New ergonomic design criteria for handles of laparoscopic dissection forceps.
ABSTRACT The shape of laparoscopic instrument handles can cause physical discomfort. This problem may be ascribed to a lack of standards for instrument design. In this study, new ergonomic requirements for the design of laparoscopic dissection forceps were created. Three representative handles (a Karl Storz [click-line] scissors handle, an Access Plus scissors handle, and an Aesculap cylindrical handle) currently available on the market were evaluated according to the new list of ergonomic criteria.
The handles were subjectively (questionnaire) and objectively (video analyses) tested in order to find out whether the new requirements are valid for the evaluation and design of instrument handles.
The outcome of the subjective and objective tests matched the predictions by the new criteria list. New criteria were introduced (neutral wrist excursions), and existing general criteria were specified (e.g., a minimal contact area of 10 mm). Significant differences were found among the three handles. The Storz handle met 8 of the 10 requirements, the Access handle met 5, and the Aesculap handle met only 4.
The new list of ergonomic requirements is a valid tool to determine the ergonomic value of a handle for laparoscopic dissecting tasks. It gains its strength from its specialized character. Significant differences were found among the three tested handles. Cylindrical handles were inferior to scissors handles.
Full-textDOI: · Available from: Richard Goossens, Feb 04, 2015
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- "Overall, physical ergonomic issues have been identified in the operating room environment: the operating room table height, width and adjustability (Albayrak et al., 2004; Kranenburg & Gossot, 2004; Matern & Koneczny, 2007; Van Veelen,, Jakimowicz, & Kazemier, 2004), OR lights and lighting (Kaya et al., 2008; Matern & Koneczny, 2007), floor space and layout of ORs (Albayrak et al., 2004; Decker & Bauer, 2003; Kaya et al., 2008; Koneczny, 2009; Kranenburg & Gossot, 2004), trip hazard from cables (Koneczny, 2009; Matern & Koneczny, 2007), and monitor placement (Albayrak et al., 2004; Berguer, 1999; Decker & Bauer, 2003; Kaya et al., 2008; Matern & Koneczny, 2007; Van Veelen et al., 2001); Lin et al., 2007;. There has also been work examining the tools provided in the OR, especially those for minimally invasive or laparoscopic surgery: instruments (Kaya et al., 2008; Matern, 2001; Nguyen et al., 2001; Sheikhzadeh et al., 2009; Trejo et al., 2006; Trejo et al., 2007; Van Veelen et al., 2001), instrument carts (Albayrak et al., 2004; Sheikhzadeh et al., 2009), and foot pedals (Kranenburg & Gossot, 2004; Van Veelen et al., 2001). In addition, work has continued on identifying and quantifying the negative effects experienced by surgical team members as a result of the postures adopted during procedures (Albayrak et al., 2007; Kranenburg & Gossot, 2004; Matern & Koneczny, 2007), which can result in pain or work related musculoskeletal disorders (Forst, Friedman, & Shapiro, 2006; Gerbrands, Albayrak, & Kazemier, 2004; Kaya et al., 2008; Koneczny, 2009; Nguyen et al., 2001; Park et al., 2010; Sheikhzadeh et al., 2009). "
ABSTRACT: Given the complexity of health care and the 'people' nature of healthcare work and delivery, STSA (Sociotechnical Systems Analysis) research is needed to address the numerous quality of care problems observed across the world. This paper describes open STSA research areas, including workload management, physical, cognitive and macroergonomic issues of medical devices and health information technologies, STSA in transitions of care, STSA of patient-centered care, risk management and patient safety management, resilience, and feedback loops between event detection, reporting and analysis and system redesign.07/2011; 1(1):145-160. DOI:10.1080/19488300.2011.619158
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- "Physicians report that limited dexterity at the grasper tip can cause them to compensate with excessive, awkward arm motions (Van Veelen et al. 2001b). Articulation at the tip would enhance the capability of the surgeon by increasing the tool's degrees of freedom. "
ABSTRACT: 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.Relevance to industryLaparoscopic 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.International Journal of Industrial Ergonomics 01/2006; 36(1-36):25-35. DOI:10.1016/j.ergon.2005.06.008 · 1.21 Impact Factor
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ABSTRACT: This paper presents the design and fabrication of a novel minimally invasive surgical (MIS) tool – FlexDex TM – that provides enhanced dexterity, intuitive actuation, and natural force feedback in a cost-effective compact package. These attributes are accomplished by means of a fundamentally new MIS tool design paradigm that employs a tool reference attached to the surgeon's arm, and utilizes a virtual center at the tool input that coincides with the surgeon's wrist. The resulting physical configuration enables a highly intuitive one-to-one mapping of the surgeon's arm and hand motions at the tool input to the end-effector motions at the tool output inside the patient's body. Furthermore, a purely mechanical design ensures low-cost, simple construction, and natural force feedback. A functional decomposition of the proposed design paradigm and associated physical configuration is carried out to identify key modules in the system. This allows for the conceptual and detailed design of each module, followed by system-level integration. The key innovative aspects of the tool design include a three-dimensional parallel-kinematic virtual center mechanism, a decoupled 2DoF end-effector design, and the associated transmissions system.Journal of Medical Devices 01/2009; 4(3). DOI:10.1115/DETC2009-87824 · 0.62 Impact Factor