Chen Chi Chiung Grace, Green Isabel C, Colbert-Getz Jorie M, Steele Kimberly, Chou Betty, Lawson Shari M, Andersen Dana K, Satin Andrew J
Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21224, USA,
Int Urogynecol J. 2013 Oct;24(10):1615-22. doi: 10.1007/s00192-013-2066-2. Epub 2013 Apr 11.
Our aim was to assess the impact of immediate preoperative laparoscopic warm-up using a simulator on intraoperative laparoscopic performance by gynecologic residents.
Eligible laparoscopic cases performed for benign, gynecologic indications were randomized to be performed with or without immediate preoperative warm-up. Residents randomized to warm-up performed a brief set of standardized exercises on a laparoscopic trainer immediately before surgery. Intraoperative performance was scored using previously validated global rating scales. Assessment was made immediately after surgery by attending faculty who were blinded to the warm-up randomization.
We randomized 237 residents to 47 minor laparoscopic cases (adnexal/ tubal surgery) and 44 to major laparoscopic cases (hysterectomy). Overall, attendings rated upper-level resident performances (postgraduate year [PGY-3, 4]) significantly higher on global rating scales than lower-level resident performances (PGY-1, 2). Residents who performed warm-up exercises prior to surgery were rated significantly higher on all subscales within each global rating scale, irrespective of the difficulty of the surgery. Most residents felt that performing warm-up exercises helped their intraoperative performances.
Performing a brief warm-up exercise before a major or minor laparoscopic procedure significantly improved the intraoperative performance of residents irrespective of the difficulty of the case.
我们的目的是评估妇科住院医师在术前立即使用模拟器进行腹腔镜热身对术中腹腔镜操作表现的影响。
因良性妇科指征而进行的符合条件的腹腔镜手术被随机分为术前立即进行热身或不进行热身两组。被随机分配到热身组的住院医师在手术前立即在腹腔镜训练器上进行一组简短的标准化练习。术中表现使用先前验证过的整体评分量表进行评分。由对热身随机分组不知情的主治教员在手术后立即进行评估。
我们将237名住院医师随机分配到47例小型腹腔镜手术（附件/输卵管手术）和44例大型腹腔镜手术（子宫切除术）中。总体而言，主治教员在整体评分量表上对高年级住院医师（研究生三年级[PGY - 3、4]）表现的评分显著高于低年级住院医师（PGY - 1、2）。无论手术难度如何，术前进行热身练习的住院医师在每个整体评分量表的所有子量表上的评分都显著更高。大多数住院医师认为进行热身练习有助于他们的术中表现。
无论病例难度如何，在大型或小型腹腔镜手术前进行简短的热身练习都能显著提高住院医师的术中表现。
