Predicting Wrist Ergonomics in Laparoscopy using the HandX®

Laparoscopic surgery has become increasingly popular due to its benefits over open surgery. However, one of the major challenges in laparoscopic surgery is the ergonomics of the surgeon. Ergonomics plays a crucial role in laparoscopic surgery, as surgeons are at risk of developing musculoskeletal disorders (MSDs) due to prolonged and repetitive motions [1,2]. One of the most common areas affected by MSDs in surgeons is the wrist, which can be affected by various factors such as handle design, awkward postures, and high force demands [3]. Laparoscopic surgery requires precise and delicate movements, that can put a significant strain on the wrist. Wrist flexion and deviation refer to the bending of the wrist forward and backward and twisting of the wrist to the left or right, respectively. Optimal wrist posture minimizes the degree of flexion and deviation, allowing for a neutral wrist position. On the other hand, excessive wrist flexion and deviation can lead to musculoskeletal pain, fatigue, and reduced grip strength. Neutral wrist posture with a lower degree of flexion and deviation has been shown to reduce musculoskeletal symptoms, increase dexterity, and improve surgical precision. Additionally, forearm rotation (pronation and supination) also plays a role in wrist ergonomics. Based on the rapid upper limb assessment (RULA), for wrist flexion/extension a range of 0-15° is recommended, and close to neutral position for wrist deviation, whilst pronation or supination of the forearm is considered ergonomic for up to 45° [4], [5]. The HandX® [6] is a hand-held laparoscopic, software-driven, robotic platform, used to manipulate 5mm fully articulating instruments. The HandX has four robotic degree-of-freedom (DoF), here we focus on the two DoF’s for controlling articulation. The HandX’s sphere-like control interface (CI) allows the surgeon to manipulate the articulated instruments' end-effector in all directions, over two axes: pitch and yaw