title: Ergonomic analysis of robot-assisted and traditional laparoscopic procedures.
abstract: BACKGROUND
  Many laparoscopic surgeons report musculoskeletal symptoms that are thought to be related to the ergonomic stress of performing laparoscopy. Robotic surgical systems may address many of these limitations. To date, however, there have been no studies exploring the quantitative ergonomics of robotic surgery. In this study, we sought to compare the activation of bilateral biceps, triceps, deltoid, and trapezius muscle groups during traditional laparoscopic surgery (TLS) and robot-assisted laparoscopic surgery (RALS) procedures, as quantified by surface electromyography (sEMG).
  
  
  METHODS
  One surgeon with expertise in TLS and RALS performed 18 operative procedures (13 TLS, 5 RALS) while sEMG measurements were obtained from bilateral biceps, triceps, deltoid, and trapezius muscles. sEMG measurements were normalized to the maximum voluntary contraction of each muscle (%MVC). We compared mean %MVC values for each muscle group during TLS and RALS with unpaired t-tests and considered differences with a p value <0.05 to be statistically significant.
  
  
  RESULTS
  Muscle activation was higher during TLS compared to RALS in bilateral biceps (L Biceps RALS:1.01%MVC, L Biceps TLS:3.14, p = 0.01; R Biceps RALS:1.81%MVC, R Biceps TLS:4.53, p = 0.0002). Muscle activation was higher during TLS compared to RALS in bilateral triceps (L Triceps RALS:1.73%MVC, L Triceps TLS:3.58, p = 0.04; R Triceps RALS:1.59%MVC, R Triceps TLS:5.11, p = 0.02). Muscle activation was higher during TLS compared to RALS in bilateral deltoids (L Deltoid RALS:1.50%MVC, L Deltoid TLS:3.68, p = 0.03; R Deltoid RALS:1.19%MVC, R Deltoid TLS:2.57, p = 0.01). Significant differences were not detected in the bilateral trapezius muscles (L Trapezius RALS:1.50 %MVC, L Trapezius TLS:3.68, p = 0.03; R Trapezius RALS:1.19%MVC, R Trapezius TLS:2.57, p = 0.01).
  
  
  CONCLUSIONS
  We have quantitatively examined the ergonomics of TLS and RALS and shown that in a single surgeon, TLS procedures are associated with significantly elevated biceps, triceps, and deltoid activation bilaterally when compared to RALS procedures.
authors.affiliation: Department of Surgery, Section of Minimally Invasive 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: Sohyung
authors.initials: S
authors.lastname: Cho
authors.forename: Michael M
authors.initials: MM
authors.lastname: Awad
mesh_terms: D001132:Arm / Q000502:physiology*; D004576:Electromyography; D006804:Ergonomics; D006801:Humans; D010535:Laparoscopy; D018482:Muscle, Skeletal / Q000502:physiology*; D012371:Robotics