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WO1993021619A1 - Mannequin de simulation chirurgicale, procede pour s'exercer a effectuer des operations d'apprentissage, accomplissement de controles de resultats ou similaires - Google Patents

Mannequin de simulation chirurgicale, procede pour s'exercer a effectuer des operations d'apprentissage, accomplissement de controles de resultats ou similaires Download PDF

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Publication number
WO1993021619A1
WO1993021619A1 PCT/DE1993/000338 DE9300338W WO9321619A1 WO 1993021619 A1 WO1993021619 A1 WO 1993021619A1 DE 9300338 W DE9300338 W DE 9300338W WO 9321619 A1 WO9321619 A1 WO 9321619A1
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WO
WIPO (PCT)
Prior art keywords
simulation model
model according
abdominal
cavity
diaphragm
Prior art date
Application number
PCT/DE1993/000338
Other languages
German (de)
English (en)
Inventor
Martin Neumann
Original Assignee
Martin Neumann
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Martin Neumann filed Critical Martin Neumann
Publication of WO1993021619A1 publication Critical patent/WO1993021619A1/fr

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Classifications

    • G—PHYSICS
    • G09—EDUCATION; CRYPTOGRAPHY; DISPLAY; ADVERTISING; SEALS
    • G09B—EDUCATIONAL OR DEMONSTRATION APPLIANCES; APPLIANCES FOR TEACHING, OR COMMUNICATING WITH, THE BLIND, DEAF OR MUTE; MODELS; PLANETARIA; GLOBES; MAPS; DIAGRAMS
    • G09B23/00—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes
    • G09B23/28—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes for medicine
    • G—PHYSICS
    • G09—EDUCATION; CRYPTOGRAPHY; DISPLAY; ADVERTISING; SEALS
    • G09B—EDUCATIONAL OR DEMONSTRATION APPLIANCES; APPLIANCES FOR TEACHING, OR COMMUNICATING WITH, THE BLIND, DEAF OR MUTE; MODELS; PLANETARIA; GLOBES; MAPS; DIAGRAMS
    • G09B23/00—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes
    • G09B23/28—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes for medicine
    • G09B23/30—Anatomical models

Definitions

  • the invention relates to a surgical simulation model, including methods for practicing training operations, carrying out success checks or the like, according to the preambles of claims 1 and 25.
  • minimally invasive surgery general surgery is currently experiencing an incomparable “boom”, since now with The endoscopic surgical technique in body cavities (abdominal cavity, chest cavity and small pelvis) directly affects the most common operations (gallbladder removal, appendectomy, inguinal cord surgery and operations on the colon) of general surgery.
  • the small pelvis is extremely inaccessible, so that must be operated with long instruments.
  • the viewing angle and illumination are severely restricted.
  • This conventional surgical technique makes it difficult to prepare the rectum in the small pelvis, which is particularly narrow in men and narrows downwards in a funnel shape, with important structures such as the bladder, ureter, vessels, nerves, prostate, and seminal vesicles , Vas deferens in men - uterus and ovaries in women - lie close together.
  • the simulation model can also be used for training conventional rectal resection on the open stomach.
  • other operations or special surgical techniques, as well as transplant surgery can be trained in the same way.
  • the result is a higher quality standard and greater safety in the corresponding operation on humans or animals.
  • the simulation model provides the prerequisites for a clinical training, research, development and test center with regard to surgical operating techniques, especially the training-intensive laparoscopic, thoracoscopic and endoscopic operating techniques.
  • the control, training task and quality assurance of the laparoscopic "boom" can thus be moved closer to the clinical area of responsibility.
  • the object of the present invention is to propose a simulation model for surgical training purposes, in particular laparoscopic, thoracoscopic and endoscopic (corresponds to minimally invasive surgery) surgical technique ⁇ gene, by means of which in an artificial, anatomically correct Body cavity on the open stomach or minimally invasively trained and can be operated.
  • the invention also relates to a method for practicing training operations on a simulation model according to the invention.
  • the present invention advantageously enables the gradual adaptation to the reality demands desired for the training.
  • organs or parts of organs can be placed in the body cavity and training can be minimally invasive on them.
  • the next step is the topographical implantation of animal and / or artificial organs or parts of organs.
  • the step becomes reality through an animal "full transplant” (heart, lung, abdominal cavity organs) or through a transplant from individual animal organs or organ ⁇ achieved parts that are implanted in one or more body cavities (abdominal cavity, chest cavity, small pelvis) of the artificial model for the training operations.
  • an animal "full transplant” herein, lung, abdominal cavity organs
  • a transplant from individual animal organs or organ ⁇ achieved parts that are implanted in one or more body cavities (abdominal cavity, chest cavity, small pelvis) of the artificial model for the training operations.
  • body cavities anterior cavity, chest cavity, small pelvis
  • Heart-lung machine or only “heart machine” is supplied with the “donor blood”.
  • the model thus prepared is for learning the minimally invasive surgical technique bleeding and complications caused can also be realistically simulated.
  • Figure 1 is a semi-schematic view of the simulation model with an insight into the chest cavity, abdominal cavity and small pelvis; The abdominal wall and thoracic lid are removed
  • FIG. 2 shows a cross section through the abdominal cavity at the navel level with the abdominal wall relaxed
  • FIG. 2a shows a cross section through the abdominal cavity at navel height with the abdominal wall inflated
  • FIG. 2b shows an enlarged detail with the abdominal wall frame and the sealing area to the lower shell of the model
  • FIG. 3 shows a cross section through the diaphragm plate, which separates the abdominal cavity from the chest area.
  • 3a shows a cross section through the upper sealing area of the diaphragm plate
  • FIG. 4 shows a semi-schematic longitudinal section through a female model pool
  • FIG. 5 shows a semi-schematic longitudinal section through a male model pool
  • FIG. 6 shows a schematic view from above into a female model pool
  • FIG. 7 shows the anal canal with a screw-in coupling for the intestinal connection
  • FIG. 8 the anal region with a needle ring and pressure ring for fixing the intestinal exit
  • FIG. 9 shows schematic drawings of resective and reconstructive training operations on the colorectum.
  • Figure 10 is a semi-schematic view of the upper body shell with the recesses of the intercostal spaces and the recess of the abdominal wall area, and the lower body shell.
  • FIG. 1 shows the anatomically correct model of a human body.
  • Approach neck 1 arms 2 and legs 3 are formed.
  • Anatomical structures such as the clavicles 4, are indicated.
  • An anatomically correct thoracic cover which can be removed separately or together with the abdominal wall, has been removed.
  • the ribs 8 and the elevation of the spine 5a are visible on the inner wall of the chest cavity A.
  • the diaphragm plate 9, as a partition between the chest space A and the abdominal cavity B, can be inserted tightly from the ventral into a corresponding groove 20 and, with the ventral surface, complements the circumferential placement and sealing surface 10 for the tightly attachable thoracic lid 22 and the abdominal area which can also be placed tightly ceiling 14.
  • a bracket can also be inserted for this purpose without the two caves A and B being separated.
  • the elevation of the spine 5b in the abdominal cavity B is also designed as a continuation 5c in the small pelvis.
  • the hollow system of the kidneys 6 and the ureters 7, which lie largely retroperitoneally under one layer, is shown in dashed lines.
  • FIG. 2 shows a cross section through the empty abdominal cavity B approximately at the level of the navel.
  • the abdominal wall 14 with the frame 13 can be exchanged for an undamaged cover if it has become unusable due to trocar punctures or cuts.
  • the abdominal wall 14 expands to a desired degree, depending on the pressure (FIG. 2a).
  • Diaphragm or top edge of the temple can be pressed.
  • the sides of the groove 16 are lined on both sides with an elastic, sealing material 17.
  • Handles 18 on the frame 13 provide attachment points for lifting off or lifting off the abdominal wall 14.
  • the same principle can be used to remove the thoracic lid 22 from the chest cavity A and to place it tightly again.
  • the thoracic lid 22 is not constructed from comparable elastic layers and is therefore not expandable to the extent that gas is pumped into the closed chest cavity A. It therefore seems sufficient to rigidly design the thoracic lid. Structures such as the continuation of the clavicles 4, the continuation of the ribs 8, the sternum or the nipples are favorable for orientation.
  • FIG. 3 shows the top view of a part of the diaphragm plate 9, which is sealed by the seal 19 in the groove 20 on the Inner surface of the body wall is attached. Also shown is part of the upper wall edge 10 with the groove 16 for the thoracic lid 22 or the abdominal wall 14. Passage openings 21 for, for example, arteries, veins and esophagus are preferably provided in the central region of the diaphragm plate 9.
  • FIG. 3a shows a cross section through the upper part of the diaphragm plate 9.
  • FIGS. 4 and 5 show in FIG a sagittal section the anatomical conditions in the small pelvis C in a female model (Fig. 4) and a male model (Fig. 5).
  • the elevation of the spine 5c bends dorsally in the area of the promontory 5d and ends in an arc shape as the tailbone 5e.
  • the small pelvis narrows downwards in a funnel shape and becomes forward in the man (Fig.
  • the anterior border in the female model is formed by vagina 30, uterus 31 with adnexa 40, bladder 28 and anterior abdominal wall 29.
  • the abdominal cavity B with continuation into the small pelvis C and the organs in the small pelvis are at least partially covered by a translucent layer 32 comparable to the peritoneum.
  • the presacral cavity D is also covered by individual layers (comparable to the Waldeyer "see fascia 33 and the Denonvillier ⁇ see fascia 34). In the corresponding layer are the replicas of the two urethers (left urether 35 in FIG.
  • FIG. 6 shows a view from above into the small pelvis C of a female model and illustrates how it narrows in a funnel shape towards the anal canal 23.
  • part of an implanted rectum 38 which is held away by a hook 39 so that the uterus 31 and the adnexa 40 (part of the model) are visible. If the graft cannot be implanted with the anal canal and anus, the intestinal lumen of the graft can be seen through the
  • FIG. 7 shows the artificial anus 24 and the tubular anal canal 23, which is equipped with an internal thread 25 at its inner end.
  • the animal rectum 38 is pulled onto a short piece of pipe 41 and tightened with a tobacco pouch suture 43 pierced into the intestinal wall.
  • a bead-shaped edge 42 at the end of the pipe section 41 additionally prevents the casing 38 from sliding off the pipe section 41. With the casing 38 fixed in this way, the pipe section 41 equipped with a thread is screwed into the artificial anal canal 23.
  • FIG. 9 schematically shows several examples of resective and reconstructive operations on the intestine.
  • FIG. 10 shows the upper body shell 51, which can be placed in a sealing manner on the lower body shell 52.
  • the legs, arms and neck are cut 53a, 54a, or indicated 53, 54, 61.
  • the abdominal wall 55 is recessed, as well as the intercostal spaces 56 in the area which corresponds to the areas between the sternum 57, collarbone 58, shoulder blade 59, or the ventral edge of the latissimus dorsi 60 and diaphragm 61 (indicated by dashed lines).
  • the webs 62 between the intermediate rib spaces 56 remain as a rib replica.
  • the circumferential edge 63 around the recess in the area of the abdominal wall 55 is indicated.
  • cooling coils in the body cavity or in the preferred example in the body wall, which can be connected to a cooling machine, so that one in the body cavity Desired cooling or freezing temperature can be achieved.
  • the metabolic processes are slowed down. This reduces the need for "nutrients” and oxygen. If you only practice on organs that have already died, cooling serves as a preservation during insertion into the simulation model or storage in the same.
  • the natural outcome of the intestine implanted in the simulation model is also required in a test procedure with an anastomosis tester.
  • This consists of an air pump, a manometer and an adapter with a valve that is adapted to the outer shape of the anal region. It is expedient if this adapter piece can be separated from the pump system and / or supply system with the valve and can be pressed onto the anus in isolation with the valve and possibly the pressure gauge or Can be kept tight on the anus on the anal region via a holding device for the period of the measurement or measurement series.
  • the intestine In order to be able to build up pressure retrograde in the intestinal lumen with the anastomosis tester, the intestine must be temporarily disconnected proximal to the anastomosis at a suitable height, ie for the duration of the measurement period.
  • ERCP endoscopic iretrograde otiolangiography / ancreatography and / or intraoperative cholangiography). It is particularly expedient for the diaphragm to have holding devices on which the animal liver or organ replicas, possibly in combination with further holding devices, can be implanted and fixed approximately in an anatomically correct position. An opening on the diaphragm plate is conceivable for this purpose, through which portions of the animal diaphragm, which in places is firmly grown together with the associated liver, can be passed through the diaphragm plate from below.
  • the part of the diaphragm carried out from below can then be fixed to the surface of the diaphragm plate either in a clamping device, or with a bracket or a pressure plate on the top of the diaphragm plate.
  • the animal liver is against the diaphragm plate from below

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Abstract

Un mannequin de simulation chirurgicale servant à apprendre à pratiquer des interventions, notamment dans le domaine de la chirurgie laparoscopique, thoracoscopique et endoscopique doit être conçu de manière à ce qu'il soit possible de s'entraîner à pratiquer des interventions à ventre ouvert ou de manière aussi peu invasive que possible, dans la cavité d'un corps artificiel reproduisant fidèlement l'anatomie de l'homme. A cet effet, la forme et la surface de l'intérieur d'au moins une cavité du corps humain ou du corps d'un animal sont reproduites fidèlement sur le plan anatomique et topographique, conformément aux différents niveaux, du moins partiellement ou par zones. La face extérieure du mannequin reproduit la forme ou la structure anatomique au moins partiellement ou par zones. Des objets, des reproductions artificielles d'organes ou des implants organiques peuvent être introduits et/ou implantés dans la ou les cavité(s) du corps, les parties du tube digestif, de la circulation sanguine et du système bronchique, ainsi que des lignes pour le courant électrique, des liquides, des gaz, de la lumière ou similaires, ont un accès vers l'extérieur, et la ou les cavité(s) de corps est (sont) étanche(s) aux gaz ou aux liquides, après la mise en place ou l'implantation d'objets ou d'organes.
PCT/DE1993/000338 1992-04-18 1993-04-18 Mannequin de simulation chirurgicale, procede pour s'exercer a effectuer des operations d'apprentissage, accomplissement de controles de resultats ou similaires WO1993021619A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DEP4212908.7 1992-04-18
DE19924212908 DE4212908A1 (de) 1992-04-18 1992-04-18 Chirurgisches Simulationsmodell, einschließlich Verfahren zur Einübung von Trainingsoperationen, Durchführung von Erfolgskontrollen oder dergleichen

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WO1993021619A1 true WO1993021619A1 (fr) 1993-10-28

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DE (1) DE4212908A1 (fr)
WO (1) WO1993021619A1 (fr)

Cited By (17)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1994006109A1 (fr) * 1992-09-07 1994-03-17 Diethelm Wallwiener Appareil d'entrainement a la pratique medicale
EP0624861A3 (fr) * 1993-05-13 1995-08-16 Gerhard Szinicz Appareil et procédé d'entraînement chirurgical.
US5518407A (en) * 1993-11-02 1996-05-21 Greenfield; Cathy L. Anatomically correct artificial organ replicas for use as teaching aids
EP0870292A4 (fr) * 1995-06-09 1998-10-14
WO2001008126A1 (fr) * 1999-07-23 2001-02-01 Replicant Limited Appareil d'entrainement au fibroscope
DE102005056997A1 (de) * 2005-11-30 2007-06-06 Universität Leipzig Simulationssystem für chirurgische Eingriffe in der Human- und Veterinärmedizin
US7594815B2 (en) 2003-09-24 2009-09-29 Toly Christopher C Laparoscopic and endoscopic trainer including a digital camera
US7665995B2 (en) 2000-10-23 2010-02-23 Toly Christopher C Medical training simulator including contact-less sensors
US7845949B2 (en) 2005-02-10 2010-12-07 Wilkins Jason D Ultrasound training mannequin
US7850454B2 (en) 2000-10-23 2010-12-14 Toly Christopher C Simulated anatomical structures incorporating an embedded image layer
US7857626B2 (en) 2000-10-23 2010-12-28 Toly Christopher C Medical physiological simulator including a conductive elastomer layer
US8007281B2 (en) 2003-09-24 2011-08-30 Toly Christopher C Laparoscopic and endoscopic trainer including a digital camera with multiple camera angles
DE102010037443A1 (de) * 2010-09-10 2012-03-15 Erbe Elektromedizin Gmbh Übungsvorrichtung für die endoskopische Untersuchung und die Bearbeitung von Hohlorganen
WO2018022443A1 (fr) * 2016-07-25 2018-02-01 Rush University Medical Center Modèle inanimé pour réparation laparoscopique
US10037715B2 (en) 2013-10-16 2018-07-31 Simulab Corporation Detecting insertion of needle into simulated vessel using a conductive fluid
US10127838B2 (en) 2016-11-22 2018-11-13 PraxiCut, LLC Surgical simulation systems, methods, and compositions
IT202200015282A1 (it) * 2022-07-20 2024-01-20 Human Shape Tech Srl Simulatore per training in sala operatoria virtuale di interventi chirurgici con fistuloscopio e metodo di verifica dell’efficienza dell’operatore

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DE19716341C2 (de) * 1997-03-19 2000-09-21 Erbe Elektromedizin Trainingsmodell, insbesondere Torso
US5915729A (en) * 1997-11-26 1999-06-29 Vap Creative Limited Three-dimensional book
EP1168278A1 (fr) * 2000-06-21 2002-01-02 Pharmabotics Limited Simulateur
US8556635B2 (en) 2000-10-23 2013-10-15 Christopher C. Toly Physiological simulator for use as a brachial plexus nerve block trainer
US6780016B1 (en) * 2000-10-23 2004-08-24 Christopher C. Toly Human surgical trainer and methods for training
DE20313207U1 (de) * 2003-08-25 2004-02-12 Strohmaier, Walter Ludwig, Prof. Dr. Dr. Trainingsmodell zur perkutanen Behandlung eines Organs, insbesondere einer Niere
DE102006002707B3 (de) * 2006-01-19 2007-07-05 Erbe Elektromedizin Gmbh Trainingsmodell für endoskopische Untersuchung und Bearbeitung von Hohlorganen
WO2009067778A1 (fr) 2007-11-29 2009-06-04 Darrin Allan Hudson Modèle d'entraînement pour procédures médicales
DE102009047886A1 (de) 2008-10-02 2010-04-08 3Di Gmbh Anatomisches Trainingsmodell für chirurgische Behandlungsverfahren
DE202014011133U1 (de) 2014-03-18 2018-01-17 Pratap Banerjee Vorrichtung zur Simulation gynäkologischer Operationen
DE102014103706B4 (de) 2014-03-18 2018-05-30 Pratap Banerjee Vorrichtung zur Simulation gynäkologischer Operationen
DE102018118918B3 (de) 2018-08-03 2019-11-28 Phacon Gmbh System und Verfahren zur Validierung und zum Training invasiver Eingriffe

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Cited By (22)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1994006109A1 (fr) * 1992-09-07 1994-03-17 Diethelm Wallwiener Appareil d'entrainement a la pratique medicale
EP0624861A3 (fr) * 1993-05-13 1995-08-16 Gerhard Szinicz Appareil et procédé d'entraînement chirurgical.
US5518407A (en) * 1993-11-02 1996-05-21 Greenfield; Cathy L. Anatomically correct artificial organ replicas for use as teaching aids
EP0870292A4 (fr) * 1995-06-09 1998-10-14
US5951301A (en) * 1995-06-09 1999-09-14 Simulab Corporation Anatomical simulator for videoendoscopic surgical training
WO2001008126A1 (fr) * 1999-07-23 2001-02-01 Replicant Limited Appareil d'entrainement au fibroscope
US6827580B1 (en) 1999-07-23 2004-12-07 Replicant Limited Fiberscope training apparatus
US8162668B2 (en) 2000-10-23 2012-04-24 Simulab Corporation Medical training simulator including contact-less sensors
US8323029B2 (en) 2000-10-23 2012-12-04 Toly Christopher C Medical physiological simulator including a conductive elastomer layer
US7665995B2 (en) 2000-10-23 2010-02-23 Toly Christopher C Medical training simulator including contact-less sensors
US7850454B2 (en) 2000-10-23 2010-12-14 Toly Christopher C Simulated anatomical structures incorporating an embedded image layer
US7857626B2 (en) 2000-10-23 2010-12-28 Toly Christopher C Medical physiological simulator including a conductive elastomer layer
US8007281B2 (en) 2003-09-24 2011-08-30 Toly Christopher C Laparoscopic and endoscopic trainer including a digital camera with multiple camera angles
US7594815B2 (en) 2003-09-24 2009-09-29 Toly Christopher C Laparoscopic and endoscopic trainer including a digital camera
US7845949B2 (en) 2005-02-10 2010-12-07 Wilkins Jason D Ultrasound training mannequin
DE102005056997A1 (de) * 2005-11-30 2007-06-06 Universität Leipzig Simulationssystem für chirurgische Eingriffe in der Human- und Veterinärmedizin
DE102010037443A1 (de) * 2010-09-10 2012-03-15 Erbe Elektromedizin Gmbh Übungsvorrichtung für die endoskopische Untersuchung und die Bearbeitung von Hohlorganen
US10037715B2 (en) 2013-10-16 2018-07-31 Simulab Corporation Detecting insertion of needle into simulated vessel using a conductive fluid
WO2018022443A1 (fr) * 2016-07-25 2018-02-01 Rush University Medical Center Modèle inanimé pour réparation laparoscopique
US11348482B2 (en) 2016-07-25 2022-05-31 Rush University Medical Center Inanimate model for laparoscopic repair
US10127838B2 (en) 2016-11-22 2018-11-13 PraxiCut, LLC Surgical simulation systems, methods, and compositions
IT202200015282A1 (it) * 2022-07-20 2024-01-20 Human Shape Tech Srl Simulatore per training in sala operatoria virtuale di interventi chirurgici con fistuloscopio e metodo di verifica dell’efficienza dell’operatore

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DE4212908A1 (de) 1993-10-21
AU3947393A (en) 1993-11-18

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