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

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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 between tools. For FLS peg transfer, self-reported physical workload was lower for B than for A70, and mean wrist postures showed significantly higher flexion for in-line than for 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 for 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 for 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 of 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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Acknowledgments

The authors would like to acknowledge the support and participation of the surgeons involved in this study. We would also like to thank Mary, Ray, Laurie, and Pam for technical and administrative support. This study was funded in part by Stryker Endoscopy and by the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

Funding

Stryker Endoscopy, San Jose, CA (Yu, Lowndes, Morrow, Bingener, and Hallbeck); Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (Yu, Lowndes, Morrow, and Hallbeck); Mayo Clinic, Department of Surgery Research (Bingener and Hallbeck); U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (K23 DK 93553) (Bingener).

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Authors and Affiliations

  1. Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Denny Yu, Bethany Lowndes, Missy Morrow & Susan Hallbeck

  2. Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Bethany Lowndes, Missy Morrow & Kenton Kaufman

  3. Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Juliane Bingener & Susan Hallbeck

Authors
  1. Denny Yu
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  2. Bethany Lowndes
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  3. Missy Morrow
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  4. Kenton Kaufman
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  5. Juliane Bingener
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  6. Susan Hallbeck
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Corresponding author

Correspondence to Susan Hallbeck.

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Disclosures

Drs. Hallbeck and Bingener completed this study with funding from Stryker Endoscopy. Dr. Bingener is supported through a research grant (NIDDK K23 DK 93553), specified research through Nestle, has received travel support from Intuitive Surgical, and serves on the Surgeon Advisory Board for Titan Medical. Drs. Yu and Morrow have research funding from Stryker Endoscopy. Bethany Lowndes is supported through research grants from AHRQ and Stryker Endoscopy. Dr. Kaufman has no conflicts of interest or financial ties to disclose.

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Yu, D., Lowndes, B., Morrow, M. et al. Impact of novel shift handle laparoscopic tool on wrist ergonomics and task performance. Surg Endosc 30, 3480–3490 (2016). https://doi.org/10.1007/s00464-015-4634-7

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  • DOI: https://doi.org/10.1007/s00464-015-4634-7

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