Ergonomic Design and Assessment of an Improved Handle for a Laparoscopic Dissector Based on 3D Anthropometry

Abstract

Laparoscopic surgery (LS) has been shown to provide great benefits to patients compared with open surgery. However, surgeons experience discomfort, low-efficiency, and even musculoskeletal disorders (MSDs) because of the poor ergonomic design of laparoscopic instruments. A methodology for the ergonomic design of laparoscopic dissector handles considering three-dimensional (3D) hand anthropometry and dynamic hand positions was addressed in this research. Two types of hand positions for grasping and stretching were scanned from 21 volunteers using a high-resolution 3D scanner. The 3D anthropometric data were extracted from these 3D hand pose models and used to design an improved handle (IH) that provides additional support for the thumb, a better fit to the purlicue, and a more flexible grasp for the index finger. Thirty subjects were invited to evaluate the IH in terms of muscular effort, goniometric study of motion, and efficiency and effectiveness during four trials of a laparoscopic training task. Questionnaires provided subjective parameters for ergonomic assessment. Positive results included less muscle load in the trapezius as well as significant but small angular differences in the upper limb. No significant reduction in the trial time and no increased percentage of the achievement were observed between the IH and the commercial handle (CH). Improved intuitiveness, comfort, precision, stability, and overall satisfaction were reported. IH provides significant ergonomic advantages in laparoscopic training tasks, demonstrating that the proposed methodology based on 3D anthropometry is a powerful tool for the handle design of laparoscopic dissectors and other surgical instruments.

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.…”

“…All these measurement methods appeared to be relevant and appropriately controlled. Seven studies utilized questionnaires to refine tool handle prototypes [ 54 , 55 , 57 , 62 , 65 , 66 , 68 ]; by nature these studies contained more subjectivity. 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.…”

“…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 ].…”

“…Figure 6 shows the most extreme values for the 5th and 95th percentiles of hand measurement based on data from Du et al [ 55 ], Green et al [ 58 ], Kasai et al [ 59 ], Kono et al [ 61 ], Matern and Waller [ 63 ], Ordóñez-Ríos et al [ 64 ], Sreekanth et al [ 65 ], and Stellon et al [ 67 ]. Some of these values were taken from the surgeons participating in the included studies, other measurements came from larger anthropometric investigations referenced within the articles.…”