Laparoscopic surgery has revolutionized general surgery, yet the instrument interface is awkward,1 resulting in longer operating times, higher cost, and increasingly frequent physical complaints from laparoscopic surgeons.2 The article by Emam et al is the latest in a series of laboratory studies from that institution investigating the best physical arrangement of current instrumentation in laparoscopic surgery. The authors conclude that an intracorporeal-extracorporeal instrument length of less than 1.0 (that is, more than half of the instrument outside the trocar) is undesirable because it results in the slowest performance and greatest range of movement of the shoulder and elbow joint. In other words, when the intracorporeal-extracorporeal ratio is less than 1.0, surgeons must "row" through the motions rather than use their hands and wrists.
Berguer R. Effect of Intracorporeal-Extracorporeal Instrument Length Ratio on Endoscopic Task Performance and Surgeon Movements—Invited Critique. Arch Surg. 2000;135(1):66. doi:10.1001/archsurg.135.1.66