Development of an Ergonomic Instrument for Laparoscopic and Less Surgery

Jakeb D Riggle, Adam E De Laveaga, Jake Kaufman, Chad A Lagrange, MD, Dmitry Oleynikov, MD FACS, M Susan Hallbeck, PhD PE CPE. University of Nebraska – Lincoln and University of Nebraska Medical Center


The most common laparoscopic surgical tools in use have been shown to be detrimental to surgeons’ health, causing hand and finger pain potentially leading to nerve lesions and numbness. In an effort to reduce the pain and awkward postures surgeons endure during laparoscopic surgery, a new laparoscopic tool was developed starting with direct observation of minimally invasive surgery (MIS), surgeon input, and basic ergonomic design. The objective of this design was to reduce surgeon discomfort during surgery, potentially reducing surgical errors caused by discomfort and awkward postures, and to improve performance of certain tasks during laparoscopic surgery. Basic design of the instrument began with contextual inquiry interviews of surgeons in the operating room to examine the cause of discomfort and pain during surgery as well as the use of current instruments. This ethnographic approach opened lines of communication between the researchers and the surgeons, enabling a true user-centered design process. The size of the instrument was fashioned to comfortably fit a 5th percentile woman and a 95th percentile man using an adjustable mock handle. The shape of the handle was created to reduce abduction of the arm, reduce radial deviation of the wrist during surgery, and decrease actuation grip strength. Functional characteristics such as an articulating end effector with 360-degree circumduction and 60-degree flexion and extension were developed using surgeon feedback through interviews and surveys. This unique articulation would give the instrument the ability to overcome the lack of triangulation present in laparoendoscopic single-site surgery (LESS). Usability testing showed that use of the prototype ergonomically-designed tool improved performance on select Fundamentals of Laparoscopic Surgery (FLS) training tasks and reduced harmful arm and wrist angles adopted during laparoscopic surgery. Further usability testing and surveys confirmed that both experienced surgeons and novice users preferred the prototype instrument to a common scissors-type laparoscopic instrument. Despite high marks and praise from nearly all users tested, the ergonomically-designed laparoscopic instrument encountered muted interest when presented to industry instrument manufacturers. The complex control mechanisms were deemed difficult to manufacture and prone to failure after extended use. The user-centered design process resulted in a surgeon-friendly instrument that was not feasible to manufacture, prompting researchers to reevaluate the functional characteristics and mechanical design of the tool. Novel functions were weighed against reliability and ergonomics to determine what features could be modified to maintain the instrument’s ergonomic advantage over current instruments and improved usability in the operating room. The final iteration of the redesign process has yielded an ergonomic and universally fitting instrument with an articulating end grasper capable of 360-degree circumduction, ideal for use in both laparoscopic and LESS surgeries. Additionally, the new design is able to withstand the forces and environment encountered during MIS, giving the instrument the capabilities to perform most laparoscopic surgical tasks, including needle driving. The end result is a fully functional, unique ergonomic laparoscopic instrument.

Session Number: Poster – Poster Presentations
Program Number: P410
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