Table 1 Leiden-surgical rating scale

1. Extremely poor conditions: The surgeon is unable to work due to coughing or due to the inability to obtain a visible laparoscopic field due to inadequate muscle relaxation.

2. Poor conditions: There is a visible laparoscopic field, but the surgeon is severely hampered by inadequate muscle relaxation with continuous muscle contractions, movements, or both with the hazard of tissue damage.

3. Acceptable conditions: There is a wide visible laparoscopic field but muscle contractions, movements or both occur regularly causing some interference with the surgeon’s work.

4. Good conditions: There is a wide laparoscopic working field with sporadic muscle contractions, movements or both.

5. Optimal conditions: There is a wide visible laparoscopic working field without any movement or contractions.