Assessment of surgical proficiency based on evaluating muscle activity, bimanual muscle coordination, and fatigue susceptibility in simulated laparoscopic tasks.

Surgical complications pose significant risks to patient safety and impose financial burdens, underscoring the need for reliable surgical skill training. Effective skill training requires accurate assessment. Conventional assessment methods are often subjective and labor-intensive. While motion metrics evaluate surgical performance, they provide limited insight into physiological mechanisms. This study assessed surgical proficiency through electromyography (EMG) during simulated laparoscopic tasks. Eighteen participants were recruited: five experts, five intermediates, and eight novices. EMG signals were recorded from Biceps Brachii, Triceps Brachii, Brachioradialis, Wrist Flexors, and Wrist Extensors of both arms. Root mean squared (RMS) values assessed muscle activity amplitude, mutual information (MI) quantified bimanual coordination, and instantaneous median frequency (IMDF) evaluated fatigue susceptibility. Higher skill levels, compared to lower levels, had significantly lower RMS EMG values in Biceps and Triceps, suggesting more relaxed muscle states. They exhibited significantly higher MI values, indicating superior bimanual coordination. Novices showed a significant decline in mean IMDF over trials, highlighting fatigue susceptibility, particularly in the Biceps and Triceps. These findings underscore EMG metrics' merit in objectively assessing surgical skill, providing insight into motor control, coordination, and fatigue. This multilevel physiological approach can inform training strategies and ergonomic interventions to improve surgical performance and reduce fatigue risk.