Priscila R Armijo, MD, Chun-Kai Huang, PhD, Gurteshwar Rana, MD, Dmitry Oleynikov, MD, Ka-Chun Siu, PhD. University of Nebraska Medical Center
Introduction: The aim of this study was to determine how objectively-measured and self-reported fatigue of the upper-limb differ between laparoscopic and robotic surgical training environments.
Methods: Surgeons at the 2016 SAGES Conference Learning Center, and at our institution were enrolled. Two surgical skills practical environments were utilized: 1) a laparoscopic training-box environment (FLS) and 2) the Mimic® dV-trainer (MIMIC). Two standardized surgical tasks were chosen for both environments: peg transfer, and needle passing. Each task was performed twice. Objective fatigue was evaluated by muscle activation and fatigue, and comparisons were made between FLS and MIMIC, for each surgical task. Muscle activation of the upper trapezius, anterior deltoid, flexor carpi radialis, and extensor digitorum were recorded during practice using surface electromyography (EMG; TrignoTM, Delsys, Inc., Boston, MA). The maximal voluntary contraction (MVC) was obtained to normalize muscle effort as %MVC. The median frequency (MDF) was calculated to assess muscle fatigue. Subjective fatigue was self-reported by completing the validated 10-scale score Piper Fatigue Scale-12 (PFH-12) before and after practice. Statistical analysis was done using SPSS v23.0, with α=0.05.
Results: This abstract represented the performance of 15 trainees (FLS: N=8, MIMIC: N=7) as part of larger cohort of the study. For peg transfer, EMG analysis revealed that MIMIC had a significant increase in mean muscle activation for the upper trapezius and anterior deltoid, both p<0.001. Conversely, practice with FLS led to significantly more muscle fatigue than MIMIC for the same muscle groups (upper trapezius: p=0.028, anterior deltoid: p=0.015), represented by a significantly lower MDF. Similarly, for needle passing, MIMIC had a significant increase in mean muscle activation for the upper trapezius (p=0.034) and anterior deltoid (p=0.031), but practice with FLS significantly induced more muscle fatigue effort for anterior deltoid (p=0.004). Survey analysis revealed a significant decrease in self-reported fatigue after performing FLS tasks (before:3.85±1.66, after:3.05±1.54, p=0.044), but no difference after MIMIC tasks (before:4.00±2.27, after:4.22±2.56, p=0.417).
Conclusions: Although different muscle groups are preferentially required in the performance of FLS and MIMIC, our analysis for both surgical tasks showed practice with MIMIC required more activation of shoulder muscles, whereas practice with FLS could lead more muscle fatigue for the same muscle groups. Interestingly, surgeons reported improved or no change in perceived fatigue after the tasks, despite of having an increase in muscular activation and effort. Subjective self-report fatigue might not truly reflect the level of fatigue when trainees practice surgical tasks using FLS or MIMIC.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87116
Program Number: P769
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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