title: Which causes more ergonomic stress: Laparoscopic or open surgery?
abstract: There is increasing awareness of potential ergonomic challenges experienced by the laparoscopic surgeon. The purpose of this study is to quantify and compare the ergonomic stress experienced by a surgeon while performing open versus laparoscopic portions of a procedure. We hypothesize that a surgeon will experience greater ergonomic stress when performing laparoscopic surgery.
  
  
  
  We designed a study to measure upper-body muscle activation during the laparoscopic and open portions of sigmoid colectomies in a single surgeon. A sample of five cases was recorded over a two-month time span. Each case contained significant portions of laparoscopic and open surgery. We obtained whole-case electromyography (EMG) tracings from bilateral biceps, triceps, deltoid, and trapezius muscles. After normalization to a maximum voltage of contraction (%MVC), these EMG tracings were used to calculate average muscle activation during the open and laparoscopic segments of each procedure. Paired Student's t test was used to compare the average muscle activation between the two groups (*p < 0.05 considered statistically significant).
  
  
  
  Significant reductions in mean muscle activation in laparoscopic compared to open procedures were noted for the left triceps (4.07 ± 0.44% open vs. 2.65 ± 0.54% lap, 35% reduction), left deltoid (2.43 ± 0.45% open vs. 1.32 ± 0.16% lap, 46% reduction), left trapezius (9.93 ± 0.1.95% open vs. 4.61 ± 0.67% lap, 54% reduction), right triceps (2.94 ± 0.62% open vs. 1.85 ± 0.28% lap, 37% reduction), and right trapezius (10.20 ± 2.12% open vs. 4.69 ± 1.18% lap, 54% reduction).
  
  
  
  Contrary to our hypothesis, the laparoscopic approach provided ergonomic benefit in several upper-body muscle groups compared to the open approach. This may be due to the greater reach of laparoscopic instruments and camera in the lower abdomen/pelvis. Patient body habitus may also have less of an effect in the laparoscopic compared to open approach. Future studies with multiple subjects and different types of procedures are planned to further investigate these findings.
authors.affiliation: Department of Surgery, Section of Minimally Invasive Surgery, Washington University in St Louis, St Louis, MO, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Wang
authors.affiliation: Department of Surgery, Section of Minimally Invasive Surgery, Washington University in St Louis, St Louis, MO, USA.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Liang
authors.affiliation: Department of Surgery, Section of Minimally Invasive Surgery, Washington University in St Louis, St Louis, MO, USA. zihnia@wudosis.wustl.edu.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Zihni
authors.affiliation: Department of Surgery, Section of Minimally Invasive Surgery, Washington University in St Louis, St Louis, MO, USA.
authors.forename: Shuddhadeb
authors.initials: S
authors.lastname: Ray
authors.affiliation: Department of Surgery, Section of Minimally Invasive Surgery, Washington University in St Louis, St Louis, MO, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Awad
mesh_terms: D000328:Adult; D003082:Colectomy / Q000379:methods*; D004576:Electromyography; D006804:Ergonomics; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D018482:Muscle, Skeletal / Q000502:physiology*; D012810:Sigmoid Diseases / Q000601:surgery; D013312:Stress, Physiological / Q000502:physiology*
keywords: Ergonomics; Human factors; Laparoscopic surgery; Open surgery; Surgical task performance