The relationship between hand size and difficulty using surgical instruments: A survey of 726 laparoscopic surgeons

Background: Hand size is an important variable to consider when designing hand tools. Laparoscopic surgical instruments have been reported to cause hand and upper extremity discomfort. This study investigates the correlation between surgical glove size, preexisting musculoskeletal problems, and difficulty using laparoscopic instruments. Methods: Approximately 11,000 questionnaires were sent to SAGES, AAGL, and AWS members. Questions included basic demographic and practice data, surgical glove size, the presence of musculoskeletal problems, and the perceived difficulty using several types laparoscopic instruments. There were 726 responses (from 159 women and 567 men). Subjects were grouped by hand size (Small less than or equal to6.5, Medium 7.0-7.5, Large >7.5; female group only: Small less than or equal to6.0, Medium 6.5, Large >6.5). ANOVA was used to test for differences between groups. Results: The percentage of time subjects reported having difficulty using all laparoscopic instruments was greater for the Small glove size group compared to both the Medium and Large groups (p<0.001). In females, the scissors and staplers were more difficult to use for the Small and Medium glove size group compared to the Large group (p<0.001). Subjects who reported musculoskeletal problems (n=145) performed a significantly greater percent of laparoscopic cases and found the stapler and graspers difficult to use for a greater percentage of time than those not reporting problems (n=559). Conclusion: Hand size is a significant determinant of difficulty using laparoscopic surgical instruments. Individuals using glove sizes 6.5 or smaller experience significantly more difficulty using common laparoscopic instruments, and in particular laparoscopic staplers. Manufacturers of surgical hand tools should consider hand size when designing future surgical instruments.