Background Fascia iliaca block (FIB) is an effective technique for analgesia. While FIB using ultrasound is preferred, there is no current standardised training technique or assessment scale. We aimed to create a valid and reliable tool to assess ultrasound-guided FIB. Method This prospective observational study was conducted in the ABS-Lab simulation centre, University of Poitiers, France between 26–29 October and 14–17 December 2021. Psychometric testing included validity analysis and reliability between two independent observers. Content validity was established using the Delphi method. Three rounds of feedback were required to reach consensus. To validate the scale, 26 residents and 24 emergency physicians performed a simulated FIB on SIMLIFE, a simulator using a pulsated, revascularised and reventilated cadaver. Validity was tested using Cronbach’s α coefficient for internal consistency. Comparative and Spearman’s correlation analysis was performed to determine whether the scale discriminated by learner experience with FIB and professional status. Reliability was analysed using the intraclass correlation (ICC) coefficient and a correlation score using linear regression (R 2 ). Results The final 30-item scale had 8 parts scoring 30 points: patient positioning, preparation of aseptic and tools, anatomical and ultrasound identification, local anaesthesia, needle insertion, injection, final ultrasound control and signs of local anaesthetic systemic toxicity. Psychometric characteristics were as follows: Cronbach’s α was 0.83, ICC was 0.96 and R 2 was 0.91. The performance score was significantly higher for learners with FIB experience compared with those without experience: 26.5 (22.0; 29.0) vs 22.5 (16.0; 26.0), respectively (p=0.02). There was a significant difference between emergency residents’ and emergency physicians’ scores: 20.5 (17.0; 25.0) vs 27.0 (26.0; 29.0), respectively (p=0.0001). The performance was correlated with clinical experience (Rho=0.858, p<0.0001). Conclusion This assessment scale was found to be valid, reliable and able to identify different levels of experience with ultrasound-guided FIB.

Objectives The aim of this study was to assess intraosseous (IO) access placement performance during a multidisciplinary simulation-based training (SBT) program according to the professional status, experience of caregivers, and the setting of the course. Method This prospective, multicentric study included emergency physicians, residents, certified registered nurse anesthetists, registered nurses, and students. It was carried out between April 6, 2020 and April 30, 2021 in emergency medical services, an emergency department, and a simulation center. Trainee performance was evaluated by 2 independent observers using a validated scale, before and after SBT. Self-assessment of satisfaction was carried out. Interobserver reproducibility was analyzed by intraclass correlation coefficient. The continuous variables were compared using a Student t test or a nonparametric Mann-Whitney U test. Comparative analysis between the different groups used analysis of variance. Correlation analysis was performed by a nonparametric Spearman test. A P value of 0.05 was considered significant. Results Ninety-eight participants were included. Intraclass correlation coefficient between the 2 observers was 0.96. Performance significantly increased after training, regardless of the site or device used (for the semiautomatic device, P = 0.004 in tibia and P = 0.001 in humeral; for the manual device, P < 0.001). Simulation-based training significantly reduced time for IO access (P = 0.02). After SBT, no difference was found according to professional status and the setting of the course. Performance was not correlated with professional experience. All trainees were satisfied with the training. Conclusions Simulation-based training improved the IO access using a semiautomatic or a manual device, regardless of the experience or status of the trainees. Simulation-based training would work for many disciplines regardless of locations (simulation or clinical facilities).

INTRODUCTION:Emergent umbilical venous catheter (eUVC) insertion is the recommended vascular access in neonatal resuscitation. Although the theoretical knowledge can be taught, existing models are either unrealistic (plastic) or train only the steps of the task. This study aimed to develop and test a hybrid simulator for eUVC insertion training that would be realistic, reproducible, easy to build, and inexpensive, thereby facilitating detailed learning of the procedure.METHODS:Development took place in the Poitiers simulation laboratory using a neonatal mannequin into which a real umbilical cord was integrated. In the first phase, pediatric and emergency physicians and residents tested the model. In the second phase, another group of participants tested the hybrid simulator and the same neonatal mannequin associated with an artificial umbilical cord. Participants completed a satisfaction survey.RESULTS:A real umbilical cord connected to an intra-abdominal reservoir containing artificial blood was added to the mannequin, allowing insertion of the eUVC, drawback of blood, and infusion of fluids using the real anatomical structures. The model was easily reproduced and assembled in less than 30 minutes; the cost of construction and use was evaluated at €115. One hundred two participants tested the model, 60 in the first phase and 42 in the second. The success rate was higher in fully trained compared with untrained participants. All were satisfied, 97% found the model realistic, and 78.6% strongly recommended the use of this model. The participants believed that the hybrid simulator allowed better learning and a gain in performance and self-confidence in comparison with the same mannequin with an artificial umbilical cord.CONCLUSIONS:A hybrid simulator was developed for eUVC insertion. Participants were satisfied with this model, which was realistic, reproducible, easy to use, inexpensive, and facilitated an understanding of the anatomy and performance of all steps for successful eUVC insertion.

OBJECTIVES The World Health Organization (WHO) supports increasing the availability and acceptability of long-acting reversible contraception including intra-uterine device (IUD), but its insertion includes certain risks (uterine perforation). The objective was to develop and validate an IUD insertion performance assessment checklist. MATERIAL AND METHODS This prospective study took place in hospitals and simulation center of the Poitou-Charentes region, France. The checklist content reached consensus among 10 experts solicited by a Delphi method. A modified gynecologic mannequin Zoe (Gaumard®) was used for simulations. Psychometric testing included 30 multi-professional participants for internal consistency and reliability between two independent observers, and 27 residents for assessment of score evolution over time and reliability. Cronbach alpha (CA) and intraclass coefficient (ICC) were used. Progression of performance was carried out using ANOVA for repeated measures. The data collected were used to plot receiver operating characteristic (ROC) curves for the score values and the area under the curve (AUC) was determined. RESULTS The checklist included 27 items (2 sections, total score = 27). Psychometric testing showed CA = 0.79, ICC = 0.99, and good clinical relevance. The checklist is discriminative, showing a significant increase in performance scores when the simulations were repeated (F = 77.6, p < 0.0001). ROC curve [AUC: 0.792 (95% CI: 0.71-0.89); p < 0.0001] revealed the best score cutoff predictive of 100% sensitivity, i.e., true positive rate or success rate. Performance score was highly correlated to success rate. The cut-off score guaranteeing successful IUD insertion was 22/27. CONCLUSIONS This coherent and reproducible checklist for IUD insertion provide an objective assessment of the procedure during SBT, with the aim of obtaining a score ≥ 22/27.

Oral cavity defects occur after resection of lesions limited to the mucosa, alveolar gum, or minimally affecting the bone. Aiming at esthetical and functional improvements of intraoral reconstruction, the possibility of harvesting a new galeo-pericranial free flap was explored. The objective of this study was to assess the technical feasibility of flap harvesting through anatomical dissections and surgical procedure simulations. Ten head and neck specimens were dissected to simulate the surgical technique and evaluate the vascular calibers of temporal and cervical vessels. The procedure was therefore reproduced on a revascularized and ventilated donor cadaver. Anatomical dissections demonstrated that the mean cervical vascular calibers are compatible with superficial temporal ones, proving to be adequate for anastomosis. Perforating branches of the superficial temporal vascularization nourishing the pericranium were identified in all specimens. In conclusion, blood flow presence was recorded after anastomosing superficial temporal and facial vessels in the revascularized donor cadaver, demonstrating both this procedure’s technical feasibility and the potential revascularization of the flap and therefore encouraging its potential in vivo application.

Background: The most common type of fracture of the lateral tibial plateau is the Schatzker type II split-depressed fracture. Minimally invasive surgery using balloon reduction appears to be very promising compared to the gold standard using a bone tamp. This surgery aims to have the best reduction and stabilization to benefit from an early passive and active rehabilitation to avoid stiffening and muscle wasting. Using a balloon for fracture reduction has allowed the use of semi-liquid Injectable Bone Cement (IBC) fillers. These fillers can be phosphocalcic or polymethyl methacrylate (PMMA). The latest recommendations on these IBCs in spinal surgery increasingly rule out phosphocalcic fillers because of their low mechanical strength.Questions/purposes: 1) What is the mechanical influence of IBC filling (PMMA) regarding the split and depression components of a Schatzker type II fracture? 2) What is the mechanical influence of osteosynthesis regarding the split and depression components of a Schatzker type II fracture with or without PMMA filing in three different kinds of percutaneous fixations?Methods: This biomechanical study was performed on 36 fresh frozen tibia/fibula specimens. Six groups were formed according to the type of percutaneous osteosynthesis or possible PMMA filling. Mechanical strength tests were carried out using a Unicompartmental Knee prosthesis and displacement components were measured on either side of the separation on the anterolateral facet by optical method.Results: We found a significant difference between cementless and cemented osteosynthesis for depression fracture stabilization (difference -507.56N with 95% confidence interval [-904.17; -110.94] (p-value = 0.026)). The differences between the different types of osteosynthesis were not significant (p-value = 0.58). There was a significant difference between osteosynthesis without cement and osteosynthesis with cement on separation (difference -477.72N [-878.52; -76.93] (p-value = 0.03)). The differences between the different types of fixations were not significant regarding separation (p-value = 0.99).Conclusion: PMMA cement significantly improves primary stability, regardless of the type of osteosynthesis for a Schatzker type II plateau fracture. Filling with PMMA cement during tuberoplasty seems to be a very promising strategy in association with percutaneous osteosynthesis to allow rapid recovery after surgery.

Classical surgical education has to face both a forensic reality and a technical issue: to train a learner in more complex techniques in an increasingly short time. Moreover, surgical training is still based on an empirical hierarchical relationship in which learners must reproduce a sequence of actions in a situation of strong emotional pressure. However, the effectiveness of learning and its quality are linked to the emotional states in which learners find themselves. Among these emotions, epistemic confusion can be found that arises in complex learning situations where there is a cognitive imbalance related to the comprehension of the task, and which results from a rupture between the pre-established patterns of the learner and the new learning task. Although one knows that confusion can have a beneficial or a negative impact on learning, depending on whether it is well regulated or not, the factors that can influence it positively are still poorly understood. Thus, the objective of this experiment is to assess the impact of confusion on the learning of a surgical procedure in an augmented reality context and to determine if this impact varies according to the feedback given to the learners and according to the occurrence of disruptive events. Medical externs were recruited (N = 15) who were required to perform a suturing task on a simulator and whose performance was measured using a Motion Capture (MoCap) system. Even though the statistical analyzes did not allow a conclusion to be reached, the protocol already established makes it possible to consider a longer-term study that will allow (by increasing the number of sessions and the number of participants) more significant results to be obtained in order to develop new surgical learning protocols. This preliminary study opens a new field of research on the influence of epistemic emotions, and more particularly of confusion, which is likely to upset traditional surgical teaching, and is based on negative conditioning and strong emotions with negative valence as well as stress and coercion.

Open book pelvic ring fractures are potentially life-threatening, due to their instability and major hemorrhage risk. During the open reduction and internal fixation, the pelvic approach remains a technical challenge, as the surgeon wants to prevent any iatrogenic damage of the vascular loop located in the retro-pubic area called corona mortis (CMOR). Recently, the cadaver perfused SimLife® technology has been developed to improve the surgeon training, out of the operating room. This study aimed to compare two models of cadaveric dissection, to assess the interest of the perfused SimLife® in providing dynamic aspect of anatomy in the identification of CMOR and its topography. Twelve human cadaveric pelvises have been dissected, following two protocols. 12 hemi-pelvises of the dissections were performed without perfusion (Model A), whereas the 12 other hemi-pelvises have been prepared with the SimLife® pulsatile perfusion (Model B). The prevalence and morphologic parameters determined: length, diameter and distance between the CMOR and the pubic symphysis. The CMOR has been found in 66.67 These results suggest that the CMOR is easier to identify and to dissect with the SimLife® perfusion. As part of the surgical training of any trauma surgeon, this model could help him to keep in mind the CMOR topography, to improve the open book lesion management.

Background: Sentinel lymphonodal biopsy (SLB) is nowadays regarded has a standard procedure in breast cancer surgical treatment. Moreover some authors are investigating the option to omit SLB in tumor less than two cm. On the other hand axillary dissection has become a "rare" indication for breast cancer surgery, thus decreasing surgeon performance and the possibility of learning this procedure among young surgeons. To utilize cadaver body for learning is a valuable tool for surgery competence acquisition. Sim- life is a patented device helping cadaver body utilization for learning process. Material and methods: We analyze the ideal steps to learn axillary dissection, for young breast cancer surgeon throughout an individual experience of a trainee. The doctor attended the fourth year specialization school in Gynecology, with a dedicated time (8 months) at the breast cancer treatment at the University of Turin (Breast cancer Unit around 1000 cases per yr). The learning process developed throughout five steps for eight months duration: the first at the master of senology helping teacher in preparing anatomical lesson. The second as assistant in 20 surgical breast cancer procedures. The third as first operator in 20 breast cancer surgical procedures including SLB and starting with treating the axilla (axillary dissection) in a gradual manner. The fourth phase included a cadaver-lab course at University center of Poitier together with the senior tutor for two days, utilizing Sim- life patented device (revitalized cadaver system) and performing 4 complete axillary dissections (both sides per cadaver). In the fifth step the trainee performed two axillary dissections on patients under senior tutor assistance. The trainee had to fill a form developed to describe time of different surgical procedures, surgical difficulties and competences acquisition. Results: Both timing criteria and surgical items increases during the training period of 8 months with a decrease in time performing SLB of 50% (p = 0.005) and increase of more than 80% (p = 0.04) in competence acquisition in identifying anatomical structures during axillary dissection procedure in a statistically significant manner. Trainee self- confidence was also increased together with satisfaction even from a psychological point of view (data registered with a questionnaire). Conclusions: Programmed learning/tutoring process through pre-defined steps, in association with cadaver-lab, Sim-life device and hands-on practice improve surgical competences acquisition permitting practice also surgery that nowadays remains necessary, even though more rarely than in the past according to clinical indications, such as axillary dissection. No conflict of interest.

INTRODUCTION:This study aims to determine the best method for achieving optimal performance of pediatric cardiopulmonary resuscitation (CPR) during simulation-based training, whether with or without a performance aid. METHODS:In this randomized controlled study, 46 participants performed simulated CPR in pairs on a Resusci Baby QCPR™ mannequin, repeated after four weeks. All participants performed the first simulation without performance aids. For the second simulation, they were randomly assigned to one of three groups with stratification based on status: throughout CPR, Group A (n = 16) was the control group and did not use a performance aid; Group B (n = 16) used the CPR checklist; Group C (n = 14) used real-time visualization of their CPR activity on a feedback device. Overall performance was assessed using the QCPR™. RESULTS:All groups demonstrated improved performance on the second simulation (p < 0.01). Use of the feedback device resulted in better CPR performance than use of the CPR checklist (p = 0.02) or no performance aid (p = 0.04). Additionally, participants thought that the QCPR™ could effectively improve their technical competences. CONCLUSIONS:Performance aid based on continuous feedback is helpful in the learning process. The use of the QCPR™, a real-time feedback device, improved the quality of resuscitation during infant CPR simulation-based training.

AbstractIntroduction:Dispatchers should be trained to interrogate bystanders with strict protocols to elicit information focused on recognizing cardiac arrest and should provide telephone cardiopulmonary resuscitation (CPR) instructions in all cases of suspected cardiac arrest. While an objective assessment of training outcomes is needed, there is no performance assessment scale for simulated dispatcher-assisted CPR.Study Objective:The aim of the study was to create a valid and reliable performance assessment scale for simulated dispatcher-assisted CPR.Methods:In this prospective, randomized, controlled, multi-centric simulation-based trial (registration number TCTR20210130002), the scale was developed according to the European Resuscitation Council (ERC) and American Heart Association (AHA) Guidelines 2015 and revised by experts. The performance of 48 dispatchers’ telephone-CPR and of 48 bystanders carrying out CPR on a manikin was assessed by two independent evaluators using the scale and using a SkillReporter (PC) software to provide CPR objective performance. Continuous variables were described as mean (SD) and categorical variables as numbers and percentage (%). Comparative analysis between two groups used a Student t-test or a non-parametric test of Mann-Whitney. The internal structure of the scale was evaluated, including internal consistency using α Cronbach coefficient, and reproducibility using intraclass correlation coefficient (ICC) and linear correlation coefficient (R2) calculation.Results:The scale included three different parts: two sections for dispatchers’ (32 items) and bystanders’ CPR performance (15 items) assessment, and a third part recording times. There was excellent internal consistency (α Cronbach coefficient = 0.77) and reproducibility (ICC = 0.93; R² = 0.86). For dispatchers’ performance assessment, α Cronbach coefficient = 0.76; ICC = 0.91; R2 = 0.84. For bystanders’ performance assessment, α Cronbach coefficient = 0.75; ICC = 0.93; R2 = 0.87. Reproducibility was excellent for nine items, good for 19 items, and moderate for 19 items. No item had poor reproducibility. There was no significant difference between dispatch doctors’ and medical dispatch assistants’ performances (33.0 [SD = 4.7] versus 32.3 [SD = 3.2] out of 52, respectively; P = .70) or between trained and untrained bystanders to follow the instructions (14.3 [SD = 2.0] versus 13.9 [SD = 1.8], respectively; P = .64). Objective performance (%) was significantly higher for trained bystanders than for untrained bystanders (67.4 [SD = 14.5] versus 50.6 [SD = 19.3], respectively; P = .03).Conclusion:The scale was valid and reliable to assess performance for simulated dispatcher-assisted CPR. To the authors’ knowledge, no other valid performance tool currently exists. It could be used in simulated telephone-CPR training programs to improve performance.

The anatomical subject is still a key element to learn complex procedures in plastic surgery. We present here the evaluation of an in-training operator on a SIMLIFE® model, hyper realistic model consisting in human bodies donated to science equipped with pulsating recirculation and reventilation device.From February 2019 to October 2019, 8 forearm flaps with radial proximal pedicle were harvested by the learner on a SIMLIFE® model. Conditions were as close as possible to the operating room : asepsy, sterile draping, assistant and instrumentation including electrocoagulation.The procedure was decomposed in 13 distinct steps. Mean total surgery time was 90,5±11,62minutes. There was only one case of arterial pedicle lesion resulting in major blood leak. Bleeding was measured by fake blood loss from the SIMLIFE® console. Mean intraoperatoy bleeding was 171±108 milliliters. We review pros and cons of this new technology particulary suited for complex plastic and reconstructive surgery training.Using SIMLIFE® technology we have a new mean to train for complex procedures in plastic and reconstructive surgery. This new technology could be applied to numerous other surgical procedures. Broader applications are still limited by cost and cadaver use legislation.

Minimally invasive methods, such as balloon kyphoplasty (BKP) and percutaneous sacroplasty (PS), which are now widely used for the surgical treatment of compression fractures, involve injection of a bolus of poly (methyl methacrylate) bone cement (hereafter, "bone cement") into the fractured tissue. Many of the common complications following these surgeries, such as cement leakage and adjacent-level fractures (in the case of BKP), have been postulated to be related to the quality of the cancellous bone-bone cement interface, which, in turn, is a function of its fracture resistance. It is common to use bovine cancellous bone or polyurethane foam (PF) as a substitute for human cancellous bone in biomechanical studies of these surgical methods. The literature is lacking in studies of determination of fracture properties of human cancellous bone-bone cement interface, bovine cancellous bone-bone cement interface, and PF-bone cement interface. In the present work, an integrated methodology (combination of wedge splitting test and Heaviside-based digital image correlation) was used to make these determinations as well as those for the bone cement, bones and the PF alone. The fracture properties determined were maximum fracture load (F-max), fracture toughness (K-c), and specific fracture energy (G(f)). For example, G(f) values for human cancellous bone and human cancellous bone-bone interface were 0.48 +/- 0.14 N/mm and 0.38 +/- 0.05 N/mm, respectively, whereas in the case of bovine cancellous bone and bovine cancellous bone-bone cement interface, they were 1.08 +/- 0.11 N/mm and 0.22 +/- 0.05 N/mm, respectively, and for PF (Grades 12.5 and 15.0) and PF-bone cement interface, they were 0.81 +/- 0.12 and 0.55 +/- 0.06 N/mm, respectively. The same trends were seen in the F-max and K-c results. These results suggest that it may not be justified to use either bovine cancellous bone or either of the PF grades as a substitute for human cadaveric cancellous bone in biomechanical studies of BKP, PS, and similar surgical methods.

Introduction. - The anatomical subject is still a key element to learn complex procedures in plastic surgery. We present here the evaluation of an in-training operator on a SIMLIFE1 model, hyper realistic model consisting in human bodies donated to science equipped with pulsating recirculation and reventilation device. Material and methods. - From February 2019 to October 2019, 8 forearm flaps with radial proximal pedicle were harvested by the learner on a SIMLIFE1 model. Conditions were as close as possible to the operating room : asepsy, sterile draping, assistant and instrumentation including electrocoagulation. Results. - The procedure was decomposed in 13 distinct steps. Mean total surgery time was 90,5 +/- 11,62 minutes. There was only one case of arterial pedicle lesion resulting in major blood leak. Bleeding was measured by fake blood loss from the SIMLIFE (R) console. Mean intraoperatoy bleeding was 171 +/- 108 milliliters. We review pros and cons of this new technology particulary suited for complex plastic and reconstructive surgery training. Conclusion. - Using SIMLIFE (R) technology we have a new mean to train for complex procedures in plastic and reconstructive surgery. This new technology could be applied to numerous other surgical procedures. Broader applications are still limited by cost and cadaver use legislation. (C) 2020 Elsevier Masson SAS. All rights reserved.

A new autonomous camera-holder robotic system for Laparoscopic Surgery (LS) is presented in this paper. In the proposed system, a 7-DoF collaborative robot holds and moves the laparoscope, or surgical camera, so that it permanently points towards the instruments' tips. A motion capture (MoCap) system, tracking online the surgical instruments, provides the robot's controller with instrument's motion data. Unlike the existing systems, this paper proposes an autonomous robot-assistant, freeing up surgeons from the laparoscope motion control, fully responding to the surgical community requirements. Moreover, a fully compliance control law is implemented. In task-space, it is suitable for smoothing robot movements and reducing the contact forces generated at the trocar. Null-space is also exploited through a compliance control law restricting the elbow's robot motion into a desired range, defined to avoid undesired collisions with the rest of the medical equipment. Robot Operating System (ROS) framework has been used to establish the communication between the robot and MoCap system, using the UDP protocol for data exchange. Training tasks, such as suturing training, have been performed by surgeons to validate the usefulness of the proposed platform, proving that a collaborative robot can autonomously comply with camera-holder assistant tasks.

This paper deals with a robotic manipulator dedicated to craniotomy with a remote center of motion based on a Spherical Parallel Manipulator (SPM) architecture. The SPM is proposed to handle the drilling tool through the requested craniotomy Degrees of Freedom (DoF) with two rotations. The proposed architecture allows one degree of redundancy according to the total DoF. Thus, a first contribution of this work focuses on the experimental analysis of craniotomy surgery tasks. Secondly, its behavior is improved, taking advantage of the redundancy of the SPM using the spinning motion as a reconfiguration variable. The spinning angle modulation allows the reconfigurable manipulator to minimize its motor torques. A series of motion capture and force experimentations is performed for the analysis of the kinematic and force interaction characterizing Burr hole craniotomy procedures. Experimentations were carried out by a neurosurgeon on a human cadaver, ensuring highly realistic conditions.

In initial surgical formation and continuing surgical education, simulation has become a compulsory technique. Just as becoming an airplane pilot requires skills, the acquisition of technical skills is essential to becoming a surgeon. The old apprenticeship model “I see, I do, and I teach” is no longer entirely compatible with the socio-economic constraints of the operating room, demands for guaranteeing patient safety, and the compulsory reduction in resident working hours. We propose a new surgical simulation model, using cadavers donated to science that are rendered dynamic with pulsatile vascularization and ventilation. Such models are available for simulation of both open surgery and laparoscopy. Surgery on a human body donated to science makes it possible to accurately reproduce the hand gestures characteristic of surgical procedures. Learning in an appropriate and realistic simulation context increases the level of skills acquired by residents and reduces stress and anxiety when they come to perform real procedures.

En 2015, nous avions relaté notre expérience à propos de la courbe d'apprentissage en chirurgie de la réassignation génitale et souligné un concept d'apprentissage traditionnel en quatre étapes. Dans cet article, nous présentons notre première expérience d'aïdoïopoïèse (vaginoplastie) menée sur modèle SIMLIFE®, mannequin humanoïde à très haut degré de réalisme utilisant des corps humains issus de don du corps associés à un dispositif de circulation pulsatile et un dispositif de ventilation. La technique chirurgicale utilisée était celle de l'inversion pénienne, décomposée en 14 étapes distinctes. Le temps chirurgical total fut de 182 minutes. On ne dénotait aucune complication intraopératoire, et il n'y eut aucune lésion de l'urètre ou du rectum. Le saignement intraopératoire mesuré par la perte de liquide opératoire était de 280 mL. Nous revenons sur les avantages de cette technologie adaptée à la chirurgie de la transsexualité. Nous avons démontré la faisabilité d'une aïdoïopoïèse avec le modèle humanoïde de simulation SIMLIFE® et l'amélioration de la technique d'apprentissage de ce type de chirurgie avec ce modèle. Cette technologie pourrait trouver de nombreuses autres applications chirurgicales. Elle se heurte cependant aux contraintes de coût et de la législation sur les cadavres. In 2015, we reported our experience with the learning curve in genital reassignment surgery and highlighted a four-step learning concept. In this article, we present our first vaginoplasty performed on a humanoid model SIMLIFE®, a human body associated with a pulsating circulation device and a ventilation device. The surgical technique included 14 steps. The total surgical time was 182 minutes. There was no intraoperative complication, and there was no damage to the urethra or rectum. The intraoperative bleeding measured by the loss of operative fluid was 280 mL. We discuss the advantages of this technology perfectly adapted to transsexual surgery. We demonstrated the feasibility of vaginoplasty performed on a humanoid model SIMLIFE® and highlighted improvement of the surgical skills with this model. This technology could find many other surgical applications. However, it faces cost constraints and legislation on corpses.

Le savoir-faire technique en chirurgie robotique nécessite de nouveaux modèles d'apprentissage. L'objectif de cette étude est d'évaluer l'apport du sujet anatomique re-perfusé et ventilé par le système SimLife dans le cadre d'un masterclass de chirurgie robotique pédiatrique. Les corps donnés à la science sont drainés de leur sang, remplacé par un avatar visqueux au moyen de canules artérielles et veineuses, puis trachéotomisés et ventilés. Douze chirurgiens expérimentés venant de huit pays et six instructeurs ont évalué les six ateliers de chirurgie robotique à orientation thoracique, viscérale et urologique sur robots da Vinci (Xi, Si, X). (1) Tous les participants ont considéré le masterclass très utile (58 %) ou utile (42 %) pour leur activité professionnelle ; (2) modèle facilitant l'apprentissage d'une procédure technique 73 % ; (3) réalisme du modèle 86 % ; (4) satisfaction générale du modèle 80 %. Deux corps ont dû être remplacés après la découverte d'une fistule aorto-trachéo-oesophagienne et d'une volumineuse tumeur rectale méconnues, les causes de décès ne pouvant être légalement divulguées. Un troisième corps a été remplacé après identification tardive d'une hémorragie artérielle, démontrant l'importance d'un solide briefing pré-chirurgie. Le modèle des cadavres re-perfusés et re-ventilés est une alternative pertinente pour l'apprentissage de la chirurgie robotique.