Preconditioning in laparoscopic surgery--results of a virtual reality pilot study

Langenbecks Arch Surg. 2014 Oct;399(7):889-95. doi: 10.1007/s00423-014-1224-4. Epub 2014 Jul 27.


Background: This prospective study investigated the effect of preconditioning in laparoscopic cholecystectomy (LC) and appendectomy (LA) based on pre- and postoperative virtual reality laparoscopy (VRL) performances, with specific regard to the impact of different motor skills, types of surgery and levels of experience.

Study design: Forty laparoscopic procedures (28 LC and 12 LA) were performed by 13 residents in the operating room. Participants completed a defined set of tasks on the VRL simulator directly prior to and after the operation: one preparational task (PT), a virtual procedural task with emphasis on fine preparation (VPT) and a navigational manoeuvre for instrument coordination (ICT). VRL performances were evaluated based on the assessed items of the simulator.

Results: Overall analysis of the surgeons' performance demonstrated better postoperative results for PT and VPT in 28 and 26 cases (p = 0.001 and p = 0.034), respectively. No significant difference was found for ICT (p = 0.638). Less-experienced residents had better postoperative results for PT and VPT (p = 0.009 and p = 0.041), whereas more-experienced surgeons had better postoperative results for PT only (p = 0.030). LC resulted in better postoperative performance for PT (p = 0.007). LA improved performance for PT and VPT (p = 0.034 and p = 0.006, respectively). Comparisons of surgeon's experience demonstrated a significant advantage for more-experienced surgeons in ICT (p = 0.033), while type of surgery showed an advantage for LA in VPT (p = 0.022).

Conclusion: There is a preconditioning effect in laparoscopic surgery. The differing results related to LC and LA and the experience levels of surgeons suggest that differentiated warm-up strategies are required.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Appendectomy / methods
  • Cholecystectomy, Laparoscopic / education
  • Cholecystectomy, Laparoscopic / methods*
  • Clinical Competence*
  • Computer Simulation*
  • General Surgery / education
  • Humans
  • Internship and Residency
  • Laparoscopy / methods*
  • Motor Skills
  • Pilot Projects
  • Prospective Studies
  • Task Performance and Analysis