Surgical Endoscopy

, Volume 24, Issue 7, pp 1712–1721 | Cite as

A study of surgeons’ postural muscle activity during open, laparoscopic, and endovascular surgery

  • G. P. Y. Szeto
  • P. Ho
  • A. C. W. Ting
  • J. T. C. Poon
  • R. C. C. Tsang
  • S. W. K. Cheng



Different surgical procedures impose different physical demands on surgeons and high prevalence rates of neck and shoulder pain have been reported among general surgeons. Past research has examined electromyography in surgeons mainly during simulated conditions of laparoscopic and open surgery but not during real-time operations and not for long durations. The present study compares the neck-shoulder muscle activities in three types of surgery and between different surgeons. The relationships of postural muscle activities to musculoskeletal symptoms and personal factors also are examined.


Twenty-five surgeons participated in the study (23 men). Surface electromyography (EMG) was recorded in the bilateral cervical erector spinae, upper trapezius, and anterior deltoid muscles during three types of surgical procedures: open, laparoscopic, and endovascular. In each procedure, EMG data were captured for 30 min to more than 1 h. The surgeons were asked to rate any musculoskeletal symptoms before and after surgery.


The present study showed significantly higher muscle activities in the cervical erector spinae and upper trapezius muscles in open surgery compared with endovascular and laparoscopic procedures. Muscle activities were fairly similar between endovascular and laparoscopic surgery. The upper trapezius usually has an important role in stabilizing both the neck and upper limb posture, and this muscle also recorded higher activities in open compared with laparoscopic and endovascular surgeries. Surgeons reported similar degrees of musculoskeletal symptoms in open and laparoscopic surgeries, which were higher than endovascular surgery.


The present study showed that open surgery imposed significantly greater physical demands on the neck muscles compared with endovascular and laparoscopic surgeries. This may be due to the lighter manual task demands of these minimally invasive surgeries compared with open procedures, which generally required more dynamic movements and more forceful exertions.


Surgeon Minimally invasive surgery Laparoscopy Ergonomics Electromyography Neck pain 



The authors express their sincere appreciation to the Bupa Foundation for funding this research project, and thank all of the surgeons who participated in the study. The authors thank the research assistants, Silvana Lau, Y. Y. Wong, Winnie Leung, and Ted Wong; without their help, this project would not be run so smoothly. The authors acknowledge Mr. Raymond Chung from the Hong Kong Polytechnic University for providing expert advice on statistical analysis, and Mr. Man Cheung for the technical advice on EMG data collection and analysis.


The current project has been funded by Bupa Foundation Medical Research Grants. G. P. Y. Szeto, P. Ho, A. C. W. Ting, J. T. C. Poon, R. C. C. Tsang, and S. W. K. Cheng have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • G. P. Y. Szeto
    • 1
  • P. Ho
    • 2
    • 3
  • A. C. W. Ting
    • 2
  • J. T. C. Poon
    • 2
  • R. C. C. Tsang
    • 4
  • S. W. K. Cheng
    • 2
  1. 1.Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityKowloonHong Kong, SAR China
  2. 2.Department of Surgery, University of Hong Kong Medical CentreQueen Mary HospitalPokfulamHong Kong, SAR China
  3. 3.Department of SurgeryNational University of Singapore, National University HospitalSingaporeSingapore
  4. 4.Department of PhysiotherapyQueen Mary HospitalPokfulamHong Kong, SAR China

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