• Chi Chiung Grace Chen, Isabel C Green, Jorie M Colbert-Getz, Kimberly Steele, Betty Chou, Shari M Lawson, Dana K Andersen, and Andrew J Satin.
• Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21224, USA, cchen127@jhmi.edu.
• Int Urogynecol J. 2013 Oct 1;24(10):1615-22.

Introduction And HypothesisOur aim was to assess the impact of immediate preoperative laparoscopic warm-up using a simulator on intraoperative laparoscopic performance by gynecologic residents.MethodsEligible 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.ResultsWe 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.ConclusionPerforming 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.

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