Surgical stress: the muscle and cognitive demands of robotic and laparoscopic surgery.
Surgical stress: the muscle and cognitive demands of robotic and laparoscopic surgery.
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DOI：
10.1097/as9.0000000000000284
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发表时间：
2023-04-28
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影响因子：
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通讯作者：
Gaffney CJ
中科院分区：
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作者：
Shugaba A;Subar DA;Slade K;Willett M;Abdel-Aty M;Campbell I;Heywood N;Vitone L;Sheikh A;Gill M;Zelhof B;Nuttall HE;Bampouras TM;Gaffney CJ
外科医生是与工作相关的肌肉骨骼衰退风险最高的专业人士之一，他们对精神的要求很高。这项研究检测了外科医生在手术中的肌电(EMG)和脑电(EEG)活动。进行活体腹腔镜(LS)和机器人(RS)手术的外科医生进行了肌电和脑电测量。使用无线肌电图仪测量双侧4组肌肉(二头肌、三角肌、上斜方肌和背阔肌)的肌肉活动，并使用8通道无线脑电图仪测量认知需求。在(1)非危重肠壁剥离，(2)危重血管剥离，和(3)血管控制后剥离时，同时完成脑电和脑电记录。采用稳健单因素方差分析比较LS和RS的%MVCRMS和α功率。13名男性外科医生进行了26次LS和28次RS。LS组右侧三角肌(P=0.006)、上斜方肌(左侧P=0.041；右侧P=0.032)和背阔肌(左侧P=0.003；右侧P=0.014)的肌活性显著高于对照组。在两种手术方式中，右二头肌比左二头肌有更大的肌肉激活(P=0.0001)。手术时间对脑电活动有显著影响(P<；0.0001)。与LS相比，RS对α、β、β、增量和伽马的认知需求显著增加(P=0.002-P&t；0.0001)。这些数据表明，在腹腔镜手术中对肌肉的需求更大，但在RS中对认知的需求更大。这项试验在ClinicalTrials.gov(NCT04477746)上注册。本研究调查了外科医生在真实手术过程中的肌电和脑电活动。在腹腔镜手术中对肌肉的需求更大，但在机器人手术中对认知的需求更大。这些发现表明，机器人手术后肌肉骨骼损伤的风险较低。
Surgeons are among the most at-risk professionals for work-related musculoskeletal decline and experience high mental demands. This study examined the electromyographic (EMG) and electroencephalographic (EEG) activities of surgeons during surgery. Surgeons who performed live laparoscopic (LS) and robotic (RS) surgeries underwent EMG and EEG measurements. Wireless EMG was used to measure muscle activation in 4 muscle groups bilaterally (biceps brachii, deltoid, upper trapezius, and latissimus dorsi), and an 8-channel wireless EEG device was used to measure cognitive demand. EMG and EEG recordings were completed simultaneously during (1) noncritical bowel dissection, (2) critical vessel dissection, and (3) dissection after vessel control. Robust ANOVA was used to compare the %MVCRMS and alpha power between LS and RS. Thirteen male surgeons performed 26 LS and 28 RS. Muscle activation was significantly higher in the right deltoid (P = 0.006), upper trapezius (left, P = 0.041; right, P = 0.032), and latissimus dorsi (left, P = 0.003; right, P = 0.014) muscles in the LS group. There was greater muscle activation in the right biceps than in the left biceps in both surgical modalities (both P = 0.0001). There was a significant effect of the time of surgery on the EEG activity (P < 0.0001). A significantly greater cognitive demand was observed in the RS than in the LS with alpha, beta, theta, delta, and gamma (P = 0.002 – P <0.0001). These data suggest greater muscle demands in laparoscopic surgery, but greater cognitive demands in RS. This trial was registered at Clinicaltrials.gov (NCT04477746). Mini Abstract This study examined the electromyographic and electroencephalographic activities of surgeons during real-life surgery. There was greater muscle demand in laparoscopic surgery, but greater cognitive demand in robotic surgery. These findings indicate a lower risk of musculoskeletal injury after robotic surgery.