Usability of Laparoscopic Tools
Laura Jones, Human Factors Consultant.
Laura completed her Master’s thesis at Loughborough University, which was recently published in the Journal of Minimally Invasive Gynecology: Human Factors Evaluation of Surgeons’ Working Positions for Gynecologic Minimal Access Surgery.
The evolution of Human Factors within healthcare is growing at wonderfully healthy rate. In April 2005, Laparoscopic Surgeons truly experienced the benefit of the role of usability engineering.
A group of human factors and engineering students at the University of Nebraska designed and created a more user-friendly tool for performing laparoscopic procedures. The Intuitool: a laparoscopic tool built to reduce physical stress on physicians. Unlike other instruments, essentially surgical tools on a stick, it was designed for one-handed use and features an articulating grasper that can be controlled simply (intuitively, hence the name) by moving the control sphere in the direction the physician wants the grasper to move. Patients benefited to, because surgery time can be shortened when surgeons do not have to take brief breaks to reduce hand and arm strain.
Image Credit: Intuitool, UNeMed Corporation
Image Credit: Hignett, S., Gyi, D., Calkins, L., Jones, L., & Moss, E. (2017). Human Factors Evaluation of Surgeons’ Working Positions for Gynecologic Minimal Access Surgery. Journal of Minimally Invasive Gynecology.
It is well-documented that surgeons performing Minimal Access Surgery (MAS) report significantly higher rates of injury and musculoskeletal disorders (MSDs) than those performing traditional open surgery. This is due to surgeons being required to hold awkward postures for extended periods of time and perform fine precision movements leading to work-related MSDs, commonly in the lower back, shoulders, neck and wrist/hands.
While technology and equipment design has enhanced surgical techniques, there are still many operating rooms across the UK without access to advanced or inclusively designed tools. This causes surgeons to ‘make do’ and work with the equipment available to them. While this equipment may be technically correct for the task, it’s use is limited by the physical strain it causes the surgeon.
Female MAS surgeons are particularly at risk from workplace MSDs, with symptoms often exaggerated due to having a shorter stature than males, less upper body strength and smaller hands. This is particularly an issue in laparoscopic procedures for a few reasons:
Increased working heights due to abdomen insufflation, straight stick instruments and inappropriate table height adjustment.
The size and weight of the patient can increase difficulty significantly.
There needs to be more emphasis in the engineering and usability of purpose-built equipment that considers the surgeon as the vital user. As far as the surgeon is concerned, the patient comes first, and is often accompanied by the mentality to get the job done with little regard for their own wellbeing, but this mindset leads to injury.
The design of these tools should be approached through the surgeon’s lens, placing more emphasis on the surgeon’s comfort and wellbeing, and seeing the surgeon as the primary user. A more comprehensive consideration of ergonomic and human factors informing the design of technical instruments will mean not only are they more intuitive and easy to use, but will reduce work-related injuries for surgeons.