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Warm-up in a Virtual Reality Environment Improves Performance in the Operating Room

Calatayud, Dan MD*; Arora, Sonal MBBS; Aggarwal, Rajesh PhD; Kruglikova, Irina MD; Schulze, Svend DSc*; Funch-Jensen, Peter DSc; Grantcharov, Teodor PhD§

doi: 10.1097/SLA.0b013e3181deb630
Original Articles

Objective: To assess the impact of warm-up on laparoscopic performance in the operating room (OR).

Background: Implementation of simulation-based training into clinical practice remains limited despite evidence to show that the improvement in skills is transferred to the OR. The aim of this study was to evaluate the impact of a short virtual reality warm-up training program on laparoscopic performance in the OP.

Methods: Sixteen Laparoscopic Cholecystectomies were performed by 8 surgeons in the OR. Participants were randomized to a group which received a preprocedure warm-up using a virtual reality simulator and no warm-up group. After the initial laparoscopic cholecystectomy all surgeons served as their own controls by performing another procedure with or without preoperative warm-up. All OR procedures were videotaped and assessed by 2 independent observers using the generic OSATS global rating scale (from 7 to 35).

Results: There was significantly better surgical performance on the laparoscopic Cholecystectomy following preoperative warm-up, median 28.5 (range = 18.5–32.0) versus median 19.25 (range = 15–31.5), P = 0.042. The results demonstrated excellent reliability of the assessment tool used (Cronbach's α = 0.92).

Conclusion: This study showed a significant beneficial impact of warm-up on laparoscopic performance in the OP. The suggested program is short, easy to perform, and therefore realistic to implement in the daily life in a busy surgical department. This will potentially improve the procedural outcome and contribute to improved patient safety and better utilization of OR resources.

This study evaluates the impact of warm-up in a virtual reality environment on performance in the operating room. Results suggest that a short period of warm-up (15 minutes) does improve the quality of technical performance. Further studies should replicate this finding for other procedures and determine the effects of warm-up on nontechnical performance and patient outcomes.

From the *Department of Surgery D, Glostrup University Hospital, Glostrup, Denmark; †Department of Biosurgery and Surgical Technology, Imperial College, London, United Kingdom; ‡Department of Surgery L, Aarhus University Hospital, Aarhus, Denmark; and §Division of General Surgery, St. Michael's Hospital, Toronto, Canada.

Reprints: Sonal Arora, MBBS, Department of Biosurgery and Surgical Technology, Imperial College, 10th Floor, QEQM Building, St. Mary's Hospital, Praed St, London, W2 1NY, United Kingdom. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.