Minimum invasive surgery is based on bilateral teleoperation in which surgeon interacts with the master side to the slave side that is located at a distance. The synchronization in between the two ends is through a communication channel. The primary objective in the telesurgery is the position and force tracking providing the surgeon with high fidelity. The presence of time delays in the communication channels makes the realization more difficult, and sometimes it may even destabilize the system. The work focuses on a design of the force control system by using Model Predictive Control to compensate for the effects of the time delay related to the use of surgical arms. Another vital issue of minimum impact velocity during contact with the environment has been tried to achieve by using the prediction from the Model Predictive Control to prevent accidental tissue damage. This work also addresses a problem of the developing a simple delayed free predictive kinematic imaging to understand the type of behavior of the system during contact with the environment when no perception is available.

The surgical robot experienced rapid uptake throughout hospitals in the US despite lack of clinical evidence that it is superior to existing methods and undeterred by its high cost. This type of technology may be a “weapon” in the medical arms race hypothesis which asserts that competition among hospitals may be welfare reducing wherein it encourages resource use that is not commensurate with beneficial health outcomes. This paper is a case-study of the diffusion of the surgical robot among hospitals in Florida. We address the medical arms race hypothesis directly by investigating whether a hospital’s decision to adopt a robot is a function of the neighboring, competing hospitals’ decisions to do so. Using a spatial autoregressive probit model, we find that the spatial coefficient is significant and negative. That is, when neighboring hospitals operate a robot, a given hospital is less likely to operate one. Indeed, hospitals appear to consider the behavior of rival hospitals, but not in a way that would be consistent with a medical arms race. Support is lent to the hypothesis that as more hospitals become providers of robotic-assisted surgery, the less profitable it becomes to enter the market.

Ce travail de thèse suit une logique exposée dans trois chapitres, pour terminer par un exposé sur des applications futures. La première partie fait l’inventaire des difficultés de l’apprentissage des habiletés de base de la chirurgie robotique, notamment dans ses aspects de l’exploitation des avantages ergonomiques. Elle se fonde notamment les travaux de master 2 des Docteurs N. Hubert et C. Perrenot auxquels l’auteur a participé. On conclut ainsi à la nécessité de développer un outil de monitoring de l’ergonomie plus efficace que celui existant sur les logiciels du simulateur dV-Trainer®. La deuxième partie décrit la conception et la validation d’un système de capteurs de pression des avant-bras sur les appuis-bras de la console du robot et/ou des simulateurs (Système de Surveillance de Pression - SSP-). Il est créé le concept d’Armrest Load, formule plus efficace d’évaluation des performances des stagiaires en matière d’ergonomie que l’évaluation automatique par le simulateur. La troisième partie décrit l’amélioration du système SSP via l’ajout de fonctions supplémentaires et leurs évaluations : - une alarme informant l’étudiant des mauvaises positions. Ce système crée un réflexe conditionné, accélère l’utilisation ergonomique des appuis-bras du simulateur, mais également améliore les performances globales. - des caméras et une interface, « Contrôleur d’Évènement en Simulation Robotique » (CESIR), permettant au stagiaire de visionner à volonté et pour chaque exercice les vidéos de référence, celles avec les erreurs à éviter et ses propres performances. Ces techniques vidéo, largement répandues dans le milieu sportif sont utilisées pour la première fois en chirurgie et prouvent ici leur efficacité. La partie « conclusion » synthétise les résultats de tout le travail de thèse et expose des perspectives d’amélioration du système CESIR et de son utilisation dans la poursuite de la collaboration franco-chinoise en formation robotique. / This thesis is logically split into three chapters, concluding with a discussion on future applications. The first part makes an inventory of the difficulties in learning the basic skills in robotic surgery, especially in the aspects of exploiting the ergonomic benefits. It relies in particular on the master degrees of Drs N. Hubert and C.Perrenot to which the author participated. It is concluded that there is a need to develop a more efficient monitoring tool for ergonomics than the existing software on the dV-Trainer® simulator. The second part describes the design and validation of a system of forearms pressure sensors attached on the robot’s console and/or simulator’s armrests (SSP- Pressure Surveillance System). The concept of Armrest Load is created, a more effective formula for evaluating the trainees’ performance in ergonomics than the automatic evaluation provided by the simulator. The third part describes the improvement of the SSP system by adding additional functions and their evaluation: - An alarm informing the student of bad positions. This system creates a conditioned reflex, speeds up the ergonomic use of armrests on the simulator, and also improves the overall performance. - Cameras and a "Controller of Event in Robotic Simulation " (CESIR) interface, allowing the participant to view at will the reference video, the one with mistakes to avoid and the video of their own performances. This video technique is widely used in sports but is applied for the first time in surgery and proves its effectiveness. The conclusion part summarizes the results of the whole thesis and outlines the possibilities for CESIR’s improvement and its development in the French-Chinese collaboration in robotic training.