Electromyography in abdominal laparoscopic and robot-assisted laparoscopic surgery: A scoping review

Technological advancements have expanded options available for minimally invasive surgery, particularly laparoscopic surgery (LS) and robot-assisted laparoscopic surgery (RALS). However, these developments raise important questions about their impact on surgeon performance and well-being. This scoping review aimed to systematically map the current literature on the use of electromyography (EMG) to assess muscle activation in surgeons performing LS and RALS.

This study was a scoping review of the literature and did not require ethical approval. This review was conducted following the Joanna Briggs Institute (JBI) guidelines and the PRISMA-ScR checklist. A comprehensive search was performed across multiple databases including MEDLINE, Scopus, PubMed, EMBASE, and others. Studies were screened and selected using the Population, Concept, and Context (PCC) framework. Data were charted using a custom extraction form and analysed descriptively. Studies were included if they took place in a surgical setting (including simulated environments) involving laparoscopic abdominal surgery and used EMG to measure electrical activity, ergonomics, or muscular stress of a muscle group.

Ninety-four unique studies published between 1997 and 2025 were included. Most studies focussed on LS (n = 62), with fewer investigating RALS (n = 5), comparing LS and RALS directly (n = 12) or isolated laparoscopic task settings (n = 15). EMG was primarily used to assess muscle activation in the deltoids, trapezius, and forearm muscles. Studies employed various methodologies, including root mean squared (RMS) amplitude and median frequency analysis, and often integrated EMG with other tools such as EEG, kinematic analysis, and questionnaires. Within the subset of comparative studies between RALS and LS, findings consistently suggested lower muscle activation in RALS compared to LS, particularly in the upper body musculature. However, this should be interpreted cautiously because the comparative evidence base is relatively small and heterogeneous.

EMG is a well-established and versatile tool for evaluating the ergonomic demands of minimally invasive surgery. While the broader literature maps the muscular demands of LS, a specific trend within comparative studies suggests RALS may reduce electrical activity compared to LS, especially in the shoulders and upper back. However, methodological variability and limited longitudinal data highlight the need for standardised protocols and further research. Future studies should explore long-term musculoskeletal outcomes and integrate EMG into surgical training to enhance ergonomic awareness. A future meta-analysis may be feasible, but only for carefully defined subgroups with comparable EMG protocols, task types, muscle groups, normalization procedures, and outcome measures.