title: Preconditioning in laparoscopic surgery--results of a virtual reality pilot study.
abstract: BACKGROUND
  This prospective study investigated the effect of preconditioning in laparoscopic cholecystectomy (LC) and appendectomy (LA) based on pre- and postoperative virtual reality laparoscopy (VRL) performances, with specific regard to the impact of different motor skills, types of surgery and levels of experience.
  
  
  METHODS
  Forty laparoscopic procedures (28 LC and 12 LA) were performed by 13 residents in the operating room. Participants completed a defined set of tasks on the VRL simulator directly prior to and after the operation: one preparational task (PT), a virtual procedural task with emphasis on fine preparation (VPT) and a navigational manoeuvre for instrument coordination (ICT). VRL performances were evaluated based on the assessed items of the simulator.
  
  
  RESULTS
  Overall analysis of the surgeons' performance demonstrated better postoperative results for PT and VPT in 28 and 26 cases (p = 0.001 and p = 0.034), respectively. No significant difference was found for ICT (p = 0.638). Less-experienced residents had better postoperative results for PT and VPT (p = 0.009 and p = 0.041), whereas more-experienced surgeons had better postoperative results for PT only (p = 0.030). LC resulted in better postoperative performance for PT (p = 0.007). LA improved performance for PT and VPT (p = 0.034 and p = 0.006, respectively). Comparisons of surgeon's experience demonstrated a significant advantage for more-experienced surgeons in ICT (p = 0.033), while type of surgery showed an advantage for LA in VPT (p = 0.022).
  
  
  CONCLUSIONS
  There is a preconditioning effect in laparoscopic surgery. The differing results related to LC and LA and the experience levels of surgeons suggest that differentiated warm-up strategies are required.
authors: Department of General, Visceral and Transplant Surgery, University Medicine of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
authors: M
authors: M
authors: Paschold
authors: T
authors: T
authors: Huber
authors: D W
authors: DW
authors: Kauff
authors: K
authors: K
authors: Buchheim
authors: H
authors: H
authors: Lang
authors: W
authors: W
authors: Kneist
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000193:education / Q000379:methods*; D002983:Clinical Competence; D003198:Computer Simulation; D013502:General Surgery / Q000193:education; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000379:methods*; D009048:Motor Skills; D010865:Pilot Projects; D011446:Prospective Studies; D013647:Task Performance and Analysis