One size does not fit all: Current disposable laparoscopic devices do not fit the needs of female laparoscopic surgeons

Introduction: An increasing number of women are entering the field of general surgery. Because surgical devices have traditionally been targeted at men, we hypothesized that, due to smaller hand size, female general surgery residents would have significantly more difficulty utilizing the "one size fits all" handles of disposable laparoscopic (lap) devices when compared with male residents. Methods: General surgery residents were anonymously surveyed at four university general surgery training programs. Participants were asked to describe their use of four disposable lap instruments: the lap stapler, lap Harmonic scalpel™ (Ethicon, Inc., Somerville, New Jersey), lap LigaSure™ (Valleylab, Boulder, Colorado), and lap retrieval bag. Data were tabulated and analyzed, comparing male with female residents for each instrument as well as according to glove size. Results: A total of 120 residents were asked to participate with 65 anonymous responses (28 women and 37 men). Women's median glove size was significantly smaller than men's (6.5 vs. 7.5, p < 0.0001), whereas the clinical year and number of lap cases were not significantly different. Women reported the following devices more awkward than their male counterparts: lap stapler, lap Harmonic scalpel™, and the lap LigaSure™. Women were more likely to use two hands and describe these devices as "always awkward." When results were analyzed by glove size independently of gender we found that, with increasing glove size, residents were more likely to describe these devices as easy to use and used these devices with only one hand. Conclusions: Current disposable lap devices are not designed for individuals with small hands. Women have significantly smaller hands than their male counterparts and have difficulty with the "one size fits all" lap device handles. With the increasing number of women entering general surgery programs, this problem will likely persist until devices are designed for surgeons with small hand sizes.