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Basic Skills : Peg transfer

Main page
Result and Statistics

Categories:   Basic Skills


The "Peg Transfer" Task is similar to the Task 1 of the FLS course (Fundamentals of Laparoscopic Surgery)*. Need to transfer back and forth 6 prisms with both instruments alternately.

Learning objectives

  • Coordinate movements of the both instruments.
  • Usage of the designated rotation wheel for instrument rotation.
  • Visual-spatial orientation based on “flat” 2D-picture – confident determination of object position and distance to it, precise movement of the scope to the desired location.
  • Learn "fulcrum effect" (lever effect), gain its control and compensation.
  • Keep ergonomic body and hands position during the endosurgical procedure.

Task description

Equipment: Two Maryland dissectors, one Platform with 12 pegs, 6 colour rubber prisms.

Setup: Place the platform with pegs on the lower velcro stripes of the trainer. Adjust the camera so platform to middle of the screen and back opening is not visible. All six coloured prisms can be randomly aligned on the pegs on the side of user’s non-dominant hand.

Aim: coloured object (prism) have to be picked up, transferred to the other instrument and placed on peg at the opposite side. As soon as all six prisms are transfered repeat it backwards.

Performance: grasp the prism with dissector in non-dominant hand, transfer the object mid-air to the dissector in dominant hand and then place it on any peg on the opposite side of the pegboard. Color and peg sequence are not important. Each transfer must be mid-air without using the board or pegs for assistance. Once all six objects have been transferred to the opposite side of the board, reverse the process and first grasp each object with your dominant hand, transfer mid-air to your non-dominant hand, and place it on the original side of the platform.

Proficiency: according to the principles of the proficiency-based training the task should be practiced until it can be performed in proficiency time (112 sec) or less; this level should be demonstrated consecutively twice. If a trainee cannot achieve this level of performance after 80 repetitions of the task, that trainee should proceed to the next task.

Start: Touch the first object.

Finish: Release of the last object.

Objective Parameters

  • Time limit (sec): 300
  • Target time (sec): 112
  • Passing score: 100
  • Path: left and right instruments
  • Ambidexterity, %: 40-60
  • Speed: overage left and right; maximal left and right instruments

Errors, Penalties and Failures

Error: prism is dropped. In this case the prism pick up the prism with the hand it was dropped with and continue the task. There is no penalty for dropping the object within the field of view. If prism is dropped outside of the field of view or cannot be retrieved due to length of instrument, the task is continued with the remaining objects. For each prism dropped away in the first part of the task penalty is 20 points, in the second part – 10 points.

Fails  (task aborted):

  • the task is aborted when the task rules are violated, e.g. start with wrong instrument;
  • no change of instruments;
  • the drop is used as the transfer point, etc.


Copyrights (с) 2015-2018, BESTA.guru

Time limit (sec):600
Time target (sec):112
Number of points:100
Ambidexterity, %:50
Evaluated parameters:Proper hands, droped triangles, all triangles moved forth and back.
Formula:Formula Score = 212 – t – 20*(p1) – 10*(p2), where t – is fulfilment time, p1 – number of dropped away prisms at the first part of the task, p2 – number of prisms dropped away at the second part of the task.

  • Compare with you:

Date Attempt


Dropped Away

Path, mm Av.Speed, mm/sec Max.Speed, mm/sec






Target values: 100 112 - 50 - - - - - -

Help and manual



1. Activate your computer. Program BESTA.guru works online on the activated computer only. The computer is activated at the factory. If you reinstall the operating system, the activation will be terminated.

2. User registration is possible on an activated computer only. The number of users is unlimited. The user must enter a login in Latin letters, and this is the only restriction. By default, the user is allocated to the training center to which the device is assigned.

3. Editing of the user is possible online, please log in to his account, where one can edit all personal data and settings. Statistics of the tasks is available in the user’s account. Please notice that your personal statistics is visible for the instructor of the center and the administrator of the BESTA.guru.

4. Statistics Overview. User can view an overview (statistics) of the tasks fulfilment. Each of the tasks is presented by the number of trials, attempts to perform tasks (Trials), the number of tasks brought to the end (Done), the number of tasks performed with the achievement of proficiency level (Proficient). Also the table shows the scores of the last approach (Last), the average score of the last three trials (Last-3), the best result demonstrated by the user (Your Best), the average result for his group (Your group) and the best demonstrated result in the group (Best in group).

5. Statistics of each task appears on its page – at the tab "Result and Statistics". For each of the task trials, various objective parameters are presented: the result in points, the time shown, ambidexterity (the ratio between the right and left hands in percentage), the path length in mm of the right and left hands, the average speed of movement in mm/sec of the right and left tools, the maximum speed of movement in mm/sec of the right and left tools. By default, the graph shows the following curves: points achieved, duration and ambidexterity. User can mark and unmark parameters to display their curves on the chart. The dashed lines on the chart indicate the average values of the corresponding parameters demonstrated by the users of your group. User can select the average of the entire center, whole country or the world.


All exercises fall into four different categories: Basic skills; Visualization; Clinical skills; Suture, ligation.

1. Base skills. The category contains several tasks aimed at practicing basic, basic skills, such as coordination, visual and spatial perception, fulcrum effect compensation (lever effect, rotation around the fulcrum), etc.

2. Visualization. The category contains several tasks aimed at mastering the skills of the laparoscope, its confident movement, visualization of objects hidden from direct view, navigation by the laparoscope, coordination of combined movements of the laparoscope and the instrument

3. Clinical skills. The category contains several tasks aimed at practicing clinical skills. In particular, this includes the exercise of "Clipping and intersection" to simulate mechanical ligating anatomical structures using the latest technology, and gentle treatment of fabrics.

4. Endoscopic suture. The skills required to perform an endoscopic suture are being practiced. The category includes a number of exercises to practice and test the needle holder, correct and confident positioning of the needle in the branches, the formation of the Reder node and the imposition of a loop on the structure, extracorporeal and intracorporeal suturing.


The program of the BESTA (Basic endosurgical simulation training and certification) was created by a Working group organized in April 2015 by the initiative of the all- Russian public organization "Russian society for simulation education in medicine" ROSOMED. The program contains 15 tasks dedicated to the training of the necessary basic endosurgical skills. All together they form an effective training and certification course. 10 tasks out of 15 serve not only for the training, but for the objective assessment of the acquired skills (certification) also.

FLS program (Fundamentals of Laparoscopic Surgery) is one of the first and no doubt the most deeply researched program of simulation training of the laparoscopy skills. Its tasks have been extensively validated – there were conducted over 1.5 thousand studies around the world. Currently, FLS is recognized in many countries of America, Europe and Asia, it is a mandatory component of the surgical training in several countries.

Since 2010, FLS is included into the list of mandatory programs for residents of surgery in Canada and the United States and is as a mandatory initial course of training and evaluation of resident surgeons SAGES (Society of American Gastrointestinal and Endoscopic Surgeons-Society of American gastrointestinal and endoscopic surgeons). To date, about 100 FLS testing Centers are accredited in North America, and there are such centers in Israel, France, Singapore and Saudi Arabia.

The practical part of the course FLS (Fundamentals of Laparoscopic Surgery) consists of 5 tasks, which are also listed on the site BESTA.guru


The Tab "Tasks" contains all the assignment Tasks of the both courses – BESTA and FLS. It is recommended to pass the tasks in the specified sequence, starting with the basic. User will practice the basics of manipulation of laparoscopic instruments and their interaction and coordination, such as "Scope navigation", "Peg Transfer", "Bimanual coordination", "Precision Cutting". Only after their confident and proficient performance is achieved, when the specified proficiency level is reached (100 points or above) one can proceed to the following exercises, such as "Clip and Cut", "Needle Driving". And at the final stage consistently move to the group of tasks for gaining skills in endoscopic suturing, also moving from one exercise to another. Insufficient level in the basic skills will not allow to carry out tasks of the higher level of complexity.


To start automatic assessment you need to download BESTA.guru application.