FLS Frequently Asked Questions
Answers to frequently asked questions about FLS and the Limbs & Things FLS trainer.
What is the FLS program mission?
To provide surgical residents, fellows and practicing surgeons an opportunity to learn the fundamentals of laparoscopic surgery in a consistent, scientifically accepted format; and to test cognitive, surgical decision-making, and technical skills, all with the goal of improving the quality of patient care.
About FLS
The Fundamentals of Laparoscopic Surgery program, (FLS), is a comprehensive web-based education module and assessment tool, designed to teach the fundamental knowledge, judgment and technical skills of basic laparoscopic surgery.
A combination of cognitive learning, hands-on skills training and a proctored exam ensures a minimum standard of care for all patients who undergo laparoscopic surgery, and a way for trainees and surgeons to assess and document their skills.
FLS is a joint educational offering of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the American College of Surgeons (ACS) Division of Education. For more information, please visit FLS Program.
FLS includes a multimedia presentation of didactic content and “watch & do” exercises that focus on manual skills training. The content is available in a web-based format accessed online.
Many surgeons who were already in practice during the advent of the laparoscopic revolution learned basic information and skills that were still a work in progress. FLS will help to refresh those cognitive and technical skills and provides you with a way to document those skills.
To participate in the program, visit the FLS Testing Information page to learn more about the process and how to apply.
This page had all the essential links and forms you will need to begin your training for the FLS assessment and exams, including:
- FLS order form
- Guides for registration and test appointments
- Further details on modules and the written components of the FLS assessment
About FLS Trainer Boxes
FLS Trainer Boxes are designed for residents and practicing physicians, to aide in the development of psychomotor skills and dexterity that’s required when performing laparoscopic surgery.
These portable units and their accessories can be used in a variety of tasks to simulate specific surgical techniques.
When studying for the FLS exam, you can use any laparoscopic trainer and have a similar training experience. However, as our FLS Trainer Box is the standardized exam model used within the FLS Manual Skills Exam, it can be beneficial in developing familiarity with the model, reducing anxiety and highlighting gaps in knowledge when using it while training.
About FLS Tasks
The manual skills component of the FLS course evaluates skills based on efficiency (speed) and precision (accuracy) of the surgeon’s maneuvers using the FLS Laparoscopic Trainer Box.
The test consists of five non-procedure specific simulation tasks incorporating most of the psychomotor skills necessary for basic laparoscopic surgery.
Under each task objective below is a list of FLS equipment and consumables needed to support course learning needs.
A base component of a laparoscopic training box is needed, the following FLS approved models are available:
The task should be practiced until it can be performed in 48 seconds with no objects dropped outside of the field of view. This level of performance should be achieved on two consecutive repetitions and then again on 10 more non-consecutive repetitions for reinforcement. If a trainee cannot achieve this level of performance in 80 repetitions, that trainee should proceed to Task 2.
Equipment: Two Maryland dissectors, one pegboard, six rubber ring objects
- Maryland Dissector (2 required for task)
- Pegboard with 6 triangles (rubber ring objects
The task should be practiced until it can be performed in 98 seconds with all cuts made within the section between the two lines of the training gauze. This level of performance should be achieved on two consecutive repetitions or for a maximum of 80 repetitions.
Equipment: One Maryland dissector, one pair of endoscopic scissors, one jumbo clip, one 4x4 piece of gauze with a pre-marked circle, two alligator clips (attached to the bottom of the trainer box)
- Maryland Dissector (2 required for task)
- Endoscopic Scissors
- Jumbo Clip
- Alligator Clips on lengths of string (pack of 2)
- Gauze Pad with pre-marked circle
- Single Circle Gauze Pads (pack of 100)
- Double Circle Gauze Pads (pack of 100)
The task should be practiced until it can be performed in 53 seconds with up to 1mm accuracy errors. This level of performance should be achieved on two consecutive repetitions or for a maximum of 80 repetitions.
Equipment: One grasper (choice of one Maryland dissector or one grasper with locking or ratcheted handle), one pair of endoscopic scissors, one jumbo clip, one pre-tied ligating loop or endoloop, one red foam organ with appendages.
- Grasper, choice of
- Endoscopic Scissors
- Jumbo Clip
- Pre-tied Ligating Loop
- Foam Organs
The task should be practiced until it can be performed in 136 seconds with up to 1mm accuracy errors. This level of performance should be achieved on two consecutive repetitions or for a maximum of 80 repetitions.
Equipment: Two needle drivers (or choice of one needle driver and one Maryland dissector), one knot pusher (either open or closed), one 2-0 silk suture of 90cm or 120cm length, one pair of endoscopic scissors, one penrose drain with marked targets, one suture block.
- Needle Drivers, choice of
- Knot Pusher (pack of 2, open and closed)
- Suture 2-0 Silk, choice of
- Endoscopic Scissors
- Penrose Drains (pack of 100)
- Suture Block
Note: self-righting needle drivers and hemostats are not permitted.
The task should be practiced until it can be performed in 112 seconds with up to 1mm accuracy errors. This level of performance should be achieved on two consecutive repetitions and then again on 10 more non-consecutive repetitions for reinforcement or for a maximum of 80 repetitions.
Equipment: Two needle drivers, one 2-0 silk suture of 15 cm length, one pair of endoscopic scissors, one suture block, one penrose drain with marked targets.
- Needle Drivers, choice of
- Suture 2-0 Silk, choice of
- Endoscopic Scissors
- Penrose Drains (pack of 100)
- Suture Block
Note: self-righting needle drivers are not permitted.
About the FLS Curriculum
Yes, the FLS's didactic curriculum covers interactive patient scenarios and manual skills training, and contains printable text reviews and practise questions.
Yes, this curriculum is specifically designed for use in residency training programs in preparation for the skills portion of the FLS exam.
The Training Curriculum outlined in this protocol is proficiency-based, whereby trainees are oriented to the materials and self-practice until expert-derived performance levels are reached. Residents may practice as much or as little as needed in order to acquire the validated skills incorporated into the FLS exam.
This protocol ensures that all trainees achieve an excellent level of performance and has correlated with a uniform successful passing score according to the FLS technical skills testing criteria. This curriculum is recommended for all resident levels.
The assessment component is a two-part, proctored exam that covers cognitive knowledge and manual skills.
The cognitive component is a timed multiple-choice exam administered via computer. It is designed to test the understanding and application of the basic fundamentals of laparoscopy with emphasis on clinical judgment or intra-operative decision-making.
The manual skills component evaluates skills based on efficiency (speed) and precision (accuracy) of the surgeon’s maneuvers using the FLS Laparoscopic Trainer Box. The test consists of five non-procedure specific simulation tasks incorporating most of the psychomotor skills necessary for basic laparoscopic surgery.
About the FLS Exam
The exam is a two-part assessment consisting of a computer-based multiple-choice cognitive assessment and a performance-based manual skills assessment (that is broken down into 5 individual tasks).
- Task 1: Peg Transfer - tests hand-eye coordination and dexterity by moving colored pegs around the field of vision
- Task 2: Precision Cutting - tests ambidexterity, hand-eye coordination and depth perception
- Task 3: Ligating Loop - tests hand-eye coordination and accuracy ligating tissue with a ligating loop (endoloop)
- Task 4: Suture with Extracorporeal Knot - tests external knot tying skills using Penrose Drains
- Task 5: Suture with Intracorporeal Knot - tests internal knot tying skills using Penrose Drains
Completing both components demonstrates the candidate has the required knowledge, judgment and technical skills that are essential to performing basic laparoscopic surgery.
The manual skill assessment consists of five simulation exercises reflecting skills uniquely required in laparoscopic surgery. This includes: ambidexterity, depth perception, hand-eye coordination, controlled movement of instruments and efficiency of movement. Task performance is scored on both efficiency (time) and precision (accuracy).
The computer-based cognitive assessment is made up of multiple-choice questions, including visual and clinical scenarios. It has been specifically designed to test the understanding and application of the basic fundamentals of laparoscopy, with emphasis on clinical judgment and intra-operative decision-making.
Limbs & Things, through the fls-products website, only supply the FLS training equipment needed to practice for the Fundamentals of Laparoscopic Surgery exam. Anything related to participation in FLS assessments and exams needs to be purchased and registered with FLS/SAGES, links below.