The benefits of EMG-based monitoring in robotic-assisted surgeries
March 18, 2025
By Seth Grant, BSN, RN, Senior Clinical Product Specialist at Senzime
Robotic-assisted surgery (RAS) has significantly advanced the medical field by enabling precise, minimally invasive procedures. These surgeries rely on highly controlled movements, making the use of neuromuscular blocking agents (NMBAs) essential to immobilizing the patient during the procedure. Because of this, accurate and precise train-of-four (TOF) monitoring is crucial.
A key innovation in this space is the integration of electromyography (EMG)-based TOF monitoring. This technology measures compound muscle action potential (CMAP), offering real-time feedback and improving both surgical precision and patient safety.
EMG-based monitoring continuously assesses the patient’s neuromuscular activity, allowing anesthesia providers to make real-time adjustments to NMBA administration. By ensuring an appropriate level of muscle relaxation throughout the procedure, EMG-based monitoring improves both patient safety and surgical efficiency.
Studies have shown that EMG monitoring significantly reduces intraoperative complications compared to visual or tactile monitoring techniques (Weigel et al., 2022).
EMG-based monitoring continuously assesses the patient’s neuromuscular activity, allowing anesthesia providers to make real-time adjustments to NMBA administration. By ensuring an appropriate level of muscle relaxation throughout the procedure, EMG-based monitoring improves both patient safety and surgical efficiency.
Studies have shown that EMG monitoring significantly reduces intraoperative complications compared to visual or tactile monitoring techniques (Weigel et al., 2022).
Robotic surgeries require complete patient stillness to maintain optimal surgical conditions. EMG-based monitoring provides full visibility into all levels of neuromuscular block, from TOF ratio (TOFR) to post-tetanic count (PTC).
By utilizing PTC, providers can anticipate and prevent premature recovery of neuromuscular function, ensuring uninterrupted surgical conditions.
Unlike other neuromuscular monitoring technologies, EMG does not require calibration before induction. Even without a baseline measurement, anesthesia providers can track neuromuscular activity throughout the entire case. Because EMG measures CMAP, it remains effective even when the patient’s arms are tucked—an important advantage in robotic surgeries.
Since EMG monitoring does not rely on thumb or hand movement, it eliminates many limitations associated with other methods. As a result, EMG technology is the preferred choice for leading hospitals worldwide. The days of crawling under the surgical drape to count twitches are over.
By ensuring precise neuromuscular block management, EMG-based TOF monitoring reduces the risk of postoperative pulmonary complications, such as pneumonia or reintubation. Achieving a TOFR of >0.9 (90%) is critical in preventing residual neuromuscular blockade, and EMG monitoring helps providers reach this target effectively (Weigel et al., 2022).
Real-time visualization of neuromuscular activity supports adequate recovery and improves overall patient outcomes.
EMG-based monitoring enhances neuromuscular block management during RAS by enabling precise NMBA dosing, ensuring complete immobility, offering simple and versatile monitoring, and promoting optimal muscle recovery. This technology leads to more efficient, safer procedures with better patient outcomes.
As EMG technology continues to evolve, its role in robotic surgery is becoming increasingly crucial, providing smarter and more reliable surgical care.
Seth Grant, BSN, RN, Senior Clinical Product Specialist at Senzime
Weigel WA, Williams BL, Hanson NA, et al. “Quantitative Neuromuscular Monitoring in Clinical Practice: A Professional Practice Change Initiative.” Anesthesiology, 2022; 136(6):901-915. DOI: 10.1097/ ALN.0000000000004174.