## 5 Discussion  
The development of mechanical devices to assist surgeons in surgery has continued. Robotic laparoscopic surgical instruments such as the Da Vinci and dexter robots provide users with a convenient and efficient surgical environment. However, there are still few significant benefits compared to conventional laparoscopic surgery, which has excellent operation time [16]. In addition, since the robot system is costly, an inexpensive laparoscopic holder that can be used in combination with conventional laparoscopic surgery must be developed [17]. Ethos' laparoscopic assistants were placed over the patient to maintain a free and comfortable posture from the surgical space, which substantially reduced the musculoskeletal pain of doctors. However, it increased the difficulty of most operations, and the chair's posture was evaluated as unsuitable for surgery. In addition, the study discussed the need to fix a laparoscopic camera [18]. The laparoscopic camera system using Senhance's gaze tracking supports better visualization-magnification, 3D images, and haptic feedback, and the platform is relatively cheaper than the Da Vinci system. However, this invades the surgical environment because it is expensive to purchase and maintain compared to laparoscopic holders and it is very bulky [19]. A voice-controlled robot-automated endoscopic system for optimal positioning (AESOP) is a voice-activated robotic scope holder (not commercially available). Because it is voice-operated, the instrument can be used with both hands, similar to the ICT laparoscopy system. Additionally, by remembering a specific position, the laparoscope can automatically return to that position. However, it takes up a lot of workspace and is expensive. Compared to the cart-type AESOP, the ICT laparoscopy system is compact and takes up less space [20]. The FreeHand(r) robot-assisted system operates in a form similar to the ICT laparoscopy developed in this study; hence, it does not require camera assistance. It does not occupy substantial surgical space, making it relatively inexpensive and suitable for solo surgery. In the operation of the FreeHand(r) robot-assisted system, the camera's head does not move, but because the rigid scope does move, the radius of movement is limited, and the space it occupies is relatively larger than that occupied by ICT laparoscopy [21; 22]. Existing laparoscopy camera systems are predominantly designed with an elongated tube that houses objective and relay lenses [24]. However, significant efforts have been made to investigate the application of flexible laparoscopes in abdominal surgeries to address the spatial interference issues associated with the rigid lens tube of conventional laparoscopes [25]. Another challenge is the scarcity of trained scope operators capable of maneuvering the laparoscopic camera following the requirements of the surgical procedure and situation. The extensive training period for surgical assistants to become proficient has fueled the demand for automated assistive functions for laparoscopic camera adjustment and management within the surgical domain. Although mechanical camera holders and robotic arms have been developed and commercialized, their practical application in surgeries has been limited due to the necessity of removing the tube from the body for lens cleaning. The current development phase focused on the wireless adjustment of the camera actuator via motion tracking. Our study, based on the in vivo performance and usability tests with porcine subjects using the prototype of our ICT motion-tracking laparoscopic camera system, has demonstrated the system's feasibility for conducting laparoscopic surgeries efficiently and safely without requiring manual scope adjustment. Notably, the device eliminates the requirement to remove the scope during surgery. It incorporates a CMOS sensor that transforms visual information into electrical signals.