Preoperative warm-up using a virtual reality simulator

Abstract

Background and objectives: All modern surgical procedures require a high level of cognitive and psychomotor skills achieved using different training methods, but could be influenced by fatigue and other psychological factors. We evaluated the effect of warm-up exercises on operative laparoscopic performances.

Methods: The surgical team operated on a consecutive series of 20 patients with gallstones. Patients were randomly allocated in 2 groups: group A to be operated on without warm-up exercises and group B to be operated on after a short-term warm-up. All the patients were operated on by the same surgical team. The full-time records of the operation were analyzed by 2 independent reviewers. A modified simplified Global Rating Score (GRS) was used to assess the surgical procedures. A training module using the Lap Mentor simulator was designed for the warm-up.

Results: Better performances were noted by both observers in group B only regarding "Respect for tissue" scores (3.75 0.16 vs 4.43 0.20, P=.021 and 3.87 0.22 vs 4.57 0.20, P=.041) achieving significant or marginally significant differences for all categories; GRS scores for "time and motion" and "overall impression" tend to be better after warm-up, but differences failed to reach statistical significance in our series.

Conclusion: Surgeons, even the most experienced in laparoscopic surgery, can increase specific psychomotor skills associated with a laparoscopic environment by doing simple exercises on a virtual reality simulator, just before an operation. These improvements are reflected in more accurate handling of tissue during laparoscopic cholecystectomy.

Figure 1.

Virtual reality simulator warm-up tasks: (1) Camera navigation; (2) Instrument coordination; (3) Clip applying; (4) Clipping and grasping; (5) Electrocautery; (6) Cystic pedicle dissection; (7) Cystic pedicle clipping and cutting.

Figure 2.

Global Rating Scale/Score (GRS) used to assess the surgical procedures.