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Publication date29/06/2022
<mark>Original language</mark>English
Event27th Congress of the European Society of Biomechanics - Alfandega Porto Congress Centre, Porto, Portugal
Duration: 26/06/202229/06/2022


Conference27th Congress of the European Society of Biomechanics
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Introduction Minimally invasive surgery offers excellent benefits to patients [1] and one of its modalities; Robotic-assisted laparoscopic surgery (RALS) is increasingly being adopted to perform more complex procedures [2]. One of the claimed benefits is reduced musculoskeletal stress, which is important as surgeons are amongst the most at risk profession of work-related musculoskeletal decline [3]; with a high prevalence of work-related pain [4-6], and musculoskeletal injuries [7], predominantly affecting the neck, arm, shoulder, and back. The study aimed to compare electromyogram (EMG) activity in four relevant muscle groups during live laparoscopic surgery (LS) and robot assisted laparoscopic surgery (RALS). Methods Muscle activation during surgery was measured using a wireless EMG device during 80 surgeries (45 RALS, 35 LS). Root mean square (RMS) EMG activity was obtained bilaterally from four muscle groups (biceps, deltoid, upper trapezius, and latissimus dorsi), normalised to a previously recorded maximum contraction. Recordings were obtained at three time points: non-critical dissection, critical vessel dissection, and dissection after vessel control. The percentage changes normalised to a Maximal Voluntary Contractions (%MVC) in the four muscles compared to baseline was used to determine musculoskeletal demand. Results There was greater muscle activation in the LS group except in the biceps muscle. This was significant in bilateral upper trapezius (P = 0.006 & P = 0.001) and bilateral latissimus dorsi (P = 0.09 & P = 0.0009) across all 3 time points. Only the left deltoid (P = 0.026), had higher activation in LS when surgeons performed dissection around critical blood vessels and post vessel-control dissection. In both RALS (P = 0.08) and LS (P = 0.001), comparative muscle activation was significantly greater in the right biceps. Similar greater activation in the right deltoid and right upper trapezius was observed in both groups. Figure 1: RMS EMG data of muscle activation of the left (Panel A) and right (Panel B) upper trapezius between robotic (filled bars) versus laparoscopic (empty bars) surgery. Discussion The differences found bilaterally for LS are reflective of the different tasks the arms are performing during a surgery with one arm needed to ‘hold’ while the other is needed to ‘perform’ (e.g., dissect tissue planes, make incisions etc). This increased level of muscle activation could predispose to injury, suggesting that robotic surgery might be more beneficial for surgeons’ long-term health. The lower muscle activation seen in RALS could assist in reducing muscular strain during surgeries and thus contributing to reducing the risk of work-related musculoskeletal injuries in surgeons. This finding offers some mechanism to a recent meta-analysis suggesting that robotic surgery is ergonomically superior to laparoscopic surgery [8]. References 1. Patankar et al, Diseases of the colon & rectum, 46(5):601-611, 2003. 2. Schreuder et al, BJOG: An International Journal of Obstetrics & Gynaecology, 119(2):137-149, 2012. 3. Money et al, Estimation from THOR surveillance data, 2019. 4. Adams et al, Journal of minimally invasive gynecology, 20(5):656-660, 2013. 5. Dalager et al, Journal of surgical research, 240:30-39, 2019. 6. Stucky et al, Annals of Medicine and Surgery, 27:1-8, 2018. 7. Epstein et al, JAMA surgery, 153(2):e174947-e174947, 2018. 8. Hislop et al, Surgical endoscopy, 34(1): p. 31-38, 2020. Acknowledgements This work was supported by a Clinical Research Grant from the Intuitive Foundation (grant number A105089). This funding source had no role in the design of this study, its execution, analyses, interpretation of the data, or decision to submit results.