The following is the summary of “Ergonomics in the OR: An Electromyographic Evaluation of Common Muscle Groups Used During Simulated Flexible Ureteroscopy – a Pilot Study” published in the December 2022 issue of Urology by Wright, et al.

A surface electromyography (sEMG) study was conducted using an endourology box-trainer model and a kidney phantom to evaluate the impact of various surgeon postures and ureteroscope types on muscle activation during simulated ureteroscopy. This pilot study used surface electromyography (sEMG) to assess muscle activity levels in 3 endourology fellows as they performed a variety of ureteroscopic procedures. Electrodes were attached to the thenar, forearm flexor, forearm extensor, biceps, triceps, deltoid, and trapezius muscles on the side of the body that was holding the ureteroscope. Participants used a cystoscopy table equipped with surgical drapes and an endoscopic video tower in a surgical setting while wearing a custom-fitted lead apron. 

Experiments were conducted in both the standing and seated postures using a disposable and reusable ureteroscope. To replicate the steps of the basketing, navigating the renal collecting system, and dusting procedures, each subject performed the same set of tasks in a phantom silicone kidney and ureteroscopy box trainer. In order to make meaningful comparisons between tasks, the raw EMG data was processed and normalized as a percentage of each subject’s maximum voluntary contraction. The forearm extensor muscle worked the hardest. While compared to when the subjects were standing, the subjects who were seated showed significantly higher levels of activity in the trapezius and deltoid muscles.

Reusable ureteroscopes are heavier than disposable ones, therefore using them requires more forearm extensor activation. According to preliminary data, there are discernible variations in muscle activation between surgical postures and ureteroscope designs. This emphasizes the importance of conducting additional EMG research to determine methods and tools that can improve ergonomics and reduce injury risk during flexible ureteroscopy.