V12-02: Analysis of Surgeon Biometrics During Open and Robotic Radical Cystectomy with Electromyography and Motion Capture Analysis
Three published randomized clinical trials have failed to demonstrate a significant advantage for robotics in patients undergoing radical cystectomy compared to open surgery, however, none of these trials have evaluated surgeon performance or preference regarding these procedures. The purpose of this study was to determine feasibility in measuring surgeon physical stress during both open radical cystectomy (ORC) and robotic radical cystectomy (RRC) using real-time motion capture and electromyographic (EMG) analysis.
After IRB approval, a single surgeon who routinely performs both ORC and RRC was recruited to participate in the study. Analysis was done in two patients, one patient who underwent ORC and the other RRC. Exclusion criteria included BMI > 35, history of prior radiation, node-positive disease, and >cT2 disease. The diversion was excluded from this study. The Noraxon® Biomechanical Analysis System version 3.8 was used for data analysis. We used 6 MyoMotion Kinematics Analysis Sensors to quantify the amount of joint and segmental motion of the spine, shoulders, and head. 16 channels of MyoMuscle EMG sensors were used to measure activation levels, patterns, and fatigue characteristics of key muscle groups. Surgeon strength and endurance of the core musculature was assessed with the Prone Static Plank Test (PSPT) and Modified Biering-Sorensen Test (MBST) before and after surgery each surgery. Validated techniques for motion and EMG data collection and processing were used.
Descriptive analyses were run for 5 stages of the surgeries representing ureteral dissection, posterior dissection, bladder and prostate pedicle dissection, dorsal vein ligation, and lymph node dissection. During ORC, the percentage of time spent in cervical flexion for each stage was 98%, 91.8%, 87.5%, 100%, and 97.1% respectively. During RRC, 100% of the time was spent in cervical flexion for all stages. Activation of key muscle groups for both procedures was examined across all 5 stages and expressed as a percentage of peak activation. The pre and post open surgery MBST was both 25 sec and the PSPT was 68 sec and 48 sec, respectively. The pre and post robotic surgery MBST was 25.1 sec and 32.4 sec, respectively and the PSPT was 59 sec and 51 sec, respectively.
We were able to identify meaningful data using motion and EMG analysis during ORC and RRC. Target muscle groups were identified that can be used to conduct a larger study with multiple surgeons to help identify if there is an ergonomic advantage to RRC over traditional ORC.
Funding: New Researcher Grant from the University of South Florida in conjunction with the School of Physical Therapy