Table 3 Procedural checklist and Objective Structured Assessment of Technical Skill (OSATS) scale for laparoscopic suturing and knot tying
Procedure assessment and OSATS | Yes/no | ||
|---|---|---|---|
Needle position 1 | 1 | Held at one half to two thirds distance from the tip | |
2 | Angle 90° ± 20° | ||
3 | Uses tissue or other instrument for stability | ||
4 | Attempts at positioning (≤3) | ||
Needle driving 1 (entry to incision) | 5 | Entry at 60° to 90° to tissue plane | |
6 | Driving with one movement | ||
7 | Driving needle with wrist suppination | ||
8 | Single point of entry through tissue | ||
9 | Removes needle along its curve | ||
10 | Pull suture through to establish short free end | ||
11 | Suture placed accurately, on target | ||
Needle position 2 | 12 | Held at one half to two thirds distance from the tip | |
13 | Angle 90° ± 20° | ||
14 | Uses tissue or other instrument for stability | ||
15 | Attempts at positioning (≤3) | ||
Needle driving 2 (entry in incision) | 16 | Driving with one movement | |
17 | Removes needle along its curve | ||
Techniques of knots | 18 | Correct C-loop | |
19 | Smoothly executed throw, no fumbles | ||
20 | Knot laid flat without air knots | ||
21 | Short free end maintained | ||
22 | Correct inverse C-loop | ||
23 | Smoothly executed throw, no fumbles | ||
24 | Knot laid flat without air knots | ||
25 | Correct third C-loop | ||
26 | Smoothly executed throw, no fumbles | ||
27 | Knot laid flat without air knots | ||
Pulling the suture | 28 | Needle on needle holder in view at all times | |
29 | Uses the pully concept | ||
30 | Knot squared | ||
31 | Appropriate tissue reapproximation without strangulation | ||
32 | Good use of both hands to facilitate knot tying | ||
General | 33 | Kept needle in view at all times when grasping | |
34 | Non-dominant hand helps dominant hand in suturing |