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. Incision / Port Placement Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Poor choice of port Functional but Safe, efficient position; unsafe somewhat and optimal technique in awkward port positioning of insertion or positioning; ports for removal generally safe procedure and technique; some anatomy difficulty inserting ports Substantial Some Minimal Direction Direction Direction 1 2 3 4 5 NA Exposure - Pneumoperitoneum Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Inadequate Adequate establishment Efficient pneumoperitoneum, and maintenance of establishment and camera angle and appropriate maintenance of retraction with pneumoperitoneum, appropriate frequent loss camera angle and pneumoperitoneum, of exposure retraction but with camera angle and occasional loss of retraction exposure Substantial Some Minimal Direction Direction Direction 1 2 3 4 5 NA Exposure - Identification Poor Fair Good Very Good Excellent 1 2 3 4 5 NA
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. Incision / 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; some difficulty inserting ports Safe, efficient and optimal positioning of ports for procedure and anatomy Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Exposure - Pneumoperitoneum Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Inadequate pneumoperitoneum, camera angle and retraction with frequent loss of exposure Adequate establishment and maintenance of appropriate pneumoperitoneum, camera angle and retraction but with occasional loss of exposure Efficient establishment and maintenance of appropriate pneumoperitoneum, camera angle and retraction Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Exposure - Identification Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA