An Exoskeleton Upper Extremity Support for Laparoscopic Surgery : A Pilot Simulation Study

Abstract

Background : Laparoscopic surgeons manipulate instruments placed through ports in the abdominal wall and can develop fatigue in the elbow and shoulder. We developed the Surgical Assist Suit (SAS), an exoskeleton wearable device that maintains upper extremity position at the surgeon's discretion. We conducted a pilot simulation study of the effectiveness of the SAS to reduce fatigue of the surgeon's upper extremities. Materials and Methods : The SAS maintains the upper extremities in a lifted position and has both locked and unlocked modes. Electromyography of both deltoid muscles of four skilled male laparoscopic surgeons was performed. The surgeon stood to the left of a laparoscopic training box and sutured with the right elbow elevated. The task involved placing interrupted sutures to close a 120mm incision in the posterior wall of an ex-vivo porcine stomach. Electromyography of both deltoid muscles was recorded, and the number of continuous sutures determined. A written questionnaire was administered after the simulation. Results : Electromyography of the right deltoid muscle with the SAS was 63% lower than without the SAS (p＝0.013) while the left deltoid muscle was higher (p＝0.020). The number of sutures increased while wearing the SAS (p＝0.073). The questionnaire showed a favorable opinion of the SAS. Conclusions : The SAS decreases muscle activity in the shoulder on the side of suturing and may increase suturing efficiency during laparoscopic surgery, especially with the elbow raised. Exoskeleton support devices may reduce surgeon physical fatigue while performing surgery.