General Surgery PGY-4


This curriculum aims to provide the participant with the essential simulation assignments needed to acquire the skills and core competencies for General Surgery PGY-4 training.

The course components include:

  1. FLS Training
  2. Suturing & Knot Tying
  3. Advanced Suturing
  4. Laparoscopic Cholecystectomy Procedure (Advanced Level)
  5. Gastric Bypass

FLS Training

Tasks include peg transfer, pattern cutting and placement of ligating loop.

Suturing and Knot Tying

Practice knot tying techniques such as ligature and surgeon`s knot and performing interrupted and continuous suture. Tasks are illustrated by instructional videos.

Advanced Suturing

Practice intracorporeal suturing and knotting techniques for all fields of laparoscopic surgery, including: ‘backhand’ technique, U-Stich and suturing in a curved suture line angle. Tasks are illustrated by instructional videos. Real suturing handles enable realistic training.

Laparoscopic Cholecystectomy Procedure (Advanced Level)

Patient cases with easy to difficult anatomical variations to the cystic duct and positions of arteries, which may otherwise not be experienced during a training period. This course component enables free-style training using different techniques, alternative approaches, and acquisition of the skills and knowledge necessary to safely cope with possible complications.

Gastric Bypass

Provides surgeons with the opportunity to perform advanced tasks including creation of the gastric pouch, measurement and division of the jejunum, gastrojejunal anastomosis and enteroenterostomy anastomosis. Trainees practice the technical aspects of laparoscopic Roux-en Y creation and jejunojejunostomy and gain an in-depth understanding of intra-operative problems during lap bypass surgery and how to avoid them. Familiarity with instruments is gained by experience with a variety of procedure specific surgical instruments, while instructional videos enhance knowledge of the procedure.

  • To become accustomed with the fulcrum effect, laparoscopic depth perception and eye hand coordination.
  • To practice coordinated hand movements.
  • To accurately and efficiently grasp objects and transfer them to designated areas.
  • To train on use of laparoscopic scissors for cutting.
  • To become familiarized with the method of placing a ligating loop.
  • To learn and implement backhand technique.
  • To practice suturing in difficult suture line angles as encountered in real life procedures.
  • To become familiarized with different knot tying techniques such as half knot, square knot, and ligature and surgeon`s knot.
  • To perform interrupted and continuous suture.
  • To familiarize with the pitfalls of easy to difficult anatomical variations to the cystic duct and positions of arteries.
  • To practice the skills and techniques essential for the laparoscopic cholecystectomy procedure in a simulated environment.
  • To practice the skills and techniques essential for the laparoscopic gastric bypass procedure in a simulated environment.
Target Audience

General Surgery PGY-4


Prerequisite: Completed basic laparoscopic skills training and basic laparoscopic procedure training.

Suggested Time Length

18 hours


The Suturing and Laparoscopic Cholycystectomy and Gastric Bypass modules were developed in collaboration with:

  • Amir Szold, MD, Medical Director, Assia Medical Group, Assuta Hospital, Tel Aviv, Israel.
  • David Nocca, MD, Faculty of medicine of Montpellier.  Universitary hospital of Montpellier, FRANCE.
  • Jeffrey L. Ponsky, M.D., Oliver H. Payne Professor and Chairman, Department of Surgery, CWRU School of Medicine, Surgeon in Chief, University Hospitals, Case Medical Center, Cleveland, Ohio
  • Rajesh Aggarwal MD PhD MA FRCS, Instructor in Gastrointestinal Surgery, University of Pennsylvania.
  • Raul J. Rosenthal MD FACS, Assistant Professor of Surgery, Ohio State School of Medicine. Medical Director of the Bariatric Institute and Section Head of Minimally Invasive Surgery, Cleveland Clinic Florida.
  • Yaron Munz, MD, Senior Surgeon, Dept. of General Surgery, Rabin Medical Center, Golda Campus – Hasharon. Director of Surgical Simulation, The Israel Centre for Medical Simulation, Sheba Medical Centre, Tel Hashomer.