A study of surgeons’ postural muscle activity during open, laparoscopic, and endovascular surgery

BackgroundDifferent surgical procedures impose different physical demands on surgeons and high prevalence rates of neck and shoulder pain have been reported among general surgeons. Past research has examined electromyography in surgeons mainly during simulated conditions of laparoscopic and open surgery but not during real-time operations and not for long durations. The present study compares the neck-shoulder muscle activities in three types of surgery and between different surgeons. The relationships of postural muscle activities to musculoskeletal symptoms and personal factors also are examined.MethodsTwenty-five surgeons participated in the study (23 men). Surface electromyography (EMG) was recorded in the bilateral cervical erector spinae, upper trapezius, and anterior deltoid muscles during three types of surgical procedures: open, laparoscopic, and endovascular. In each procedure, EMG data were captured for 30 min to more than 1 h. The surgeons were asked to rate any musculoskeletal symptoms before and after surgery.ResultsThe present study showed significantly higher muscle activities in the cervical erector spinae and upper trapezius muscles in open surgery compared with endovascular and laparoscopic procedures. Muscle activities were fairly similar between endovascular and laparoscopic surgery. The upper trapezius usually has an important role in stabilizing both the neck and upper limb posture, and this muscle also recorded higher activities in open compared with laparoscopic and endovascular surgeries. Surgeons reported similar degrees of musculoskeletal symptoms in open and laparoscopic surgeries, which were higher than endovascular surgery.ConclusionsThe present study showed that open surgery imposed significantly greater physical demands on the neck muscles compared with endovascular and laparoscopic surgeries. This may be due to the lighter manual task demands of these minimally invasive surgeries compared with open procedures, which generally required more dynamic movements and more forceful exertions.

[1]  P. V. Patil,et al.  Effect of fixation of shoulder and elbow joint movement on the precision of laparoscopic instrument manipulations , 2005, Surgical Endoscopy And Other Interventional Techniques.

[2]  R H M Goossens,et al.  Assessment of the ergonomically optimal operating surface height for laparoscopic surgery. , 2002, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[3]  J. Cram,et al.  Introduction to Surface Electromyography , 1998 .

[4]  B Jonsson,et al.  Measurement and evaluation of local muscular strain in the shoulder during constrained work. , 1982, Journal of human ergology.

[5]  Grace P. Y. Szeto,et al.  Work-related Musculoskeletal Symptoms in Surgeons , 2009, Journal of Occupational Rehabilitation.

[6]  P. gordon,et al.  Injuries sustained by colorectal surgeons performing colonoscopy , 2005, Surgical Endoscopy And Other Interventional Techniques.

[7]  K Ohlsson,et al.  Electromyographic fatigue in neck/shoulder muscles and endurance in women with repetitive work. , 1992, Ergonomics.

[8]  R Berguer,et al.  An ergonomic evaluation of surgeons' axial skeletal and upper extremity movements during laparoscopic and open surgery. , 2001, American journal of surgery.

[9]  G. Kazemier,et al.  A newly designed ergonomic body support for surgeons , 2007, Surgical Endoscopy.

[10]  U. Lundberg,et al.  Trapezius muscle activity, neck and shoulder pain, and subjective experiences during monotonous work in women , 2000, European Journal of Applied Physiology.

[11]  Svend Erik Mathiassen,et al.  Changes in the degree of motor variability associated with experimental and chronic neck–shoulder pain during a standardised repetitive arm movement , 2008, Experimental Brain Research.

[12]  C. Giebmeyer,et al.  Monitor position in laparoscopic surgery , 2005, Surgical Endoscopy And Other Interventional Techniques.

[13]  L. Straker,et al.  Examining the low, high and range measures of muscle activity amplitudes in symptomatic and asymptomatic computer users performing typing and mousing tasks , 2009, European Journal of Applied Physiology.

[14]  R H Westgaard,et al.  Trapezius muscle activity as a risk indicator for shoulder and neck pain in female service workers with low biomechanical exposure , 2001, Ergonomics.

[15]  R. Berguer,et al.  A comparison of surgeons' posture during laparoscopic and open surgical procedures , 1997, Surgical Endoscopy.

[16]  H. Hermens,et al.  European recommendations for surface electromyography: Results of the SENIAM Project , 1999 .

[17]  Pascal Madeleine,et al.  Shoulder muscle co-ordination during chronic and acute experimental neck-shoulder pain. An occupational pain study , 1999, European Journal of Applied Physiology and Occupational Physiology.

[18]  L. Wauben,et al.  Application of ergonomic guidelines during minimally invasive surgery: a questionnaire survey of 284 surgeons , 2006, Surgical Endoscopy And Other Interventional Techniques.

[19]  J. R. Engsberg,et al.  Assessment of fatigue, monitor placement, and surgical experience during simulated laparoscopic surgery , 2002, Surgical Endoscopy.

[20]  J. Pierie,et al.  Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines , 2009, Surgical Endoscopy.

[21]  Alfred Cuschieri,et al.  Ergonomic assessment of optimum operating table height for hand-assisted laparoscopic surgery , 2009, Surgical Endoscopy.

[22]  C. Giebmeyer,et al.  Ergonomic aspects of five different types of laparoscopic instrument handles under dynamic conditions with respect to specific laparoscopic tasks: An electromyographic-based study , 2004, Surgical Endoscopy And Other Interventional Techniques.

[23]  B. Jonsson,et al.  Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. , 1987, Applied ergonomics.

[24]  Toshisada Nishida,et al.  Natural history of a tool-using behavior by wild chimpanzees in feeding upon wood-boring ants , 1982 .

[25]  R. Berguer,et al.  An ergonomic comparison of in-line vs pistol-grip handle configuration in a laparoscopic grasper , 1998, Surgical Endoscopy.

[26]  Deborah Falla,et al.  Patients With Chronic Neck Pain Demonstrate Altered Patterns of Muscle Activation During Performance of a Functional Upper Limb Task , 2004, Spine.

[27]  A. E. Park,et al.  The effect of using laparoscopic instruments on muscle activation patterns during minimally invasive surgical training procedures , 2003, Surgical Endoscopy And Other Interventional Techniques.

[28]  Warren D. Smith,et al.  Ergonomic problems associated with laparoscopic surgery , 1999, Surgical Endoscopy.

[29]  Leon M Straker,et al.  A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work--1: neck and shoulder muscle recruitment patterns. , 2005, Manual therapy.

[30]  W. D. Smith,et al.  An ergonomic study of the optimum operating table height for laparoscopic surgery , 2002, Surgical Endoscopy And Other Interventional Techniques.

[31]  Annika Åström,et al.  Load pattern and pressure pain threshold in the upper trapezius muscle and psychosocial factors in medical secretaries with and without shoulder/neck disorders , 1997, International archives of occupational and environmental health.