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Investigation of the Association Between Surgeon Sex and Laparoscopic Device Ergonomic Strain in Gynecologic Surgery

Study Objective

To assess if female compared to male sex is associated with greater ergonomic strain
with use of 4 advanced energy laparoscopic devices (LigaSure, HALO PKS, ENSEAL, and
Harmonic scalpel).


Online survey distributed by e-mail using the REDCap platform. All responses were


Nationwide survey in the United States.


Gynecologic surgeons were surveyed through the Society of Gynecologic Surgeons listserv
and 4 Obstetrics and Gynecology departmental listservs.


The survey was distributed between 5/01/2020-11/01/2020.

The primary outcome was the presence of physical complaints due to laparoscopic devices.
Descriptive statistics compared surgeon characteristics and ergonomic symptoms. Logistic
regression was performed, adjusted for surgeon characteristics.

Measurements and Main Results

The response rate was 39%, comprising 149 women (78%) and 41 men (22%). Women compared
to men had a significantly younger age (mean 34 vs 44 years old, p<.01), smaller glove
size (mean 6.5 vs 7.5, p<.01), shorter height (median 66 vs 71 in, p<.01), and were
less frequently in practice for >10 years (19% vs 49%, p<.01). Women significantly
more often reported physical complaints related to use of laparoscopic devices (79%
vs 41%, p<.01). Women reported all devices had too large a fit for appropriate use
(p<.01). Women were found to have 5.37 times the odds of physical complaints attributed
to the use of laparoscopic instruments (cOR 5.37, 95% CI 2.56-11.25); with adjustment
for glove size, age, and laparoscopic case volume and duration, this was no longer
significant (aOR 2.02, 95% 0.59-6.93).


Women significantly more often report physical complaints and inappropriate fit of
the LigaSure, HALO PKS, ENSEAL, and Harmonic scalpel. Female sex is associated with
fivefold greater odds of physical complaints with laparoscopic device use. Further
investigation of the surgeon factors underlying device-related strain is a critical
next step to understanding and reducing surgeon ergonomic injury.

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