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Endo Suturing: Ligating Loop

Main page
Result and Statistics

Categories:   Endo Suturing

Courses:    BESTA

The task “Endoloop” is a part of FLS Course (Fundamentals of Laparoscopic Surgery).




Learning objectives

  • Proper loop positioning;
  • Secure the knot by running down the rod of the pusher;
  • Visual-spatial orientation;
  • Fulcrum effect compensation;
  • Coordinated movements of both instruments;
  • Ergonomic body and hands position.

Task description

Equipment: Dissector to grasper 5 mm; pusher 5 mm with round hole; Metzenbaum curved scissors; red foam organ with 3 appendages; silk or other dark braided suture 75-120 cm long.
 

Setup: Place the foam organ into the jumbo clip with three appendages hanging out towards you. Locate the clip onto the distal velcro strip and adjust camera so that the foam is in the middle of the field of view. Pre-tied ligating loop with Roeder knot.
 

Aim of the task: Place Endo-Loop on the marked appendage and cut off the thread.
 

Performance: Introduce dissector and pusher with the knot into the trainer. Booth assistance with the Maryland dissector (or grasper) or one-handed technique are allowed. A locking grasper may be used to enable the use of two hands to manipulate the ligating loop.Once the loop is positioned secure the knot on the mark of the foam appendage by sliding the pusher rod down. Complete the task by cutting the end of your loop material inside the trainer.
 

Proficiency

The task should be practiced until it can be performed in 53 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: Thread has been cut inside the trainer and instruments removed.
 

Objective Parameters

  • Time limit (sec): 180
  • Target time (sec): 53
  • Precision: placed on mark (<1,0 mm)
  • Passing score: 100
  • Path: left and right instruments
  • Ambidexterity, %: not relevant
  • Speed: overage left and right; maximal left and right instruments

Errors

Instrument pulls too hard;

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 loop from the mark more than 1 mm.

Failures

Wrong performance of the task.

The foam organ is detached from the clip.

The slit in the drain is not closed.
 

Copyrights (с) 2015-2018, BESTA.guru



Parameters
Time limit (sec):180
Time target (sec):53
Number of points:100
Ambidexterity, %:0
Evaluated parameters:Standard Parameters, Loop placement precision
Formula:Score = 236 – t (sec) - Penalty

  • Compare with you:













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Date Attempt
Points
Time
Time application
Precision application
Ambidext.:		 Path, mm Av.Speed, mm/sec Max.Speed, mm/sec
Right
Left
Right
Left
Right
Left
Target values: 100 53 -- 0 - - - - - -


Help and manual

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Users

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.

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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.

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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