title: The effect of forceps manipulation for expert pediatric surgeons using an endoscopic pseudo-viewpoint alternating system: the phenomenon of economical slow and fast performance in endoscopic surgery.
abstract: OBJECTIVE
  Endoscopic surgery is performed under a horizontal view in comparison to the vertical view that is associated with open surgery. We developed an endoscopic pseudo-viewpoint alternation system with out any scope action. We investigate the effect of this novel system on forceps manipulation among expert pediatric surgeons.
  
  
  METHODS
  Six expert pediatric surgeons performed a Nissen wrap in a fundoplication simulator either with or without this system. The constructed Nissen wrap was evaluated. The total path length and the average velocity of the forceps were also analyzed.
  
  
  RESULTS
  The times required either with or without this system were 587.5 ± 122.7 and 634.0 ± 212.4 s (p = 0.45), respectively. The total path lengths of right and left forceps either with or without this system were 12,309 ± 2495.5 and 15,726 ± 5649.6 mm (p = 0.07), 10,091 ± 2439.2 and 12,575 ± 5511.1 mm (p = 0.11), respectively. The average velocity of the right and left forceps with or without this system were 26.9 ± 5.29 and 31.6 ± 1.62 mm/s (p = 0.04), 21.6 ± 2.48 and 25.5 ± 6.48 mm/s (p = 0.15), respectively. There was no significance in the suture balance and suture interval.
  
  
  CONCLUSIONS
  The endoscopic pseudo-viewpoint alternation system thus made it possible for expert pediatric surgeons to carry out slow and economical forceps manipulation. These effects make it possible for surgeons to perform safe and precise surgery, thus leading to a shortening of operation time.
authors: Department of Pediatric Surgery, Reproductive and Development Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan. satoshi@med.kyushu-u.ac.jp.|Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan. satoshi@med.kyushu-u.ac.jp.
authors: Satoshi
authors: S
authors: Ieiri
authors: Department of Pediatric Surgery, Reproductive and Development Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan.
authors: Takahiro
authors: T
authors: Jimbo
authors: Faculty of Engineering, Waseda University, Tokyo, Japan.
authors: Yuta
authors: Y
authors: Koreeda
authors: Department of Pediatric Surgery, Reproductive and Development Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan.
authors: Satoshi
authors: S
authors: Obata
authors: Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan.
authors: Munenori
authors: M
authors: Uemura
authors: Department of Pediatric Surgery, Reproductive and Development Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan.|Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan.
authors: Ryota
authors: R
authors: Souzaki
authors: Faculty of Engineering, Waseda University, Tokyo, Japan.
authors: Yo
authors: Y
authors: Kobayashi
authors: Faculty of Engineering, Waseda University, Tokyo, Japan.
authors: Masakatsu G
authors: MG
authors: Fujie
authors: Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan.
authors: Makoto
authors: M
authors: Hashizume
authors: Department of Pediatric Surgery, Reproductive and Development Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan.
authors: Tomoaki
authors: T
authors: Taguchi
mesh_terms: D002648:Child; D018662:Fundoplication / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods*; D010372:Pediatrics / Q000379:methods; D000066908:Simulation Training / Q000379:methods*; D066231:Surgeons; D013525:Surgical Instruments
keywords: Expert surgeon; Forceps manipulation; Fundoplication; Pseudo-viewpoint alternation system