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March 1993

Laparoscopist's Thumb: An Occupational Hazard

Author Affiliations

Sheffield, England

Arch Surg. 1993;128(3):357. doi:10.1001/archsurg.1993.01420150117022

To the Editor.—Laparoscopic procedures can be tedious and time-consuming and require carefully coordinated eye-hand movements. The fulcrum of motion of laparoscopic instruments is the anterior abdominal wall. A small arc of hand movement is thus amplified at the working end of the instrument, necessitating tight control of the handles.

We report two instances of injury to a digital nerve of the surgeon's thumb caused by pressure from the handle of a pair of laparoscopic retracting forceps.

Report of Cases.—Case 1.—Laparoscopic cholecystectomy was performed on a fit young adult. On laparoscopy, the gallbladder was found to be thick-walled with a large gallstone impacted in the Hartmann's pouch and an enlarged lymph node in Calot's triangle. Dissection of the cystic artery and duct was tedious and required sustained periods of traction with forceps held in the left hand (Fig 1). The operation, although successful, lasted approximately 2 hours. The

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