Top GUN LEVELS
Level 1
Course Description:
The purpose of this course is to allow surgeons to acquire advanced laparoscopic skills in both instrument manipulation and laparoscopic suturing. When Dr. Rosser formulated Top Gun in 1990, he started with ten drills, and correlated them to intracorporeal suturing. Only three correlated with increased proficiency completing intracorporeal sutures. Top Gun has a large database of all course participants. Surgeons are given a percentile ranking, which is indicative of where they compare to their colleagues who have taken the course. Every surgeon who has participated in Dr. Rosser’s program has finished with the ability to tie an intracorporeal knot by the end of the course. The Top Gun training method has been featured as part of the ACS since 1996, and SAGES and SLS have also featured it at their annual conventions.
​
Course Objectives:
See Drills
Level 2
Course Description:
The ultimate test of a surgeon’s laparoscopic skill, the purpose of the Master’s Course is to establish superior skill in intracorporeal suturing and take the next step: becoming fully ambidextrous while achieving proficiency in troubleshooting algorithms. The final product of this course is the mastering of Rosser’s Rules of intracorporeal suturing and the establishment of the student to educate and train others
​
Course Objectives:
To be eligible for Top Gun Surgeon Level Two Prior a surgeon must complete Top Gun Level One and score in at least the 50th percentile. Students who successfully complete course must rank in the 90th percentile or above. The surgeon must also be able to achieve a score in the 70th percentile suturing using his or her non-dominant hand.
The next step in the process test the surgeon’s ability to suture with a very small length of suture. The surgeon must execute as many knots as possible using a 4-inch suture. The final test of skill involves recovery of the needle and placement into the proper suturing position utilizing the dominant and non-dominant hands. They must then diagnose errors in ten separate video clips and provide the appropriate countermeasures to correct errors. This will help the students to become instructors and effectively pass their knowledge on to others.
Level 3
Course Description:
The Top Gun Surgeons Level 3 course is designed to empower surgeons with the proper techniques and skills necessary to complete a uniform, structurally sound intestinal anastomosis. With an emphasis on peer review and self-analysis, surgeons will become proficient with an open procedural icon completed without mechanical but by hand.
Course Objectives:
Initially, surgeons participate in a short preliminary course to evaluate their Level 1 skills, using the scientifically validated drills utilized in the Level 1. Next, a short refresher course on intracorporeal suturing is completed.
Details of the correct technique for creation of an intracorporeal anastomosis complete with CD-ROM demonstration, lecture, photo review, and a detailed explanation of the criteria for evaluation of an anastomosis are presented. Once students have become familiar with the methodology, the real challenge begins. Participants are first separated into teams of two, and must cooperate in the completion of an anastomosis on inanimate tissue. It must have no less than eight interrupted sutures on the back wall and a running anastomosis on the front wall. Surgeons will then be instructed in principles regarding optical correctness, and port placement. The participants must then perform the anastomosis on a section of porcine bowel. It is then examined by instructors using strict grading criteria such as: proper length and depth of sutures, uniformity of placement, knot integrity, ability to work as a team, and overall anastomosis integrity.