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
Article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Surgeon Minimally invasive surgery Laparoscopy Ergonomics Electromyography Neck pain 

Notes

Acknowledgments

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.

Disclosures

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.

References

  1. 1.
    Wauben LSGL, van Veelen MA, Gossot D, Goossens RHM (2006) Application of ergonomic guidelines during minimally invasive surgery: a questionnaire survey of 284 surgeons. Surg Endosc 20:1268–1274CrossRefPubMedGoogle Scholar
  2. 2.
    Liberman AS, Shrier I, Gordon PH (2005) Injuries sustained by colorectal surgeons performing colonoscopy. Surg Endosc 19:1606–1609CrossRefPubMedGoogle Scholar
  3. 3.
    Szeto GPY, Ho P, Ting ACW, Poon JTC, Cheng SWK, Tsang RCC (2009) Work-related musculoskeletal symptoms in surgeons. J Occup Rehabil 19:175–184CrossRefPubMedGoogle Scholar
  4. 4.
    van Det MJ, Meijerink WJHJ, Hoff C, Totte ER, Pierie JPEN (2009) Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines. Surg Endosc 23:1279–1285CrossRefPubMedGoogle Scholar
  5. 5.
    Berguer R, Gerber S, Kilpatrick G, Beckley D (1998) An ergonomic comparison of in-line vs pistol-grip handle configuration in a laparoscopic grasper. Surg Endosc 12:805–808CrossRefPubMedGoogle Scholar
  6. 6.
    Matern U, Kuttler G, Giebmeyer C, Waller P, Faist M (2004) Ergonomics aspects of five different types of laparoscopic instrument handles under dynamic conditions with respect to specific laparoscopic tasks: an electromyographic-based study. Surg Endosc 18:1231–1241CrossRefPubMedGoogle Scholar
  7. 7.
    Berguer R, Rab GT, Abu-Ghaida H, Alarcon A, Chung JA (1997) A comparison of surgeons’ posture during laparoscopic and open surgical procedures. Surg Endosc 11:139–142CrossRefPubMedGoogle Scholar
  8. 8.
    Matern U, Faist M, Kehl K, Giebmeyer C, Buess G (2005) Monitor position in laparoscopic surgery. Surg Endosc 19:436–440CrossRefPubMedGoogle Scholar
  9. 9.
    Berguer R, Smith WD, Davis S (2002) An ergonomic study of the optimum operating table height for laparoscopic surgery. Surg Endosc 16:416–421CrossRefGoogle Scholar
  10. 10.
    Manasnayakorn S, Cuschieri A, Hanna GB (2009) Ergonomic assessment of optimum operating table height for hand-assisted laparoscopic surgery. Surg Endosc 23:783–789CrossRefPubMedGoogle Scholar
  11. 11.
    van Veelen MA, Kazemier G, Koopman J, Goossens RH, Meijer DW (2002) Assessment of the ergonomically optimal operating surface height for laparoscopic surgery. J Laparoendosc Adv Surg Tech 12:47–52CrossRefGoogle Scholar
  12. 12.
    Albayrak A, van Veelen MA, Prins JF, Snijders CJ, de Ridder H, Kazemier G (2007) A newly designed ergonomic body support for surgeons. Surg Endosc 21:1835–1840CrossRefPubMedGoogle Scholar
  13. 13.
    Nguyen NT, Ho HS, Smith WD, Phillips C, Lewis C, De Vera RM, Berguer R (2001) An ergonomic evaluation of surgeons’ axial and upper extremity movements during laparoscopic and open surgery. Am J Surg 182:720–724CrossRefPubMedGoogle Scholar
  14. 14.
    Patil PV, Hanna GB, Frank TG, Cuschieri A (2005) Effect of fixation of shoulder and elbow joint movement on the precision of laparoscopic instrument manipulations. Surg Endosc 19:366–368CrossRefPubMedGoogle Scholar
  15. 15.
    Uhrich ML, Underwood RA, Standeven JW, Soper NJ, Engsberg JR (2002) Assessment of fatigue, monitor placement, and surgical experience during simulated laparoscopic surgery. Surg Endosc 16:635–639CrossRefPubMedGoogle Scholar
  16. 16.
    Szeto GPY, Straker LM, O’Sullivan PB (2005) A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work—1. Neck and shoulder muscle recruitment patterns. Man Ther 10:270–280CrossRefPubMedGoogle Scholar
  17. 17.
    Hägg GM, Astrom A (1997) Load pattern and pressure pain threshold in the upper trapezius muscle and psychosocial factors in medical secretaries with and without shoulder/neck disorders. Int Arch Occup Environ Health 69:423–432CrossRefPubMedGoogle Scholar
  18. 18.
    Madeleine P, Lundager B, Voigt M, Arendt-Nielsen L (1999) Shoulder muscle co-ordination during chronic and acute experimental neck-shoulder pain. Eur J Appl Physiol 79:127–140CrossRefGoogle Scholar
  19. 19.
    Falla D, Bilenkij G, Jull G (2004) Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task. Spine 29:1436–1440CrossRefPubMedGoogle Scholar
  20. 20.
    Cram JR, Kasman GS, Holtz J (1998) Introduction to surface electromyography, 1st edn. Aspen Publisher Incorporation, Gaithersburg, pp 15–20Google Scholar
  21. 21.
    Hermen HJ, Freriks B, Merletti R et al (1999) European recommendations for surface electromyography: results of the SENIAM project, 2nd edn. Roessingh Research and Development, The Netherlands, pp 101–110Google Scholar
  22. 22.
    Kuorinka I, Jonsson B, Kilbom Å, Vinterberg H, Biering-Sörenson F, Andersson A, Jorgensen K (1987) Standardised Nordic Questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 18(3):233–237CrossRefPubMedGoogle Scholar
  23. 23.
    Jonsson B (1982) Measurement and evaluation of local muscular strain in the shoulder during constrained work. J Hum Ergol 11:73–88CrossRefGoogle Scholar
  24. 24.
    Berguer R, Forkey DL, Smoth WD (1999) Ergonomic problems associated with laparoscopic surgery. Surg Endosc 13:466–468CrossRefPubMedGoogle Scholar
  25. 25.
    Quick NE, Gillete JC, Shapiro R, Adrales GL, Gerlach D, Park AE (2003) The effect of using laparoscopic instruments on muscle activation patterns during minimally invasive surgical training procedures. Surg Endosc 17:462–465CrossRefPubMedGoogle Scholar
  26. 26.
    Sandsjo L, Melin B, Rissen D, Dohns L, Lundberg U (2000) Trapezius muscle activity, neck and shoulder pain, and subjective experiences during monotonous work in women. Eur J Appl Physiol 83:235–238CrossRefPubMedGoogle Scholar
  27. 27.
    Westgaard RH, Vasseljen O, Holte KA (2001) Trapezius muscle activity as a risk indicator for shoulder and neck pain in female service workers with low biomechanical exposure. Ergonomics 44:339–353CrossRefPubMedGoogle Scholar
  28. 28.
    Szeto GPY, Straker LM, O’Sullivan PB (2009) Examining the low, high and range measures of muscle activity amplitudes in symptomatic and asymptomatic computer users performing typing and mousing tasks. Eur J Appl Physiol 106:243–251CrossRefPubMedGoogle Scholar
  29. 29.
    Madeleine P, Mathiassen SE, Arendt-Nielsen L (2008) Changes in the degree of motor variability associated with experimental and chronic neck-shoulder pain during a standardized repetitive arm movement. Exp Brain Res 185:689–698CrossRefPubMedGoogle Scholar
  30. 30.
    Hansson GA, Stromberg U, Larsson B, Ohlsson K, Balogh I, Moritz U (1992) Electromyographic fatigue in neck/shoulder muscles and endurance in women with repetitive work. Ergonomics 35:1341–1352CrossRefPubMedGoogle Scholar

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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