Alexandra Nassar

Editorial Commentary Should nasogastric enteral feeding become a standard escalation to reverse malnutrition in liver transplant candidates? Alexandra Nassar, Claire Francoz, Christian Hobeika

Alexandra Nassar, Théo Braquet, Béatrice Aussilhou, Maxime Ronot, Emmanuel Weiss, Federica Dondéro, Mickael Lesurtel, Safi Dokmak. Ann Hepatobiliary Pancreat Surg 2024;28:283-90. https://doi.org/10.14701/ahbps.24-040

Purpose Laparoscopic surgery has improved outcomes in abdominal surgery, but presents kinematic restrictions for surgeons. Robotic comanipulation with adaptative damping has been investigated in simple laparoscopic tasks. The present protocol aimed to determine the contribution of adaptive damping in complex bimanual tasks approaching clinical setting. Methods Fourteen residents in general surgery performed three exercises, and for each three repetitions without (classic repetitions) and three with robotic assistance (robotic repetitions) in a randomised order. The exercises chosen were trajectory, modified Pea on a Peg and intracorporeal suture. Task performance, gesture performance, workload and impression were measured. Also, a semi-directed interview was performed to collect the participants’ feeling about companipulated robots and their potential application in clinical practice. Results Adaptative damping assistance did not impact task performance, but allowed an economy of movement in the non-dominant hand during suture exercise (distance 916 ± 500 mm in classic vs. 563 ± 261 mm in robotic, p < 0.001). Perceived workload (p = 0.12) and user’s impression were not different between classic and robotic repetitions, except novelty (p < 0.001). Participants’ interviews revealed their interest for the robotic devices, particularly the gravity compensation, and were ready to use the adaptative damping provided an intermittent use, for example to dissect dangerous areas. Conclusion Adaptative damping applied by comanipulated robots does not influence the performance of the task, but improves the performance of the gesture itself, particularly for the non-dominant hand, and during the realisation of a complex task like suturing. For residents in digestive surgery, this assistance does increase workload, and they would use this help in the operating room under certain conditions.