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

Background/Objectives: Minimally invasive surgery benefits patients but places physical and cognitive demands on surgeons. While robot-assisted laparoscopic surgery (RALS) reduces musculoskeletal strain, it may increase cognitive load. This study examined 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 min simulation tasks on the Da Vinci system), and psychological warm-up (10 min PETTLEP-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 activity in the right deltoid and right trapezius (p < 0.05) compared to control, with no differences observed in other muscle groups. EEG alpha power data 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.