title: Ergonomic comparison of laparoscopic hand instruments in a single site surgery simulator with novices.
abstract: BACKGROUND
  Single-site surgery improves cosmesis but increases procedural difficulty. Enhanced instruments could improve procedural efficiency leading to better patient outcomes.
  
  
  METHODS
  One pair of non-articulating (straight) and two different pairs of articulating laparoscopic instruments were evaluated using a peg-transfer surgical task simulator by premedical college students. The instruments were comparatively tested using task performance measures, ergonomic measures, and participant questionnaires.
  
  
  RESULTS
  The straight instrument produced significantly higher task performance scores and lower task times compared to both articulating instruments (p < 0.05). The straight instrument required less muscle activation and less wrist deviation than the articulating instruments to perform the same task. Participants rated the straight instrument significantly easier to use and less difficult to complete the task than with either articulating instrument (p < 0.05 for both).
  
  
  CONCLUSIONS
  This exploratory study suggests that novices have difficulty using articulating instruments and perform better using straight laparoscopic instruments when first attempting LESS surgical tasks. Although a study with post-graduate medical trainees is needed to confirm these results, trainees should initially practice LESS with non-articulating instruments to gain proficiency at basic laparoscopic tasks. Additionally, redesigning articulating instruments to specifically address the spatial constraints and learning curve of LESS may also improve trainee performance and instrument usability.
authors.affiliation: University of Nebraska Medical Center , Omaha, NE , USA.
authors.forename: Jakeb D
authors.initials: JD
authors.lastname: Riggle
authors.forename: Emily E
authors.initials: EE
authors.lastname: Miller
authors.forename: Bernadette
authors.initials: B
authors.lastname: McCrory
authors.forename: Alex
authors.initials: A
authors.lastname: Meitl
authors.forename: Eric
authors.initials: E
authors.lastname: Lim
authors.forename: M Susan
authors.initials: MS
authors.lastname: Hallbeck
authors.forename: Chad A
authors.initials: CA
authors.lastname: LaGrange
mesh_terms: D000293:Adolescent; D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D004867:Equipment Design; D006804:Ergonomics; D005260:Female; D006225:Hand / Q000502:physiology; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation*; D059032:Learning Curve; D008297:Male; D012737:Sex Factors; D014953:Wrist / Q000502:physiology; D055815:Young Adult
keywords: SILS; ergonomics; simulation; single access laparoscopic surgery laparoscopic instruments