EP863 - Ergonomics of Laparoscopic Versus Robotic-Assisted Surgery: A Case Study of an Experienced Colorectal Surgeon

ePoster Presenter(s)

• 

  Michelle Chan, MD (she/her/hers)

  General surgery resident
  The Ohio State University
  The Ohio State University
  Columbus, OH, United States

  Disclosure information not submitted.

Author(s)

• 

  JC Chen, MD MPH (they/them/theirs)

  Resident
  Ohio State University
  Ohio State University
  Columbus, OH, United States

  Disclosure information not submitted.
• JZ

  Joy Zhang, MD

  General Surgery Resident
  The Ohio State University Wexner Medical Center - Columbus, OH
  Columbus, Ohio, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Melik Kagan Aktas, MD (he/him/his)

  Postdoctoral Clinical Research Fellow
  The Ohio State University Department of Surgery
  The Ohio State University
  Columbus, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Nikita Wadhwani, MD (she/her/hers)

  Colon and rectal surgery fellow
  The Ohio State University
  University of Alabama at Birmingham
  Columbus, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• SB

  Sydney C. Beache, MD, MPHS (she/her/hers)

  Fellow
  The Ohio State University
  The Ohio State University
  Columbus, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Senior Author(s)

• 

  Syed Husain, MB.,BS.

  Professor of Surgery-Clinical
  The Ohio State University
  Ohio State University
  Columbus, Ohio, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Purpose/Background: One of the many perceived benefits of robotic-assisted surgery compared to laparoscopic surgery is the reported improvement in ergonomics, as the surgeon is able to operate in a seated position at the console while maintaining a neutral posture. However, there are few studies that objectively quantify the muscle strain of surgeons during each surgical modality. In fact, some studies suggest that robotic surgery may expose surgeons to potentially harmful neck angles and longer operating times. Specific to colorectal surgery, operating in the pelvis may expose surgeons to increased ergonomic risk factors. This case study evaluates the ergonomics of laparoscopic versus robotic-assisted surgery using surface electromyography (EMG) data collected intra-operatively from an experienced colorectal surgeon.

Methods/Interventions: The subject of this case study was an experienced colon and rectal surgeon practicing at a large academic medical center. To record EMG data during surgery, EMG electrodes were placed over the bilateral finger flexor muscle groups (primarily the flexor digitorum superficialis), anterior and middle deltoids, upper trapezius, semispinalis capitis, and erector spinae muscles. EMG data was collected during six low anterior resection (LAR) cases: two robotic-assisted and four laparoscopic. 15 seconds of data were collected every three minutes during each operation. Since the data was not normally distributed, Kruskal-Wallis tests were performed to evaluate for statistical differences in median muscle activity between laparoscopic and robotic-assisted cases. Post-hoc comparisons were made using the Dwass-Steel-Critchlow-Fligner (DSCF) method.

Results/Outcomes: Overall, there was no significant difference in muscle activity between laparoscopic versus robotic LARs (p=0.86). Furthermore, there was no difference between laparoscopic and robotic modalities when specifically evaluating the rectal dissection portion of the case (p=0.64). However, more granular analysis suggests that laparoscopic approaches had increased finger flexor use (L: p< 0.001, R: p=0.002) and erector spinae muscle use overall (L and R: p< 0.001), whereas robotic approaches had increased upper trapezius muscle use overall (L and R: p< 0.001) and increased neck extensor use in the rectal dissection stage (L: p=0.031).

Conclusion/Discussion: Our results suggest that contrary to common belief, there is no overall difference in ergonomics between laparoscopic and robotic-assisted surgery. Instead, muscle stress may simply be redistributed from one group of muscles to another. Of note, this study was conducted using the da Vinci Xi robot. As advances in ergonomic technology continue to be implemented, such as in the new da Vinci 5 robot, further studies are needed to assess the benefit of robotic systems on the physical demand of surgeons in the operating room.

Laparoscopic vs. Robotic Surgery: Overall LAR
There was no significant difference in muscle activity between laparoscopic versus robotic LARs overall (p=0.86). Laparoscopy involved increased finger flexor and erector spinae muscle use, whereas robotic surgery had increased upper trapezius muscle use.
Laparoscopic vs. Robotic Surgery: Rectal Dissection Stage
There was no difference between laparoscopic and robotic modalities when specifically evaluating the rectal dissection portion of the LARs (p=0.64). Laparoscopy had increased finger flexor and erector spinae muscle use, while robotic surgery had increased upper trapezius and neck extensor use.