Ergonomic hands-on performance on Gynecological laparoendoscopic single-site (LESS) surgery

Abstract Background : Few previous studies have introduced general techniques to overcome the “chopstick effect” in laparoendoscopic single-site surgery (LESS). We aim to investigate and highlight the key ergonomic methodologies for gynaecologic LESS based on the surgeon's hands-on performance. Methods : The first author surgeon A reviewed and analyzed the LESS procedures performed by herself and how she taught surgeon A B, from January 2021 to April 2022. The procedures were classified based on technical difficulty and learning periods, and the hands-on technical skills of the surgeons during the LESS module were evaluated. Results: Surgeon A conducted 580 LESS procedures, which were divided into the novice (n=48) and intermediate (n=33) periods, and the remaining cases were included in the routine period. We took ergonomic aspects into account and formed a special ergonomic LESS operating methodology: 1 Maintain good LESS laparoscopic spatial sensation, keep hand-eye coordination, well cooperation between the main surgeon and the assistant; 2 Improve basic LESS technique: grasp, lift, transfer and place objects, and proficient in blunt separating, coagulation, cutting and handling produce. 3 Coordination location, orientation, movements, functions, and flexion or extension of shoulders, arms, elbow, wrist and finger joints; 4 Maintain strength, tension, ambidexterity, depth perception, continuous postures and repetition with joint and muscular efforts to control instruments. 5 Experienced multiport laparoscopy surgery (MPS) skills on basic surgical proceduresand familiarity with anatomical structures were also determining elements. Surgeon B learned the above experiences by performing 39 LESS procedures under the guidance of surgeon A. Conclusion: This educational research sheds light on the common challenges faced in LESS and presents the importance of ergonomic hands-on performance skills in improving surgical outcomes. The findings could serve as a guide for future training and education in LESS.