title: Warm-up on a simulator improves residents' performance in laparoscopic surgery: a randomized trial.
abstract: OBJECTIVE
  Our 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 randomized to be performed with or without immediate preoperative warm-up. Residents randomized to warm-up performed a brief set of standardized exercises on a laparoscopic trainer immediately before surgery. Intraoperative performance was scored using previously validated global rating scales. Assessment was made immediately after surgery by attending faculty who were blinded to the warm-up randomization.
  
  
  RESULTS
  We randomized 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21224, USA, cchen127@jhmi.edu.
authors.forename: Chi Chiung Grace
authors.initials: CC
authors.lastname: Chen
authors.forename: Isabel C
authors.initials: IC
authors.lastname: Green
authors.forename: Jorie M
authors.initials: JM
authors.lastname: Colbert-Getz
authors.forename: Kimberly
authors.initials: K
authors.lastname: Steele
authors.forename: Betty
authors.initials: B
authors.lastname: Chou
authors.forename: Shari M
authors.initials: SM
authors.lastname: Lawson
authors.forename: Dana K
authors.initials: DK
authors.lastname: Andersen
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Satin
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007044:Hysterectomy; D007396:Internship and Residency; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D017063:Outcome Assessment, Health Care; D010052:Ovariectomy; D057234:Preoperative Period; D013246:Sterilization, Tubal; D016896:Treatment Outcome; D063996:Warm-Up Exercise / Q000523:psychology*