Abstract
Background
Our aim was to determine how objectively-measured and self-reported muscle effort and fatigue of the upper-limb differ between surgeons performing laparoscopic (LAP) and robotic-assisted (ROBOT) surgeries.
Methods
Surgeons performing LAP or ROBOT procedures at a single-institution were enrolled. Objective muscle activation and self-reported fatigue were evaluated, and comparisons were made between approaches. Muscle activation of the upper trapezius (UT), anterior deltoid (AD), flexor carpi radialis (FCR), and extensor digitorum (ED) were recorded during the surgical procedure using Trigno wireless surface electromyography (EMG). The maximal voluntary contraction (MVC) was obtained to normalize root-mean-square muscle activation as %MVCRMS. The median frequency (MDF) was calculated to assess muscle fatigue. Each surgeon also completed the validated Piper Fatigue Scale-12 (PFH-12) before and after the procedure for self-perceived fatigue assessment. Statistical analysis was done using SAS/STAT software, with α = 0.05.
Results
28 surgeries were recorded (LAP: N = 18, ROBOT: N = 10). EMG analysis revealed the ROBOT group had a higher muscle activation than LAP for UT (37.7 vs. 25.5, p = 0.003), AD (8.9 vs. 6.3, p = 0.027), and FCR (14.4 vs. 10.9, p = 0.019). Conversely, LAP required more effort for the ED, represented by a significantly lower MDF compared to the ROBOT group (91.2 ± 1.5 Hz vs. 102.8 ± 1.5 Hz, p < 0.001). Survey analysis revealed no differences in self-reported fatigue before and after the surgery between approaches, p = 0.869.
Conclusions
Our analysis revealed surgeons show similar fatigue levels performing the first case of the day using either robotic or LAP surgery. Surgeons performing LAP surgery had more fatigue in the forearm, robotic surgery required more shoulder and neck use, but neither was superior. Neither technique produced significant overall fatigue on survey. Long-term selective use of these different muscles could be correlated with different patterns of injury. Future studies are needed to fully understand long-term implications of prolonged surgery on occupational injury.
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References
Berguer R, Forkey D, Smith W (1999) Ergonomic problems associated with laparoscopic surgery. Surg Endosc 13(5):466–468
Wang R, Liang Z, Zihni AM, Ray S, Awad MM (2017) Which causes more ergonomic stress: laparoscopic or open surgery? Surg Endosc 31(8):3286–3290
Peters BS, Armijo PR, Krause C, Choudhury SA, Oleynikov D (2018) Review of emerging surgical robotic technology. Surg Endosc 32(4):1636–1655
Capone AC, Parikh PM, Gatti ME, Davidson BJ, Davison SP (2010) Occupational injury in plastic surgeons. Plast Reconstr Surg 125(5):1555–1561
Zihni AM, Ohu I, Cavallo JA, Cho S, Awad MM (2014) Ergonomic analysis of robot-assisted and traditional laparoscopic procedures. Surg Endosc 28(12):3379–3384
Janki S, Mulder EE, IJzermans JN, Tran TK (2017) Ergonomics in the operating room. Surg Endosc 31(6):2457–2466
Armijo PR, Pagkratis S, Boilesen E, Tanner T, Oleynikov D (2018) Growth in robotic-assisted procedures is from conversion of laparoscopic procedures and not from open surgeons’ conversion: a study of trends and costs. Surg Endosc 32(4):2106–2113
van der Schatte Olivier RH, Van’t Hullenaar CD, Ruurda JP, Broeders IA (2009) Ergonomics, user comfort, and performance in standard and robot-assisted laparoscopic surgery. Surg Endosc 23(6):1365–1371
Kant IJ, de Jong LC, van Rijssen-Moll M, Borm PJ (1992) A survey of static and dynamic work postures of operating room staff. Int Arch Occup Environ Health 63(6):423–428
Lux MM, Marshall M, Erturk E, Joseph JV (2010) Ergonomic evaluation and guidelines for use of the daVinci robot system. J Endourol 24(3):371–375
Judkins TN, Oleynikov D, Narazaki K, Stergiou N (2006) Robotic surgery and training: electromyographic correlates of robotic laparoscopic training. Surg Endosc Other Interv Tech 20(5):824–829
Sánchez A, Rodríguez O, Jara G et al (2018) Robot-assisted surgery and incisional hernia: a comparative study of ergonomics in a training model. J Rob Surg. https://doi.org/10.1007/s11701-017-0777-y
Huang CK, Boman A, White A, Oleynikov D, Siu KC (2016) Effects of hand dominance and postural selection on muscle activities of virtual laparoscopic surgical training tasks. Stud Health Technol Inf 220:142–145
Reeve BB, Stover AM, Alfano CM et al (2012) The piper fatigue scale-12 (PFS-12): Psychometric findings and item reduction in a cohort of breast cancer survivors. Breast Cancer Res Treat 136(1):9–20
Park A, Lee G, Seagull FJ, Meenaghan N, Dexter D (2010) Patients benefit while surgeons suffer: an impending epidemic. J Am Coll Surg 210(3):306–313
Lee G, Lee M, Green I, Allaf M, Marohn M (2017) Surgeons’ physical discomfort and symptoms during robotic surgery: a comprehensive ergonomic survey study. Surg Endosc 31(4):1697–1706
González-Sánchez M, González-Poveda I, Mera-Velasco S, Cuesta-Vargas AI (2017) Comparison of fatigue accumulated during and after prolonged robotic and laparoscopic surgical methods: a cross-sectional study. Surg Endosc 31(3):1119–1135
Ehlers L, Suh IH, LaGrange C, Oleynikov D, Siu KC (2013) Examination of muscle effort and fatigue during virtual and actual laparoscopic surgical skills practice. Stud Health Technol Inf 184:122–128
Suh IH, Mukherjee M, Schrack R et al (2011) Electromyographic correlates of learning during robotic surgical training in virtual reality. Stud Health Technol Inf 163:630–634
Judkins TN, Oleynikov D, Stergiou N (2009) Objective evaluation of expert and novice performance during robotic surgical training tasks. Surg Endosc 23(3):590
Huang CK, Suh IH, Chien JH, Vallabhajosula S, Oleynikov D, Siu KC (2012) Investigating the muscle activities of performing surgical training tasks using a virtual simulator. Stud Health Technol Inf 173:200–204
Lee GI, Lee MR, Clanton T, Sutton E, Park AE, Marohn MR (2014) Comparative assessment of physical and cognitive ergonomics associated with robotic and traditional laparoscopic surgeries. Surg Endosc 28(2):456–465
Sanchez-Margallo FM, Sanchez-Margallo JA (2018) Assessment of postural ergonomics and surgical performance in laparoendoscopic single-site surgery using a handheld robotic device. Surg Innov. https://doi.org/10.1177/1553350618759768
Aitchison LP, Cui CK, Arnold A, Nesbitt-Hawes E, Abbott J (2016) The ergonomics of laparoscopic surgery: a quantitative study of the time and motion of laparoscopic surgeons in live surgical environments. Surg Endosc 30(11):5068–5076
Lawson EH, Curet MJ, Sanchez BR, Schuster R, Berguer R (2007) Postural ergonomics during robotic and laparoscopic gastric bypass surgery: a pilot project. J Rob Surg 1(1):61–67
Sánchez-Margallo FM, Sánchez-Margallo JA (2017) Ergonomics in laparoscopic surgery. Laparosc Surg. https://doi.org/10.5772/66170
Sánchez-Margallo FM, Sánchez-Margallo JA, Pagador JB, Moyano JL, Moreno J, Usón J (2010) Ergonomic assessment of hand movements in laparoscopic surgery using the CyberGlove®. In: Miller K, Nielsen P (eds) Computational biomechanics for medicine. Springer, New York, pp. 121–128
Park AE, Zahiri HR, Hallbeck MS et al (2017) Intraoperative “micro breaks” with targeted stretching enhance surgeon physical function and mental focus: a multicenter cohort study. Ann Surg 265(2):340–346
Occhino JA (2018) Ergonomics in robotic surgery—clinical trials. https://clinicaltrials.gov/ct2/show/NCT03096769?term=ergonomics+in+robotic+surgery&rank=1. Accessed March 2018
Funding
Funding for this study was provided by the SAGES Robotic Surgery Research Grant and Center for Advanced Surgical Technology at the University of Nebraska Medical Center.
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Dmitry Oleynikov is the shareholder of Virtual Incision Corporation. Priscila Rodrigues Armijo, Chun-Kai Huang, Robin High, Melissa Leon and Ka-Chun Siu have no conflicts of interest or financial ties to disclose.
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Armijo, P.R., Huang, CK., High, R. et al. Ergonomics of minimally invasive surgery: an analysis of muscle effort and fatigue in the operating room between laparoscopic and robotic surgery. Surg Endosc 33, 2323–2331 (2019). https://doi.org/10.1007/s00464-018-6515-3
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DOI: https://doi.org/10.1007/s00464-018-6515-3