title: Preoperative warming up exercises improve laparoscopic operative times in an experienced laparoscopic surgeon.
abstract: OBJECTIVE
  Performing warm-up exercises before athletic competition or stage performance is very common; however, most surgeons do not "warm up" before performing complex surgery. We analyzed the intraoperative effects of warming up before surgery in an experienced laparoscopic surgeon.
  
  
  METHODS
  A retrospective review of all laparoscopic partial (LPN) and radical nephrectomies (LRN) completed by an experienced laparoscopic surgeon (RVC) were analyzed according to whether warm-up exercises were performed before surgery. Routine warm-up consisted of 15 to 20 minutes of pelvic trainer suturing exercises (forehand and backhand sutures and knot tying), using both hands. Intraoperative and postoperative parameters were examined.
  
  
  RESULTS
  LRN and LPN subjects were well matched among the warm-up group and nonwarm-up group. Patients in the LPN warm-up group did have significantly larger tumors (3.7 cm vs 2.4 cm, P=0.02). Despite larger tumors, surgical time was significantly less in the warm-up group (227 min vs 281 min, P=0 .04), and total operating room time trended toward significance (320 min vs 371 min, P=0.0501). Similarly, in the LRN group, operative times and total operating room time was significantly less in the preoperative warm-up group (P=0.0068 and P=0.014, respectively). Intraoperative and postoperative complications, estimated blood loss, positive margin rate, warm ischemia time, length of stay, changes in hemoglobin and creatinine levels from baseline were not significantly different between the two groups.
  
  
  CONCLUSIONS
  Performing warm-up exercises before complex laparoscopic surgery may improve operative times and performance in the operating room, especially for complex laparoscopic surgeries.
authors: Department of Urology, Temple University Medical Center, Philadelphia, Pennsylvania 19140, USA. mucksava@temple.edu
authors: Phillip
authors: P
authors: Mucksavage
authors: Jason
authors: J
authors: Lee
authors: David C
authors: DC
authors: Kerbl
authors: Ralph V
authors: RV
authors: Clayman
authors: Elspeth M
authors: EM
authors: McDougall
mesh_terms: D000368:Aged; D002983:Clinical Competence; D015444:Exercise; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D010820:Physicians; D011300:Preoperative Care / Q000379:methods*; D013536:Suture Techniques; D013997:Time Factors