Impact of novel shift handle laparoscopic tool on wrist ergonomics and task performance

Abstract

Background Laparoscopic tool handles causing wrist flexion and extension more than 15° from neutral are considered “at-risk” for musculoskeletal strain. Therefore this study measured the impact of laparoscopic tool handle angles on wrist postures and task performance. Methods Eight surgeons performed standard and modified Fundamentals of Laparoscopic Surgery (FLS) tasks with laparoscopic tools. Tool A had three adjustable handle angle configurations, i.e., in-line 0° (A0), 30° (A30), and pistol-grip 70° (A70). Tool B was a fixed pistol-grip grasper. Participants performed FLS peg transfer, inverted peg transfer, and inverted circle-cut with each tool and handle angle. Inverted tasks were adapted from standard FLS tasks to simulate advanced tasks observed during abdominal wall surgeries, e.g., ventral hernia. Motion tracking, video-analysis, and modified NASA-TLX workload questionnaires were used to measure postures, performance (e.g., completion time and errors), and workload. Results Task performance did not differ among tools. For FLS peg transfer, self-reported physical workload was lower for B than A70, and mean wrist postures showed significantly higher flexion for in-line than pistol-grip tools (B and A70). For inverted peg transfer, workload was higher for all configurations. However, less time was spent in at-risk wrist postures for in-line (47%) than pistol-grip (93-94%), and most participants preferred Tool A. For inverted circle cut, workload did not vary across configurations, mean wrist posture was 10° closer to neutral for A0 than B, and median time in at-risk wrist postures was significantly less for A0 (43%) than B (87%). Conclusion The best ergonomic wrist positions for FLS (floor) tasks are provided by pistol-grip tools and for tasks on the abdominal wall (ventral surface) by in-line handles. Adjustable handle angle laparoscopic tools can reduce ergonomic risks for musculoskeletal strain and allow versatility for tasks alternating between the floor and ceiling positions in a surgical trainer without impacting performance.

Natural-Setting PHR Usability Evaluation using the NASA TLX to Measure Cognitive Load of Patients

“…We chose to use the NASA Task Load Index (NASA TLX) to subjectively, quantitatively measure participants' cognitive load in this study given its multi-dimensional nature and its use within the healthcare and health information technology domains [41][42][43][44][45][46]. This validated instrument yields a computed cognitive load score based on either raw or weighted averages of a subject's rating across the following six subscales: mental demand, physical demand, temporal demand, performance, effort, and frustration [39].…”

Validation of Inertial Measurement Units for Upper Body Kinematics

“…Upper body kinematic measures are widely used in ergonomics 1–2 , orthopedics 3–4 , and rehabilitation 5–7 to describe normal and pathological motion of the trunk, head, and arms. Traditional methods of motion capture utilize marker-based and electromagnetic laboratory-based systems to acquire highly accurate (within 1–3°) kinematic quantification 6 .…”

Comparative Study of the Use of Different Sizes of an Ergonomic Instrument Handle for Laparoscopic Surgery

“…This posture was also maintained for all the different handle sizes evaluated in the study. Other studies, using commercially available instruments [40] and prototypes of instrument handles [41,42], also reported that a pistol handle configuration provides an ergonomically adequate wrist flexion, providing a significantly better wrist posture than using a conventional laparoscopic tool. The results of the presented study are consistent with those presented in a previous study in which we evaluated another ergonomic power grip handle for a handheld robotic laparoscopic instrument [43].…”