Basketball players, baseball pitchers, and athletes warm up before they perform, and now researchers in the US are investigating whether surgeons should do the same to ensure they are better prepared for when they have to perform.

Dr Tom Lendvay, assistant professor in the Department of Urology at the University of Washington in Seattle thinks there could be something in this idea, and to this end the US Army Medical Research and Materiel Command has awarded him some funds to study the effect of pre-operative warm-up on virtual reality surgical task proficiency.

Maj Timothy Brand, a surgeon based at Madigan Army Medical Center in Tacoma, Washington, is collaborating with Lendvay on the study.

Lendvay, who is also co-director of Seattle Children’s Robotic Surgery Center, told the press that:

“We are investigating whether surgical trainees should warm up prior to surgery, and we’re including experienced surgeons in our study.”

“We might discover that everyone should warm up before operating,” he added, commenting that such a revelation would lead to a “complete paradigm shift in surgical preparation”.

To study the effect of warm up on surgeon performance, the researchers intend to use a virtual reality simulator based on the da Vinci surgical robot, which surgeons use to carry out complex minimally invasive surgery such as prostatectomies.

The surgeon controls the robot, which is made by Intuitive Surgical and sports several arms holding various tools (eg scalpel, scissors, camera, cauterizer), using two hand-held controllers and two foot pedals. While the surgeon is doing this he or she also sees 3-D views of what is happening, a great advantage over the 2-D views with traditional laparoscopic surgery.

Lendvay and colleagues will develop software and hardware, and a “proficiency-based curriculum with measurable outcomes”. They intend to recruit medical students, surgical residents and faculty members to test the curriculum over an 18-month period which ends around March 2011.

The University of Washington (UW) has tackled the subject of surgeon warm-ups already, in an earlier study published in February 2009, UW researchers teamed up with colleagues from Arizona State University and found that warming up did make a difference to surgeon performance, as Lendvay explained:

“Even experienced surgeons derived benefit from the warm-up and there was an error reduction in surgical skills.”

In that study, the researchers found that a warm up comprising 15 to 20 minutes of simple surgical exercises involving both psychomotor and cognitive skills before an operation raised surgeons’ alertness to a higher level for surgical procedures and also helped fatigued surgeons perform better.

Lendvay said findings from the new study could be useful not only for general surgical training, but also for designing ways to keep surgeons deployed by the military overseas up to date so they can carry on practising when they return to the US.

“These surgeons have ebbs and flows in the number of patients they’ll see and experience some down time,” said Lendvay.

“It’s likely that they would benefit from virtual reality surgical task training,” he added.

Seattle Children’s Robotic Surgery Center uses the da Vinci robotic system to carry out minimally invasive robot assisted laparoscopy (RAL).

During RAL the child’s stomach is filled with filled with carbon dioxide (CO2) which creates a space or a bubble in which to do the surgery. Then the surgeon makes three small keyhole incisions through which the robot arms insert a video camera and surgical instruments.

Related articles:

Warm-Up Helps Surgeons Improve Performance (Feb 2009)

oBand Surgery Centers Perform The World’s First Outpatient Robotic Surgery Using The Da Vinci(R) Surgical System

Sources: University of Washington, Seattle Children’s.

Written by: Catharine Paddock, PhD