First experiences with Augmented Gravity Bronchoscopy

<bold>Background:</bold> Bronchoscopy procedures involves long periods with elevated arm postures and static muscle activity for the bronchoscopist. In accordance, the bronchoscopists often experience pain in arms, shoulders and neck muscles. This study presents the first experiences with the use of a robotic weight relief system to support the bronchoscopist’s arm and thereby decrease muscle activity during EBUS. <bold>Methods:</bold> Six bronchoscopists each conducted two 40-minutes EBUS procedures on a GI-BRONCH Mentor (Surgical Science, Sweden) bronchoscopy simulator. One trial was done with conventional procedure and one with the robotic weight relief system attached with a wristband to the hand holding the EBUS-scope, and counteracting gravity to relieve the load of the shoulder muscles. Surface electromyography (EMG) were used to record forearm and shoulder muscles activity as % of maximal activation. Arm elevation was recorded by accelerometers. <bold>Results:</bold> Shoulder muscle activity was reduced, specifically, for the anterior and medial deltoid, when performing the weight-relieved bronchoscopy compared to the conventional procedure. In contrast, forearm muscle activity increased and also arm elevation angle increased with 5.9 degrees. <bold>Conclusion:</bold> The decrease in shoulder muscle activity indicated a positive impact of the weight relief system. The increase in arm elevation may be interpreted as the weight relief allowing a more optimal body posture for better scope positioning. The increased activity of the forearm may be caused by poor ergonomic design of the wrist-band. Together the pilot results provide an incentive for further development of the system to improve its effectiveness in reducing musculoskeletal pain among bronchoscopists.