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Result and Statistics

Categories:   Endo Suturing

Courses:    BESTA

The task Needle Driving (Needle Guidance) is dedicated for the training of ambidexterity, needle-holder manipulation, proper needle positioning in the jaws of needle-holder and visual-spatial coordination.

Learning objectives

The task was originally developed for BESTA.

  • Learn how to insert the needle into the working space;
  • Learn how to grasp the needle;
  • Acquire skill of proper positioning of the needle in needle-holder;
  • Correct needle driving through tissue in different directions;
  • How to pull thread safely through the tissues;
  • Visual-spatial orientation;  fulcrum effect compensation;  coordinated movements of both instruments;  ergonomic body and hands position.

Task description

Equipment: two needle-holders 5 mm; platform for task 1 (Peg Transfer); silk or other dark braided suture 15 cm long, 2-0, on taper needle 25 mm, ½ circle; red rubber band width 4 mm, diameter 25 mm, thickness 1 mm.

Setup: Peg Transfer Platform is positioned in the way that rectangle is on non-dominate side, and hexagon – on dominate side (i.e. for right-handed – hexagon on the right side). The red rubber band is stretched on the right pins in form of hexagon.

Aim of the task: pass through rubber band needle with thread in six points.

Performance: Grasp the needle by the thread – that assures secure insertion. Insert the needle into the training Lap-Box. Position the needle in jaws of right needle-holder and stitch the rubber strip in the space between two pins on the right side, from outside inwards. Drive the needle through the rubber by rotation movement. Pull the thread through the ribbon, so only the short end of the thread is left. Pull it not directly by needle, but using the second needle-holder. This technique is less traumatic for tissues and helps to keep the needle visible on the screen. Repeat stitches in and out in the neighbouring intervals, shifted in a counter-clockwise direction. For safety reasons make sure that the needle is constantly visible on the screen. After all six spaces between the pins will be sutured remove the instruments from the box.


Proficiency: the task should be preformed in 200 seconds. This level of performance should be demonstrated on 2 consecutive attempts. 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

Objective Parameters

  • Time limit (sec): 600
  • Target time (sec): 200 (further validation is needed)
  • Passing score: 100
  • Ambidexterity, %: 50-70%


  • By inserting the needle-holder grasped the needle, not the thread;
  • Needle was grabbed in the wrong place;
  • By stitching tissue needle was not revolving;
  • Needle frequently disappeared or longer was not visible on the screen;
  • By pulling thread through the tissues used needle, not the second instrument;
  • Non-ergonomic position of the trainee, leading to back or hands strain.


No penalties for errors


Wrong performance of the task, wrong position of the stiches

Copyrights (с) 2016-2018, BESTA.guru

Time limit (sec):600
Time target (sec):120
Number of points:100
Ambidexterity, %:0
Evaluated parameters:
Formula:Formula Score = 220 – t (sec)

  • Compare with you:

Date Attempt


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






Target values: 100 120 0 - - - - - -

Help and manual



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.

2. User registration is possible on an activated computer only. The number of users is unlimited. The user must enter a login in Latin letters, and this is the only restriction. By default, the user is allocated to the training center to which the device is assigned.

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.


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.


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


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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