Zihni Ahmed M, Ohu Ikechukwu, Cavallo Jaime A, Ousley Jenny, Cho Sohyung, Awad Michael M
Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, St. Louis, MO, 63110, USA,
Surg Endosc. 2014 Aug;28(8):2459-65. doi: 10.1007/s00464-014-3497-7. Epub 2014 Mar 12.
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.
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.
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.
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.
机器人手术可能会给外科医生带来人体工程学方面的益处。在这项初步研究中，我们利用表面肌电图（sEMG）来描述一种方法，该方法使用经过验证的腹腔镜手术基础（FLS）任务来识别腹腔镜和机器人平台之间的人体工程学差异。我们假设，通过sEMG量化，腹腔镜和机器人手术平台上的FLS任务表现将在平均肌肉激活方面产生显著差异。
六名右手优势且经验各异的受试者在腹腔镜和机器人平台上执行FLS钉转移（PT）、图案切割（PC）和体内缝合（IS）任务。从每个受试者的双侧二头肌、三头肌、三角肌和斜方肌获取sEMG测量值。将肌电图测量值归一化为每个受试者各肌肉的最大自主收缩（MVC）。受试者在每个平台上对每个任务重复三次，并使用平均值进行汇总分析。计算所有受试者在每项FLS任务中每个肌肉组的平均归一化肌肉激活（%MVC）。我们使用配对t检验比较平均%MVC值，并将p值小于0.05的差异视为具有统计学意义。
与机器人IS任务相比，腹腔镜IS任务期间右二头肌（腹腔镜2.7%MVC，机器人1.3%MVC，p = 0.019）和右三角肌（腹腔镜2.4%MVC，机器人1.0%MVC，p = 0.019）的平均激活显著升高。与腹腔镜PT（腹腔镜1.6%MVC，机器人3.5%MVC，p = 0.040）和PC（腹腔镜1.3%MVC，机器人3.6%MVC，p = 0.0018）任务相比，机器人任务期间右斜方肌的平均激活显著升高。
FLS任务是经过验证且易于获得的工具，可用于证明手术平台之间的人体工程学差异。在本研究中，我们使用FLS任务比较了腹腔镜和机器人任务执行期间四个肌肉组的平均肌肉激活。FLS任务可作为更大规模研究的基础，以进一步描述腹腔镜手术和机器人手术之间的人体工程学差异。
