RU2803868C1 - Simulator for working with the operational stages of hernioplasty of inguinal hernia - Google Patents

Abstract

FIELD: teaching aids in medicine.

SUBSTANCE: simulator for working with the operational stages of inguinal hernia repair is used for the acquiring and development of manual skills in inguinal hernia surgery by students and residents undergoing training. The simulator includes a platform measuring 40*40*1.5 cm with the lines imitating the boundaries of the human body, and materials imitating the anatomy of the inguinal region and inguinal canal. The simulator contains simulators of femoral vessels of the right and left lower extremities, spermatic cord, hernial sac simulator, inguinal ligaments simulators, and subcutaneous fat simulator.

EFFECT: ensuring the development of the stages and techniques for performing methods of inguinal hernia repair.

1 cl, 12 dwg

Description

The simulator for practicing the surgical stages of inguinal hernia hernioplasty relates to the educational process in medicine, namely, it serves to acquire and practice manual skills in the surgery of inguinal hernias by students and residents undergoing training at the surgical departments of higher educational institutions of medical education.

A partial mannequin of the human body is known from the prior art (Patent US 2012148994 A1, 06/14/2012), represented by an anatomical model of the ilioinguinal region, including a platform with vascular simulators, a spermatic cord simulator, simulators of skin-fatty tissue, a hernial sac, which are made of silicone resin.

A partial mannequin of the human body has a number of disadvantages, such as complex manufacturing technology for silicone simulators, the high cost of consumables when practicing operational skills, and one-sided execution of the model, which does not allow practicing bilateral hernioplasty.

When developing this invention, the goal was to create a simulator for practicing the operational stages of inguinal hernia repair techniques, which would be easy to manufacture, allow various types of hernioplasty to be performed repeatedly, have accessible consumables and have high economic profitability.

The result of the implementation of this goal is a simulator for practicing the operational stages of inguinal hernia hernioplasty, which includes a platform measuring 40*40*1.5 cm, on which lines are drawn that imitate the boundaries of the human body, and materials are placed that imitate the anatomy of the inguinal region and inguinal canal. Four silicone suction cups with a diameter of 3 cm are installed in the base at the corners of the platform at a distance of 1 cm from the edges (Fig. 1).

Three M5*30 mm bolts are installed in the platform for fixing materials that model the anatomy of the anterior abdominal wall, left and right iliac regions. The first bolt is 5.5 cm from the side edge and 14.5 cm from the top edge. The second bolt is installed symmetrically to the first on the opposite side of the platform. The first and second bolts model the right and left anterior superior iliac spine. The third bolt is located 20 cm from the side edge and 26 cm from the top. This bolt will fix the peritoneum, preperitoneal tissue, spermatic cords, inguinal ligaments, transversalis fascia, transverse and internal oblique muscles of the abdomen, aponeurosis of the external oblique muscle. The third bolt models the pubic tubercle.

Two polyurethane rollers with a length of 12 cm, a width of 2.5 cm, and a roller height of 0.7 cm are installed on the platform, simulating the femoral vessels of the right and left lower extremities (Fig. 2).

8 cm from the right side edge and 15.5 cm from the top edge, a nut and bolt are installed in the platform that fix the upper part of a silicone tube with a diameter of 1 cm, simulating the spermatic cord, and the hernial sac, represented by spunbond non-woven material. Next, the model of the spermatic cord and hernial sac passes into a 2 cm hole through the preperitoneal tissue and transverse fascia, simulating the course of an oblique inguinal hernia through the internal inguinal ring into the inguinal canal. Preperitoneal tissue is represented by yellow foam rubber 35*22 cm, 0.5 cm thick. The transverse fascia is modeled with spunbond material 35*22 cm, 0.1 cm thick (Fig. 3). The internal oblique and transverse abdominal muscles are imitated by a pentagonal-shaped polystyrene material with a base width of 30 cm, side lengths of 5 cm and 20 cm, and a thickness of 0.5 cm. Mounted on three vertices with bolts (Fig. 4).

The inguinal ligaments are represented by a textile sling 20 cm long, 2.5 cm wide, 1.5 mm thick. They are secured between the bolts modeling the anterior superior iliac spines and the third bolt modeling the pubic tubercle.

The distal part of the spermatic cord, through a 2 cm hole in the aponeurosis of the external oblique muscle, simulating the external inguinal ring, exits the simulated inguinal canal and is attached to the third bolt. The aponeurosis of the external oblique muscle is represented by a rectangular piece of viscose material 35*22, 0.3 mm thick. After placing the viscose material on the bolts, install a plastic washer with a diameter of 2 cm and fix it with a cap nut (Fig. 5)

To simulate subcutaneous fat, use a rectangular piece of foam rubber 35*22 cm, 1 cm thick. The skin is modeled with a rectangular piece of dermantine 35*22 cm, 2 mm thick, flesh-colored. The pieces of foam rubber and dermantine are fixed with three DIN 912 M5*20 mm bolts on the left and right into M5 nuts installed in the platform. The first nut is installed 4 cm from the side edge and 10 cm from the top edge, the second 18 cm from the top edge and 4 cm from the side, the third nut 24 cm from the top edge and 4 cm from the side.

On this simulator, cadets can perform tension hernioplasty techniques using local tissues (Bassini plastic, Postemsky plastic) and non-tension methods using a mesh implant (for example, Lichtenstein plastic). The student needs to determine the access line, make an incision in the skin and subcutaneous fat (Fig. 6), visualize the external inguinal ring and dissect the aponeurosis of the external oblique abdominal muscle in the projection of the inguinal canal. Isolate the hernia and the spermatic cord by holding it on a holder (Fig. 7). Dissect the hernial sac, stitch it at the neck, cut off and immerse the stump into the abdominal cavity (Fig. 8). Perform the selected plastic surgery (Fig. 9, Fig. 12) and sutured the wound layer by layer (Fig. 10, Fig. 11).

The simulator for practicing the surgical stages of inguinal hernia hernioplasty has the following advantages:

• allows you to practice surgical skills, such as determining the boundaries of access based on anatomical landmarks, the stages of performing surgical access for inguinal hernias, the skill of tying a surgical knot while simulating tissue tension; skill in applying various modifications of surgical sutures; work out the stages of suturing the surgical wound;

• allows you to work out the stages and technique of performing tension and non-tension methods of inguinal hernia repair;

• the ability to perform repair of hernias of right-sided and left-sided localization;

• availability of consumables;

• easy to manufacture.

Brief description of drawings

Fig. 1 - A simulator for practicing the operational stages of inguinal hernia hernioplasty;

Fig. 2 - Simulator platform for practicing the operational stages of inguinal hernia hernioplasty;

Fig. 3 - Simulator platform for practicing the operational stages of inguinal hernia hernioplasty with installed materials simulating the peritoneum, preperitoneal tissue, transverse fascia, hernial protrusions, spermatic cords, inguinal ligaments;

Fig. 4 - Simulator platform for practicing the operational stages of inguinal hernia hernioplasty with installed materials simulating the peritoneum, preperitoneal tissue, transverse fascia, hernial protrusions, spermatic cords, inguinal ligaments, transverse and internal oblique abdominal muscles;

Fig. 5 - Simulator platform for practicing the operational stages of inguinal hernia hernioplasty with installed materials simulating the aponeurosis of the external oblique muscle and fixing washers;

Fig. 6 - Access for inguinal hernia;

Fig. 7 - Isolated hernia and spermatic cord taken on a holder;

Fig. 8 - The hernial sac is stitched and cut off;

Fig. 9 - Plastic surgery with local tissues according to Bassini;

Fig. 10 - Suture of the aponeurosis of the external oblique muscle;

Fig. 11 - Interrupted skin suture;

Fig. 12 - Tension-free Lichtenstein plastic.

Claims (7)

A simulator for practicing the operational stages of inguinal hernia hernioplasty, including a platform, simulators of the femoral vessels, a simulator of the spermatic cord, skin and subcutaneous fat, and a simulator of a hernial sac, characterized in that the platform has dimensions of 40 * 40 * 1.5 cm, lines imitating the boundaries of the human body are applied to it and three M5 * 30 mm bolts are installed to fix the simulators of the abdominal wall, the left and right iliac regions, and the imitation of the right and left anterior superior iliac spine and pubic tubercle, simulators of the femoral vessels of the right and left lower extremities are made in the form of polyurethane rollers 12 cm long, 2.5 cm wide and 0.7 cm high and installed on a platform, 8 cm from the right side edge and 15.5 cm from the top edge, a nut and bolt are installed on the platform to fix the upper part of a silicone tube with a diameter of 1 cm, simulating the spermatic cord; the hernial sac simulator is made of spunbond and, together with the spermatic cord simulator, passes into a 2 cm hole through simulators of preperitoneal tissue and transverse fascia, inguinal ligament simulators are made of a textile sling 20 cm long, 2.5 cm wide, 1.5 mm thick and secured between bolts simulating the anterior superior iliac spines and the pubic tubercle, the distal part of the spermatic cord simulator passes through a 2 cm hole in the simulator of the aponeurosis of the external oblique muscle of the abdomen, which is made in the form of a rectangular piece of viscose material 35*22, 0.3 mm thick, fixed with a cap nut, and secured to the third bolt, The simulator of subcutaneous fatty tissue is made in the form of a rectangular piece of foam rubber 35*22 cm, 1 cm thick, and the skin simulator is made in the form of a rectangular piece of leatherette 35*22 cm, 2 mm thick, flesh-colored, while the simulator of subcutaneous fatty tissue and the skin simulator fixed with six bolts on the left and right into nuts installed on the platform.