Foot‐Pedal Monitoring Camera Improves Pedal Operation During Simulated Therapeutic Endoscopy

ABSTRACT Objectives Therapeutic endoscopic procedures often require the coordinated use of multiple foot pedals, making pedal operation challenging. We developed a foot‐pedal monitoring camera system that displays the pedal area on the endoscopic monitor, allowing operators to confirm pedal position without looking away from the procedural field. This study evaluated the effect of the system on foot‐pedal operation during simulated therapeutic endoscopy. Methods This single‐center simulation study used a custom‐built simulator that displayed one of four commands on a monitor: cutting, coagulation, water jet, or injection. Participants responded by pressing the corresponding foot pedal. Each participant completed three sets of 20 commands under two conditions: with and without camera assistance. The primary outcome was participant‐level mean reaction time. Secondary outcomes included participant‐level median reaction time, incorrect pedal presses, and gaze shifts toward the foot pedals. Results Eighteen endoscopists from 13 institutions completed all simulation tasks under both study conditions. Camera assistance significantly reduced the mean reaction time compared with the conventional condition (1190.4 ms vs. 1280.8 ms; p = 0.0024). Participant‐level median reaction times were also significantly shorter with camera assistance. In addition, camera assistance reduced incorrect pedal presses and gaze shifts. Conclusions The foot‐pedal monitoring camera improved the speed of pedal operation and reduced incorrect pedal presses and gaze shifts during simulated therapeutic endoscopy. Further clinical investigation is needed to determine whether these findings translate into improved pedal operation during actual therapeutic endoscopy. Trial Registration : University Hospital Medical Information Network: UMIN000060763