Summary: This task requires throwing a forehand stitch through the two marked dots on the suturing model and then tying a knot intracorporeally.
Equipment: 2 needle drivers or 1 needle driver and 1 maryland, 1 pair of laparoscopic scissors, and one 15 cm 2-0 Silk suture on an SH needle. Interrupted suture pad with one pair of black dots.
Rules: Use a right-handed forehand suturing technique taking full thickness bites of both sides. The first throw must be a surgeon’s knot, followed by two square knots alternating hands. You will then cut both ends of your suture.
Timing: The timing will start when any instrument is seen on the monitor and will stop when both ends of the suture are cut.
Cutoff time: Maximum time for task completion is 10 minutes (cutoff = 600sec). If the task is not completed within the allotted time, you will be asked to stop.
Errors:
- Accuracy = Distance in (mm) suture is outside of the target black dots
- Tissue Gap = Distance in (mm) between model edges between the target black dots
- Air Knot = any space is visible between the first knot and the model, or between subsequent knots, 10 points, each occurrence
- Square Knot = correct loop formation and alternating the tails 1800 during each throw, 15 points, each occurrence
- Breakage = 20 points if ligature is broken during any portion of exercise, each occurrence
- Not a full thickness bite (including a lembert) – 10 points, each occurrence
- Bunny ear (tail caught in knot) – 10 points, any occurrence (all or nothing)
Holding the needle while tying knots – 10pts, any occurrence (all or nothing) - Tail length <5mm or > 20mm – 1pt, each individual tail
- Not performing surgeon’s knots – automatic fail
Scoring Formula: Score = 600 – time – 10 (sum of errors)
- Basic Proficiency Level: 438 (162s with no errors)
- Advanced Proficiency Level: 459 (141s with no errors)
- Expert Proficiency Level: 480 (120s with no errors)
- Proficiency Training Protocol: Achieve proficiency score on 2 consecutive repetitions (max 80 repetitions)
- Proficiency Testing (Pre- and Post-test): 1 repetition
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