Fundamentals of Laparoscopic Surgery

...the definitive laparoscopic skills enhancement and assessment module.

What Is FLS

 

Program Mission

To provide surgical residents, fellows and practicing surgeons an opportunity to learn the fundamentals of laparoscopic surgery in a consistent, scientifically accepted format; and to test cognitive, surgical decision-making, and technical skills, all with the goal of improving the quality of patient care.

Program Overview

FLS is a comprehensive, CD-ROM and soon to be web-based education module that includes a hands-on skills training component and assessment tool designed to teach the physiology, fundamental knowledge, and technical skills required in basic laparoscopic surgery.

FLS was designed for surgical residents, fellows and practicing surgeons to learn and practice laparoscopic skills to have the opportunity to definitely measure and document those skills.  The FLS Test measures cognitive knowledge, case/problem management skills and manual dexterity.  The FLS program content has been endorsed by the American College of Surgeons (ACS) and is a joint educational offering of SAGES and ACS.  FLS is also CME accredited.  Click here to download Frequently-Asked-Questions about FLS.

Valuable as a foundation or supplement to any current MIS curriculum, FLS is also an appropriate learning tool for disciplines such as gynecology and urology, as FLS is not procedure-specific  Click here to download a brochure.

FLS Objectives

Program Description

FLS establishes a standard set of didactic information and manual skills serving as a basic curriculum to guide surgical residents, fellows and practicing surgeons in the performance of basic laparoscopic surgery.  By mastering the curriculum and gathering of skills in this inanimate modality, it is expected that surgical residents and surgeons will initiate and carry out their performance of laparoscopy more effectively, with greater skills, greater safety, and with lower complication rates than previously.  The specific aim of FLS is that the knowledge and skills gained by those who master the FLS curriculum will improve the quality and safety of surgical care delivered to their patients.

Technical Skills Training Curriculum

The FLS program may be effectively used to teach and assess both cognitive and technical skill aspects related to laparoscopic surgery. Over the past two years, SAGES FLS committee members have developed a technical skills curriculum specifically designed for use in residency training programs. The curriculum is proficiency-based, whereby trainees are oriented to the materials and self-practice until expert-derived performance levels are reached.

Residents may practice as much or as little as needed in order to acquire the validated skills incorporated into the FLS modules. The video materials serve as a robust source of feedback for the learner and additional proctoring is considered optional. This protocol ensures that all trainees achieve an excellent level of performance, and has correlated with a uniform successful passing score according to the FLS technical skills testing criteria. We recommend this curriculum for all resident levels. Surgery interns may benefit by mastering these skills early in their training, such that they are better prepared for opportunities in the operating room and can undergo additional training throughout their residency as needed. Similarly, mid-level and senior residents may benefit by ensuring that all trainees have suitable skills to perform a wide array of laparoscopic procedures.

We have partnered with other ongoing national initiatives, and this curriculum is now part of the Basic and Advanced Laparoscopic Skills Modules included in the ACS/APDS National Skills Curriculum Project; detailed information concerning these modules is available through the ACS website www.facs.org/education/surgicalskills/html.

Download technical skills proficiency-based curriculum.

Components

FLS consists of:

  1. two multi-media CD-ROM study guides - soon to be web-based;
  2. hands-on manual skills practice and training via the FLS Laparoscopic Trainer Box; and
  3. an assessment tool that measure your cognitive and technical skills.

The CD-ROM study guides cover didactics, interactive patient scenarios and manual skills training.  The CD-ROM includes printable text reviews and practice questions.  This content will soon also be available in a web-based format.

The FLS Laparoscopic Trainer Box allows practice of technical skills to improve dexterity and psychomotor skills.  The simulated laparoscopic manipulation includes instrument navigation, coordination and cutting or knot-tying.

The Assessment Component is a two-part, proctored exam that covers cognitive knowledge and manual skills.

The cognitive component is a timed, 75-question multiple-choice exam administered via computer.  It is designed to test the understanding and application of the basic fundamentals of laparoscopy with emphasis on clinical judgment or intraoperative decision-making.   

The manual skills component evaluates skills based on speed and accuracy of the surgeon's maneuvers using the FLS Laparoscopic Trainer Box.  The test consists of five non-procedure specific simulation exercises incorporating most of the psychomotor skills necessary for basic laparoscopic surgery. 

FLS Benefits

Exam Eligibility

FLS candidates are

After completion of the self-instructional CD program, candidates may schedule the FLS Exam.

Supporting Literature

 

  1. Scott DJ, Ritter EM, Tesfay ST, Pimental EA, Nagji L, Fried GM. Certification pass rate of 100% for fundamentals of laparoscopic surgery skills after proficiency-based training.  Surgical Endoscopy 2008 10.1107/x00464-0089745-y (online).
  2. Ritter EM, Scott DJ (2007) Design of a proficiency-based skills training curriculum for the Fundamentals of Laparoscopic Surgery. Surg Innov 14; 107, 2007.
  3. Swanstrom LL. Fried GM. Hoffman KI. Soper NJ. Beta test results of a new system assessing competence in laparoscopic surgery. Journal of the American College of Surgeons; 202(1): 62-9, 2006.  
  4. Korndorffer Jr JR, Dunne JB, Sierra R, Stefanidis D, Touchard CL, Scott DJ. Simulator training for laparoscopic suturing using performance goals translates to the OR. J Am Coll Surg, 201:23 – 29, 2005.
  5. Stefanidis D, Sierra R, Markley S, Korndorffer Jr JR, Scott DJ.  Proficiency maintenance: impact of ongoing simulator training on laparoscopic skill retention. J Am Coll Surg, 202:599 – 603, 2006.
  6. Stefanidis D, Sierra R, Korndorffer Jr JR, Dunne JB, Markley S, Touchard C, Scott DJ. Intensive CME course training on simulators results in proficiency for laparoscopic suturing. Am J Surg, 191:23 –27, 2006.
  7. Dauster B, Steinberg AP, Vassiliou MC, Bergman S, Stanbridge DD, Feldman LS, Fried GM: Validity of the MISTELS Simulator for Laparoscopy Training in Urology. J Endourol. Jun; 19:541-5, 2005.
  8. Fraser SA, Feldman LS, Stanbridge D, Fried GM: Characterizing the learning curve for a basic laparoscopic drill. Surgical Endoscopy, 19(12): 1572-8, 2005.
  9. Fried GM, Feldman LS, Vassiliou MC, Fraser SA, Stanbridge D, Ghitulescu G, and Andrew CG.  Proving the value of simulation in laparoscopic surgery. Ann Surg 2004; 240: 518-528.   
  10. Peters JH, Fried GM, Swanstrom LL, Soper NJ, Sillin LF, Schirmer B, Hoffman K and the SAGES FLS Committee. Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery. Surgery 2004; 135: 21-27
  11. Feldman LS, Sherman V, Fried GM. Using simulators to assess laparoscopic competence: ready for widespread use? Surgery 2004; 135: 28-42
  12. Feldman LS, Hagarty SE, Ghitulescu G, Stanbridge D, Fried GM. Relationship between objective assessment of technical skills and subjective in-training evaluations in surgical residents. J Am Coll Surg 2004; 198:105–110
  13. Fraser SA, Klassen DR, Feldman LS, Ghitulescu GA, Stanbridge D, Fried GM.  Evaluating laparoscopic skills; setting the pass/fail score for the MISTELS system.  Surgical Endoscopy 2003; 17(6): 964-967
  14. Keyser EJ, Derossis AM, Antoniuk M, Sigman HH, Fried GM. A simplified simulator for the training and evaluation of laparoscopic skills. Surgical Endoscopy 2000; 14: 149-153
  15. Fried GM, Derossis AM, Bothwell J, Sigman HH. Comparison of laparoscopic performance in vivo with performance measured in laparoscopic simulator. Surgical Endoscopy 1999; 13: 1077-1081
  16. Derossis AM, Antoniuk M, Fried GM: Evaluation of laparoscopic skills: a 2-year follow-up during residency training. Canadian Journal of Surgery 1999; 42:293-296
  17. Derossis AM, Fried GM, Abrahamowicz M, Sigman HH, Barkum JS, Meakins JL.  Development of a model for training and evaluation of laparoscopic skills.  American Journal of Surgery 1998; Vol.175: 482-487
  18. Derossis AM, Bothwell J Sigman HH, Fried GM. The effects of practice on performance in a laparoscopic simulator.  Surgical Endoscopy 1998; 12: 1117-1120

 

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