9 research outputs found
Laparoscopic skills Acquisition in obstetrics and Gynaecology and General Surgical trainees (LAGGS)
No full textMUSCLE ACTIVITY ASSOCIATED WITH PERFORMING ROBOT- ASSISTED AND CONVENTIONAL LAPAROSCOPY
No full textIntroduction Minimally invasive surgery offers excellent benefits to patients [1] and one of its modalities; Robotic-assisted laparoscopic surgery (RALS) is increasingly being adopted to perform more complex procedures [2]. One of the claimed benefits is reduced musculoskeletal stress, which is important as surgeons are amongst the most at risk profession of work-related musculoskeletal decline [3]; with a high prevalence of work-related pain [4-6], and musculoskeletal injuries [7], predominantly affecting the neck, arm, shoulder, and back. The study aimed to compare electromyogram (EMG) activity in four relevant muscle groups during live laparoscopic surgery (LS) and robot assisted laparoscopic surgery (RALS). Methods Muscle activation during surgery was measured using a wireless EMG device during 80 surgeries (45 RALS, 35 LS). Root mean square (RMS) EMG activity was obtained bilaterally from four muscle groups (biceps, deltoid, upper trapezius, and latissimus dorsi), normalised to a previously recorded maximum contraction. Recordings were obtained at three time points: non-critical dissection, critical vessel dissection, and dissection after vessel control. The percentage changes normalised to a Maximal Voluntary Contractions (%MVC) in the four muscles compared to baseline was used to determine musculoskeletal demand. Results There was greater muscle activation in the LS group except in the biceps muscle. This was significant in bilateral upper trapezius (P = 0.006 & P = 0.001) and bilateral latissimus dorsi (P = 0.09 & P = 0.0009) across all 3 time points. Only the left deltoid (P = 0.026), had higher activation in LS when surgeons performed dissection around critical blood vessels and post vessel-control dissection. In both RALS (P = 0.08) and LS (P = 0.001), comparative muscle activation was significantly greater in the right biceps. Similar greater activation in the right deltoid and right upper trapezius was observed in both groups. Figure 1: RMS EMG data of muscle activation of the left (Panel A) and right (Panel B) upper trapezius between robotic (filled bars) versus laparoscopic (empty bars) surgery. Discussion The differences found bilaterally for LS are reflective of the different tasks the arms are performing during a surgery with one arm needed to ‘hold’ while the other is needed to ‘perform’ (e.g., dissect tissue planes, make incisions etc). This increased level of muscle activation could predispose to injury, suggesting that robotic surgery might be more beneficial for surgeons’ long-term health. The lower muscle activation seen in RALS could assist in reducing muscular strain during surgeries and thus contributing to reducing the risk of work-related musculoskeletal injuries in surgeons. This finding offers some mechanism to a recent meta-analysis suggesting that robotic surgery is ergonomically superior to laparoscopic surgery [8]. References 1. Patankar et al, Diseases of the colon & rectum, 46(5):601-611, 2003. 2. Schreuder et al, BJOG: An International Journal of Obstetrics & Gynaecology, 119(2):137-149, 2012. 3. Money et al, Estimation from THOR surveillance data, 2019. 4. Adams et al, Journal of minimally invasive gynecology, 20(5):656-660, 2013. 5. Dalager et al, Journal of surgical research, 240:30-39, 2019. 6. Stucky et al, Annals of Medicine and Surgery, 27:1-8, 2018. 7. Epstein et al, JAMA surgery, 153(2):e174947-e174947, 2018. 8. Hislop et al, Surgical endoscopy, 34(1): p. 31-38, 2020. Acknowledgements This work was supported by a Clinical Research Grant from the Intuitive Foundation (grant number A105089). This funding source had no role in the design of this study, its execution, analyses, interpretation of the data, or decision to submit results
What laparoscopic skills are necessary for Certificate of Completion of Training? : A prospective nationwide cross-sectional survey of Obstetrics & Gynaecology and General Surgery trainees and consultants in the UK
No full textObjectives: To explore the views of Obstetrics & Gynaecology (O&G) and General Surgery (GS) trainees and consultants on the laparoscopic skills considered necessary to achieve the Certificate of Completion of Training (CCT) and identify any mismatch between consultants and trainees in their expectations of these skills. Design: A prospective nationwide cross-sectional study in the UK. Setting: A national survey distributed through Health Education, England and national training bodies such as the Royal College of Obstetricians & Gynaecologist (RCOG), British society for gynaecological endoscopy (BSGE) and the Association of Surgeons of Great Britain and Ireland (ASGBI). Participants: O&G and GS consultants and specialty trainees in O&G and GS. Specialty trainees below ST3 level and consultants performing open surgery or minor laparoscopic surgery only were excluded. Interventions: Trainees completed a 27-item questionnaire on their training characteristics, rated their confidence and perceived importance of 10 laparoscopic skills required for CCT using a 5-point Likert scale. Consultants answered a 36-item questionnaire on their demographic details, their views on the importance of the same 10 laparoscopic skills, their confidence and the standard of laparoscopic skills they observed amongst trainees approaching CCT. Results: 345 participants responded to the questionnaire: 117 O&G trainees, 95 O&G consultants, 57 GS trainees & 76 GS consultants. O&G trainees and consultants expected similar laparoscopic skills required for CCT for all ten skills (P> 0.050), whilst GS consultants had higher expectations of GS trainees for suturing (P=0.003), use of endovascular devices (P=0.020) and staplers (P=0.020). Consultants in both specialties observed that trainees were performing significantly below the expected standards; P< 0.010 (O&G) and P<0.001 (GS) for all 10 listed skills. O&G trainees reported lower confidence than GS trainees for all 10 laparoscopic skills (P<0.001). Conclusions: This nationwide study showed that UK O&G trainees and consultants both agree on the skills required for CCT, but GS consultants had higher expectations than their trainees. Trainees in GS were more confident in their surgical skills than those in O&G. However, consultants in both specialities believed that trainees were not achieving the requisite laparoscopic skills required for CCT
Should all minimal access surgery be robot-assisted? : A systematic review into the musculoskeletal and cognitive demands of laparoscopic and robot-assisted laparoscopic surgery
No full textBackground: Surgeons are amongst the most at risk of work-related musculoskeletal health decline because of the physical demands of surgery, which is also associated with cognitive fatigue. Minimally invasive surgery offers excellent benefits to patients but the impact of robotic or laparoscopic surgery on surgeon well-being is less well understood. This work examined the musculoskeletal and cognitive demands of robot-assisted versus standard laparoscopic surgery. Methods: Medline, Embase, and Cochrane databases were systematically searched for “Muscle strain” AND “musculoskeletal fatigue” AND “occupational diseases” OR “cognitive fatigue” AND “mental fatigue” OR “standard laparoscopic surgery” AND “robot-assisted laparoscopic surgery”. Primary outcomes measured were electromyographic (EMG) activity for musculoskeletal fatigue and questionnaires (NASA TLX, SMEQ, or Borg CR-10) for cognitive fatigue. A systematic review was conducted in accordance with the Synthesis Without Meta-analysis (SWiM) Guidelines. The study was preregistered on Prospero ID: CRD42020184881. Results: Two hundred and ninety-eight original titles were identified. Ten studies that were all observational studies were included in the systematic review. EMG activity was consistently lower in robotic than in laparoscopic surgery in the erector spinae and flexor digitorum muscles but higher in the trapezius muscle. This was associated with significantly lower cognitive load in robotic than laparoscopic surgery in 7 of 10 studies. Conclusions: Evidence suggests a reduction in musculoskeletal demands during robotic surgery in muscles excluding the trapezius, and this is associated with most studies reporting a reduced cognitive load. Robotic surgery appears to have less negative cognitive and musculoskeletal impact on surgeons compared to laparoscopic surgery
Obstetrics and Gynaecology trainees face higher musculoskeletal demands than General Surgery trainees in simulated laparoscopic tasks - an observational study
No full textComparing proficiency of obstetrics and gynaecology trainees with general surgery trainees using simulated laparoscopic tasks in Health Education England, North-West:a prospective observational study
No full textBackground: Training programmes for obstetrics and gynaecology (O&G) and general surgery (GS) vary significantly, but both require proficiency in laparoscopic skills. We sought to determine performance in each specialty.Design: Prospective, observational study.Setting: Health Education England North-West, UK.Participants: 47 surgical trainees (24 O&G and 23 GS) were subdivided into four groups: 11 junior O&G, 13 senior O&G, 11 junior GS and 12 senior GS trainees.Objectives: Trainees were tested on four simulated laparoscopic tasks: laparoscopic camera navigation (LCN), hand–eye coordination (HEC), bimanual coordination (BMC) and suturing with intracorporeal knot tying (suturing).Results: O&G trainees completed LCN (p < 0.001), HEC (p < 0.001) and BMC (p < 0.001) significantly slower than GS trainees. Furthermore, O&G found fewer number of targets in LCN (p = 0.001) and dropped a greater number of pins than the GS trainees in BMC (p = 0.04). In all three tasks, there were significant differences between O&G and GS trainees but no difference between the junior and senior groups within each specialty. Performance in suturing also varied by specialty; senior O&G trainees scored significantly lower than senior GS trainees (O&G 11.4±4.4 vs GS 16.8±2.1, p=0.03). Whilst suturing scores improved with seniority among O&G trainees, there was no difference between the junior and senior GS trainees (senior O&G 11.4±4.4 vs junior O&G 3.6±2.1, p = 0.004).Discussion: GS trainees performed better than O&G trainees in core laparoscopic skills, and the structure of O&G training may require modification.Trial registration number: ClinicalTrials.gov Registry (NCT05116332).</div
Obstetrics and Gynecology Trainees Face Higher Musculoskeletal Demands than General Surgery Trainees in Simulated Laparoscopic Tasks—An Observational Study
No full textBackground/Objectives: Laparoscopic surgery has become the pre-eminent surgical approach for performing general surgical and gynecological operations, but it can lead to musculoskeletal disorder in surgeons. This study aimed to investigate the musculoskeletal demands of completing four core laparoscopic skills tasks amongst Obstetrics and Gynecology (O&G) and General Surgery (GS) trainees, recognizing that differences between specialties may create different ergonomic and muscular demands. Methods: Ten O&G and ten GS trainees both performed the same four tasks to evaluate their core laparoscopic skills whilst using electromyography (EMG) to assess the physical demand of each task in the trainee groups as a percent of maximum voluntary contraction. Results: O&G trainees had significantly higher muscle activity when completing a hand–eye coordination (HEC) task (167.9 ± 63.8 vs. 92.5 ± 31.3%, p = 0.019), bimanual coordination (BMC) task (205.6 ± 80.7 vs. 106.9 ± 47.0%, p = 0.017), and suturing (267.7 ± 121.6 vs. 122.2 ± 33.0%, p = 0.016) task in the right trapezius and deltoid muscle groups compared to GS trainees. No difference was observed between trainee groups in the laparoscopic camera navigation (LCN) task (p = 0.438). Conclusions: There appears to be increased muscular activity in O&G compared to GS trainees during the same simulated laparoscopic tasks. The findings should inform training policy around the optimization of ergonomics to minimize the risk of musculoskeletal disorder
Surgical stress : the muscle and cognitive demands of robotic and laparoscopic surgery
No full textIntroduction: 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 Conclusion: These data suggest greater muscle demands in laparoscopic surgery, but greater cognitive demands in robotic surgery
Obstetrics and Gynecology Trainees Face Higher Musculoskeletal Demands than General Surgery Trainees in Simulated Laparoscopic Tasks—An Observational Study
No full textBackground/Objectives: Laparoscopic surgery has become the pre-eminent surgical approach for performing general surgical and gynecological operations, but it can lead to musculoskeletal disorder in surgeons. This study aimed to investigate the musculoskeletal demands of completing four core laparoscopic skills tasks amongst Obstetrics and Gynecology (O&G) and General Surgery (GS) trainees, recognizing that differences between specialties may create different ergonomic and muscular demands. Methods: Ten O&G and ten GS trainees both performed the same four tasks to evaluate their core laparoscopic skills whilst using electromyography (EMG) to assess the physical demand of each task in the trainee groups as a percent of maximum voluntary contraction. Results: O&G trainees had significantly higher muscle activity when completing a hand–eye coordination (HEC) task (167.9 ± 63.8 vs. 92.5 ± 31.3%, p = 0.019), bimanual coordination (BMC) task (205.6 ± 80.7 vs. 106.9 ± 47.0%, p = 0.017), and suturing (267.7 ± 121.6 vs. 122.2 ± 33.0%, p = 0.016) task in the right trapezius and deltoid muscle groups compared to GS trainees. No difference was observed between trainee groups in the laparoscopic camera navigation (LCN) task (p = 0.438). Conclusions: There appears to be increased muscular activity in O&G compared to GS trainees during the same simulated laparoscopic tasks. The findings should inform training policy around the optimization of ergonomics to minimize the risk of musculoskeletal disorder
