Investigation of the Association between Surgeon Sex and Ergonomic Strain with Laparoscopic Device Use

Abstract

<h3>Study Objective</h3> To determine if surgeon sex is associated with amount of grip strength decline with use of 3 advanced energy laparoscopic devices. <h3>Design</h3> Observational cohort study. <h3>Setting</h3> Ergonomic simulation performed at an academic tertiary care site. <h3>Patients or Participants</h3> 20 participants (sex and academic role matched) were recruited from the Department of Obstetrics and Gynecology between 2/2021-3/2021. <h3>Interventions</h3> Anthropometric measurements were collected. Baseline grip strength was measured using a handheld dynamometer. Subjects performed 120-second trials of rapid repetitive use of the LigaSure, HALO PKS, and ENSEAL. Order was randomized with 5 minutes rest between trials. Grip strength at 0, 60, and 120 seconds and after 5 minutes rest was normalized to each participant's baseline grip strength. Participants completed a NASA Raw Task Load Index (RTLX) scale to assess workload for each device. <h3>Measurements and Main Results</h3> Using one-way ANOVA, the intervention was confirmed to result in grip strength decline, with up to 18% loss of grip strength after 120 seconds of exertion and recovery to baseline after rest. Grip strength decline was not significantly dependent on sex or device type using two-way repeated measures ANOVA, although there was a trend towards an effect of device type (p=0.05). Using linear regression, no significant association was found between hand length and grip strength decline. Female and male participants reported similar levels of physical discomfort, muscle fatigue, and RTLX workload for each device. Participants of smaller versus larger glove size reported greater cumulative discomfort (p=0.02) and RTLX workload (p=0.04). <h3>Conclusion</h3> This experiment adequately captured participant grip strength decline over time with laparoscopic device use. No associations between participant sex or hand size and grip strength decline were demonstrated, although participants of smaller glove size reported greater perceived workload. Future evaluation using electromyography in an operating room setting will continue to explore predisposing characteristics to ergonomic strain.