Ergonomic Impact of an Automated Device for Endoscopic Tool Insertion and Transfer.

Abstract

Background and aims: Endoscopists frequently experience musculoskeletal injuries, particularly in the distal upper extremities, due to substantial forces, awkward postures, and repetitive movements during procedures. A significant but underexplored risk factor is the repetitive exchange of endoscopic instruments. This study aimed to develop and evaluate an automatic endoscopic instrument insertion and transfer device, "INSERTrument," to reduce ergonomic strain and assess its impact on wrist movements and postures.

Methods: The INSERTrument was evaluated during in vivo gastric endoscopic submucosal dissection (ESD) procedures on porcine models, conducted by two experienced endoscopists. Outcomes included the number of wrist snaps, total instrument exchange time, and the percentage of time spent in high-risk wrist postures. Inertial measurement units (IMUs) were used to objectively analyze wrist joint angles. The device's performance was compared to conventional manual methods across various endoscopic instruments.

Results: The INSERTrument significantly reduced the number of wrist snaps per instrument exchange (7.3 ± 1.0 vs. 69.3 ± 8.3; p < 0.05) and per ESD procedure (68.6 ± 9.4 vs. 656.0 ± 71.8; p < 0.05), achieving an average reduction of approximately 90% compared to the conventional manual method. The total instrument exchange time per ESD was also significantly reduced in the INSERTrument group compared to the conventional group (127.6 ± 19.4 sec vs. 151.6 ± 10.9 sec; p < 0.05). IMU data revealed that the INSERTrument significantly decreased the percentage of time spent in high-risk wrist postures (10.4 ± 2.4% vs. 44.4 ± 5.1%; p<0.05).

Conclusions: The use of INSERTrument minimized repetitive wrist movements and high-risk postures associated with endoscopic instrument exchanges. These findings suggest that INSERTrument could improve the ergonomics of endoscopic procedures, potentially reducing the incidence of musculoskeletal injuries among endoscopists. Further studies are warranted to explore the long-term benefits and clinical implications of this device in routine endoscopic practice.