title: Effect of Preoperative Warm-up Exercise Before Laparoscopic Gynecological Surgery: A Randomized Trial.
abstract: BACKGROUND
  Laparoscopic surgical procedures require a high level of cognitive and psychomotoric skills. Thus, effective training methods to acquire an adequate level of expertise are crucial. The aim of this study was to investigate the effect of preoperative warm up training on surgeon׳s performance during gynecologic laparoscopic surgery.
  
  
  METHODS
  In this randomized controlled trial, surgeons performed a preoperative warm up training using a virtual reality simulator before laparoscopic unilateral salpingo-oophorectomy. Serving as their own controls, each subject performed 2 pairs of laparoscopic cases, each pair consisting of 1 case with and 1 without warm up before surgery. Surgeries were videotaped and psychomotoric skills were rated using objective structured assessment of technical skills (OSATS) and the generic error rating tool by a masked observer. Perioperative complications were assessed. Statistical analysis was performed using a mixed model, and mean OSATS scores were compared between both the groups.
  
  
  RESULTS
  In total, data of 10 surgeons and 17 surgeries were available for analysis. No differences between educational level and surgical experiences were observed between the groups. Mean standard error psychomotoric and task-specific OSATS scores of 19.8 (1.7) and 3.7 (0.2) were observed in the warm up group compared with 18.6 (1.7) and 3.8 (0.2) in the no warm up group, respectively (p = 0.51 and p = 0.29). Using generic error rating tool, the total number of errors was 8.75 (2.15) in the warm up group compared with 10.8 (2.18) in the no warm-up group (p = 0.53). Perioperative complications and operating time did not differ between both the groups.
  
  
  CONCLUSIONS
  The present study suggests that warm-up before laparoscopic salpingo-oophorectomy does not increase psychomotoric skills during surgery. Moreover, it does not influence operating time and complication rates. (Medical University of Vienna-IRB approval number, 1072/2011, ClinicalTrials.gov number, NCT01712607).
authors.affiliation: Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria. Electronic address: stephan.polterauer@meduniwien.ac.at.
authors.forename: Stephan
authors.initials: S
authors.lastname: Polterauer
authors.affiliation: Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Husslein
authors.affiliation: Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria.
authors.forename: Marlene
authors.initials: M
authors.lastname: Kranawetter
authors.affiliation: Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria.
authors.forename: Richard
authors.initials: R
authors.lastname: Schwameis
authors.affiliation: Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Reinthaller
authors.affiliation: Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Heinze
authors.affiliation: Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Grimm
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000193:education*; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D011597:Psychomotor Performance; D011795:Surveys and Questionnaires; D014584:User-Computer Interface; D014741:Video Recording; D063996:Warm-Up Exercise
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; computer-simulation; laparoscopic training; salpingo-oophorectomy; training; warm-up