Task 5 – Tension Suturing

Summary: This task requires closure of a gap under tension using one interrupted suture with a slip knot technique.

Equipment: 2 needle drivers or 1 needle drive and 1 maryland, 1 pair of laparoscopic scissors and three 25 cm 2-0 Silk sutures on SH needle. Tension suture pad with three pairs of black dots.

Rules: Use a right-handed forehand suturing technique to close the last pair of dots at the widest part of the triangular opening. The first throw must be a slip knot, followed two square knots. 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 the tails are cut.

Cutoff time: Maximum time for task completion is 5 minutes (cutoff = 300sec). 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 subsequent knots excluding first slip knot, 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 slip knot – automatic fail

Scoring Formula: Score = 300 – time – 10 (sum of errors)

• Basic Proficiency Level: 154 (146s with no errors)
• Advanced Proficiency Level: 171 (129s with no errors)
• Expert Proficiency Level: 188 (112s 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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