title: Comparison of fatigue accumulated during and after prolonged robotic and laparoscopic surgical methods: a cross-sectional study.
abstract: The aim of the present study was to analyse the fatigue experienced by surgeons during and after performing robotic and laparoscopic surgery and to analyse muscle function, self-perceived fatigue and postural balance.
  
  
  
  Cross-sectional study considering two surgical protocols (laparoscopic and robotic) with two different roles (chief and assistant surgeon). Fatigue was recorded in two ways: pre- and post-surgery using questionnaires [Profile of Mood States (POMS), Quick Questionnaire Piper Fatigue Scale and Visual Analogue Scale (VAS)-related fatigue] and parametrising functional tests [handgrip and single-leg balance test (SLBT)] and during the intervention by measuring the muscle activation of eight different muscles via surface electromyography and kinematic measurement (using inertial sensors). Each surgery profile intervention (robotic/laparoscopy-chief/assistant surgeon) was measured three times, totalling 12 measured surgery interventions. The minimal duration of surgery was 180 min.
  
  
  
  Pre- and post-surgery, all questionnaires showed that the magnitude of change was higher for the chief surgeon compared with the assistant surgeon, with differences of between 10 % POMS and 16.25 % VAS (robotic protocol) and between 3.1 % POMS and 12.5 % VAS (laparoscopic protocol). In the inter-profile comparison, the chief surgeon (robotic protocol) showed a lower balance capacity during the SLBT after surgery. During the intervention, the kinematic variables showed significant differences between the chief and assistant surgeon in the robotic protocol, but not in the laparoscopic protocol. Regarding muscle activation, there was not enough muscle activity to generate fatigue.
  
  
  
  Prolonged surgery increased fatigue in the surgeon; however, the magnitude of fatigue differed between surgical profiles. The surgeon who experienced the greatest fatigue was the chief surgeon in the robotic protocol.
authors.affiliation: Health Sciences Faculty, Department of Health Science, University of Jaén, Campus de las Lagunillas SN. Ed. B3 - Despacho 412, 23071, Jaén, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: González-Sánchez
authors.affiliation: Surgeon into Servicio de Cirugía General de Carlos Haya SAS (Sistema Andaluz de Salud), Malaga, Spain.
authors.forename: Ivan
authors.initials: I
authors.lastname: González-Poveda
authors.affiliation: Surgeon into Servicio de Cirugía General de Carlos Haya SAS (Sistema Andaluz de Salud), Malaga, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Mera-Velasco
authors.affiliation: Departamento de psiquiatria y fisioterapia, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Arquitecto Francisco Peñalosa s/n. (ampliación Campus Teatinos), 29071, Malaga, Spain. acuesta@uma.es.|School of Clinical Sciences, Queensland University, Brisbane, Australia. acuesta@uma.es.
authors.forename: Antonio I
authors.initials: AI
authors.lastname: Cuesta-Vargas
mesh_terms: D003430:Cross-Sectional Studies; D004576:Electromyography; D018737:Hand Strength; D006801:Humans; D010535:Laparoscopy; D018763:Muscle Fatigue; D061646:Operative Time; D065287:Robotic Surgical Procedures; D066231:Surgeons
keywords: Balance; Handgrip; Kinematic measurement; Profile of Mood States; Quick Questionnaire Piper Fatigue Scale; Surface EMG