Electromyographic response is altered during robotic surgical training with augmented feedback

Ergonomics Analysis for Subjective and Objective Fatigue Between Laparoscopic and Robotic Surgical Skills Practice Among Surgeons

Introduction. Our aim was to determine how self-reported and objectively measured fatigue of upper limb differ between laparoscopic and robotic surgical training environments. Methods. Surgeons at the 2016 SAGES Conference Learning Center and at our institution were enrolled. Two standardized surgical tasks (peg transfer [PT] and needle passing [NP]) were performed twice in each surgical skills practical environments: (1) laparoscopic training-box environment (Fundamentals of Laparoscopic Surgery [FLS]) and (2) Mimic dV-trainer (MIMIC). Muscle activation of upper trapezius (UT), anterior deltoid (AD), flexor carpi radialis, and extensor digitorum were recorded using surface electromyography (EMG; Trigno, Delsys, Inc, Natick, MA). Subjective fatigue was self-reported using Piper Fatigue Scale-12. Analysis was done using SPSS v25.0, α = .05. Results. Demographics were similar between FLS (N = 14) and MIMIC (N = 12). For PT, MIMIC had a significant increase in EMG_RMS of UT (P < .001) and AD (P < .001). Conversely, FLS led to significant decreased muscle fatigue in UT (P = .015). For NP, MIMIC had a significant increase in EMG_RMS for UT (P = .034) and AD (P = .031), but FLS induced more muscle fatigue for AD (P = .004). There was significant decrease in self-reported fatigue after performing FLS tasks (P = .030) but not after MIMIC (P = .663). Conclusion. Our results showed that practice with MIMIC resulted in greater activation of shoulder muscles, while FLS caused more significant muscle fatigue in the same muscles. This could be due to ergonomic disadvantages and nonoptimal ergonomic settings. Further studies are needed to understand the optimal ergonomics and its impact on fatigue and muscle activation during use of both the FLS and MIMIC training systems.

Surgeons' muscle load during robotic-assisted laparoscopy performed with a regular office chair and the preferred of two ergonomic chairs: A pilot study

Surgeons work in awkward work postures and have high precision demands - well-known risk factors for musculoskeletal pain. Robotic-assisted laparoscopy is expected to be less demanding compared to conventional laparoscopy; however, studies indicate that robotic-assisted laparoscopy is also associated with poor ergonomics and musculoskeletal pain. The ergonomic condition in the robotic console is partially dependent upon the chair provided, which often is a regular office chair. Our study quantified and compared the muscular load during robotic-assisted laparoscopy using one of two custom built ergonomic chairs and a regular office chair. The results demonstrated no differences that could be considered clinically relevant. Overall, the study showed high levels of static and mean muscular activity, increased perceived physical exertion from pre-to-post surgery, and moderate to high risk for musculoskeletal injuries measured by the Rapid Upper Limb Assessment worksheet. Authors advocate for further investigation in surgeons' ergonomics and physical work demands in robotic surgery.

Skills learning in robot-assisted surgery is benefited by task-specific augmented feedback

BACKGROUND

Providing augmented visual feedback is one way to enhance robot-assisted surgery (RAS) training. However, it is unclear whether task specificity should be considered when applying augmented visual feedback.

METHODS

Twenty-two novice users of the da Vinci Surgical System underwent testing and training in 3 tasks: simple task, bimanual carrying (BC); intermediate task, needle passing (NP); and complex task, suture tying (ST). Pretraining (PRE), training, and posttraining (POST) trials were performed during the first session. Retention trials were performed 2 weeks later (RET). Participants were randomly assigned to 1 of 4 feedback training groups: relative phase (RP), speed, grip force, and video feedback groups. Performance measures were time to task completion (TTC), total distance traveled (D), speed (S), curvature, relative phase, and grip force (F).

RESULTS

Significant interaction for TTC and curvature showed that the RP feedback training improved temporal measures of complex ST task compared to simple BC task. Speed feedback training significantly improved the performance in simple BC task in terms of TTC, D, S, curvature, and F even after retention. There was also a lesser long-term effect of speed feedback training on complex ST task. Grip force feedback training resulted in significantly greater improvements in TTC and curvature for complex ST task. For the video feedback training group, the improvements in most of the outcome measures were evident only after RET.

CONCLUSIONS

Task-specific augmented feedback is beneficial to RAS skills learning. Particularly, the RP and grip force feedback could be useful for training complex tasks.

Training and learning robotic surgery, time for a more structured approach: a systematic review

BACKGROUND

Robotic assisted laparoscopic surgery is growing rapidly and there is an increasing need for a structured approach to train future robotic surgeons.

OBJECTIVES

To review the literature on training and learning strategies for robotic assisted laparoscopic surgery.

SEARCH STRATEGY

A systematic search of MEDLINE, EMBASE, the Cochrane Library and the Journal of Robotic Surgery was performed.

SELECTION CRITERIA

We included articles concerning training, learning, education and teaching of robotic assisted laparoscopic surgery in any specialism.

DATA COLLECTION AND ANALYSIS

Two authors independently selected articles to be included. We categorised the included articles into: training modalities, learning curve, training future surgeons, curriculum design and implementation.

MAIN RESULTS

We included 114 full text articles. Training modalities such as didactic training, skills training (dry lab, virtual reality, animal or cadaver models), case observation, bedside assisting, proctoring and the mentoring console can be used for training in robotic assisted laparoscopic surgery. Several training programmes in general and specific programmes designed for residents, fellows and surgeons are described in the literature. We provide guidelines for development of a structured training programme.

AUTHORS' CONCLUSIONS

Robotic surgical training consists of system training and procedural training. System training should be formally organised and should be competence based, instead of time based. Virtual reality training will play an import role in the near future. Procedural training should be organised in a stepwise approach with objective assessment of each step. This review aims to facilitate and improve the implementation of structured robotic surgical training programmes.