Effect of Intracorporeal-Extracorporeal Instrument Length Ratio on Endoscopic Task Performance and Surgeon Movements

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Abstract
THERE IS A great variation in the build and size of patients requiring treatment with minimal-access surgery. Because the port sites are determined by ergonomic considerations such as manipulation, elevation, and azimuth angles with respect to the operative field,1 the current use of standard-length endoscopic instruments (360 mm) for all patients and different procedures results in varying intracorporeal-extracorporeal length ratios. These variations in the pivot points (at the anterior abdominal wall) along the length of the instrument are likely to influence execution, such as the force needed to perform certain tasks and the pattern of hand-arm movement outside the body cavity to effect specific manipulations within the operative field. To our knowledge, there have been no published studies on the optimum intracorporeal-extracorporeal instrument length ratio needed for minimal-access surgery. This has been addressed in the present study, which was designed to investigate the effect of 3 intracorporeal-extracorporeal instrument ratios on endoscopic task performance and patterns of upper-limb motion of the surgeon.

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