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Muscle activation during traditional laparoscopic surgery compared with robot-assisted laparoscopic surgery: a meta-analysis

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Abstract

Background

The repetitive and forceful motions used by operating surgeons increase the risk of developing musculoskeletal disorders. Most ergonomists consider the surgical environment to be incredibly harsh for its workers. Traditional Laparoscopic Surgery (TLS) in particular has a number of physical and mental challenges associated with it, and while Robotic-Assisted Laparoscopic Surgery (RALS) provides several features that improve upon TLS, some surgeons have still reported musculoskeletal symptoms they attribute to RALS. In this paper, we endeavored to systematically review muscle activation for both TLS and RALS, to compare the modalities and present the results as a meta-analysis.

Methods

A literature search was conducted using Pubmed, Embase, and Cochrane databases in November 2018 with the following inclusion criteria: full text was available in English, the paper contained original data, EMG was one of the primary measurement techniques, and the paper included EMG data for both TLS and RALS. Results from studies were compared using standardized mean difference analysis.

Results

A total of 379 papers were found, and through screening ten were selected for inclusion. Sample populations ranged from 1 to 31 surgeons, and a variety of study designs and metrics were used between studies. The biceps were the only muscle group that consistently and significantly demonstrated lower muscle activation for RALS for all included studies.

Conclusions

The results may support the belief that RALS is ergonomically superior to TLS, shown through generally lower muscle activation scores. However, these results must be interpreted with caution due to the heterogeneity between the studies and multiple potential sources for bias within studies. This analysis would be strengthened with a higher number of homogenous, high-quality studies examining larger sample sizes.

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Author information

Authors and Affiliations

  1. Department of Mechanical Engineering and Product Design Engineering, Swinburne University of Technology, Melbourne, Australia

    Jaime Hislop & Mats Isaksson

  2. School of Health Sciences, Swinburne University of Technology, Melbourne, Australia

    Oren Tirosh

  3. Centre for Transformative Media Technologies, Swinburne University of Technology, Melbourne, Australia

    John McCormick

  4. School of Software and Electrical Engineering, Swinburne University of Technology, Melbourne, Australia

    Romesh Nagarajah

  5. FRACS, CLAM Conjoint Senior lecturer Monash University Department of Surgery and University of Adelaide, University of Adelaide, LapSurgery Australia, Melbourne, Australia

    Chris Hensman

Authors
  1. Jaime Hislop
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  2. Oren Tirosh
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  5. Chris Hensman
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  6. Mats Isaksson
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Corresponding author

Correspondence to Jaime Hislop.

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Disclosures

J Hislop has received Grant funding from Mulgrave Private Hospital and Healthe Care during the course of this study. Dr. Isaksson reports grants from IR Robotics Pty Ltd, for unrelated studies. Authors Dr. Tirosh, Dr. McCormick, Prof. Nagarajah, and Mr. Hensman have no conflicts of interest or financial ties to disclose.

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Hislop, J., Tirosh, O., McCormick, J. et al. Muscle activation during traditional laparoscopic surgery compared with robot-assisted laparoscopic surgery: a meta-analysis. Surg Endosc 34, 31–38 (2020). https://doi.org/10.1007/s00464-019-07161-7

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  • DOI: https://doi.org/10.1007/s00464-019-07161-7

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