Ergonomics of laparoscopic graspers and the importance of haptic feedback: the surgeons’ perspective

Abstract

Haptic feedback is drastically reduced in laparoscopic surgery compared to open surgery. Introducing enhanced haptic feedback in laparoscopic instruments might well improve surgical safety and efficiency. In the design process of a laparoscopic grasper with enhanced haptic feedback, handle design should be addressed to strive for optimal usability and comfort. Additionally, the surgeons’ perspective on the potential benefits of haptic feedback should be assessed to ascertain the clinical interest of enhanced haptic feedback. A questionnaire was designed to determine surgeons’ use and preferences for laparoscopic instruments and expectations about enhanced haptic feedback. Surgeons were also asked whether they experience physical complaints related to laparoscopic instruments. The questionnaire was distributed to a group of laparoscopic surgeons based in Europe. From the 279 contacted subjects, 98 completed the questionnaire (response rate 35 %). Of all respondents, 77 % reported physical complaints directly attributable to the use of laparoscopic instruments. No evident similarity in the main preference for graspers was found, either with or without haptic feedback. According to respondents, the added value of haptic feedback could be of particular use in feeling differences in tissue consistencies, feeling the applied pressure, locating a tumor or enlarged lymph node, feeling arterial pulse, and limiting strain in the surgeon’s hand. This study stresses that the high prevalence of physical complaints directly related to laparoscopic instruments among laparoscopic surgeons is still relevant. Furthermore, the potential benefits of enhanced haptic feedback in laparoscopic surgery are recognized by laparoscopic specialists. Therefore, haptic feedback is considered an unmet need in laparoscopy.

A survey of work‐related musculoskeletal disorders associated with performing laparoscopic veterinary surgery

“…These percentages were lower than in some body areas; however, it has been shown that laparoscopic graspers require more force to operate compared with hemostats, and this can lead to surgeon discomfort . In this study, only 33% of respondents thought that the pain was attributable to laparoscopic surgery, which is less than in a study in those performing surgery in humans in which 77% attributed pain directly to laparoscopic instruments . With regard to ergonomics, 41% said that laparoscopic surgery has poor ergonomics compared with open surgery, and there were some additional responses that it depended on the operating room setup.…”

An Ergonomic Customized-Tool Handle Design for Precision Tools using Additive Manufacturing: A Case Study

“…Another fundamental challenge is faced when trying to make sure that the shape and dimensions of the design are consistent with the type and specific functionality of each instrument type [5]. For the instruments used in laparoscopic surgery, Alleblas et al [6] notes the need to assess expert opinions regarding the current designs of their handles. This is done in order to determine surgeons' needs and expectations with respect to the laparoscopic instruments they currently use and the possibility of the future implementation of haptic feedback in their design.…”

“…A few even appear in the healthcare sector, such as "Ergonomics Guidelines" [21] for surgical instruments, although none specifically discuss laparoscopic graspers. Most of these ergonomic design guides are too generic for specific applications, and there is a clear need to develop more specific guidelines for the ergonomic design of precision MIS tools [6,[22][23][24][25].…”

Finger-attachment device for the feedback of gripping and pulling force in a manipulating system for brain tumor resection

“…However, these manipulator systems do not have a force feedback system, which is used to find the mechanical compliance of tissues undergoing the microsurgery robotic operation [17][18][19][20][21]. The authors developed a force-detecting gripper and a force feedback system for neurosurgery applications [22].…”