Priscila R Armijo, MD, Chun-Kai Huang, PhD, Ka-Chun Siu, PhD, Dmitry Oleynikov, MD. University of Nebraska Medical Center
Introduction: The aim of this study was to determine how objectively-measured and self-reported muscle effort and fatigue of the upper-limb differ between laparoscopic (LAP) and robotic-assisted (RA) surgical approaches in the operating room.
Methods: Surgeons (fellows or attending physicians) performing either LAP or RA procedures at a single-institution were enrolled in this study. Objective muscle activation and self-reported fatigue were evaluated, and comparisons were made between approaches. Muscle activation of the upper trapezius, anterior deltoid, flexor carpi radialis, and extensor digitorum were recorded during the surgical procedure 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. Each surgeon also completed the validated Piper Fatigue Scale-12 (PFH-12) before and after the procedure for self-reported fatigue assessment. The PFS-12 has four subscales (behavior, affective, sensory, and cognitive), and a total 10-scale score, with 0 meaning no fatigue. Statistical analysis was done using SPSS v23.0, with α=0.05.
Results: 25 surgeries were recorded (LAP: N=18, RA: N=7). EMG analysis revealed that the RA group had a significant increase in mean muscle activation for the anterior deltoid (LAP: 2.44±1.81%, RA: 3.22±2.45%; p=0.018). Conversely, LAP required more effort for the extensor digitorum, represented by a significantly lower MDF compared to the RA group (LAP: 91.29±20.30Hz; RA: 102.57±14.25Hz, p=0.049). No significant differences were seen between approaches in upper trapezius and flexor carpi radialis activation. Survey analysis revealed no differences in self-reported fatigue before and after the surgery in LAP (preoperative: 2.60±1.49, postoperative: 2.91±1.11, p=0.322) and RA (preoperative: 2.33±1.47, postoperative: 2.77±1.25, p=0.132). There were also no significant differences between the two approaches, p=0.869. A significant increase in self-reported fatigue for the behavior subscale was seen after the surgery for both approaches (preoperatively: 2.17±1.27; postoperatively: 2.62±1.17, p=0.018).
Conclusions: Our analysis showed that different muscle groups are preferentially activated in the performance of LAP and RA. Performing robotic surgery utilizes more shoulder muscles whereas laparoscopic surgeries require increased forearm activation. However, no difference was observed in self-reported fatigue between the two groups. The difference in muscle activation between RA and LAP could be a driving force to shape the ergonomic design of the surgical tools and systems in the operating room. Our future studies will include the assessment of back and neck muscle activation to determine the impact of surgical approach on these muscle groups.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87004
Program Number: S107
Presentation Session: Diversity and Innovation Session
Presentation Type: Podium
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