Investigation of Hand Pain With Laparoscopy Among Gynecologic Surgeons

To investigate the areas of greatest hand pain among laparoscopic gynecologic surgeons and to analyze surgeon variables associated with discomfort.

Secondary analysis of observational cohort survey data.

US nationwide survey.

Gynecologic surgeons were surveyed via email through the Society of Gynecologic Surgeons and a convenience sample of US academic institutions.

Surgeons reported demographic characteristics, presence of hand pain in specific locations, and use of laparoscopic advanced energy devices.

Of 190 participants, a majority (68.9%) reported discomfort attributed to laparoscopy; over half (56.8%) reported hand pain. Prevalence of pain in the thumb, forefinger, and wrist was greater among surgeons of female sex, glove size <7, and trainee status. After adjustment for glove size, residents had increased odds of pain in the thumb (aOR 4.18, CI 1.82-10.81), forefinger (aOR 4.16, CI 1.24-13.92), and wrist (aOR 4.47, CI 1.60-12.53) compared to attendings with >10 years of experience. Surgeons of glove size <7 had increased odds of pain in the thumb (aOR 2.23, CI 1.10-4.52), forefinger (aOR 3.03, CI 1.16-7.96), and wrist (aOR 2.53, CI 1.15-5.58) after adjustment for level of experience. Among LigaSure users, residents more often endorsed pain at each hand site and reported the LigaSure device as too large (71.4%) compared to fellows and attendings (p = .012).

Hand pain is highly prevalent among gynecologic laparoscopists. Surgeons of smaller glove size had over two times and residents had over four times the odds of hand pain with laparoscopy. Prioritization of surgical ergonomics education among trainees and the development of ergonomic laparoscopic tools remains critical, as does research on surgeon real-time experiences to eliminate the self-selection bias inherent in survey-based research.