Proefschrift Universiteit Maastricht. / Met lit. opg. - Met een samenvatting in het Italiaans en Nederlands.

Thèse d'exercice : Chirurgie dentaire : Université de Nantes : 2007. / Bibliogr.

Thesis (doctoral)--Katholieke Universiteit Leuven, 1982. / Includes bibliographical references (p. 139-154).

Minimally invasive surgery (MIS) consists in operating through small incisions in which a camera and adapted instruments are inserted. It allows to perform many interventions with reduced trauma for the patient. One of these is the ablation of peripheral pulmonary nodules.<p><p>Nevertheless, the means for detecting nodules during MIS are limited. In fact, because of the lack of direct contact, the surgeon cannot palpate the lung to find invisible lesions, as he would do in classical open surgery. As a result, only clearly visible nodules can be treated by MIS presently.<p><p>This work aims at designing, building and controlling a teleoperated palpation instrument, in order to extend the possibilities of MIS in the thoracic field. Such an instrument is made of a master device, manipulated by an operator, and a slave device which is in contact with the patient and reproduces the task imposed by the master. Adequate control laws between these two parts allow to restore the operator's haptic sensation. The goal is not to build a marketable prototype, but to establish a proof of concept.<p><p>The palpation device has been designed in collaboration with thoracic surgeons on the basis of the study of the medical gesture. The specifications have been deduced through experiments with experiencied surgeons from the Erasmus Hospital and the Charleroi Civil Hospital.<p><p>A pantograph has been built to be used as the master of the palpation tool. The slave is made of a 2 degrees of freedom (dof) clamp, which can be actuated in compression and shear. The compression corresponds to vertical moves of the pantograph, and the shear to horizontal ones. Force sensors have been designed within this project to measure the efforts along these directions, both at the master and the slave side, in order to implement advanced force-feedback control laws and for validation purposes.<p><p>Teleoperation control laws providing a suitable kinesthetic force feedback for lung palpation have been designed and validated through simulations. These simulations have been realized using a realistic model of lung, validated by experienced surgeons. Among the implemented control schemes, the 3-Channel scheme, including a local force control loop at the master side, is the most efficient for lung palpation. Moreover, the increased efficiency of a 2 dof device with respect to a 1 dof tool has been confirmed. Indeed, a characteristic force profile due to the motion in 2 directions appeared in the compression force tracking, making the lesion easier to locate. / Doctorat en Sciences de l'ingénieur / info:eu-repo/semantics/nonPublished

Qu’est-ce qui détermine la survie et le succès des organisations à travers les différents régimes institutionnels? La présente étude tente à répondre à la question en analysant l’évolution d'une institution médicale publique russe, c. à. d. l'Institution de l'Etat Fédéral « Le Complexe Intersectoriel de Recherche et Technologie « Microchirurgie de l'Œil » de Rosmedtechnologie. L’étude s’étend sur quatre périodes bien définies: 1960-1985 (la Russie Soviétique, la période de pré-perestroïka), 1986-1991 (la perestroïka de Gorbatchev), 1992-2000 (la transition), et 2001-2009 (la Russie actuelle, la période post-Fyodorov). L’analyse se centre sur une coévolution des institutions externes et de la structure organisationnelle de l'entreprise, le système de droits de propriété, les tendances d'innovation et les canaux de diffusion technologique. Les conclusions suggèrent que l'environnement institutionnel général exerce une influence sur la performance de l'entreprise en déterminant « les règles du jeu » pour les transactions économiques et en établissant un ensemble de possibilités de développement. C'est alors les processus internes à l'entreprise, ses compétences dynamiques et sa capacité à innover qui déterminent si l'organisation peut s'adapter aux changements externes, reconnaître les possibilités de développement et en profiter. Par ailleurs, la direction (le leadership), le type de technologie et le niveau de sa diffusion, l’initial soutien de l'Etat, de même que la demande jouent un rôle apparent pour soutenir la performance réussie. Une structure multi-niveaux des récompenses de performance en combinaison avec les méthodes de traitement innovatrices (c. à. d. l’usage d’un conveyor chirurgical et la production en brigades) ont amené à des volumes de procédures cliniques performées plus élevées, de même que la qualité, la complexité et la diversité de traitement plus élevées. D’autant plus, pendant les étapes plus anciennes du développement de l’entreprise, la présence des inventeurs prolifiques et la structure organisationnelle qui soutenait l’apprentissage, la production et l’accumulation des connaissances (le cycle « clinique – ingénierie – approbation – production – clinique ») étaient cruciaux pour la création d’une base d’innovation persistante. Pendant les périodes plus récentes, la combinaison d’accès aux ressources (matérielles, financières, capital humain), les collaborations externes, les méthodes innovatrices d’organisation de traitement, la diffusion extensive des technologies inter- et intra-firme ont aussi contribué à des hauts niveaux d’innovation. Au total, le travail soutient une approche interdisciplinaire à l’étude des organisations, c. à. d. une combinaison de l'analyse institutionnelle, l’économie évolutionnaire et l’économie dynamique d’organisations, le management stratégique, l’économie d'innovation, l’analyse des droits de propriété et le rôle de leadership. / What determines organizational survival and success across different institutional regimes? The present historical case study attempts to answer the question by analyzing the evolution of a Russian state medical institution, i.e. the S.N. Fyodorov “Inter-Sectoral Research and Technology Complex “Eye Microsurgery””. The study spans over four clearly defined regimes: 1960 – 1985 (Soviet Russia, pre-perestroika period), 1986 – 1991 (Gorbachev’s perestroika), 1992 – 2000 (the transition years), and 2001 – 2009 (current Russia, post-Fyodorov period). The analysis focuses on the co-evolution of the external institutions and the firm’s organizational structure, the system of property rights, innovation patterns and the channels of technological diffusion. The findings suggest that the general institutional environment exerts influence on the firm’s performance through determining the “rules of the game” for economic transactions and through establishing a set of development possibilities. It is then the firm’s internal processes, dynamic competences and the ability to innovate that determine whether the organization can adapt to external changes, recognize the development possibilities and take advantage of them. In addition, the roles of leadership, the type of technology and its diffusion scope, initial State support, as well as the extent of demand are apparent in sustaining successful performance. Multi-level high performance rewards structure in combination with novel industrialized treatment methods (e.g. the use of a surgical conveyer and team production) resulted in greater volumes of clinical procedures performed, as well as higher quality, complexity and diversity of treatment. In addition, at the earlier stages of the firm’s development, the presence of prolific innovators and the organizational structure that supported learning, knowledge production and accumulation (the “clinic – engineering – approbation – production – clinic” cycle) were crucial for creating a basis for persistent innovation. In later periods, the combination of resource availability (material, financial, human capital), external collaborations, novel ways of organizing treatment, extensive inter and intra-firm diffusion of technologies also contributed to high levels of innovation. Overall, the work provides support for an interdisciplinary approach to the study of organizations, i.e. combining institutional analysis, evolutionary and dynamic organizational economics, strategic management, the economics of innovation, the analysis of property rights and the role of leadership.

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