Ergonomic differences in mesh placement and mesh fixation between laparoscopic and robotic inguinal hernia repair with mesh

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 28; no. 6; pp. 2355 - 2365
• Main Authors: Tieken, Kelsey R., Siu, Ka-Chun, Ma, Jihyun, Murante, Anthony, Tanner, Tiffany N., Kothari, Vishal M., Haskins, Ivy N.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.10.2024; Springer Nature B.V
• Subjects: Abdominal Surgery; Electromyography; Ergonomics; Fatigue; Hernia; Hernias; Laparoscopy; Medicine; Medicine & Public Health; Muscle contraction; Muscle fatigue; Original Article; Surgeons; Minimally invasive surgery; EMG analysis; Mesh placement; Ergonomics; Inguinal hernia
• ISSN: 1248-9204; 1265-4906; 1248-9204
• DOI: 10.1007/s10029-024-03168-9

Purpose General differences in surgeon ergonomics between laparoscopic and robotic-assisted inguinal hernia repairs (LIHR vs. RIHR) have been previously studied. However, specific differences in the ergonomics of mesh placement (MP) and mesh fixation (MF) are undetermined. Our aim was to determine if there are differences in the ergonomics of MP and MF between the surgical approaches. We hypothesize that we will identify differences, with the potential for worse ergonomics during LIHR. Methods Data was collected from fifteen LIHR and fifteen RIHR. All cases were elective, primary inguinal hernias completed by a fellowship-trained minimally invasive surgeon. Surface electromyography (EMG) of four upper extremity muscle groups, including the upper trapezius (UT), anterior deltoid (AD), flexor carpi radialis (FCR) and extensor digitorum (ED), was recorded bilaterally during MP and MF. Muscle activation as a percent of maximum voluntary contraction (%MVC RMS ) and muscle fatigue denoted as the median frequency of muscle activations (Fmed) were calculated for each muscle. Results EMG analysis showed increased %MVC RMS in LIHR compared to RIHR cases, with significant findings in the left UT, right UT, ED, and FCR for MP and MF and the left FCR during MP. Muscle fatigue was decreased in LIHR compared to RIHR cases, with significant differences in left FCR and right ED and AD. Conclusion Despite greater muscle activations during LIHR, RIHR had greater muscle fatigue. It is possible that short periods of high muscle activation are ergonomically protective during minimally invasive inguinal hernia repair. Identifying these differences may aid in development of procedure-specific interventions to improve ergonomics.