title: A comparison of the physical effort required for laparoscopic and open surgical techniques.
abstract: OBJECTIVE
  Performing complex tasks requires greater muscle effort with laparoscopic instruments than with open surgical instruments.
  
  
  METHODS
  A nonrandomized 2-condition trial.
  
  
  METHODS
  A semienclosed ergonomics station in the exhibit hall at the Annual Meeting of the Society of American Gastrointestinal Endoscopic Surgeons.
  
  
  METHODS
  Twenty-one surgeons volunteered to participate in the study.
  
  
  METHODS
  Knot tying during 90 seconds, performed first using a laparoscopic technique (ie, axial instruments in a standard laparoscopic trainer) and then using an open technique (ie, 2 hemostats).
  
  
  METHODS
  Mean and peak surface electromyographic (EMG) signals collected from the thenar compartment, the flexor digitorum superficialis, and the deltoid muscles of the dominant arm.
  
  
  RESULTS
  Compared with open knot-tying, laparoscopic tasks resulted in higher average EMG amplitudes in all 3 muscles (thumb, P =.02; forearm flexor, P =.01; and deltoid, P =.01) and higher peak EMG in the thumb (P =.04) and deltoid (P =.02) muscles. Body part discomfort scores were significantly higher during laparoscopic knot-tying for the forearm flexor and deltoid muscles (P =.02 for both).
  
  
  CONCLUSIONS
  Complex manipulative tasks using laparoscopic techniques require substantially higher upper-extremity muscle effort compared with open surgical techniques.
authors.affiliation: Department of Surgery, University of California, Davis, School of Medicine and the Veterans Affairs Northern California Health Care System, Martinez, 94553, USA. rberguer@yahoo.com
authors.forename: Ramon
authors.initials: R
authors.lastname: Berguer
authors.forename: Jerry
authors.initials: J
authors.lastname: Chen
authors.forename: Warren D
authors.initials: WD
authors.lastname: Smith
mesh_terms: D000328:Adult; D004576:Electromyography; D004867:Equipment Design; D006804:Ergonomics; D005260:Female; D013502:General Surgery / Q000379:methods*; D006801:Humans; D020706:Laparoscopes; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology*; D005082:Physical Exertion / Q000502:physiology; D013525:Surgical Instruments; D013536:Suture Techniques / Q000295:instrumentation*