Anastomosis in all of its combinations is the best way to develop advanced laparoscopic suturing skills. In this combination, end-to-side, a loose end of the penrose drain must be attached to the side of a long penrose drain suspended on the Advanced Suturing Platform.

1. Cut the sides of the drain with scissors on the corresponding sites.
2. Grab the needle from starting position.
3. Position the needle in needle holder and pierce from the outer side through the inferior surface of the right drain.
4. Pierce through the inferior surface of the left drain from the lumen side.
5. Drag the suture so that few centimeters are left on the side without a needle.
6. Tie 1×1 sliding knot.
7. Pierce through the following parts of the module in 0,5-1 cm interspaces until the whole lumen of the drain is supported with sliding knots. Remember to tie knots only on the outer side of the drain.
8. Cut off the excessive part of the suture.

📌 Training Module

1. Connect the upper and lower parts of the insert by pressing them together until you hear a click. The screws should be on the right side.
2. Prepare the remaining insert components: the starting point and two drain pieces (one longer, one shorter).
3. Loosen the screws enough to lift the side panels and slide the drains underneath.
4. Position the drains perpendicularly to each other, maintaining a 1 cm gap between them.
5. Tighten the screws firmly to prevent the drains from slipping out during suturing.
6. Attach the needle starting point to the upper part of the insert.

📌 Accessories

1. Prepare a needle with 25 cm suture.
2. Place it in the start position.

📌 Training module position
Place the module in the training area in the middle position.

📌 Instruments
Prepare 5 mm instruments: dissector, needle holder and scissors.

📌 Instrument ports
Use the 2nd and 9th instrument ports.

Ultimately, you are the best judge of your training experience. Take a moment to reflect and ask yourself if you’ve met the criteria outlined below.

 Congratulations! This is the last scenario in this course!

Your hard work has paid off. Now it’s time for the next challenge – move on to the next course and continue developing your skills!