Ergonomics of hand-assisted laparoscopic surgery.

Hand-assisted laparoscopic surgery (HALS) facilitates complex or advanced laparoscopic operations without appreciable loss of the advantages of the total laparoscopic approach. The internal hand enables atraumatic exposure and stretching of tissue planes, finger dissection, restores palpation of internal organs and structures, and provides a rapid and effective means of hemostasis. Particularly during complex surgery performed on the liver and pancreas, this ability to control bleeding by placing pressure between the index finger and thumb reduces the stress on the surgeon. HALS does, however, carry a number of ergonomic problems that are consequent on the encroachment of the hand and device on the workspace. It also imposes an awkward lordotic stance, hence back and shoulder strain on the surgeon. These problems can be resolved by further development of the hand-access devices and also with modifications of existing laparoscopic instruments, or the design and development of HALS-dedicated specific instrumentation. Further progress and increased scope of HALS will only be achieved with designs based on ergonomic research.