Ergonomic Assessment of a Laparoscopic Stapler

Abstract

The laparoscopic stapler is a surgical instrument that automatically creates visceral anastomosis. Although the laparoscopic stapler is widely used, objective ergonomic assessments are lacking. The purpose of this study was to quantitatively assess the force and muscle activities involved during the use of a laparoscopic stapler. The mechanical force needed to create anastomosis in a cattle colon was measured using a tensile tester. Three different loads (150 N, 200 N, and 250 N) were applied individually to compare the anastomosis conditions. The force and muscle activities of the operators of the laparoscopic stapler were also examined. Eleven healthy female subjects (age, 27.4±10.7 years) participated in the study. Force and surface electromyography (EMG) of the flexor digitorum superficialis and flexor digitorum profundus muscles during the use of the laparoscopic stapler were measured and compared to each subjectʼ s maximum grip strength. Approximately 250 N was necessary to operate the laparoscopic stapler appropriately. Although the mean grip strength of the subjects was 27.1±6.8 kg, the mean force applied when they gripped the laparoscopic stapler was 15.1±4.1 kg. Integrated EMG showed no differences between operating the laparoscopic stapler and gripping the hand dynamometer. This study demonstrated that the current design of laparoscopic stapler requires too much force to operate for individuals with small hands and/or low grip strength. In addition, the EMG results indicated that the enormous upper extremity muscular effort is not transmitted efficiently into power to operate the laparoscopic stapler, because of its handle design. Therefore, reconsidering the mechanism of the laparoscopic stapler is crucial to improve the usability of the laparoscopic stapler.

Does surgeon sex and anthropometry matter for tool usability in traditional laparoscopic surgery? A systematic review and meta-analysis

“…Twenty-nine non-randomized studies were included in this review [ 19 , 21 – 30 , 32 – 34 , 50 , 52 , 54 , 55 , 57 , 59 , 61 – 68 , 70 ]. For this study design, the MMAT considers appropriateness of measurement and analysis methods, administration of or exposure to intervention, completeness of results, accounting for confounders, and generalizability.…”

“…For this study design, the MMAT considers appropriateness of measurement and analysis methods, administration of or exposure to intervention, completeness of results, accounting for confounders, and generalizability. Data collection methods included physical measurements [ 50 , 55 , 59 , 61 , 63 – 67 ], EMG [ 52 , 55 , 59 , 68 ], dynamometry [ 59 , 61 , 63 , 70 ], and performance metrics [ 19 , 21 – 30 , 32 – 34 , 55 ]. All these measurement methods appeared to be relevant and appropriately controlled.…”

“…There was no concern about adherence to an experimental condition because in most studies participants were grouped based on inherent qualities, rather than an applied intervention. The factors of interest (including biological sex, physical proportions or strength, handedness, and surgical experience) did not change during the cross-sectional study [ 19 , 21 – 30 , 32 – 34 , 50 , 52 , 54 , 55 , 57 , 59 , 61 – 68 , 70 ]. Regarding completeness, a few studies reported dropout [ 24 , 33 ] or incomplete datasets [ 19 , 21 ].…”

Variables affecting surgeons’ use of, and preferences for, instrumentation in veterinary laparoscopy

“…Interestingly, left‐handed surgeons in our study also had a significant increase in difficulty with the endoscopic stapler, confirming the ergonomics of this specific instrument needs improvement to fully satisfy a wider population of veterinary surgeons. The use of endoscopic stapling equipment requires not only the force to close the jaws, which can be substantially higher than grip strength in surgeons with small glove size, 19 but also necessitates manipulation to cut the tissue and to articulate or position the blade. An improper handle‐to‐hand‐size relationship for surgeons with smaller glove sizes is likely responsible for the increased difficulty associated with performing maneuvers designed to be executed with a single hand.…”

Perceived comfort and tool usability during robot-assisted and traditional laparoscopic surgery: a survey study

“…The excessive force required to operate TLS tools is well documented. Kasai et al [ 19 ] demonstrated that 250 N was required to properly fire an anastomotic stapler. This level of force is sometimes unattainable for female surgeons due to their strength and grip diameter.…”