Another use of the mobile device: warm-up for laparoscopic surgery. Simulated Procedure Rehearsal Is More Effective Than a Preoperative Generic Warm-Up for Endovascular Procedures Warm-up in a Virtual Reality Environment Improves Performance in the Operating Room The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Laparoscopic warm-up exercises improve performance of senior-level trainees during laparoscopic renal surgery. The Effect of Video Game “Warm-up” on Performance of Laparoscopic Surgery Tasks Effect of short-term pretrial practice on surgical proficiency in simulated environments: a randomized trial of the "preoperative warm-up" effect. Virtual reality robotic surgery warm-up improves task performance in a dry laboratory environment: a prospective randomized controlled study. The effect of an intermittent, high-intensity warm-up on supramaximal kayak ergometer performance Warm-up on a simulator improves residents’ performance in laparoscopic surgery: a randomized trial Does a surgical simulator improve resident operative performance of laparoscopic tubal ligation? Respiratory muscle specific warm-up and elite swimming performance Does Surgical “Warming up” Improve Laparoscopic Simulator Performance?
BACKGROUND An important facet of laparoscopic surgery is its psychomotor component . As this aspect of surgery gains attention , lessons from other psychomotor-intense fields such as athletics have led to an investigation of the benefits of " warming up " prior to entering the operating room . Practical implementation of established methods of warm-up is hampered by a reliance on special equipment and instrumentations that are not readily available . In light of emerging evidence of translatability between video-game play and operative performance , we sought to find if laparoscopic task performance improved after warming up on a mobile device balance game . MATERIAL S AND METHODS Laparoscopic novices were r and omized into either the intervention group ( n = 20 ) or the control group ( n = 20 ) . The intervention group played a mobile device balance game for 10 min while the control group did no warm-up whatsoever . Assessment was performed using two tasks on the ProMIS laparoscopic simulation system : " object positioning " ( where small beads are transferred between four cups ) and " tissue manipulation " ( where pieces of plastic are stretched over pegs ) . Metrics measured were time to task completion , path length , smoothness , h and dominance , and errors . RESULTS The intervention group made fewer errors : object positioning task 0.20 versus 0.70 , P = 0.01 , tissue manipulation task 0.15 versus 0.55 , P = 0.05 , total errors 0.35 versus 1.25 , P = 0.002 . The two groups performed similarly on the other metrics . CONCLUSIONS Warm-up using a mobile device balance game decreases errors on basic tasks performed on a laparoscopic surgery simulator , suggesting a practical way to warm-up prior to cases in the operating room Introduction : Patient-specific simulated rehearsal ( PsR ) of a carotid artery stenting procedure ( CAS ) enables the interventionalist to rehearse the case before performing the procedure on the actual patient by incorporating patient-specific computed tomographic data into the simulation software . This study aim ed to evaluate whether PsR of a CAS procedure can enhance the operative performance versus a virtual reality ( VR ) generic CAS warm-up procedure or no preparation at all . Methods : During a 10-session cognitive/technical VR course , medical residents were trained in CAS . Thereafter , in a r and omized crossover study , each participant performed a patient-specific CAS case 3 times on the simulator , preceded by 3 different tasks : a PsR , a generic case , or no preparation .  Technical performances were assessed using simulator-based metrics and expert-based ratings . Results : Twenty medical residents ( surgery , cardiology , radiology ) were recruited . Training plateaus were observed after 10 sessions for all participants . Performances were significantly better after PsR than after a generic warm-up or no warm-up for total procedure time ( 16.3 ± 0.6 vs 19.7 ± 1.0 vs 20.9 ± 1.1 minutes , P = 0.001 ) and fluoroscopy time ( 9.3 ± 0.1 vs 11.2 ± 0.6 vs 11.2 ± 0.5 minutes , P = 0.022 ) but did not influence contrast volume or number of roadmaps used during the “ real ” case . PsR significantly improved the quality of performance as measured by the expert-based ratings ( scores 28 vs 25 vs 25 , P = 0.020 ) . Conclusions : Patient-specific simulated rehearsal of a CAS procedure significantly improves operative performance , compared to a generic VR warm-up or no warm-up . This technology requires further investigation with respect to improved outcomes on patients in the clinical setting Objective : To assess the impact of warm-up on laparoscopic performance in the operating room ( OR ) . Background : Implementation of simulation-based training into clinical practice remains limited despite evidence to show that the improvement in skills is transferred to the OR . The aim of this study was to evaluate the impact of a short virtual reality warm-up training program on laparoscopic performance in the OP . Methods : Sixteen Laparoscopic Cholecystectomies were performed by 8 surgeons in the OR . Participants were r and omized to a group which received a preprocedure warm-up using a virtual reality simulator and no warm-up group . After the initial laparoscopic cholecystectomy all surgeons served as their own controls by performing another procedure with or without preoperative warm-up . All OR procedures were videotaped and assessed by 2 independent observers using the generic OSATS global rating scale ( from 7 to 35 ) . Results : There was significantly better surgical performance on the laparoscopic Cholecystectomy following preoperative warm-up , median 28.5 ( range = 18.5–32.0 ) versus median 19.25 ( range = 15–31.5 ) , P = 0.042 . The results demonstrated excellent reliability of the assessment tool used ( Cronbach 's & agr ; = 0.92 ) . Conclusion : This study showed a significant beneficial impact of warm-up on laparoscopic performance in the OP . The suggested program is short , easy to perform , and therefore realistic to implement in the daily life in a busy surgical department . This will potentially improve the procedural outcome and contribute to improved patient safety and better utilization of OR re sources Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more 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 .  MATERIAL S 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 r and omly 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 This study suggests that those who “ warm-up ” with select video games may have improved laparoscopic clinical task performance compared to those not engaged in “ warm-up . BACKGROUND Surgery is a skill-driven discipline . While other high-stake professions with comparable cognitive and psychomotor skill requirements often use warm-up exercises for achieving better proficiency , the effects of such practice have not been investigated sufficiently in surgical tasks . DESIGN Subjects performed st and ardized exercises as a preoperative warm-up , after which the st and ardized exercises were repeated in a r and omized order . In a variation to investigate the generalizability of preoperative warm-up , the experimental group was allowed to warm-up with the st and ardized exercises , after which a different task ( electrocautery simulation ) was performed . To investigate the effect of warm-up on fatigue , participants were involved in eight sessions ( four before night call , four after night call ) , after which the tasks were repeated . Results were analyzed using ANOVA to plot differences between warm-up and followup condition . RESULTS All outcomes measures demonstrated statistically significant improvements after all of the post-warm-up exercises ( p < 0.01 ) , and were seen in all groups with differing experience levels . In addition , the simple warm-up exercises led to a significant increase in proficiency in followup electrocautery task for the experimental group when compared with the control group ( p < 0.0001 ) . There was also significant improvement in performance of the fatigued group to approximately baseline performance ( p < 0.05 ) , although they were not able to reach their optimal potential performance . CONCLUSION Preoperative warm-up for 15 to 20 minutes with simple surgical exercises leads to a substantial increase in surgical skills proficiency during followup tasks BACKGROUND Preoperative simulation warm-up has been shown to improve performance and reduce errors in novice and experienced surgeons , yet existing studies have only investigated conventional laparoscopy . We hypothesized that a brief virtual reality ( VR ) robotic warm-up would enhance robotic task performance and reduce errors . STUDY DESIGN In a 2-center r and omized trial , 51 residents and experienced minimally invasive surgery faculty in General Surgery , Urology , and Gynecology underwent a vali date d robotic surgery proficiency curriculum on a VR robotic simulator and on the da Vinci surgical robot ( Intuitive Surgical Inc ) .  Once they successfully achieved performance benchmarks , surgeons were r and omized to either receive a 3- to 5-minute VR simulator warm-up or read a leisure book for 10 minutes before performing similar and dissimilar ( intracorporeal suturing ) robotic surgery tasks . The primary outcomes compared were task time , tool path length , economy of motion , technical , and cognitive errors . RESULTS Task time ( -29.29 seconds , p = 0.001 ; 95 % CI , -47.03 to -11.56 ) , path length ( -79.87 mm ; p = 0.014 ; 95 % CI , -144.48 to -15.25 ) , and cognitive errors were reduced in the warm-up group compared with the control group for similar tasks . Global technical errors in intracorporeal suturing ( 0.32 ; p = 0.020 ; 95 % CI , 0.06 - 0.59 ) were reduced after the dissimilar VR task . When surgeons were stratified by earlier robotic and laparoscopic clinical experience , the more experienced surgeons ( n = 17 ) demonstrated significant improvements from warm-up in task time ( -53.5 seconds ; p = 0.001 ; 95 % CI , -83.9 to -23.0 ) and economy of motion ( 0.63 mm/s ; p = 0.007 ; 95 % CI , 0.18 - 1.09 ) , and improvement in these metrics was not statistically significantly appreciated in the less-experienced cohort ( n = 34 ) . CONCLUSIONS We observed significant performance improvement and error reduction rates among surgeons of varying experience after VR warm-up for basic robotic surgery tasks . In addition , the VR warm-up reduced errors on a more complex task ( robotic suturing ) , suggesting the generalizability of the warm-up It has previously been shown that the metabolic acidaemia induced by a continuous warm-up at the ' lactate threshold ' is associated with a reduced accumulated oxygen deficit and decreased supramaximal performance . The aim of this study was to determine if an intermittent , high-intensity warm-up could increase oxygen uptake ( V02 ) without reducing the accumulated oxygen deficit , and thus improve supramaximal performance . Seven male 500 m kayak paddlers , who had represented their state , volunteered for this study . Each performed a grade d exercise test to determine V02max and threshold parameters . On subsequent days and in a r and om , counterbalanced order , the participants then performed a continuous or intermittent , high-intensity warm-up followed by a 2 min , all-out kayak ergometer test . The continuous warm-up consisted of 15 min of exercise at approximately 65 % V02max . The intermittent , high-intensity warm-up was similar , except that the last 5 min was replaced with five 10 s sprints at 200 % V02max , separated by 50 s of recovery at ~55 % V02max . Significantly greater ( P<0.05 ) peak power ( intermittent vs continuous : 629 ± 199 vs 601 ± 204W ) and average power ( intermittent vs continuous : 328±39.0 vs 321 ±42.4 W ) were recorded after the intermittent warm-up . There was no significant difference between conditions for peak V02 , total V02 or the accumulated oxygen deficit . The results of this study indicate that 2 min all-out kayak ergometer performance is significantly better after an intermittent rather than a continuous warm-up Introduction and hypothesisOur aim was to assess the impact of immediate preoperative laparoscopic warm-up using a simulator on intraoperative laparoscopic performance by gynecologic residents . Methods Eligible laparoscopic cases performed for benign , gynecologic indications were r and omized to be performed with or without immediate preoperative warm-up . Residents r and omized to warm-up performed a brief set of st and ardized exercises on a laparoscopic trainer immediately before surgery . Intraoperative performance was scored using previously vali date d global rating scales . Assessment was made immediately after surgery by attending faculty who were blinded to the warm-up r and omization . Results We r and omized 237 residents to 47 minor laparoscopic cases ( adnexal/ tubal surgery ) and 44 to major laparoscopic cases ( hysterectomy ) . Overall , attendings rated upper-level resident performances ( postgraduate year [ PGY-3 , 4 ] ) significantly higher on global rating scales than lower-level resident performances ( PGY-1 , 2 ) . Residents who performed warm-up exercises prior to surgery were rated significantly higher on all subscales within each global rating scale , irrespective of the difficulty of the surgery . Most residents felt that performing warm-up exercises helped their intraoperative performances . Conclusion Performing a brief warm-up exercise before a major or minor laparoscopic procedure significantly improved the intraoperative performance of residents irrespective of the difficulty of the case OBJECTIVE The purpose of this study was to assess whether a surgical skills simulator laboratory improves  resident knowledge and operative performance of laparoscopic tubal ligation . STUDY DESIGN Twenty postgraduate year 1 residents were assigned r and omly to either a surgical simulator laboratory on laparoscopic tubal ligation together with apprenticeship teaching in the operating room or to apprenticeship teaching alone . Tests that were given before and after the training assessed basic knowledge . Attending physicians who were blinded to resident r and omization status evaluated postgraduate year 1 performance on a laparoscopic tubal ligation in the operating room with 3 vali date d tools : a task-specific checklist , global rating scale , and pass/fail grade . RESULTS Postgraduate year 1 residents who were assigned r and omly to the surgical simulator laboratory performed significantly better than control subjects on all 3 surgical assessment tools ( the checklist , the global score , and the pass/fail analysis ) and scored significantly better on the knowledge posttest ( all P < .0005 ) . CONCLUSION Compared with apprenticeship teaching alone , a surgical simulator laboratory on laparoscopic tubal ligation improved  resident knowledge and performance in the operating room Background Inspiratory muscle training has been shown to improve performance in elite swimmers , when used as part of routine training , but its use as a respiratory warm-up has yet to be investigated . Aim To determine the influence of inspiratory muscle exercise ( IME ) as a respiratory muscle warm-up in a r and omised controlled cross-over trial . Methods A total of 15 elite swimmers were assigned to four different warm-up protocol s and the effects of IME on 100 m freestyle swimming times were assessed . Each swimmer completed four different IME warm-up protocol s across four separate study visits : swimming-only warm-up ; swimming warm-up plus IME warm-up ( 2 sets of 30 breaths with a 40 % maximum inspiratory mouth pressure load using the Powerbreathe inspiratory muscle trainer ) ; swimming warm-up plus sham IME warm-up ( 2 sets of 30 breaths with a 15 % maximum inspiratory mouth pressure load using the Powerbreathe inspiratory muscle trainer ) ; and IME-only warm-up . Swimmers performed a series of physiological tests and scales of perception ( rate of perceived exertion and dyspnoea ) at three time points ( pre warm-up , post warm-up and post time trial ) . Results The combined st and ard swimming warm-up and IME warm-up were the fastest of the four protocol s with a 100 m time of 57.05 s. This was significantly faster than the IME-only warm-up ( mean difference=1.18 s , 95 % CI 0.44 to 1.92 , p<0.01 ) and the swim-only warm-up ( mean difference=0.62 s , 95 % CI 0.001 to 1.23 , p=0.05 ) . Conclusions Using IME combined with a st and ard swimming warm-up significantly improves 100 m freestyle swimming performance in elite swimmers Introduction The objective of this study was to determine if preoperative warming up by obstetrics and gynecology trainees , using a vali date d bench model for intracorporeal suturing , improves efficiency , precision , and quality of laparoscopic suturing . Methods A r and omized crossover design was used . Fourteen obstetrics and gynecology residents were r and omized [ 3 junior ( year 2 ) and 11 senior ( years 3–5 ) residents ] . Participants were r and omized to warm-up or no warm-up and then acted as their own controls at least 2 weeks later . Warm-up consisted of the use of a laparoscopic bench model to practice intracorporeal suturing for 15 minutes . All participants performed a prevali date d intracorporeal suturing task ( after either warm-up or no warm-up ) , which was scored based on time , precision , and knot strength . Each participant also completed a question naire anonymously to determine if they believed that warming up improved their performance , regardless of the score they received . Results Thirteen participants completed the study . There was no difference in score when warm-up was compared with no warm-up for the group as a whole . When the junior residents were excluded from the analysis , however , analysis of variance showed a significant improvement in score only when a warm-up was completed in the second session ( P = 0.022 ) . The question naire revealed that 81.8 % of participants felt that warming up subjectively improved their ability , independent of their actual score . Conclusions This study demonstrates that a preoperative warm-up , combined with repetition , is beneficial in improving senior obstetrics and gynecology residents ’ laparoscopic suturing performance . This demonstrates a novel approach to resident education for teaching advanced laparoscopic skills
Background The concept of warming-up before a performance has been accepted across many disciplines including sports and music .
In contrast , it is uncommon for a surgeon to “ warm-up ” prior to operating .
Objective To date , few studies from various specialties have attempted to answer this question whether warm-up improved the intraoperative performance of the surgeon .
However , there has not been a systematic review of these studies .
The aim of our systematic review is to assess the effect of warming-up preoperatively on the laparoscopic performance of the surgeon .