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EISENHOWER ARMY MEDICAL CENTER
U.S. ARMY MEDICAL DEPARTMENT
Sim Center-FLS Training

Fundamentals of Laproscopic Surgery Manual Skills Training

Peg Transfer
The peg transfer exercise requires you to lift the six objects with a grasper/dissector, first in your non-dominant hand, and to transfer the object midair to your dominant hand. Then, place each object on a peg on the opposite side of the board. There is no importance placed on the color of the objects or the order in which they are placed. Once all six objects have been transferred, the process is reversed. Each object is lifted in turn using the dominant hand from the pegboard, transferred midair to the other hand and placed on the pegs on the original side of the board.

 

Precision Cutting
One hand should be used to provide traction on the gauze using the grasper and to place the gauze at the best possible angle to the cutting hand. If you wish, you may exchange instruments at any time during this task. You must start cutting from an edge of the gauze as demonstrated in Module 5 of the didactic curriculum.

 

Securing of Ligating Loop
In this task, you are required to place a pre-tied ligating loop or endoloop around a tubular foam appendage and secure the knot on the provided mark. Once you have inserted the endoloop into the field of view, break off the end of the plastic pusher at the scored mark. Once you have positioned the endoloop properly, secure the knot on the mark near the base of the foam appendage by sliding the pusher rod down. A penalty will be assessed if the knot is not secure and for any distance that the tie misses the mark.

 

Simple Suture with Extracorporeal Knot
This suturing task requires you to place a long suture through two marks in a longitudinally slit Penrose drain. You are then required to tie 3 single throws extracorporeally, using the knot-pusher to secure each throw on the drain. You must tie the knot tightly enough to close the slit in the drain. Be careful not to avulse the drain off the foam block.


 

Simple Suture with Intracorporeal Knot
This suturing task requires you to place a suture precisely through two marks on a Penrose drain that has been slit along its long axis. You are then required to tie the knot intracorporeally. The first throw must be a surgeon’s knot or double throw, followed by two single throws. You must exchange hands with your needle between each throw, so that you are tying with the opposite hand for each throw to ensure the knot is square.

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