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Background The da Vinci robot provides a sitting position and an armrest to decrease workload and increase dexterity. We investigated the surgeon's ergonomic behaviour by installing force sensors on the dV-Trainer® simulator's armrest to measure the 'armrest load' during the performance of simulated exercises. Methods Five experts and 48 novices performed two robotic simulation exercises on the dV-Trainer. We calculated the armrest load and evaluated their armrest-using habits. Overall score and workspace range were evaluated automatically by the simulator and compared with armrest load. Results Statistically significant differences exist for overall score, workspace range and armrest load between novices and experts. Conclusion The armrest load score is a direct, sensitive measure for the ergonomic evaluation of a simulator's armrest use. This experience-dependent ergonomic difference between experts and novices (p = 0.007) highlights the importance of ergonomic training for novice robot users. Copyright © 2016 John Wiley & Sons, Ltd.

To study variations in the anatomical relationships of the branches of the ulnar nerve in Guyon’s canal relative to the hamulus of hamate (HH) in a grip encountered among cyclists. Forty-seven wrist examinations were performed on a 3-T MRI (soft antenna, 16 channels) in propeller sequence in the plane perpendicular to the carpus in 28 healthy volunteers in three cycling positions (neutral, hyperextension and ulnar deviation). The positions and distance between the superficial (SB) and deep (DB) branches of the ulnar nerve with respect to the HH were determined on the section passing through the HH. The mean distances between the SB (d s) and DP (d p) and HH were 2.4 and 0.6 mm, respectively. The d s in hyperextension and ulnar deviation were 2.2 mm (P = 0.3) and 3 mm (P = 0.07), respectively. The d p in hyperextension and ulnar deviation were 0.3 mm (P = 0.02) and 0.5 mm (P = 0.15), respectively. Hyperextended, 60 % of SB and 40 % of DB were close to the HH, and 26 % of DB came directly in contact with it. In ulnar deviation, 30 % of SB and 29 % of DB approached HH, and 47 % of DB were in contact with it. This study shows that SB and DB positions of the ulnar nerve vary with respect to the HH depending on the position of the wrist, and such differences may promote Guyon’s canal syndrome in cyclists.

Limited pancreatic resections are increasingly performed, but the rate of postoperative fistula is higher than after classical resections. Pancreatic segmentation, anatomically and radiologically identifiable, may theoretically help the surgeon removing selected anatomical portions with their own segmental pancreatic duct and thus might decrease the postoperative fistula rate. We aimed at systematically and comprehensively reviewing the previously proposed pancreatic segmentations and discuss their relevance and limitations. PubMed database was searched for articles investigating pancreatic segmentation, including human or animal anatomy, and cadaveric or surgical studies. Overall, 47/99 articles were selected and grouped into 4 main hypotheses of pancreatic segmentation methodology: anatomic, vascular, embryologic and lymphatic. The head, body and tail segments are gross description without distinct borders. The arterial territories defined vascular segments and isolate an isthmic paucivascular area. The embryological theory relied on the fusion plans of the embryological buds. The lymphatic drainage pathways defined the lymphatic segmentation. These theories had differences, but converged toward separating the head and body/tail parts, and the anterior from posterior and inferior parts of the pancreatic head. The rate of postoperative fistula was not decreased when surgical resection was performed following any of these segmentation theories; hence, none of them appeared relevant enough to guide pancreatic transections. Current pancreatic segmentation theories do not enable defining anatomical–surgical pancreatic segments. Other approaches should be explored, in particular focusing on pancreatic ducts, through pancreatic ducts reconstructions and embryologic 3D modelization.

In robotic surgery, the coordination between the console-side surgeon and bed-side assistant is crucial, more than in standard surgery or laparoscopy where the surgical team works in close contact. Xperience™ Team Trainer (XTT) is a new optional component for the dv-Trainer® platform and simulates the patient-side working environment. We present preliminary results for face, content, and the workload imposed regarding the use of the XTT virtual reality platform for the psychomotor and communication skills training of the bed-side assistant in robot-assisted surgery. Participants were categorized into "Beginners" and "Experts". They tested a series of exercises (Pick & Place Laparoscopic Demo, Pick & Place 2 and Team Match Board 1) and completed face validity questionnaires. "Experts" assessed content validity on another questionnaire. All the participants completed a NASA Task Load Index questionnaire to assess the workload imposed by XTT. Twenty-one consenting participants were included (12 "Beginners" and 9 "Experts"). XTT was shown to possess face and content validity, as evidenced by the rankings given on the simulator's ease of use and realism parameters and on the simulator's usefulness for training. Eight out of nine "Experts" judged the visualization of metrics after the exercises useful. However, face validity has shown some weaknesses regarding interactions and instruments. Reasonable workload parameters were registered. XTT demonstrated excellent face and content validity with acceptable workload parameters. XTT could become a useful tool for robotic surgery team training.

Background The effect of telesurgical training was evaluated at two latency levels. Methods Eleven subjects were randomly assigned to two delay groups (400 and 600 ms). Each group trained with latency on a simple task of dV-Trainer® and performed a difficult task before (pre-test) and after (post-test) the training. The follow-up was conducted 1 week after the training. Results The difficulty decreased gradually during training for both groups, while the task completion time and the instrument motion improved only in the 600 ms group. Both groups made progress from pre- to post-test, but statistical significance was not achieved. In the follow-up, subjects maintained their highest level achieved during training. Conclusions Latency training is effective and this effect lasts at least 1 week. Latency training on a simple task may improve results in complex procedures. However, attention should be paid to avoiding carelessness due to confidence from training. Copyright © 2014 John Wiley & Sons, Ltd.

Objectifs Le nombre croissant de publications mettant en parallele les milieux aeronautiques et medicaux temoigne des similarites dans ces activites. Certains principes utilises en aviation sont certainement extrapolables. Ainsi, la formation sur simulateurs de mirage 2000 etant assuree par des formateurs specialises et non des pilotes, il a paru interessant d’appliquer ce principe de subsidiarite a la formation au competences techniques de base en chirurgie robotique. Methodes De septembre 2015 a mai 2018, la formation en chirurgie robotique a fait appel a des formateurs issus de l’armee de l’air et specifiquement entraines a l’usage des simulateurs de robotique (DV-trainer mimic® ou DVSS intuitive®) ainsi qu’a l’utilisation de la console robot Da Vinci. Les chirurgiens experts/universitaires intervenaient pour le programme pedagogique, la chirurgie sur animal. L’evaluation etait faite par un questionnaire de satisfaction en fin de session (survey monkey). Resultats Vingt et un sessions de formation ont ete evaluees pour un total de 144 chirurgiens. Sur les 5 ateliers qui etaient encadres specifiquement par les formateurs, la pertinence des conseils etait cotee plus de 4/5. Pour l’evaluation globale, le sentiment de progression des stagiaires etait superieur a 4,5/5 de meme que l’impact de la formation sur la qualite du futur travail. A la question « cette formation est-elle a recommander », les reponses etaient a 4,8/5. Conclusion Le principe de subsidiarite (recherche du niveau le plus pertinent et le plus proche pour resoudre des problemes) a montre sa pertinence lors de la formation a la chirurgie robotique en allegeant la tâche des chirurgiens experts/universitaires tout en apportant un haut degre de satisfaction aux chirurgiens stagiaires.

Introduction/Objectifs La mise en evidence d’une segmentation pancreatique permettrait la realisation de resections chirurgicales anatomiques [1] . De telles resections pourraient alors aboutir a une diminution du taux de complications locales postoperatoire, notamment de fistules [2] . Le but de cette etude etait de proposer une segmentation pancreatique basee sur les territoires de drainage lymphatiques du pancreas, par l’injection de colorant lymphophile dans differentes parties pancreatiques chez le cochon vivant [3] . Materiels/patients et methodes Quinze cochons vivants issus de l’Ecole de chirurgie de Nancy ont ete injectes par bleu Patente avant d’etre sacrifies, disseques et photographies. L’injection a ete realisee selon un protocole reproductible (aucune dissection prealable de l’etage abdominal superieur, profondeur 1 cm, 2 mL). Les injections etaient realisees dans le lobe duodenal (LD) (1) en haut et en avant, (2) en haut et en arriere, (3) en bas et en avant et dans le lobe splenique (LS) (4) proximal et (5) distal. Resultats Les injections dans le LD superieur montraient une diffusion lymphatique vers le pedicule hepatique et vers le LS jusque le bord gauche de la veine mesenterique superieure (VMS). Les injections dans le LD inferieur donnaient une diffusion uniquement vers le lobe communicant (LC). Les injections distales dans le LS montraient une diffusion locale jusqu’au pedicule splenique. Les injections proximales dans le LS donnaient une diffusion a gauche dans tout le LS jusqu’au pedicule splenique, mais aussi a droite jusqu’au bord gauche de la VMS sans la depasser et aucune de diffusion vers le pedicule hepatique. Conclusions Ce travail a confirme la faisabilite d’exploration des voies lymphatiques peri-pancreatiques chez un etre vivant. Il pourrait nuancer les theories de segmentation lymphatiques pancreatiques actuelles qui reposent sur des travaux cadaveriques. Cette etude est limitee par le modele utilise car les anatomies pancreatiques humaine et porcine different largement.

Summary background data Robotic surgery has witnessed a huge expansion. Robotic simulators have proved to be of major interest in training. Some authors have suggested that prior experience in micro-surgery could improve robotic surgery training. Objective To test micro-surgery as a new approach in training, we proposed a prospective study comparing the surgical performance of micro-surgeons with that of general surgeons on a robotic simulator. Methods 49 surgeons were enrolled; 11 in the micro-surgery group (MSG); 38 n the control group (CG). Performance was evaluated based on five dV-Trainer® exercises. Results MSG achieved better results for all exercises including exercises requiring visual evaluation of force feed-back, economy of motion, instrument force and position. Conclusions These results show that experience in micro-surgery could significantly improve surgeons' abilities and their performance in robotic training. So, as micro-surgery practice is relatively cheap, it could be easily included in basic robotic surgery training. Copyright © 2013 John Wiley & Sons, Ltd.

International audience; Background: In robotic surgery, the professional ergonomic habit of using an armrest reduces operator fatigue and increases the precision of motion. We designed and validated a pressure surveillance system (PSS) based on force sensors to investigate armrest use. The objective was to evaluate whether adding an alarm to the PSS system could shorten ergonomic training and improve performance.Study design: Twenty robot and simulator-naïve participants were recruited and randomized in two groups (A and B). The PSS was installed on a robotic simulator, the dV-Trainer, to detect contact with the armrest. The Group A members completed three tasks on the dV-Trainer without the alarm, making 15 attempts at each task. The Group B members practiced the first two tasks with the alarm and then completed the final tasks without the alarm. The simulator provided an overall score reflecting the trainees' performance. We used the new concept of an "armrest load" score to describe the ergonomic habit of using the armrest.Results: Group B had a significantly higher performance score (p < 0.001) and armrest load score (p < 0.001) than Group A from the fifth attempt of the first task to the end of the experiment.Conclusions: Based on the conditioned reflex effect, the alarm associated with the PSS rectified ergonomic errors and accelerated professional ergonomic habit acquisition. The combination of the PSS and alarm is effective in significantly shortening the learning curve in the robotic training process.

International audience; Objective: This study evaluated the effectiveness of using a video recording and replaying system in robotic surgical training.Summary background data: Robotic surgical videos are reviewed to accelerate the acquisition of robotic surgical skills. However, few professional recording and replaying systems have been used during robotic surgical training. The effectiveness of these professional video systems should be investigated and validated.Methods: A randomized study was conducted to analyze the performance of 60 participants, who were unfamiliar with surgical robotics, in a robotic simulator. Participants were enrolled in 2 groups to perform 2 exercises on a Mimic dV-Trainer. One group was trained with the new protocol based on a recording and replaying system (controller of events on simulator and robot) and the other group was trained with the conventional method. The overall scores were automatically evaluated by the simulator. The number of additional requests for reviewing the videos or watching the trainer's demonstration and the learning curves based on the overall scores were compared between the 2 groups.Results: The group trained with controller of events on simulator and robot presented a significantly improved learning curve in both exercises (P < 0.001) with more additional requests (P < 0.001) in comparison with the group trained with the conventional method.Conclusions: In robotic skills training, the use of a recording and replay system is beneficial and more efficient than the conventional training method.

International audience; The objective of this study was to develop a simple and useful injection protocol for imaging cadaveric vascularization and dissection. Mixtures of contrast agent and cast product should provide adequate contrast for two types of ex vivo imaging (MRI and CT) and should harden to allow gross dissection of the injected structures. We tested the most popular contrast agents and cast products, and selected the optimal mixture composition based on their availability and ease of use. All mixtures were first tested in vitro to adjust dilution parameters of each contrast agent and to fine-tune MR imaging acquisition sequences. Mixtures were then injected in 24 pig livers and one human pancreas for MR and computed tomography (CT) imaging before anatomical dissection. Colorized latex, gadobutrol and barite mixture met the above objective. Mixtures composed of copper sulfate (CuSO 4) gadoxetic acid (for MRI) and iodine (for CT) gave an inhomogeneous signal or extravasation of the contrast agent. Agar did not harden sufficiently for gross dissection but appears useful for CT and magnetic resonance imaging (MRI) studies without dissection. Silicone was very hard to inject but achieved the goals of the study. Resin is particularly difficult to use but could replace latex as an alternative for corrosion instead of dissection. This injection protocol allows CT and MRI images to be obtained of cadaveric vascularization and anatomical casts in the same anatomic specimen. Post-imaging processing software allow easy 3D reconstruction of complex anatomical structures using this technique. Applications are numerous, e.g. surgical training, teaching methods, postmortem anatomic studies, pathologic studies, and forensic diagnoses.

Objectives To investigate operators' performance quality, mental stress, and ergonomic habits through a training curriculum on robotic simulators. Design Forty volunteers without robotic surgery experience were recruited to practice 2 exercises on a dV-Trainer (dVT) for 14 hours. The simulator software (M-score a ) provided an automatic evaluation of the overall score for the surgeons' performance. Each participant provided a subjective difficulty score (validity to be proven) for each exercise. Their ergonomic habits were evaluated based on the workspace range and armrest load—validated criteria for evaluating the proficiency of using the armrest. They then repeated the same tasks on a da Vinci Surgical Skill Simulator for a final-level test. Their final scores were compared with their initial scores and the scores of 5 experts on the da Vinci Surgical Skill Simulator. Results A total of 14 hours of training on the dVT significantly improved the surgeons' performance scores to the expert level with a significantly reduced workload, but their ergonomic score was still far from the expert level. Conclusion Sufficient training on the dVT improves novices' performance, reduces psychological stress, and inculcates better ergonomic habits. Among the evaluated criteria, novices had the most difficulty in achieving expert levels of ergonomic skills. The training benefits of robotic surgery simulators should be determined with quantified variables. The detection of the limitations during robotic training curricula could guide the targeted training and improve the training effect.

Evo–devo is the science that studies the link between evolution of species and embryological development. This concept helps to understand the complex anatomy of the human nose. The evo–devo theory suggests the persistence in the adult of an anatomical entity, the olfactory fascia, that unites the cartilages of the nose to the olfactory mucosa. We dissected two fresh specimens. After resecting the superficial tissues of the nose, dissection was focused on the disarticulation of the fibrocartilaginous noses from the facial and skull base skeleton. Dissection shows two fibrocartilaginous sacs that were invaginated side-by-side in the midface and attached to the anterior skull base. These membranous sacs were separated in the midline by the perpendicular plate of the ethmoid. Their walls contained the alar cartilages and the lateral expansions of the septolateral cartilage, which we had to separate from the septal cartilage. The olfactory mucosa was located inside their cranial ends. The olfactory fascia is a continuous membrane uniting the nasal cartilages to the olfactory mucosa. Its origin can be found in the invagination and differentiation processes of the olfactory placodes. The fibrous portions of the olfactory fascia may be described as ligaments that unit the different components of the olfactory fascia one to the other and the fibrocartilaginous nose to the facial and skull base skeleton. The basicranial ligaments, fixing the fibrocartilaginous nose to the skull base, represent key elements in the concept of septorhinoplasty by disarticulation.

To determine the impact of communication latency on telesurgical performance using the robotic simulator dV-Trainer $$^{\textregistered }$$ Surgeons were enrolled during three robotic congresses. They were randomly assigned to a delay group (ranging from 100 to 1000 ms). Each group performed three times a set of four exercises on the simulator: the first attempt without delay (Base) and the last two attempts with delay (Warm-up and Test). The impact of different levels of latency was evaluated. Thirty-seven surgeons were involved. The different latency groups achieved similar baseline performance with a mean task completion time of 207.2 s ( $$p>0.05$$ ). In the Test stage, the task duration increased gradually from 156.4 to 310.7 s as latency increased from 100 to 500 ms. In separate groups, the task duration deteriorated from Base for latency stages at delays $$\ge $$ 300 ms, and the errors increased at 500 ms and above ( $$p\

The implementation of robotic technology in minimally invasive surgery has led to the need to develop more efficient and effective training methods, as well as assessment and skill maintenance tools for surgical education. Multiple simulators and procedures are available for educational and training purposes. A need for comparative evaluations of these simulators exists to aid users in selecting an appropriate device for their purposes. We conducted an objective review and comparison of the design and capabilities of all dedicated simulators of the da Vinci robot, the da Vinci Skill Simulator (DVSS) (Intuitive Surgical Inc., Sunnyvale, CA, USA), dV-Trainer (dVT) (Mimic Technologies Inc., Seattle, WA, USA), and Robotic Surgery Simulator (RoSS) (Simulated Surgical Skills, LLC, Williamsville, NY, USA). This provides base specifications of the hardware and software, with an emphasis on the training capabilities of each system. Each simulator contains a large number of training exercises, DVSS = 40, dVT = 65, and RoSS = 52 for skills development. All three offer 3D visual images but use different display technologies. The DVSS leverages the real robotic surgeon’s console to provide visualization, hand controls, and foot pedals. The dVT and RoSS created simulated versions of all of these control systems. They include systems management services which allow instructors to collect, export, and analyze the scores of students using the simulators. This study is the first to provide comparative information of the three simulators functional capabilities with an emphasis on their educational skills. They offer unique advantages and capabilities in training robotic surgeons. Each device has been the subject of multiple validation experiments which have been published in the literature. But those do not provide specific details on the capabilities of the simulators which are necessary for an understanding sufficient to select the one best suited for an organization’s needs.

The introduction of simulation into minimally invasive robotic surgery is relatively recent and has seen rapid advancement; therefore, a need exists to develop training curriculums and identify systems that will be most effective at training surgical skills. Several simulators have been introduced to support these aims—the daVinci skills simulator, Mimic dV-Trainer, Surgical Simulated Systems’ RoSS, and Simbionix Robotix Mentor. While multiple studies have been conducted to demonstrate the validity of these systems, studies comparing the perceived value of these devices as tools for education and skills are lacking. Subjects who qualified as medical students or physicians (n = 105) were assigned a specific order to use each of the three simulators. After completing a demographic questionnaire, participants performed one exercise on the three simulators and completed a second questionnaire regarding their experience with the device. After using all systems, they completed a final questionnaire, which detailed their comparative preferences. The subject’s performance metrics were also collected from each simulator. The data confirmed the face, content, and construct validity for the dV-trainer and skills simulator. Similar validities could not be confirmed for the RoSS. >80 % of the time, participants chose the skills simulator in terms of physical comfort, ergonomics, and overall choice. However, only 55 % thought the skills simulator was worth the cost of the equipment. The dV-Trainer had the highest cost preference scores with 71 % of respondents feeling it was worth the investment. Usability can affect the consistency and commitment of users of robotic surgical simulators. In a previous study, these simulators were objectively reviewed and compared in terms of their system capabilities. Collectively, this work will offer end-users and potential buyers a comparison of the perceived value and preferences of robotic simulators.

But Evo-devo est la science qui etudie les liens entre l’evolution des especes et le developpement embryologique. Ce concept aide a comprendre l’anatomie complexe du nez. Le concept Evo-Devo evoque la persistance chez l’adulte d’une entite anatomique, le fascia olfactif qui unit les cartilages du nez avec la muqueuse olfactive du nez. Methode Nous avons disseque dans le cadre d’une etude preliminaire 2 specimens. Apres ablation du tissu superficiel du nez, la dissection etait ensuite focalisee sur la desarticulation du nez fibrocartilagineux de la face vers la base du crâne. Resultats La dissection a mis en evidence 2 sacs fibrocartilagineux qui etaient invagines cote a cote en medio-facial et attaches a la base du crâne. Ces deux sacs membraneux etaient separes medialement par la lame perpendiculaire de l’ethmoide. Leurs parois contenaient les cartilages alaires et les cartilages lateraux qui avaient ete separes du cartilage septal. La muqueuse olfactive etait localisee au niveau de l’extremite craniale des sacs. Conclusion Le fascia olfactif correspond a une membrane continue qui unit les cartilages du nez a la muqueuse olfactive. Il provient embryologiquement de l’invagination et la differenciation des placodes olfactives. La portion fibreuse du fascia olfactif correspond a des ligaments qui unissent les differentes parties du fascia olfactif les unes aux autres et le nez fibrocartilagineux a la base du crâne. Les ligaments basicrâniaux representent l’element princeps des septorhinoplasties par desarticulation.

International audience

Introduction La citerne du chyle est une structure anatomique situee, lorsqu’elle existe, sous le diaphragme, en avant de la paroi abdominale posterieure et a droite de l’aorte abdominale. Cette structure anatomique recoit les trois-quarts de la circulation lymphatique du corps humain et represente l’origine du conduit thoracique. Objectifs Une solide connaissance des variations anatomiques de la citerne du chyle et de ses reseaux affluents est necessaire pour guider le radiologue et le chirurgien en cancerologie. Materiels et methodes Seize cadavres humains (7 femmes et 9 hommes) ont ete inclus pour cette etude. Le conduit thoracique a ete injecte de maniere retrograde, apres abord thoracique, par une solution de latex, gadobutrol (3 mL/L) et baryte (10 %). Cette solution permet de donner un contraste adequat en IRM et scanner, puis durcit, autorisant sa dissection. Apres acquisition scanner (120 kV, 110 mA, collimation 1 mm) et IRM (3D FSPGR, TR : 8,5 ms, TE : 3,6 ms, matrice : 179 × 256, resolution : 0,6 × 0,6 mm), les sujets etaient disseques. Resultats La moyenne d’âge des sujets etait de 76,9 ans. La citerne etait visualisee a la fois en imagerie et apres dissection dans 80 % des cas. Sa forme et ses dimensions ont ete mesurees. Chez un sujet, les voies afferentes etaient visualisees. Conclusion Cette etude rapporte une nouvelle possibilite de visualisation ex vivo de la citerne du chyle par injection retrograde, imagerie TDM et IRM puis par dissection anatomique.

Introduction L’objectif de cette etude etait de developper une technique simple et reproductible de visualisation des reseaux vasculaires de pieces anatomiques. La preparation devait donner un contraste en IRM et scanner, puis durcir pour permettre la dissection anatomique des structures injectees. Materiels et methodes Les agents de contraste testes ont ete choisis selon leur accessibilite et leur facilite de manipulation. Tous les melanges ont d’abord ete testes in vitro pour ajuster les parametres de dilution de chaque agent de contraste et pour affiner les sequences d’acquisition d’IRM. Les melanges ont ensuite ete injectes dans 24 foies porcins et un pancreas humain. Les acquisitions IRM et scanner permettaient une reconstruction 3D des reseaux vasculaires avant comparaison avec la dissection anatomique. Resultats Un melange compose de latex colore, baryte liquide et gadobutrol represente la reference pour l’injection des pieces anatomiques. La resine pourrait remplacer le latex comme alternative, pour corrosion au lieu de la dissection. L’agar ou la gelatine se revelent utiles pour les etudes de TDM et d’IRM sans dissection. Conclusion Cette technique permet d’obtenir des images scanner et IRM des reseaux vasculaires injectes, puis reconstruction tridimensionnelle. Elle permet egalement de confronter les resultats d’imagerie avec la dissection. Les applications sont nombreuses, comme les etudes preoperatoires, l’enseignement fondamental, les etudes anatomiques post-mortem, les etudes anatomo-pathologiques et les diagnostics medico-legaux. Cette technique simple et reproductible pourrait s’imposer comme la reference dans les laboratoires d’Anatomie.

Background Since the US Food and Drug Administration approved robotically assisted surgical devices for human surgery in 2000, the number of surgeries utilizing this innovative technology has risen. In 2015, approximately 650 000 robot-assisted procedures were performed worldwide. Surgeons must be properly trained to safely transition to using such innovative technology. Multiple virtual reality robotic simulators are now commercially available for educational and training purposes. There is a need for comparative evaluations of these simulators to aid users in selecting an appropriate device for their purposes. Methods We conducted a comparison of the design and capabilities of all dedicated simulators of the da Vinci robot – the da Vinci Skills Simulator (dVSS), dV-Trainer (dVT), Robotic Skills Simulators (RoSS) and the RobotiX Mentor. This paper provides the base specifications of the hardware and software, with an emphasis on the training capabilities of each system. Results Each simulator contains a large number of training exercises for skills development: dVSS n = 40, dVT n = 65, RoSS n = 52, RobotiX Mentor n = 31. All four offer 3D visual images but use different display technologies. The dVSS leverages the real robotic surgical console to provide visualization, hand controls and foot pedals. The dVT, RoSS and RobotiX Mentor created simulated versions of all of these control systems. Each includes systems management services that allow instructors to collect, export and analyze the scores of students using the simulators. Conclusions This study provides comparative information on the four simulators' functional capabilities. Each device offers unique advantages and capabilities for training robotic surgeons. Each has been the subject of validation experiments, which have been published in the literature. But those do not provide specific details on the capabilities of the simulators, which are necessary for an understanding sufficient to select the one best suited for an organization's needs. This article provides comparative information to assist with that type of selection.

Reconstructing the eyelash margin is a challenge for plastic surgeons because eyelashes have specific characteristics. There is still no gold standard procedure for this type of reconstruction, which seeks to protect the eyeball and make the eyelid appear natural. The eyebrow composite graft can be a good option for reconstructing the eyelash margin because it is technically simple and safe, and takes advantage of the structural similarity between the eyelashes and eyebrow. The results presented showed the effectiveness of the technique by providing improved occlusion and a good aesthetic result.

International audience; BACKGROUND:Sleeve gastrectomy is a bariatric surgical procedure that may result in particular morbidity or mortality due to gastric fistula in the proximal part of the gastric tube. Two theories are currently proposed to explain this specific leak location. The vascular theory attributes the leaks to reduced perfusion in the gastric tube, and the mechanical theory suggests the etiology as gastric tube hyper-pressure due to pyloric conservation. The aim of this study was to map the arterial gastric vascular supply on fresh cadavers after performing sleeve gastrectomy to evaluate the effect of vascular changes on gastric leakage.METHODS:We performed sleeve gastrectomies on 11 cadaveric trunks with a detailed anatomical study of the gastric vascular supply after latex injection in the three branches arising from the celiac trunk.RESULTS:In 55 % of cases, the sleeve procedure changed the gastric vascular supply. In 9.1 %, it divided the three left gastric artery branches arising from the lesser curvature. Few changes were noted in the antrum or pylorus.CONCLUSIONS:This anatomical study demonstrates that the vascular supply of the proximal part of the gastric tube can be damaged by a sleeve procedure, which can sever one or more of the branches arising from the left gastric artery. Such weakness could be exacerbated by disparities in vascular supply. The uninterrupted vascular supply of the antrum and pylorus may explain the preferential localization of the fistula to the proximal part of the gastric tube.

International audience; BACKGROUND:The primary limitation of telesurgery is the communication latency. Accurate and detailed data are lacking to reveal the latency effects on surgical performance; furthermore, the maximum acceptable latency in telesurgery remains unclear.METHODS:Sixteen medical students performed an energy dissection exercise and a needle-driving exercise on the robotic simulator dV-Trainer(®), and latencies varying between 0 and 1,000 ms with a 100-ms interval were randomly and blindly presented. Task completion time, instrument motion, and errors were automatically recorded. The difficulty, security, precision, and fluidity of manipulation were self-scored by subjects between 0 and 4 (0 the best, 2 moderate, and 4 the worst).RESULTS:Task completion time, motion, and errors increased gradually as latency increased. An exponential regression was fit to the mean times and motions (R (2) > 0.98). Subjective scorings of the four items were similar. The mean scores were less than 1 at delays ≤200 ms, then increased from 1 to 2 at 300-700 ms, and finally approached 3 at delays above. In both exercises, latencies ≤300 ms were judged to be safe by all and 400-500 ms were accepted by 66-75 % of subjects. Less than 20 % of subjects accepted delays ≥800 ms.CONCLUSIONS:The surgical performance deteriorates in an exponential way as the latency increases. The delay impact on instrument manipulation is mild at 0-200 ms, then increases from small to large at 300-700 ms, and finally becomes very large at 800-1,000 ms. Latencies ≤200 ms are ideal for telesurgery; 300 ms is also suitable; 400-500 ms may be acceptable but are already tiring; and 600-700 ms are difficult to deal with and only acceptable for low risk and simple procedures. Surgery is quite difficult at 800-1,000 ms, telementoring would be a better choice in this case.

Whilst laparoscopic surgical simulators are becoming increasingly realistic they can not, as yet, fully replicate the experience of live surgery. In particular tissue dissection in one task that is particularly challenging to replicate. Limitation of current attempts to simulate tissue dissection include: poor visual rendering; over simplification of the task and; unrealistic tissue properties. In an effort to generate a more realistic model of tissue dissection in laparoscopic surgery we propose a novel method based on task analysis. Initially we have chosen to model only the basic geometrics of this task rather than a whole laparoscopic procedure. Preliminary work has led to the development of a real time simulator performing organ dissection with a haptic thread at 1000Hz. A virtual cutting tool, manipulated through a haptic device, in combination with 1D and 2D soft-tissue models accuratelyreplicatetheprocessoflaparoscopictissuedissection.

Objectifs En chirurgie robotique, l’utilisation d’un appuie-bras de facon professionnelle reduit la fatigue de l’operateur et augmente la precision du mouvement. Nous avons concu et valide un systeme de surveillance de pression (SSP) utilisant des capteurs de pression pour evaluer l’utilisation des appuie-bras. L’objectif de l’etude etait d’evaluer si l’ajout d’une alarme au systeme SSP pouvait raccourcir l’acquisition d’une position ergonomique et ameliorer les performances. Methodes Vingt participants naifs en robotique et en simulation ont ete recrutes et randomises en deux groupes (A et B). Le systeme SSP a ete installe sur les appuie-bras d’un simulateur robotique, le dV-Trainer ® (Mimic, Seattle, Etats-Unis). Les membres du groupe A ont realise trois exercices sur le dV-Trainer sans l’alarme, faisant 15 tentatives pour chacun. Les membres du groupe B ont realise les deux premiers exercices avec l’alarme puis l’exercice final sans alarme. Le simulateur fournissait un score global refletant la performance des stagiaires. La mesure du taux d’appui sur les avant-bras evaluait l’adoption d’une position ergonomique sur les appuie-bras. Resultats Le groupe B avait des performances significativement plus elevees sur le score global ( p p Conclusion Par le developpement d’un reflexe conditionne, l’alarme associee au SSP rectifie les erreurs ergonomiques et accelere l’acquisition d’une position ergonomique. La combinaison du SSP et d’une alarme raccourcit significativement la courbe d’apprentissage dans les exercices testes.

The effects of pristane on some immunity parameters in BALB c mice were studied. The intraperitoneal administration of a single dose of pristane induced a strong inflammatory reaction that lasted longer than 10 days. When mice were immunized with sheep erythrocytes 10 days after pristane administration, the response of hemolytic IgM-forming cells was increased and that of hemolytic IgG-forming cells was decreased; however, the total number of antibody-forming cells did not change. The proliferative response of splenocytes to concanavalin A was increased in mice that received pristane 10 days earlier. Development of the syngeneic NS1 plasmacytoma was enhanced by administration of pristane 2 days or 10 days before tumor transplantation. We concluded that enhancement of plasmacytoma development was not due to immunosuppressive properties of pristane but to other factors such as ascites induction.

Exponential development of minimally invasive techniques, such as robotic-assisted devices, raises the question of how to assess robotic surgery skills. Early development of virtual simulators has provided efficient tools for laparoscopic skills certification based on objective scoring, high availability, and lower cost. However, similar evaluation is lacking for robotic training. The purpose of this study was to assess several criteria, such as reliability, face, content, construct, and concurrent validity of a new virtual robotic surgery simulator.This prospective study was conducted from December 2009 to April 2010 using three simulators dV-Trainers(®) (MIMIC Technologies(®)) and one Da Vinci S(®) (Intuitive Surgical(®)). Seventy-five subjects, divided into five groups according to their initial surgical training, were evaluated based on five representative exercises of robotic specific skills: 3D perception, clutching, visual force feedback, EndoWrist(®) manipulation, and camera control. Analysis was extracted from (1) questionnaires (realism and interest), (2) automatically generated data from simulators, and (3) subjective scoring by two experts of depersonalized videos of similar exercises with robot.Face and content validity were generally considered high (77 %). Five levels of ability were clearly identified by the simulator (ANOVA; p = 0.0024). There was a strong correlation between automatic data from dV-Trainer and subjective evaluation with robot (r = 0.822). Reliability of scoring was high (r = 0.851). The most relevant criteria were time and economy of motion. The most relevant exercises were Pick and Place and Ring and Rail.The dV-Trainer(®) simulator proves to be a valid tool to assess basic skills of robotic surgery.