Genevieve Chartrand, BSc, Pepa Kaneva, Msc, Chao Li, MD, Andrea M Petrucci, MD, Andrew F Mutter, BSc, Franco Carli, MD, Liane S Feldman, MD, Gerald M Fried, MD, Melina C Vassiliou, MD
McGill University
INTRODUCTION: Exercise is recognized to be beneficial to learning. The purpose of this research was to determine whether an episode of acute aerobic exercise prior to practice improves the acquisition and retention of laparoscopic skills in the Fundamentals of Laparoscopic Surgery (FLS) simulator.
METHODS/PROCEDURES: Participants were FLS naïve undergraduates. Maximal physical fitness (VO2 max) and performance on Peg Transfer (PT), Pattern Cut (PC), and Intracorporeal Suture (ICS) were measured at baseline. Participants were then randomized into exercise (E) and control (C) groups. C did unrelated work for 40 minutes and then practiced PT and PC for 10 mins, and ICS for 15 mins. Final scores were recorded at the end of the session. In E, participants ran on a treadmill for 20 minutes at 60% of their previously determined VO2 max. After a 15- min cool down, they engaged in identical FLS simulator practice as group C. Both groups completed the NASA Task Load Index (TLX) after each task to assess workload. Retention was recorded at a third visit, 2 months after the practice session. Groups were compared using t-tests, chi-square and Wilcoxon rank tests. P <0.10 was considered significant.
RESULTS: There were 52 participants (22 in C; 30 in E). The groups were similar in age (C: 21.5, ± 3.5; E: 19.9, ±1.4), BMI (C: 22.1±2.7; E: 22.2 ±2.2), baseline VO2 max (C: 46.1 ± 9.3; E: 47.2±10.6), gender (C: 61.3% female, E: 56.3% female) and scores on the 3 tasks at baseline (all p-values NS). Scores at the end of training were higher in the E group (Table). There were no differences in scores between C and E groups at retention. The majority of items on the NASA-TLX, in both training and retention scenarios, trended towards decreased workload in the E group.
FLS Scores
| Session | Tasks | Control | Exercise | P-values |
| Baseling | Peg Transfer | 128[90:168] | 142 [138:176] | 0.3 |
| Baseline | Pattern Cut | 76 [65:137] | 68 [23:112] | 0.7 |
| Baseline | ICK | 93 [0:164] | 105 [0:177] | 0.9 |
| Training | Peg Transfer | 225 [197:233] | 232 [219:240] | 0.03 |
| Training | Pattern Cut | 201 [140:222] | 213 [191:224] | 0.1 |
| Training | ICK | 338 [138:397] | 377 [290:436] | 0.1 |
NASA TLX (Selected scores)
| NASA TLX subscale | Control | Exercise | p-value | |
| Training | Frustration, Peg transfer | 8 [4:13] | 6 [3:11] | 0.2 |
| Training | Physical Demand, ICK | 13 [10:16] | 10 [5:14] | 0.1 |
| Retention | Frustration, ICK | 14.4 [12:17] | 11.5 [5:15] | 0.02 |
CONCLUSIONS: Acute exercise prior to practice on the FLS simulator improved final scores, however did not seem to affect retention. Exercise also reduces frustration and overall workload. The use of exercise in the surgical curriculum, or as a tool to enhance learning, remains of great interest and warrants further investigation regarding how best to apply it.
Session: Poster Presentation
Program Number: P182
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