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.