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.

Rather than being based on a set number of completed cases, robotic surgery credentialing should involve the demonstration of proficiency and safety in executing basic robotic skills and procedural tasks. In addition, the accreditation process should be iterative to ensure accountability to the patient.

Performing warm-up exercises before complex laparoscopic surgery may improve operative times and performance in the operating room, especially for complex laparoscopic surgeries.

This study confirms the face, content, construct and concurrent validity of the dV-Trainer, which may have a potential role as an assessment tool.