Description of the LSS Multi-Level Programme

Recent reports on safety and quality of surgical performance, as for example by the World Health Organization, stress the urgent need for improvement of training, assessment, and accreditation for technology dependent surgical procedures such as laparoscopy. Laparoscopic Surgical Skills (LSS) is the answer to satisfy the needs of both the surgeons and the healthcare authorities. LSS is an initiative by the European Association for Endoscopic Surgery (EAES) to provide a standard to (re)credential surgeons to perform laparoscopic surgery effectively and safely.

LSS focuses on safeguarding the quality of performance in laparoscopic procedures and goes beyond the basic skills. LSS is the first standard that combines criterion-based assessment in the skills lab with clinical assessment of performance on index procedures. Within each LSS level, the assessment incorporates a sequence of tests to evaluate a surgeon’s proficiency in cognitive skills, surgical technical skills, and judgment.

The LSS programme is divided into two grades. Grade 1 is divided into three consecutive levels and includes all basic laparoscopic skills and fundamental laparoscopic procedures. Grade 2 consists of several separate assessments each focusing on a specific advanced laparoscopic procedure.

Description of LSS Grade 1 Level 1 Accredited Courses

The LSS accredited courses follow a goal-oriented and criterion-based approach which takes the training needs of each individual participant into account. The courses are constructed around hands-on simulator training and interactive expert discussions. The LSS assessments are an integrated part of LSS accredited courses.

Description of the LSS Assessments

To certify that participants have reached the appropriate level of performance required to obtain the certificate for LSS Grade 1 Level 1, they need to pass all of the following performance assessments:

  • Knowledge test
  • Scenario based assessment
  • Simulator assessment
  • Clinical performance assessment
  • The LSS Grade 1 Level 1 accredited courses aim to teach and assess the knowledge and skills that a surgeon requires to effectively and safely perform laparoscopic cholecystectomy, laparoscopic appendectomy, and diagnostic laparoscopy.

All surgical specialties involving laparoscopic procedures.

Target Audience

All who meet the eligibility requirements can enrol for the LSS Grade 1 Level 1 assessment. For the subsequent levels additional conditions for enrolment apply. Eligible candidates can enrol either for the LSS assessment or for an LSS accredited course, of which the LSS assessment is an integral part. This provides surgeons of all levels of expertise the opportunity to efficiently obtain LSS accreditation.

Eligible to register for LSS assessments or LSS accredited courses are:

  • Surgical trainees and fellows enrolled in an accredited programme for general surgery, urology, gynaecology, paediatric surgery, or other specialty involving laparoscopic procedures.
  • Certified practicing surgeons, urologists, gynaecologists, paediatric surgeons, or other physicians performing laparoscopic procedures.


All participants who enrol for LSS Grade 1 Level 1 are provided with the course documents describing the theory and knowledge that need to be acquired on the index procedures corresponding to LSS Grade 1 Level 1. Proper knowledge of the generic laparoscopic topics is also considered to be essential within each LSS level. Adequate acquaintance with the theory presented in the LSS course documents is tested using a knowledge test. Passing this web-based exam is a requirement to being admitted to the scenario based assessment and simulator assessment.

Basic psychomotor skills

Possessing basic laparoscopic skills is essential before mastering the procedural skills. To get the most out of the LSS Grade 1 Level 1 course, participants are expected to start practicing their basic laparoscopic skills at their home institute prior to the course. The pre-course training can be done on any kind of validated simulator system offering basic laparoscopic skills training- box trainer, virtual reality, or augmented reality systems. To verify the baseline basic laparoscopic skills level of each participant, LSS accredited courses start with a dexterity test.


Development, validation and project coordination of LSS are done by:

Project leaders:

  • Prof. dr. Jack Jakimowicz
  • Prof. dr. George Hanna
  • Prof. dr. Abe Fingerhut

Scientific project coordination:

  • Sonja Buzink

Operations, logistics and finance:

  • Excellence in Society and Congress