Does surgeon sex and anthropometry matter for tool usability in traditional laparoscopic surgery? A systematic review and meta-analysis

Jaime Hislop; Dominic Orth; Oren Tirosh; Mats Isaksson; Chris Hensman; John McCormick

doi:10.1007/s00464-023-10228-1

Does surgeon sex and anthropometry matter for tool usability in traditional laparoscopic surgery? A systematic review and meta-analysis

Surg Endosc. 2023 Sep;37(9):6640-6659. doi: 10.1007/s00464-023-10228-1. Epub 2023 Jul 11.

Authors

Jaime Hislop¹, Dominic Orth², Oren Tirosh^{3

4}, Mats Isaksson¹, Chris Hensman^{5

6

7

8}, John McCormick⁹

Affiliations

¹ Department of Mechanical Engineering and Product Design Engineering, Swinburne University of Technology, Melbourne, VIC, Australia.
² School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia.
³ School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia. otirosh@swin.edu.au.
⁴ Institute for Health and Sport, Victoria University, Footscray, VIC, Australia. otirosh@swin.edu.au.
⁵ Department of Surgery, Monash University,, Melbourne, VIC, Australia.
⁶ Department of Surgery, University of Adelaide, Adelaide, SA, Australia.
⁷ Swinburne University of Technology, Melbourne, VIC, Australia.
⁸ LapSurgery Australia, Melbourne, VIC, Australia.
⁹ Centre for Transformative Media Technologies, Swinburne University of Technology, Melbourne, VIC, Australia.

Abstract

Introduction: Hand size, strength, and stature all impact a surgeon's ability to perform Traditional Laparoscopic Surgery (TLS) comfortably and effectively. This is due to limitations in instrument and operating room design. This article aims to review performance, pain, and tool usability data based on biological sex and anthropometry.

Methods: PubMed, Embase, and Cochrane databases were searched in May 2023. Retrieved articles were screened based on whether a full-text, English article was available in which original results were stratified by biological sex or physical proportions. Article quality was discussed using the Mixed Methods Appraisal Tool (MMAT). Data were summarized in three main themes: task performance, physical discomfort, and tool usability and fit. Task completion times, pain prevalence, and grip style results between male and female surgeons formed three meta-analyses.

Results: A total of 1354 articles were sourced, and 54 were deemed suitable for inclusion. The collated results showed that female participants, predominantly novices, took 2.6-30.1 s longer to perform standardized laparoscopic tasks. Female surgeons reported pain at double the frequency of their male colleagues. Female surgeons and those with a smaller glove size were consistently more likely to report difficulty and require modified (potentially suboptimal) grip techniques with standard laparoscopic tools.

Conclusions: The pain and stress reported by female or small-handed surgeons when using laparoscopic tools demonstrates the need for currently available instrument handles, including robotic hand controls, to become more size-inclusive. However, this study is limited by reporting bias and inconsistencies; furthermore, most data was collected in a simulated environment. Additional research into how anthropometric tool design impacts the live operating performance of experienced female surgeons would further inform this area of investigation.

Keywords: Discomfort; Ergonomics; Gender; Injury; Traditional laparoscopic surgery (TLS).

Publication types

Meta-Analysis
Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Anthropometry
Ergonomics / methods
Female
Humans
Laparoscopy* / methods
Male
Pain
Surgeons*