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WO2012168287A1 - Organes artificiels pour formation par simulation chirurgicale et procédé de production d'organes artificiels - Google Patents

Organes artificiels pour formation par simulation chirurgicale et procédé de production d'organes artificiels Download PDF

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Publication number
WO2012168287A1
WO2012168287A1 PCT/EP2012/060674 EP2012060674W WO2012168287A1 WO 2012168287 A1 WO2012168287 A1 WO 2012168287A1 EP 2012060674 W EP2012060674 W EP 2012060674W WO 2012168287 A1 WO2012168287 A1 WO 2012168287A1
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WIPO (PCT)
Prior art keywords
bladder
human
mammalian
heart
origin
Prior art date
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Ceased
Application number
PCT/EP2012/060674
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English (en)
Inventor
Malcolm Wells MACKENZIE
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LAPSKILL MEDICAL AS
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LAPSKILL MEDICAL AS
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Filing date
Publication date
Application filed by LAPSKILL MEDICAL AS filed Critical LAPSKILL MEDICAL AS
Publication of WO2012168287A1 publication Critical patent/WO2012168287A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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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 present invention relates to surgical training devices and methods, in particular to the production of real tissue artificial organs for use in surgical training simulations. Background
  • simulation of minimally invasive surgical procedures has employed a variety of "tissue” models eg. human embalmed and fresh cadaveric, live anesthetized porcine and ovine preparations, total and partial porcine explants, as well as surgical model constructs utilizing wholly synthetic materials.
  • tissue models eg. human embalmed and fresh cadaveric, live anesthetized porcine and ovine preparations, total and partial porcine explants, as well as surgical model constructs utilizing wholly synthetic materials.
  • Non-physical models include computer based "virtual" constructs. Measures of "similarity" of the various simulation models to actual surgery and how the performance of tasks on these simulation models prepares the operator for the real surgical procedure in real settings include “face”, “construct” and “predictive” validity as well as the concept of "haptics”.
  • RTMs real tissue models
  • the present invention overcomes the disadvantages of the prior art by providing both a method of production and product for surgical training in the form of an endoscopic/laparoscopic surgical
  • tissue cassettes are constructed to closely mimic the great variety of normal and abnormal human anatomy. Such tissue cassettes may be vacuum packed and frozen indefinitely awaiting future use. On thawing, the tissue cassette is then placed within a combination laparoscopic/hysteroscopic "box” trainer, allowing the performance of standard surgical procedures utilizing standard instruments, including standard surgical energy systems, and providing for the full measure of validity and haptics.
  • Tissue model cassettes are constructed to
  • tissue model cassettes not limited to the representative models presented here, mirrors the full range of surgical pathologic conditions that are the object of gynaecologic, urologic and general surgical training and the focus of such surgical practice.
  • Figures 1-14 illustrate the steps for preparing a basic "Uterus and Cervix" prep model according to the invention.
  • Figures 15-28 illustrate the steps for preparing a basic Laparoscopy "Full Pelvic Model" according to the invention.
  • Figures 29-46 illustrate the steps for preparing a basic
  • Porcine upper vagina - an approximately 6cm length of vagina
  • transglutaminase powder cyanoacrylate, sandpaper, surgical
  • Model Assembly a) Bladder 10 having ureter 12, urethra 14 and light mesenteric tissue 16 is trimmed as shown in Figs 1 and 2. Invert bladder in the direction of the arrows shown in Fig 2 inside out and rinse with water. As shown in Fig 3, the anatomic inner surface 18, and the anatomic exterior surface 20 are now reversed.
  • sandpaper 22 "scouring" with sandpaper 22 to achieve a roughened surface 24.
  • the heart can be chosen for size or sculpted to size.
  • Alternatives include a bovine heart untrimmed or an ovine heart trimmed to left ventricle by excising the right ventricle 28 (smaller chamber) to the ventricular septum margin 30. Trim down great vessels 32 to their base.
  • the urethra may need a sagittal cut to allow for adequate opening .
  • Porcine/Ovine/bovine maximum length esophagus Two (2) Porcine/Ovine distal uterus-fallopian tubes with ovaries attached .
  • Gastric muscularis prep strip gastric mucosa from muscularis - tightly contracted, non-hemorrhagic, non-petechial muscularis best.
  • Esophagus prep strip out the endothelium from the muscularis. Cut the cylindrical esophagus in half lengthwise. One of the muscularis split halves will form the "round ligaments", the other the “ovarian suspensory ligaments” blending into the "infundibulopelvic
  • Ureter prep do not clear ureters of attached fat and peritoneum. Additional fat and lacy tissue can be packed around the ureter when it is placed as the "uterine artery”.
  • Ovary/Fallopian tube prep excise large calibre portion of uterus leaving the smaller ends of the uterus/fallopian tube/ovary complex. Try to maintain integrity of peritoneal attachments between tube and ovary.
  • suture points A and D are 1 ⁇ 2 cm.
  • Suture points B and E are posterolaterally oriented on the uterus and at the
  • the Porcine ovaries 76 are sutured at points marked A-D. Apply cyanoacrylate glue along segments A-C and B-D to fully attach adnexa in Fig 26. Separate segments of prepared chicken intestine may be attached to point B and to point A to constitute "fallopian tubes”.
  • Heart 26 prep As seen in Figs 28 and 29, trim heart great vessels 78 to septum 80 and excise ventricular septum to create single cavity heart. Excise valve leaflets and papillary muscles (set aside papillary muscles for use as endometrial polyps) . Excise cone shaped portion of the apex 34 of the heart at the lowest portion in order to expose small opening into the heart cavity. Roughen/scour with sandpaper both external and internal surface of heart.
  • Bladder with ureters attached 84 (Bladder prep #1) : Doubly and tightly suture ligate the urethra at the cystourethral base 86 and trim urethra excess. Clear fat and loose tissue 88 from ureters. Cut small opening 90 in the dome of the bladder at the midline.
  • Invert the bladder identify the ureteral orifices, excise the small ureteral valve leaflets covering the ureteral orifices and dilate the ureteral orifices. Reinvert the bladder. Lightly scour/roughen with sandpaper the external surface of the bladder. This bladder prep will be placed inside the heart with the bladder' s external surface adhered to the inner surface of the heart chamber. The dilated ureteral orifices will be the "tubal ostia" and the inner surface of this bladder will be the "endometrial” surface of the "uterus” .
  • Bladder without ureters (Bladder prep #2 - see Figure 7 and 8) :
  • Gastric muscularis prep As shown in Figs 32 and 33, strip gastric mucosa layer from muscularis 92 - contracted muscularis best for creating vaginal canal. Cut 6x12cm portion of muscularis that if possible includes ruggaeted folds 94. Roll and suture the long edges of the muscularis into a cylinder 96 of approximately 12 cm circumference and 6 cm length such that the ruggaeted folds are on the inner surface.
  • Vaginal muscle prep Referring to Fig 34, cut a 3-4 cm length 98 of the cylindrical vagina - the part that is thickest ie closest to the bicornuate uterus is the best portion. This will become the
  • Fig 38 place the heart (with ureters now extruding from the lateral openings) into the bladder prep #2 92 (bladder prep #2), orienting the apex 34 of the heart towards the urethra/bladder neck.
  • Figs 39 and 40 through each side of the dome of the external bladder (bladder prep #2) make a small opening 102 through which the ureters are then drawn with a clamp.
  • cyanoacrylate to attach this to the base of the ureter as it exits the bladder/heart. Distally ligate both the uterus and ureter in order to close off the ureteral opening. Trim the excess. Repeat this for the opposite side ureter. This then completes the "fallopian tubes" with ligation effected at their end in order to prevent efflux of hysteroscopy fluid during the simulation procedure.
  • thologic "Uterine" prep alternatives for laparoscopy and hysteroscopy a) Chicken or Turkey Gizzard whole/uncut -makes for "fibroids" implantable in uterus with surface attachment achieved by transglutaminase or cyanoacrylate. b) Larger "fibroids” are constructed of bromide blanched (1:10 dilution of bromide as >2 hr soak) semi-dessicated heart muscle masses cut to size and glued into concave defects scooped out of the heart muscle prep prior to the overlay of the bladder. Alternatively, multiple whole and part segments of
  • Porcine/ovine Colon segment - makes for "sigmoid/rectum” segment .
  • Porcine small intestine segment - makes for "small intestine” with cyanoacrylate for adhesive attachment.
  • Multicystic ovary chicken lung intact explants cannulated and under pressure filled with water. Alternatively, multiple porcine/ovine ovaries adhered together. ii) "Ovarian Solid Masses”: Immature Porcine/ovine/bovine testes adhered to "ovarian suspensory ligament".
  • Ovine/Porcine distal uterine horn segments (alternatively cleaned chicken small intestine) within which is drawn proximal ureter segments (with interfaced transglutaminase) affixed along surrounding cylindrical wrap of half-cut length of esophagus muscularis makes for tubal segment appropriate for reanastomosis and pathologic alteration eg ectopic.
  • "Ectopic Pregnancy" - 2 cc amount of lung and spleen puree placed within a doubly ligated dilated segment of proximal ureter then placed within a segment of ovine/porcine distal uterine horn. This prep then affixed along the half-cut
  • Laparoscopy - Laparoscopic Total Hysterectomy Prep - uterus (normal sized ⁇ 200 gm) without fibroids, vagina, fallopian tubes and ovaries, uterine arteries, uterosacral ligaments, round ligaments, peritoneum
  • Rectosigmoid repair ureterostomy/reanastomosis - Laparoscopic Total Hysterectomy Prep with bladder and ureters along normal anatomic course, sigmoid colon and exiting rectum.
  • Hysteroscopic Myomectomy Prep Uterus with multiple small 1-4 cm submucosal (type 1) or intramural (type 2) fibroids.
  • Hysteroscopic Tubal Occlusion Procedures - Patent bilateral tuba ostia .

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  • Engineering & Computer Science (AREA)
  • Physics & Mathematics (AREA)
  • General Physics & Mathematics (AREA)
  • Computational Mathematics (AREA)
  • Mathematical Analysis (AREA)
  • Medicinal Chemistry (AREA)
  • General Health & Medical Sciences (AREA)
  • Algebra (AREA)
  • Health & Medical Sciences (AREA)
  • Chemical & Material Sciences (AREA)
  • Medical Informatics (AREA)
  • Mathematical Optimization (AREA)
  • Mathematical Physics (AREA)
  • Pure & Applied Mathematics (AREA)
  • Business, Economics & Management (AREA)
  • Educational Administration (AREA)
  • Educational Technology (AREA)
  • Theoretical Computer Science (AREA)
  • Prostheses (AREA)

Abstract

L'invention concerne un modèle d'organes ex vivo composé d'organes et de tissus mammaliens non humains disposés pour reproduire un utérus et un col de l'utérus humains et éventuellement un vagin, un péritoine, des trombes de Fallope et des ovaires humains. Conformément à un mode de réalisation, un cœur de porc ou de bœuf est disposé à l'intérieur d'une vessie de porc ou de bœuf pour reproduire l'utérus, et un segment cylindrique de tissu est disposé sur l'ouverture de la vessie pour reproduire le col de l'utérus. Des tissus supplémentaires sont connectés à la structure pour représenter divers ligaments et diverses structures cervicales.
PCT/EP2012/060674 2011-06-06 2012-06-06 Organes artificiels pour formation par simulation chirurgicale et procédé de production d'organes artificiels Ceased WO2012168287A1 (fr)

Applications Claiming Priority (2)

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US201161493527P 2011-06-06 2011-06-06
US61/493,527 2011-06-06

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WO2012168287A1 true WO2012168287A1 (fr) 2012-12-13

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US9449532B2 (en) 2013-05-15 2016-09-20 Applied Medical Resources Corporation Hernia model
US9472121B2 (en) 2010-10-01 2016-10-18 Applied Medical Resources Corporation Portable laparoscopic trainer
US9548002B2 (en) 2013-07-24 2017-01-17 Applied Medical Resources Corporation First entry model
US9898937B2 (en) 2012-09-28 2018-02-20 Applied Medical Resources Corporation Surgical training model for laparoscopic procedures
US9922579B2 (en) 2013-06-18 2018-03-20 Applied Medical Resources Corporation Gallbladder model
US9940849B2 (en) 2013-03-01 2018-04-10 Applied Medical Resources Corporation Advanced surgical simulation constructions and methods
US9959786B2 (en) 2012-09-27 2018-05-01 Applied Medical Resources Corporation Surgical training model for laparoscopic procedures
US10081727B2 (en) 2015-05-14 2018-09-25 Applied Medical Resources Corporation Synthetic tissue structures for electrosurgical training and simulation
US10121391B2 (en) 2012-09-27 2018-11-06 Applied Medical Resources Corporation Surgical training model for laparoscopic procedures
US10198966B2 (en) 2013-07-24 2019-02-05 Applied Medical Resources Corporation Advanced first entry model for surgical simulation
US10198965B2 (en) 2012-08-03 2019-02-05 Applied Medical Resources Corporation Simulated stapling and energy based ligation for surgical training
US10223936B2 (en) 2015-06-09 2019-03-05 Applied Medical Resources Corporation Hysterectomy model
US10332425B2 (en) 2015-07-16 2019-06-25 Applied Medical Resources Corporation Simulated dissectible tissue
US10354556B2 (en) 2015-02-19 2019-07-16 Applied Medical Resources Corporation Simulated tissue structures and methods
US10395559B2 (en) 2012-09-28 2019-08-27 Applied Medical Resources Corporation Surgical training model for transluminal laparoscopic procedures
US10490105B2 (en) 2015-07-22 2019-11-26 Applied Medical Resources Corporation Appendectomy model
US10535281B2 (en) 2012-09-26 2020-01-14 Applied Medical Resources Corporation Surgical training model for laparoscopic procedures
CN110767016A (zh) * 2019-11-02 2020-02-07 上海市第一妇婴保健院 一种模拟不同临床状况的宫颈环扎术模拟教学模型及教学方法
RU2718764C1 (ru) * 2019-06-07 2020-04-14 Федеральное государственное бюджетное военное образовательное учреждение высшего образования "Военно-медицинская академия имени С.М. Кирова" Министерства обороны Российской Федерации (ВМедА) Устройство для обучения врачей-хирургов техникам эндовидеохирургических вмешательств
US10679520B2 (en) 2012-09-27 2020-06-09 Applied Medical Resources Corporation Surgical training model for laparoscopic procedures
US10706743B2 (en) 2015-11-20 2020-07-07 Applied Medical Resources Corporation Simulated dissectible tissue
US10720084B2 (en) 2015-10-02 2020-07-21 Applied Medical Resources Corporation Hysterectomy model
US10796606B2 (en) 2014-03-26 2020-10-06 Applied Medical Resources Corporation Simulated dissectible tissue
US10818201B2 (en) 2014-11-13 2020-10-27 Applied Medical Resources Corporation Simulated tissue models and methods
CN111899621A (zh) * 2020-08-22 2020-11-06 上海萱闱医疗科技有限公司 一种含有压合器的动物心脏模拟子宫及其制备方法
US10847057B2 (en) 2017-02-23 2020-11-24 Applied Medical Resources Corporation Synthetic tissue structures for electrosurgical training and simulation
CN112102696A (zh) * 2020-09-30 2020-12-18 北京博医时代教育科技有限公司 卵巢囊肿剥除术训练模型及其制作方法和使用方法
US11030922B2 (en) 2017-02-14 2021-06-08 Applied Medical Resources Corporation Laparoscopic training system
WO2021146786A1 (fr) * 2020-01-22 2021-07-29 Fundação Oswaldo Cruz Biomodèle de rat pour l'entraînement aux techniques médicales de craniotomie
US11120708B2 (en) 2016-06-27 2021-09-14 Applied Medical Resources Corporation Simulated abdominal wall
US11158212B2 (en) 2011-10-21 2021-10-26 Applied Medical Resources Corporation Simulated tissue structure for surgical training
CN114419971A (zh) * 2022-03-11 2022-04-29 北京博医时代教育科技有限公司 子宫模型、宫腔镜手术训练模型及其制作方法
CN114550564A (zh) * 2022-03-11 2022-05-27 北京博医时代教育科技有限公司 宫腔镜手术训练模型、制作方法及应用
CN114708778A (zh) * 2022-04-01 2022-07-05 北京博医时代教育科技有限公司 泌尿系统手术训练模型、制作方法及应用
US11403968B2 (en) 2011-12-20 2022-08-02 Applied Medical Resources Corporation Advanced surgical simulation
CN114927044A (zh) * 2022-05-17 2022-08-19 付佩尧 一种离体动物胃保存液及使用其制备的胃部病变模拟装置
US20230290280A1 (en) * 2022-03-09 2023-09-14 Intuitive Surgical Operations, Inc. Surgical training model including a simulated human uterus and associated methods
US20240021105A1 (en) * 2022-07-13 2024-01-18 Intuitive Surgical Operations, Inc. Surgical training model including a simulated human prostate and associated methods

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