Electromyographic response is altered during robotic surgical training with augmented feedback |
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| Authors: | Timothy N. Judkins Dmitry Oleynikov Nick Stergiou |
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| Affiliation: | 1. Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, 100 Penn Street Suite 115, Baltimore, MD 21201, USA;2. Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA;3. HPER Biomechanics Laboratory, University of Nebraska at Omaha, Omaha, NE, USA;4. Department of Environmental, Agricultural and Occupational Health Sciences, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA;1. Laboratory of Image, Signal and Telecommunications Devices (LIST), CP165/51, Université Libre de Bruxelles, Avenue F. Roosevelt 50, 1050 Bruxelles, Belgium;2. UR2NF – Neuropsychology and Functional Neuroimaging Research Unit at CRCN – Centre de Recherches en Cognition et Neurosciences and UNI – ULB Neurosciences Institute, CP191, Université Libre de Bruxelles, Avenue F. Roosevelt 50, B1050 Bruxelles, Belgium;3. Department of Pediatric Neurology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Bruxelles, Belgium;1. Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong;2. Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong;3. Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong;4. School of Sport and Exercise, Massey University, New Zealand;5. School of Public Health, The University of Hong Kong, Hong Kong;1. City of Hope National Cancer Center, Duarte, CA, USA;2. Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA;3. Fundació Puigvert, Barcelona, Spain;4. Department of Urology, University of Tübingen, Tübingen, Germany;5. Department of Urology, University Vita-Salute San Raffaele, Milan, Italy;6. Department of Urology, University of Bern, Bern, Switzerland;7. Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA;8. Academic Urology Unit, University of Sheffield, Sheffield, UK;9. Karolinska University Hospital, Urology, Stockholm, Sweden;10. Department of Surgery, Oncology, and Gastroenterology – Urology Clinic, University of Padua, Padua, Italy;1. University Innsbruck, Department of Sport Science, Fürstenweg 185, A-6020 Innsbruck, Austria;2. Centre of Technology of Ski and Alpine Sport, Fürstenweg 185, A-6020 Innsbruck, Austria;3. Research Institute for Textile Chemistry and Textile Physics, Höchster Straße 73, A-6850 Dornbirn, Austria;1. Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan;2. Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan;3. TAOS Institute, Tokyo, Japan;1. Research Group in Sport Biomechanics (GIBD), Department of Physical Education and Sports, University of Valencia, Valencia, Spain;2. Biophysics and Medical Physics Group, Department of Physiology, University of Valencia, Valencia, Spain |
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| Abstract: | There is a growing prevalence of robotic systems for surgical laparoscopy. We previously developed quantitative measures to assess robotic surgical proficiency, and used augmented feedback to enhance training to reduce applied grip force and increase speed. However, there is also a need to understand the physiological demands of the surgeon during robotic surgery, and if training can reduce these demands. Therefore, the goal of this study was to use clinical biomechanical techniques via electromyography (EMG) to investigate the effects of real-time augmented visual feedback during short-term training on muscular activation and fatigue. Twenty novices were trained in three inanimate surgical tasks with the da Vinci Surgical System. Subjects were divided into five feedback groups (speed, relative phase, grip force, video, and control). Time- and frequency-domain EMG measures were obtained before and after training. Surgical training decreased muscle work as found from mean EMG and EMG envelopes. Grip force feedback further reduced average and total muscle work, while speed feedback increased average muscle work and decreased total muscle work. Training also increased the median frequency response as a result of increased speed and/or reduced fatigue during each task. More diverse motor units were recruited as revealed by increases in the frequency bandwidth post-training. We demonstrated that clinical biomechanics using EMG analysis can help to better understand the effects of training for robotic surgery. Real-time augmented feedback during training can further reduce physiological demands. Future studies will investigate other means of feedback such as biofeedback of EMG during robotic surgery training. |
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