Ergonomic Analysis of Basic and Advanced Laparoscopic Procedures

Ahmed M Zihni, MD, MPH, Jaime A Cavallo, MD, MPHS, Ikechukwu Ohu, BS, Sohyung Cho, PhD, Michael M Awad, MD, PhD. Department of Surgery, Washington University School of Medicine; Department of Engineering, Southern Illinois University Edwardsville.

 INTRODUCTION: A majority of laparoscopic surgeons report chronic musculoskeletal complaints. These complaints are associated with high laparoscopic case volume. We seek to quantify the ergonomic challenges of laparoscopic surgery using surface EMG (sEMG). We compare the ergonomic stress associated with performing basic and advanced laparoscopic procedures, as defined by the ACGME. We hypothesize that a significantly higher degree of ergonomic stress, as quantified by sEMG data, will be associated with advanced laparoscopic cases when compared to basic laparoscopic cases.

METHODS: One right-hand-dominant surgeon performed 13 laparoscopic procedures (9 advanced, 4 basic) while sEMG data was collected from bilateral bicep, tricep, deltoid, and trapezius muscles for the duration of each case. Data was analyzed in 1-minute segments. Average muscle activation (%MVC) was calculated for each muscle group during each procedure. We compared mean %MVC values between basic and advanced laparoscopic cases using unpaired t-tests.

RESULTS: Mean activation of left bicep, tricep, and deltoid muscles, and right tricep and trapezius muscles are significantly elevated during advanced compared to basic laparoscopic procedures (see table).

CONCLUSIONS: sEMG quantified ergonomic differences between basic and advanced laparoscopic procedures. Statistically significant differences were noted in five of eight muscle groups during advanced laparoscopy. These findings suggest that advanced laparoscopic procedures are more ergonomically challenging. Surgeons who specialize in advanced laparoscopy may therefore face heightened ergonomic risks.

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