Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 28;4(2):e284.
doi: 10.1097/AS9.0000000000000284.

Surgical stress: the muscle and cognitive demands of robotic and laparoscopic surgery

Abdul Shugaba  1   2 , Daren A Subar  3   2 , Kate Slade  4 , Mark Willett  3 , Mohammed Abdel-Aty  3 , Iain Campbell  3 , Nick Heywood  3 , Louis Vitone  3 , Adnan Sheikh  3 , Mike Gill  3 , Bachar Zelhof  5 , Helen E Nuttall  4 , Theodoros M Bampouras  6 , Christopher J Gaffney  1
Affiliations

Surgical stress: the muscle and cognitive demands of robotic and laparoscopic surgery

Abdul Shugaba et al. Ann Surg Open. .

Abstract

Introduction: Surgeons are among the most at-risk professionals for work-related musculoskeletal decline and experience high mental demands. This study examined the electromyographic (EMG) and electroencephalographic (EEG) activities of surgeons during surgery.

Methods: Surgeons who performed live laparoscopic (LS) and robotic (RS) surgeries underwent EMG and EEG measurements. Wireless EMG was used to measure muscle activation in four muscle groups bilaterally (biceps brachii, deltoid, upper trapezius, and latissimus dorsi), and an 8-channel wireless EEG device was used to measure cognitive demand. EMG and EEG recordings were completed simultaneously during (i) noncritical bowel dissection, (ii) critical vessel dissection, and (iii) dissection after vessel control. Robust ANOVA was used to compare the %MVCRMS and alpha power between LS and RS.

Results: Thirteen male surgeons performed 26 laparoscopic surgeries (LS) and 28 robotic surgeries (RS). Muscle activation was significantly higher in the right deltoid (p = 0.006), upper trapezius (left, p = 0.041; right, p = 0.032), and latissimus dorsi (left, p = 0.003; right, p = 0.014) muscles in the LS group. There was greater muscle activation in the right biceps than in the left biceps in both surgical modalities (both p = 0.0001). There was a significant effect of the time of surgery on the EEG activity (p <0.0001). A significantly greater cognitive demand was observed in the RS than in the LS with alpha, beta, theta, delta, and gamma (p = 0.002 - p <0.0001).

Conclusion: These data suggest greater muscle demands in laparoscopic surgery, but greater cognitive demands in robotic surgery.

Keywords: Electroencephalography; Electromyography; Laparoscopic surgery; Minimally invasive surgery; Robotic surgery.

PubMed Disclaimer

Conflict of interest statement

AS, DAS, HEN, TB, and CG received a clinical research grant from the Intuitive Foundation (A105089), which funded this work. KS and HEN are supported by BBSRC (BB/S008527/1). MW, MA-A, IC, NH, LV, AS, MG, & BZ declare that they do not have any conflicts of interest. This trial was registered at Clinicaltrials.gov (NCT04477746). Conflict of interest This work was funded by a clinical research grant from the Intuitive Foundation. The funder had no role in the study design, its execution, analyses, interpretation of the data, or decision to submit the results.

Figures

FIGURE 1.
FIGURE 1.
EEG electrode placement.
FIGURE 2.
FIGURE 2.
RMS EMG data of muscle activation of the left (left panel) and right (right panel) between robotic (filled bars) versus laparoscopic (empty bars) surgery. Data are presented as means + SEM. A, EMG activity across time in the left biceps. B, EMG activity across time in the right biceps. C, EMG activity across time in the left deltoid. D, EMG activity across time in the right deltoid. E, EMG activity across time in the left trapezius. F, EMG activity across time in the right trapezius. G, EMG activity across time in the left latissimus dorsi. H, EMG activity across time in the right latissimus dorsi.
FIGURE 3.
FIGURE 3.
RMS EMG data of muscle activation of the left (filled bars) and right muscle (empty bars) groups in the robotic and laparoscopic surgery groups. A, EMG activity across time within RS group in the biceps muscle. B, EMG activity across time within LS group in the biceps muscle. *P < 0.05.
FIGURE 4.
FIGURE 4.
Alpha power indicated that there was greater overall cognitive demand in RS (dark gray bars) relative to LS (light gray bars). In both RS and LS, cognitive demand increased in surgery relative to baseline, and was sustained throughout surgery. Exploratory analyses of EEG activity in different frequency bands reflected similar observations. A, Alpha power activity across time. B, Beta power activity across time. C, Theta power activity across time. D, Delta power activity across time. E, Gamma power activity across time. *P < 0.05; **P < 0.01; ***P < 0.001; ****P < 0.0001.
See this image and copyright information in PMC

References

    1. Rassweiler J, Rassweiler MC, Kenngott H, et al. . The past, present and future of minimally invasive therapy in urology: a review and speculative outlook. Minim Invasive Ther Allied Technol. 2013;22:200–209. - PubMed
    1. Scarpa M, Cavallin F, Saadeh L, et al. . Hybrid minimally invasive esophagectomy for cancer: impact on postoperative inflammatory and nutritional status. Dis Esophagus. 2016;29:1064–1070. - PubMed
    1. van der Pas MH, Haglind E, Cuesta MA, et al. ; COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14:210–218. - PubMed
    1. John AS, Caturegli I, Kubicki NS, et al. . The rise of minimally invasive surgery: 16 year analysis of the progressive replacement of open surgery with laparoscopy. JSLS. 2020;24:e2020.00076. - PMC - PubMed
    1. Fu Y, Pan B, Li K, et al., eds. Laparoscopic robot design and kinematic validation. 2006 IEEE International Conference on Robotics and Biomimetics. IEEE; 2006.