Ergonomic simulation investigating the association between surgeon characteristics and laparoscopic device strain in gynecologic surgery

Laparoscopic instruments are known to contribute to the ergonomic injury of surgeons. Laparoscopic devices have largely been designed as one-size-fits-all, however women surgeons and surgeons of smaller glove size have reported increased odds of physical strain from use of these devices. Our objective was to perform an ergonomic simulation to assess whether surgeon characteristics, including sex and hand size, were associated with grip strength decline with use of 3 advanced energy laparoscopic devices (LigaSure, HALO PKS, and ENSEAL). An ergonomic simulation was performed at an academic tertiary care site. 20 participants were recruited from the Department of Obstetrics and Gynecology between 2/2021-3/2021, matched by surgeon sex. Surgeon demographics and anthropometric measurements were collected in a standard fashion. Each participant was positioned in an idealized ergonomic posture and completed a fatiguing 120-second trial of rapid repetitive use of 3 laparoscopic advanced energy devices (LigaSure, HALO PKS, and ENSEAL) in a randomized order. A 5-minute rest period occurred in between each trial. A handheld dynamometer was used to collect grip strength measurements at baseline and throughout each 120-second trial. Subjects completed the NASA Raw Task Load Index (RTLX) scale after use of each device to assess ergonomic workload. 10 women (50%) and 10 men (50%) were recruited to complete the simulation. Women compared to men were found to have a significantly smaller hand span (20 vs 22 cm, p<0.01) and lower baseline grip strength (304 vs 428 N, p<0.01). Subjects with glove size <7 compared to size ≥7 also had a significantly lower baseline grip strength (286 vs 409 N, p<0.01). Grip strength decline was not found to be significantly associated with either surgeon sex or hand size. While female and male participants reported similar levels of RTLX workload for each device, surgeons of glove size <7 compared to ≥7 reported significantly more ergonomic workload for all cumulative devices (5.4 vs 4.3, p=0.04). Although surgeon sex and hand size were not found to be significantly associated with the amount of grip strength decline experienced throughout an ergonomic simulation using laparoscopic advanced energy devices, surgeons of smaller hand sizes still reported experiencing greater ergonomic workload. It is critical to further evaluate surgeon experiences using laparoscopic devices both in the operating room and through simulation models in order to fully understand the factors related to surgeon ergonomic strain.