BiPAD®: for surgeons with superior dexterity

Most people would readily admit that they are a little slower, a little more clumsy with their feet than their hands. The underlying reason for this is simple – our feet are simply further away from our brains. An impulse has further to travel along our nerves; distance equates to time along our neurons and across our synapses, so our eye-foot reaction time is always at a disadvantage compared to our hand-eye coordination.


As well as the physical limitations of the feet compared to the hands, the normal functions of our hands and feet influence the way we use our limbs – hands are well-practiced and dexterous; we have evolved long, steady fingers for fine work, and we favour our hands and put them through rigorous, near-constant training simply through everyday use. Our physical evolution has influenced our technological inventiveness, and our tools and device interfaces are overwhelmingly hand-controlled.


The inherently longer reaction time of the feet can be improved somewhat by practice – professional sports players can significantly improve their reaction times with intense training, though feet reaction times still do not surpass hand reaction times.[i] People born without arms or who have had bilateral arm amputations can develop incredible dexterity and responsiveness in their feet, and necessity has been the mother of ingenious invention for people without hands or use of their hands. For most people, however, the hand will always be more reactive and useful than the foot.


The fact that feet are generally clumsier than hands is undeniable, and that reaction times are objectively slower is a biological fact.

The difference is mere milliseconds, but that can be enough to make a difference when time is of the essence. In surgery, timing is critical, with crises occurring in a matter of seconds rather than minutes. Even the smallest delays can be catastrophic so any tool available to a surgeon that might help save time at these crucial moments can literally mean the difference between life and death, between major bleeding and effective coagulation, between a successful operation and an horrific tragedy.


Some surgeons actually admit to choosing monopolar diathermy and adapting their techniques simply to avoid using awkward bipolar foot controls.[ii] There are many, many circumstances where bipolar diathermy is more appropriate than monopolar; however adept a surgeon is with monopolar diathermy, it is not always the right choice. Used improperly, monopolar can actually present significant dangers ranging from minor burns to damaged implanted devices for patients and practitioners alike.[iii] When problems with ergonomic design impact on whether a surgeon chooses the right tool for the job, we have a real problem.


Surgeons, perhaps more than any other profession, require incredibly fine dexterity; perhaps not more so than accomplished musicians and craftspeople, but certainly with the greatest burden of responsibility. To have reached this era of surgical advancement and innovation without having effectively solved a common and simple problem is shocking; we have robotic microsurgery, telesurgery and augmented reality surgery. Modern surgery is, literally, cutting edge, yet surgeons are still restricted by a basic mechanical issue.[iv]


BiPAD® hand switches for bipolar forceps are the long-awaited response to an almost universal problem encountered in surgery; the diathermy foot control. Foot controls restrict surgeons’ movement, they fall off foot stools, they can be inadvertently depressed or take time to find at a time-critical point.[v] Surgeons sometimes have to stop to look under the table to find a foot pedal or have nurses crawling on the floor beneath them to place the controls. The effective use of foot controls is also restricted by the inherent delay in foot response times[vi], and so synchronized diathermy can be best effected by hand controls.


Bipolar forceps require very fine, deliberate hand movements, so creating bipolar diathermy forceps controls which could be operated by hand without causing involuntary movement of the forceps tips was the main hurdle to creating hand-operated controls. The BiPAD® diathermy cord features a simple hand control which allows complete control and steady manipulation of the forceps even while operating the switch.


BiPAD® enables surgeons to fully realize the extent of their dexterity and skill, facilitating the very best in surgical techniques through evidence-based ergonomic design.


[i], R., Bueno, I., Candel, J., & Pons, A. M. (2000). Eye-hand and eye-foot visual reaction times of young soccer players. Optometry (St. Louis, Mo.), 71(12), 775-780. https://europepmc.org/article/med/11145302

[ii], A. M. V., Donner, S., & Kraft, M. (2012). Ergonomic problems originating in the use of high-frequency and ultrasonic medical devices. http://dx.doi.org/10.14279/depositonce-6473

[iii] Vilos, G. A., & Rajakumar, C. (2013). Electrosurgical generators and monopolar and bipolar electrosurgery. Journal of minimally invasive gynecology, 20(3), 279–287. https://doi.org/10.1016/j.jmig.2013.02.013

[iv]Choi, S. D. (2012). A review of the ergonomic issues in the laparoscopic operating room. Journal of Healthcare Engineering, 3(4), 587-603. https://downloads.hindawi.com/journals/jhe/2012/129817.pdf

[v]Saucken, A. M. V., Donner, S., & Kraft, M. (2012). Ergonomic problems originating in the use of high-frequency and ultrasonic medical devices. http://dx.doi.org/10.14279/depositonce-6473

[vi] Pfister, M., Lue, J. C., Stefanini, F. R., Falabella, P., Dustin, L., Koss, M. J., & Humayun, M. S. (2014). Comparison of reaction response time between hand and foot controlled devices in simulated microsurgical testing. BioMed research international, 2014, 769296. https://doi.org/10.1155/2014/769296

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