Preoperative warm-up using a virtual reality simulator.
OBJECTIVE
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.


CONCLUSIONS
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.
University of Medicine and Pharmacy Gr.T. Popa Iasi, Romania. rmoldovanu@gmail.com
Radu
R
Moldovanu
Eugen
E
Târcoveanu
Gabriel
G
Dimofte
Cristian
C
Lupaşcu
Costel
C
Bradea
D016009:Chi-Square Distribution; D017081:Cholecystectomy, Laparoscopic / Q000193:education*; D002983:Clinical Competence; D006801:Humans; D011597:Psychomotor Performance; D014584:User-Computer Interface