Berguer R, Gerber S, Kilpatrick G, Beckley D
Department of Surgery, University of California Davis, 4301 X Street, Room 2310, Sacramento, CA 95817, USA.
Surg Endosc. 1998 Jun;12(6):805-8. doi: 10.1007/s004649900717.
Laparoscopic instruments incorporate both in-line and pistol-grip handle configurations, yet it is unclear which design is most advantageous for surgeons, particularly when operating at angles perpendicular to the surgeon's position. We present a detailed electromyographic (EMG) comparison of these handle configurations under different force and angle conditions.
Nine general surgeons used a Microsurge grasper with the handle in an in-line (MS-IL) and pistol (MS-PS) configuration, as well as a standard hemostat (HE), to grasp and close two spring-loaded metal plates. The task was performed randomly by each subject with the three instrument configurations at two forces levels (0.7 N, 4.2 N) and at three angles to the surgeons' body (0, 45, and 90 degrees). Surface EMG was measured from the flexor carpi ulnaris (FCU), flexor digitorum profundus (FDP), flexor digitorum superficialis (FDS), extensor carpi ulnaris (ECU), extensor digitorum comunis (EDC), and thenar compartment (TH). The peak root mean squared (RMS) EMG voltage was calculated for each instrument, force, and angle condition. Statistical comparison was carried out by ANOVA.
Both laparoscopic handle configurations required significantly higher contractions of all muscle groups compared to the hemostat at the high force level. TH was not affected by laparoscopic handle configuration. MS-IL required higher FCU, ECU, and EDC contractions at 45 degrees compared to MS-PS. However, MS-IL decreased the flexor compartment muscle contractions (FDP, FDS, FCU) at 90 degrees compared to MS-PS.
Laparoscopic grasping requires higher forearm and thumb muscle contractions compared to the use of a hemostat. The in-line handle configuration is no better than the pistol configuration except when grasping at 90 degrees to the surgeon, where rotation of the handle and wrist back toward the surgeon significantly decreases forearm flexor compartment muscle contractions.
腹腔镜器械包括直列式和手枪式握把配置，但尚不清楚哪种设计对外科医生最有利，尤其是在与外科医生位置垂直的角度操作时。我们对这些握把配置在不同力和角度条件下进行了详细的肌电图（EMG）比较。
九名普通外科医生使用手柄为直列式（MS-IL）和手枪式（MS-PS）配置的微型手术抓钳，以及标准止血钳（HE），来抓取并闭合两个弹簧加载的金属板。每个受试者以三种器械配置在两个力水平（0.7 N、4.2 N）以及与外科医生身体的三个角度（0、45和90度）随机执行该任务。从尺侧腕屈肌（FCU）、指深屈肌（FDP）、指浅屈肌（FDS）、尺侧腕伸肌（ECU）、指总伸肌（EDC）和鱼际肌间隙（TH）测量表面肌电图。计算每种器械、力和角度条件下的肌电图电压峰值均方根（RMS）。通过方差分析进行统计比较。
在高力水平下，与止血钳相比，两种腹腔镜握把配置都需要所有肌肉群明显更高的收缩。TH不受腹腔镜握把配置的影响。与MS-PS相比，MS-IL在45度时需要更高的FCU、ECU和EDC收缩。然而，与MS-PS相比，MS-IL在90度时降低了屈肌间隙肌肉收缩（FDP、FDS、FCU）。
与使用止血钳相比，腹腔镜抓取需要更高的前臂和拇指肌肉收缩。直列式握把配置并不比手枪式配置好，除非在与外科医生成90度抓取时，此时手柄和手腕向外科医生方向旋转会显著降低前臂屈肌间隙肌肉收缩。
