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Background and Purpose: Surgery is a high-stakes ''performance.'' Yet, unlike athletes or musicians, surgeons do not engage in routine ''warm-up'' exercises before ''performing'' in the operating room. We study the impact of a preoperative warm-up exercise routine (POWER) on surgeon performance during laparoscopic surgery. Materials and Methods: Serving as their own controls, each subject performed two pairs of laparoscopic cases, each pair consisting of one case with POWER ( + POWER) and one without (-POWER). Subjects were randomly assigned to + POWER or -POWER for the initial case of each pairing, and all cases were performed ‡ 1 week apart. POWER consisted of completing an electrocautery skill task on a virtual reality simulator and 15 minutes of laparoscopic suturing and knot tying in a pelvic box trainer. For each case, cognitive, psychomotor, and technical performance data were collected during two different tasks: mobilization of the colon (MC) and intracorporeal suturing and knot tying (iSKT). Statistical analysis was performed using SYSTAT v11.0. Results: A total of 28 study cases (14 + POWER, 14 -POWER) were performed by seven different subjects. Cognitive and psychomotor performance (attention, distraction, workload, spatial reasoning, movement smoothness, posture stability) were found to be significantly better in the + POWER group (P £ 0.05) and technical performance, as scored by two blinded laparoscopic experts, was found to be better in the + POWER group for MC (P = 0.04) but not iSKT (P = 0.92). Technical scores demonstrated excellent reliability using our assessment tool (Cronbach f = 0.88). Subject performance during POWER was also found to correlate with intraoperative performance scores. Conclusions: Urologic trainees who perform a POWER approximately 1 hour before laparoscopic renal surgery demonstrate improved cognitive, psychomotor, and technical performance.

Orthopedic drilling as a skill demands high levels of dexterity and expertise from the surgeon. It is a basic skill that is required in many orthopedic procedures. Inefficient drilling can be a source of avoidable medical errors that may lead to adverse events. It is hence important to train and evaluate residents in safe environments for this skill. This paper presents a virtual orthopedic drilling simulator that was designed to provide visiohaptic interaction with virtual bones. The simulation provides a realistic basic training environment for orthopedic surgeons. It contains modules to track and analyze movements of surgeons, in order to determine their surgical proficiency. The simulator was tested with senior surgeons, residents and medical students for validation purposes. Through the multi-tiered testing strategy it was shown that the simulator was able to produce a learning effect that transfers to real-world drilling. Further, objective measures of surgical performance were found to be able to differentiate between experts and novices.