The Effect of a Physical and Psychological Warm-up on The Demands Experienced by Surgeons Performing Robot-Assisted Laparoscopic Surgery: A Randomized Crossover Trial

Shugaba, A, Tod, D, Lambert, JE, Bampouras, TM ORCID: 0000-0002-8991-4655, Hayes, LD, Nuttall, HE, Subar, DA, Sanal-Hayes, NEM and Gaffney, CJ (2026) The Effect of a Physical and Psychological Warm-up on The Demands Experienced by Surgeons Performing Robot-Assisted Laparoscopic Surgery: A Randomized Crossover Trial. Surgeries, 7 (3). ISSN 2673-4095

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Abstract

Background/Objectives: Minimally invasive surgery benefits patients but places phys-ical and cognitive demands on surgeons. While robot-assisted laparoscopic surgery (RALS) reduces musculoskeletal strain, it may increase cognitive load. This study ex-amined whether physical and psychological preparatory protocols (warm-ups) influence surgeon strain during RALS. Methods: Ten consultant surgeons from East Lancashire Hospitals NHS Trust (UK) participated in a preregistered, randomized study. Each performed RALS under three conditions: control, physical warm-up (10-minute simu-lation tasks on the Da Vinci system), and psychological warm-up (10-minute PETLEP-based mental imagery). Electromyography (EMG) and electroencephalography (EEG) were recorded during key surgical phases. EMG data were normalized to maximal voluntary contractions. Results: The physical warm-up significantly increased EMG ac-tivity in the right deltoid and right trapezius (p<0.05) compared to control, with no dif-ferences observed in other muscle groups. EEG alpha power did not significantly differ between conditions. Conclusions: These findings suggest that brief physical warm-up can enhance muscle activation in key regions involved in RALS, potentially improving motor control and reducing fatigue. Incorporating such strategies may support surgeon performance and well-being.

Item Type:	Article
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RC Internal medicine > RC1200 Sports Medicine R Medicine > RD Surgery
Divisions:	Sport and Exercise Sciences
Publisher:	MDPI
Date of acceptance:	24 June 2026
Date of first compliant Open Access:	25 June 2026
Date Deposited:	25 Jun 2026 08:25
Last Modified:	01 Jul 2026 08:15
DOI or ID number:	10.3390/surgeries7030078
URI:	https://researchonline.ljmu.ac.uk/id/eprint/28894

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