Electromyographical study on surgeons in urology. II. Determination of muscular fatigue

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Abstract
An electromyographical fatigue analysis was performed in the operating theatre on four surgeons during 14 urological operations in which ‘direct endoscopy’ (cf. Luttmann el al. 1996, Part I) was applied. Surface electromyograms (EMG) were derived from the m. trapezius on both sides of the body, the right m. deltoideus, and the left m. erector spinae. The surgeons’ activities were documented by simultaneously recording an electrical activity code signal parallel to the EMGs. The electrical activity (EA) was formed from the raw EMG by rectification and continuous averaging. For purposes of spectral analysis, the EMGs were digitized and converted to the frequency domain by Fast Fourier Transformation. During the performance of endoscopic surgery, an increase in EA, as well as a spectral shift towards lower frequencies, are observed for at least one of the muscles under test in all of the operations. This indicates the development of muscular fatigue in the course of the operations. The finding is confirmed by applying a newly developed method for the joint analysis of the spectrum and the amplitude of EMGs (JASA) which permits discrimination between fatigue-induced and force-related changes in the EMG. Utilizing this method, the development of fatigue was confirmed for 11 of the 14 operations in the case of the right m. trapezius. The right trapezius muscle therefore constitutes a bottleneck for the performance of the operations. The endurance time was estimated from the increase in EA and compared with the actual duration of the operations. Since both are of the same order of magnitude, it is concluded that the final part of an operation has to be performed when the muscles are already fatigued. Application of the newly available method known as ‘monitor endoscopy’ (cf. Part I) can lead to a reduction in muscular strain and fatigue. This, in turn, will enable operations to be performed at less risk to the patient.