Impact of Preoperative Warm-Up on Surgical Performance of Resident Physicians: A Randomized Controlled Trial

Surgical learning is a complex process that involves resident characteristics, instructional methods, and technological tools. As surgical residency programs become more diverse, there is a growing need for adaptable training methods that align with various learning styles and backgrounds. Manual dexterity and self-assessment skills are essential for residents, and recent studies highlight those residents with refined manual skills perform better in surgery. Preoperative warm-up is emerging as a potential strategy to improve immediate surgical performance. The study aimed to analyze whether preoperative warm-up in low-cost surgical simulators (training boxes) is related to an immediate improvement in the intraoperative performance of general surgery residents inexperienced in laparoscopy.

The study used a swine model for surgical simulations in a controlled training environment. 105 first-year general surgery residents were divided into 2 groups: the control group (performed procedures without warm-up) and the intervention group (performed a 10-minute preoperative warm-up using a training box).

The Intervention group demonstrated improved efficiency in cholecystectomy (2.97 ± 0.4 vs 2.41 ± 0.91, p = 0.03), with reductions of 41.5% in cholecystectomy dissection time (4.82 ± 4.94 vs 8.23 ± 5.15 minutes, p = 0.02) and 15.6% in left radical nephrectomy dissection time (13.03 ± 4.49 vs 16.77 ± 3.90 minutes, p = 0.012).

Preoperative warm-up using a training box significantly improved the qualitative and quantitative surgical performance of general surgery residents with no prior laparoscopic experience, particularly by increasing efficiency in cholecystectomy and reducing dissection times in both cholecystectomy and left radical nephrectomy.