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Preconditioning in laparoscopic surgery—results of a virtual reality pilot study

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Abstract

Background

This prospective study investigated the effect of preconditioning in laparoscopic cholecystectomy (LC) and appendectomy (LA) based on pre- and postoperative virtual reality laparoscopy (VRL) performances, with specific regard to the impact of different motor skills, types of surgery and levels of experience.

Study design

Forty laparoscopic procedures (28 LC and 12 LA) were performed by 13 residents in the operating room. Participants completed a defined set of tasks on the VRL simulator directly prior to and after the operation: one preparational task (PT), a virtual procedural task with emphasis on fine preparation (VPT) and a navigational manoeuvre for instrument coordination (ICT). VRL performances were evaluated based on the assessed items of the simulator.

Results

Overall analysis of the surgeons’ performance demonstrated better postoperative results for PT and VPT in 28 and 26 cases (p = 0.001 and p = 0.034), respectively. No significant difference was found for ICT (p = 0.638). Less-experienced residents had better postoperative results for PT and VPT (p = 0.009 and p = 0.041), whereas more-experienced surgeons had better postoperative results for PT only (p = 0.030). LC resulted in better postoperative performance for PT (p = 0.007). LA improved performance for PT and VPT (p = 0.034 and p = 0.006, respectively). Comparisons of surgeon’s experience demonstrated a significant advantage for more-experienced surgeons in ICT (p = 0.033), while type of surgery showed an advantage for LA in VPT (p = 0.022).

Conclusion

There is a preconditioning effect in laparoscopic surgery. The differing results related to LC and LA and the experience levels of surgeons suggest that differentiated warm-up strategies are required.

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Abbreviations

LC:

Laparoscopic cholecystectomy

LA:

Laparoscopic appendectomy

VRL:

Virtual reality laparoscopy

ICT:

Instrument coordination

PT:

Preparation task

VPT:

Virtual procedural task

References

  1. Macdonald W, Bendak S (2000) Effects of workload level and 8- versus 12-h workday duration on test battery performance. Int J Ind Ergon 26(3):399–416. doi:10.1016/S0169-8141(00)00015-9

    Article  Google Scholar 

  2. Wright MC, Phillips-Bute B, Mark JB, Stafford-Smith M, Grichnik KP, Andregg BC, Taekman JM (2006) Time of day effects on the incidence of anesthetic adverse events. Qual Saf Health Care 15(4):258–263. doi:10.1136/qshc.2005.017566

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  3. Gurusamy KS, Aggarwal R, Palanivelu L, Davidson BR (2009) Virtual reality training for surgical trainees in laparoscopic surgery. Cochran Data Syst Rev (1):CD006575. doi:10.1002/14651858.CD006575.pub2

  4. Larsen CR, Oestergaard J, Ottesen BS, Soerensen JL (2012) The efficacy of virtual reality simulation training in laparoscopy: a systematic review of randomized trials. Acta Obstet Gynecol Scand 91(9):1015–1028. doi:10.1111/j.1600-0412.2012.01482.x

    Article  PubMed  Google Scholar 

  5. Zendejas B, Brydges R, Hamstra SJ, Cook DA (2013) State of the evidence on simulation-based training for laparoscopic surgery: a systematic review. Ann Surg 257(4):586–593. doi:10.1097/SLA.0b013e318288c40b

    Article  PubMed  Google Scholar 

  6. Kneist W, Huber T, Paschold M, Lang H (2013) 3D Virtual reality laparoscopic simulation in surgical education—results of a pilot study. Zentralbl Chir. doi:10.1055/s-0033-1350609

    PubMed  Google Scholar 

  7. Paschold M, Huber T, Zeissig SR, Lang H, Kneist W (2013) Tailored instructor feedback leads to more effective virtual-reality laparoscopic training. Surg Endosc Nov 2 (Epub ahead of print). doi:10.1007/s00464-013-3258-z

  8. Lee JY, Mucksavage P, Kerbl DC, Osann KE, Winfield HN, Kahol K, McDougall EM (2012) Laparoscopic warm-up exercises improve performance of senior-level trainees during laparoscopic renal surgery. J Endourol / Endourol Soc 26(5):545–550. doi:10.1089/end.2011.0418

    Article  Google Scholar 

  9. Hafford ML, Van Sickle KR, Willis RE, Wilson TD, Gugliuzza K, Brown KM, Scott DJ (2013) Ensuring competency: are fundamentals of laparoscopic surgery training and certification necessary for practicing surgeons and operating room personnel? Surg Endosc 27(1):118–126. doi:10.1007/s00464-012-2437-7

    Article  PubMed  Google Scholar 

  10. Kroft J, Ordon M, Arthur R, Pittini R (2012) Does surgical “warming up” improve laparoscopic simulator performance? Simul Healthc J Soc Simul Healthc 7(6):339–342. doi:10.1097/SIH.0b013e31826230d4

    Article  Google Scholar 

  11. Moldovanu R, Tarcoveanu E, Dimofte G, Lupascu C, Bradea C (2011) Preoperative warm-up using a virtual reality simulator. JSLS J Soc Laparoendoscop Surg 15(4):533–538. doi:10.4293/108680811X13176785204409

    Article  Google Scholar 

  12. Calatayud D, Arora S, Aggarwal R, Kruglikova I, Schulze S, Funch-Jensen P, Grantcharov T (2010) Warm-up in a virtual reality environment improves performance in the operating room. Ann Surg 251(6):1181–1185. doi:10.1097/SLA.0b013e3181deb630

    Article  PubMed  Google Scholar 

  13. Do AT, Cabbad MF, Kerr A, Serur E, Robertazzi RR, Stankovic MR (2006) A warm-up laparoscopic exercise improves the subsequent laparoscopic performance of Ob-Gyn residents: a low-cost laparoscopic trainer. JSLS J Soc Laparoendoscop Surg 10(3):297–301

    Google Scholar 

  14. Chen CC, Green IC, Colbert-Getz JM, Steele K, Chou B, Lawson SM, Andersen DK, Satin AJ (2013) Warm-up on a simulator improves residents’ performance in laparoscopic surgery: a randomized trial. Int Urogynecol J. doi:10.1007/s00192-013-2066-2

    Google Scholar 

  15. Lendvay TS, Brand TC, White L, Kowalewski T, Jonnadula S, Mercer LD, Khorsand D, Andros J, Hannaford B, Satava RM (2013) Virtual reality robotic surgery warm-up improves task performance in a dry laboratory environment: a prospective randomized controlled study. J Am Coll Surg 216(6):1181–1192. doi:10.1016/j.jamcollsurg.2013.02.012

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kahol K, Satava RM, Ferrara J, Smith ML (2009) Effect of short-term pretrial practice on surgical proficiency in simulated environments: a randomized trial of the “preoperative warm-up” effect. J Am Coll Surg 208(2):255–268. doi:10.1016/j.jamcollsurg.2008.09.029

    Article  PubMed  Google Scholar 

  17. Nickel F, Bintintan VV, Gehrig T, Kenngott HG, Fischer L, Gutt CN, Muller-Stich BP (2013) Virtual reality does not meet expectations in a pilot study on multimodal laparoscopic surgery training. World J Surg 37(5):965–973. doi:10.1007/s00268-013-1963-3

    Article  PubMed  Google Scholar 

  18. Plerhoples TA, Zak Y, Hernandez-Boussard T, Lau J (2011) Another use of the mobile device: warm-up for laparoscopic surgery. J Surg Res 170(2):185–188. doi:10.1016/j.jss.2011.03.015

  19. Mucksavage P, Lee J, Kerbl DC, Clayman RV, McDougall EM (2012) Preoperative warming up exercises improve laparoscopic operative times in an experienced laparoscopic surgeon. J Endourol 26(7):765–768. doi:10.1089/end.2011.0134

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Acknowledgments

Financial support for the simulator was provided by the medical education project “MAICUM” from the Medical Centre of the Johannes Gutenberg University of Mainz. Financial support for the laparoscopic equipment was provided by the German Research Foundation (DFG: INST 371/8-1 FUGG; 573323).

Conflicts of interest

The authors have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of General, Visceral and Transplant Surgery, University Medicine of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany

    M. Paschold, T. Huber, D. W. Kauff, K. Buchheim, H. Lang & W. Kneist

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  1. M. Paschold
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  2. T. Huber
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  3. D. W. Kauff
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  4. K. Buchheim
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  5. H. Lang
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  6. W. Kneist
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Corresponding author

Correspondence to W. Kneist.

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Paschold, M., Huber, T., Kauff, D.W. et al. Preconditioning in laparoscopic surgery—results of a virtual reality pilot study. Langenbecks Arch Surg 399, 889–895 (2014). https://doi.org/10.1007/s00423-014-1224-4

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  • DOI: https://doi.org/10.1007/s00423-014-1224-4

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