To evaluate the effect of surgical warm-up on operative performance through a systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials.

This is a systematic review and meta-analysis of prospective randomized controlled trials, and it was prospectively registered in PROSPERO (CRD420251127516).

Academic and teaching hospitals worldwide, involving surgical training environments with simulation and real procedures.

Medical students, residents, and surgeons included across eligible randomized trials.

Warm-up significantly reduced operative time. Trial sequential analysis confirmed the robustness of the findings, indicating that sufficient information is already available in the literature to consider this outcome reliable without the immediate need for further trials. Secondary outcomes showed improvements in tissue handling, psychomotor skills, and task flow.

Surgical warm-up appears to be an effective, low-cost strategy to optimize technical performance, particularly in training contexts. Future multicenter trials should define optimal warm-up duration, method, and implementation in surgical curricula.