BESTA: Extracorporeal Suture
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The task "Extracorporeal Suture". Three single throws of a knot are tied extracorporeally. Using a knot pusher trainee secures each throw onto the drain.
- Safe needle insertion;
- Proper needle positioning;
- Correct needle driving through tissues;
- Safe thread pulling through the tissues;
- Running down the throw by pusher;
- Visual-spatial orientation;
- Fulcrum effect compensation;
- Coordinated movements of both instruments;
- Ergonomic body and hands position.
Equipment: two needle-holders 5 mm; pusher 5 mm with notch; Metzenbaum curved scissors; red foam suture block with velcro strip; silk or other dark braided suture 75 cm, 90 cm or 120 cm long, 2-0, on taper needle 25 mm, ½ circle; penrose drain with “wound” and two marks.
Setup: Fix penrose drain vertically in the middle of the velcro strip of the red foam suture block. Place the suture block horizontally into the box, so that it appears at the lower part of the screen.
Aim of the task: "Extracorporeal Suture" (endosurgical suture with extracorporeal tying): drive needle through two marks on the sides of the “wound” on penrose drain, form triple knot extracorporeally, secure each throw with pusher and cut the ends with scissors.
Performance: plan over left or right port the throw will be tied and take corresponding needle-holder. Grasp with needle-holder the thread near needle and introduce it into the lap-trainer. Position needle in the needle-holder of dominate hand and drive the needle through the two marks in the penrose drain. The needle may be driven through the drain in one rotation motion, or two or more motions. Pull half of the thread through tissues gently, so that penrose drain will not be detached from the suture block. Retrieve the thread with the needle through the same port. Tie three single throws of a knot extracorporeally. Secure each throw onto the drain using a knot pusher. At the end of the task, once all three throws have been secured onto the drain, cut both ends of the suture inside the trainer. The ends may be cut together or separately and the tail length is not important for this task.
The task should be practiced until it can be performed in 136 seconds with up to 1mm accuracy errors; this level of performance should be achieved on 2 consecutive repetitions or for a maximum of 80 repetitions.
Start The first instrument is visible on the screen.
Finish Both ends of your suture have been cut inside the trainer.
- Time limit (sec): 600
- Target time (sec): 136
- Precision: right mark and left mark (<1,0 mm)
- Passing score: 100
- Path: left and right instruments
- Ambidexterity, %: 40-80%
- Speed: overage left and right; maximal left and right instruments
The suture must be grasped by the thread and not the needle while introducing it into the trainer;
The pulling of the suture was done with the needle;
Instrument with needle was frequently or long out of the screen;
Non-ergonomic position of the trainee, leading to back or hands strain;
Rotating wheel of scissors was not used when necessary.
Deviation of the puncture from the two marks on the penrose drain more than 1 mm (penalty 10 point).
Wrong performance of the task.
The penrose drain is detached from the suture block.
The slit in the drain is not closed.
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Time limit (sec): 600 Time target (sec): 136 Number of points: 100 Ambidexterity, %: 20 Evaluated parameters: Formula:
Compare with you:
X Date Attempt
Path, mm Av.Speed, mm/sec Max.Speed, mm/sec
Target values: 100 136 20 - - - - - -