BESTA: Clip and Cut
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Task is dedicated to the training the proper and safe technique of applying laparoscopic clips and presice cutting structures between them.
The task was originally developed for BESTA.
- Acquire proper and secure technique of the clip placement.
- Proper and secure scissors dissection of the clipped structures.
- Usage of the designated rotation wheel for instruments’ rotation.
- Visual-spatial orientation, fulcrum effect compensation, coordinated movements of the both instruments, ergonomic body and hands position.
Equipment: clip-applicator 10 mm for ML clips; four ML clips; dissector 5 mm; Metzenbaum scissors; platform for task 1 (Peg Transfer); two red rubber rings (1x1 mm, diameter 20 mm).
Setup: on the platform for Peg Transfer task place two red rubber rings (1x1 mm, diameter 20 mm), so that the left ring formes a rectangle, and the right one creates hexagon (see picture). Load clip-applicator with a clip and hold it in right hand, while dissector in left hand. This setup is actual for right-handed trainee. Accordingly, for the left-handed trainee change all sides to the opposite. Aim: precise and secure place 4 clips on the rubber rings and dissect the rubber by scissors between 2 clips.
Performance: the clip-applicator hold in the right (dominant) hand is inserted. The clip is placed on the duplicated rubber around the proximal right pin of the rectangle. When applying the clips both jaws have to be visualized, while it is related to patient safety. Use dissector in left hand to assist for correct exposure of rubber ring. The next clip is placed on the rubber ring around the far right pin of the hexagon. Then the two clips are placed on the rubbers of rectangle and hexagon connecting them together. Distance of more than 10 mm from one clip to other should be ensured. Always keep both jaws of the clip-applier in the field of view during clip-application - that allows safe and accurate clip placement. Under dissector assistance the duplicated rubber rings are divided by curved Metzenbaum scissors. The intersection of the “vessels” has to be performed in two steps – each rubber ring separately. Partial cutting of the clipped vessel ensures secure clip position, and therefore attention should be given this point.
Proficiency level: this level of performance (target time and passing score) should be demonstrated on 2 consecutive attempts or for a maximum of 80 repetitions. If a trainee cannot achieve this level of performance after 80 repetitions, that trainee should proceed to the next task.
Start: Instrument is inserted to the Lap-trainer (visible on the screen)
Finish: Last instrument is removed from the Lap-Trainer
- Time limit (sec): 300
- Target time (sec): 100 (further validation needed)
- Passing score: 100
- Path: left and right instruments
- Ambidexterity, %: 40-60
- Speed: overage left and right; maximal left and right instruments
Errors and Penalties
- Non-ergonomic position of the trainee (no penalty)
- Low usage of rotating wheel (no penalty)
- Clip safety: both jaws were not seen by clip-applying: penalty 10 points
- Clip placement precision.
- Distance between clips 3-4 is 9 mm or less: penalty 10 points
- Cut safety: dissection by scissors was not done in 2 steps: penalty 10 points
- Cut precision: dissection was done in 3 mm or closer to a clip: penalty 10 points
- By slipping the rubber ring out of the applied clip task is terminated, demonstrated values are cancelled.
- Failure wrong performance of the task, wrong site of clip’s placement.
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Time limit (sec): 150 Time target (sec): 100 Number of points: 100 Ambidexterity, %: 0 Evaluated parameters: Formula: Formula Score = 190 – t (sec) – Penalties
Compare with you:
X Date Attempt
Path, mm Av.Speed, mm/sec Max.Speed, mm/sec
Target values: 100 90 0 - - - - - -