Evidence-Based Guidelines for Instrument and Handle Selection for Ergonomic Optimization in Laparoscopic Surgery

Area of Science:

• Minimally Invasive Surgery
• Surgical Ergonomics
• Musculoskeletal Health

Background:

• Laparoscopic surgery demands prolonged, precise movements, increasing the risk of musculoskeletal strain for surgeons.
• Instrument handle design is a critical factor influencing surgeon comfort and performance during laparoscopic procedures.
• Current guidelines for ergonomic optimization in laparoscopic surgery are lacking due to insufficient evidence on instrument design efficacy.

Purpose of the Study:

• To systematically review and evaluate existing literature on laparoscopic instrument handle designs.
• To identify evidence-based recommendations for ergonomic optimization in laparoscopic surgery.
• To inform the development of future instrument designs and practice guidelines.

Main Methods:

• A comprehensive systematic review adhering to PRISMA guidelines was conducted.
• Searches included major databases (MEDLINE, Embase, CINAHL, Cochrane Library) up to February 2025.
• Studies on needle drivers, graspers, and electrosurgical devices were analyzed for impact on operative performance, muscle workload, motion efficiency, and surgeon discomfort.

Main Results:

• Twenty-three studies were included, predominantly simulation-based trials with small sample sizes.
• Limited evidence exists for needle driver handle superiority; some grasper designs may improve wrist posture and reduce muscle activation.
• Electrosurgical device ergonomics are influenced by handle geometry and button placement, but no consistent superiority was found.

Conclusions:

• Current evidence on laparoscopic instrument handle designs for ergonomic optimization is limited and inconsistent.
• Conventional instruments are suitable for routine use; alternative designs may be considered selectively.
• Further prospective studies with standardized ergonomic metrics are essential for evidence-based instrument development and reducing surgeon musculoskeletal strain.