title: FLS tasks can be used as an ergonomic discriminator between laparoscopic and robotic surgery.
abstract: BACKGROUND
  Robotic surgery may result in ergonomic benefits to surgeons. In this pilot study, we utilize surface electromyography (sEMG) to describe a method for identifying ergonomic differences between laparoscopic and robotic platforms using validated Fundamentals of Laparoscopic Surgery (FLS) tasks. We hypothesize that FLS task performance on laparoscopic and robotic surgical platforms will produce significant differences in mean muscle activation, as quantified by sEMG.
  
  
  METHODS
  Six right-hand-dominant subjects with varying experience performed FLS peg transfer (PT), pattern cutting (PC), and intracorporeal suturing (IS) tasks on laparoscopic and robotic platforms. sEMG 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 of each subject. Subjects repeated each task three times per platform, and mean values used for pooled analysis. Average normalized muscle activation (%MVC) was calculated for each muscle group in all subjects 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
  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 compared to the robotic IS task. The mean activation of the right trapezius muscle was significantly elevated during robotic compared to the laparoscopic PT (1.6 %MVC lap, 3.5 %MVC robotic, p = 0.040) and PC (1.3 %MVC lap, 3.6 %MVC robotic, p = 0.0018) tasks.
  
  
  CONCLUSIONS
  FLS tasks are validated, readily available instruments that are feasible for use in demonstrating ergonomic differences between surgical platforms. In this study, we used FLS tasks to compare mean muscle activation of four muscle groups during laparoscopic and robotic task performance. FLS tasks can serve as the basis for larger studies to further describe ergonomic differences between laparoscopic and robotic surgery.
authors.affiliation: Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, St. Louis, MO, 63110, USA, zihnia@wudosis.wustl.edu.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Zihni
authors.forename: Ikechukwu
authors.initials: I
authors.lastname: Ohu
authors.forename: Jaime A
authors.initials: JA
authors.lastname: Cavallo
authors.forename: Jenny
authors.initials: J
authors.lastname: Ousley
authors.forename: Sohyung
authors.initials: S
authors.lastname: Cho
authors.forename: Michael M
authors.initials: MM
authors.lastname: Awad
mesh_terms: D000704:Analysis of Variance; D004576:Electromyography; D006804:Ergonomics; D006801:Humans; D010535:Laparoscopy; D009119:Muscle Contraction / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology*; D010865:Pilot Projects; D065287:Robotic Surgical Procedures; D034941:Upper Extremity / Q000502:physiology*