Abstract
Introduction
Robotic surgery may result in ergonomic benefits to surgeons. In this pilot study, we utilize surface electromyography (sEMG) to describe a method for identifying ergonomic differences between laparoscopic and robotic platforms using validated Fundamentals of Laparoscopic Surgery (FLS) tasks. We hypothesize that FLS task performance on laparoscopic and robotic surgical platforms will produce significant differences in mean muscle activation, as quantified by sEMG.
Methods
Six right-hand-dominant subjects with varying experience performed FLS peg transfer (PT), pattern cutting (PC), and intracorporeal suturing (IS) tasks on laparoscopic and robotic platforms. sEMG measurements were obtained from each subject’s bilateral bicep, tricep, deltoid, and trapezius muscles. EMG measurements were normalized to the maximum voluntary contraction (MVC) of each muscle of each subject. Subjects repeated each task three times per platform, and mean values used for pooled analysis. Average normalized muscle activation (%MVC) was calculated for each muscle group in all subjects for each FLS task. We compared mean %MVC values with paired t tests and considered differences with a p value less than 0.05 to be statistically significant.
Results
Mean activation of right bicep (2.7 %MVC lap, 1.3 %MVC robotic, p = 0.019) and right deltoid muscles (2.4 %MVC lap, 1.0 %MVC robotic, p = 0.019) were significantly elevated during the laparoscopic compared to the robotic IS task. The mean activation of the right trapezius muscle was significantly elevated during robotic compared to the laparoscopic PT (1.6 %MVC lap, 3.5 %MVC robotic, p = 0.040) and PC (1.3 %MVC lap, 3.6 %MVC robotic, p = 0.0018) tasks.
Conclusions
FLS tasks are validated, readily available instruments that are feasible for use in demonstrating ergonomic differences between surgical platforms. In this study, we used FLS tasks to compare mean muscle activation of four muscle groups during laparoscopic and robotic task performance. FLS tasks can serve as the basis for larger studies to further describe ergonomic differences between laparoscopic and robotic surgery.
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Acknowledgments
The authors thank Gyusung Lee, PhD of the Department of Surgery at Johns Hopkins University (Baltimore, MD) for his valuable advice. This study was supported by a research grant from the Society of Gastrointestinal and Endoscopic Surgeons (SAGES), and also by a research grant from Intuitive Surgical, Inc. (Sunnyvale, CA).
Disclosures
Dr. Zihni has received research grant funding for unrelated studies from the National Institutes of Health. Dr. Cavallo has received research grant funding for unrelated studies from the National Institutes of Health, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), and the American Hernia Society in collaboration with Davol® Incorporated; and has served as a one-time consultant for Guidepoint Global® Incorporated. Dr. Cho has received research grant funding from the Society of Gastrointestinal and Endoscopic Surgeons (SAGES) and Intuitive, Surgical Inc. (Sunnyvale, CA). Dr. Awad has received research grant funding from the Society of Gastrointestinal and Endoscopic Surgeons (SAGES) and Intuitive, Surgical Inc. (Sunnyvale, CA). Mr. Ohu and Ms. Ousley have no conflicts of interest or financial ties to disclose.
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Zihni, A.M., Ohu, I., Cavallo, J.A. et al. FLS tasks can be used as an ergonomic discriminator between laparoscopic and robotic surgery. Surg Endosc 28, 2459–2465 (2014). https://doi.org/10.1007/s00464-014-3497-7
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DOI: https://doi.org/10.1007/s00464-014-3497-7