title: Ergonomics with the use of curved versus straight laparoscopic graspers during rectosigmoid resection: results of a multiprofile comparative study.
abstract: BACKGROUND
  A detailed ergonomic comparison of motions and muscular activity in the left upper extremity using a laparoscopic straight or curved grasper in rectosigmoid resection is presented.
  
  
  METHODS
  The study had two parts: experimental and clinical. In the experiment part, 30 laparoscopic sigmoid resections were performed under animal organ phantom conditions. The operations were divided into three groups according to instrument and trocar position. Group 1 (n = 10) underwent operations performed with a curved grasper in the excentral trocar position (in relation to the telescope trocar), with the left-hand curved grasper placed in the right flank and the right hand instrument in the right lower quadrant. In group 2 (n = 10), straight forceps were used in the excentral trocar position. Group 3 (n = 10) underwent laparoscopic sigmoid resection performed with a straight grasper in the central position (in relation to the telescope trocar), with the instruments placed at both sides of the lower abdomen. To measure ergonomic aspects during rectosigmoid resection, several overview video cameras, surface electromyography (EMG), an ultrasound tracking system (UTS), and a questionnaire were used. In the clinical part of the study, laparoscopic rectosigmoid resections (n = 5) were performed using a curved instrument in the excentral trocar position. The surgeon's left-hand movement and body posture were recorded for further analysis.
  
  
  RESULTS
  The curved grasper required the fewest contractions (group 1) of the measured muscles. A comparison of the UTS analysis in the experimental part of the study and the video analysis in the clinical part showed economy of movements in group 1. According to subjective estimation, both physical activity and mental stress remain at the lowest level when the excentral trocar position is used (groups 1 and 2).
  
  
  CONCLUSIONS
  The combination of the curved grasper and the excentral trocar position (in relation to the telescope trocar) is, according to our examinations, the best ergonomic adjustment for laparoscopic rectosigmoid surgery.
authors.affiliation: Section for Minimally Invasive Surgery, University Clinic of General, Visceral, and Transplantation Surgery, Waldhoernlestrasse 22, 72072, Tuebingen, Germany. grigorii@doctor.com
authors.forename: G A
authors.initials: GA
authors.lastname: Manukyan
authors.forename: M
authors.initials: M
authors.lastname: Waseda
authors.forename: N
authors.initials: N
authors.lastname: Inaki
authors.forename: J R
authors.initials: JR
authors.lastname: Torres Bermudez
authors.forename: I A
authors.initials: IA
authors.lastname: Gacek
authors.forename: A
authors.initials: A
authors.lastname: Rudinski
authors.forename: G F
authors.initials: GF
authors.lastname: Buess
mesh_terms: D000818:Animals; D002417:Cattle; D012809:Colon, Sigmoid / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D004195:Disease Models, Animal; D004867:Equipment Design; D004869:Equipment Safety; D006804:Ergonomics; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation; D011897:Random Allocation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020694:Sigmoidoscopes; D012812:Sigmoidoscopy / Q000379:methods*