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The use of dyadic designs could help to deepen our understanding as it would take into account the interdependence of both partners.Purpose The manual generation of training data for the semantic segmentation of medical images using deep neural networks is a time-consuming and error-prone task. In this paper, we investigate the effect of different levels of realism on the training of deep neural networks for semantic segmentation of robotic instruments. An interactive virtual-reality environment was developed to generate synthetic images