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TASKS

Main page
Result and Statistics

Categories:   Endo Suturing

Courses:    FLS BESTA

The task "Extracorporeal Suture". Three single throws of a knot are tied extracorporeally. Using a knot pusher trainee secures each throw onto the drain.


Learning objectives

  • 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.

Task description

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.
 

Proficiency

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.
 

Objective Parameters

  • 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

Errors

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.

Penalties

Deviation of the puncture from the two marks on the penrose drain more than 1 mm (penalty 10 point).

Failures

Wrong performance of the task.

The penrose drain is detached from the suture block.

The slit in the drain is not closed.
 

Copyrights (с) 2015-2018, BESTA.guru



Parameters
Time limit (sec):600
Time target (sec):136
Number of points:100
Ambidexterity, %:20
Evaluated parameters:
Formula:

  • Compare with you:













X
Date Attempt
Points

Time

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

Right

Left

Right

Left

Right

Left
Target values: 100 136 20 - - - - - -


Help and manual

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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.

Categories

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.

Courses

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

Tasks

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.

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