Surgical Stress: The Muscle and Cognitive Demands of Robotic and Laparoscopic Surgery

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 4 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 (1) noncritical bowel dissection, (2) critical vessel dissection, and (3) 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 LS and 28 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). Conclusions: These data suggest greater muscle demands in laparoscopic surgery, but greater cognitive demands in RS. This trial was registered at Clinicaltrials.gov (NCT04477746).

Cognitive ergonomics and robotic surgery

“…In this study, different surgeons performed, depending on their expertise, either laparoscopic or robotic real-life surgery but not both. The increased cognitive demand with robotic surgery was attributed to greater demand on visual attention systems partly related to loss of haptic feedback and increased mental fatigue as evidenced by alpha and beta desynchronization on EEG monitoring [ 24 ].…”

European Robotic Surgery Consensus (ERSC): Protocol for the development of a consensus in robotic training for gastrointestinal surgery trainees

“…These advantages stem from features such as three-dimensional visualisation, articulating instruments, and enhanced access to complex or narrow anatomical areas [6,7]. Additionally, robotic systems enable direct camera control, tremor reduction, and decrease surgeon muscle strain and fatigue [8,9]. However, longer operative times and higher costs are associated with robotic surgery when compared to laparoscopy [10].…”