Optimal Angle Between Instrument Shaft and Handle for Laparoscopic Bowel Suturing

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Abstract
LAPAROSCOPIC INSTRUMENT manipulations require a sound ergonomic setup to optimize conditions that control the tissue-instrument-surgeon interface. Factors that govern tissue-instrument interface include port location, task alignment, and endoscope-camera assembly. Port location determines the manipulation angle between instruments, the elevation angle between the instrument and horizontal plane, and the azimuth angle between the instrument and optical axis of the endoscope.1,2 Optimal laparoscopic suturing and reduced muscle workload are achieved with vertical suturing and an isoplanar monitor display of the operative field.3 The ergonomics of the instrument-needle-tissue relationship are also important for optimal task performance.4 Operators of the endoscope-camera assembly should avoid working from the opposite side of the instruments5 and viewing the instrument plane from below.6 In addition, factors that control surgeon-instrument interface affect the quality of task performance and the surgeon's posture and muscle workload. The height of the operating table should allow the laparoscopic instrument handles to be close to the surgeon's elbow level to minimize discomfort and upper limb muscle workload.7 The handle design of laparoscopic instruments also affects the quality of task performance, choreography of movement, and muscle workload by the surgeon.8,9 Neuropraxia of digital nerves and pectoralis major tendonitis have been reported with the use of laparoscopic instruments.10-13

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