Prediction of Muscle Fatigue during Minimally Invasive Surgery Using Recurrence Quantification Analysis

Abstract

Due to its inherent complexity such as limited work volume and degree of freedom, minimally invasive surgery (MIS) is ergonomically challenging to surgeons compared to traditional open surgery. Specifically, MIS can expose performing surgeons to excessive ergonomic risks including muscle fatigue that may lead to critical errors in surgical procedures. Therefore, detecting the vulnerable muscles and time-to-fatigue during MIS is of great importance in order to prevent these errors. The main goal of this study is to propose and test a novel measure that can be efficiently used to detect muscle fatigue. In this study, surface electromyography was used to record muscle activations of five subjects while they performed fifteen various laparoscopic operations. The muscle activation data was then reconstructed using recurrence quantification analysis (RQA) to detect possible signs of muscle fatigue on eight muscle groups (bicep, triceps, deltoid, and trapezius). The results showed that RQA detects the fatigue sign on bilateral trapezius at 47.5 minutes (average) and bilateral deltoid at 57.5 minutes after the start of operations. No sign of fatigue was detected for bicep and triceps muscles of any subject. According to the results, the proposed novel measure can be efficiently used to detect muscle fatigue and eventually improve the quality of MIS procedures with reducing errors that may result from overlooked muscle fatigue.

Tool-tissue forces in surgery: A systematic review

“…Using this data to assess the effect of human factors on operative performance (e.g. fatigue, personal stress) could facilitate the development of supportive work environments which optimise surgical care [ 56 , 57 ].…”

Muscle-specific endurance of the trapezius muscles using electrical twitch mechanomyography

“…In previous studies, fatigue of the trapezius or shoulder muscles have been measured as perceptions of fatigue or changes in surface EMG signals. 14,30 Standardized tests to identify fatigability in the trapezius muscles usually involve performing functional tasks based on activities of daily living. 14,30 Sustained or repetitive tasks have also been performed.…”

“…14,30 Standardized tests to identify fatigability in the trapezius muscles usually involve performing functional tasks based on activities of daily living. 14,30 Sustained or repetitive tasks have also been performed. 10,20,22,31 These tasks involved voluntary movements that can be limited by motivation or reduced central activation.…”

Shoulder Muscular Fatigue From Static Posture Concurrently Reduces Cognitive Attentional Resources

“…This bodes the question whether the attentional resource decline is independent of the muscular fatigue location. The physical demands previously identified for laparoscopic surgeons (Berguer et al, 2003;Panahi & Cho, 2016;Quick et al, 2003;Szeto et al, 2012) may have more far-reaching repercussions than previously heralded (Park et al, 2010); the current research demonstrates that the fatigue expected in the shoulder musculature may undermine the attentional resources and temporal decision-making necessary for procedural success (Goodell, Cao, & Schwaitzberg, 2006;Pugh et al, 2011). It is therefore doubly important that surgeons (and other workers that perform physically-fatiguing tasks that also demand attentional resources) attempt to mitigate this fatigue through job task manipulation (Raina & Dickerson, 2009), work breaks (Dorion & Darveau, 2013;Sundelin & Hegberg, 1989), or augmentation (Gillette & Stephenson, 2018) whenever possible (Bourne, Walcott, Sheth, & Coumans, 2013).…”