RU2798062C1 - Medical simulator for training the technique of forming laparoscopic suture - Google Patents

Abstract

FIELD: teaching aids in medicine.

SUBSTANCE: medical simulator for teaching the technique of forming a laparoscopic suture is a rigid frame in the form of a box having the shape of a rectangular parallelepiped, on the lower horizontal surface of which a training structure is placed. The upper horizontal surface of the frame has a video camera and holes for the introduction of laparoscopic instruments. The training structure consists of two rectangular plates, the first of which is hinged to the upper edge of the rear wall of the simulator frame, and the second is hinged to the first. Two rods in the form of a rectangular parallelepiped are attached to the inner surface of the outer edges of the plates by means of a cylindrical hinge, which abut against the holes made along the entire length of the upper surface of the square-shaped pipes fixed along the outer edges of the lower horizontal surface of the simulator structure. On the side surfaces of the profile pipes at the level of the said holes there are holes coinciding with the holes of the rods of the first plate for fixing the rods of the first plate of the upper horizontal surface of the simulator structure using a cylindrical rod. A metal plate is fixed on the lower surface of the frame, to which connecting nuts are welded to fix the training structure. The training structure consists of a rigid frame with clamps and a hinged mechanism. The frame contains two clips for fixing a removable material imitating human tissues. At the base of the frame, a metal plate is fixed in the middle, in the center of which there is a threaded connection for fixing the threaded stud, which is a part of a simple cylindrical hinge. On the threaded rod there is a wing nut for tightening the threaded connection. The second part of the specified hinge there is a threaded stud screwed into one of the connecting nuts of the metal plate of the lower horizontal surface of the simulator structure and rigidly fixed using a wing nut. The ends of the threaded studs are represented by oval plates with holes in the center, and on one of them there are five holes circularly relative to the central hinged hole, and on the second one there is one hole of the same diameter for passing a cylindrical rod through them. On the second plate of the upper horizontal surface, in the middle between the right and left edges, there is a hole for attaching a rigid frame to the upper horizontal surface.

EFFECT: ensuring the development of the technique of laparoscopic suture under conditions of different levels of complexity.

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Description

The invention relates to medicine and education, in particular to equipment for practical training of medical students, residents, surgeons in various methods of endoscopic wound closure and development of basic laparoscopic skills.

In modern surgery, the number of endoscopic interventions has increased significantly and prevails over open ones. In this connection, obtaining manual endoscopic skills is an urgent task. Techniques of laparoscopic surgery are studied only theoretically in the senior courses of medical universities, and practically only during postgraduate education. The most realistic way to develop the skills of endoscopic surgery is to perform operations on laboratory animals in a vivarium. However, the main disadvantages of this approach are limited accessibility during group classes and often the lack of proper material and technical base. As a result, the acquisition of skills in laparoscopic surgery and the educational process do not occur properly, which is eliminated by the use of laparoscopy simulators.

Known medical simulator for teaching the technique of laparoscopy [RF Patent for utility model No. RU207 075C1, 10.04.1997]. Represents an elastic frame with an abdominal cavity wall simulator, curved to form an abdominal cavity simulator. Inside the simulator of the abdominal cavity, simulators of anatomical organs and formations are marked. Its disadvantage is the lack of a camera and an optical device for practicing skills.

Known medical simulator for the development of surgical skills during endoscopic operations [RF Patent for utility model No. RU147842U1, 20.11.2014]. including a rigid frame with a cavity, placed inside the training structure, as well as two manipulators and a video camera on a tripod, three holes for which are located in the upper part of the cavity. The cavity is made closed, with the possibility of changing its volume due to the internal imitation abdominal layer. The disadvantages of the simulator are:

- the impossibility of adjusting the training surface of the simulator relative to the surface with laparoports;

- the presence of only three laparoports in the upper part of the cavity limits the variability of simulating clinical situations;

- the inability to practice the skill of suturing tissues in the upper horizontal plane;

- the impossibility of arranging tissues for suturing on the working surface at different angles relative to the horizontal and vertical planes;

- cumbersome design.

A close analogue is a portable simulation simulator for the development of manual skills in laparoscopic surgery [RF Patent for utility model RU 2768590C1 dated May 21, 2021]. Includes racks in the form of a plate of polymethyl methacrylate. In the center of the front surface of the plates, working holes are formed that imitate the holes of laparoports. There is a tripod for a webcam or phone, F-shaped clamps, working sponges for fixing to the stand, and two rectangular transparent platforms made of polymethyl methacrylate with suction cups for fixing to the work surface. The simulator is compact, easy to use and allows you to work out basic laparoscopic skills.

The disadvantages of this simulator are also:

- the impossibility of adjusting the distance between the training surface of the simulator and the surface with laparoports;

- the presence of only two laparoports on the racks, the distance between which can only be changed parallel to the edge of the table;

- there is no possibility of working out the skill of suturing tissues in the upper horizontal plane;

- the impossibility of arranging tissues for suturing on the working surface at different angles relative to the horizontal and vertical planes.

Another closest analogue is a simulator for practicing manual skills during laparoscopic correction of diastasis of the rectus abdominis muscles [RF Patent for utility model No. RU2772923C1, dated 08/06/2021], including a video camera, a training laparoscope and a sheet of transparent monolithic polymethyl methacrylate, which has 5 bends and 5 surfaces. The training design of the simulator imitates the anterior abdominal wall well, which allows you to work out the manual skills of laparoscopic correction of abdominal muscle diastasis.

The disadvantages are:

- the impossibility of adjusting the training surface of the simulator relative to the surface with laparoports, which standardizes the volume of the practiced skill, reducing the variative approach;

- a small number of laparoports and their presence only on a smaller surface area limits the possibility of simulating a variety of clinical situations;

- there is no adjustment of the distance between the surface with laparoports and the lower horizontal surface with the training case.

EFFECT: creation of a device with extended functionality, allowing to master and practice laparoscopic manual skills, including tissue stitching, under conditions of different levels of complexity.

The solution to the problem and technical conditions provides a simulator for teaching the technique of forming a laparoscopic suture (figure 1).

The main function of the presented simulator is the possibility of developing and practicing the skills of laparoscopic intracorporeal stapling of tissues in various planes and at any angle, under conditions of variability in the distance between the laparoport and the area of work with instruments. This makes it possible to simulate various conditions and difficulties during a laparoscopic operation, which contributes to the gradual acquisition of manual laparoscopic skills. In addition to the main function of the simulator, it is possible to form basic laparoscopic skills aimed at teaching how to work with instruments, developing coordination, and attention. This is achieved by using commercially available basic exercise elements that can be freely placed on the work surface of the machine. Thus, the simulator allows you to get laparoscopic skills that will be successfully transferred and reproduced in real conditions.

Brief description of the drawings

Fig. 1. Side view of the simulator with the placement of the training structure in the lower horizontal plane.

Fig. 2. View of the simulator in transport condition.

Fig. 3. Rear view of the simulator with a fixed training structure to the upper horizontal plane.

Fig. 4. General view of the training structure.

Fig. 5. Front view of the simulator with the placement of the training structure in the upper horizontal plane.

The simulator is a rigid frame in the form of a box having the shape of a rectangular parallelepiped (Fig. 2). A training structure (1) is placed in the cavity of the frame on the lower horizontal surface. The upper horizontal surface is provided with holes imitating laparoports through which laparoscopic instruments are inserted into the cavity and a video camera connected to a personal computer monitor (2) is fixed. Laparoports are located at an optimal distance from each other, which allows the instruments to move along a natural trajectory that mimics real operations. The volume of the cavity of the structure, and, accordingly, the distance from the laparoports to the training structure, changes due to the movement of the upper horizontal surface of the simulator. This is achieved due to the peculiarities of its design. It consists of two rectangular plates (3, 4). The first plate is attached movably with the help of loops to the upper edge of the rear wall of the simulator frame. The second plate is attached to the first one using the same loops (Fig. 3). Two rods in the form of a rectangular parallelepiped (5, 6) are attached to the inner surface of the outer edges of the first and second plates by means of a cylindrical hinge. The rods of the second plate are collapsible for easy transportation. Disassembly is carried out due to the threaded connection of the two parts in the middle of these rods. Holes are made at the ends of the rods of the first plate in the horizontal transverse direction.

The rods of the first and second plates abut against the holes made along the entire length of the upper surface of the square-shaped profile pipes fixed along the outer edges of the lower horizontal surface of the simulator structure (7). On the side surfaces of the profile pipes at the level of the above holes, there are holes that coincide with the holes of the rods of the first plate. This is necessary for fixing the first plate of the upper horizontal surface of the simulator structure (8) with a cylindrical rod.

A metal plate is fixed on the lower horizontal surface, to which three connecting nuts (9) are welded. Two nuts on the edges of the plate and one in the middle between them. Connecting nuts are needed to fix the training structure to them.

The training structure consists of a rigid frame with clamps and a hinged mechanism for setting the frame in the desired plane (Fig. 4). The rigid frame contains two clamps for fixing a removable material imitating human tissues (10). For example, to simulate the peritoneum, a polyethylene film of various thicknesses or thin fabric is used, to simulate an aponeurosis, artificial skin of various density and thickness is used. At the base of the frame, a metal plate (11) is fixed in the middle, in the center of which there is a threaded connection for fixing the threaded stud, which is part of a simple cylindrical hinge (12). For rigid fixation of the frame to the threaded stud, the latter has a wing nut that provides tightening of the threaded connection. The second part of the specified hinge is a threaded stud, which is screwed into one of the connecting nuts of the metal plate of the lower horizontal surface of the simulator structure and is rigidly fixed with a wing nut.

For hinged connection between threaded studs, their ends are represented by oval plates, in the center of which holes are made. Through them, these parts are interconnected using a bolt, lock washer and wing nut, which is necessary to adjust the degree of tightening of the threaded connection and, consequently, change the position of the rigid frame with clamps. In addition, on one of the oval plates of the threaded studs, 5 holes are made circularly relative to the central hinged hole. On the oval plate of the second threaded stud, one hole of the same diameter (13) is made, coinciding in turn with all five of the first plate during the operation of the hinge, which is necessary for passing a cylindrical rod through them. This allows you to standardize the angle of the clamps with the material fixed in them. Thus, all described connections are movable, which allows you to make any position of the clamps, fixing it with wing washers.

The design of the simulator allows you to fix a rigid frame with clamps to the rear wall of the upper horizontal surface (Fig. 3). To do this, a hole (14) is made on the second plate of the upper horizontal surface in the middle between the right and left edges. The rigid frame is attached to the upper horizontal surface through the indicated hole with a wing screw and washer (15).

During operation, the simulator is used as follows. The material for suturing is fixed in the clamps of the training structure. Depending on the set educational task, the training structure is attached to one of the connecting nut of the metal plate of the lower horizontal surface and is installed in the desired plane and at the required angle. This is achieved due to the rotation of the training structure at the junction of the threaded studs of the hinge with the connecting nut and the threaded connection of the metal plate of the base of the rigid frame with clamps, as well as due to the operation of the hinge itself. The selected position of the training structure is fixed with the help of wing pins of the swivel threaded studs, a bolt with a swivel wing washer and, if standardization of the angle of inclination of the rigid frame with clamps is required, a cylindrical rod passed through the holes of the oval hinge plates. Then the upper horizontal plates are adjusted relative to each other and to the training structure with the help of rods, the free edges of which are inserted into the symmetrical holes of the profile pipes of the lower horizontal surface of the simulator. At the end of the adjustment of the upper horizontal plates, the rods of the first upper horizontal plate are fixed to the profile pipes using cylindrical rods. This is necessary to securely hold the plates in the selected position.

Next, the camera and instruments are installed in the laparoports and the training task is performed (Fig. 1). The image from the camera is displayed on the PC monitor.

When practicing the skill of suturing in the upper horizontal plane, the training structure is fixed to the rear surface of the second upper horizontal plate with the help of a wing bolt. The camera and instruments are inserted into the laparoports of the first upper horizontal plate and the training task is performed (Fig. 5)

To bring the simulator into the transport state, it is necessary to remove the training structure, disassemble the rods of the second upper horizontal plate. The rods are pressed against the rear surface of the upper horizontal plates due to the swivel connection, which makes it possible to close them by leaning against the upper surface of the side walls of the simulator structure. All removed elements are placed in the formed simulator box. Thus, the three-dimensional design of the simulator, which is formed for practicing laparoscopic skills, is transformed into a box (Fig. 2).

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

- features of the device of the training structure make it possible to form and develop the skills of laparoscopic intracorporeal tissue suturing in various planes and at any angle;

- the adjustable upper horizontal surface of the simulator contributes to the development of laparoscopic skills in conditions of variability in the distance between the laparoport and the area of work with instruments;

- the design features of the simulator make it possible to simulate various conditions and difficulties during a laparoscopic operation, which contributes to the gradual acquisition of manual laparoscopic skills;

- the same conditions, provided by the design features of the simulator, allow you to objectively control the process of mastering the skill;

- there is no need for additional lighting of the training structure - enough lighting in the room;

- the manufacture of the simulator does not require complex, expensive materials;

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

- simplicity and no need for special storage conditions;

- the ability to transform the simulator into a relatively small box allows it to be easily transported and used not only permanently in the training room, but also in the surgical departments of medical institutions;

- the volume of the box after the transformation of the simulator into the transport position allows you to place in it a training structure, removable rods of the second upper horizontal plate, a camera with a wire, as well as consumables related to skill development.

Claims (1)

A medical simulator for teaching the technique of forming a laparoscopic suture, which is a rigid frame in the form of a box, having the shape of a rectangular parallelepiped, on the lower horizontal surface of which a training structure is placed, characterized in that its upper horizontal surface has holes with the possibility of introducing laparoscopic instruments and a video camera, with In this case, the training structure consists of two rectangular plates, the first of them is fixed with loops to the upper edge of the rear wall of the simulator frame, and the second is fixed with loops to the first one, two rods in the form are attached to the inner surface of the outer edges of the plates using a cylindrical hinge. rectangular parallelepiped, which abut against the holes made along the entire length of the upper surface of the square-shaped shaped pipes, fixed along the outer edges of the lower horizontal surface of the simulator structure, while on the side surfaces of the shaped pipes at the level of the above holes there are holes that coincide with the holes of the rods of the first plate for the possibility of fixing using a cylindrical rod of the rods of the first plate of the upper horizontal surface of the simulator structure, while a metal plate is fixed on the lower surface of the frame, to which connecting nuts are welded to fix the training structure, and the training structure consists of a rigid frame with clamps and a hinge mechanism, at the same time, the frame contains two clamps with the possibility of fixing a removable material imitating human tissues, and on the basis of the frame, a metal plate is fixed in the middle, in the center of which there is a threaded connection for fixing a threaded pin, which is part of a simple cylindrical hinge, while a wing pin is located on the threaded pin. a nut for the possibility of tightening the threaded connection, and the second part of the specified hinge is a threaded stud, which is screwed into one of the connecting nuts of the metal plate of the lower horizontal surface of the simulator structure and rigidly fixed using a wing nut, while the ends of the threaded studs are oval plates with holes in the center , and on one of them there are 5 holes circularly relative to the central hinge hole, and on the second one - one hole of the same diameter for the possible passage of a cylindrical rod through them, also on the second plate of the upper horizontal surface in the middle between the right and left edges there is a hole for the possibility fixing a rigid frame to the upper horizontal surface.

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