Department of Urology, University of California, Irvine, Orange, California 92868, USA.
J Endourol. 2012 May;26(5):545-50. doi: 10.1089/end.2011.0418. Epub 2012 Jan 4.
Surgery is a high-stakes "performance." Yet, unlike athletes or musicians, surgeons do not engage in routine "warm-up" exercises before "performing" in the operating room. We study the impact of a preoperative warm-up exercise routine (POWER) on surgeon performance during laparoscopic surgery.
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.
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.
Urologic trainees who perform a POWER approximately 1 hour before laparoscopic renal surgery demonstrate improved cognitive, psychomotor, and technical performance.
手术是一项高风险的“表演”。然而，与运动员或音乐家不同，外科医生在手术室“表演”前并不进行常规的“热身”练习。我们研究了术前热身练习（POWER）对腹腔镜手术中外科医生表现的影响。
每位受试者均作为自己的对照，完成了两组腹腔镜手术，每组包含一例进行 POWER（+POWER）和一例未进行 POWER（-POWER）的手术。受试者在每对手术的第一例中随机分配到+POWER 或-POWER，且所有手术均相隔至少 1 周。POWER 包括在虚拟现实模拟器上完成电烙技能任务以及在盆腔盒训练器上进行 15 分钟腹腔镜缝合和打结。对于每个病例，在两个不同的任务中收集认知、心理运动和技术性能数据：结肠移动（MC）和体腔内缝合和打结（iSKT）。统计分析使用 SYSTAT v11.0 进行。
共进行了 28 例研究病例（14+POWER，14-POWER），由 7 位不同的受试者完成。在+POWER 组中，认知和心理运动表现（注意力、分心、工作量、空间推理、运动平滑度、姿势稳定性）显著更好（P≤0.05），并且由两位盲法腹腔镜专家评分的技术表现也更好，在 MC（P=0.04）中，但在 iSKT 中则没有（P=0.92）。使用我们的评估工具，技术评分显示出极好的可靠性（Cronbach ∝=0.88）。受试者在 POWER 期间的表现也与术中表现评分相关。
在腹腔镜肾手术前大约 1 小时进行 POWER 的泌尿科受训者表现出改善的认知、心理运动和技术表现。
