Laparoscopic instruments cause increased forearm fatigue: A subjective and objective comparison of open and laparoscopic techniques

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Abstract
Background: Endoscopic surgery presents new ergonomic conditions for surgeons that may cause fatigue and decreased performance during prolonged laparoscopic procedures. This study uses a post-operative questionnaire and surface electromyography (EMG) to compare upper extremity discomfort and muscle contraction during real and simulated laparoscopic and open surgical tasks. Methods: We asked surgeons to rank upper extremity discomfort immediately following laparoscopic or open operations on a scale of 0–3. We also measured the surface EMG activity of the right upper forearm flexor and extensor compartment, Deltoid and Trapezius muscles in three surgeons during simulated surgical tasks. The maximum voluntary contraction (MVC) for each muscle was used to normalize the data between subjects. Statistical comparisons were carried out using paired t-tests and P lt; 0.05. Results: Surgeons reported a significant increase in moderate/severe discomfort of the dominant foream following laparoscopic operations. We found a significant increase in forearm flexor muscle contraction during tasks performed with the laparoscopic instrument compared to the haemostat (P = 0.01). Task repetition resulted in significant increases in the Deltoid (P = 0.02) and EDC (P = 0.05) muscle contractions with the laparoscopic instrument only. Conclusion: Use of laparoscopic instruments results in greater forearm discomfort, possibly due to the need for increased forearm flexor muscle contractions compared to conventional surgical instruments. Further studies and design changes are needed to optimize laparoscopic instrument design.