Muscular workload of veterinary students during simulated open and laparoscopic surgery: A pilot study

Objective: To compare upper extremity muscle activity and workload between simulated open surgery, multiple port laparoscopic surgery (MLS), and single incision laparoscopic surgery (SLS) techniques in veterinary students. Study design: Pilot study. Population: Veterinary students (n510) from years 1 to 4. Methods: Bipolar skin surface electrodes were fixed bilaterally to the forearm flexor, forearm extensor, biceps brachii, triceps brachii, and upper trapezius muscles. Electromyography data were recorded during one repetition of 2 simulated surgical exercises via open surgery, MLS, and SLS. Participants completed a validated workload survey after each simulated surgical technique. Muscle activity and perceived workload were compared between surgical techniques with 1-way ANOVAs and Fisher's LSD post hoc tests. Results: Muscle activity during peg transfer was higher with MLS and SLS compared to simulated open surgery in the right and left forearm extensors (both P<. 0001), right (P<. 0001) and left biceps (P=.0005), right triceps (P=.0004), and right upper trapezius muscles (P=.0211). Similar results were found for the right and left forearm extensors (both P<. 0001), right (P=.0381) and left (P=.0147) forearm flexors, right biceps (P<. 0001), and right triceps (P=.0004) during a simulated suture task. Participants found laparoscopic techniques more mentally demanding, physically demanding, complex, and stressful compared to a simulated open surgical technique. Conclusion: In veterinary students, average muscle activity and perceived workload were highest using MLS and SLS compared to an open surgical technique when performing simulated surgical exercises in a laparoscopic box trainer.