Design and evaluation of a new ergonomic handle for instruments in minimally invasive surgery

Sancibrián, Ramón; Gutierrez-Diez, María C.; Torre-Ferrero, Carlos; Benito-Gonzalez, Maria A.; Redondo‐Figuero, Carlos; Manuel-Palazuelos, José C.

doi:10.1016/j.jss.2013.12.021

Cited by 37 publications

(16 citation statements)

References 21 publications

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“…Previous studies looking at possible alleviating effects of ergonomic initiatives in LAP and RALS had contradictory results. The lack of a significant effect of ergonomic improvements may be explained by a number of studies reporting that surgeons do not utilize the ergonomic possibilities, or are even unaware of good ergonomic work practice.…”

Section: Discussionmentioning

confidence: 93%

Surgeons' posture and muscle strain during laparoscopic and robotic surgery

Dalager

Jensen

Eriksen

et al. 2020

British Journal of Surgery

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Background: It is assumed that conventional laparoscopy (LAP) and robotic-assisted laparoscopic surgery (RALS) differ in terms of the surgeon's comfort. This study compared muscle workload, work posture and perceived physical exertion of surgeons performing LAP or RALS.Methods: Colorectal surgeons with experience in advanced LAP and RALS performed one of each operation. Bipolar surface electromyography (EMG) recordings were made from forearm, shoulder and neck muscles, and expressed relative to EMG maximum (%EMG max ). The static, median and peak levels of muscle activity were calculated, and an exposure variation analysis undertaken. Postural observations were carried out every 10 min, and ratings of perceived physical exertion before and after surgery were recorded.Results: The study included 13 surgeons. Surgeons performing LAP showed higher static, median, and peak forearm muscle activity than those undertaking RALS. Muscle activity at peak level was higher during RALS than LAP. Exposure variation analysis demonstrated long-lasting periods of low-level intensity muscle activity in the shoulders for LAP, in the forearms for RALS, and in the neck for both procedures. Postural observations revealed a greater need for a change in work posture when performing LAP compared with RALS. Perceived physical exertion was no different between the surgical modalities.Conclusion: Minimally invasive surgery requires long-term static muscle activity with a high physical workload for surgeons. RALS is less demanding on posture. MethodsColorectal surgeons from two Danish hospitals participated. The surgeons were eligible if certified in both surgical modalities, had performed LAP and RALS almost equally, and had a high weekly caseload. The surgeons gave written informed consent to participate, and the Danish Data Protection Agency approved the study (record number 2015-57-0008). Approval from the regional ethics committee was sought, but the present study was exempted. Measurements were conducted on site during normal work procedures. Each surgeon performed two operations -one with LAP and one with RALS. Each of the procedures

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Section: Discussionmentioning

confidence: 93%

Surgeons' posture and muscle strain during laparoscopic and robotic surgery

Dalager

Jensen

Eriksen

et al. 2020

British Journal of Surgery

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“…35,36 Furthermore, new designs in laparoscopic handles, in this case with a pistol grip handle, compared with the ring handle instrument, was found to be superior in ergonomics. 37 A review has also proposed a framework for ergonomic research on laparoscopic handles to standardize the work on laparoscopic instrument design. 38 Moreover, Adams et al demonstrated that there is a need for more suitable disposable laparoscopic devices to better fit in the smaller hands of female surgeons.…”

Section: Discussionmentioning

confidence: 99%

Validation of a Novel Needle Holder to Train Advanced Laparoscopy Skills to Novices in a Simulator Environment

et al. 2020

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Background. Our aim was to determine if a newly designed Najar needle holder (NNH) shortens the time for novices to improve advanced laparoscopy (AL) techniques (suturing/knot tying), compared with a conventional macro needle holder (MNH) in a simulator. Furthermore, we aimed to validate a new video scoring system determining AL skills. Methods. Forty-six medical students performed identical surgical tasks in a prospective, crossover study evaluating AL skills (NNH vs MNH). All subjects performed a double-throw knot, 2 single-throw knots following 3 running sutures in the Simball Box (SB) simulator. After resting, subjects switched needle holders. All tasks were videotaped and analyzed using SB software and by 2 independent reviewers using the Objective Video Evaluation Scoring Table (OVEST). Trial performance expressed as SB Overall Score (SBOS) and OVEST. Results. In the group starting with NNH (followed by MNH) OVEST was consistently high during both trials (median = 12.5, range = 6.5-18.0, and median = 13.5, range = 6.5-21.0; P = .2360). However, in the group starting with MNH, OVEST improved significantly when the participants changed to NNH (median = 10.0, range = 2.5-19.5, vs median = 14.5, range = 4.5-18.0; P = .0003); an improvement was also found with SBOS (median = 37%, range = 27% to 92%, vs median = 48%, range = 34% to 70%; P = .0289). In both trials, both independent reviewers’ OVEST measures correlated well: Trial 1: β = 0.97, P < .0001; and Trial 2: β = 0.95, P < .0001. A correlation also existed between SBOS and OVEST in both trials (β = 2.1, P < .0001; and β = 1.9, P = .0002). Conclusions. This study indicates a significantly higher improvement in laparoscopic suturing skills in novices training AL skills using NNH compared with MNH. Starting early, AL training in novices using NNH is a feasible option. Furthermore, OVEST used in experimental settings as an evaluation tool is comparable with the validated SBOS.

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“…A lot of research interest has been devoted to the interface between the laparoscopic instrument and the surgeon since technical and ergonomic features are continuously being developed (Berguer, Forkey, & Smith, 2001; Berguer, Gerber, Kilpatrick, Remler, & Beckley, 1999; Emam, Frank, Hanna, & Cuschieri, 2001; Matern, Koneczny, Tedeus, Dietz, & Buess, 2005; Matern, Kuttler, Giebmeyer, Waller, & Faist, 2004; Matern & Waller, 1999; Sancibrian et al, 2014; Uchal, Brogger, Rukas, Karlsen, & Bergamaschi, 2002; van Veelen et al, 2003; van Veelen & Meijer, 1999; van Veelen, Meijer, Goossens, & Snijders, 2001). In this context, this study evaluated a pistol grip handle piece that can rotate 360° transversely to the instrument’s shaft (rot-HP).…”

Section: Introductionmentioning

confidence: 99%

Ergonomic Benefits From a Laparoscopic Instrument With Rotatable Handle Piece Depend on the Area of the Operating Field and Working Height

Steinhilber¹,

Reiff²,

Seibt³

et al. 2017

Hum Factors

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Objective To evaluate the effect of a laparoscopic instrument with a 360° rotatable handle piece (rot-HP) on biomechanical stress and precision in different areas of a simulated operating field at two working heights. Background Surgeons performing laparoscopic procedures are exposed to biomechanical stress and have an increased risk of musculoskeletal complaints. Method Fifty-seven healthy subjects (27 men, median age 26) without experience in laparoscopy performed a precision task in four quadrants (A-D) of the operating field using the rot-HP or a common fixed handle piece (fixed-HP) at an individually adjusted lower or higher working height. Biomechanical stress was assessed by surface EMG, wrist joint angles, and arm postures and precision by the number of mistakes. Results Using the rot-HP reduced muscle activity of the biceps brachii and flexor carpi radialis muscle. An interaction of flexor activity and area of the operating field occurred with the lowest activity in Quadrant C. Wrist joint angles were more neutral using the rot-HP, especially when the lower working height was applied and in Quadrants B and C. However, increased wrist dorsal flexion occurred in Quadrant A while using the rot-HP. Arm postures and precision were less affected. Conclusion The rot-HP allows some reductions of stresses in the arm and hand region, whereas the stress in the shoulder neck region is not modified. Application The instrument's position and the working height may have to be considered as mediatory factors when describing the effectiveness of an ergonomic handle design for laparoscopic instruments.

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Design and evaluation of a new ergonomic handle for instruments in minimally invasive surgery

Cited by 37 publications

References 21 publications

Surgeons' posture and muscle strain during laparoscopic and robotic surgery

Surgeons' posture and muscle strain during laparoscopic and robotic surgery

Validation of a Novel Needle Holder to Train Advanced Laparoscopy Skills to Novices in a Simulator Environment

Ergonomic Benefits From a Laparoscopic Instrument With Rotatable Handle Piece Depend on the Area of the Operating Field and Working Height

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