JP7066137B2 - Surgical training equipment - Google Patents

Description

The present invention relates to a surgical training device.

Patent Document 1 discloses a surgical training device used for training of coronary artery bypass surgery under pulsation.
This surgical training device includes a simulated body including a simulated blood vessel and a simulated myocardium, a holding body that holds the simulated body, a support that operably supports the holding body, and a wire that connects the holding body and the supporting body. It is equipped with a control unit that controls the operation of the holder. The holding body includes a holding plate attached to the lower surface of the simulated myocardium, a cylindrical central protrusion that protrudes downward from the central portion of the lower surface of the holding plate, a coil spring attached to the central protrusion, and the lower surface of the holding plate. It is provided with a cylindrical corner protrusion protruding downward from each corner portion in the above. The wire is made of a Ti—Ni-based or Ti—Ni—Cu-based shape memory alloy that can shrink due to heat generation, and connects each corner protrusion and the support. The control unit controls the operation of the holding body by changing the supply state of the current supplied to the wire and changing the shape of the wire.

According to such a conventional surgical training device, the simulated body held by the holding body can be operated at 60 to 100 BPM (Beats Per Minute). This corresponds to the resting heart rate of a typical adult.

Japanese Unexamined Patent Publication No. 2009-122130 Patent No. 4326011

By the way, in the case of the surgical training device described in Patent Document 1, the simulated body is held by a holding plate constituting the holding body, and the holding plate is elastically supported by a coil spring. Therefore, even if a part of the simulated body is pressed with tweezers or the like, the simulated body is difficult to move in the pressing direction, and the movement of the simulated body tends to be unnatural. Therefore, there is still room for improvement in simulating the heart.

It should be noted that these problems are not limited to the training device for coronary artery bypass surgery under pulsation, but also occur in the training device for surgery targeting other living tissues.
An object of the present invention is to provide a surgical training device capable of bringing the movement of a simulated body closer to the movement of an actual living tissue.

The surgical training device for achieving the above object is a surgical training device used for surgical training for a living tissue, and includes a simulated body simulating the living tissue and a flexible membrane supporting the simulated body. , Equipped with.

According to the same configuration, since the simulated body is supported by the flexible film, when the simulated body is pressed with tweezers or the like, the flexible film stretches and the simulated body moves smoothly in the pressing direction. Therefore, the movement of the simulated body can be made closer to the movement of the actual living tissue.

In the surgical training device, it is preferable that the simulated body has a flexible sheet shape and is supported in a state of being superposed on the flexible membrane.
According to the same configuration, the simulated body also has a flexible sheet shape, so when a part of the simulated body is pressed with tweezers or the like, the simulated body and the flexible membrane move smoothly in the pressing direction around the pressed portion. Will come to do. Therefore, the movement of the simulated body can be made closer to the movement of the actual living tissue.

In the surgical training device, it is preferable that the entire simulated body is supported in a state of being superposed on the flexible membrane.
According to the same configuration, since the entire simulated body is supported in a state of being superposed on the flexible membrane, even if any part of the simulated body is pressed with tweezers or the like, the pressed portion is the center. The simulated body and the flexible membrane move smoothly in the pressing direction. Therefore, the movement of the simulated body can be made closer to the movement of the actual living tissue.

In the surgical training device, the flexible membrane has a downward displacement amount of 1 to 1 to 10 when a load of 10 g is applied to the region of the flexible membrane having a diameter of 20 mm in which the simulated body is arranged. It is preferable to have an elastic property of 100 mm.

For example, when a load of 10 g is applied to a region having a diameter of 20 mm in which a simulated body is arranged in the flexible membrane, and the amount of downward displacement of the flexible membrane in the region is smaller than 1 mm, the flexible membrane is used. Is too stiff, and the movement of the simulated body tends to be unnatural.

On the other hand, when the amount of downward displacement of the flexible film in the region is larger than 100 mm, the flexible film becomes too soft, and the movement of the simulated body tends to be unnatural.
In this respect, according to the above configuration, the elastic properties of the flexible membrane can be brought close to the elastic properties of the actual living tissue.

In the surgical training device, it is preferable that the simulated body is provided with a driving device for operating the simulated body in a manner simulating the expansion / contraction motion of the living tissue, and the driving device is provided with the flexible membrane.

According to the same configuration, the flexible membrane forming the driving device is operated in a manner simulating the expansion / contraction motion of the living tissue. Therefore, the movement of the simulated body can be made closer to the actual stretching movement of the living tissue.

In the surgical training device, the flexible membrane is preferably an electroactive polymer actuator.
According to this configuration, the motion speed of the simulated body, that is, the responsiveness can be increased as compared with the actuator made of shape memory alloy, and it becomes possible to support surgical training simulating a patient with a high heart rate such as a child. .. Therefore, it is possible to deal with various variations of surgical training.

In the surgical training device, the electroactive polymer actuator is a dielectric actuator, and the flexible film may have a dielectric layer made of a dielectric elastomer and an electrode layer made of a conductive elastomer and sandwiching the dielectric layer. preferable.

According to the same configuration, it is possible to embody a drive device that stably operates the simulated body with a simple configuration.
In the surgical training device, the flexible membrane has the dielectric layer and the electrode layer, respectively, and a plurality of drive layers arranged on the same surface and the plurality of drive layers from both sides in the thickness direction thereof. It is preferable that the simulated body is provided on the insulating layer so as to be sandwiched and provided with an insulating layer common to the plurality of driving layers, and the simulated body is provided so as to straddle the plurality of driving layers adjacent to each other.

According to the same configuration, it is possible for a plurality of drive layers to separately exert a force on different parts of the simulated body. Therefore, if the operation modes of the drive layers are made different from each other by the control device, the simulated body can be operated in a complicated pattern. Therefore, the movement of the simulated body can be made closer to the actual stretching movement of the living tissue.

According to the present invention, the movement of the simulated body can be made close to the movement of the actual living tissue.

The perspective view in one Embodiment of the surgical training apparatus. Sectional drawing along line 2-2 of FIG. The plan view of the dielectric actuator of the same embodiment. FIG. 3 is a cross-sectional view taken along the line 4-4 of FIG. The schematic diagram of the dielectric actuator and the control device of the same embodiment.

Hereinafter, one embodiment will be described with reference to FIGS. 1 to 5.
The surgical training device of the present embodiment is used for training of cardiovascular anastomosis surgery, more specifically, coronary artery bypass surgery under pulsation, and is provided in a case (not shown) having an opening at the upper part. ..

As shown in FIGS. 1 and 2, the drive device 20 has a square plate shape in a plan view, and is a frame member composed of a lower frame member 23 and an upper frame member 24 that are vertically stacked and fixed to each other. 22 is provided.

The frame members 23 and 24 have central holes 23a and 24a having a square shape with a rounded plan view.
Four support members 21 extending downward are provided at the four corners of the lower frame member 23.

As shown in FIG. 1, a pair of recesses 24A and 24B are provided at a pair of corners located on the diagonal of the square of the upper frame member 24 in the inner peripheral edge of the central hole 24a of the upper frame member 24. There is.
Of the inner peripheral edge of the central hole 23a of the lower frame member 23, it is on the diagonal of the square of the lower frame member 23, and is different from the diagonal on which the pair of recesses 24A and 24B of the upper frame member 24 are located. A pair of recesses (not shown) are provided in each of the pair of corners located on the corners.

As shown in FIGS. 1 and 2, a peripheral portion of a flexible sheet-shaped dielectric actuator 30 having a substantially square plan view is fixed between the lower frame member 23 and the upper frame member 24 via an adhesive. ing. The dielectric actuator 30 corresponds to the flexible film according to the present invention.

As shown in FIGS. 3 and 4, the dielectric actuator 30 (DEA: Dielectric Elastomer Actuator) is composed of a sheet-shaped dielectric layer 31 made of a dielectric elastomer and a conductive elastomer, and the dielectric layer 31 is formed from both sides in the thickness direction thereof. It is an elastomer piezoelectric element having a pair of electrode layers 32, 33 sandwiching the electrode layers 32, 33 and an insulating layer 34 sandwiching the electrode layers 32, 33 from both sides in the thickness direction.

More specifically, the dielectric actuator 30 has a pair of electrode layers (positive electrode layer 32 and negative electrode layer 33) sandwiching the dielectric layer 31 and the dielectric layer 31, respectively, and two drive layers 30A arranged on the same surface. , 30B and the two drive layers 30A and 30B are sandwiched from both sides in the thickness direction thereof, and an insulating layer 34 common to the drive layers 30A and 30B is provided. Since the insulating layer 34 is transparent, the drive layers 30A and 30B located inside the insulating layer 34 are shown by solid lines in FIGS. 1 and 3.

In this embodiment, the dielectric layer 31 is formed of a dielectric elastomer containing a crosslinked polyrotaxane. Specifically, the dielectric elastomer consists of polyethylene glycol as a linear molecule, cyclodextrin as a cyclic molecule, and adamantaneamine as a blocking group.

Further, in the present embodiment, the electrode layers 32 and 33 are formed of a conductive elastomer containing an insulating polymer and a conductive filler. Polyrotaxane is used as the insulating polymer. Further, as the conductive filler, Ketjen Black (registered trademark) is used.

The thicknesses of the dielectric layer 31 and the electrode layers 32 and 33 are all tens to several hundreds of μm.
As shown in FIGS. 1 and 3, the drive layer 30A (30B) is located on the inner peripheral side of the inner peripheral edge of the central hole 23a and has a substantially U-shaped outer peripheral edge extending along the inner peripheral edge thereof. It has a 35A (35B) and an opposing edge portion 36A (36B) extending linearly between both ends P1 and P2 (P3, P4) of the outer peripheral edge portion 35A (35B). The facing edges 36A and 36B of the drive layers 30A and 30B face each other with a gap.

As shown in FIG. 4, the outer peripheral edge portion of the dielectric actuator 30 and the portion between the drive layers 30A and 30B are composed of only the insulating layer 34.
As shown in FIGS. 1 and 3, in the portion of the outer peripheral edge portion 35A of the drive layer 30A corresponding to the recess 24A of the upper frame member 24, a projecting piece 32A in which the positive electrode layer 32 projects toward the outer peripheral side is provided. ing. Further, in the portion of the outer peripheral edge portion 35A of the drive layer 30A corresponding to the recess (not shown) of the lower frame member 23, a projecting piece 33A in which the negative electrode layer 33 projects toward the outer peripheral side is provided.

A projecting piece 32B in which the positive electrode layer 32 projects toward the outer periphery is provided in a portion of the outer peripheral edge portion 35B of the drive layer 30B corresponding to the recess 24B of the upper frame member 24. Further, in the portion of the outer peripheral edge portion 35B of the drive layer 30B corresponding to the recess (not shown) of the lower frame member 23, a projecting piece 33B in which the negative electrode layer 33 projects toward the outer peripheral side is provided.

As shown in FIG. 5, each projecting piece 32A, 33A (32B, 33B) is provided with a contact point with a control board 61 that controls a driving mode of the dielectric actuator 30.
As shown in FIGS. 1 to 3, the simulated body 50 is fixed to the central portion of the upper surface of the dielectric actuator 30.

The simulated body 50 simulates a part of the living tissue to be trained, specifically, a part of the heart surface exposed by the coronary arteries.
The simulated body 50 is fixed to a simulated myocardium 51 having a flexible sheet shape having a square view smaller than the inner peripheral edge of the central hole 23a, and a central portion in the width direction on the upper surface of the simulated myocardium 51, and has a length of the simulated myocardium 51. It has a cylindrical simulated blood vessel 52 extending along the direction. Both the simulated myocardium 51 and the simulated blood vessel 52 are formed of an elastic member such as a silicone elastomer.

The entire simulated myocardium 51 is supported in a state of being overlapped in a manner straddling two drive layers 30A and 30B adjacent to each other. In this embodiment, the simulated myocardium 51 is fixed on the insulating layer 34 via an adhesive.

The thickness of the simulated body 50 is, for example, 2 mm.
Here, as the dielectric actuator 30, when a load of 10 g is applied to a region having a diameter of 20 mm in which the simulated body 50 of the dielectric actuator 30 is arranged, the amount of downward displacement of the region is 1 to 100 mm. It is preferable to have elastic properties such as. The dielectric actuator 30 of the present embodiment has an elastic characteristic that the amount of downward displacement of the region is about 10 mm.

The Young's modulus of the dielectric actuator 30 is preferably 1 to 3 MPa.
In the training of coronary artery bypass surgery in the present embodiment, an incision is made in the middle portion of the simulated blood vessel 52, and one end side of another simulated blood vessel (not shown) is anastomosed to the incised portion.

As shown in FIG. 5, control devices 60 for controlling these drive modes are electrically connected to the drive layers 30A and 30B of the dielectric actuator 30. The control device 60 includes a control board 61 and a terminal device 62 such as a tablet terminal. Further, the power supply 63 is electrically connected to the control board 61.

The control board 61 controls an application mode when a DC voltage of, for example, 900 to 1500V is applied from the power supply 63 between the electrode layers 32 and 33 of the drive layers 30A and 30B in response to the input signal from the terminal device 62. Specifically, the control board 61 drives the drive layers 30A and 30B within a range of 0 to 300 BPM (Beats Per Minute) by variably setting the applied voltage within a frequency range of 0 to 5 Hz.

Next, the basic operation of the surgical training device of the present embodiment will be described.
In the training of coronary artery bypass surgery using the surgical training device of the present embodiment, the drive modes of the drive layers 30A and 30B are controlled by controlling the mode of energization of the drive layers 30A and 30B by the control device 60. The operation of the simulated body 50 is controlled.

That is, when a DC voltage is applied between the positive electrode layer 32 and the negative electrode layer 33 of the drive layer 30A (30B), the positive charge and the negative charge try to approach each other inside the drive layer 30A (30B). The force of the dielectric layer 31 is compressed in the thickness direction and stretches in the direction along the surface of the dielectric layer 31. Then, as the elastic force of the drive layer 30A (30B) decreases, the central portion of the drive layer 30A (30B) is displaced downward due to its own weight.

After that, when the application of the voltage to the drive layer 30A (30B) is stopped, the elastic force of the drive layer 30A (30B) is restored by restoring the thickness of the dielectric layer 31, and the drive layer 30A (30B). Will be displaced upward.

In particular, in the present embodiment, the phases in which the voltage is applied to the drive layers 30A and 30B are made different from each other.
By alternately moving the drive layers 30A and 30B up and down in this way, the simulated body 50 provided in a mode straddling the drive layers 30A and 30B operates in a mode simulating the expansion and contraction motion of the heart. ..

According to the surgical training device according to the present embodiment described above, the following effects can be obtained.
(1) The surgical training device is a device used for surgical training for the heart, and is a simulated body 50 that simulates a part of the heart and a dielectric actuator 30 as a flexible film that supports the simulated body 50. And.

According to such a configuration, since the simulated body 50 is supported by the dielectric actuator 30 which is a flexible film, when the simulated body 50 is pressed with tweezers or the like, the dielectric actuator 30 extends and the simulated body 50 smoothly moves in the pressing direction. It will move. Therefore, the movement of the simulated body 50 can be made closer to the actual movement of the heart.

(2) The simulated body 50 has a flexible sheet shape, and is supported in a state of being superposed on the dielectric actuator 30.
According to such a configuration, since the simulated body 50 also has a flexible sheet shape, when a part of the simulated body 50 is pressed with tweezers or the like, the simulated body 50 and the dielectric actuator 30 are pressed in the pressing direction centering on the pressed portion. It will move smoothly. Therefore, the movement of the simulated body 50 can be made closer to the actual movement of the heart.

(3) The entire simulated body 50 is supported in a state of being superposed on the dielectric actuator 30.
According to such a configuration, since the entire simulated body 50 is supported in a state of being overlapped on the dielectric actuator 30, even if any part of the simulated body 50 is pressed with tweezers or the like, the pressed portion. The simulated body 50 and the dielectric actuator 30 move smoothly in the pressing direction around the center. Therefore, the movement of the simulated body 50 can be made closer to the actual movement of the heart.

(4) When a load of 10 g is applied to a region having a diameter of 20 mm in which the simulated body 50 of the dielectric actuator 30 is arranged, the amount of downward displacement of the dielectric actuator 30 is 1 to 100 mm. Has elastic properties.

For example, when a load of 10 g is applied to the inside of the region and the amount of downward displacement of the dielectric actuator 30 is smaller than 1 mm, the dielectric actuator 30 becomes too hard, so that the simulated body The movement of 50 tends to be unnatural.

On the other hand, when the amount of downward displacement of the dielectric actuator 30 in the region is larger than 100 mm, the dielectric actuator 30 becomes too soft, and the operation of the simulated body 50 tends to be unnatural.

In this respect, according to the above configuration, the elastic characteristics of the dielectric actuator 30 can be brought close to the elastic characteristics of the actual heart.
(5) The surgical training device includes a driving device 20 that operates the simulated body 50 in a manner simulating the expansion / contraction motion of the heart. The drive device 20 includes a dielectric actuator 30 as a flexible film.

According to such a configuration, the dielectric actuator 30 forming the drive device 20 is operated in a manner simulating the expansion / contraction motion of the heart. Therefore, the movement of the simulated body 50 can be brought closer to the actual expansion and contraction movement of the heart.

(6) The drive device 20 includes a flexible sheet-shaped dielectric actuator 30. The dielectric actuator 30 has a dielectric layer 31 made of a dielectric elastomer and electrode layers 32 and 33 made of a conductive elastomer and sandwiching the dielectric layer 31.

For example, since the heart rate of a child is about 150 BPM, which is higher than that of a general adult, surgery for children is difficult and the need for surgical training is high. However, since the surgical operation training device described in Patent Document 1 uses a wire formed of a shape memory alloy as an actuator for operating the holder, the wire is heated from the start of energization until the temperature of the wire rises, or. It takes a long time for the wire to drop in temperature after the power is cut off. Therefore, the movement speed of the holder, that is, the responsiveness is low, and it is not possible to support surgical training simulating a patient with a high heart rate such as a child.

In this regard, according to the above configuration, the drive device 20 includes a flexible sheet-shaped dielectric actuator 30. Therefore, as compared with the conventional actuator made of a shape memory alloy, the operating speed of the simulated body 50, that is, the responsiveness can be increased, and it becomes possible to support surgical training simulating a patient with a high heart rate such as a child. .. Therefore, it is possible to deal with various variations of surgical training. Further, with a simple configuration, it is possible to embody the drive device 20 that stably operates the simulated body 50.

(7) The dielectric actuator 30 has a dielectric layer 31 and electrode layers 32 and 33, respectively, and has two drive layers 30A and 30B arranged on the same surface and two drive layers 30A and 30B having a thickness thereof. It is sandwiched from both sides in the direction and is provided with an insulating layer 34 common to the two drive layers 30A and 30B. The simulated body 50 is provided on the insulating layer 34 in a manner straddling two drive layers 30A and 30B adjacent to each other.

According to such a configuration, the two drive layers 30A and 30B can exert a force separately on different parts of the simulated body 50. Therefore, if the operation modes of the drive layers 30A and 30B are made different from each other by the control device, the simulated body 50 can be operated in a complicated pattern. Therefore, the movement of the simulated body 50 can be brought closer to the actual stretching movement of the heart.

<Modification example>
This embodiment can be modified and implemented as follows. The present embodiment and the following modified examples can be implemented in combination with each other within a technically consistent range.

-In the above embodiment, the dielectric actuator 30 provided with the two drive layers 30A and 30B has been exemplified, but the dielectric actuator may be provided with three or more drive layers, or may be provided with one drive layer. There may be.

The dielectric elastomer constituting the dielectric layer 31 is not limited to polyrotaxane, and other dielectric elastomers such as silicone elastomer, acrylic elastomer, and urethane elastomer can also be adopted.

The insulating polymer of the conductive elastomer constituting the electrode layers 32 and 33 is not limited to polyrotaxane, and other insulating polymers such as silicone elastomer, acrylic elastomer, and urethane elastomer can also be adopted. Further, one of these insulating polymers may be used, or a plurality of types may be used in combination.

-The conductive filler of the conductive elastomer constituting the electrode layers 32 and 33 is not limited to Ketjen black, and other carbon black and metal particles such as copper and silver can also be adopted. Further, one of these conductive fillers may be used, or a plurality of types may be used in combination.

-The drive device is not limited to the one provided with a dielectric actuator. Alternatively, for example, another electroactive polymer actuator (EPA) such as an ion exchange polymer metal composite (IPMC) can be adopted.

-The flexible membrane according to the present invention is not limited to the electroactive polymer actuator. For example, the flexible membrane made of elastomer having the elastic properties exemplified in the above embodiment and the frame member supporting the flexible membrane are reciprocated up and down by another actuator such as an actuator equipped with a wire formed of a shape memory alloy. It may be.

-The surgical training device according to the present invention is not limited to that used for training of coronary artery bypass surgery under pulsation, and is used for training of surgery for living tissue other than the heart that expands and contracts, such as catheter surgery. You can also. In addition, the present invention can also be applied to surgical training for living tissues that do not expand and contract.

20 ... drive device, 21 ... support member, 22 ... frame member, 23 ... lower frame member, 24 ... upper frame member, 23a, 24a ... center hole, 24A, 24B ... recess, 30 ... dielectric actuator, 30A, 30B ... Drive layer, 31 ... Dielectric layer, 32 ... Positive electrode layer, 33 ... Negative electrode layer, 32A, 32B, 33A, 33B ... Projections, 34 ... Insulation layer, 35A, 35B ... Outer peripheral edge, 36A, 36B ... Opposing edge Department, 50 ... simulated body, 51 ... simulated myocardium (living tissue that expands and contracts), 52 ... simulated blood vessel, 60 ... control device, 61 ... control board, 62 ... terminal device, 63 ... power supply.

Claims (7)

A surgical training device used for surgical training on living tissues.
A simulated body that simulates the living tissue and
A flexible membrane that supports the simulated body is provided.
The flexible film is a sheet-shaped electroactive polymer actuator, and its peripheral edge is fixed in a state where downward displacement is allowed.
Surgical training equipment. The simulated body has a flexible sheet shape and is supported in a state of being superposed on the flexible film.
The surgical training device according to claim 1. The entire simulated body is supported in a state of being superposed on the flexible membrane.
The surgical training device according to claim 1 or 2. The flexible membrane has elastic characteristics such that when a load of 10 g is applied to the region of the flexible membrane having a diameter of 20 mm in which the simulated body is arranged, the amount of downward displacement of the region is 1 to 100 mm. Have,
The surgical training device according to any one of claims 1 to 3. A drive device for operating the simulated body in a manner simulating the expansion / contraction motion of the living tissue is provided.
The drive device comprises the flexible membrane.
The surgical training device according to any one of claims 1 to 4. The electric field responsive polymer actuator is a dielectric actuator, and is
The flexible film has a dielectric layer made of a dielectric elastomer and an electrode layer made of a conductive elastomer and sandwiching the dielectric layer.
The surgical training device according to any one of claims 1 to 5 . The flexible film has the dielectric layer and the electrode layer, respectively, and sandwiches the plurality of drive layers arranged on the same surface and the plurality of the drive layers from both sides in the thickness direction thereof, and the plurality of the drives. It has a common insulating layer and
The simulated body is provided on the insulating layer in a manner straddling a plurality of driving layers adjacent to each other.
The surgical training device according to claim 6 .

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