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Laparoscopic Warm-up Exercises Improve Performance of Senior-Level Trainees During Laparoscopic Renal Surgery      7/23/2013


Jason Y. Lee, Phillip Mucksavage, David C. Kerbl, Kathryn E. Osann, Howard N. Winfield, Kanav Kahol, and Elspeth M. McDougall. Journal of Endourology. May 2012, 26(5): 54

Serving as their own controls, each subject performed two pairs of laparoscopic cases, each pair consisting of one case with POWER (+POWER) and one without (–POWER). Subjects were randomly assigned to +POWER or −POWER for the initial case of each pairing, and all cases were performed ≥1 week apart. POWER consisted of completing an electrocautery skill task on a virtual reality simulator and 15 minutes of laparoscopic suturing and knot tying in a pelvic box trainer. For each case, cognitive, psychomotor, and technical performance data were collected during two different tasks: mobilization of the colon (MC) and intracorporeal suturing and knot tying (iSKT). Statistical analysis was performed using SYSTAT v11.0.

Results: A total of 28 study cases (14+POWER, 14−POWER) were performed by seven different subjects. Cognitive and psychomotor performance (attention, distraction, workload, spatial reasoning, movement smoothness, posture stability) were found to be significantly better in the +POWER group (P≤0.05) and technical performance, as scored by two blinded laparoscopic experts, was found to be better in the +POWER group for MC (P=0.04) but not iSKT (P=0.92). Technical scores demonstrated excellent reliability using our assessment tool (Cronbach =0.88). Subject performance during POWER was also found to correlate with intraoperative performance scores.

Conclusions: Urologic trainees who perform a POWER approximately 1 hour before laparoscopic renal surgery demonstrate improved cognitive, psychomotor, and technical performance

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