Arm posture and muscular activity while inserting and aiming with laparoscopic tools

Two laparoscopic tools, a scissor-type grasper and an economically designed grasper, were compared in terms of arm posture and muscle activity during insertion into a trocar and during a standardized aiming task. Participants were asked to insert a laparoscopic tool into a simulated abdomen and hit five cross-shaped targets using their dominant hand; similar to reaching an organ during laparoscopic surgery. Twenty-six right-handed novice participants volunteered for the study. Two electrogoniometers were used to measure wrist flexion/extension, wrist deviation, and elbow flexion/extension angles. Six surface electrodes were used to measure %MVE of wrist flexors, wrist extensors, biceps brachii, triceps brachii, deltoid, and upper trapezius. The conditions used were five target positions, two touch screen monitor angles, and five hand postures. The scissors-type tool caused the largest wrist flexion, but the smallest %MVE from the wrist flexors. The method of gripping the tools was the most important factor determining joint angles and muscular load during the insertion and aiming tasks.