Preoperative Rehearsal Research Articles

Improving Clinical Performance Using Rehearsal or Warm-up

To determine whether rehearsal (the deliberate practice of skills specific to a procedure) or warm-up (the act or process of warming up by light exercise or practice) prior to performing complex clinical procedures on patients can improve the task performance of operators and operating teams. The authors performed an advanced literature search for clinical studies published between 1975 and October 2012 using MEDLINE, EMBASE, the Cochrane Controlled Trials Register, ISI Web of Knowledge, and clinicaltrials.gov. They identified randomized controlled trials and observational studies that evaluated the effects of physical rehearsal or warm-up prior to performing complex clinical procedures. Two reviewers independently reviewed titles and abstracts and then full texts before abstracting data using a standardized form. They resolved disagreements by consensus. The authors identified 1,886 potential articles and included 7 in their review (2 randomized controlled trials and 5 observational studies). All reported that rehearsal or warm-up by operators or operating teams is feasible. Only two clinical studies objectively demonstrated that warm-up can improve overall technical performance. Other objective evidence supporting the positive effects of rehearsal or warm-up for other team or nontechnical outcomes was limited. The potential benefits of and optimal techniques for performing physical rehearsal and warm-up have not been established. Preliminary findings suggest that preoperative rehearsal or warm-up can improve the performance of operators or operating teams, but there is a paucity of objective evidence and comparative clinical studies in the existing literature to support their routine use.

Stereoscopic virtual reality simulation for microsurgical excision of cerebral arteriovenous malformation: case illustrations

Background Use of virtual reality planning and rehearsal for planning and training of cerebral aneurysm clipping was recently reported. We aimed to illustrate its applications in preoperative planning and training for cerebral AVM excision. Case Description We illustrated the application of preoperative rehearsal for excision of cerebral AVM for 2 patients in a stereoscopic virtual reality environment. One patient was a 44-year-old lady with a right posterior temporal AVM, and 1 patient was a 23-year-old lady with a left frontal AVM. Through Dextroscope, an anatomical understanding of arterial feeders, nidus, and draining veins in relationship to surrounding cerebral cortex was obtained. It allowed one to see the exposure with the different angles of visualization, similar to what happened under the operative microscope. Conclusion Dextroscopic virtual reality stimulation provided an illustrated preoperative planning and training for excision of cerebral AVM.

Virtual 3D planning and guidance of mandibular distraction osteogenesis

We present a system for 3D planning and pre-operative rehearsal of mandibular distraction osteogenesis procedures. Two primary architectural components are described: a planning system that allows geometric bone manipulation to rapidly explore various modifications and configurations, and a visuohaptic simulator that allows both general-purpose training and preoperative, patient-specific procedure rehearsal. We provide relevant clinical background, then describe the underlying simulation algorithms and their application to craniofacial procedures.

Preoperative and intraoperative rehearsal in hypnoanesthesia for major surgery.

Abstract The applications and limitations of both hypnoanesthesia for major surgery and Schultz's preoperative rehearsal technique are reviewed. The difficulties encountered by an unanticipated operative maneuver and the ensuing disruption of hypnoanesthesia are presented. Recommendations are offered which include preparing the surgical team more thoroughly for the unique demands of hypnoanesthesia, training the patient before surgery with a posthypnotic signal to reenter hypnosis, and utilizing a new variation of Schultz's technique called intraoperative rehearsal.

Management of Bone in Digital Replantation

Microvascular surgical techniques have been applied to the problem of digital amputation, persistent nonunion and complicated extremity injuries with segmental bone and soft tissue loss. In replantations, adequate bone shortening and fixation with intramedullary pins or rods is mandatory. Proper patient selection, preoperative management of the amputated parts, application of microsurgical disciplines, employment of an organized surgical sequence, and rigid postoperative monitoring has resulted in an 80% viability rate in 121 replantations. Recent advances in the management of skeletal injuries using microvascular techniques include free vascularized bone grafting and salvage of the preamputation limb using free composite grafts of skin, subcutaneous tissue and bone. These free composite grafts techniques are exacting and time consuming. Meticulous planning, preoperative rehearsal and careful coordination between the operating teams make the functional restoration of a severely injured limb possible.