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Objective analysis of surgeons’ ergonomy during laparoendoscopic single-site surgery through the use of surface electromyography and a motion capture data glove

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Abstract

Background

Adding to the ergonomic inconveniences already presented by traditional laparoscopy (LAP), laparoendoscopic single-site (LESS) surgery has been found to entail other more specific problems, including greater reduction in movement freedom, in-line vision with loss of triangulation, and greater proximity of instruments. The objective of this study was to evaluate surgeons’ ergonomy during LESS surgery, through the study of muscular activity, wrist angle, and hand movements, and compare it with conventional laparoscopy.

Methods

The study group was composed by 14 experienced laparoscopic surgeons, all right-handed. Each one performed dissection tasks on a physical simulator through LAP and LESS approaches. For LAP, straight laparoscopic scissors and dissector were used, whilst for LESS articulating tip scissors and dissector were chosen. During both tasks, muscular activity of biceps brachii, triceps brachii, forearm flexors and extensors, and trapezius muscles was registered through surface electromyography. Simultaneously right-hand movements and wrist angles were obtained through a motion capture data glove (CyberGlove®), which allowed for the use of a modified RULA test applied to the recorded angles with subsequent establishment of risk levels for the wrist joint.

Results

Muscular activity for trapezius (LAP 6.94 ± 4.12 vs. LESS 11.32 ± 4.68; p ≤ 0.05) and forearm extensor muscles (LAP 9.2 ± 2.45 vs. LESS 37.07 ≤ 16.05; p ≤ 0.001) was significantly lower in conventional laparoscopy compared with LESS approach. No statistical significance was obtained between the different sensors, except in 3 of the 11 analyzed CyberGlove® sensors. The modified RULA test showed a score of 3 for laparoscopy (unacceptable), whereas for LESS a score of 2 was obtained (acceptable), with statistically significant differences between them (p ≤ 0.05).

Conclusions

The LESS approach entails greater level of muscular activity in the trapezius and forearm extensor muscles, but we have found evidences of a better wrist position during LESS compared with traditional laparoscopy.

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Acknowledgments

The authors are especially grateful to MISCJUs personnel for their technical assistance. This work has been partially funded by project PI12/01467 granted by the Institute of Health Carlos III-FIS of Spain.

Disclosures

Drs. F. J. Pérez-Duarte, M. Lucas-Hernández, A. Matos-Azevedo, J. A. Sánchez-Margallo, I. Díaz-Güemes, and F. M. Sánchez-Margallo have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Laparoscopy Unit, Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521 Km 41.8, 10071, Cáceres, Spain

    F. J. Pérez-Duarte, A. Matos-Azevedo & I. Díaz-Güemes

  2. Bioengineering and Health Technology Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain

    M. Lucas-Hernández & J. A. Sánchez-Margallo

  3. Scientific Direction, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain

    F. M. Sánchez-Margallo

Authors
  1. F. J. Pérez-Duarte
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  2. M. Lucas-Hernández
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  3. A. Matos-Azevedo
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  4. J. A. Sánchez-Margallo
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  6. F. M. Sánchez-Margallo
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Correspondence to F. J. Pérez-Duarte.

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Pérez-Duarte, F.J., Lucas-Hernández, M., Matos-Azevedo, A. et al. Objective analysis of surgeons’ ergonomy during laparoendoscopic single-site surgery through the use of surface electromyography and a motion capture data glove. Surg Endosc 28, 1314–1320 (2014). https://doi.org/10.1007/s00464-013-3334-4

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  • DOI: https://doi.org/10.1007/s00464-013-3334-4

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