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Randomized Controlled Trial
. 2012 May;26(5):545-50.
doi: 10.1089/end.2011.0418. Epub 2012 Jan 4.

Laparoscopic warm-up exercises improve performance of senior-level trainees during laparoscopic renal surgery

Jason Y Lee  1 , Phillip Mucksavage, David C Kerbl, Kathryn E Osann, Howard N Winfield, Kanav Kahol, Elspeth M McDougall
Affiliations
Randomized Controlled Trial

Laparoscopic warm-up exercises improve performance of senior-level trainees during laparoscopic renal surgery

Jason Y Lee et al. J Endourol. 2012 May.

Abstract

Background and purpose: Surgery is a high-stakes "performance." Yet, unlike athletes or musicians, surgeons do not engage in routine "warm-up" exercises before "performing" in the operating room. We study the impact of a preoperative warm-up exercise routine (POWER) on surgeon performance during laparoscopic surgery.

Materials and methods: Serving as their own controls, each subject performed two pairs of laparoscopic cases, each pair consisting of one case with POWER (+POWER) and one without (-POWER). Subjects were randomly assigned to +POWER or -POWER for the initial case of each pairing, and all cases were performed ≥ 1 week apart. POWER consisted of completing an electrocautery skill task on a virtual reality simulator and 15 minutes of laparoscopic suturing and knot tying in a pelvic box trainer. For each case, cognitive, psychomotor, and technical performance data were collected during two different tasks: mobilization of the colon (MC) and intracorporeal suturing and knot tying (iSKT). Statistical analysis was performed using SYSTAT v11.0.

Results: A total of 28 study cases (14+POWER, 14-POWER) were performed by seven different subjects. Cognitive and psychomotor performance (attention, distraction, workload, spatial reasoning, movement smoothness, posture stability) were found to be significantly better in the +POWER group (P ≤ 0.05) and technical performance, as scored by two blinded laparoscopic experts, was found to be better in the +POWER group for MC (P=0.04) but not iSKT (P=0.92). Technical scores demonstrated excellent reliability using our assessment tool (Cronbach ∝=0.88). Subject performance during POWER was also found to correlate with intraoperative performance scores.

Conclusions: Urologic trainees who perform a POWER approximately 1 hour before laparoscopic renal surgery demonstrate improved cognitive, psychomotor, and technical performance.

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Figures

FIG. 1.
FIG. 1.
Psychomotor performance.
FIG. 2.
FIG. 2.
Cognitive performance.
FIG. 3.
FIG. 3.
Cognitive performance (receiver operating characteristic curve for Index of Cognitive Activity). AUC=area under curve.
FIG. 4.
FIG. 4.
Technical performance. MC=mobilization of the colon.
None
See this image and copyright information in PMC

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