Traditional laparoscopic surgery (TLS) has increasingly been associated with physical muscle strain for the operating surgeon. Robot-assisted laparoscopic surgery (RALS) may offer improved ergonomics. Ergonomics for the surgeon on these two platforms can be compared using surface electromyography (sEMG) to measure muscle activation, and the National Aeronautics and Space Administration Task Load Index (NTLX) survey to assess workload subjectively.
Subjects were recruited and divided into groups according to level of expertise in traditional laparoscopic (TLS) and robot-assisted laparoscopic surgery (RALS): novice, traditional laparoscopic surgeons (TL surgeons), robot-assisted laparoscopic surgeons (RAL surgeons). Each subject performed three fundamentals of laparoscopic surgery (FLS) tasks in randomized order while sEMG data were obtained from bilateral biceps, triceps, deltoid, and trapezius muscles. After completing all tasks, subjects completed the NTLX survey. sEMG data normalized to the maximum voluntary contraction of each muscle (MVC%), and NTLX data were compared with unpaired t tests and considered significant with a p ≤ 0.05.
Muscle activation was higher during TLS compared to RALS in most muscle groups for novices except for the trapezius muscles. Muscle activation scores were also higher for TLS among the groups with more experience, but the differences were less significant. NTLX scores were higher for the TLS platform compared to the RALS platform for novices.
TLS is associated with higher muscle activation in all muscle groups except for trapezius muscles, suggesting greater strain on the surgeon. Increased trapezius muscle activation on RALS has previously been documented and is likely due to the position of the eye piece. The differences seen in muscle activation diminish with increasing levels of expertise. Experience likely mitigates the ergonomic disadvantage of TLS. NTLX survey data suggest there are subjective benefits to RALS, namely in the perception of temporal demand. Further research to correlate NTLX data and sEMG measurements, and to investigate whether these metrics affect patient outcomes is warranted.
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The authors thank Gyusung Lee, PhD of the American College of Surgeons (Chicago, IL) for his valuable advice. This study was supported by research grants from the Society of Gastrointestinal and Endoscopic Surgeons (SAGES) and Intuitive Surgical, Inc (Sunnyvale, CA).
Dr. Zihni 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) Dr. Ohu has received unrelated research grants from the American Heart Association. Dr. Zárate Rodriguez has no conflicts of interest or financial ties to disclose.
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Zárate Rodriguez, J.G., Zihni, A.M., Ohu, I. et al. Ergonomic analysis of laparoscopic and robotic surgical task performance at various experience levels. Surg Endosc 33, 1938–1943 (2019). https://doi.org/10.1007/s00464-018-6478-4
- Robot-assisted laparoscopic surgery
- Laparoscopic surgery