71FRS was designed with the agreement of the various surgical specialties that
each specialty would develop an advanced, specialty-specific FRS which empha-
sized the basic skills unique to their specialty that was not common to all specialties
(and therefore not included in the FRS) – for example, clipping and stapling were
not included in FRS because all of the specialties did not use surgical clips or
staples.
Development within the gynecologic branch, FRGS has already been completed
and that for thoracic surgeons is under development. While many of the skills criti-
cal to safe and effective robotic handling are constant across different specialties,
the actual procedures vary widely. Proposed additions to FRGS include VR
simulation- based training on the dissection of the bladder flap, the colpotomy inci-
sions, the closure of the vaginal cuff, and the dissection of the ureter.
Fig. 5.16 FRS Task 3: Railroad track. The trainee must perform horizontal mattress suturing
through a series of target points to approximate the tissue, followed by anchoring the needle by
passing it through the final two target points twice. Primary skills: holding and manipulation of the
needle, following the curve of the needle, utilizing the full range of motion of the endowrist, and
using graspers. Secondary skills: eye-hand instrument coordination, passing objects between
instruments, appropriate handling of suture material, and running suture
Fig. 5.17 FRS Task 4:
Third arm cutting. The
trainee must switch control
between different
instruments to use the
monopolar scissors to cut
the vein transversely at the
hash marks. Primary skills:
switching between and
controlling multiple arms
and cutting. Secondary
skills: atraumatic handling
of tissue and eye-hand
instrument coordination
5 Performance Assessment in Minimally Invasive Surgery