Task 4

Task 4 – CONFINED SPACE SUTURING
Summary: This task requires inserting the needle through the two marked dots on the tissue and then tying a knot intracorporeally inside a space constrainer.
Equipment: 2 needle drivers or 1 needle driver and 1 maryland, 1 pair of laparoscopic scissors, and one 15cm 2-0 Silk suture on an SH needle. Interrupted Suture pad with one pair of black dots and space constrainer. Rules: Use a right-handed forehand suturing technique. The first throw must be a surgeon’s knot, followed by two square knots. It is allowable for instruments to touch the edge of the space constrainer. However, you should avoid using excessive force causing the model to move. 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, 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 Dislodging space constrainer (the Velcro attachment is completely disrupted) – 30pts Not performing surgeon’s knots – automatic fail Scoring Formula: Score = 600 – time – 10 (sum of errors) Basic Proficiency Level: 420 (180s with no errors) Advanced Proficiency Level: 453 (147s with no errors) Expert Proficiency Level: 485 (115s with no errors) Proficiency Training Protocol: Achieve proficiency score on 2 consecutive repetitions (max 80 repetitions) Proficiency Testing (Pre- and Post-test): 1 repetition

Task 4 – CONFINED SPACE SUTURING

Summary: This task requires inserting the needle through the two marked dots on the tissue and then tying a knot intracorporeally inside a space constrainer.

Equipment: 2 needle drivers or 1 needle driver and 1 maryland, 1 pair of laparoscopic scissors, and one 15cm 2-0 Silk suture on an SH needle. Interrupted Suture pad with one pair of black dots and space constrainer.
Rules: Use a right-handed forehand suturing technique. The first throw must be a surgeon’s knot, followed by two square knots. It is allowable for instruments to touch the edge of the space constrainer. However, you should avoid using excessive force causing the model to move.
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, 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
          Dislodging space constrainer (the Velcro attachment is completely disrupted) – 30pts
          Not performing surgeon’s knots – automatic fail
Scoring Formula: Score = 600 – time – 10 (sum of errors)
Basic Proficiency Level: 420 (180s with no errors)
Advanced Proficiency Level: 453 (147s with no errors)
Expert Proficiency Level: 485 (115s 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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