59trainees must transfer the needle to their other hand. Skills required include proper
placement of the needle in the needle holder, needle transferring, suturing skills, and
knot tying. A penalty is applied for any deviation of the needle from the marks, for
any gap in the longitudinal slit in the drain and for a knot that slips when tension is
applied to it. If the drain is avulsed from the block to which it is secured by
VelcroTM, a score of zero will be applied. The required proficiency score is 112 s
with up to 1 mm accuracy error; no knot security errors (slippage) allowed.
Proficiency scores must be achieved on 2 consecutive repetitions and on 10 addi-
tional (nonconsecutive is acceptable) repetitions.
BLUS
The American Urological Association (AUA) stood on the shoulders of FLS to cre-
ate BLUS, the Basics of Laparoscopic Urologic Surgery. As FLS was created to
apply to all specialties who might utilize laparoscopic surgery, it purposefully
avoids anatomic specificity. BLUS simply adds to FLS to make it more appropriate
Fig. 5.5 Task 4: Simple
suture with extracorporeal
knot (Fundamentals of
Laparoscopic Surgery®
(FLS) Program is owned
by Society of American
Gastrointestinal and
Endoscopic Surgeons and
American College of
Surgeons. Images used
with permission)
Fig. 5.6 Task 5: Simple
suture with intracorporeal
knot Fundamentals of
Laparoscopic Surgery®
(FLS) Program is owned
by Society of American
Gastrointestinal and
Endoscopic Surgeons and
American College of
Surgeons. Images used
with permission
5 Performance Assessment in Minimally Invasive Surgery