Articulating vs. conventional laparoscopic grasping tools - Surgeons' opinions

An ergonomically designed articulating laparoscopic prototype tool was developed based on task analyses, evaluation of current tools and surgeon's opinions. A questionnaire was developed to compare the prototype developed to conventional laparoscopic surgical grasping tools. Thirty-eight surgeons evaluated the prototype tool and shared their opinions via a written survey. Surgeons were asked about problems they experience with use of conventional grasper tools and then gave evaluations of the prototype grasper tool. A Wilcoxon Signed Rank Test was used to statistically analyze the questions. Results showed that a significant number of surgeons experience problems in each of fourteen problem areas, including physical (e.g. pain, stiffness and inability to perform precision motions) and cognitive (e.g. mental fatigue) difficulties. The responses had up to a 66% rate of experience by surgeons, with an alarming 29% of surgeons reporting numbness of the fingers or thumb after surgery with conventional tools. When asked to evaluate the prototype grasper, surgeons preferred the articulating prototype grasper to a conventional grasper, felt the prototype would alleviate discomfort caused by conventional tools and would be easier to manipulate. Laparoscopic surgery requires surgeons to perform complex operative procedures using a standardized set of tools. The surgeon performs the operation with surgical tools and video cameras that are inserted into the patient through port sites (trocars). Surgical tools used in laparoscopic surgery are still being developed, and many have been adapted from conventional surgical tools by adding a long (45-52 cm) stylus to fit through the trocar, putting the handle at a right angle to the long axis (shaft) of the tool. Although the advantages of minimally invasive surgery have been clearly established for the patient, studies have shown that the surgeon is faced with numerous disadvantages caused by poorly designed instrument handles, including the potential of harm to the surgeon due to awkward postures, high repetition and high force exertions and the likelihood of harm to the patient due to poorly designed tools. Thus, there is a crucial need to develop and assess laparoscopic tools that more fully address the needs of laparoscopic surgery and its surgeons.