Ergonomic analysis of robot-assisted and traditional laparoscopic procedures.

ABSTRACT

INTRODUCTION: Many laparoscopic surgeons report musculoskeletal symptoms that are thought to be related to the ergonomic stress of performing laparoscopy. Robotic surgical systems may address many of these limitations. To date, however, there have been no studies exploring the quantitative ergonomics of robotic surgery. In this study, we sought to compare the activation of bilateral biceps, triceps, deltoid, and trapezius muscle groups during traditional laparoscopic surgery (TLS) and robot-assisted laparoscopic surgery (RALS) procedures, as quantified by surface electromyography (sEMG). METHODS: One surgeon with expertise in TLS and RALS performed 18 operative procedures (13 TLS, 5 RALS) while sEMG measurements were obtained from bilateral biceps, triceps, deltoid, and trapezius muscles. sEMG measurements were normalized to the maximum voluntary contraction of each muscle (%MVC). We compared mean %MVC values for each muscle group during TLS and RALS with unpaired t-tests and considered differences with a p value <0.05 to be statistically significant. RESULTS: Muscle activation was higher during TLS compared to RALS in bilateral biceps (L Biceps RALS1.01%MVC, L Biceps TLS3.14, p = 0.01; R Biceps RALS1.81%MVC, R Biceps TLS4.53, p = 0.0002). Muscle activation was higher during TLS compared to RALS in bilateral triceps (L Triceps RALS1.73%MVC, L Triceps TLS3.58, p = 0.04; R Triceps RALS1.59%MVC, R Triceps TLS5.11, p = 0.02). Muscle activation was higher during TLS compared to RALS in bilateral deltoids (L Deltoid RALS1.50%MVC, L Deltoid TLS3.68, p = 0.03; R Deltoid RALS1.19%MVC, R Deltoid TLS2.57, p = 0.01). Significant differences were not detected in the bilateral trapezius muscles (L Trapezius RALS1.50 %MVC, L Trapezius TLS3.68, p = 0.03; R Trapezius RALS1.19%MVC, R Trapezius TLS2.57, p = 0.01). DISCUSSION: We have quantitatively examined the ergonomics of TLS and RALS and shown that in a single surgeon, TLS procedures are associated with significantly elevated biceps, triceps, and deltoid activation bilaterally when compared to RALS procedures.