DOES YOUR SURGEON “WARM-UP� BEFORE SURGERY?

DOES YOUR SURGEON “WARM-UPâ€� BEFORE SURGERY?

Given that it is generally thought that performing sham surgical operations on human beings is a bad thing, I rarely include surgical research in this column as there are no randomized, controlled clinical surgery research trials being performed. As I am a surgeon, however, I am always on the look-out for an interesting surgery research study that can be included in this weekly health research column. In the current issue of the Journal of the American College of Surgeons, I came across an interesting little study looking at the value of “preoperative warm-upâ€� exercises by surgeons who are about to go into the operating room to perform a surgical procedure.

Modern surgical procedures require a great deal of both cognitive and motor skills, and there has recently been a new emphasis on borrowing “best practicesâ€� guidelines from other professions that, similarly, require the integration of these two high-level skills. For example, today, using “best practicesâ€� borrowed from the airline industry, the operating team is required to go through a check-list of at least 7 different patient safety parameters before the surgeon may begin the actual operation. In this particular surgery research study, the authors have sought to learn whether or not a brief period of simulated surgical maneuvers, when performed just prior to the actual operation, can improve a surgeon’s performance during surgery.

Much as professional athletes warm-up before the big game, and practice key skills before facing their opponents on the court or field, the researchers conducting this study hypothesized that a brief period of “preoperative warm-upâ€� exercises, before the big operation, might improve the surgeon’s dexterity and precision during the course of the actual operation. The “warm-upâ€� exercises consisted of simulated laparoscopic surgery procedures whereby surgeons transferred small objects from one place to another while watching a television monitor. A particularly fascinating aspect of this study was the inclusion of surgeons who had been up all night on call, in an effort to determine whether or not “warm-upâ€� exercises can reduce the decrease in cognitive and motor skills that is known to occur in fatigued surgeons.

In this prospective surgery research study, 15 to 20 minutes of simulated practice with simple laparoscopic surgical maneuvers, prior to performing surgery, resulted in significant improvements in performance during the conduct of surgical operations on live patients. Moreover, significant improvements were noted among both very junior and very senior surgeons following completion of these “warm-upâ€� exercises. Interestingly, the performance of surgeons who had been up all night while on call was also significantly improved after performing these “warm-upâ€� exercises. However, although their surgical skills were improved, the “warm-upâ€� exercises still could not restore these surgeons’ skills to the levels that they had demonstrated before starting their on-call shifts.

Certainly, both surgeons and their patients should find the results of this innovative little study to be of interest, although its findings are not particularly surprising. Most surgeons already know that, as with most complex psychomotor skills, surgical performance improves with frequent repetition. Indeed, over the course of a long day in the operating room, most of us are probably unconsciously aware that our movements become more precise and more fluid with each successive operation that we perform.