Influence of steep Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy

The steep (40 degrees) Trendelenburg position optimizes surgical exposure during robotic prostatectomy. The goal of the current study was to investigate the combined effect of this position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during these procedures. Physiological data were recorded during the whole surgical procedure in 31 consecutive patients who underwent robotic endoscopic radical prostatectomy under general anaesthesia. Heart rate, mean arterial pressure, central venous pressure, Sp(o2), Pe'(co2), P-Plat, tidal volume, compliance, and minute ventilation were monitored and recorded. Arterial samples were obtained to determine the arterial-to-end-tidal CO2 tension gradient. Continuous regional cerebral tissue oxygen saturation (Sct(o2)) was determined by near-infrared spectroscopy. Although patients were in the Trendelenburg position, all variables investigated remained within a clinically acceptable range. Cerebral perfusion pressure (CPP) decreased from 77 mm Hg at baseline to 71 mm Hg (P=0.07), and Sct(o2) increased from 70% to 73% (P < 0.001). Pe'(co2) increased from 4.12 to 4.79 kPa (P < 0.001) and the arterial-to-Pe'(co2) tension difference increased from 1.06 kPa in the normal position to a maximum of 1.41 kPa (P < 0.001) after 2 h in the Trendelenburg position. The combination of the prolonged steep Trendelenburg position and CO2 pneumoperitoneum was well tolerated. Haemodynamic and pulmonary variables remained within safe limits. Regional cerebral oxygenation was well preserved and CPP remained within the limits between which cerebral blood flow is usually considered to be maintained by cerebral autoregulation

Surgeons versus computer vision:a comparative analysis on surgical phase recognition capabilities

PURPOSE: Automated surgical phase recognition (SPR) uses artificial intelligence (AI) to segment the surgical workflow into its key events, functioning as a building block for efficient video review, surgical education as well as skill assessment. Previous research has focused on short and linear surgical procedures and has not explored if temporal context influences experts' ability to better classify surgical phases. This research addresses these gaps, focusing on robot-assisted partial nephrectomy (RAPN) as a highly nonlinear procedure.METHODS: Urologists of varying expertise were grouped and tasked to indicate the surgical phase for RAPN on both single frames and video snippets using a custom-made web platform. Participants reported their confidence levels and the visual landmarks used in their decision-making. AI architectures without and with temporal context as trained and benchmarked on the Cholec80 data set were subsequently trained on this RAPN data set.RESULTS: Video snippets and presence of specific visual landmarks improved phase classification accuracy across all groups. Surgeons displayed high confidence in their classifications and outperformed novices, who struggled discriminating phases. The performance of the AI models is comparable to the surgeons in the survey, with improvements when temporal context was incorporated in both cases.CONCLUSION: SPR is an inherently complex task for expert surgeons and computer vision, where both perform equally well when given the same context. Performance increases when temporal information is provided. Surgical tools and organs form the key landmarks for human interpretation and are expected to shape the future of automated SPR.</p

ANALYSE TRI-GÉNÉRATIONNELLE DU PROCESSUS ADOLESCENTAIRE AU REGARD DU CONTEXTE SOCIÉTAL INDIVIDUALISTE ACTUEL

peer reviewedThis article considers the transition to adulthood in the Western world today, a context in which individualist mythology weighs heavily. We wanted to investigate the impact of this mythology on the individualization process specific to adolescence. In order to do this, we observed and analyzed the functioning of four “average” (non-pathological) families with a male adolescent in order to assess the creativity and reorganization of their family system. The process through which the adolescent acquires autonomy was studied using a systemic approach from three perspectives: those of the teenager, the parents, and the grandparents. The aim of this study is to highlight, albeit on a small scale, the importance of the family system in the advent of the individual, as families can provide a sort of “family skin-ego” that provides the conditions for the transition to adulthood

La stérilisation volontaire à visée contraceptive comme facteur de transformation positive chez des femmes sans enfant

peer reviewedEn 2018, le Service de Gynécologie du CHU Saint-Pierre de Bruxelles a décidé d’ouvrir une consultation pour les femmes, sans enfant, en demande de stérilisation à visée contraceptive. Le nombre de ces demandes est en augmentation. Au moyen d’un canevas de questions semi-directives et des cartes Dixit comme « objet flottant », nous sommes allées à la rencontre de trois femmes sans enfant et stérilisées depuis six mois à un an et demi afin d’explorer les motivations et vécus à l’origine de leur choix. Les résultats mettent en évidence le poids d’événements historiques singuliers dans la décision d’inscrire corporellement leur non-maternité. Il semble que ces trois femmes se soient dirigées vers la stérilisation à un moment où elles ont eu besoin d’agir pour se réapproprier leur corps et leur vie, et de rétablir un vécu de sécurité suite à différents événements douloureux voire traumatiques. L’exploration de leurs parcours révèle que la stérilisation est l’aboutissement d’un cheminement mais aussi un processus de transformation d’une souffrance. Une fois stérilisées, elles rapportent ressentir un apaisement et un bien-être à la fois physique et psychologique, et évoquent l’émergence d’une vie différente et d’une identité plus alignée. Dans leurs histoires singulières, la stérilisation apparaît comme ayant eu un effet thérapeutique et libérateur

Troubles des conduites alimentaires et périnatalité

editorial reviewedAprès avoir exposé l’importance des expériences sensorielles précoces et les étapes du développement de l’alimentation, de la grossesse à la diversification, l’article présente un bref historique de la compréhension des troubles alimentaires et des classifications actuelles. La définition du TAP ou trouble alimentaire pédiatrique permet de dégager la multitude des axes engagés dans sa compréhension. L’importance d’une évaluation multiaxiale et d’une prise en charge multidisciplinaire est démontrée