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. Incision / 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; some difficulty inserting ports Safe, efficient and optimal positioning of ports for procedure and anatomy 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 Poor/inadequate pneumoperitoneum, camera angle and retraction with frequent loss of exposure Adequate establishment and maintenance of pneumoperitoneum, camera angle and retraction but with occasional loss of exposure Optimizes exposure, efficiently directs retraction and camera to maintain exposure and pneumoperitoneum Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Elevation of Peritoneal Flap Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Poor technique, excessive bleeding and trauma to flap Satisfactory technique but makes closure somewhat difficult Excellent technique, minimal bleeding, flap intact, easy closure
Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Preperitoneal Space Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Difficult entrance into peritoneal cavity; difficulty with balloon insertion and inflation Moderate efficiency in balloon insertion and inflation Avoidance of peritoneal injury, careful insertion of balloon and inflation Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Reducing the Sac Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Poor technique requiring greater than expected time Moderate efficiency in reducing the sac Careful and efficient reduction of the sac Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Mesh Insertion Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Poor technique and excessive time for mesh insertion and/or inappropriate staple placement Moderately efficient mesh insertion and placement Efficient and accurate placement with appropriate securing of mesh Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA
General Criteria Instrument Handling Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Tentative or awkward movements, often did not visualize tips of instrument or clips poorly placed Competent use of instruments, occasionally appeared awkward or did not visualize instrument tips Fluid movements with instruments consistently using appropriate force, keeping tips in view, and placing clips securely Respect for Tissue Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Frequent unnecessary tissue force or damage by inappropriate instrument use Careful tissue handling, occasional inadvertent damage Consistently handled tissue carefully (appropriately), minimal tissue damage Time and Motion Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Many unnecessary moves Efficient time and motion, some unnecessary moves Clear economy of motion, and maximum efficiency Operation Flow Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Frequent lack of forward progression; frequently stopped operating and seemed unsure of next move Some forward planning, reasonable procedure progression Obviously planned course of operation and anticipation of next steps