I use a trackball, you can set it next to you on the couch and just use it normal. As for gaming, I still freak out people when I tell them I use a trackball for gaming.

The only issue is games like Skyrim when lock picking requires moving the mouse around, doing it with a trackball is a painful experience.

Similar with Kingdom Come: Deliverance, especially with the combat that requires you to try and point at a certain limb.

Although I blame the lock picking mini games and the combat for that, since using a controller doesn't make them any less of an annoyance.