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Main page
Result and Statistics

Categories:   Endo Suturing

Courses:    BESTA

A 15 cm long suture is passed through six markings on a Penrose drain, and three throws are tied in an intracorporeal fashion forming purse string suture. Errors: inaccuracy of needle cuts, improper tying technique, knot insecurity, model avulsion.

The task "Purse String Suture" (Continuous Suture with Intracorporeal Knot Placement).

The task was originally developed for BESTA.

Performance: Shorten the thread of the atraumatic suture till 12-15 cm length (use scale on the box as a sample). Grasp the the thread by the needle-holder in non-dominate hand and introduce suture into the box-trainer.  Once inside the trainer, position the needle in the jaws of needle-holder in dominate hand.  Pass the needle through the two marks in the tissue (penrose drain). The needle pass through the drain may be done in one motion, or two or more motions. Cut through the next markings till the thread forms a Purse String Suture. Tie the first double throw of a knot intracorporeally, than sequentenly two single throws. Secures each throw onto the drain. 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. Remove sutures and instruments from the trainer. 

Timing for this task begins when your first instrument is visible on the monitor. Timing ends when you withdraw instruments out of the trainer.

Possible errors:

  • The suture must be grasped by the thread and NOT the needle when introducing it into the trainer.
  • Any deviation of the thread from the two marks on the penrose drain. 
  • The slit in the drain is not properly closed.
  • The knot slips or comes apart when tension is applied to the drain.
  • The penrose drain avulses or separates from the suture block (failure of the task).

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Time limit (sec):360
Time target (sec):185
Number of points:100
Ambidexterity, %:50
Evaluated parameters:
Formula:285 - t (sec) - P

  • Compare with you:

Date Attempt


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






Target values: 100 185 50 - - - - - -

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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