title: Ergonomic aspects of four different types of laparoscopic instrument handles with respect to elbow angle. An electromyogram-based study.
abstract: BACKGROUND
  Only few studies have tested different ergonomic aspects of the working posture assumed by laparoscopic surgeons. Although no experimental data are available for a laparoscopic setting, a working posture with a horizontal forearm or an elbow angle 90 degrees to 120 degrees has been recommended for performing minimally invasive surgery (MIS). The comparison of electromyogram (EMG) activities in different muscles provides information about the force developed by each muscle and allows assessment of its contribution to a functional movement. The current study aimed to investigate whether certain handles do not support this posture.
  
  
  METHODS
  For this study, 12 volunteers were postured in two different standardized arm positions, defined by elbow angles of 90 degrees and 120 degrees. They were manipulating a 0.1-N and a 2.5-N microswitch with four different types of instrument handle design: axial handle, ring handle, shank handle, Hirschberg handle. During the test, the EMG activities of five forearm muscles were recorded and normalized with respect to the maximum voluntary activity of the respective muscle.
  
  
  RESULTS
  Virtually no significant difference in EMG activity was found between the two elbow angles in any of five forearm muscles for a simple grasping maneuver. Thus, the muscle activity required to manipulate different types of MIS handles is similar for the elbow angles of 120 degrees and 90 degrees.
  
  
  CONCLUSIONS
  The current study did not show relevant differences between the two elbow angles for any of the four handles during a simple grasping maneuver with respect to the force required in the main forearm muscles.
authors.affiliation: Department of General Surgery, Study Group Surgical Technologies, University Hospital Freiburg, Hugstetter Strasse 55, 79106 Freiburg i. Br., Germany. matern@ch11.ukl.uni-freiburg.de
authors.forename: U
authors.initials: U
authors.lastname: Matern
authors.forename: C
authors.initials: C
authors.lastname: Giebmeyer
authors.forename: R
authors.initials: R
authors.lastname: Bergmann
authors.forename: P
authors.initials: P
authors.lastname: Waller
authors.forename: M
authors.initials: M
authors.lastname: Faist
mesh_terms: D004550:Elbow / Q000502:physiology*; D004576:Electromyography / Q000379:methods*; D006804:Ergonomics / Q000295:instrumentation*; D005542:Forearm / Q000502:physiology; D013502:General Surgery / Q000193:education; D006801:Humans; D020706:Laparoscopes; D018482:Muscle, Skeletal / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology*