Electromyographical study on surgeons in urology. I. Influence of the operating technique on muscular strain

Abstract

An electromyographical field study was performed in the operating theatre on four surgeons during 15 urological operations. In the course of the operations two endoscopic techniques were applied alternately: (1) direct endoscopy, and (2) monitor endoscopy. During direct endoscopy the surgeon looks into the urethra and the bladder via an endoscope. In monitor endoscopy, by contrast, the operating area is observed via a video system consisting of a camera mounted on top of the endoscope and a monitor. During the operations surface electromyograms were derived from both trapezius muscles, the right deltoideus muscle and the left erector spinae muscle. An activity code describing the surgeons' activity was additionally recorded. Analysis of the activity recording reveals that the monitor endoscopic method is preferred in the first third of the operations, whereas preference is given to the direct method in the last third. The electromyographical measurements indicate that during monitor endoscopy the myoelectrical activity of both trapezius muscles and of the right deltoideus muscle is significantly reduced in comparison with the activity for the direct endoscopic technique. A significant influence of the surgical technique on the myoelectrical activity could not be established for the erector spinae muscle. The electromyographical findings reveal that the activity of the shoulder musculature required for the maintenance of the posture and the performance of the operation is significantly lower in monitor endoscopy than in direct endoscopy. Consequently, a clear reduction in muscular strain can be achieved during the performance of endoscopic operations in urology if a video system is employed.

Muscular Strain and Fatigue among Urologists during Transurethral Resections Using Direct and Monitor Endoscopy

“…The EMGs were transmitted via a telemetric system and recorded on an analog magnetic tape. (A detailed description of the procedure for deriving, recording and evaluation of the EMGs is given in Luttmann et al [5, 6]). The evaluation of the EMGs was performed off-line.…”

“…The occurrence of muscular fatigue was indicated by means of typical fatigue-induced changes in the EMG amplitude and frequency spectrum. A comprehensive description of the methods used for the indication of muscular fatigue and some results of fatigue analyses in various field studies were presented previously [3, 4, 5, 6]. …”

Ergonomics in Office-Based Surgery: A Survey-Guided Observational Study

“…The ergonomic approach has been widely applied in office‐based surgical procedures, primarily in the field of dentistry or dental surgery 4–9 . In recent years, the science of ergonomics has been applied to other surgical specialties, including microsurgical procedures, laparoscopy, and minimally invasive surgical procedures 10–20 …”

Is rotating between static and dynamic work beneficial for our fatigue state?

“…Fig. 4 presents two-dimensional JASA plots (Joint Analysis of EMG Spectrum and Amplitude; Luttmann et al, 1996) for all muscles. The symbols in the subfigures for each of the rotation schedule are mainly in the lower right quadrant (increase in EMG amplitude accompanied by a decrease in median frequency), which indicates muscle fatigue (Basmajian and De Luca, 1985; Table 1).…”