Forearm compression by laparoscopic hand-assist devices

Background and Purpose: Laparoscopic hand-assist devices have facilitated the broad application and acceptance of laparoscopy in urology and other surgical fields. This study evaluated forearm compression by these devices. Materials and Methods: Five commercially available hand-assist devices were tested (Gelport, Intromit, PneumoSleeve, Handport, LapDisc). In three surgeons using a porcine model, compressive forces were measured along the paths of the median and ulnar nerves at the point of maximum proximal forearm circumference using FlexiForce A101 sensors. Glove size for all three surgeons was 7 1/2; however, the maximum forearm circumference ranged from 26 to 33 cm. The hand-assist devices were placed in pigs after skin and fascial incision (9 cm), and the insufflation pressure was set at 18 mm Hg. Surgeons subjectively rated the ease of device insertion and hand insertion, degree of forearm compression, and the development of paresthesias. Results: The LapDisc was rated superior with regard to insertion. The Gelport was rated superior for hand insertion and removal; however, moderate to severe forearm compression and paresthesias were reported. The maximum forearm compression forces were highest with the LapDisc (97 mm Hg) and the Gelport (78 mm Hg) and lowest with the Handport (33 mm Hg). Conclusion: The choice of hand-assist device is dependent on its ease of use, efficacy at maintaining insufflation, and effect on the surgeon's performance and fatigue. The impact of forearm compression should be considered in the selection of the hand-assist device and in the development of new devices.