The impact of obesity on surgeon ergonomics in robotic and straight stick laparoscopic surgery

Abstract

OBJECTIVE: Work-related musculoskeletal symptoms (WMS) are reported to be increasing in surgeons performing minimally invasive procedures. To investigate the use of Inertial Measurement Units (IMU) and electromyography sensor (EMG) recorders to record real-time information on the muscle movement/activity required to perform training exercises in simulated in normal and high body mass index (BMI) models. DESIGN: Prospective study SETTING: University Hospital SAMPLE: Four consultant gynaecological Oncol.ogy surgeons experienced in complex straight-stick laparoscopic (SS) and robotic surgery (RA). INTERVENTIONS: Three exercises (hoops onto pegs and wire chase) using SS and RA on two abdominal models: A) normal BMI; B) high BMI. MEASUREMENTS AND MAIN RESULTS: Time to complete exercise and surgeon muscle movement/activity. The time to complete the all the exercises was significantly lower RA as compared to SS (p<0.001). The movement of the surgeons' core was significantly greater in model SS-B compared to SS-A for all three exercises (p<0.001). Muscle usage, as determined by EMG peak, was significantly higher in SS-A, and even higher in SS-B, but generally flat for all the RA-A and RA-B exercises (p<0.05). CONCLUSIONS: Detailed real-time information can be collected through IMU/EMG sensors Our results indicate that RA requires less surgeon movements and muscle activity to complete tasks compared to SS, particularly in a high BMI model. The implications of these results are that RA in high BMI patients may therefore have less physical impact on the surgeon compare to SS, and may result in lower WMS rates.