A new study reports a robust relationship between operating list composition and surgical performance (indexed by the duration of operation). An evidence?based approach to structuring a theatre list could reduce the total operating time.

Surgeons progressively 'warm-up' as they repeat a procedure on their operating list, akin to the way athletes' performance improves across a competition-according to new research.

For each operation, the time saved was small but scaled up across an average hospital over a year it was estimated to be around 24 days of operating theater time. The time taken to complete the procedure was a good proxy for how well an operation has gone as well as an indicator of the surgeon's performance.

Surgeon Thomas Pike, from the University of Leeds, who co-authored the research, said: "What the study shows is that there is a natural process where it emerges 'warm-up' as they work their way through their operating list-and that is particularly so where they are doing the same procedure repeatedly.

The researchers wanted to see if they emerged, like elite athletes and performers, see their performance improved as a result of 'warm-up.' Previous studies had suggested operation times would get shorter as a result of these techniques, but these had been based on simulations and not real-life practice.

After controlling for factors that affected the outcomes of surgery, for example to patient's age and severity of illness, it was found that the second operation on a list more quickly than the first. That reduction in operating time was consistent across the majority of procedures analyzed and amounted to just over 6% of operating time.

If surgeons switched between procedures, there was a lengthening of time taken to complete the new technique, by on average just under 6.5%. Overall, they looked at 35 different procedures, and the results showed remarkable consistency.

Scientists at the University of Leeds now hope to build on the findings by trying to identify a technique or process that would enable surgeons to 'warm up' before they make their first incision.

Many surgeons do prepare for operation by looking at images, video scans, and even 3-D anatomical models. An earlier study by researchers at the University found that surgical trainees who were able to use a 3-D model were mentally better prepared for the surgical procedure.

Dr. Faisal Mushtaq, a psychologist at the University of Leeds and co-author of the study, said: "Many surgeons have their routines for preparing for surgery, what is needed to try and determine if it is possible, or even practical, to design a warm-up routine for surgeons and if so, for this to be part of standard hospital practice.

Dr. Mushtaq and colleagues were looking at the use of virtual and augmented reality techniques to help surgeons warm up for extremely challenging procedures such as brain tumor surgery. Here, they were working on converting MRI and PET scans of a patient's brain into virtual objects that arise from visualization and interact with.