{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T01:26:11Z","timestamp":1787102771698,"version":"build-2736575974"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["OBES SURG"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      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                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200969) used a human laparoscope operator (Reverse Trendelenburg position, legs apart); the M group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200969) used the Lock-Arm\u00ae 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\u2009\u2265\u2009III complications, and postoperative length of stay. The study was reported in accordance with the STROBE statement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patient demographics were comparable between groups. OR occupancy time was shorter in the M group (175.7\u2009\u00b1\u200919.8 vs. 182.7\u2009\u00b1\u200921.2\u00a0min; MD\u2009\u2212\u20097.0\u00a0min, 95% CI\u2009\u2212\u200913.8 to \u2212\u20090.1;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.049). Operative time was significantly reduced (104.7\u2009\u00b1\u200914.5 vs. 117.1\u2009\u00b1\u200919.8\u00a0min; MD\u2009\u2212\u200912.4\u00a0min, 95% CI\u2009\u2212\u200918.2 to \u2212\u20096.6;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001; Cohen\u2019s d\u2009=\u20090.72). Body temperature at end of surgery was higher in the M group (37.1\u2009\u00b1\u20090.4 vs. 36.6\u2009\u00b1\u20090.4\u00a0\u00b0C; MD\u2009+\u20090.43\u00a0\u00b0C, 95% CI\u2009+\u20090.29 to +\u20090.57;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001; Cohen\u2019s d\u2009=\u20091.04). No Clavien-Dindo\u2009\u2265\u2009III complications occurred in either group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Mechanizing the laparoscope operator role with the Lock-Arm\u00ae was associated with a significant reduction in operative time of approximately 12\u00a0min (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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11695-026-08737-8","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T11:52:48Z","timestamp":1778759568000},"page":"3161-3166","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mechanizing the Laparoscope Operator in Sleeve Gastrectomy: A Single-Surgeon Before-and-After Study of a Pneumatic Endoscope-Holding Device (Lock-Arm\u00ae)"],"prefix":"10.1007","volume":"36","author":[{"given":"Susumu","family":"Inamine","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasunori","family":"Uesato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"8737_CR1","unstructured":"Japan Society of Gastroenterological Surgery. Public statement on the current status and future projections of the gastrointestinal surgical workforce in Japan. 2024. Available at: https:\/\/www.jsgs.or.jp\/news\/citizen\/1914\/ [in Japanese]."},{"issue":"9","key":"8737_CR2","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.1007\/s00464-001-9174-7","volume":"16","author":"S Aiano","year":"2002","unstructured":"Aiano S, Gilbert JM, Soin B, Finlay PA, Gordan A. Controlled trial of the introduction of a robotic camera assistant (EndoAssist) for laparoscopic cholecystectomy. Surg Endosc. 2002;16(9):1267\u201370. https:\/\/doi.org\/10.1007\/s00464-001-9174-7.","journal-title":"Surg Endosc"},{"issue":"4","key":"8737_CR3","doi-asserted-by":"publisher","first-page":"2334","DOI":"10.1007\/s00464-021-08508-9","volume":"36","author":"PJM Wijsman","year":"2022","unstructured":"Wijsman PJM, Voskens FJ, Molenaar L, van \u2019t Hullenaar CDP, Consten ECJ, Draaisma WA, Broeders IAMJ. 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On 8\/14\/26 it changed to Open Access.","order":8,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was approved by the Institutional Review Board of Ohama Daiichi Hospital (approval number: 276) and was performed in accordance with the Declaration of Helsinki.","order":1,"name":"Ethics","label":"Ethics Approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from all participants prior to surgery.","order":2,"name":"Ethics","label":"Informed Consent","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing Interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}