Scientific Article|Articles in Press

Helping Surgeons’ Hands: A Biomechanical Evaluation of Ergonomic Instruments

Published:February 04, 2023DOI:


      “Ergonomic” is a common descriptor for a desk or computer workspace but is a term rarely used to describe a surgical instrument. Instead, surgeons spend many hours in inconvenient positions, often using instruments that are not ergonomic. Improving the ergonomics of surgical instruments may decrease the required force for simple tasks and allow for more efficient surgery.


      To evaluate the impact of ergonomic surgical instruments, the authors developed ergonomic screwdriver handles. The shape and size of these handles were engineered using previous dental studies and 3-dimensional modeling to create an ideal handle for specific glove sizes. Participants were recruited to test 3 different ergonomic handle sizes against a standard screwdriver while assessing digital peak force, digital contact area, and participant preference. Ten participants (3 women) with glove sizes ranging from 6 to 8 were evaluated.


      Ergonomic screwdriver handles sized for glove sizes 6 and 7 required significantly less thumb peak force than the standard screwdriver for all participants (702 N for glove size 6 and 567 N for glove size 7 ergonomic screwdrivers, vs 1780 N for “one size fits all” standard screwdriver). Participants consistently preferred screwdrivers that required lower thumb and index finger forces. All ergonomic handles required lower thumb and index finger force. Eighty percent of participants preferred a screwdriver modeled within 1 glove size of their own.


      Improved ergonomic handles require less force and are preferred by surgeons.

      Clinical relevance

      The significant decrease in thumb peak force for glove sizes 6 and 7 suggests that there is room for ergonomic improvement in instruments, especially for surgeons with smaller hands. Manufacturing ergonomic screwdriver handles and using the evolving convenience of 3-dimensional printing may help to develop a more comfortable work environment for surgeons.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lakhiani C.
        • Fisher S.M.
        • Janhofer D.E.
        • Song D.H.
        Ergonomics in microsurgery.
        J Surg Oncol. 2018; 118: 840-844
        • Nimbarte A.D.
        • Sivak-Callcott J.A.
        • Zreiqat M.
        • Chapman M.
        Neck postures and cervical spine loading among microsurgeons operating with loupes and headlamp.
        IIE Trans Occup Ergon Hum Factors. 2013; 1: 215-223
        • Roquelaure Y.
        • Mechali S.
        • Dano C.
        • et al.
        Occupational and personal risk factors for carpal tunnel syndrome in industrial workers.
        Scand J Work Environ Health. 1997; 23: 364-369
        • Silverstein B.A.
        • Fine L.J.
        • Armstrong T.J.
        Occupational factors and carpal tunnel syndrome.
        Am J Ind Med. 1987; 11: 343-358
        • Solovieva S.
        • Vehmas T.
        • Riihimäki H.
        • et al.
        Finger osteoarthritis and differences in dental work tasks.
        J Dent Res. 2006; 85: 344-348
        • Slack P.S.
        • Coulson C.J.
        • Ma X.
        • Webster K.
        • Proops D.W.
        The effect of operating time on surgeons’ muscular fatigue.
        Ann R Coll Surg Engl. 2008; 90: 651-657
        • Slack P.S.
        • Ma X.
        Time dependency assessment of muscular fatigue index and hand tremor under operating conditions.
        Annu Int Conf IEEE Eng Med Biol Soc. 2007; 2007: 4822-4825
        • Plerhoples T.A.
        • Hernandez-Boussard T.
        • Wren S.M.
        The aching surgeon: a survey of physical discomfort and symptoms following open, laparoscopic, and robotic surgery.
        J Robot Surg. 2012; 6: 65-72
        • Miller K.
        • Benden M.
        • Pickens A.
        • Shipp E.
        • Zheng Q.
        Ergonomics principles associated with laparoscopic surgeon injury/illness.
        Hum Factors. 2012; 54: 1087-1092
        • Knudsen M.L.
        • Ludewig P.M.
        • Braman J.P.
        Musculoskeletal pain in resident orthopaedic surgeons: results of a novel survey.
        Iowa Orthop J. 2014; 34: 190-196
        • Alqahtani S.M.
        • Alzahrani M.M.
        • Tanzer M.
        Adult reconstructive surgery: a high-risk profession for work-related injuries.
        J Arthroplasty. 2016; 31: 1194-1198
        • Dong H.
        • Barr A.
        • Loomer P.
        • Laroche C.
        • Young E.
        • Rempel D.
        The effects of periodontal instrument handle design on hand muscle load and pinch force.
        J Am Dent Assoc. 2006; 137: 1123-1130
        • Berguer R.
        • Hreljac A.
        The relationship between hand size and difficulty using surgical instruments: a survey of 726 laparoscopic surgeons.
        Surg Endosc. 2004; 18: 508-512
        • Sutton E.
        • Irvin M.
        • Zeigler C.
        • Lee G.
        • Park A.
        The ergonomics of women in surgery.
        Surg Endosc. 2014; 28: 1051-1055
        • Lucas-Hernández M.
        • Pagador J.B.
        • Pérez-Duarte F.J.
        • Castelló P.
        • Sánchez-Margallo F.M.
        Ergonomics problems due to the use and design of dissector and needle holder: a survey in minimally invasive surgery.
        Surg Laparosc Endosc Percutan Tech. 2014; 24: e170-e177
        • Santos-Carreras L.
        • Hagen M.
        • Gassert R.
        • Bleuler H.
        Survey on surgical instrument handle design: ergonomics and acceptance.
        Surg Innov. 2012; 19: 50-59
        • Kong Y.K.
        • Lowe B.D.
        • Lee S.J.
        • Krieg E.F.
        Evaluation of handle shapes for screwdriving.
        Appl Ergon. 2008; 39: 191-198
        • Dong H.
        • Loomer P.
        • Barr A.
        • Laroche C.
        • Young E.
        • Rempel D.
        The effect of tool handle shape on hand muscle load and pinch force in a simulated dental scaling task.
        Appl Ergon. 2007; 38: 525-531
        • Dong H.
        • Loomer P.
        • Villanueva A.
        • Rempel D.
        Pinch forces and instrument tip forces during periodontal scaling.
        J Periodontol. 2007; 78: 97-103
        • Nanayakkara V.K.
        • Cotugno G.
        • Vitzilaios N.
        • Venetsanos D.
        • Nanayakkara T.
        • Sahinkaya M.N.
        The role of morphology of the thumb in anthropomorphic grasping: a review.
        Front Mech Eng. 2017; 3: 5
        • Ballard D.H.
        • Mills P.
        • Duszak R.
        • Weisman J.A.
        • Rybicki F.J.
        • Woodard P.K.
        Medical 3D printing cost-savings in orthopedic and maxillofacial surgery: cost analysis of operating room time saved with 3D printed anatomic models and surgical guides.
        Acad Radiol. 2020; 27: 1103-1113
        • Freund J.
        • Takala E.P.
        • Toivonen R.
        Effects of two ergonomic aids on the usability of an in-line screwdriver.
        Appl Ergon. 2000; 31: 371-376