Tung Kryztopher D, Shorti Rami M, Downey Earl C, Bloswick Donald S, Merryweather Andrew S
Mechanical Engineering Department, University of Utah, Salt Lake City, USA,
Surg Endosc. 2015 Sep;29(9):2500-5. doi: 10.1007/s00464-014-4005-9. Epub 2014 Dec 24.
Many factors can affect a surgeon's performance in the operating room; these may include surgeon comfort, ergonomics of tool handle design, and fatigue. A laparoscopic tool handle designed with ergonomic considerations (pistol grip) was tested against a current market tool with a traditional pinch grip handle. The goal of this study is to quantify the impact ergonomic design considerations which have on surgeon performance. We hypothesized that there will be measurable differences between the efficiency while performing FLS surgical trainer tasks when using both tool handle designs in three categories: time to completion, technical skill, and subjective user ratings.
The pistol grip incorporates an ergonomic interface intended to reduce contact stress points on the hand and fingers, promote a more neutral operating wrist posture, and reduce hand tremor and fatigue. The traditional pinch grip is a laparoscopic tool developed by Stryker Inc. widely used during minimal invasive surgery. Twenty-three (13 M, 10 F) participants with no existing upper extremity musculoskeletal disorders or experience performing laparoscopic procedures were selected to perform in this study. During a training session prior to testing, participants performed practice trials in a SAGES FLS trainer with both tools. During data collection, participants performed three evaluation tasks using both handle designs (order was randomized, and each trial completed three times). The tasks consisted of FLS peg transfer, cutting, and suturing tasks.
Feedback from test participants indicated that they significantly preferred the ergonomic pistol grip in every category (p < 0.05); most notably, participants experienced greater degrees of discomfort in their hands after using the pinch grip tool. Furthermore, participants completed cutting and peg transfer tasks in a shorter time duration (p < 0.05) with the pistol grip than with the pinch grip design; there was no significant difference between completion times for the suturing task. Finally, there was no significant interaction between tool type and errors made during trials.
There was a significant preference for as well as lower pain experienced during use of the pistol grip tool as seen from the survey feedback. Both evaluation tasks (cutting and peg transfer) were also completed significantly faster with the pistol grip tool. Finally, due to the high degree of variability in the error data, it was not possible to draw any meaningful conclusions about the effect of tool design on the number or degree of errors made.
许多因素会影响外科医生在手术室的表现；这些因素可能包括外科医生的舒适度、工具手柄设计的人体工程学以及疲劳程度。一款经过人体工程学考量设计的腹腔镜工具手柄（手枪式握把）与一款市场上现有的采用传统捏握式手柄的工具进行了测试对比。本研究的目的是量化人体工程学设计考量对外科医生表现的影响。我们假设在使用这两种工具手柄设计执行佛罗里达腹腔镜手术技能培训（FLS）任务时，在完成时间、技术技能和主观用户评分这三个类别上的效率会存在可测量的差异。
手枪式握把采用了一种人体工程学界面，旨在减少手部和手指上的接触应力点，促进手腕更自然的操作姿势，并减少手部震颤和疲劳。传统捏握式手柄是史赛克公司开发的一种腹腔镜工具，在微创手术中广泛使用。选择了23名（13名男性，10名女性）没有上肢肌肉骨骼疾病且没有腹腔镜手术经验的参与者参与本研究。在测试前的培训阶段，参与者使用这两种工具在SAGES FLS训练器中进行练习试验。在数据收集阶段，参与者使用两种手柄设计完成三项评估任务（顺序随机，每项试验重复三次）。任务包括FLS钉转移、切割和缝合任务。
测试参与者的反馈表明，他们在各个类别中都明显更喜欢人体工程学设计的手枪式握把（p < 0.05）；最值得注意的是，参与者在使用捏握式工具后手部不适感更强。此外，与捏握式设计相比，参与者使用手枪式握把完成切割和钉转移任务的时间更短（p < 0.05）；缝合任务的完成时间之间没有显著差异。最后，工具类型与试验期间所犯错误之间没有显著交互作用。
从调查反馈来看，对于手枪式握把工具，使用者不仅有明显的偏好，而且在使用过程中疼痛感更低。使用手枪式握把工具时，两项评估任务（切割和钉转移）的完成速度也明显更快。最后，由于错误数据的高度变异性，无法就工具设计对所犯错误的数量或程度的影响得出任何有意义的结论。
