title: Effect of different warm-up strategies on simulated laparoscopy performance: a randomized controlled trial.
abstract: OBJECTIVE
  The objective of this trial was to assess which type of warm-up has the highest effect on virtual reality (VR) laparoscopy performance. The following warm-up strategies were applied: a hands-on exercise (group 1), a cognitive exercise (group 2), and no warm-up (control, group 3).
  
  
  METHODS
  This is a 3-arm randomized controlled trial.
  
  
  METHODS
  The trial was conducted at the department of surgery of the University Hospital Basel in Switzerland.
  
  
  METHODS
  A total of 94 participants, all laypersons without any surgical or VR experience, completed the study.
  
  
  RESULTS
  A total of 96 participants were randomized, 31 to group 1, 31 to group 2, and 32 to group 3. There were 2 postrandomization exclusions. In the multivariate analysis, we found no evidence that the intervention had an effect on VR performance as represented by 6 calculated subscores of accuracy, time, and path length for (1) camera manipulation and (2) hand-eye coordination combined with 2-handed maneuvers (p = 0.795). Neither the comparison of the average of the intervention groups (groups 1 and 2) vs control (group 3) nor the pairwise comparisons revealed any significant differences in VR performance, neither multivariate nor univariate. VR performance improved with increasing performance score in the cognitive exercise warm-up (iPad 3D puzzle) for accuracy, time, and path length in the camera navigation task.
  
  
  CONCLUSIONS
  We were unable to show an effect of the 2 tested warm-up strategies on VR performance in laypersons. We are currently designing a follow-up study including surgeons rather than laypersons with a longer warm-up exercise, which is more closely related to the final task.
authors.affiliation: Department of Visceral Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Enrico
authors.initials: E
authors.lastname: Brönnimann
authors.affiliation: Department of Visceral Surgery, University Hospital Basel, Basel, Switzerland. Electronic address: henry.hoffmann@usb.ch.
authors.forename: Henry
authors.initials: H
authors.lastname: Hoffmann
authors.affiliation: Department of Visceral Surgery, University Hospital Basel, Basel, Switzerland; Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland.
authors.forename: Juliane
authors.initials: J
authors.lastname: Schäfer
authors.affiliation: Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Dieter
authors.initials: D
authors.lastname: Hahnloser
authors.affiliation: Department of Visceral Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Rachel
authors.initials: R
authors.lastname: Rosenthal
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D008297:Male; D015999:Multivariate Analysis; D011214:Practice, Psychological; D013647:Task Performance and Analysis; D014584:User-Computer Interface
keywords: Medical Knowledge; Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; laparoscopy; surgical outcome improvement; virtual reality; warm-up