Fundamentals of Laparoscopic Surgery: Tutorial and Tips

Abstract

Video Objective To provide a stepwise tutorial and task-specific tips for trainees preparing for the manual skills component of the Fundamentals of Laparoscopic Surgery exam. Setting The American Board of Obstetricians and Gynecologists announced that starting in 2020 all OB/GYN residents must pass the Fundamentals of Laparoscopic Surgery (FLS) test in order to be eligible for board certification. This initiative is part of an effort to standardize knowledge and skill across programs. Interventions The manual skills component of FLS consists of five tasks: peg transfer, precision cutting, ligating loop, extracorporeal suturing, and intracorporeal suturing. For the peg transfer, the rotating dial on the Maryland graspers should be used to optimize the position of the graspers and rotate the objects into an optimal position for transferring and placement. For precision cutting, if right-handed, consider starting to the right of the midline. The left hand provides traction on the gauze and directionality must be adjusted throughout the task. Rotate the scissors as necessary to match the curve of the circle pattern. For the ligating loop, use a locking grasper to free both hands to break the endoloop. Trainees should be familiar with the multiuse trainer loops. Extracorporeal suturing can be performed with either an open or closed knot pusher but should always be performed by pushing 90 degrees off of the knot. The knot pusher can be gently rotated to reduce twisted sutures, and tension should be released if the knot pusher slips off. For intracorporeal suturing, the needle can be rotated to optimize the suture loop. Additionally, the needle should be aligned parallel to the needle driver. Conclusion The FLS manual tasks can easily be completed by trainees with the assistance of the tips depicted in this video.