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Randomized Controlled Trial
. 2023 Nov;34(11):2751-2758.
doi: 10.1007/s00192-023-05595-1. Epub 2023 Jul 14.

Effect of pre-operative warm-up on trainee intraoperative performance during robot-assisted hysterectomy: a randomized controlled trial

Chi Chiung Grace Chen  1 , Anand Malpani  2 , Madeleine M Waldram  3 , Caitlin Romanczyk  3 , Edward J Tanner  4 , Amanda N Fader  4 , Stacey A Scheib  5 , Gregory D Hager  2 , S Swaroop Vedula  2
Affiliations
Randomized Controlled Trial

Effect of pre-operative warm-up on trainee intraoperative performance during robot-assisted hysterectomy: a randomized controlled trial

Chi Chiung Grace Chen et al. Int Urogynecol J. 2023 Nov.

Abstract

Introduction and hypothesis: The objective was to study the effect of immediate pre-operative warm-up using virtual reality simulation on intraoperative robot-assisted laparoscopic hysterectomy (RALH) performance by gynecology trainees (residents and fellows).

Methods: We randomized the first, non-emergent RALH of the day that involved trainees warming up or not warming up. For cases assigned to warm-up, trainees performed a set of exercises on the da Vinci Skills Simulator immediately before the procedure. The supervising attending surgeon, who was not informed whether or not the trainee was assigned to warm-up, assessed the trainee's performance using the Objective Structured Assessment for Technical Skill (OSATS) and the Global Evaluative Assessment of Robotic Skills (GEARS) immediately after each surgery.

Results: We randomized 66 cases and analyzed 58 cases (30 warm-up, 28 no warm-up), which involved 21 trainees. Attending surgeons rated trainees similarly irrespective of warm-up randomization with mean (SD) OSATS composite scores of 22.6 (4.3; warm-up) vs 21.8 (3.4; no warm-up) and mean GEARS composite scores of 19.2 (3.8; warm-up) vs 18.8 (3.1; no warm-up). The difference in composite scores between warm-up and no warm-up was 0.34 (95% CI: -1.44, 2.13), and 0.34 (95% CI: -1.22, 1.90) for OSATS and GEARS respectively. Also, we did not observe any significant differences in each of the component/subscale scores within OSATS and GEARS between cases assigned to warm-up and no warm-up.

Conclusion: Performing a brief virtual reality-based warm-up before RALH did not significantly improve the intraoperative performance of the trainees.

Keywords: Randomized controlled trial; Robotic hysterectomy; Simulation; Warm-up.

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