Association Professor Cornell University College of Veterinary Medicine
A proportion of surgeons must compromise their ideal ergonomics to use laparoscopic instruments. Poor ergonomic design of laparoscopic instruments increases muscle fatigue, surgeon discomfort, and is considered a major risk factor for developing work related musculoskeletal disorders. Our objective was to investigate the effects of surgeon physical attributes on use and preference of laparoscopic instruments. We hypothesized that glove size would be associated with difficulty using certain laparoscopic instruments. An internet survey of surgeons with at least 3 years of laparoscopic experience was distributed on the list-serves of: VES, VSSO, SVSTS, VIRIES, ACVECC, and AWVS. Demographic and surgical practice data was collected. Glove sizes of 7.5 (28%) and 6 (23.5%) were most common. 37% of respondents reported musculoskeletal problems with neck (35%) and shoulder (31%) injuries being most common. Using the EndoGIA stapler was seen as more difficult by more respondents (42%). Glove size was significantly associated with difficulty using certain instruments. Reusable instruments were preferred over disposable for all tasks. Pistol grip instruments were preferred for grasping and retracting and for fine dissection. Axial grips were preferred for suturing and knot tying. Experienced surgeons with smaller glove sizes experienced more difficulty using certain laparoscopic instruments. The main study limitation is the survey basis of data collection which can be biased and miss possible participants. The relationship between glove size and difficulty with laparoscopic instruments and musculoskeletal injury sheds light on changes to laparoscopic instrumentation that could make laparoscopy safer for the surgeon and more efficient.
