Muscle Activity Patterns Change with Skill Acquisition for Minimally Invasive Surgery: A Pilot Study

This paper presents a pilot study to investigate which arm muscles change their activity most through skill acquisition in Minimally Invasive Surgery (MIS), specifically through training for laparoscopy. Three novice subjects trained with a laparoscopy training box with the hoop transfer game, in five experiment sessions of 20 minutes each in two weeks. We monitored the activity of three upper and two lower arm muscles – upper arm: Lateral Deltoid (LD), Biceps, Triceps; lower arm: Extensor Digitorum (ED), and Flexor Carpi Radialis (FCR) – with Surface-Electromyography (EMG) during the first and fifth (last) experiment sessions, before and after training, respectively. A consistent change in the activity of any of these muscles across the initial and final measurements would indicate which muscles were of most importance and subject to a change in activity pattern during laparoscopy training. The results showed that, after training and consistently across all three subjects, the ED and FCR muscle activities reduced at pick-up, whereas ED increased and FCR decreased at drop-off of the hoops. We did not find any noticeably consistent change in the activation patterns of the upper arm muscles. The results of this pilot study show that the lower arm muscles ED and FCR are important for laparoscopy training and inform us that we should focus on these two lower arm muscles in our future and extended studies in order to associate quantified changes of muscle activity with laparoscopy skill acquisition. Such quantified knowledge can be used in assessment of skills and developing training systems with feedback of biological sensors.