Washington University in Saint Louis, St. Louis, MO, USA.
Providence Portland Medical Center, Portland, OR, USA.
Surg Endosc. 2019 Jun;33(6):1938-1943. doi: 10.1007/s00464-018-6478-4. Epub 2018 Oct 22.
Traditional laparoscopic surgery (TLS) has increasingly been associated with physical muscle strain for the operating surgeon. Robot-assisted laparoscopic surgery (RALS) may offer improved ergonomics. Ergonomics for the surgeon on these two platforms can be compared using surface electromyography (sEMG) to measure muscle activation, and the National Aeronautics and Space Administration Task Load Index (NTLX) survey to assess workload subjectively.
Subjects were recruited and divided into groups according to level of expertise in traditional laparoscopic (TLS) and robot-assisted laparoscopic surgery (RALS): novice, traditional laparoscopic surgeons (TL surgeons), robot-assisted laparoscopic surgeons (RAL surgeons). Each subject performed three fundamentals of laparoscopic surgery (FLS) tasks in randomized order while sEMG data were obtained from bilateral biceps, triceps, deltoid, and trapezius muscles. After completing all tasks, subjects completed the NTLX survey. sEMG data normalized to the maximum voluntary contraction of each muscle (MVC%), and NTLX data were compared with unpaired t tests and considered significant with a p ≤ 0.05.
Muscle activation was higher during TLS compared to RALS in most muscle groups for novices except for the trapezius muscles. Muscle activation scores were also higher for TLS among the groups with more experience, but the differences were less significant. NTLX scores were higher for the TLS platform compared to the RALS platform for novices.
TLS is associated with higher muscle activation in all muscle groups except for trapezius muscles, suggesting greater strain on the surgeon. Increased trapezius muscle activation on RALS has previously been documented and is likely due to the position of the eye piece. The differences seen in muscle activation diminish with increasing levels of expertise. Experience likely mitigates the ergonomic disadvantage of TLS. NTLX survey data suggest there are subjective benefits to RALS, namely in the perception of temporal demand. Further research to correlate NTLX data and sEMG measurements, and to investigate whether these metrics affect patient outcomes is warranted.
传统腹腔镜手术（TLS）与手术医生的身体肌肉劳损越来越相关。机器人辅助腹腔镜手术（RALS）可能提供更好的人体工程学。可以使用表面肌电图（sEMG）来测量肌肉激活，并用国家航空航天局任务负荷指数（NTLX）调查来主观评估工作负荷，从而比较这两种平台上的外科医生的人体工程学。
根据传统腹腔镜（TLS）和机器人辅助腹腔镜手术（RALS）的专业水平，招募并将受试者分为两组：新手、传统腹腔镜外科医生（TL 外科医生）和机器人辅助腹腔镜外科医生（RAL 外科医生）。每个受试者以随机顺序执行三个腹腔镜手术基础任务（FLS），同时从双侧二头肌、三头肌、三角肌和斜方肌获取 sEMG 数据。完成所有任务后，受试者完成 NTLX 调查。将 sEMG 数据归一化为每个肌肉的最大自主收缩（MVC%），并使用配对 t 检验比较 NTLX 数据，并认为 p≤0.05 时有统计学意义。
对于新手，除了斜方肌外，TLS 期间大多数肌肉群的肌肉激活都高于 RALS。在经验更丰富的组中，TLS 的肌肉激活评分也更高，但差异不明显。对于新手来说，TLS 平台的 NTLX 评分高于 RALS 平台。
TLS 与所有肌肉群（除了斜方肌外）的肌肉激活更高，这表明手术医生的压力更大。以前已经记录到 RALS 中斜方肌的激活增加，这可能是由于目镜的位置所致。随着专业水平的提高，肌肉激活方面的差异会减小。经验可能减轻了 TLS 的人体工程学劣势。NTLX 调查数据表明，RALS 具有主观优势，即感知时间需求方面。需要进一步研究来关联 NTLX 数据和 sEMG 测量，并研究这些指标是否会影响患者的结果。
