A comparison of the physical effort required for laparoscopic and open surgical techniques

Hypothesis: Performing complex tasks requires greater muscle effort with laparoscopic instruments than with open surgical instruments. Design: A nonrandomized 2-condition trial. Setting: A semienclosed ergonomics station in the exhibit hall at the Annual Meeting of the Society of American Gastrointestinal Endoscopic Surgeons. Subjects: Twenty-one surgeons volunteered to participate in the study. Interventions: Knot tying during 90 seconds, performed first using a laparoscopic technique (ie, axial instruments in a standard laparoscopic trainer) and then using an open technique (ie, 2 hemostats). Main Outcome Measures: Mean and peak surface electromyographic (EMG) signals collected from the thenar compartment, the flexor digitorum superficialis, and the deltoid muscles of the dominant arm. Results: Compared with open knot-tying, laparoscopic tasks resulted in higher average EMG amplitudes in all 3 muscles (thumb, P=.02 forearm flexor, P=.01 and deltoid, P=.01) and higher peak EMG in the thumb (P=.04) and deltoid (P=.02) muscles. Body part discomfort scores were significantly higher during laparoscopic knot-tying for the forearm flexor and deltoid muscles (P=.02 for both). Conclusion: Complex manipulative tasks using laparoscopic techniques require substantially higher upper extremity muscle effort compared with open surgical techniques.