Page 25 - World Journal of Laparoscopic Surgery

WJOLS

Effect of Warm-up Exercises on Laparoscopic Trainer: Improvement of Operator Smoothness

Graph 1: Interaction plot for time Graph 2: Interaction plot for acceleration
Post hoc comparisons of warm-up showed that those
who had warmed up had significantly higher mean
smoothness than those in the control group (p = 0.0358)
(Graph 3 and Table 3).
Surgical level was a significant predictor of working
areas (p = 0.0125). While warm warm-up reduces straying
it was not significant the 5% level (p = 0.0562).
Post hoc comparisons of the surgical level group
showed surgeons had significantly lower mean working
areas than surgical trainees (p = 0.0039). Medical student
also had significantly lower mean working areas than
surgical trainees (p = 0.0470). There was no significant
difference between mean working areas for surgeons
and medical students (p = 0.1677) (Graph 4 and Table 4).
Graph 3: Interaction plot for smoothness
dISCuSSION This study was aimed to investigate the hypothesis
Minimally invasive surgery (MIS) has revolutionized that a warm-up activity prior to laparoscopic task on
the way surgeries are performed since its introduction a simulator improves subsequent performance of speci-
and many open procedures are almost replaced by MIS fied task.
because of the benefits for patients. Overall, the minimal The performance was analyzed using a software
incisions reduce postoperative pain and lead to earlier named InSTrAC which analyses multiple movement
mobilization of patients and, therefore, shorter hospital metrics. A study performed by rowland et al demon-
stays. However, MIS is challenging for the surgeons strated the construct validity of the software.
performing the operation, because of the reduced tactile Table 5 formulas used to calculate metrics reproduced
feedback and a loss of 3-dimensional (3D) vision. For with permission.
trainees learning curves are longer and surgeries take This study was performed with 23 controls and 21
longer time, triggering the need to find ways to improve participants. controls were recruited for each group
speed and performance in the operating theater. 10 (Surgeons, Surgical trainees, and medical students) and

Table 3: Smoothness analysis variable: smoothness
Operator Warm-up Participants Mean Std dev Minimum Maximum
Medical student Control 9 0.17 0.28 0.04 0.91
Post warm-up 8 0.21 0.29 0.06 0.92
Surgeon Control 6 0.65 0.43 0.02 1.12
Post warm-up 6 1.30 0.80 0.10 2.35
Surgical trainee Control 8 0.22 0.18 0.09 0.63
Post warm-up 7 0.50 0.53 0.07 1.36
World Journal of Laparoscopic Surgery, January-April 2015;8(1):21-25 23