QS120 - Assessing Colon and Rectal Surgeon Workload During Open, Laparoscopic, and Robotic-assisted Procedures Through an Ergonomics-centered Case Study

Purpose/Background: Surgeons are exposed to a wide range of ergonomic stressors (e.g., asymmetric/extreme postures, extended low-level muscle contraction). As a result, they often experience musculoskeletal pain and discomfort. Colon and rectal surgeons may be at increased risk due to geometry and nature of rectal procedures; however, limited data exist regarding ergonomics specific to colon and rectal surgery. This study investigated colon and rectal surgeon workload using quantitative and qualitative methods, comparing open (OPN), laparoscopic (LAP), and robotic-assisted (ROB) procedures.

Methods/Interventions: A case study was performed with an experienced colon and rectal surgeon (14 yr) in an academic hospital. Surface electromyography (EMG) data were collected from 12 muscle sites during 8 low anterior resection surgical procedures (4 LAP, 2 OPN, 2 ROB). Amplitude and cumulative EMG data characterize exposure for each surgery. We focus here on the rectal dissection stage because it was common to all procedures. A modified SURG-TLX was used at the end of each procedure to assess participant’s perceived workload.

Results/Outcomes: For left and right finger flexor muscle groups, EMG activity during OPN and LAP surgery was significantly greater than during ROB, except for 90th %-ile EMG for left finger flexor group in which OPN resulted in greater muscle activity compared to LAP or ROB. Lower activity was recorded but for generally longer duration in ROB compared with higher activity levels but shorter durations in OPN surgeries (Fig. 1, 2).

For shoulder region muscles (middle deltoid, anterior deltoid, and upper trapezius), for 10th, 50th, and 90th %-ile values, OPN resulted in significantly greater activity compared to LAP and ROB surgery.

Neck extensor muscle activity during OPN was greater than LAP or ROB; however, for the left side 10th and 50th %-ile EMG values, ROB resulted in greater muscle activation than LAP. Analysis of erector spinae activity indicated comparable bilateral results, where OPN, LAP, and ROB all were significantly different from each other, with highest activity during OPN and lowest during ROB.

Qualitative analysis of the modified SURG-TLX indicated that for almost all procedures observed, mental and physical demands were perceived as high.

Conclusion/Discussion: Results indicate that various surgical platforms exert distinct ergonomic stresses. Although OPN procedures generally entail higher intensity, stress is typically of shorter duration compared to LAP or ROB approaches; the latter two subject surgeons to lower-intensity stress, that is more sustained over time. Given trade-offs between muscle activity amplitude and stage duration, cumulative muscle activity should be further explored to better appreciate workload experienced by colon and rectal surgeons.  This study, while limited to eight surgical procedures, illustrates a need for continued research into ergonomic challenges associated with colon and rectal surgery.