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 Functional but Safe, efficient port position; somewhat and optimal unsafe technique awkward port positioning of in 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 Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Poor/inadequate Adequate Optimizes pneumoperitoneum, establishment and exposure, efficiently camera angle and maintenance of directs retraction retraction with pneumoperitoneum, and camera to frequent loss of camera angle and maintain exposure exposure retraction but with and occasional loss of pneumoperitoneum exposure Substantial Some Minimal Direction Direction Direction 1 2 3 4 5 NA Elevation of Peritoneal Flap Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Poor technique, Satisfactory Excellent excessive technique but technique, bleeding and makes closure minimal bleeding, trauma to flap somewhat difficult flap intact, easy closure
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 Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Poor/inadequate pneumoperitoneum, camera angle and retraction with frequent loss of exposure Adequate establishment and maintenance of pneumoperitoneum, camera angle and retraction but with occasional loss of exposure Optimizes exposure, efficiently directs retraction and camera to maintain exposure and pneumoperitoneum Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Elevation of Peritoneal Flap Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Poor technique, excessive bleeding and trauma to flap Satisfactory technique but makes closure somewhat difficult Excellent technique, minimal bleeding, flap intact, easy closure