Cyril Perrenot | University of Lorraine (original) (raw)

Papers by Cyril Perrenot

Research paper thumbnail of Robotic-assisted right colectomy. Official expert recommendations delivered under the aegis of the French Association of Surgery (AFC)

Journal of Visceral Surgery

Research paper thumbnail of Colectomie droite par abord robotique. Recommandations formalisées d’experts sous l’égide de l’Association française de chirurgie (AFC)

Journal de Chirurgie Viscérale

Research paper thumbnail of Iconographies supplémentaires de l'article : Place de la simulation dans l’apprentissage de la chirurgie robotique

Elsevier Masson, Dec 4, 2020

Research paper thumbnail of Botulinum toxin injection before giant incisional hernia repair: Surgical technique

Journal of Visceral Surgery, 2022

Research paper thumbnail of Technique d’injection de toxine botulique avant cure d’une grande éventration

Journal de Chirurgie Viscérale, 2022

Research paper thumbnail of Exploration des voies lymphatiques péri-pancréatiques chez un modèle porcin vivant

Morphologie, 2018

Introduction/Objectifs La mise en evidence d’une segmentation pancreatique permettrait la realisa... more 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.

Research paper thumbnail of Élaboration D’Un Programme D’Enseignement Pratique Par Simulation en Chirurgie Viscérale et Digestive

Journal de Chirurgie Viscérale, 2020

Resume Jusqu’en 2013, la formation pratique des internes inscrits au DES/DESC de chirurgie viscer... more Resume Jusqu’en 2013, la formation pratique des internes inscrits au DES/DESC de chirurgie viscerale et digestive en France n’etait pas standardisee. Depuis 2017, le troisieme cycle des etudes medicales a ete restructure autour de deux axes : connaissances theoriques et competences techniques et non-techniques. Celui-ci comporte notamment un programme de formation pratique par simulation, hors bloc operatoire, national, structure, uniformise et standardise. Le developpement de ce programme de formation est le fruit d’un travail de consensus national sous l’egide du college francais de chirurgie viscerale et digestive permettant d’offrir un guide de formation a tous les futurs chirurgiens de la specialite. Quatre seances de conference de consensus reunissant une commission de 8 membres ont abouti a la redaction du « Livret de l’Interne pour l’Enseignement Pratique en Chirurgie Viscerale et Digestive ». Ce referentiel detaille en 272 pages les objectifs (phase I), les moyens d’apprentissage de chaque competence (phase II) et enfin les methodes d’evaluation (phase III) pour les phases socles et des phases d’approfondissement du DES de chirurgie viscerale et digestive. En complement de ce livret, nous avons mene une reflexion sur la structuration et la mise en place de ce programme a l’echelle nationale a compter de novembre 2017 qui est detaille a la fin de cet article.

Research paper thumbnail of Residency training in robotic surgery: The role of simulation

Journal of Visceral Surgery, 2020

Simulation has become increasingly important in surgical teaching in recent years and the French ... more Simulation has become increasingly important in surgical teaching in recent years and the French National Authority for Health (HAS) recently underlined the goal and ethical priority: ''never the first time on the patient''. Simulation programs have been tested and validated for laparotomy and for laparoscopy, but there is not yet a validated program specific for robotic surgery. Due to substantial advances in this new technology, we have developed a program in Nancy dedicated to outside-the-operating room (OR) teaching of robotic surgery using the Da Vinci robot. This teaching is based on a combined program of theoretical teaching (e-learning) and learning of practical skills using virtual simulators (DV-Trainer ® , Robotic Mentor ® , DVSS ®), mechanical simulators (Dome, Applied ® abdominal simulators), microsurgery and wet lab using ex vivo animal organs, anesthetized animals, and cadavers. This program also emphasizes team training. The course is intended for residents in surgical training and is integrated into the specialized study diploma (DES) program for Visceral and Digestive Surgery; it also can be used by qualified surgeons who can integrate it with the Inter-University Diploma (DIU) in General Robotic Surgery for basic techniques and also for DIUs in other surgical specialties (digestive and gynecologic surgery) for robotic uses within their specialty. These courses are based on the concept of step-by-step skills acquisition and verification allowing a transition to safe clinical activity.

Research paper thumbnail of Development of a program for teaching practical skills in visceral and digestive surgery by simulation

Journal of Visceral Surgery, 2020

Research paper thumbnail of Surgical apprenticeship in the era of simulation

Journal of Visceral Surgery, 2020

Research paper thumbnail of Le compagnonnage en chirurgie à l’heure de la simulation

Journal de Chirurgie Viscérale, 2020

Resume Les nouveaux outils de transmission des connaissances et des competences chirurgicales tel... more Resume Les nouveaux outils de transmission des connaissances et des competences chirurgicales tels que la simulation, la retransmission d’intervention, la realite virtuelle ou la realite augmentee offrent un renouveau du compagnonnage. Le reseau de pairs s’elargit, la diffusion des savoirs est acceleree. Chaque facette du metier de chirurgien beneficie de ces nouvelles modalites d’enseignement : le raisonnement clinique, la realisation des procedures techniques, la gestion du stress, la communication ou la gestion des evenements indesirables graves ou exceptionnels. Autrefois confine au sein de l’equipe chirurgicale, le compagnonnage s’etend dans les centres de simulation qui deviennent des hopitaux virtuels et sur internet via les reseaux sociaux. Au sein de ce compagnonnage numerique, les objectifs sont plus structures, l’evaluation des competences est plus standardisee, les phases d’apprentissage sont redefinies, des contrats de formation personnalises sont formalises.

Research paper thumbnail of Apprentissage de la chirurgie robotique et principe de subsidiarité : une nouvelle convergence avec l’aéronautique

Progrès en Urologie, 2018

Research paper thumbnail of Construct, Face, and Content Validation on Voxel-Man® Simulator for Otologic Surgical Training

International Journal of Otolaryngology, 2017

Objective. To assess the face, content, and construct validity of the Voxel-Man TempoSurg Virtual... more Objective. To assess the face, content, and construct validity of the Voxel-Man TempoSurg Virtual Reality simulator. Participants and Methods. 74 ear, nose, and throat (ENT) surgeons participated. They were assigned to one of two groups according to their level of expertise: the expert group (n=16) and the novice group (n=58). The participants performed four temporal bone dissection tasks on the simulator. Performances were assessed by a global score and then compared to assess the construct validity of the simulator. Finally, the expert group assessed the face and content validity by means of a five-point Likert-type scale. Results. experienced surgeons performed better (p<.01) and faster (p<.001) than the novices. However, the groups did not differ in terms of bone volume removed (p=.11) or number of injuries (p=.37). 93.7% of experienced surgeons stated they would recommend this simulator for anatomical learning. Most (87.5%) also thought that it could be integrated into su...

Research paper thumbnail of L’optimisation par une alarme de l’utilisation des appuie-bras pourrait améliorer les courbes d’apprentissage des novices sur simulateur robotique

Progrès en Urologie, 2016

Research paper thumbnail of Training tools for robotic surgery

Oncologie, 2016

RésuméLa combinaison de chirurgies complexes, notamment en oncologie, et d’une interface homme–ma... more RésuméLa combinaison de chirurgies complexes, notamment en oncologie, et d’une interface homme–machine nécessitant une nouvelle gestuelle chirurgicale impose la structuration de l’apprentissage en chirurgie robotique. Une pédagogie idéale face à cet enjeu doit répondre à trois exigences : limiter le nombre d’erreurs, réduire la courbe d’apprentissage sur le patient et, enfin, certifier chaque compétence du chirurgien et de l’équipe. Le développement rapide de la chirurgie robotique a plusieurs fois été confronté, en France et aux États- Unis, au débat sur une formation insuffisante ou inadéquate des chirurgiens. Nous proposons dans cet article un plan en quatre étapes pour réussir sa formation robotique. Il faut dans un premier temps lister les compétences spécifiques à la chirurgie robotique, la conférence de consensus « Fundamentals of Robotic Surgery » a pour cela défini les 25 items de formation fondamentaux, mais la liste sera personnalisée selon l’expérience antérieure du chirurgien. La deuxième étape sera le choix des outils de formation précliniques (cours théoriques, exercices inanimés, entraînements sur tissus, travail sur animal et/ou cadavre et simulation virtuelle) et cliniques (observation, pratique de l’aide opératoire et pratique chirurgicale en compagnonnage). Ensuite, il faudra standardiser l’évaluation et la certification des professionnels de santé ; de nombreux outils existent : R-OSATS, GEARS, checklists, évaluation automatisée sur simulateur, analyse des mouvements, analyse des données du robot, modèles statistiques de Markov… In fine, il faudra organiser un programme de formation, personnalisé selon les objectifs de chaque équipe chirurgicale, faisant appel à plusieurs modalités et incluant des évaluations standardisées. L’objectif final étant l’introduction en toute sécurité de cette nouvelle technologie dans les blocs opératoires.AbstractThe combination of complex surgeries, in particular within the field of oncology, and the man–machine interface requiring new surgical techniques means that training in robotic surgery must be well structured. With this challenge in mind, the ideal form of teaching should focus on meeting three requirements: limiting the number of errors, reducing the learning curve on the patient and finally certifying each of the surgeon’s and team’s skills. There has been much debate in both France and the USA regarding the rapid development of robotic surgery and the lack of adequate and appropriate training for surgeons. In this paper, we are proposing a four-stage plan to meet these robotic surgery training needs. Initially, a list of skills specific to robotic surgery needs to be created. The Fundamentals of Robotic Surgery consensus conference has defined 25 basic training areas, however the list will be adapted, based on the previous experience of the surgeon. The second stage will be to select the pre-clinical (theory courses, model exercises, training on tissue samples, training on animals and/or cadavers and virtual reality simulation) and clinical (observations, surgical-assistant practice and mentor-observed surgical practice) training tools. Next, there will need to be standardisation of the assessment and certification methods for healthcare professionals; numerous tools are currently available: R-OSATS, GEARS, checklists, simulator-based automated assessment, movement analysis, robot data analysis, Markov statistical models, etc. Finally, a training programme will need to be organised, adapted to meet the objectives of each surgical team, drawing on multiple methods and including standardised assessments. The final objective being the safe introduction of this new technology into operating theatres.

Research paper thumbnail of A new system for evaluation of armrest use in robotic surgery and validation of a new ergonomic concept - armrest load

The International Journal of Medical Robotics and Computer Assisted Surgery, 2016

Background The da Vinci robot provides a sitting position and an armrest to decrease workload and... more 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.

Research paper thumbnail of 286 Virtual Reality Robotic Surgery Simulator: Mimic® DV-Trainer, a Tool for Certification?

European Urology Supplements, 2011

Research paper thumbnail of Apprentissage de la chirurgie assistée par robot : expérience innovante française

Progrès en Urologie, 2013

0-134 Association du rs1139971, polymorphisme du gene KAI1, a la progression metastatique osseuse... more 0-134 Association du rs1139971, polymorphisme du gene KAI1, a la progression metastatique osseuse dans le cancer de prostate mais pas a la progression metastatique ganglionnaire M. Audouina, G. Cancel Tassinb, C. Gafforyb, V. Ondetb, S. Oudardc, A.R. Azzouzi d, A. Valeri e, M. Roupret f, O. Cussenota a Hopital Tenon, Paris, France b CeRePP, Paris, France c AP—HP, Paris, France d CHU d’Angers, Angers, France e CHU de Brest, Brest, France f CHU Pitie-Salpetriere, Paris, France

Research paper thumbnail of Relative contribution of haptic technology to assessment and training in implantology

BioMed research international, 2014

The teaching of implant surgery, as in other medical disciplines, is currently undergoing a parti... more The teaching of implant surgery, as in other medical disciplines, is currently undergoing a particular evolution. To assess the usefulness of haptic device, a simulator for learning and training to accomplish basic acts in implant surgery. A total of 60 people including 40 third-year dental students without knowledge in implantology (divided into 2 groups: 20 beginners and 20 experiencing a simulator training course) and 20 experienced practitioners (experience in implantology >15 implants) participated in this study. A basic exercise drill was proposed to the three groups to assess their gestural abilities. The results of the group training with the simulator tended to be significantly close to those of the experienced operators. Haptic simulator brings a real benefit in training for implant surgery. Long-term benefit and more complex exercises should be evaluated.

Research paper thumbnail of Robotic Roux-en-Y gastric bypass surgical simulation curriculum

Obesity surgery, 2014

Roux-en-Y gastric bypass (RYGB) is one of the most common procedure performed robotically in gene... more Roux-en-Y gastric bypass (RYGB) is one of the most common procedure performed robotically in general surgery [1]. Specific skills are mandatory before safely starting in O.R. Simulation training was proved as efficient for teaching robotic skills [1, 2, 3] in addition to traditional training but no procedure-specific simulator is available for robotic RYGB. After three hundred robotic RYGB, we developed a dedicated curriculum using basic skills exercises on simulator.

Research paper thumbnail of Robotic-assisted right colectomy. Official expert recommendations delivered under the aegis of the French Association of Surgery (AFC)

Journal of Visceral Surgery

Research paper thumbnail of Colectomie droite par abord robotique. Recommandations formalisées d’experts sous l’égide de l’Association française de chirurgie (AFC)

Journal de Chirurgie Viscérale

Research paper thumbnail of Iconographies supplémentaires de l'article : Place de la simulation dans l’apprentissage de la chirurgie robotique

Elsevier Masson, Dec 4, 2020

Research paper thumbnail of Botulinum toxin injection before giant incisional hernia repair: Surgical technique

Journal of Visceral Surgery, 2022

Research paper thumbnail of Technique d’injection de toxine botulique avant cure d’une grande éventration

Journal de Chirurgie Viscérale, 2022

Research paper thumbnail of Exploration des voies lymphatiques péri-pancréatiques chez un modèle porcin vivant

Morphologie, 2018

Introduction/Objectifs La mise en evidence d’une segmentation pancreatique permettrait la realisa... more 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.

Research paper thumbnail of Élaboration D’Un Programme D’Enseignement Pratique Par Simulation en Chirurgie Viscérale et Digestive

Journal de Chirurgie Viscérale, 2020

Resume Jusqu’en 2013, la formation pratique des internes inscrits au DES/DESC de chirurgie viscer... more Resume Jusqu’en 2013, la formation pratique des internes inscrits au DES/DESC de chirurgie viscerale et digestive en France n’etait pas standardisee. Depuis 2017, le troisieme cycle des etudes medicales a ete restructure autour de deux axes : connaissances theoriques et competences techniques et non-techniques. Celui-ci comporte notamment un programme de formation pratique par simulation, hors bloc operatoire, national, structure, uniformise et standardise. Le developpement de ce programme de formation est le fruit d’un travail de consensus national sous l’egide du college francais de chirurgie viscerale et digestive permettant d’offrir un guide de formation a tous les futurs chirurgiens de la specialite. Quatre seances de conference de consensus reunissant une commission de 8 membres ont abouti a la redaction du « Livret de l’Interne pour l’Enseignement Pratique en Chirurgie Viscerale et Digestive ». Ce referentiel detaille en 272 pages les objectifs (phase I), les moyens d’apprentissage de chaque competence (phase II) et enfin les methodes d’evaluation (phase III) pour les phases socles et des phases d’approfondissement du DES de chirurgie viscerale et digestive. En complement de ce livret, nous avons mene une reflexion sur la structuration et la mise en place de ce programme a l’echelle nationale a compter de novembre 2017 qui est detaille a la fin de cet article.

Research paper thumbnail of Residency training in robotic surgery: The role of simulation

Journal of Visceral Surgery, 2020

Simulation has become increasingly important in surgical teaching in recent years and the French ... more Simulation has become increasingly important in surgical teaching in recent years and the French National Authority for Health (HAS) recently underlined the goal and ethical priority: ''never the first time on the patient''. Simulation programs have been tested and validated for laparotomy and for laparoscopy, but there is not yet a validated program specific for robotic surgery. Due to substantial advances in this new technology, we have developed a program in Nancy dedicated to outside-the-operating room (OR) teaching of robotic surgery using the Da Vinci robot. This teaching is based on a combined program of theoretical teaching (e-learning) and learning of practical skills using virtual simulators (DV-Trainer ® , Robotic Mentor ® , DVSS ®), mechanical simulators (Dome, Applied ® abdominal simulators), microsurgery and wet lab using ex vivo animal organs, anesthetized animals, and cadavers. This program also emphasizes team training. The course is intended for residents in surgical training and is integrated into the specialized study diploma (DES) program for Visceral and Digestive Surgery; it also can be used by qualified surgeons who can integrate it with the Inter-University Diploma (DIU) in General Robotic Surgery for basic techniques and also for DIUs in other surgical specialties (digestive and gynecologic surgery) for robotic uses within their specialty. These courses are based on the concept of step-by-step skills acquisition and verification allowing a transition to safe clinical activity.

Research paper thumbnail of Development of a program for teaching practical skills in visceral and digestive surgery by simulation

Journal of Visceral Surgery, 2020

Research paper thumbnail of Surgical apprenticeship in the era of simulation

Journal of Visceral Surgery, 2020

Research paper thumbnail of Le compagnonnage en chirurgie à l’heure de la simulation

Journal de Chirurgie Viscérale, 2020

Resume Les nouveaux outils de transmission des connaissances et des competences chirurgicales tel... more Resume Les nouveaux outils de transmission des connaissances et des competences chirurgicales tels que la simulation, la retransmission d’intervention, la realite virtuelle ou la realite augmentee offrent un renouveau du compagnonnage. Le reseau de pairs s’elargit, la diffusion des savoirs est acceleree. Chaque facette du metier de chirurgien beneficie de ces nouvelles modalites d’enseignement : le raisonnement clinique, la realisation des procedures techniques, la gestion du stress, la communication ou la gestion des evenements indesirables graves ou exceptionnels. Autrefois confine au sein de l’equipe chirurgicale, le compagnonnage s’etend dans les centres de simulation qui deviennent des hopitaux virtuels et sur internet via les reseaux sociaux. Au sein de ce compagnonnage numerique, les objectifs sont plus structures, l’evaluation des competences est plus standardisee, les phases d’apprentissage sont redefinies, des contrats de formation personnalises sont formalises.

Research paper thumbnail of Apprentissage de la chirurgie robotique et principe de subsidiarité : une nouvelle convergence avec l’aéronautique

Progrès en Urologie, 2018

Research paper thumbnail of Construct, Face, and Content Validation on Voxel-Man® Simulator for Otologic Surgical Training

International Journal of Otolaryngology, 2017

Objective. To assess the face, content, and construct validity of the Voxel-Man TempoSurg Virtual... more Objective. To assess the face, content, and construct validity of the Voxel-Man TempoSurg Virtual Reality simulator. Participants and Methods. 74 ear, nose, and throat (ENT) surgeons participated. They were assigned to one of two groups according to their level of expertise: the expert group (n=16) and the novice group (n=58). The participants performed four temporal bone dissection tasks on the simulator. Performances were assessed by a global score and then compared to assess the construct validity of the simulator. Finally, the expert group assessed the face and content validity by means of a five-point Likert-type scale. Results. experienced surgeons performed better (p<.01) and faster (p<.001) than the novices. However, the groups did not differ in terms of bone volume removed (p=.11) or number of injuries (p=.37). 93.7% of experienced surgeons stated they would recommend this simulator for anatomical learning. Most (87.5%) also thought that it could be integrated into su...

Research paper thumbnail of L’optimisation par une alarme de l’utilisation des appuie-bras pourrait améliorer les courbes d’apprentissage des novices sur simulateur robotique

Progrès en Urologie, 2016

Research paper thumbnail of Training tools for robotic surgery

Oncologie, 2016

RésuméLa combinaison de chirurgies complexes, notamment en oncologie, et d’une interface homme–ma... more RésuméLa combinaison de chirurgies complexes, notamment en oncologie, et d’une interface homme–machine nécessitant une nouvelle gestuelle chirurgicale impose la structuration de l’apprentissage en chirurgie robotique. Une pédagogie idéale face à cet enjeu doit répondre à trois exigences : limiter le nombre d’erreurs, réduire la courbe d’apprentissage sur le patient et, enfin, certifier chaque compétence du chirurgien et de l’équipe. Le développement rapide de la chirurgie robotique a plusieurs fois été confronté, en France et aux États- Unis, au débat sur une formation insuffisante ou inadéquate des chirurgiens. Nous proposons dans cet article un plan en quatre étapes pour réussir sa formation robotique. Il faut dans un premier temps lister les compétences spécifiques à la chirurgie robotique, la conférence de consensus « Fundamentals of Robotic Surgery » a pour cela défini les 25 items de formation fondamentaux, mais la liste sera personnalisée selon l’expérience antérieure du chirurgien. La deuxième étape sera le choix des outils de formation précliniques (cours théoriques, exercices inanimés, entraînements sur tissus, travail sur animal et/ou cadavre et simulation virtuelle) et cliniques (observation, pratique de l’aide opératoire et pratique chirurgicale en compagnonnage). Ensuite, il faudra standardiser l’évaluation et la certification des professionnels de santé ; de nombreux outils existent : R-OSATS, GEARS, checklists, évaluation automatisée sur simulateur, analyse des mouvements, analyse des données du robot, modèles statistiques de Markov… In fine, il faudra organiser un programme de formation, personnalisé selon les objectifs de chaque équipe chirurgicale, faisant appel à plusieurs modalités et incluant des évaluations standardisées. L’objectif final étant l’introduction en toute sécurité de cette nouvelle technologie dans les blocs opératoires.AbstractThe combination of complex surgeries, in particular within the field of oncology, and the man–machine interface requiring new surgical techniques means that training in robotic surgery must be well structured. With this challenge in mind, the ideal form of teaching should focus on meeting three requirements: limiting the number of errors, reducing the learning curve on the patient and finally certifying each of the surgeon’s and team’s skills. There has been much debate in both France and the USA regarding the rapid development of robotic surgery and the lack of adequate and appropriate training for surgeons. In this paper, we are proposing a four-stage plan to meet these robotic surgery training needs. Initially, a list of skills specific to robotic surgery needs to be created. The Fundamentals of Robotic Surgery consensus conference has defined 25 basic training areas, however the list will be adapted, based on the previous experience of the surgeon. The second stage will be to select the pre-clinical (theory courses, model exercises, training on tissue samples, training on animals and/or cadavers and virtual reality simulation) and clinical (observations, surgical-assistant practice and mentor-observed surgical practice) training tools. Next, there will need to be standardisation of the assessment and certification methods for healthcare professionals; numerous tools are currently available: R-OSATS, GEARS, checklists, simulator-based automated assessment, movement analysis, robot data analysis, Markov statistical models, etc. Finally, a training programme will need to be organised, adapted to meet the objectives of each surgical team, drawing on multiple methods and including standardised assessments. The final objective being the safe introduction of this new technology into operating theatres.

Research paper thumbnail of A new system for evaluation of armrest use in robotic surgery and validation of a new ergonomic concept - armrest load

The International Journal of Medical Robotics and Computer Assisted Surgery, 2016

Background The da Vinci robot provides a sitting position and an armrest to decrease workload and... more 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.

Research paper thumbnail of 286 Virtual Reality Robotic Surgery Simulator: Mimic® DV-Trainer, a Tool for Certification?

European Urology Supplements, 2011

Research paper thumbnail of Apprentissage de la chirurgie assistée par robot : expérience innovante française

Progrès en Urologie, 2013

0-134 Association du rs1139971, polymorphisme du gene KAI1, a la progression metastatique osseuse... more 0-134 Association du rs1139971, polymorphisme du gene KAI1, a la progression metastatique osseuse dans le cancer de prostate mais pas a la progression metastatique ganglionnaire M. Audouina, G. Cancel Tassinb, C. Gafforyb, V. Ondetb, S. Oudardc, A.R. Azzouzi d, A. Valeri e, M. Roupret f, O. Cussenota a Hopital Tenon, Paris, France b CeRePP, Paris, France c AP—HP, Paris, France d CHU d’Angers, Angers, France e CHU de Brest, Brest, France f CHU Pitie-Salpetriere, Paris, France

Research paper thumbnail of Relative contribution of haptic technology to assessment and training in implantology

BioMed research international, 2014

The teaching of implant surgery, as in other medical disciplines, is currently undergoing a parti... more The teaching of implant surgery, as in other medical disciplines, is currently undergoing a particular evolution. To assess the usefulness of haptic device, a simulator for learning and training to accomplish basic acts in implant surgery. A total of 60 people including 40 third-year dental students without knowledge in implantology (divided into 2 groups: 20 beginners and 20 experiencing a simulator training course) and 20 experienced practitioners (experience in implantology >15 implants) participated in this study. A basic exercise drill was proposed to the three groups to assess their gestural abilities. The results of the group training with the simulator tended to be significantly close to those of the experienced operators. Haptic simulator brings a real benefit in training for implant surgery. Long-term benefit and more complex exercises should be evaluated.

Research paper thumbnail of Robotic Roux-en-Y gastric bypass surgical simulation curriculum

Obesity surgery, 2014

Roux-en-Y gastric bypass (RYGB) is one of the most common procedure performed robotically in gene... more Roux-en-Y gastric bypass (RYGB) is one of the most common procedure performed robotically in general surgery [1]. Specific skills are mandatory before safely starting in O.R. Simulation training was proved as efficient for teaching robotic skills [1, 2, 3] in addition to traditional training but no procedure-specific simulator is available for robotic RYGB. After three hundred robotic RYGB, we developed a dedicated curriculum using basic skills exercises on simulator.