when any instrument is seen on the monitor and will stop when the final suture is cut. Cutoff time: Maximum time for task completion is 15 minutes. If the task is not completed within the allotted time, you will be asked to stop. |
Task placement and camera adjustment:
Place the task block on the base of the FLS Trainer as shown below. Make sure the task is centered within the FLS Trainer video camera’s field of view by adjusting the camera. |
6. Continous Suturing (Cutoff= 20 mins)
Summary: This task requires closure of a defect using continuous suturing.
Equipment: 2 needle drivers, 1 forceps, 1 knot pusher (open or closed), 1 pair of laparoscopic scissors and two 75 cm 2-0 Silk sutures. Participants will be allowed to use any of the instruments provided and can decide on the suture length Rules: Participants will be allowed to use more than one suture if necessary. For each interrupted knot, the needle should pass precisely through the black dots along the length of the opening. Participants should perform a minimum of 3 ties per knot. Assessment: Performance will be assessed on time, quality of the closure. Timing: The timing will start when any instrument is seen on the monitor and will stop when the suture is cut after closing the defect. Cutoff time: Maximum time for task completion is 20 minutes. If the task is not completed within the allotted time, you will be asked to stop. |
Task placement and camera adjustment:
Place the task block on the base of the FLS Trainer as shown above. Make sure the task is centered within the FLS Trainer video camera’s field of view by adjusting the camera. |