UT Southwestern Medical Center at Dallas, Southwestern Center for Minimally Invasive Surgery
Robotic Basic Skills Curriculum
Task 1: Peg Transfer
Description: The pegboard is centered in the camera's field of view. Six pegs are on the left side of the pegboard. The
peg transfer exercise requires the trainee to lift the six objects with the needle driver in the left hand, transfer midair to
the right hand, and then place each peg on a post on the right side of the pegboard. Once all six pegs have been
transferred, the process is reversed using the right hand.
Start: When the first peg is grasped with the left hand.
Stop: When the last peg is placed back on the left side with the left hand.
Instruments: Left hand: Needle driver
Right hand: Needle driver
Camera: Zero degree, centered on Pegboard, surgeon controlled movement is not allowed
Fourth arm: Not used
Clutching: Allowed but should not be needed
Errors: Pegs dropped out of the field of view = 1 point for each peg dropped
Proficiency Testing Protocol: 1 repetition with proctor
Proficiency Training Protocol: Achieve proficiency score on 2 consecutive repetitions (max 80)
Maximum time allowed: 300 seconds
Scoring Formula: Score = 300 ‐ completion time ‐ (errors)10
Proficiency Score: 234 (revised level based on mean performance of 8 experts ‐ Jan 2011 version)
Proficiency Time: 66 seconds (1 min 6 sec) with no errors
Trainee Scores:
Date
Rep. #
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Time
Pegs Not
Transferred
Score
Date
Rep. #
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Time
Pegs Not
Transferred
Score
UT Southwestern Medical Center at Dallas, Southwestern Center for Minimally Invasive Surgery
Robotic Basic Skills Curriculum
Task 2: Clutch and Camera Movement
Description: This task requires the trainee to move and navigate the camera (in a clockwise manner beginning and
ending with shape “A”). Using the camera, follow the path from target A to target B. At each square target, the camera
will be frozen before moving on to the next target and the trainee will notify the proctor that the shape is completely in
view with no red dots seen and all corners visible. Only after notification can the trainee move on to the next target.
This is continued until all targets have been visualized.
Start: When trainee moves the camera for the first time
Stop: Trainee returns to target “A” and notifies proctor of visualization.
Instruments: Left hand: No instrument
Right hand: No instrument
Camera: Zero degree, centered on middle of hexagon
Fourth arm: Not used
Clutching and camera required
Errors: Red dot visualized = 1 point for each dot seen.
Corners of target not in view = 1 point for each occurrence
Proficiency Testing Protocol: 1 repetition with proctor
Proficiency Training Protocol: Achieve proficiency score on 2 consecutive repetitions (max 80)
Maximum time allowed: 300 seconds
Scoring Formula: Score = 300 ‐ time ‐ (sum of errors)10
Proficiency Score: 248 (revised level based on mean performance of 8 experts ‐ Jan 2011 version)
Proficiency Time: 52 seconds with no errors
Trainee Scores:
Date
Rep. #
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Time
Dots
Corners
Score
Date
Rep. #
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Time
Dots
Corners
Score
UT Southwestern Medical Center at Dallas, Southwestern Center for Minimally Invasive Surgery
Robotic Basic Skills Curriculum
Task 3: Rubberband Transfer
Description: The trainee must grasp the rubberband placed at the base of the copper wire model (position "A") with the
left needle driver, transfer it to the right needle driver, and place it on the model on the right side (position "B"). This
task must be performed in a left‐to‐right direction from “A” to “B” and “C” to “D”, then reversed from a right‐to‐left
direction from “D” to “C” and “B” to “A”.
Time starts: When the first rubberband is grasped
Time stops: When the last rubberband is placed back at position "A"
Instruments: Left hand: Needle driver
Right hand: Needle driver
Fourth arm: Not used
Camera: Zero degree, centered, surgeon controlled movement is not allowed
Clutching: Allowed but should not be needed
Errors: Dropping rubberbands outside field of view = 1 point.
Avulsion of model = 1 point
Proficiency Testing Protocol: 1 repetition with proctor
Proficiency Training Protocol: Achieve proficiency score on 2 consecutive repetitions (max 80)
Maximum time allowed: 300 seconds
Scoring Formula: Score = 300 ‐ time ‐ (sum of errors)10
Proficiency Score: 229 (revised level based on mean performance of 8 experts ‐ Jan 2011 version)
Proficiency Time: 75 seconds (1 min 15 sec) with no errors
Trainee Scores:
Date
Rep. #
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Time
Rubber
Bands
Dropped
Avulsion
Score
Date
Rep. #
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Time
Rubber
Bands
Dropped
Avulsion
Score
UT Southwestern Medical Center at Dallas, Southwestern Center for Minimally Invasive Surgery
Robotic Basic Skills Curriculum
Task 4: Simple Interrupted Suture.
Description: The trainee must perform a simple interrupted suture on the Penrose drain (FLS suturing model). The FLS
model is oriented perpendicular with a 2cm vertical slit. The trainee must pass the needle (2‐0 silk, 12cm length, tapered
needle) through both 2mm marked targets, located 5 mm away from the incision on opposite sides of the Penrose drain.
Using instrument ties the trainee performs a surgeon's knot, followed by 2 square knots; (3 knots total) and then cuts
the suture tails to 1cm in length using fourth arm scissors. The FLS laparoscopic suturing protocol must be used (i.e.
alternating hands). Care must be taken not to avulse the model.
Start: When needle is grasped.
Stop: When both suture tails have been cut to 1cm in length.
Instruments: Left hand: Needle driver
Right hand: Needle driver
Camera: Zero degree, centered on FLS model, surgeon movement not allowed
Fourth arm: Curved Scissors
Clutching required only for the fourth arm
Errors: Accuracy: Sum of distances in (mm) needle passed outside of each colored target
Gap (air knot): Distance in (mm) between targets on FLS suturing model (minimum = 2mm = no error)
Breakage of suture: 10 points
Bunny Ears: Incorrect knot = 1 point
Frayed Suture: 1 point if outside of knot, 10 points if within knot
Avulsion of model = a score of zero.
Slippage of knot: 10 points for slip >3 mm
Tails: Fails to cut tails to 1 cm = 1 point for each occurrence
Proficiency Testing Protocol: 1 repetition with proctor
Proficiency Training Protocol: Achieve proficiency score on 2 consecutive repetitions (max 80)
Maximum time allowed: 600 seconds
Scoring Formula: Score = 600 ‐ completion time ‐ 10(sum of errors)
Proficiency Score: 509 (revised level based on mean performance of 8 experts ‐ Jan 2011 version)
Proficiency Time: 91 seconds (1 min 31 sec) with no errors
Trainee Scores:
Date
Rep.
#
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Time
Accuracy
Gap
Error
Breakage
Bunny
ears
Frayed
within
Knot
Frayed
outside
Knot
Avulsion
Knot
Slippage
Tail
Length
Score
Date
Rep.
#
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Time
Accuracy
Gap
Error
Breakage
Bunny
ears
Frayed
within
Knot
Frayed
outside
Knot
Avulsion
Knot
Slippage
Tail
Length
Score
UT Southwestern Medical Center at Dallas, Southwestern Center for Minimally Invasive Surgery
Robotic Basic Skills Curriculum
Task 5: Clutch and Camera Peg Transfer
Description: This task requires the trainee to grasp the rubber peg at position “A” with the left needle driver and place it
at position “B”; then pick up the peg with the right needle driver and place it at position "C". This process is repeated
until the peg has been returned to position "A". Clutching and camera movement are required to complete this task.
Care must be taken not to drop the peg outside of the field of view.
Time starts: When the camera is first moved by the trainee
Time stops: When the peg is placed at position "A"
Instruments: Left hand: Needle driver
Right hand: needle driver
Camera: Zero degree, centered and zoomed out, surgeon adjustments as needed
Fourth arm: Not used
Clutching is required
Errors: Peg dropped out of field of view
Proficiency Training Protocol: Achieve proficiency score on 2 consecutive repetitions (max 80 reps)
Proficiency Testing Protocol: 1‐proctored repetition
Maximum time allowed: 300 seconds
Scoring Formula: Score = 300 ‐ time ‐ 10(errors)
Proficiency Score: 251 (revised level based on mean performance of 8 experts ‐ Jan 2011 version)
Proficiency Time: 49 seconds with no errors
Trainee Scores:
Date
Rep. #
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Time
Pegs
Dropped
Score
Date
Rep. #
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Time
Pegs
Dropped
Score
UT Southwestern Medical Center at Dallas, Southwestern Center for Minimally Invasive Surgery
Robotic Basic Skills Curriculum
Task 6: Stair Rubberband Transfer
Description: The trainee must grasp the rubberband placed at position “A” with the left needle driver and transfer it to
position “B”. The right needle driver is then used to grasp the rubberband and place it at the next target (position “C”).
The task is completed when the trainee has placed the rubberband back at position “A” with the left needle driver.
Clutching and camera movement are required to perform this task.
Time starts: When the camera is first moved
Time stops: When the rubberband has been placed back at position "A" with the left needle driver
Instruments: Left hand: Needle driver
Right hand: Needle driver
Camera: Zero degree, centered, surgeon adjustments as needed
Fourth arm: Not used
Errors: Pegs dropped out of the field of view = 1 point.
Avulsion of model = a score of zero
Proficiency Testing Protocol: 1‐proctored repetition
Proficiency Training Protocol: Achieve proficiency score on 2 consecutive repetitions (max 80 reps)
Maximum time allowed: 300 seconds
Scoring Formula: Score = 300 ‐ time ‐ 10(errors)
Proficiency Score: 242 (revised level based on mean performance of 8 experts ‐ Jan 2011 version)
Proficiency Time: 58 seconds with no errors
Trainee Scores:
Date
Rep. #
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Time
Rubber
Bands
Dropped
Avulsion
Score
Date
Rep. #
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Time
Rubber
Bands
Dropped
Avulsion
Score
UT Southwestern Medical Center at Dallas, Southwestern Center for Minimally Invasive Surgery
Robotic Basic Skills Curriculum
Task 7: Running and Cutting Rubberband
Description: This task uses a 12cm long rubberband model that is marked with 10 target segments at 1cm intervals. The
red marked segments indicate beginning and end points. The trainee must grasp the rubberband (on the first & third
marked segments) using both needle drivers, activate the 4th arm (scissors), and cut the rubberband in between each
marked interval. This process is then repeated until all 10 marked segments have been cut. Clutching and 4th arm
activation is required to successfully perform this task.
Time starts: When the rubberband is first grasped
Time stops: When the tenth section of rubberband is released by the needle drivers
Instruments: Left hand: Needle driver
Right hand: Needle driver
Camera: Zero degree, centered, surgeon adjustments as needed
Fourth arm: Curved Scissors
Clutching as needed
Errors: Cutting outside of black marked segments = 1 point
Proficiency Testing Protocol: 1‐proctored repetition
Proficiency Training Protocol: Achieve proficiency score on 2 consecutive repetitions (max 80 reps)
Maximum time allowed: 300 seconds
Scoring Formula: Score = 300 ‐ time ‐ 10(errors)
Proficiency Score: 202 (revised level based on mean performance of 8 experts ‐ Jan 2011 version)
Proficiency Time: 98 seconds (1 min 38 sec) with no errors
Trainee Scores:
Date
Rep. #
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Time
Black Lines
Missed
Score
Date
Rep. #
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Time
Black Lines
Missed
Score
UT Southwestern Medical Center at Dallas, Southwestern Center for Minimally Invasive Surgery
Robotic Basic Skills Curriculum
Task 8: Pattern Cut
Description: FLS testing gauze (with a simple circle) is placed on the plastic clip at one end. The fourth arm grasper is
initially placed by the surgeon to hold counter traction on the gauze. The surgeon then activates the right hand scissors
and cuts along and within the black line using the left hand grasper to aid with traction. The surgeon is encouraged to
bring the camera close to the operating field and continuously adjust the view such that precision cutting (within the
black line) may be achieved. Only the top layer of gauze must be cut.
Start: When the gauze is grasped by the fourth arm grasper
Stop: Completion of cutting the marked circle
Instruments: Left hand: Maryland Bipolar Forceps
Right hand: Curved Scissors
Camera: Zero degree, centered on the 4x4 square gauze, adjustments are encouraged
Fourth arm: Prograsp or Cadiere graspers (activated at the start of task)
Clutching as needed
Errors: Cuts outside of the line (either side)
Proficiency Testing Protocol: 1 repetition with proctor
Proficiency Training Protocol: Achieve proficiency score on 2 consecutive repetitions (max 80 reps)
Maximum time allowed: 300 seconds
Scoring Formula: Score = 300 ‐ time ‐ 50(errors)
Proficiency Score: 147 (revised level based on mean performance of 8 experts ‐ Jan 2011 version)
Proficiency Time: 153 seconds (2 min 33 sec) with no errors
Trainee Scores:
Date
Rep. #
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Time
Cuts Outside
of Line
Score
Date
Rep. #
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Time
Cuts Outside
of Line
Score
UT Southwestern Medical Center at Dallas, Southwestern Center for Minimally Invasive Surgery
Robotic Basic Skills Curriculum
Task 9: Running Suture
Description: This task uses the FLS suturing model with 5 pairs of inked targets placed on either side of a 2cm slit. The
trainee must perform a running suture (2‐0 silk, 15cm length) by approximating the 2cm slit. Using the FLS laparoscopic
suturing protocol (i.e. alternating hands), the trainee will perform a surgeon’s knot followed by 2 square knots; (3 knots
total). These knots must be tied on the first and last pairs of inked targets. The needle must be passed through the
remaining targets in a continuous fashion. Suture tails must be cut to 1cm in length.
Time starts: When the trainee picks up the needle with needle driver
Time stops: When all suture tails have been cut to 1cm in length
Instruments: Left Hand: Needle driver
Right Hand: Needle driver
Camera: Zero degree, centered, surgeon adjustments as needed
Fourth Arm: Curved Scissors
Clutching required for activation of fourth arm
Errors: Accuracy: Sum of distances in (mm) needle passed outside of each colored target
Gap (air knot): Distance in (mm) between targets on FLS suturing model (minimum = 2mm = no error)
Breakage of suture: 10 points
Bunny Ears: Incorrect knot = 1 point
Frayed Suture: 1 point if outside of knot, 10 points if within knot
Avulsion of model = a score of zero.
Slippage of knot: 10 points for slip >3 mm
Tails: Fails to cut tails to 1 cm = 1 point for each occurrence
Proficiency Testing Protocol: 1‐proctored repetition
Proficiency Training Protocol: Achieve proficiency score on 2 consecutive repetitions (max 80 reps)
Maximum time allowed: 600 seconds
Scoring Formula: Score = 600 ‐ time ‐ 10(errors)
Proficiency Score: 340 (revised level based on mean performance of 8 experts ‐ Jan 2011 version)
Proficiency Time: 260 seconds (4 min 20 sec) with no errors
Trainee Scores:
Date
Rep.
#
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Time
Accuracy
Gap
Error
Breakage
Bunny
ears
Frayed
within
Knot
Frayed
outside
Knot
Avulsion
Knot
Slippage
Tail
Length
Score
Date
Rep.
#
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Time
Accuracy
Gap
Error
Breakage
Bunny
ears
Frayed
within
Knot
Frayed
outside
Knot
Avulsion
Knot
Slippage
Tail
Length
Score