title: A randomized trial of training the non-dominant upper extremity to enhance laparoscopic performance.
abstract: BACKGROUND
  In laparoscopy, the surgeon's dominant arm will execute difficult tasks with less effort compared to the non-dominant arm. This leads to a relative overuse of muscles on this side. We hypothesized that training the non-dominant arm would improve laparoscopic skills.
  
  
  METHODS
  At baseline, all participants performed three validated tasks on a virtual reality simulator. After randomization, subjects in the intervention group were assigned training tasks. All these tasks had to be performed with the non-dominant hand. Within a week after a three-week study period, participants performed the same three tasks as before.
  
  
  RESULTS
  Twenty-six participants were included, 13 in each group. At baseline, there were no differences between groups on all tested parameters. Compliance to training tasks was good. At the end of three weeks, subjects in both groups showed similar improvement of skills on the non-dominant side. On the dominant side, however, subjects in the training group showed significant better improvement of skills on four out of eight parameters.
  
  
  CONCLUSIONS
  Specific training of the non-dominant upper extremity appears to lead to improvement of skills on the dominant side, a phenomenon known in literature as intermanual transfer of skill learning. To improve laparoscopic skills, bimanual training is recommended.
authors.affiliation: Department of Obstetrics & Gynecology, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands. b.nieboer@obgyn.umcn.nl
authors.forename: Theodoor E
authors.initials: TE
authors.lastname: Nieboer
authors.forename: Vicdan
authors.initials: V
authors.lastname: Sari
authors.forename: Kirsten B
authors.initials: KB
authors.lastname: Kluivers
authors.forename: Martin J N
authors.initials: MJ
authors.lastname: Weinans
authors.forename: Mark E
authors.initials: ME
authors.lastname: Vierhout
authors.forename: Dick F
authors.initials: DF
authors.lastname: Stegeman
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D007839:Functional Laterality / Q000502:physiology*; D058733:Hand-Assisted Laparoscopy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D018709:Statistics, Nonparametric; D013647:Task Performance and Analysis; D034941:Upper Extremity; D014584:User-Computer Interface