Electromyography of the Sternocleidomastoid and Forearm Muscles During Laparoscopic Surgery (LS) and Robot-Assisted Laparoscopic Surgery (RALS)

Davitt, Matt and Hayes, Lawrence and Gaffney, Christopher and Subar, Daren (2026) Electromyography of the Sternocleidomastoid and Forearm Muscles During Laparoscopic Surgery (LS) and Robot-Assisted Laparoscopic Surgery (RALS). Masters thesis, Lancaster University.

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Abstract

Introduction Minimally invasive surgery (MIS), including robot-assisted laparoscopic surgery (RALS) and laparoscopic surgery (LS), has become a key method of conducting abdominal surgery. It has transformed surgical practise but has put surgeons at greater risk of musculoskeletal injury, potentially shortening careers. The use of surface electromyography (EMG) offers an objective method of quantifying muscular demand in surgery. This thesis aimed to evaluate EMG activity in key muscle groups of surgeons during RALS and LS, to determine differences in ergonomic risk and consider the scope of EMG as a tool to measure muscular demand within MIS. Methods A scoping review of the literature was conducted to synthesise current evidence of the use of EMG within the field of MIS. In total 96 unique studies were included with an identified lack of research in the comparison between RALS and LS in terms of muscular activation. An experimental study investigated the sternocleidomastoid and forearm muscle groups in surgeons when comparing RALS and LS using normalised EMG muscular activation as the primary measure. Results The literature indicated that EMG was a well-utilised and versatile tool within this field, with a heavy focus being placed on investigating muscular demand within LS but less so on RALS, simulated tasks and the comparison between RALS and LS. The experimental study suggested that there was no obvious acute difference in the sternocleidomastoid and forearm muscles when comparing RALS and LS, almost half of the variation in muscle activity between groups was due to surgeon variability and there was consistently higher muscle activation in the sternocleidomastoid compared to the forearm muscles. Conclusion EMG is a reliable tool for measuring muscular demand in minimally invasive surgeons. Evidence may suggest that RALS reduces muscular demand compared to LS in some muscles, but evidence is mixed and requires future meta-analyses and longitudinal studies to clarify any ergonomic benefits.