Shape and mechanical structure of instruments play a large part in the lack of ergonomics during laparoscopic surgery. Providing intra-abdominal mobility and rethinking handles design are two solutions to increase comfort and precision of gestures. Based on previous work that determined the optimal intra-abdominal kinematics, this study analyses the influence of handle design on both gesture and ergonomic performance. A virtual reality laparoscopic simulator was developed to perform an experimental comparison between two novel robotized instruments and standard ones. A group of 10 surgeons and 6 researchers in robotics carried out two representative surgical tasks with each instrument. Based on instrument and arm segments tracking, a gesture performance index and an ergonomic performance index were computed. The study demonstrates that distal mobilities combined with improved handle design and integration increase ergonomic level during laparoscopy and facilitate complex gestures.
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