title: [Warming up with endotrainer prior to laparoscopic cholecystectomy].
abstract: BACKGROUND
  Laparoscopic cholecystectomy is a safe and effective treatment and remains the gold standard in patients with benign disease. However it presents difficulties such as: the limited movement range of the instruments, the loss of depth perception, haptic feedback and the fulcrum effect. Previous training can optimize surgical performance in patients to master basic skills.
  
  
  OBJECTIVE
  Assess the effectiveness of surgeons warming up with an endotrainer before performing laparoscopic cholecystectomy.
  
  
  METHODS
  Single-blind controlled clinical trial with 16 surgeons who performed 2 laparoscopic cholecystectomies, the first according to standard practice and the second with warm-up comprising 5 MISTELS system exercises. Patient and surgeon demographics were recorded, in addition to findings and complications during and after surgery for each procedured.
  
  
  RESULTS
  We found a decrease in surgical time of 76.88 (±18.87) minutes in the group that did not warm up to prior to surgery compared with 72.81 (±35.5) minutes in the group with warm-up (p=0.0196). In addition, increased bleeding occurred in the procedures performed with warm-up 31.25 (±30.85) ml compared with the group that had no warm-up 23.94 (±15.9) (p=0.0146).
  
  
  CONCLUSIONS
  Performing warm up on a MISTELS system endotrainer before performing laparoscopic cholecystectomy reduces the operating time of surgery for all surgeons. Surgery bleeding increases in operations performed by surgeons with less experience in laparoscopic surgery.
authors.affiliation: Servicio de Cirugía General, Hospital General Dr. Fernando Quiroz Gutiérrez, ISSSTE, Ciudad de México, México. Electronic address: alissonn23@gmail.com.
authors.forename: Alicia
authors.initials: A
authors.lastname: Troncoso-Bacelis
authors.affiliation: Servicio de Cirugía General, Hospital General Dr. Fernando Quiroz Gutiérrez, ISSSTE, Ciudad de México, México.
authors.forename: Jaime
authors.initials: J
authors.lastname: Soto-Amaro
authors.affiliation: Jefatura de enseñanza e investigación, Hospital General Dr. Fernando Quiroz Gutiérrez, ISSSTE, Ciudad de México, México.
authors.forename: Carlos
authors.initials: C
authors.lastname: Ramírez-Velázquez
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000193:education*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D016037:Single-Blind Method
keywords: Calentamiento previo; Colecistectomía laparoscópica; Endotrainer; Laparoscopic cholecystectomy; Warm-up