Nurses who provide care in robotic surgery must have sufficient special training in the operation of the da Vinci robot to perform their roles with knowledge and confidence that can yield optimal patient outcomes. The local nursing practice problem in the project facility, and the focus of this doctoral project, was the lack of an evidenced-based robotics education program for registered nurses who participate in robotic surgery. The gap in practice was nurses' lack of knowledge, which interfered with the care provided to the robotic surgical population. The purpose of this project was to develop a staff robotics education program in order to answer the question if the implementation of an evidence-based robotics education program would improve nurses' knowledge in the practice of robotic surgery. The education program was developed using Knowles adult learning theory and information obtained from a comprehensive literature search. A planning team, consisting of local clinicians with expertise in robotic surgery, provided feedback and assisted with the development of the education program and accompanying competency checklist. Ten nurses received the education, and 90-100% of the nurses reported increased knowledge and confidence regarding practice in the specialty of robotic surgery following the education. Leadership at the project site have decided to require surgical nurses receive the robotic education upon their employment and annually thereafter. The social change resulting from the use of this evidence-based robotics education program could include increased nursing performance and therefore, decreased complications for patients undergoing robotic surgery.

Le développement croissant de la chirurgie robotique pose le problème de la formation. Cette nouvelle technologie tend à suppléer dans les procédures complexes la coelioscopie. Elle nécessite une adaptation du chirurgien. Il est, en effet, nécessaire de maîtriser à la fois le télémanipulateur et les procédures chirurgicales, qui ne sont pas de simples transpositions des gestes coelioscopiques. Initialement, nous avons réalisé un historique du développement de la chirurgie mini-invasive coelioscopique et robotique, ainsi qu'un historique de l'apprentissage de la chirurgie. Puis, nous nous sommes intéressés à l'apprentissage de la robotique. Les simulateurs de chirurgie coelioscopique sont très couramment employés dans l'apprentissage. En robotiques, ils ont fait récemment leur apparition sur le marché. Nous avons étudié la validité du simulateur dV-Trainer dans l'apprentissage de la chirurgie robotique. Nous avons démontré l'intérêt de cet outil dans l'acquisition de la gestuelle et des automatismes propres au robot. Nous avons par ailleurs étudié l'impact d'une formation en micro-chirurgie sur les performances développées en chirurgie robotique car, au cours d'une étude préliminaire nous avions constaté que les micro-chirurgiens présentaient de meilleures aptitudes sur le simulateur de chirurgie robotique que ceux sans expérience en micro-chirurgie. Dans un troisième temps, nous nous sommes intéressés à la téléchirurgie à longue distance qui est impactée par deux contraintes que sont la latence de transmission et le volume des informations à transmettre. Une première étude a étudié l'impact du délai de transmission sur les performances des chirurgiens. Une deuxième étude a consisté à réaliser une évaluation subjective par des chirurgiens de la qualité de vidéos de chirurgie robotique compressées afin de déterminer un seuil de compression maximal acceptable / The huge expansion of minimally invasive robotic devices for surgery ask the question of the training of this new technology. Progress of robotic-assisted surgical techniques allows today mini- invasive surgery to be more accurate, providing benefits to surgeons and patients for complex surgical procedures. But, it resulted from an increasing need for training and development of new pedagogical strategies. Indeed, the surgeon has to master the telemanipulator and the procedure, which is different from a simple transposition of a laparoscopic skill. The first part of this work treats about historical development of minimal invasive surgery from laparoscopy to robotic surgery. We also develop the evolution of training program in surgery. Virtual simulators provide efficient tools for laparoscopy training. The second part of this work, study some possible solutions for robotic training. We assess the validity of a new robotic virtual simulator (dV-Trainer). We demonstrate the usefulness of this tool for the acquisition of the basic gesture for robotic surgery. Then, we evaluate the impact of a previous experience in micro-surgery on robotic training. We propose a prospective study comparing the surgical performance of micro-surgeons to that of general surgeons on a robotic simulator. We want to determine if this experience in micro-surgery could significantly improve the abilities and surgeons performance in the field of basic gesture in robotic surgery. The last part of the study also looks to the future. Currently, telesurgery need sophisticated dedicated technical resources. We want to develop procedures for clinical routine used. Therefore, we evaluate the impact of the delay on the surgical procedure. Also, reducing data volume allow decreasing latency. An appropriate solution to reduce the amount of data could be found by introducing lossy compression for the transmission using the well-known MPEG-2 and H-264 standards