title: Comparison of neuromuscular injuries to the surgeon during hand-assisted and standard laparoscopic urologic surgery.
abstract: OBJECTIVE
  Hand-assisted procedures have assumed a greater role in the practice of many laparoscopists. We surveyed major laparoscopy program directors to compare the incidence and location of neuromuscular injury to the surgeon during hand-assisted laparoscopic (HAL) and standard laparoscopic (SL) surgery.
  
  
  METHODS
  A questionnaire on neuromuscular injuries was e-mailed to 42 laparoscopic program directors. Respondents were instructed to report only injuries or pain associated with laparoscopic surgery when they were the primary responsible surgeon and not during open or endoscopic procedures.
  
  
  RESULTS
  Surveys were returned from 23 attending laparoscopic surgeons and 2 laparoscopic fellows. Surgeons reported an average of 3.9 HAL and 6.3 SL cases per month as the primary surgeon. The HAL was completed with the GelPort, LapDisk, Omniport, or a combination of devices 55%, 22%, 5%, and 14%, respectively, of the time. Comparing HAL with SL, there was significantly more hand/wrist, forearm, and shoulder pain/injuries associated with HAL (P < 0.004). There was significantly more neck pain associated with SL than HAL (P < 0.003), but no significant difference in lower-back pain (P = 0.40). Comparing the two most commonly used hand-assist devices (GelPort and LapDisk), the LapDisk demonstrated significantly more hand/wrist pain or injury (P = 0.001).
  
  
  CONCLUSIONS
  Hand-assisted laparoscopy is associated with more frequent neuromuscular strain to the upper extremity than SL, but SL surgeons experience more neck pain or injury. Surgeon discomfort is also dependent on the type of hand-assist device. The long-term consequences of physical strain on the laparoscopic surgeon are unknown currently, but measures to minimize neuromuscular strain should be considered.
authors.affiliation: Department of Urology and Minimally Invasive Urology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA.
authors.forename: William K
authors.initials: WK
authors.lastname: Johnston
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Wolf
mesh_terms: D000328:Adult; D015331:Cohort Studies; D012090:Cumulative Trauma Disorders / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006230:Hand Injuries / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D020706:Laparoscopes / Q000009:adverse effects*; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000453:epidemiology / Q000209:etiology*; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods