The effect of ergonomic laparoscopic tool handle design on performance and efficiency

Tung, Kryztopher D.; Shorti, Rami M.; Downey, Earl C.; Bloswick, Donald S.; Merryweather, Andrew

doi:10.1007/s00464-014-4005-9

Cited by 37 publications

(23 citation statements)

References 14 publications

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“…Additionally, two recent studies also reported clinical support for a pistol-grip handle design. A pistol grip would specifically meet the need to alleviate contact stress during instrument control [28, 29]. In summary, these results suggest that a haptic feedback grasper is best equipped with a pistol grip.…”

Section: Discussionmentioning

confidence: 98%

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

Alleblas

Vleugels²,

Nieboer

2016

Gynecol Surg

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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.

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Section: Discussionmentioning

confidence: 98%

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

Alleblas

Vleugels²,

Nieboer

2016

Gynecol Surg

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“…It seems that the use of an adequate size of instrument handle helps hand-eye coordination and bimanual dexterity in the development of laparoscopic tasks, reducing the execution time, as shown by the results of this study. Tung et al also presented an innovative laparoscopic handle design with a pistol grip attempting to address some of the ergonomic limitations in laparoscopic surgery [38]. Although the validation of this handle design was mainly subjective, they reported significantly shorter execution times in performing cutting and peg transfer tasks when compared to a conventional laparoscopic tool.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Previous studies have shown that the handle design of laparoscopic instruments is crucial to surgical performance and surgeon’s ergonomics. In this study, four different sizes of an ergonomic laparoscopic handle design were tested in a blind and randomized fashion with twelve surgeons. They performed three laparoscopic tasks in order to analyze the influence of handle size. Execution time, wrist posture, and finger and palm pressure were evaluated during the performance of each task. The results show a significant reduction in the time required to complete the eye-manual coordination task using the appropriate handle. The incorrectly sized handle resulted in a rise in palm pressure and a reduction in the force exerted by the thumb during the transfer task. In the hand-eye coordination task, the use of the right handle size led to an increase in middle finger pressure. In general, surgeons had an ergonomically adequate wrist flexion in all tasks and an acceptable radio-ulnar deviation during the transfer task using the ergonomic instrument handle. Surgeons found it comfortable the use of the ergonomic handle. Therefore, the use of an appropriately sized instrument handle allows surgeons to improve ergonomics and surgical performance during the laparoscopic practice.

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“…Originally developed for NASA astronauts, this questionnaire has been published in over 500 articles regarding use in industries including aviation, military, and healthcare [34]. This tool has also been used in surgery to distinguish workload differences between surgical techniques, laparoscopic tools, and procedures [17, 35]. After completing the task using all tools, participants ranked instrument from best to worst on a one to four ordinal scale.…”

Section: Methodsmentioning

confidence: 99%

“…Laparoscopic surgeons often need to apply more force to instruments, bend wrists more, and hold arms higher than in conventional surgery due to tool length and handle design. The ramifications of inadequate laparoscopic instrument design [7, 14-17] are complaints ranging from pain and numbness to nerve lesions, and studies have reported paresthesia in the hand or finger, rotator cuff strain, and cervical radiculopathy among surgeons performing laparoscopic procedures [1, 18-23]. …”

Section: Introductionmentioning

confidence: 99%

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

Lowndes

Morrow

et al. 2015

Surg Endosc

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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.

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The effect of ergonomic laparoscopic tool handle design on performance and efficiency

Cited by 37 publications

References 14 publications

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

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

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

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

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