Department of Gynecology, Juliane Marie Centre for Children, Women and Reproduction, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.
Ann Surg. 2020 Jan;271(1):106-113. doi: 10.1097/SLA.0000000000002845.
To study musculoskeletal workload in experienced surgeons during laparoscopic surgery (LS) compared with robotic assisted laparoscopy (RALS).
70-90% of surgeons who regularly perform LS report musculoskeletal symptoms, mainly in neck and shoulders. Data regarding the potential ergonomic benefits of RALS in a clinical setting is very limited.
Twelve surgeons with advanced experience in both LS and RALS each performed 2 hysterectomies on the same day. LS was performed standing, RALS sitting, the latter allowing forearm and head support. Bipolar surface electromyogram (EMG) was recorded from several muscles and was expressed relative to EMG during maximum contractions (%EMGmax). Gaps per minute plus static (p0.1), mean (p0.5), and peak (p0.9) muscle activation were calculated. Perceived exertion was rated before and just after each surgery.
Neck muscle activity (p0.1 4.7 vs. 3.0%EMGmax, p0.5 7.4 vs. 5.3%EMGmax, p0.9 11.6 vs. 8.2%EMGmax, all P < 0.05) and static shoulder muscle activity (p0.1 5.7 vs. 2.8%EMGmax, P < 0.05) were higher for LS than for RALS. Both a higher level of gaps during RALS and a lower rating of perceived exertion, also for the legs, after RALS supported these observations. However, low back muscle activity was higher for RALS.
RALS is significantly less physically demanding than LS, and also feels less strenuous for the surgeons. However, for both types of surgeries, there still is room for improvement of working conditions. To further optimize these, we suggest a scheme to regularly observe and advise the surgeons.
研究经验丰富的外科医生在腹腔镜手术（LS）和机器人辅助腹腔镜手术（RALS）中肌肉骨骼的工作量。
70-90%经常进行 LS 的外科医生报告有肌肉骨骼症状，主要在颈部和肩部。关于 RALS 在临床环境中潜在的人体工程学优势的数据非常有限。
12 名具有 LS 和 RALS 高级经验的外科医生在同一天各进行 2 例子宫切除术。LS 采用站立式，RALS 采用坐姿，后者允许前臂和头部支撑。从几个肌肉记录双极表面肌电图（EMG），并表示为最大收缩时的 EMG 百分比（%EMGmax）。每分钟间隙加静态（p0.1）、平均（p0.5）和峰值（p0.9）肌肉激活的计算。每次手术前后都要进行感知用力的评估。
LS 的颈部肌肉活动（p0.1 为 4.7%EMGmax，p0.5 为 7.4%EMGmax，p0.9 为 11.6%EMGmax，均 P < 0.05）和肩部静态肌肉活动（p0.1 为 5.7%EMGmax，P < 0.05）均高于 RALS。RALS 间隙水平较高，以及 RALS 后腿部感知用力较低，也支持了这些观察结果。然而，RALS 时的下背部肌肉活动更高。
RALS 比 LS 的体力要求明显降低，外科医生也感觉更轻松。然而，对于这两种类型的手术，工作条件仍有改进的空间。为了进一步优化这些条件，我们建议定期观察和建议外科医生的方案。
