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

Abstract

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.

The effect of "Postural Freedom" in laparoscopic surgery

“…The results showed that the PF prototype increased the amount of time in neutral position during the experiment, especially in arm abduction, where the participants keep their arm position in neutral ranges 91,7% of the time (Table 5). This is an interesting results because the arm abduction movement is considered critic in laparoscopic surgery [19], [21], [37], [75], [76] and difficult to improve because of the practice [151]. The results obtained with the control instrument in the simulation task are consistent with the arm abduction results presented by previous literature during real procedures [76] being the results in real practice slightly worse probably due to the tension inherent to a real procedure.…”

“…The fact that they did not find significant differences between the angles 40° and 80° can be caused because each surgeon have their own optimal handle-to-shaft angle, and the use of the PF could be an effective solution to increase the comfort of the surgeons. In 2007, an study evaluating a rotatable instrument that can rotate 360° transversely to the shaft of the handle [151]. According the authors, the rotatable instrument allows some reductions of muscular activity in biceps and flexor carpi radials but they did not found these reductions on trapezius and deltoids.…”

“…The results obtained with the control instrument show the highest activity values in trapezius (Figure 43 and Figure 47) and deltoids muscles (Figure 44 and Figure 48) and the most unfavorable targets for these muscles were the Entrance and Exit target and the 135°, 180°, 225° and 270°. The cause of the high activity values during these targets is mainly the design of the instrument, because in these targets the fixed handle-to-shaft angle forces the participant to abduct and stretch the arm to reach the targets [37], [123], [151].…”

Ergonomic advantage of pistol‐grip endoscope in the ENT practice

“…To follow these studies, mMA value was used as an objective parameter to evaluate the ergonomic impact of grip design on targeted muscle during NPE, in this study. However, the sEMG value at the maximum voluntary contraction is often recorded as a reference value of a targeted muscle, to utilize the normalized sEMG value as a parameter to evaluate the level of muscle fatigue 6‐8,14 . Furthermore, a self‐reported questionnaire has been also used as a subjective parameter to evaluate ergonomic environment surrounding surgeons 13,14 .…”

“…Ergonomic analyses are widely applied today to workplace and tool design in the industry, 1,2 military, 3 sports, 4 and medicine 5 . Recently, multiple studies reported ergonomic benefits in the field of medical endoscopy, for example, laparoscopy 6,7 and ureteroscopy 8 . These reports highlighted that it is important to understand the biomechanical stress on physicians during endoscopy to identify the factors that may contribute to fatigue and discomfort related to daily clinical practice.…”