PubMed · 9309764
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J F Godin, J C Petitot, G Pioger. 1997. STIMAREC report.. https://doi.org/10.1111/j.1540-8159.1997.tb04258.x
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Although the advantages of minimally invasive surgery (MIS) have been clearly established for the patient, the surgeon must cope with disadvantages caused by unergonomic instrument handles. Pressure areas and persisting nerve lesions have been described in the literature. The shape of the instrument handles has been identified as the reason for these disorders. To prevent these, it is necessary to use ergonomically designed handles for MIS instruments. Anatomic, physiologic, and ergonomic facts as well as the results of the authors' own experiences and tests are presented. On this basis, an ideal ergonomic working posture for the laparoscopic surgeon and an optimal grasp for manipulating the instruments' functional elements are recommended. To enable the surgeon to evaluate ergonomic handles for MIS instruments according to his own needs, 14 criteria for genuine "ergonomic handles" are established. On the basis of these criteria, deficiencies of handles currently available (ring and shank handles at an angle or with axial extension to the instrument shaft, and pistol handles) are discussed. Furthermore, new handles, developed by the authors according to the criteria for genuine ergonomic handles, are presented.
The only automatic device now available to laparoscopic surgeons is Endo-Stitch, which is costly for single use and has the disadvantage of leaving a large needle hole in the tissue. A semiautomatic suturing device (Maniceps) for laparoscopic use was developed from a forceps-type of needle holder for open pelvic surgery. The first generation of the instrument was designed for use with the abdominal wall-lift method of laparoscopic surgery, whereas the second generation can be applied for gas insufflation as well. Exchange of the needle is done by an automatic grasping action of a resilient slit in one jaw and by manual pull-down of the needle via the thread onto the other jaw. The new instrument was employed in 10 cases of laparoscopic surgery for various procedures including suture of the perforated gallbladder wall and running suture of the peritoneum after mesh placement in transabdominal repair of inguinal hernia. Maniceps provides an economic advantage and has the merit of a smaller needle hole.