Does Warm-Up Training in a Virtual Reality Simulator Improve Surgical Performance? A Prospective Randomized Analysis

• Published in: Journal of surgical education Vol. 73; no. 6; pp. 974 - 978
• Main Authors: da Cruz, José Arnaldo Shiomi, MD, dos Reis, Sabrina Thalita, PhD, Cunha Frati, Rodrigo Marcus, MD, Duarte, Ricardo Jordão, MD, Nguyen, Hiep, MD, Srougi, Miguel, MD, PhD, Passerotti, Carlo Camargo, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016
• Subjects: Adult; Animals; Blood Loss, Surgical; Cholecystectomy, Laparoscopic - education; Cholecystectomy, Laparoscopic - methods; Education, Medical, Undergraduate - methods; Exercise - physiology; Female; Humans; laparoscopy; Laparoscopy - education; Male; Operative Time; Practice-Based Learning and Improvement; Preoperative Period; Prospective Studies; Quality Improvement; Reference Values; Simulation Training - methods; simulation training, warm-up exercise, work performance; Students, Medical - statistics & numerical data; Surgery; Swine; Systems-Based Practice; User-Computer Interface; laparoscopy; simulation training, warm-up exercise, work performance; Practice-Based Learning and Improvement; Systems-Based Practice
• ISSN: 1931-7204; 1878-7452
• DOI: 10.1016/j.jsurg.2016.04.020

Introduction Virtual reality surgical simulators (VRSS) have been showing themselves as a valuable tool in laparoscopy training and education. Taking in consideration the effectiveness of the VRSS, new uses for this tool have been purposed. In sports, warming up before exercise clearly shows benefit in performance. It is hypothesized that warming up in the VRSS before going to the operating room may show benefit in surgical performance. Objective Verify whether there is benefit in surgical performance with preoperatory warm-up using a VRSS. Materials and Methods A total of 20 medical students with basic knowledge in laparoscopy were divided in 2 groups (I and II). Group I performed a laparoscopic cholecystectomy in a porcine model. Group II performed preoperative warm-up in a VRSS and then performed a laparoscopic cholecystectomy in a porcine model. The performance between both groups was compared regarding quantitative parameters (time for dissection of the gallbladder pedicle, time for clipping the pedicle, time for cutting the pedicle, time for gallbladder removal, total operative time, and aspirated blood loss) and qualitative parameters (depth perception, bimanual dexterity, efficiency, tissue handling, and autonomy) based on a previously validated score system, in which the higher the score, the better the result. Data were analyzed with level of significance of 5%. Results The group that underwent preoperative warm-up (group II) showed significantly superior results as to the time for dissection of the gallbladder pedicle (11.91 ± 9.85 vs. 4.52 ± 2.89 min, p = 0.012), time for clipping the pedicle (5.51 ± 2.36 vs. 2.89 ± 2.76 min, p = 0.004), time for cutting the pedicle (1.84 ± 0.7 vs. 1.13 ± 0.51, p = 0.019), aspirated blood loss (171 ± 112 vs. 57 ± 27.8 ml, p = 0.006), depth perception (4.5 ± 0.7 vs. 3.3 ± 0.67, p = 0.004), bianual dexterity (4.2 ± 0.78 vs. 3.3 ± 0.67, p = 0.004), tissue handling (4.2 ± 0.91 vs. 3.6 ± 0.66, p = 0.012), and autonomy (4.9 ± 0.31 vs. 3.6 ± 0.96, p = 0.028). There was no difference in time for gallbladder removal (11.58 ± 4.31 vs. 15.08 ± 4.51 min, p = 0.096), total operative time (30.8 ± 11.07 vs. 25.60 ± 5.10 min, p = 0.188), and efficiency (4 ± 0.66 vs. 3.6 ± 0.69, p = 0.320). Conclusion The practice of preoperative warm-up training seems to benefit surgical performance even in subject with mild laparoscopic experience.