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Riaz et al. Mini-invasive Surg 2018;2:28 I http://dx.doi.org/10.20517/2574-1225.2018.41 Page 3 of 8

[4]
Figure 1. Mental training group instructions. (adapted from immenroth ,2007 )

Figure 2. Laparoscopic distraction exercise setup

candidate. Two laparoscopic graspers are pushed through neoprene with a non-working laparoscopic
port situated in between (to mark the area of pin swapping, when right hand instrument touches it).
The task was to transfer three paper clips from one side of the working area to the opposite side, into a
plastic container. Candidates were instructed to transfer these paper clips between their two laparoscopic
graspers, i.e., from right to left. The camera was controlled by the observer.

Setup
A home-made laparoscopic setup was used for task performance [Figure 3]. This consisted of a two-tier
shoe rack fitted with a large neoprene sheet overlying the top tier. A 5-mm trocar is pushed through the
neoprene to accommodate the 5 mm laparoscopic grasper.

The ratchet grasper (Locking) is clamped to a piece of raw neoprene 5 mm × 1 mm × 60 mm. It was
modified to allow attachment to the electronic weighing scale, without compromising its elastic behaviour
when pulled upon [Figure 4]. A piece of neoprene was attached to weighing scale using cable tie. Neoprene
has some degree of elasticity resembling human tissue, which was the reason for the selection of this
material.