title: Differential analysis of muscle fatigue induced elbow and wrist tremor in controlled laparoscopic manoeuvring.
abstract: BACKGROUND
  Fatigue induced hand tremor (FIT) is a primary limiting concern for the prolonged surgical intervention in minimally invasive surgery (MIS) and robot-assisted-minimally invasive surgery (RAMIS). A thorough analysis is necessary to understand the FIT characteristics in laparoscopic tool movement. The primary aim of this study is to perform a differential analysis of the elbow and wrist tremor due to muscle fatigue in laparoscopic manoeuvring.
  
  
  METHODS
  We have introduced a joint angle based tremor analysis method, which enables us to perform a differential study of FIT characteristics at the individual joint. Experimental data was acquired from a group of subjects during static and dynamic laparoscopic movement in an imitative RAMIS master manipulation scenario. A repetitive task was performed with a total span of 1 h for observing the effect of muscle fatigue. Along with the joint angle variation, surface electromyography (sEMG) signal was also studied in the analysis.
  
  
  RESULTS
  The wrist tremor is more predominant than tremor generated at the elbow, especially in highly fatigued condition. The high-frequency tremor (>4 Hz) is contributed by the wrist joint. Moreover, the variation of the wrist and elbow tremor ratio was found to be dependent upon the experience of the surgeons.
  
  
  CONCLUSIONS
  In this work, we have investigated the attribution of elbow and wrist joints in FIT during laparoscopic tool manipulation. The outcomes may be useful for the design of robot-assisted surgical manipulator, and can be used for quality assessment of surgical training as well.
authors.affiliation: Robotics Laboratory, Department of Engineering Design, Indian Institute of Technology Madras, Chennai, 600036, India.
authors.forename: Sourav
authors.initials: S
authors.lastname: Chandra
authors.affiliation: INRIA Sophia-Antipolis and LIRMM, University of Montpellier, 34095, Montpellier, Cedex 5, France.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Hayashibe
authors.affiliation: Robotics Laboratory, Department of Engineering Design, Indian Institute of Technology Madras, Chennai, 600036, India.
authors.forename: Asokan
authors.initials: A
authors.lastname: Thondiyath
authors.affiliation: PSG Institute of Medical Science and Research, Coimbatore, 641 004, India.
authors.forename: Manickam
authors.initials: M
authors.lastname: Ramalingam
mesh_terms: D061725:Accelerometry; D000328:Adult; D001696:Biomechanical Phenomena; D004551:Elbow Joint / Q000503:physiopathology; D004576:Electromyography; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D018763:Muscle Fatigue / Q000502:physiology*; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D013647:Task Performance and Analysis; D014202:Tremor / Q000209:etiology* / Q000503:physiopathology; D014955:Wrist Joint / Q000503:physiopathology
keywords: differential tremor analysis; fatigue induced tremor; laparoscopic tool manipulation; muscle fatigue; robot-assisted surgery; surgical accuracy