title: Comparison of second-generation hand-assisted laparoscopic devices for surgeon pain and arm circulation.
abstract: OBJECTIVE
  To compare two second-generation hand-assist devices (HADs) for surgeon pain and manual blood flow over time in an in vitro model.
  
  
  METHODS
  Nineteen participants placed their nondominant hand through both the LapDisc and GelPort into a pneumoperitoneum chamber with an insufflation pressure of 15 mm Hg for a 2-hour test period. Pain, on a 10-point visual analog scale, and manual blood flow to the index finger using a laser Doppler skin probe were measured at 10 points during the 2 hours. Participants completed a questionnaire regarding hand comfort and the physical effects of the HAD.
  
  
  RESULTS
  At 30, 45, and 60 minutes after hand insertion, the pain scores were significantly greater for the GelPort than for the LapDisc (P = 0.04, P = 0.01, and P = 0.03, respectively). The GelPort caused an immediate reduction in manual blood flow, and the LapDisc caused a small initial increase in manual blood flow (P = 0.03) and, thereafter, a decrease in blood flow. Three participants voluntarily removed their hand at 30, 45, and 60 minutes owing to the pain from GelPort use. No participant withdrew from the LapDisc because of pain.
  
  
  CONCLUSIONS
  Both HADs resulted in surgeon discomfort in our in vitro model. The GelPort resulted in more subjective pain compared with the LapDisc. Both HADs caused a reduction in manual blood flow. However, compared with the LapDisc, the GelPort caused significantly more reduction in manual blood flow. Surgeon comfort is only one parameter to consider when choosing a HAD.
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: Sujata
authors.initials: S
authors.lastname: Prabhu
authors.forename: Caroline D
authors.initials: CD
authors.lastname: Ames
authors.forename: Yan
authors.initials: Y
authors.lastname: Yan
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
authors.forename: Ramakrishna
authors.initials: R
authors.lastname: Venkatesh
mesh_terms: D001132:Arm / Q000098:blood supply*; D004867:Equipment Design; D006801:Humans; D020706:Laparoscopes; D009784:Occupational Diseases / Q000209:etiology*; D012039:Regional Blood Flow; D013997:Time Factors