Procedure-Specific Criteria Please assess performance and indicate the degree of prompting for each item. The assessment score for each item may differ from the prompting score for that item. Port Placement Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Poor choice of port position; unsafe technique in insertion or removal Functional but somewhat awkward port positioning; generally safe technique but some difficulty inserting ports Optimal positioning of ports for excellent camera view and orientation/angles of working instruments; safe and efficient placement Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Exposure Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Continued lack of exposure to the point of significant delays or potential patient harm Occasional loss of exposure (slowing procedure somewhat but not affecting outcome) due to intermittent loss of pneumoperitoneum, inefficient camera guidance, or direction of retraction Efficient establishment and maintenance of appropriate pneumoperitoneum, camera angles and retraction Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Identification and Assessment of Pathology/Disease Process
Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Complete reliance on faculty instruction for identification of lesions and associated findings (metastases, local inflammation, infection, etc.) Required some direction to identify segment of bowel for resection, perceived extent of disease with guidance Excellent identification of lesion, affected area of bowel, or metastases by visualization or palpation Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Dissection Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Unable to safely dissect or mobilize affected segment of bowel. Injured adjacent structures Reasonable development of planes of dissection but needed moderate guidance to maintain progress and protect adjacent structures Meticulous and efficient independent dissection of bowel segment from peritoneal attachments, adhesions or adjacent organs Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Extent of Resection Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Selected resection sites that would have left residual disease (would have removed too much healthy bowel, or would have left grossly ischemic bowel ends for anastomosis or stoma creation) Required some assistance in selecting optimal points of resection to safely remove disease Appropriately selected optimal proximal and distal resection sites (adequate margins for cancer, inflammation or perforation), expert handling of mesentery to maintain blood supply and achieve adequate lymphadenectomy (if applicable) Substantial Some Minimal NA
Direction 1 2 Direction 3 4 Direction 5 Prevention of Contamination Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Poor technique resulted in avoidable gross contamination from bowel contents Needed some guidance to contain contamination but demonstrated most appropriate techniques to minimize soiling Independently displayed meticulous preventive measures against intraperitoneal contamination (e.g., took measures to manage the operative field, removal of specimen and soiled instruments) Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Creation of Anastomosis (stapled or hand-sewn) OR stoma Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Complete reliance on faculty for appropriate mucosal apposition, avoidance of tension, or torsion Some guidance needed in creating anastomosis due to concern for apposition of layers, tension on the anastomosis, or orientation of the bowel OR some guidance needed for position/creation of stoma to avoid tension and allow for proper maturation Independently established excellent apposition of bowel layers and proper orientation of bowel ends to prevent torsion of the mesentery OR excellent position and creation of stoma Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA