Table 1 Assessment form for hands-on performance of LESS skills in three learning periods on Surgeons A and B

(1) Basic knowledge of anatomy in pelvic

3

Fairly familiarity with anatomy in pelvic even on occasion of server adhesion

3

3

3

2

Knew well anatomy in pelvic but on occasion of server adhesion could not distinguish

2

2

1

Insufficient knowledge of anatomy in pelvic

(2) Knowledge of surgical procedure

3

Demonstrated familiarity with all steps of procedure

3

3

3

2

Knew all important steps of procedure, did not have to be stooped at any nodal points

2

1

Insufficient knowledge looked unsure and hesitant, had to be stopped at one or more nodal points

1

(3) Scope handling and instruments usage

3

Proficient uses instruments, no stiffness or awkwardness

3

3

2

Competent use of instruments but occasionally appeared stiff or awkward

2

2

1

Repeatedly makes awkward or tentative moves with instruments through inappropriate use

1

(4) Laparoscopy spatial sensation and view field

3

Maintain good laparoscopic spatial sensation and clear view of laparoscopy field

2

Maintain clear view but occasionally lost or did not focus on the main instruments

3

3

2

1

Not able to achieve clear laparoscopy view, requiring take over

2

1

(5) Chose suitable equipment

3

Clearly, understanding equipment setup and chooses appropriate equipment for intervention

3

3

2

Required prompting for proper preparation of equipment

2

2

1

Unable to properly prepare and choose appropriate equipment for intervention

1

(6) Blunt separating, coagulation or cutting produces alternately

3

Proficient in blunt separating, coagulation or cutting produces alternately

3

3

2

Generally, proficient in blunt separating, coagulation or cutting produces

2

2

1

Poor coordination with Blunt separating, coagulation or cutting produces

1

(7) Precisely tissue handling ability and avoid tissue injuring

3

Consistently handled target tissue precisely with proper power and completely avoid tissue injure

3

3

3

2

Careful handling of tissue but occasionally failed to catch or hold, occasionally cause inadvertent damage but not important organ like bladder, intestinal or urinary.

2

1

Frequently use unnecessary force on tissue, and unnecessary cause damage to the target tissue and resulted in bleeding but not important organ like bladder, intestinal or urinary.

1

(8) Coordination with instrument with shoulder, arms, wrists and fingers

3

Obtain good power and angle with instruments, coordination well with shoulder, arms, wrists and fingers

3

3

2

Generally, obtain power and angle with instruments and hands but need improvement

2

2

1

Poor coordination with instrument by hand

1

(9) Postures, forces, and repetition with muscular effort on shoulder, arms, wrists and fingers

3

Ambidexterity, depth perception, continuous postures, forces, and repetition with muscular effort on shoulder, arms, wrists and fingers

3

3

2

Generally, obtain postures, forces, and repetition with muscular effort

2

2

1

Poorly obtain postures, forces, and repetition with muscular effort

1

(10) Communication with assistant

3

Clear instruction and cooperation with assistant and achieve excellent teamwork

3

3

3

2

Reasonable cooperation with assistant but occasional face obstacle on communication

2

2

1

Poor communication with assistant, and achieve teamwork with disappointment

Total

23

30

30

12

21

Overall performance

3

Competent

3

3

2

Reasonably competent but requires further training

2

2

1

Adequate and requires continued basic training

1