title: Effect of a laparoscopic instrument with rotatable handle piece on biomechanical stress during laparoscopic procedures.
abstract: OBJECTIVE
  To investigate the effect of a pistol grip laparoscopic instrument with a rotatable handle piece (rot-HP) on biomechanical stress and precision as well as a possible interaction between the instrument and working height (WH).
  
  
  BACKGROUND
  Biomechanical stress induced by laparoscopic surgery (LS) is associated with work-related upper limb musculoskeletal disorders in surgeons. Ergonomic handle designs of laparoscopic instruments may reduce the risk of musculoskeletal disorders.
  
  
  METHODS
  Without LS experience, 57 healthy subjects (30 women; 27 men, median age: 26) were observed while performing a laparoscopic exercise. Subjects had to pick up coloured pins and place them into a colour-coded wooden set-up inside a pelvitrainer. The exercise was performed at two WHs using the rot-HP and a standard laparoscopic (fixed) handle piece in randomized sequence. Biomechanical stress was monitored via surface electromyography (sEMG) on fife muscles from the upper limb and shoulder region. Further, the wrist angle (palmar and dorsi flexion) and posture of the dominant upper arm were recorded. Precision was assessed using the number of validly placed pins and process time.
  
  
  RESULTS
  sEMG parameters and upper arm postures indicated no differences in biomechanical stress related to either laparoscopic handle piece. The higher WH was associated with higher trapezius and deltoid activity and elevated arm postures (p < 0.05). Neutral wrist positions were more frequent using the rot-HP, and the lower WH resulted in slightly more neutral wrist positions. Precision was similar during all experimental conditions.
  
  
  CONCLUSIONS
  The rot-HP did not decrease biomechanical stress in the shoulder or lower arm muscles. However, wrist angle position may be optimized without affecting precision. Long-term effects of the rot-HP on preventing complaints of the upper extremity should be evaluated. Low WH is recommended to reduce biomechanical stress in the shoulder during laparoscopic surgery.
authors.affiliation: Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, Wilhelmstrasse 27, 72074, Tuebingen, Germany. benjamin.steinhilber@med.uni-tuebingen.de.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Steinhilber
authors.affiliation: Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, Wilhelmstrasse 27, 72074, Tuebingen, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Seibt
authors.affiliation: Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, Wilhelmstrasse 27, 72074, Tuebingen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Reiff
authors.affiliation: Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, Wilhelmstrasse 27, 72074, Tuebingen, Germany.
authors.forename: Monika A
authors.initials: MA
authors.lastname: Rieger
authors.affiliation: Department of Gyneacological and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kraemer
authors.affiliation: Department of Gyneacological and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Rothmund
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D004576:Electromyography; D006804:Ergonomics / Q000295:instrumentation*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology*; D011187:Posture / Q000502:physiology; D012782:Shoulder / Q000503:physiopathology; D034941:Upper Extremity / Q000503:physiopathology*; D014953:Wrist / Q000503:physiopathology; D055815:Young Adult
keywords: Biomechanical stress; Laparoscopic surgery; Rotatable handle piece; Simulation; sEMG
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