Procedure-Specific Criteria Please assess performance and indicate the degree of prompting for The assessment score each item. for each item may differ from the prompting score for that item. Port Placement Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Poor choice of Functional but Optimal port position; somewhat positioning of unsafe technique awkward port ports for excellent in insertion or positioning; camera view and removal generally safe orientation/angles technique but of working some difficulty instruments; safe inserting ports and efficient placement Substantial Some Minimal Direction Direction Direction 1 2 3 4 5 NA Exposure Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Continued lack of Occasional loss of Efficient exposure to the exposure (slowing establishment and point of significant procedure somewhat maintenance of delays or potential but not affecting appropriate patient harm outcome) due to pneumoperitoneum, intermittent loss of camera angles and pneumoperitoneum, retraction inefficient camera guidance, or direction of retraction Substantial Some Minimal Direction Direction Direction 1 2 3 4 5 NA Identification and Assessment of Pathology/Disease Process
Procedure-Specific Criteria Please assess performance and indicate the degree of prompting for each item. The assessment score for each item may differ from the prompting score for that item. Port Placement Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Poor choice of port position; unsafe technique in insertion or removal Functional but somewhat awkward port positioning; generally safe technique but some difficulty inserting ports Optimal positioning of ports for excellent camera view and orientation/angles of working instruments; safe and efficient placement Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Exposure Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Continued lack of exposure to the point of significant delays or potential patient harm Occasional loss of exposure (slowing procedure somewhat but not affecting outcome) due to intermittent loss of pneumoperitoneum, inefficient camera guidance, or direction of retraction Efficient establishment and maintenance of appropriate pneumoperitoneum, camera angles and retraction Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Identification and Assessment of Pathology/Disease Process