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.