Task 6 – Running Suture

Summary: This task requires closure of a defect using continuous suturing and two intracorporeal knots.  

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

Rules: Use a right-handed forehand suturing technique. First throw must be a surgeon’s knot, followed by two square knots. Continue with 4 running tissue bites. End with a surgeon’s knot to the loop, followed by two square knots. You will then cut both ends of your suture.  You must take full thickness bites of tissue

Timing: The timing will start when any instrument is seen on the monitor and will stop when the suture is cut after closing the defect.

Cutoff time: Maximum time for task completion is 15 minutes (cutoff = 900sec). 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
• Looseness of stitch = mild (3pts), severe (5pts)
• 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 lemberts) – 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
• Locked Stitch – automatic fail

Scoring Formula: Score = 900 – time – 10 (sum of errors).

• Basic Proficiency Level: 561 (339s with no errors)
• Advanced Proficiency Level: 608 (292s with no errors)
• Expert Proficiency Level: 654 (246s 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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