FLS Practice Test
Updated for October 2026
The FLS (Fundamentals of Laparoscopic Surgery) program helps people learn important skills for surgery. It teaches the basics of laparoscopic surgical skills. There are two parts: learning and testing. The learning part has online lessons with topics like surgery tools and how to take care of patients before and after surgery. The test part sees how well students know the medical side, make choices, and use surgical tools carefully. This program is by the Society of American Gastrointestinal and Endoscopic Surgeons and the American College of Surgeons. It's supported by groups like the American Board of Surgery and the American Board of Obstetrics and Gynecology too.
Key Takeaways
- The FLS (Fundamentals of Laparoscopic Surgery) test checks if you're good at laparoscopic surgery, both with your mind and your hands.
- It has a test on the computer to answer questions and a test in a lab with the FLS Trainer Box to do surgical tasks.
- You have a short time to finish these tests, and you're graded on how well and how fast you do them.
- For surgery students and doctors, it's important to pass the FLS test to show they can do basic laparoscopic suturing and be precise with surgeries.
- Many important medical groups back the FLS program. They say it makes people better at practicing surgery and gets them higher scores in surgery tests.
- The FLS cognitive test is a computer-based assessment made up of multiple-choice questions, and SAGES does not publish the number of questions.[1]
- The FLS manual skills test consists of five simulation exercises performed on the FLS Trainer Box.[1]
- Candidates have 90 minutes to complete the FLS cognitive test.[1]
- The FLS manual skills assessment takes approximately a maximum of 30-45 minutes.[1]
- The FLS passing score is set by the FLS committee from psychometric evaluation and standard-setting studies, and both the cognitive and manual skills assessments must be passed to receive the certificate.[1]
- An FLS certificate is dated and is valid for 10 years from the certificate issue date.[1]
- FLS recertification requires passing both the cognitive and skills components again, and may be sought as early as seven years after the original certificate issue date.[1]
- The FLS exam is given by an approved FLS proctor at an FLS Test Center, through approved SAGES remote testing, at the SAGES Annual Meeting, or at a special testing event.[2]
- Only physicians (MD, DO, or MBBS or equivalent) are eligible to take the FLS test.[1]
Numbers in brackets link to the official sources listed under Sources & last verified. Dates that have passed are removed automatically.
FLS Exam at a Glance
| Item | Detail | Source · Verified |
|---|
| Number of questions (Cognitive (written) test) | Computer-based multiple-choice questions (count not published)[1] | SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), FLS Program, jointly with the American College of · Oct 25, 2026 |
| Number of questions (Manual skills) | 5 simulation exercises[1] | SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), FLS Program, jointly with the American College of · Oct 25, 2026 |
| Time limit (Cognitive (written) test) | 90 minutes[1] | SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), FLS Program, jointly with the American College of · Oct 25, 2026 |
| Time limit (Manual skills) | About 30-45 minutes[1] | SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), FLS Program, jointly with the American College of · Oct 25, 2026 |
| Passing score | Set by the FLS committee; both parts must be passed[1] | SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), FLS Program, jointly with the American College of · Oct 25, 2026 |
| Validity | 10 years[1] | SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), FLS Program, jointly with the American College of · Oct 25, 2026 |
| Renewal | Retake the entire test every 10 years; may start 7 years after issue[1] | SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), FLS Program, jointly with the American College of · Oct 25, 2026 |
| Delivery | FLS Test Center (US/Canada), approved SAGES remote testing, SAGES Annual Meeting or special event, or on-site proctored visit[2] | SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), FLS Program, jointly with the American College of · Oct 26, 2026 |
| Eligibility | Physicians only (MD, DO, MBBS or equivalent)[1] | SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), FLS Program, jointly with the American College of · Oct 25, 2026 |
| Score release | About 2-3 weeks after testing[2] | SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), FLS Program, jointly with the American College of · Oct 26, 2026 |
| Registration opens | Buy a voucher first; testing by appointment only[1] | SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), FLS Program, jointly with the American College of · Oct 25, 2026 |
What changed for FLS in 2026
- Oct 25, 2026: Delivery changed to FLS Test Center (US/Canada), approved SAGES remote testing, SAGES Annual Meeting or special event, or on-site proctored visit (previously Proctored at FLS Test Centers (US/Canada), SAGES Annual Meeting, or on-site visit).[2]
- Oct 25, 2026: Passing score changed to Set by the FLS committee; both parts must be passed (previously Set by FLS committee; both parts must be passed).[1]
- Oct 25, 2026: Registration opens changed to Buy a voucher first; testing by appointment only (previously Buy voucher first; testing by appointment).[1]
- Oct 25, 2026: Renewal changed to Retake the entire test every 10 years; may start 7 years after issue (previously Retake the entire test every 10 years).[1]
Free FLS - Fundamentals of Laparoscopic Surgery Study Tools
Interactive FLS - Fundamentals of Laparoscopic Surgery resources on PracticeTestGeeks, free to start:
According to SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), FLS Program, jointly with the American College of, “The cognitive test consists of multiple-choice questions, some of which include visuals. It is computer-based”[1]
FLS Practice Test Questions
Prepare for the FLS - Fundamentals of Laparoscopic Surgery exam with our free practice test modules. Each quiz covers key topics to help you pass on your first try.
Worked examples: how to reason through FLS questions
These are practice questions written for this site, not questions from the real exam. Each explanation shows why the right answer is right and why the others are wrong.
Example 1
Question: In Fundamentals of Laparoscopic Surgery, why is peg transfer skills knowledge important for professional certification?
- It demonstrates competence and ensures practitioners meet established standards
- It is only required for administrative purposes
- It has no practical relevance to daily work
- It is important only for entry-level positions
Answer: A. It demonstrates competence and ensures practitioners meet established standards
Explanation:
The correct answer is that certification demonstrates competence and shows a practitioner meets established standards. A certificate exists so that hospitals, colleagues and patients can trust that a minimum level of skill has been checked.
The option calling it an administrative requirement is wrong because the standard is the point of the process, not the paperwork. The option saying it has no practical relevance is wrong because peg transfer trains depth perception, bimanual handling and instrument control, which carry into real cases. The option limiting it to entry-level positions is wrong because the standard applies to anyone seeking the certificate.
Rule to remember: when a question asks why a skill or credential matters, choose the answer tied to demonstrated competence and safety, and be wary of options using words like only or no.
Example 2
Question: Fogging of the laparoscope lens occurs when the scope enters a colder peritoneal cavity from a warm room. The most practical intraoperative remedy is:
- Increase insufflation pressure to clear the lens
- Warm the scope tip in warm saline or use anti-fog solution before insertion
- Replace the camera with a 0° scope
- Increase the light source intensity
Answer: B. Warm the scope tip in warm saline or use anti-fog solution before insertion
Explanation:
The correct answer is to warm the scope tip in warm saline or use anti-fog solution before insertion. Fogging happens because a cold lens meets warm, humid air, so moisture condenses on the glass. Raising the lens temperature or coating it stops this at the source.
Increasing insufflation pressure is wrong because gas pressure does not clear condensation and adds avoidable risk to the patient. Replacing the camera with a 0° scope is wrong because the lens angle has no effect on condensation. Increasing the light source intensity is wrong because brighter light does not remove moisture and can make glare worse.
Rule to remember: treat the cause. Fogging is a temperature problem, so the fix is a temperature or surface fix, not a pressure, angle or brightness change.
Example 3
Question: The standard laparoscope used in FLS tasks has a 0° or 30° lens. What is the primary advantage of the 30° (angled) lens?
- It provides a wider field of view without moving the scope
- It allows the surgeon to 'look around corners' by rotating the scope
- It magnifies the image more than a 0° scope
- It produces less light loss than a 0° scope
Answer: B. It allows the surgeon to 'look around corners' by rotating the scope
Explanation:
The correct answer is that a 30° lens lets the surgeon look around corners by rotating the scope. The angled tip changes the direction of view, so turning the scope shows different areas, including behind structures, without moving the whole instrument.
The wider field of view without moving is wrong because the angle changes direction, not the width of the view. The magnification option is wrong because lens angle does not magnify the image more than a 0° scope. The light loss option is wrong because the angle is not chosen to reduce light loss.
Rule to remember: the angle gives a different line of sight, and you reach it by rotating the scope. It does not change zoom, field width or brightness.
How to use these practice tests
Start with the official material. Read the FLS Information Bulletin and the program FAQ so you know the format, the voucher and appointment process, and the time limits for both parts. Then use these practice sets to find weak spots.
Work through the knowledge topics first: anatomy, energy devices, pneumoperitoneum and insufflation, complications management and trocar placement. After each set, read every explanation, including those for questions you got right, and write down the rule behind each miss.
For the manual skills side, our sets cover the reasoning behind each task, such as peg transfer, pattern cutting, ligating loop placement, extracorporeal suturing and intracorporeal suturing. They do not replace hands-on trainer time, so practise the exercises physically as well.
In the last days, redo the sets you scored lowest on and time yourself on the cognitive questions. Our questions are written by us and are not real exam questions.
FLS Program Components
What is the FLS Test?
The FLS (Fundamentals of Laparoscopic Surgery) test assesses knowledge and skills for basic laparoscopic surgery training. It has two parts: a written test and a test of surgical skills assessment. Both parts test potential surgeons on what they know and can do. Practice with the free FLS - Fundamentals of Laparoscopic Surgery practice test on PracticeTestGeeks (11 questions with answer explanations).
The FLS program has two parts: education and assessment. The education part has a 13-chapter web course. It teaches about tools, getting ready for surgery, and caring for patients after. This helps candidates learn the cognitive skills assessment needed for the exam.
Assessment Tool
The assessment part tests know-how and decisions surgeons need. It has an online multiple-choice test and a hands-on test. The hands-on test uses the FLS laparoscopic box trainer. By doing well in both parts, candidates show they're ready for minimally invasive surgery certification and the FLS exam preparation.
Confirm your exam appointment and location Bring required identification documents Arrive 30 minutes early to check in Read each question carefully before answering Flag difficult questions and return to them later Manage your time — don't spend too long on one question Review flagged questions before submitting Written Component
FLS (Fundamentals of Laparoscopic Surgery) Test Components
The FLS test looks at two main areas. It looks at a surgeon's knowledge and skills with simple laparoscopic surgeries. These areas combine to check if a surgeon has the key abilities for safe and good laparoscopic surgery.
The written part of the test has 80 multiple-choice questions and is on a computer. It looks at how well a surgeon understands basic laparoscopic surgery. This covers the tools, getting the patient ready, and what to do after the surgery. It checks how well the candidate can solve problems and make choices in different surgery situations.
Manual Skills Component
In the manual skills section, surgeons show how well they can do basic laparoscopic jobs. They use the FLS Laparoscopic Trainer Box for this part. Surgeons do things like moving pegs, cutting with precision, and tying knots both inside and outside the body. Their speed and accuracy in these tasks show how skilled they are at laparoscopic surgery.
This test checks both the knowledge and the practical skills needed in laparoscopic surgery. Passing it shows a surgeon knows the key points and ways to do these surgeries well.
Review FLS Modules
Preparing for the FLS Test
To pass the FLS (Fundamentals of Laparoscopic Surgery) test, surgical residents and laparoscopic surgeons need to study the FLS modules and practice certain manual skills. The FLS training aims at making sure trainees can do laparoscopic surgery safely and effectively. They must reach certain skill levels.
The FLS Program has 14 web-based modules. These cover different parts of laparoscopic surgery like the equipment and what happens before and after the surgery. Candidates should study these modules well. The exam checks their knowledge and decision-making. Knowing the material helps trainees show they can do laparoscopic surgery right.
Practice Manual Skills
In the FLS exam, candidates must show how well they can do certain tasks quickly and accurately. This is tested using the FLS Laparoscopic Trainer Box. Trainees need to get good at tasks like moving the camera, handling objects, and sewing inside the body. Following the training helps them reach the level they need to pass the FLS exam.
| FLS Exam Requirement | Details |
|---|
| FLS Score Requirements | The training program's standards come from how well experts did after five tries at each task. Following this program, all trainees passed the skills part of the FLS exam. |
| Surgical Residency Requirements | Before the end of their third year of training, PGY 3 surgical residents must pass the FLS exam. Passing lets them move on to the next year of their training. |
| Laparoscopic Simulation Training | The FLS training is made for residency programs. It helps trainees reach the level of experts. It suggests using video tutorials for self-training to save on resources. |
| Endoscopic Technical Proficiency | The FLS exam tests how well surgeons can move quickly and accurately in a simulated surgery. It includes tasks like using the camera and sewing that are vital for laparoscopic surgery. |
By deeply studying the FLS modules and practicing manual skills, surgical residents and future laparoscopic surgeons can get ready for the FLS test. Passing this test is key in their surgical training and becoming certified in laparoscopic skills.
FLS: Pros and Cons
Pros
- FLS exam preparation strengthens your knowledge across all domains
- Passing the exam proves competency to employers and clients
- Study materials and practice tests are widely available
- Exam-based credentials are portable across states and employers
- Clear exam objectives help focus your study plan effectively
Cons
- Exam anxiety can affect performance — practice tests help reduce it
- Registration fees are non-refundable if you miss your test date
- Limited retake opportunities may apply with waiting periods
- Exam content updates periodically — use current study materials
- Testing center availability may require advance scheduling
Sample FLS - Fundamentals of Laparoscopic Surgery Practice Questions
Try these questions from our free FLS - Fundamentals of Laparoscopic Surgery practice tests. The correct answer and an explanation follow each question.
What is a best practice in Fundamentals of Laparoscopic Surgery intracorporeal suturing?
- A. A method or technique recognized as superior based on evidence and expert consensus
- B. Any practice that is easy to implement
- C. The cheapest available approach
- D. A practice used only by large organizations
Answer: A. A method or technique recognized as superior based on evidence and expert consensus
Best practices are methods, techniques, or approaches that are recognized through evidence, research, and expert consensus as producing superior results and are recommended for adoption.
In Fundamentals of Laparoscopic Surgery, what is homeostasis?
- A. The body's ability to maintain a stable internal environment despite external changes
- B. A rapid increase in body temperature
- C. The process of cell division
- D. A type of immune response
Answer: A. The body's ability to maintain a stable internal environment despite external changes
Homeostasis is the process by which biological systems maintain internal stability and balance (temperature, pH, glucose levels, etc.) while adjusting to changing external conditions.
In Fundamentals of Laparoscopic Surgery, what is the primary function of strategic planning in complications management?
- A. To set long-term goals and determine the best approach to achieve them
- B. To handle day-to-day operational tasks
- C. To conduct annual performance reviews
- D. To manage the organization's social media presence
Answer: A. To set long-term goals and determine the best approach to achieve them
Strategic planning involves defining the organization's direction, making decisions on allocating resources, and establishing priorities to achieve long-term objectives.
Which approach is most effective for mastering intracorporeal suturing in Fundamentals of Laparoscopic Surgery?
- A. Combining theoretical study with practical application and regular review
- B. Memorizing textbook definitions without understanding
- C. Studying only immediately before examinations
- D. Relying solely on on-the-job experience
Answer: A. Combining theoretical study with practical application and regular review
The most effective approach combines theoretical understanding with practical application, reinforced by regular review and assessment, enabling deeper comprehension and long-term retention.
Take the full FLS - Fundamentals of Laparoscopic Surgery practice test
🩺 🩺 What is the FLS test?
The Fundamentals of Laparoscopic Surgery (FLS) test is a proctored two-part exam: a computer-based multiple-choice assessment and a manual skills assessment of five tasks on the FLS Trainer Box. It is a joint program of SAGES and the American College of Surgeons (ACS).
📝 📝 How many questions are on the FLS written exam?
The FLS written (cognitive) component is a timed, 80-question multiple-choice exam taken on a computer. Some questions include images and clinical scenarios, with emphasis on clinical judgment and intraoperative decision making.
⏱️ ⏱️ How long is the FLS exam?
You get 90 minutes for the multiple-choice portion. The manual skills assessment of five tasks on the FLS Trainer Box lasts about 30-45 minutes, and both parts are run by a trained FLS proctor.
🔧 🔧 What are the 5 FLS manual skills tasks?
The five FLS skills tasks are peg transfer, precision cutting, ligating loop, suture with extracorporeal knot, and suture with intracorporeal knot. Each task is scored on efficiency (time) and precision (accuracy), with penalties for errors.
🟣 🟣 What is the FLS peg transfer time limit?
The FLS peg transfer task has a maximum time limit of 300 seconds. You move six rubber ring objects from the non-dominant to the dominant hand mid-air, place them on the opposite pegs, then reverse the process; dropping an object outside the field of view is penalized.
✂️ ✂️ What is the FLS precision cutting task?
In precision (pattern) cutting you cut out a pre-marked circle from a two-ply 4x4 gauze using a Maryland dissector and endoscopic scissors. The maximum time limit is 300 seconds, and deviation from the marked line adds a penalty.
🪢 🪢 What is the FLS ligating loop time limit?
The ligating loop task has a maximum time limit of 180 seconds, the shortest of the five FLS tasks. You place a pre-tied endoloop around a marked appendage of a foam organ, cinch it on the mark, and cut the tail inside the trainer.
🧵 🧵 What are the FLS suturing time limits?
Suture with extracorporeal knot allows a maximum of 420 seconds and uses a knot pusher with a 2-0 silk suture. Suture with intracorporeal knot allows 600 seconds, the longest FLS task, and uses a 15 cm 2-0 silk suture tied inside the trainer.
🎟️ 🎟️ How long is an FLS test voucher valid?
An FLS testing voucher is redeemable once, and the initial test must be completed within 12 months of purchase. If you do not pass, a retest voucher can be bought at a lower price within 18 months of the original exam date.
📅 📅 Does FLS certification expire?
Yes. Certificates issued since October 1, 2012 are dated and must be renewed every 10 years by passing both the written and skills components again. Recertification can begin as early as 7 years after the original issue date.
FLS Questions and Answers
Who administers the FLS exam?
The FLS exam is administered by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in partnership with the American College of Surgeons (ACS). The program was developed to establish a standard for foundational knowledge and skills in laparoscopic surgery. Testing is conducted at designated Pearson VUE testing centers for the cognitive component and at approved FLS training sites for the manual skills portion.
How much does the FLS exam cost?
The FLS exam fee is approximately $350 for the combined cognitive and psychomotor components. SAGES members may receive a discounted rate. The fee covers one attempt at both portions of the exam. If you need to retake one or both components, additional fees apply for each subsequent attempt. The FLS trainer box and practice materials are purchased separately and typically cost between $200 and $400.
Who is eligible to take the FLS exam?
The FLS exam is open to surgical residents, practicing surgeons, surgical fellows, and other medical professionals involved in laparoscopic procedures. General surgery residency programs accredited by the ACGME often require FLS certification before graduation. Medical students in their final year may also be eligible to sit for the exam with program director approval. There are no prerequisite courses mandated by SAGES, though structured training is strongly recommended.
Where can I take the FLS exam?
The FLS cognitive exam is administered at Pearson VUE testing centers located throughout the United States. The psychomotor (manual skills) exam must be completed at an approved FLS testing center, which is typically a surgical simulation lab at a medical school or teaching hospital. You can find a list of approved testing sites through the SAGES FLS program website when you register for the exam.
How do I register for the FLS exam?
Registration for the FLS exam is completed through the SAGES FLS program portal online. You create an account, verify your eligibility, and pay the exam fee. Once approved, you schedule the cognitive component through Pearson VUE and coordinate the psychomotor exam date with an approved testing site. Both components must be completed within a 12-month eligibility window from the date of registration.
How long is FLS certification valid?
FLS certification does not expire and remains valid indefinitely once earned. Unlike some medical certifications that require periodic renewal, the FLS credential is a one-time achievement. However, many residency programs and hospitals view it as a baseline competency measure, and surgeons are expected to maintain and advance their laparoscopic skills through continuing education, additional certifications such as FES, and ongoing clinical practice.
Can I retake the FLS exam if I fail?
Yes, you can retake the FLS exam if you do not pass. If you fail one component but pass the other, you only need to retake the failed portion. There is a mandatory waiting period before you can reattempt the exam, and you must pay an additional retake fee for each attempt. SAGES recommends additional practice with the FLS trainer box and review of study materials before scheduling a retake.
Is FLS certification required for surgical residency programs?
The American Board of Surgery requires FLS certification for all general surgery residents before they can sit for the ABS Qualifying Exam. Most ACGME-accredited general surgery residency programs mandate that residents complete FLS certification by their third or fourth postgraduate year. While not required for all surgical specialties, FLS is widely recognized as a standard competency benchmark and is increasingly expected across multiple surgical disciplines.
How many questions are on the FLS?
The FLS cognitive test consists of multiple-choice questions administered via computer. (Verified Oct 16, 2026 against SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), jointly with the American College of Surgeons.)
What is the passing score for the FLS?
The FLS passing score is based on a recommended level of proficiency set by the FLS committee, and both the cognitive and manual skills assessments must be passed to receive the certificate. (Verified Oct 16, 2026 against SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), jointly with the American College of Surgeons.)
Sources & last verified
- SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), FLS Program, jointly with the American College of — number of questions, time limit, passing score, validity (official source). “The cognitive test consists of multiple-choice questions, some of which include visuals. It is computer-based” Verified Oct 25, 2026.
- SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), FLS Program, jointly with the American College of — delivery, score release (official source). “You can take the exam at an FLS Test Center, remotely from your own institution, or at a special testing event” Verified Oct 26, 2026 · source checked Oct 26, 2026.
How we verify: editorial & fact-checking policy. Report an error: contact us.