RU181388U1 - Medical simulator for learning the technique of suturing a laparotomy wound - Google Patents

Abstract

The utility model relates to medicine and the field of education, in particular, to equipment for the practical training of medical students, residents, surgeons in various methods of suturing a laparotomy wound. The purpose of the utility model is to create a device that allows you to master various methods of suturing tissue in conditions close to The proposed simulator is a rigid frame 36 × 40 cm in size, round legs of soft rubber attached to the corners of the lower surface to prevent slipping along ol. The frame contains 2 clamps for fixing removable material imitating human tissue (peritoneum, aponeurosis, subcutaneous fat, skin). To simulate the peritoneum, a polyethylene film of various thicknesses is used, to simulate aponeurosis, artificial skin of various densities and thicknesses, subcutaneous fat layer - foam rubber, skin - genuine leather of various dressing. The standard size of the material fixed in the clip is 32 × 6 cm. The maximum wide width of the material protruding from the clip is 4 cm, but if necessary it can be reduced to 1.5 cm. On the free edges of the material imitating human tissue, marks are made in the form of bright dots located on certain distances between themselves and from the edges of the alleged wound. The choice of the above distances depends on the choice of the method of suturing and helps to develop the skill of visual assessment of the length of stitches and the distances between them. This will allow technically correct suturing. The first clamp that secures the material is stationary and is located on one of the edges of the frame, corresponding to its size of 32 cm. The second clamp, the length of which also corresponds to the width of the frame, is movable and parallel to the first, freely moving relative to the side planks of the frame along the channels cut into them . Through these channels and the holes of the edges of the clamps located in the projection of each of their channels, bolts are passed connecting the parts and fixing these parts with the wing nut in the desired position when suturing is performed without tension. In case of tension, these nuts must be loosened to allow the clamp to move freely. To simulate the tension of sutured tissues, it is possible to fix the spring strain gauge between the movable clamp and the adjusting screw located in the hole of the wall of the stationary bar connecting the side bars from the side opposite from the stationary clamp. The degree of tension is changed by means of an adjusting screw located in the hole of the thickness of the stationary bar. In the channels of the side strips are mounted on 1 clamp movable clamp to limit diastasis between the edges of the sutured tissue when they are tensioned. The clamps move freely along the channels and are tightened taking into account the choice of diastasis value. To develop the skill of suturing deep in the wound, in particular peritoneum and aponeurosis, which happens with pronounced subcutaneous fat, there are two removable U-shaped wire frames with a height of 4 cm and a length of 30 cm, free edges attached on the edges of the clamps.

Description

The invention relates to medicine and to the field of education, in particular to equipment for the practical training of students of medical universities, residents, surgeons with various methods of suturing a laparotomy wound.

Mastering the technique of suturing tissue begins on a course of surgical surgery in medical universities, where classes are held on cadaveric material. The disadvantage of this technique is the difficulty of storing the material, limited availability during group classes, the spent material cannot be restored. These disadvantages are eliminated by using special simulators.

Also known is a homemade simulator for developing practical skills for surgical suturing [Neveitseva OA, Peshikov OV, Chukichev AV Home-made simulator for developing practical skills for surgical suturing / Materials of the III All-Russian (VI intra-university) scientific-practical conference "Optimization of higher medical and pharmaceutical education: quality and innovation management" dedicated to the day of Russian science // Chelyabinsk: Publishing House of the South Ural State Medical University . - 2015. - T. 6. - No. 15. - S. 81-86], consisting of a made wooden base, on which are fixed two stationery clips, in which subsequently sutured material is fixed. The disadvantage of this simulator is the lack of the possibility of tensioning the edges of the sutured material, the short length of the simulated sutured wound, the lack of marking of sutures on the material, the inability to simulate suturing of a deep wound, poor fixation of replaceable elements.

Another closest analogue is a simulator for mastering the technique of suturing tissue under tension [RF Patent for Utility Model No. RU138633U1, 03/20/2014], including an element whose physical properties correspond to tissue under tension, mounted on a support platform using clamps. The simulator allows you to repeatedly impose various types of sutures on the material used, while maintaining the feeling of tissue under tension. The disadvantages are the impossibility of dosing the tension force, the inability to simulate various types of tissues, the lack of marking of joints on the material, the unregulated distance between the edges of the simulated wound, the inability to simulate suturing of a deep wound.

A close analogue is the simulator for opening and suturing the abdominal cavity and peritoneal cavity TBP-1.01, manufactured in Russia by the Zarnitsa production association. This simulator is comparable with the proposed size, the possibility of suturing imitated tissues (peritoneum, aponeurosis, subcutaneous fat, skin) with various sutures under tension.

The disadvantages of the prototype are:

- There is no marking of seams on the material, which is necessary to assess the quality of the seam.

- The tension imitating the anterior abdominal wall of tissues is unregulated, while in real conditions this indicator may be different. Especially relevant situations in case of obesity in a patient or intra-abdominal hypertension. In addition, the standard tissue tension does not allow the student to master the skill from simple to complex.

- To ensure tension, the cylinder must be replaced if it is damaged.

- The bulkiness of the structure.

- The need to purchase specialized supplies.

The technical result is the creation of a device of simple design that allows you to master various methods of suturing tissues, in conditions that mimic real clinical.

The solution to this problem and technical conditions provides a simulator for the development of the technique of suturing a laparotomy wound (figure 1).

On the simulator presented, it is possible to develop skills in suturing the peritoneum, aponeurosis, subcutaneous fat, and skin.

The proposed simulator (figure 1) is a rigid frame measuring 36 × 40 cm, at the corners of the lower surface of which are attached round legs of soft rubber to prevent slipping on the table. The frame contains 2 clamps (1,2) for fixing removable material (3) imitating human tissue (peritoneum, aponeurosis, subcutaneous fatty tissue, skin). To simulate the peritoneum, a plastic film of various thicknesses is used, to simulate the aponeurosis - artificial skin of various densities and thicknesses, the subcutaneous fat layer - foam rubber, the skin - genuine leather of various dressings. The standard size of the material fixed in the clip is 32 × 6 cm. The maximum width of the material protruding from the clip is 4 cm, but if necessary it can be reduced to 1.5 cm. Marks in the form of bright dots are marked on the free edges of the material imitating human tissue (4), located at certain distances between themselves and from the edges of the alleged wound. The choice of the above distances depends on the choice of the method of suturing and helps to develop the skill of visual assessment of the length of stitches and the distances between them. This will allow technically correct suturing. The first 32 cm clip that secures the material is stationary and is located on one of the edges of the frame (1). The second clamp (2), whose length is also 32 cm, is movable and is parallel to the first, freely moving relative to the side planks of the frame along the channels cut into them (5). Through the said channels and the holes of the clamp edges located in the projection of each of their channels, bolts (6) are connected that connect the parts to each other and fix the specified parts with the wing nut in the desired position when suturing is performed without tension. In case of tension, these nuts must be loosened to allow the clamp to move freely. To simulate the tension of sutured tissues, it is possible to fix the spring strain gauge (7) between the movable clamp and the adjusting screw located in the hole of the wall of the stationary bar connecting the side bars from the side opposite from the stationary clamp. The degree of tension is changed by means of an adjusting screw (8) located in the hole in the thickness of the stationary bar. In the channels of the side strips are mounted on 1 clamp movable clamp (9) to limit diastasis between the edges of the sutured tissue when they are tensioned. The latches move freely along the channels and are tightened taking into account the choice of diastasis value.

To develop the skill of suturing in the depths of the wound, in particular the peritoneum and aponeurosis, which happens with severe subcutaneous fat, there are two removable U-shaped wire frames (10), 4 cm high and 30 cm long, attached at the edges of the clamps with free edges.

In the process, the simulator is used as follows. The necessary material is fixed in the clamps with the marking on it of the proposed method of suturing. Adjustment is made using the fixing screws of the maximum diastasis between the edges of the makeshift wound, and the bolts that fix the movable clamp are loosened for its free movement. Then, the degree of tension necessary for suturing is established by tightening or loosening the adjusting screw to which the strain gauge is attached, while approaching using the movable clamp of the edges of the fabric to each other. The degree of spring tension depends on the tasks set during training, depending on the simulation of the proposed clinical situation. In the case of modeling the situation without tensioning the tissues, the movable clamp is fixed with bolts after reducing the edges of the fabric.

After the preparation, with the help of an appropriate surgical instrument and suture material, one or another type of suture is performed. Needles needles should be made at the points marked on the material. The material can be used repeatedly and changed after wear. After practicing the skill of visualizing the choice while suturing the length of the stitches and the distance between them, the material can be used without marking, in order to assess the worked-out skill.

The proposed simulator for mastering the technique of suturing a laparotomy wound has the following advantages:

- an adjustable degree of tissue tension and an adjustable diastasis between them allows you to practice the skill of suturing in conditions close to real ones, as well as master the technique in stages - from simple to complex;

- marking made on a material, in particular, imitating a white line of the abdomen, allows the student to accurately determine the selected distance between the stitches and their length, which is important in practice, since the strength of the seam and, consequently, the frequency of its failure will depend on this;

- wire frames along the edges of the clamps that fix the tissue, allow you to work out the skill of suturing in the case of a deep wound, which in practice is important with a pronounced subcutaneous fat layer;

- the same conditions allow you to objectively control the process of mastering the skill with fixing the speed of suturing;

- the constructive simplicity of manufacturing the simulator does not require complex, expensive materials;

- low cost and availability of consumables allows you to use the simulator without large economic costs;

- simplicity and lack of need for special storage conditions;

- ease of transportation allows you to use the simulator not only stationary in the training room, but also in the surgical departments of medical institutions.

Claims (1)

A medical simulator for teaching the technique of suturing a laparotomy wound, comprising a rigid frame and materials imitating human tissue, characterized in that a stationary clip located at one of the edges of the frame, a movable clip mounted parallel to the stationary clip with the possibility of free movement relative to the side strips of the frame are inserted into it along the channels cut into them, connecting bolts drawn through the said channels, and a movable clamp with the possibility of fixing with nuts, an adjusting screw for adjusting tension of the sutured tissues, connected to a tensometer fixed between the movable clamp and the stationary strap connecting the side straps of the frame from the side opposite the stationary clamp, and the moving clamps mounted in the channels of the side straps, while two removable P- are fixed to the stationary and movable clamps shaped wire frames, and materials imitating human tissue are fixed in the said clips with the possibility of replacement and are provided with marking of the worked-out seam in the form of bright points located on distance from each other and from the edges of the wound.

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