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

To develop evidence-based practice guidelines for ergonomic optimization in laparoscopic surgery through the evaluation of various instrument handle designs.

A systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches of Ovid MEDLINE, Embase, CINAHL, and the Cochrane Library were performed from database inception to February 2025. Studies evaluating laparoscopic instrument handle design-including needle drivers, graspers, and electrosurgical devices-and their impact on surgeon ergonomic outcomes were included. Outcomes were grouped into 4 domains: operative performance, muscle workload and fatigue, motion efficiency, and surgeon discomfort. Study quality was assessed using the Cochrane Risk of Bias tool for randomized trials and Risk of Bias in Non-randomized Studies of Interventions for nonrandomized studies. Evidence synthesis was performed narratively owing to heterogeneity of study designs and outcomes.

Twenty-three studies met the inclusion criteria. Most were simulation-based randomized crossover trials with small sample sizes and heterogeneous outcome measures. Evidence comparing laparoscopic needle driver handle designs was limited and insufficient to support the superiority of any configuration. For graspers, in-line or intermediate handle configurations may promote more neutral wrist posture and reduce forearm muscle activation compared with the pistol-grip design, although findings were inconsistent. Studies evaluating electrosurgical devices suggest that ergonomic performance may be influenced by handle geometry, activation button placement, and surgeon-specific factors such as hand size; however, no device demonstrated consistent superiority.

Current evidence supporting specific laparoscopic instrument handle designs for ergonomic optimization remains limited and heterogeneous. Conventional instruments remain appropriate for routine use, whereas alternative designs may be considered in select circumstances. Further prospective clinical studies using standardized ergonomic metrics are needed to guide evidence-based instrument development and reduce musculoskeletal strain for surgeons.