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TASKS

Main page
Result and Statistics

Categories:   Basic Skills

Courses:    BESTA

The "Circle Cutting" is the task Nr. 4 of the BESTA program (Basic Endosurgical Simulation Training and Accreditation). Trainee needs to cut out a circle between to marked lines.




Learning objectives

  • Acquire skill of scissors precise cutting in different directions and angles.
  • Usage of the designated rotation wheel for instrument rotation.
  • Visual-spatial orientation, fulcrum effect compensation, coordinated movements of both instruments, ergonomic body and hands position.

Task description

Equipment: Grasping forceps 5 mm, Metzenbaum curved scissors 5 mm, training gauze with 2 circle marks, jumbo clip for fixation of the training gauze.
 

Setup: Place the training gauze into jumbo clip and arrange so it will be seen in the upper part of the screen (see picture).
 

Aim: cut off a circle on the training gauze between 2 round marking lines.
 

Description: grasp the lower edge of the gauze by forceps and cut it with the Metzenbaum scissors into the field between two markings. Cut off the circle. The cutting path should not contact the marking lines except of the enter point. After cut is completed place the circle aside, so the result can be recorded on video as well. If the traction of the gauze by instrument was that strong, that it caused detachment from the clip the task is terminated.
 

Proficiency: The task should be practiced until it can be performed in 118 seconds with all cuts made within the section between the two lines of the training gauze; this level of performance 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 of the task, that trainee should proceed to the next task.
 

Parameters

Start: First contact of instrument with the training gauze

Finish: The circle being completely cut out from the gauze
 

Objective Parameters

  • Time limit (sec): 180
  • Target time (sec): 118
  • Precision tolerance: 80%
  • Passing score: 100
  • Path: left and right instruments
  • Scissors used: by right and left hands
  • Ambidexterity, %: 40-60
  • Speed: overage left and right; maximal left and right instruments

Errors

  • Non-ergonomic position of the trainee, leading to back or hands strain.
  • Low usage of rotating wheel of both grasper and scissors.
  • Cut through the marks or contact the marks (cut deviation).

Penalties

  • 1 % of Deviation = 1 penalty point.

Failures (task aborted)

  • Wrong consequence of the moving from cell to cell.
  • Gauze slipped out of the clip due to strong traction by grasper.

p.score = 218 – t in sec – 5*touching – 10*intersection Task with 1 marking: p.score = 218 – t in sec – % Deviation
 

Copyrights (с) 2015-2018, BESTA.guru



Parameters
Time limit (sec):300
Time target (sec):118
Number of points:100
Ambidexterity, %:60
Evaluated parameters:Time, Precision, Path left and right, Max speed left and right, Overage speed left and right
Formula:p.score = 218 – t in sec – % Deviation

  • 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: 100 118 60 - - - - - -


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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