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Which causes more ergonomic stress: Laparoscopic or open surgery?

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Abstract

Background

There is increasing awareness of potential ergonomic challenges experienced by the laparoscopic surgeon. The purpose of this study is to quantify and compare the ergonomic stress experienced by a surgeon while performing open versus laparoscopic portions of a procedure. We hypothesize that a surgeon will experience greater ergonomic stress when performing laparoscopic surgery.

Methods

We designed a study to measure upper-body muscle activation during the laparoscopic and open portions of sigmoid colectomies in a single surgeon. A sample of five cases was recorded over a two-month time span. Each case contained significant portions of laparoscopic and open surgery. We obtained whole-case electromyography (EMG) tracings from bilateral biceps, triceps, deltoid, and trapezius muscles. After normalization to a maximum voltage of contraction (%MVC), these EMG tracings were used to calculate average muscle activation during the open and laparoscopic segments of each procedure. Paired Student’s t test was used to compare the average muscle activation between the two groups (*p < 0.05 considered statistically significant).

Results

Significant reductions in mean muscle activation in laparoscopic compared to open procedures were noted for the left triceps (4.07 ± 0.44% open vs. 2.65 ± 0.54% lap, 35% reduction), left deltoid (2.43 ± 0.45% open vs. 1.32 ± 0.16% lap, 46% reduction), left trapezius (9.93 ± 0.1.95% open vs. 4.61 ± 0.67% lap, 54% reduction), right triceps (2.94 ± 0.62% open vs. 1.85 ± 0.28% lap, 37% reduction), and right trapezius (10.20 ± 2.12% open vs. 4.69 ± 1.18% lap, 54% reduction).

Conclusions

Contrary to our hypothesis, the laparoscopic approach provided ergonomic benefit in several upper-body muscle groups compared to the open approach. This may be due to the greater reach of laparoscopic instruments and camera in the lower abdomen/pelvis. Patient body habitus may also have less of an effect in the laparoscopic compared to open approach. Future studies with multiple subjects and different types of procedures are planned to further investigate these findings.

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Acknowledgements

This study was supported by a research grant from the Society of Gastrointestinal and Endoscopic Surgeons (SAGES). Dr. Zihni received research grant funding for unrelated studies from the National Institutes of Health. Dr. Awad has received research grant funding from the Society of Gastrointestinal and Endoscopic Surgeons (SAGES) and Intuitive, Surgical Inc. (Sunnyvale, CA).

Author contributions

RW, ZL, AMZ, SR, and MMA were involved in study conception and design; Wang, Liang, and Ray were involved in acquisition of data; RW, AMZ, ZL, and SR were involved in analysis and interpretation of data; RW, AMZ, and MMA drafted the manuscript; and RW, ZL, AMZ, SR, and MMA were involved in critical revision.

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Authors and Affiliations

  1. Department of Surgery, Section of Minimally Invasive Surgery, Washington University in St Louis, St Louis, MO, USA

    Robert Wang, Zhe Liang, Ahmed M. Zihni, Shuddhadeb Ray & Michael M. Awad

Authors
  1. Robert Wang
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  2. Zhe Liang
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  3. Ahmed M. Zihni
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  4. Shuddhadeb Ray
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  5. Michael M. Awad
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Corresponding author

Correspondence to Ahmed M. Zihni.

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Disclosures

Robert Wang, Zhe Liang, Ahmed M. Zihni, Shuddhadeb Ray and Michael M. Awad have no conflicts of interest or financial ties to disclose.

Additional information

Disclaimers This study was supported by research grants from the Society of Gastrointestinal and Endoscopic Surgeons (SAGES).

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Wang, R., Liang, Z., Zihni, A.M. et al. Which causes more ergonomic stress: Laparoscopic or open surgery?. Surg Endosc 31, 3286–3290 (2017). https://doi.org/10.1007/s00464-016-5360-5

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  • DOI: https://doi.org/10.1007/s00464-016-5360-5

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