복강경 수술자의 엄지 손가락 표재 신경손상증

Abstract

Laparoscopic Surgery is procedures that use slender and long instruments through the small hole. The instruments are classified into two types, one is pistol grip the other is inline shaft pistol grip have some of motion difficulty so easy to injury the superficial nerve of fingers. But most of all laparoscopic instruments are pistol grip because it is easy to opening of the jaws, which is necessary for dissection. On the other hand, needle holder is inline shaft because the most of action are axial motion. In the case of open laparotomy, while the dominant hand uses the instruments by inserting his thumb in the finger grip hole of instruments, non-dominant hand uses hand grip that doesn't insert thumb in the hole of instruments in most cases. But in the laparoscopic surgery most instruments are finger-inserting grip(pistol grip), inevitably used by both hands, In procedure with both hands inserted in finger grips in the long period, non-dominant hand rather than dominant hand gets more fatigue leading to nerve damage in worse case. In case of author, symptoms of pain and numbness of distal phalanx region occurred after getting though of laparoscopic operation for about 4 hours. These symptoms disappeared after 1 month. But symptom of numbness was aggravated. Doctors around me who are beginning laparoscopic surgery complain the same symptoms as author's. We confirmed the nerve injury by nerve conduction velosity test. There is no report about nerve injury after repeated laparoscopic procedure even though laparoscopic procedure increases. So we wish to warn laparoscopic surgeons not to be exposed to digital nerve injury after continued laparoscopic procedures.