5 4 3 2 1 Excellent Very Good Good Fair Poor NA Efficient; Removed Inefficient; did maintained clean gallbladder intact not cleanly plane between but strayed from remove gallbladder and plane, somewhat excessive liver bed inefficient, minimal bile spillage; throughout, no bile spilled; extra repeated injury parenchymal injury cautery needed for to liver or bile spillage liver bleeding parenchyma General Criteria Instrument Handling 5 4 3 2 1 Excellent Very Good Good Fair Poor NA Fluid movements Competent use Tentative or with instruments of instruments, awkward consistently using occasionally movements, appropriate force, appeared often did not keeping tips in awkward or did visualize tips of view, and placing not visualize instrument or clips securely instrument tips clips poorly placed Respect for Tissue 5 4 3 2 1 Excellent Very Good Good Fair Poor NA Consistently Careful tissue Frequent handled tissue handling, unnecessary carefully occasional tissue force or (appropriately), inadvertent damage by minimal tissue damage inappropriate damage instrument use Time and Motion 5 4 3 2 1 Excellent Very Good Good Fair Poor NA Clear economy Efficient time and Many of motion, and motion, some unnecessary maximum unnecessary moves efficiency moves Operation Flow
5 Excellent 4 Very Good 3 Good 2 Fair 1 Poor NA Efficient; maintained clean plane between gallbladder and liver bed throughout, no parenchymal injury or bile spillage Removed gallbladder intact but strayed from plane, somewhat inefficient, minimal bile spilled; extra cautery needed for liver bleeding Inefficient; did not cleanly remove excessive bile spillage; repeated injury to liver parenchyma General Criteria Instrument Handling 5 Excellent 4 Very Good 3 Good 2 Fair 1 Poor NA Fluid movements with instruments consistently using appropriate force, keeping tips in view, and placing clips securely Competent use of instruments, occasionally appeared awkward or did not visualize instrument tips Tentative or awkward movements, often did not visualize tips of instrument or clips poorly placed Respect for Tissue 5 Excellent 4 Very Good 3 Good 2 Fair 1 Poor NA Consistently handled tissue carefully (appropriately), minimal tissue damage Careful tissue handling, occasional inadvertent damage Frequent unnecessary tissue force or damage by inappropriate instrument use Time and Motion 5 Excellent 4 Very Good 3 Good 2 Fair 1 Poor NA Clear economy of motion, and maximum efficiency Efficient time and motion, some unnecessary moves Many unnecessary moves Operation Flow