da Cruz José Arnaldo Shiomi, Dos Reis Sabrina Thalita, Cunha Frati Rodrigo Marcus, Duarte Ricardo Jordão, Nguyen Hiep, Srougi Miguel, Passerotti Carlo Camargo
Urology Department, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil; Center for Robotic Surgery, German Hospital Oswaldo Cruz, São Paulo, Brazil.
Urology Department, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.
J Surg Educ. 2016 Nov-Dec;73(6):974-978. doi: 10.1016/j.jsurg.2016.04.020. Epub 2016 May 24.
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.
Verify whether there is benefit in surgical performance with preoperatory warm-up using a VRSS.
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%.
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 ± 2.89min, p = 0.012), time for clipping the pedicle (5.51 ± 2.36 vs. 2.89 ± 2.76min, 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 ± 27.8ml, 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 ± 4.51min, p = 0.096), total operative time (30.8 ± 11.07 vs. 25.60 ± 5.10min, p = 0.188), and efficiency (4 ± 0.66 vs. 3.6 ± 0.69, p = 0.320).
The practice of preoperative warm-up training seems to benefit surgical performance even in subject with mild laparoscopic experience.
虚拟现实手术模拟器（VRSS）已成为腹腔镜手术培训和教育中的一种有价值的工具。考虑到VRSS的有效性，人们提出了该工具的新用途。在体育领域，运动前热身对提高运动表现有明显益处。据推测，在进入手术室之前在VRSS中进行热身可能对手术表现有益。
验证使用VRSS进行术前热身是否对手术表现有益。
将20名具有腹腔镜基础知识的医学生分为两组（I组和II组）。I组在猪模型中进行腹腔镜胆囊切除术。II组在VRSS中进行术前热身，然后在猪模型中进行腹腔镜胆囊切除术。基于先前验证的评分系统，比较两组在定量参数（胆囊蒂解剖时间、夹闭蒂时间、切断蒂时间、胆囊切除时间、总手术时间和吸出失血量）和定性参数（深度感知、双手灵巧性、效率、组织处理和自主性）方面的表现，评分越高结果越好。数据以5%的显著性水平进行分析。
进行术前热身的组（II组）在胆囊蒂解剖时间（11.91±9.85 vs. 4.52±2.89分钟，p = 0.012）、夹闭蒂时间（5.51±2.36 vs. 2.89±2.76分钟，p = 0.004）、切断蒂时间（1.84±0.7 vs. 1.13±0.51，p = 0.019）、吸出失血量（171±112 vs. 57±27.8毫升，p = 0.006）、深度感知（4.5±0.7 vs. 3.3±0.67，p = 0.004）、双手灵巧性（4.2±0.78 vs. 3.3±0.67，p = 0.004）、组织处理（4.2±0.91 vs. 3.6±0.66，p = 0.012）和自主性（4.9±0.31 vs. 3.6±0.96，p = 0.028）方面显示出明显更好的结果。在胆囊切除时间（11.58±4.31 vs. 15.08±4.51分钟，p = 0.096）、总手术时间（30.8±11.07 vs. 25.60±5.10分钟，p = 0.188）和效率（4±0.66 vs. 3.6±0.69，p = 0.320）方面没有差异。
术前热身训练即使对于腹腔镜经验较少的受试者似乎也有益于手术表现。
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