An ergonomic field study to evaluate the effects of a rotatable handle piece on muscular stress and fatigue as well as subjective ratings of usability, wrist posture and precision during laparoscopic surgery: an explorative pilot study

  • Bernhard Kraemer
  • Robert Seibt
  • Anne-Katrin Stoffels
  • Ralf Rothmund
  • Sara Y. Brucker
  • Monika A. Rieger
  • Benjamin SteinhilberEmail author
Original Article



The interface between surgeon and the laparoscopic instrument is an important factor in biomechanical stress that may increase the risk of musculoskeletal complaints in surgeons. This article investigates the effect of a laparoscopic instrument with a rotatable handle piece (rot-HP) on muscular stress and fatigue during routine laparoscopic procedures (LP) as well as usability, wrist posture and working precision.


40 LP (subtotal hysterectomies) performed by 11 surgeons were investigated. 20 LP were carried out with the rot-HP and 20 with a fixed (standard) laparoscopic handle piece instrument. Shoulder and arm muscle activity was monitored via surface electromyography (sEMG). The electrical activity (EA) and median power frequency (MPF) were used to determine muscular stress and fatigue. Usability, wrist posture, and working precision between handle piece conditions were assessed by a survey.


Using the rot-HP did not reduce muscular stress. A tendency of muscular fatigue (increasing EA, decreasing MPF) occurred in the upper trapezius, middle deltoid and extensor digitorum muscles; however, no differences were found between handle pieces. Wrist posture was more comfortable using the rot-HP and working precision and usability tended to be preferred using the standard handle piece.


Although wrist posture seemed to be optimized by the rot-HP, no effect on muscular stress and fatigue was observed in routine LP (< 60 min duration). Optimization of wrist posture may provide positive effects in mid- or long-term procedures. However, sufficient familiarization with the new instrument is crucial since working precision and usability could be impaired.


Laparoscopic surgery Muscular stress Muscular fatigue sEMG Usability 



We thank Florian Reiff, Gabi Weiss and Florian Ulbrich for their assistance during data acquisition as well as Tabea Pomes for her contribution to sEMG data analysis.

Authors’ contribution

BS, RR and BK initiated the research project. BK, BS, RS, RR, SB, and MR conceived and designed the study protocol. BK, RR, SB, AS performed data acquisition. BS and RS performed the statistical analysis. BK, AS, and BS drafted the manuscript. All authors were included in data interpretation process. All authors critically reviewed and revised the manuscript. All authors approved the final manuscript. The results of this study are used in the doctoral thesis of AS.


This research was partly funded by ERBE Elektromedizin GmbH, Germany. The work of the Institute of Occupational and Social Medicine and Health Services Research. Tuebingen is supported by an unrestricted grant of the employers' association of the metal and electric industry Baden-Wuerttemberg (Suedwestmetall).

Compliance with ethical standards

Conflict of interest

Prof Dr. Bernhard Kraemer, Robert Seibt, Dr. Anne-Kathrin Stoffels, Prof. Dr. Ralf Rothmund, Prof. Dr. Sara Y. Brucker, Prof. Dr. Monika A. Rieger and Dr. Benjamin Steinhilber have no conflicts of interest or financial ties to disclose.

Informed consent

All subjects gave their informed written consent and the study was approved by the ethics committee of the medical faculty of the University of Tuebingen (409/2013BO1).


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre of Women’s HealthUniversity Hospital TuebingenTuebingenGermany
  2. 2.Institute of Occupational and Social Medicine and Health Services ResearchUniversity Hospital TuebingenTuebingenGermany
  3. 3.Women’s Center BernBernSwitzerland

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