Laird Harrison

November 06, 2014

SAN FRANCISCO — Surgeons performing advanced laparoscopic surgery can improve their skills by mentally practicing procedures, according to a study presented here at the American College of Surgeons 2014 Clinical Congress.

"Mental practice improved the technical performance of surgical trainees in advanced laparoscopic surgery," said presenter Marisa Louridas, MSc, a surgery researcher at the University of Toronto.

Previous research has demonstrated that mental practice — the cognitive rehearsal of a task — can enhance performance in sports and music.

Research of mental practice in surgery has, so far, been restricted to basic operations. Louridas and her colleagues wanted to assess the effects of the technique on advanced laparoscopic skills and surgeon stress levels in a crisis scenario.

They created a script by asking eight experienced bariatric surgeons to speak out loud the steps of a laparoscopic Roux-en-Y gastric bypass, emphasizing the kinesthetic and visual cues at each step.

The surgeons included errors they had seen residents make. For example, "the residents grab the bowel when it's out of sight; therefore, they cannot see if they are applying too much force or have caused injury. This is concerning because it may result in unrecognized bowel injury."

The researchers randomly assigned 10 senior surgical residents to a conventional group and 10 to a mental practice group. All residents had performed at least five jejunostomies each because some experience in the procedure is necessary to identify the visual and kinesthetic cues.

All 20 residents underwent a didactic session and watched videos of the procedure. In addition, the 10 in the mental practice group received the scripts along with training in mental practice from an expert performance psychologist.

The researchers assessed each resident's skills before the training and during a crisis scenario in a simulated operating room, where the procedure was performed on a pig. "We made it look and feel like an OR to make it as realistic as possible for the participants," said Louridas.

Performed Better

On the objective structured assessment of technical skill and bariatric skill, surgeons in the mental practice group improved their scores significantly more than those in the conventional group (=.003).

Seven of the surgeons in the mental practice group improved their technical performance during the crisis scenario, and the rest performed as well as at baseline. In the control group, four surgeons performed less well in the crisis scenario, and the rest performed as well as at baseline.

Mental imagery ability improved significantly in the mental practice group (= .01), but not the conventional group (P = .08).

To assess the effect of mental practice on the stress levels of the surgeons during the crisis scenario, the researchers monitored their blood pressure and heart rate, and had them complete the State-Trait Anxiety Inventory. They found no difference between the two groups.

The official discussant for the presentation, Areti Tillou, MD, a general surgeon at the University of California, Los Angeles, called the study "excellent".

"Mental practice is a very interesting concept to be used in surgery," said Dr Tillou, but she cautioned that "it works better on accomplished athletes trying to optimize than on new athletes trying to acquire a skill."

Dr Tillou wanted to know how the two groups in the study compared at baseline.

Louridas reported that the mental practice group had higher scores at baseline, which is why the change in scores between the two groups was compared, rather than the actual scores.

After the presentation, a member of the audience asked if Louridas saw a role for this type of training at higher levels, including faculty. She said she thinks it could help at any level.

Another meeting attendee asked whether the mental practice group benefited more from the insights contained in the script or from the practice.

"It's almost impossible to tease them out," said Louridas. "If I just gave you the script and you just read it once, I don't think it would be as effective, but we did not have a third group who did that."

Ms Louridas and Dr Tillou have disclosed no relevant financial relationships.

American College of Surgeons (ACS) 2014 Clinical Congress. Presented October 28, 2014.

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