Fls Tasks Can Be Used to Identify Ergonomic Differences Between Laparoscopic and Robotic Surgery

Ahmed M Zihni, MD, MPH, Ikechukwu Ohu, MS, Jaime A Cavallo, MD, MPHS, Jenny Ousley, BS, Sohyung Cho, PhD, Michael M Awad, MD, PhD

Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, Missouri; Department of Industrial and Manufacturing Engineering, Southern Illinois University Edwardsville; Edwardsville, IL

INTRODUCTION: It has been well documented that surgeons suffer significant ergonomic stress when performing laparoscopic procedures. Robotic surgery holds the promise for ergonomic improvements to the field of minimally invasive surgery. This advantage can potentially be quantified using surface EMG. In this pilot study, we describe a method for identifying ergonomic differences between laparoscopic and robotic surgical platforms in a dry-lab setting using validated Fundamentals of Laparoscopic Surgery (FLS) tasks. We hypothesize that performing FLS tasks on laparoscopic and robotic surgical platforms will produce statistically significant differences in mean muscle activation, as quantified by surface EMG.

METHODS: Six subjects with varying levels of surgical experience performed FLS peg transfer (PT), pattern cutting (PC), and intracorporeal suturing (IS) tasks on laparoscopic and robotic platforms. Surface EMG measurements were obtained from each subject’s bilateral bicep, tricep, deltoid, and trapezius muscles. EMG measurements were normalized to the maximum voluntary contraction (MVC) of each muscle group. Average normalized muscle activation (%MVC) was calculated for each muscle group on both surgical platforms for each FLS task. We compared mean %MVC values with paired t-tests and considered differences with a p-value less than 0.05 to be statistically significant.

RESULTS: In our pilot, mean activation of right bicep (2.7%MVC lap, 1.3%MVC robotic, p=0.019) and right deltoid muscles (2.4%MVC lap, 1.0%MVC robotic, p=0.019) were significantly elevated during the laparoscopic IS task, when compared to robotic IS. Mean activation of the right trapezius muscle was significantly elevated during robotic PT (1.6%MVC lap, 3.5%MVC robotic, p=0.040) and robotic PC (1.3%MVC lap, 3.6%MVC robotic, p=0.0018) tasks when compared to laparoscopic. On the robotic platform, no significant difference in %MVC was seen within any muscle group when comparing the %MVC generated by that muscle group while performing the three different tasks. On the laparoscopic platform, a significant difference in %MVC was seen in the right trapezius muscle group when comparing the three tasks (PT: 1.6%MVC, PC: 1.3%MVC, IS: 3.7% MVC, F-stat 4.171, Sig 0.036). No other significant differences were seen.

CONCLUSIONS: The use of FLS tasks is a validated, readily available, standardized instrument that is feasible for use in demonstrating ergonomic differences between laparoscopic and robotic surgical platforms. In our pilot study, we used FLS tasks to identify statistically significant differences in mean muscle activation of various muscle groups when performing laparoscopic and robotic surgical tasks. The use of FLS tasks can serve as the basis for larger studies to further detail ergonomic differences between laparoscopic and robotic surgery.

Session: Poster Presentation

Program Number: P382