LapPass ®

TASK 1

Basic grasping and manipulation of polo mints

EQUIPMENT
3 posts
3 polo mints
1 piece of string/cord 15cm in length
2 Johannes forceps

TASK
Transfer 3 polo mints from post to post from a start and finish position in the floor of the simulator with the polo writing face up.
From base to post 1: Using left hand only
From post 1 to post 2: Use right hand only remove from post one and place on post two upside down
From post 2 to post 3: Remove from post two with one hand, transfer in mid air to grasper in other hand then place on post 3
From post 3 to finish: Remove from post three and in mid air pass over the cord such that the polo mint does not touch the floor of the simulator. The mint is then placed back at the starting position.

ESSENTIAL ELEMENTS
Grasping and manipulation
Spatial awareness
Pronation and supination
Tactile feedback from graspers
Smooth performance.

CLOCK STARTS: As soon as the first polo mint is touched
CLOCK STOPS: As soon as the third polo mint is placed back at the starting point.
TARGET TIME: 4 minutes

COMMENTS
If a polo mint is dropped it is placed back at the starting position and the cycle is repeated for that individual polo mint.

TASK 2

TYING EXTRACORPOREAL ROEDER KNOTS AND PLACING THEM TO SIMULATE APPENDICECTOMY

EQUIPMENT
Partially inflated glove with 4 lines at 1cm intervals along one digit.
Long length of braided suture material
Johannes or knot pusher
Laparoscopic scissors

TASK
Create and place three Roeder knots, 2 proximally in zone 1, one distally in zone three and divide in zone two. Glove must not deflate

ESSENTIAL ELEMENTS
Demonstration of accurate and effective Roeder knot.
Precision placement of endoloop
Precision cutting

CLOCK STARTS: As soon as first endoloop is passed into the simulator
CLOCK STOPS: When tip of glove is separated from main glove and the last endoloop has been cut
TARGET TIME: 8 mins

COMMENTS
The first endoloop may be constructed outside the simulator before the exercise begins and is done in front of the assessor to confirm that the knot is being accurately constructed. There is no time limit on this stage. The technique of Roeder knot formation is available on the ALS website courtesy of the Royal College of Surgeons.
Inaccurate loops must be repeated. Inaccurate division of the tip of the glove or immediate (< 1 minute) deflation of the body of the glove disqualifies the exercise which must then be repeated in its entirety.

Click for a powerpoint file with step-by-step instructions to create a Roeder knot

TASK 3

CUTTING A SHAPE

EQUIPMENT
Solid circular line on glove or chamois leather with inner and external parallel dotted lines 0.5 cm away. Diameter of circle must be at least 5 cm.
Laparoscopic scissors and graspers.
Target circle

TASK
To precisely cut a circular shape without deviation from the line on excision and without damaging underlying tissue

ESSENTIAL ELEMENTS
Precision cutting
Grasping and manipulation
Placing the tissue under tension to facilitate the exercise

CLOCK STARTS: As the first instrument is placed into the simulator
CLOCK STOPS: As the shape is confirmed to be fully excised
TARGET TIME: 3 mins

COMMENTS
Touching or breaching either dotted line disqualifies the exercise. Scissors may be used in either hand and may be used interchangeably

TASK 4

SUTURING

EQUIPMENT
Flexible pad with two pairs of dots drawn in
Braided suture
Needle driver
Johannes/ second needle holder
LLaparoscopic scissors.

TASK
To place two accurate sutures and tie them securely to draw tissue under tension

ESSENTIAL ELEMENTS
Loading of needle drivers. Accurate suturing. Precise and secure knot tying with appropriate tension. The two target spots must be touching (outer dotted lines) on completion of the excercise.

CLOCK STARTS: As soon as suture material is inserted into simulator
CLOCK STOPS: With division of the suture material after second suture
TARGET TIME: 6 minutes

COMMENTS
Acceptable knot types: Szabo knot (secure reef knot with additional throw), may be tied using two hand technique (“C” and “D” loops) or (for advanced practitioners) tied single handedly, Surgeon’s knot. Precision and tension mandatory

CAMERA HOLDING SKILLS

Minimum of 6 cases each at least 30 mins long
Sole camera holder
Forewarn operator that this is an assessable task
At least 3 cases using 30 degree laparoscope

SKILLS TO BE DEMONSTRATED
Camera precision: Target to be maintained within the centre of the image for the majority of the time and to the satisfaction of the operator
An appropriate distance from the target tissue to be maintained and to demonstrate proactive dynamism with “zooming in” for precise tasks and “zooming out” for general views and instrument exchanges
An understanding of the principles of the 30 degree laparoscope with demonstration of orientation whilst maintaining the horizon
Appropriate teamworking skills