RU2240601C2 - Experimental training cavity model for carrying out endoscopic operations - Google Patents

Abstract

FIELD: medical engineering.

SUBSTANCE: device has elastic flexible walls tightly sealed with 5-7 l large volume simulating cavity in patient body. Rigid base is attached to table surface and model walls and is enclosed into it. Trocar sleeve fastening arch is attached to the table with cantilevers. The device also has a unit for supplying air into the model and retaining the walls in melted state with simulated sealed operation cavity. Object under treatment is fixed on rigid base in the model in required position on the table.

EFFECT: enhanced effectiveness in modeling states approaching the real situations occurring in carrying out endoscopic operations.

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Description

The invention relates to medicine, namely to endoscopic surgery.

Modern industry (the company “Karl Storz)) Germany and others) produce models for testing the techniques of endoscopic surgery. Models have a rigid frame and only the upper wall of soft rubber material for the introduction of endoscopic instruments and an optical system through it. The device also contains an optical-video-television system for monitoring operator actions (see Karl Storz catalog: Karl Storz. Endoskope Laparoscopy 1998. Endoscope and instrument positioning and holding system - trainers, LHT 7В, 8В, 9А, 10A, eleven).

However, a drawback of existing models is the limited ability to move the walls to select the optimal position of the tools.

Domestic and foreign literature does not describe a cavity model that is close in its properties to ideal surgical conditions and meets the following requirements: as similar as possible to a worker in the abdominal cavity or created in the retroperitoneal space, with elastic walls that allow you to arbitrarily change the direction and angle of inclination of endoscopic instruments and optical system.

The aim of the invention is to eliminate the above disadvantages of known models and the solution of specific scientific problems.

This goal is achieved by the fact that the model has elastic walls of the case, which are hermetically closed with a volume of 5-7 l, simulating a cavity inside the patient’s body, a rigid base is fixed to the table surface and the walls of the model and inside it, the arc of attachment of the trocar sleeve is fixed by brackets to the table, as well as a device for supplying air into the model and holding the walls in a straightened state with imitation of a sealed operating cavity, while the object of influence inside the model is fixed on a rigid base in the right place the decomposition on the table.

Figure 1 presents a General view of the inventive device; figure 2 is a diagram of the relative positions of the parts of the model: endoscopic instruments, the object of influence, optical-video-television monitoring system; figure 3 is a diagram of the relationship of the axes of the instruments, optics and the plane on which the object of influence is located.

The claimed experimental-training model of the cavity for performing endoscopic operations has elastic walls 1 forming a hermetically sealed cavity with a volume of 5-7 l, simulating a cavity inside the patient's body. The walls do not transmit light and allow you to install the sleeves of the trocars for the introduction of tools, optics, as well as arbitrarily change the angle between the axes of the instruments from 0-180 °. Inside the model there is a rigid base fixed to the table surface and model walls 15 × 20 cm 2. Arc 3 is fixed by brackets to table 4 to secure the trocar sleeve 5. The trocar sleeve fixed to the arc is inserted into the model and tightly fixed in its wall. It is intended for the introduction of an optical system 6, allowing to observe the manipulations inside the model. An image recorded by the 0 ° optical system with a diameter of 10 mm 6 and a single-chip video camera 8 is displayed on the monitor 7. An artificial light source 9 supplies light through the optical system to the target 13. The device 10 serves to supply air into the model and keep the walls in a straightened state to simulate operating cavity. As an air supply device, a manual, foot pump, and insufflator (compressed gas cylinder with automatic maintenance of a given pressure inside the model cavity) can be used.

The sleeves of the trocars 11 are carried inside the model and hermetically fixed. They are intended for insertion into the model of tools 12. The object of influence 13 is placed inside the model and securely fixed on a rigid base in the desired position on the table.

Example 1

An object of influence, a piece of foam rubber, as well as a needle with a thread, was placed and fixed on a rigid base inside the model. Through the installed sleeves of the trocars, instruments and an optical system were introduced. Foam rubber was cut, and then a number of interrupted sutures were applied.

Example 2

A number of small objects: matches and peas were placed on the rigid base inside the simulated cavity. Using endoscopic clamps, items were sorted and neatly arranged in two piles.

Example 3

Inside the model, a piece of meat 150.0 g was placed on a passive electrode and fixed on a rigid base. Using endoscopic instruments, muscle fibers were dissected and coagulation was performed.

Despite the apparent simplicity, the development of a convenient and multifunctional model required lengthy experiments and refinement of the design in the process of research work.

The model allowed not only to develop the technique of endoscopic interventions, but also to develop theoretical aspects of new surgical approaches for endoscopic operations on the organs of the abdominal, chest cavity and retroperitoneal space. So, using this model, for the first time, important conclusions were obtained for science and practice, which made it possible to formulate objective criteria for evaluating operative accesses, the basic principles of the relative positioning of instruments when creating new operative accesses for performing endoscopic operations on the kidneys and the upper third of the ureter.

In particular, the optimal conditions for carrying out endoscopic operations are created with the following geometric parameters for the relative positioning of the optics and instruments in the area where the operation is performed:

см. фиг.3);1) the angle between the optical axis 14 and the plane of the operational impact 15 is 80-90 ° (

see figure 3);

см. фиг.3);2) the angle between the axes of the tools 16 is 30-40 ° (

see figure 3);

см. фиг.3);3) the angle between the optical axis and the axis of the instrument is more than 10 ° (

see figure 3);

4) the breadth of operational action is 40-45 °;

5) the optical axis should not coincide with the direction of movement of the instruments during any stage of the operation, since this causes difficulties in determining the distance of the working ends of the instruments from the target.

Endoscopic manipulations in the cavity are extremely difficult when:

1) the angle β between the tool axes is less than 10 °;

2) the angle γ between the optical axis and the axis of the instrument is less than 10 °;

3) the breadth of the operational action is 10-15 ° or less;

4) the object of influence when performing any stage of the operation is at a distance greater than the length of the part of the instrument that can be drawn through the trocar.

The claimed device has important scientific and practical value and allows you to develop new areas of endoscopic surgery, previously unknown to practical surgeons. In particular, without the claimed model, it would be difficult to expect the development of optimal surgical approaches for performing endoscopic operations on the kidneys and the upper third of the ureter.

Claims (1)

An experimental training model for performing endoscopic operations, containing an opaque case and a control system including a monitor, video camera, artificial light source and an optical system, characterized in that the case has elastic-elastic walls that simulate an operating cavity, fixed to a rigid one that can be fixed to the surface of the table to the base, the walls of the body are made with the possibility of installing sleeves of trocars for the introduction of endoscopic instruments and changing the angle between them syami from 0 to 180 °, and a sleeve for the introduction of the optical system, fixed on an arc having the possibility of fixing to the table by means of arms, wherein the model comprises a means for feeding into the air for retaining walls in the expanded state and the object exposure, fixed on the ground.

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