Mechanizing the Laparoscope Operator in Sleeve Gastrectomy: A Single-Surgeon Before-and-After Study of a Pneumatic Endoscope-Holding Device (Lock-Arm®).

BACKGROUND

Japan faces a critical shortage of gastrointestinal surgeons. In the Japanese standard of care for laparoscopic surgery, three physicians are required: a primary surgeon, a first assistant, and a dedicated laparoscope operator. Freeing the third team member by using a mechanical endoscope-holding device could preserve surgical capacity, but its impact on operative efficiency and safety has not been rigorously quantified.

METHODS

We conducted a retrospective before-and-after study of 138 consecutive laparoscopic sleeve gastrectomy (LSG) cases performed by a single surgeon at a community bariatric center. The H group (n = 69) used a human laparoscope operator (Reverse Trendelenburg position, legs apart); the M group (n = 69) used the Lock-Arm® pneumatic passive endoscope holder (Reverse Trendelenburg position, legs together). Primary outcomes were OR occupancy time and operative time. Secondary outcomes included blood loss, intraoperative body temperature at three time points, Clavien-Dindo ≥ III complications, and postoperative length of stay. The study was reported in accordance with the STROBE statement.

RESULTS

Patient demographics were comparable between groups. OR occupancy time was shorter in the M group (175.7 ± 19.8 vs. 182.7 ± 21.2 min; MD - 7.0 min, 95% CI - 13.8 to - 0.1; p = 0.049). Operative time was significantly reduced (104.7 ± 14.5 vs. 117.1 ± 19.8 min; MD - 12.4 min, 95% CI - 18.2 to - 6.6; p < 0.0001; Cohen's d = 0.72). Body temperature at end of surgery was higher in the M group (37.1 ± 0.4 vs. 36.6 ± 0.4 °C; MD + 0.43 °C, 95% CI + 0.29 to + 0.57; p < 0.0001; Cohen's d = 1.04). No Clavien-Dindo ≥ III complications occurred in either group.

CONCLUSIONS

Mechanizing the laparoscope operator role with the Lock-Arm® was associated with a significant reduction in operative time of approximately 12 min (10.6%), improved intraoperative thermoregulation, and maintained safety. This low-technology pneumatic device offers a practical strategy for sustaining laparoscopic surgical quality under surgical workforce constraints.