Does surgeon sex and anthropometry matter for tool usability in traditional laparoscopic surgery? A systematic review and meta-analysis

Abstract

Introduction Hand size, strength, and stature all impact a surgeon’s ability to perform Traditional Laparoscopic Surgery (TLS) comfortably and effectively. This is due to limitations in instrument and operating room design. This article aims to review performance, pain, and tool usability data based on biological sex and anthropometry. Methods PubMed, Embase, and Cochrane databases were searched in May 2023. Retrieved articles were screened based on whether a full-text, English article was available in which original results were stratified by biological sex or physical proportions. Article quality was discussed using the Mixed Methods Appraisal Tool (MMAT). Data were summarized in three main themes: task performance, physical discomfort, and tool usability and fit. Task completion times, pain prevalence, and grip style results between male and female surgeons formed three meta-analyses. Results A total of 1354 articles were sourced, and 54 were deemed suitable for inclusion. The collated results showed that female participants, predominantly novices, took 2.6–30.1 s longer to perform standardized laparoscopic tasks. Female surgeons reported pain at double the frequency of their male colleagues. Female surgeons and those with a smaller glove size were consistently more likely to report difficulty and require modified (potentially suboptimal) grip techniques with standard laparoscopic tools. Conclusions The pain and stress reported by female or small-handed surgeons when using laparoscopic tools demonstrates the need for currently available instrument handles, including robotic hand controls, to become more size-inclusive. However, this study is limited by reporting bias and inconsistencies; furthermore, most data was collected in a simulated environment. Additional research into how anthropometric tool design impacts the live operating performance of experienced female surgeons would further inform this area of investigation.

The Appropriateness of Medical Devices Is Strongly Influenced by Sex and Gender

“…For example, the morphological sex differences in hand width, strength, height, arm span, etc., strongly indicate the need for instruments designed for single-sex anatomy to avoid ergonomic problems arising from the chronic use of instruments that are not adapted to health carers' morphological features. A recent meta-analysis related to Traditional Laparoscopic Surgery evidenced that female surgeons were slower and reported more pain (neck and shoulder) than their male counterparts [106].…”

Small Glove Size and Female Gender Are Associated with Greater Reported Difficulty Using Orthopaedic Instruments Among Residents

“…Second, most surgeons with smaller hands are female. How hand size affects instrument use and surgeon performance was first studied in the field of laparoscopic surgery, where surgeons and trainees with smaller hands (largely but not exclusively women) frequently reported more difficulty using single-size laparoscopic instruments 9,[11][12][13][14][15][16][17][18] . In addition to causing instruments to feel awkward or uncomfortable to use, instruments that are not properly sized can lead to overuse injuries and impact surgeon satisfaction and career longevity 19,20 .…”