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WO2017126313A1 - Apprentissage de la chirurgie et système de simulation faisant appel à un organe de modélisation à texture-bio - Google Patents

Apprentissage de la chirurgie et système de simulation faisant appel à un organe de modélisation à texture-bio Download PDF

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Publication number
WO2017126313A1
WO2017126313A1 PCT/JP2016/089189 JP2016089189W WO2017126313A1 WO 2017126313 A1 WO2017126313 A1 WO 2017126313A1 JP 2016089189 W JP2016089189 W JP 2016089189W WO 2017126313 A1 WO2017126313 A1 WO 2017126313A1
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Prior art keywords
organ
surgical
training
texture
scenario
Prior art date
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Ceased
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PCT/JP2016/089189
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English (en)
Japanese (ja)
Inventor
欣一 渡辺
宮本　貴文
武志 安楽
陽 磯部
和洋 遠藤
尚宏 佐田
杉本　真樹
佑一 西原
利昭 森川
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FASOTEC CO Ltd
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FASOTEC CO Ltd
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Priority to JP2017562493A priority Critical patent/JPWO2017126313A1/ja
Publication of WO2017126313A1 publication Critical patent/WO2017126313A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • 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
    • G09B19/00—Teaching not covered by other main groups of this subclass
    • 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 a system for performing surgical training and surgical simulation using a biological texture organ reproduced or deformed according to a surgical scenario.
  • the percutaneous technique simulator disclosed in Patent Document 1 includes a convex body having a curved surface part, a placement part for placing a trachea (human body organ substitute), and skin (human body) so as to cover a part of the trachea.
  • a skin fixing part that fixes the skin substitute) to the main body, and a placement part displacement mechanism that advances and retracts the placement part in the direction perpendicular to the curved surface part.
  • a configuration in which the trachea is covered with the skin is realized in the same manner as the configuration of the human body in which the skin is covered with the organ.
  • the curved surface portion is a substitute for the human body surface.
  • an object of the present invention is to provide a surgical training system that realizes a high training effect and a low cost by using a biological texture organ reproduced or deformed according to a surgical scenario.
  • the present inventors as a result of earnest examination, comprehensively grasp the hardware part and software part of surgical training, paying attention to the accumulated know-how possessed by the software part, in particular, veteran specialists,
  • the above problem is solved by creating a surgical scenario from the know-how, defining the specifications of peripheral devices that produce living body organs, simulators and training environments, and developing hardware.
  • the surgical training system of the present invention is a system for performing surgical training or surgical simulation using a biological texture organ that reproduces or deforms the texture and appearance of an actual organ, and has the following configurations 1) to 3). Toward. 1) Biological texture organ reproduced or deformed according to the surgical scenario to be trained or simulated 2) Discriminating means for discriminating pass / fail of the check point of the surgical scenario 3) Evaluation means for evaluating the surgical skill based on the discrimination result
  • the simulation is performed to increase the accuracy of the operation on the assumption of a specific operation, whereas the training is not based on the assumption of a specific operation, Distinguish it as being done only for technical improvement.
  • the surgical training system of the present invention is suitably used for both surgical training and surgical simulation.
  • a surgical scenario is determined by setting a difficulty level according to the skill of an operator to be trained or simulated based on a medical surgical procedure such as laparoscopic cholecystectomy, for example. is there.
  • the difficulty level setting is determined by adjusting the age, BMI (Body Mass Index), surgery history, or the like of the patient to be operated. For example, when assuming a patient who has performed a similar operation in the past, many adhesions are provided and the degree of difficulty is set high.
  • the surgeon is not limited to the surgeon, but also includes related personnel such as assistants, scopists, and nurses who assist the surgeon. Therefore, the operation scenario can be set not only for the surgeon but also for the assistant, etc., so that the entire team can be trained.
  • the biological textured organ in the present invention is made of a material having flexibility and elasticity that approximates the material of the organ model to the actual organ, and approximates the entire shape and weight of the model to the actual organ.
  • This is an organ model that reproduces the texture and appearance of an actual organ.
  • the body texture organ has an organ model in which the texture and appearance of the actual organ are reproduced for the part required for the surgical scenario, and the texture and appearance of the actual organ are deformed for the part not required for the surgical scenario. is there.
  • the surgical training system of the present invention further includes a living body model including an abdominal cavity model, a chest cavity model, and other living body approximated site models that store living body organs and reproduce an anatomical body cavity structure.
  • the biological model includes an abdominal model and a thoracic cavity model that can store biological textured organs and reproduce an anatomical body cavity structure.
  • a nasal cavity model, a skull model including the periorbital region, a thyroid model, a joint There are models. It is also possible to store a biological texture organ using a commercially available dry box and use it as a biological model.
  • checkpoints are provided for each surgical scenario, and the surgical skills are evaluated by judging the quality of each checkpoint.
  • the check point may be good or bad in two stages, or may be a degree of good or bad (for example, 10 levels). The degree of pass / fail may differ depending on the checkpoint.
  • the checkpoint is provided for each phase provided for each surgical technique, for example.
  • the biological textured organ in the surgical training system of the present invention changes the three-dimensional structure inside the organ, the amount of fat surrounding the organ, the membrane including the membrane, the blood vessel, or the structure or physical properties of the nerve according to the surgical scenario, Or it is preferable that the form is deformed.
  • the parts necessary for training in the body texture organs are particularly elaborately created, and conversely, parts that are not necessary for training are simplified to create the structure and physical properties of the body texture organs according to the surgical scenario.
  • efficient and effective training can be realized.
  • the physical properties are used in the meaning including not only mechanical properties but also thermal properties and electrical properties.
  • the abdominal wall of the abdominal cavity model in the surgical training system of the present invention has flexibility corresponding to the average abdominal wall expansion change rate, and can reproduce the forceps angle associated with the abdominal wall deformation and change at the time of surgery. Since medical devices such as forceps are operated using the port of the abdominal wall as a fulcrum, the fulcrum shifts when the abdominal wall changes. Also, the repulsive force varies depending on the degree of softness of the abdominal wall in the pneumoperitoneum state. Therefore, in training, the environment of the abdominal wall is reproduced to create an environment close to actual surgery.
  • the average rate of change in abdominal wall expansion is set for seven items from around the umbilicus and from the umbilicus to the groovy for six men and four women aged 54-81 years.
  • the average value is calculated by measuring the difference in state. Specifically, for example, the average value of the length from the umbilicus to the groove is 16.25 cm in the normal state and 18.42 cm in the pneumoperitoneum, and the average rate of change of the average abdominal wall expansion is calculated based on such values. Yes.
  • the abdominal cavity model or the chest cavity model in the surgical training system of the present invention incorporates a material for changing the surgical field space for the endoscopic technique or the abdominal / thoracotomy technique.
  • a material for changing the operative field space it is possible to create a situation where the luminal region of the abdominal cavity model or the thoracic cavity model is narrowed and the operative field space similar to the actual operation is narrowed.
  • the material may be either a wet material or not a wet material.
  • the material for changing the operative field space is, for example, a simulation of fat, membranes, surrounding organs, etc., and these materials are packed into the cavity of the abdominal cavity model or chest cavity model to narrow the lumen area. .
  • the living body texture organ in the surgical training system of the present invention may be added with a deformation that simulates a lesion state including an organ tumor or adhesion.
  • a deformation that simulates a lesion state including an organ tumor or adhesion.
  • a tumor or adhesion exists in an organ. Therefore, providing a means for simulating such a lesion state enables more effective training.
  • it is used as an element for setting the difficulty level of training, such as providing a lot of adhesions and setting the difficulty level high. It is also possible to do.
  • the solid organ image that does not follow the deformation of the organ may be projected as a peripheral organ on the surface of the biological textured organ, the inner wall of the abdominal cavity model, or the inner wall of the chest cavity model in the surgical training system of the present invention.
  • the surgical training system of the present invention may synthesize and display an endoscopic scope image inserted into a living body model and an actual endoscopic surgical scope image performed in the past on a monitor screen. By combining the images, it is possible to realize more realistic training.
  • text display or voice output may be added to the above-described composite screen, and surgical procedure instructions, procedure advice, procedure notes, or procedure descriptions may be added. More effective training can be realized by adding text display or audio output.
  • the evaluation of the above-described surgical skills is performed by storing the quality level of check points in the operation of the experienced operator as an index in advance and comparing it with the index.
  • the surgical training system of the present invention is provided with means for detecting the degree of deformation of the biological textured organ based on a signal from a sensor built in or externally attached to the biological textured organ.
  • the trajectory including the grasping force of the medical instrument, the operation speed of the medical instrument, the movement amount, or the movement direction in this surgery may be stored in advance as an index and evaluated by comparison with the index.
  • quantitative evaluation can be performed instead of qualitative evaluation.
  • the sensor is a camera sensor, a pressure sensor, a temperature sensor, a speed sensor, or the like, and the signal transmission type may be either wired or wireless.
  • the surgical training system of the present invention is provided with scenario data in which each surgical process to be performed by the operator is registered in advance as a pattern, and means for generating a situation change that deviates from the pattern at the start or during the progress of the surgical process. It is preferable. Since an unexpected situation may occur in actual surgery, the surgical training system of the present invention can also generate a situation that deviates from the original pattern and improve the ability to cope with an unexpected situation. Training is also possible.
  • the situation changes are the switching of the target biological texture organ, the switching of the part to be excised in the biological texture organ, the switching of the presence or absence of the adhesion state of the biological texture organ, the change of the surgical field space, the pulsation It is preferable to change the state, the presence or absence of bleeding, or the switching of the endoscopic visual field inhibition state.
  • the situation changes by performing a procedure using an appropriate medical instrument on a textured organ according to a scenario.
  • the medical instruments used are generally expensive and there are many disposable instruments. Therefore, it is possible to cause a situation change in a pseudo manner by switching between an organ before and after the situation change without using an expensive and disposable medical instrument. This makes it possible to reduce the cost for training.
  • the surgical training system of the present invention includes scenario data and difficulty level data in which the difficulty level of surgery is set according to the situation change, rule data in which contents to be achieved, contents to be avoided and restrictions are registered, and veteran Equipped with a database consisting at least of the reference data in which the decision-making process and the surgical process of the surgeon and the information on the medical device and target organ to be used are registered, the skill of the surgeon is evaluated using the database. It is preferable. By evaluating the skills of the surgeon based on the database, it is possible to perform more appropriate evaluations that match various training scenarios.
  • the arrangement and combination of biological texture organs along the scenario data are registered in advance.
  • various patterns of training scenarios can be set.
  • the surgical training method of the present invention is a surgical training method using a surgical training system, in which a surgical training system is installed beside an experienced operator, and the trainer is synchronized with the progress of the surgical process of the experienced operator. Therefore, it is possible to learn while witnessing the surgical procedure and decision-making process of a veteran operator, and to perform training with a sense of reality. Unlike the case where only surgical training is performed, training with a sense of urgency and realism is possible by performing training in a nearby place during actual surgery.
  • the surgical training and simulation system using the living body texture organ of the present invention the effect that it can be used for thoracoscopic surgery, laparoscopic surgery, endoscopic procedures, or training and simulation of laparotomy / thoracotomy procedures There is.
  • Example 2 It is explanatory drawing of the training difficulty level design table of a living body texture organ, (1) is a patient individual information table, (2) has shown the additional setting information table. It is a relationship diagram of a training scenario and apparatus setting, (1) shows the case where training is implemented from an already defined scenario, and (2) shows the case where a new technique is developed.
  • Overall configuration diagram of surgical training and surgical simulation system The perspective view of the living body texture organ of Example 2 It is the attachment figure to the abdominal cavity simulator of the biological texture organ of Example 2, (1) is a perspective view, (2) has shown the front view. Flow of laparoscopic inguinal hernia operation of Example 2
  • FIG. 12 shows an overall configuration diagram of the surgical training and surgical simulation system. As shown in FIG. 12, each part constituting the surgical training and surgical simulation system is classified by functional unit, and is also modularized in design. As a result, when training or simulation is performed, any combination can be selected according to a predefined scenario, and setting according to the skill level can be performed. It is possible to perform objective and quantitative or qualitative skill evaluation by comparing the training results with the accumulated training result database.
  • a case is a simulator
  • an organ model is a biological texture organ.
  • FIG. 1 illustrates a system configuration diagram of a training system according to the first embodiment.
  • the training system 1 includes an abdominal cavity simulator 2, a biological texture organ 3, a sensor 4, a computer 5, a monitor 6, and a server 7, and the computer 5 includes the sensor 4, the monitor 6, the server 7, and a cable 9.
  • a living body texture organ 3 is arranged in the abdominal cavity simulator 2, and a sensor 4 is provided inside the living body texture organ 3.
  • the laparoscope 8 is connected to the monitor 6 via the cable 9, and the monitor 6 can display an image captured by a camera unit (not shown) provided at the tip of the laparoscope 8. is there.
  • the difficulty level data in which the difficulty level of the operation is set according to the scenario data and the situation change, the rule data in which the content to be achieved, the content to be avoided and the limitation content are registered, and the veteran surgeon's
  • a database includes reference data in which a decision making process and an operation process, and information on a medical device to be used and an organ to be used are registered.
  • the content to be achieved is the content for completing the process for each surgical process
  • the limited content is for each surgical process such as an instrument that can be used for each surgical process and a wide field of view. This refers to the restrictions you receive.
  • the contents to be avoided are contents that must not be performed for each surgical process.
  • FIG. 8 is an explanatory diagram regarding content determination of a training scenario and device setting based on the determination content.
  • (1) shows content determination of the training scenario
  • (2) shows device setting based on the determination content.
  • the surgical process to be trained is disassembled for each procedure, and as shown in FIG. 8 (1), contents to be achieved, contents to be avoided, and restrictions are determined.
  • the setting of the simulator is changed and the living body texture organ is designed.
  • the server 7 the arrangement and combination of biological texture organs along the scenario data are registered in advance.
  • FIG. 2 shows a flow of the surgical training system using the living body texture organ of the first embodiment.
  • an outline of the operation to be trained is determined (S101).
  • a training scenario is determined for the determined operation summary (S102).
  • a simulator suitable for the training scenario is selected (S103).
  • a simulator is set in accordance with the determined difficulty level of the training scenario (S104).
  • a living body texture organ is produced in accordance with the determined difficulty level of the training scenario (S105).
  • Training is executed (S106).
  • the degree of deformation of the living body texture organ is detected by the sensor (S107).
  • the surgical skill is quantitatively evaluated from the detected degree of deformation of the living body texture organ (S108).
  • FIG. 4 shows a perspective view of the abdominal cavity simulator of Example 1. As shown in FIG. 4, the abdominal cavity simulator 2 is provided with a large number of ports 10.
  • the surgeon specifically determines the surgery to be trained for each procedure according to his / her skills. For example, in the case of the gallbladder, a specific surgical process such as “until sufficient detachment (a critical view) of the Karo triangle is made” is clarified.
  • the “Callow triangle” means a triangle composed of the lower surface of the liver, the total hepatic duct, and the gallbladder duct. If it is “until sufficient peeling of the hollow triangle is made”, it can be said that the difficulty level is relatively low. In this embodiment, the degree of difficulty is higher than this, and a process of “peeling the membrane and the hollow triangle from the gallbladder, confirming the critical view, and then separating the bile duct and blood vessels and removing the gallbladder” is set.
  • FIG. 5 shows a perspective view of the living body texture organ of the first embodiment. As shown in FIG. 5, the living body texture organ 3 includes a gallbladder portion 31 and a liver portion 32. Although not shown, the gallbladder portion 31 is covered with a membrane. In addition, here, a scenario for handling an abnormal value is similarly created.
  • the difficulty level settings for beginner, intermediate and advanced can be set not only by changing the simulator settings, but also by changing the specifications of the biological texture organs to increase the frequency of occurrence of abnormal values for each surgical process.
  • no abnormal value is basically generated in the beginner level, but in the intermediate or advanced level, an abnormal value can be generated during the operation.
  • an abnormal value is more likely to occur than in the intermediate level, and a plurality of abnormal values are likely to occur.
  • FIG. 7 is a diagram illustrating a state relating to occurrence of an abnormal value according to the first embodiment.
  • the training scenario is drawn as if it were a picture-story show, each step of the surgical process, and in response to the decision-making results performed at each step, a scenario divided into multiple cases is drawn in advance, By combining them, it is possible to reproduce the entire operation process including the passage of time. That is, as shown in FIG. 7, there is a case where the normal value is always maintained from the normal value A 1 to the normal value A 2 , the normal value A 4 , and the normal value A 5 , but the normal value A 1 to the abnormal value B 1 exists. Furthermore, there is a case where the abnormal value level increases to the abnormal value B 2 and the abnormal value A 5 .
  • a target cost for creating living body organs is set.
  • a target cost for creating living body organs there is a case where only a part of a certain organ is used, and in that case, it is possible to reduce the cost by deforming a part that is not used in the living body texture organ.
  • FIG. 9 is an explanatory diagram of a training difficulty level design table other than the body texture organ, where (1) shows a surgical posture design table and (2) shows an additional setting information table.
  • the surgical position design table is composed of a port setting, an abdominal wall, and an assistant / scopist arrangement.
  • the insertion number and position are design factors. It becomes a design factor.
  • the scopist is a person who plays a role of projecting intra-abdominal images with a laparoscopic camera.
  • the posture on which the patient is placed on the operating table at the time of the operation is determined according to the operation method, the position of the lesion, and the like.
  • the supine, lateral, and prone positions are examples.
  • the port settings and the shape of the abdominal wall are optimized and set to increase the safety and efficiency of the operation.
  • the number of ports (holes) into which the forceps of the endoscope are inserted is adjusted depending on whether or not a rubber lid is used. For example, when using a setting with a high degree of difficulty aiming at less invasiveness to the patient, the number of ports (holes) into which the forceps of the endoscope are inserted becomes smaller.
  • the simulator setting is used as a training difficulty design factor.
  • the assistant and the scoopist are included in the surgical position design table because the setting of the position and the number of persons can change the difficulty.
  • this surgical training and simulation system is intended not only for the surgeon, but also for the entire surgical team, such as assistants, scopists, and nurses. Is set. In robotic surgery, the arrangement of each device is also a target.
  • the additional setting information table is composed of additional setting conditions, and the design factors are respiratory movement / pulsation, presence / absence / amount of sudden bleeding, and the like.
  • the perfusion / sudden bleeding system shown in FIG. 12 is adjusted and set.
  • the abdominal wall of the simulator has flexibility corresponding to the average abdominal wall expansion change rate, and can reproduce the forceps angle associated with the deformation and change of the abdominal wall at the time of surgery.
  • FIG. 3 shows a production flow of the living body texture organ of the first embodiment.
  • an organ to be a training target is determined (S201).
  • a surgical process to be trained is determined (S202).
  • the training difficulty level is determined (S203).
  • the size, color, and texture of the organ are set (S204).
  • the amount of fat is set from the BMI information (S205). If there is organ adhesion from the past history (S206), the setting of organ adhesion is performed (S207). If there is a lesion (S208), the lesion is set (S209).
  • a blood vessel running pattern is set (S210). Merckmar is set (S211). Based on the set deformation information, a model of the body texture organ is formed (S212).
  • the production of the living body texture organ is performed by designing the specifications of the living body texture organ according to the difficulty level of the training scenario.
  • the number of living body texture organs used for training may be one or two or more depending on the training scenario. For example, when training is performed in a state where there are adhesions in a plurality of organs, two or more biological texture organs are used. In order to reduce manufacturing costs, only the necessary parts for the surgical process to be performed are produced, or only the necessary parts are produced precisely and the others are simplified, or the structure can be used multiple times. It is also possible to produce as.
  • the biological texture organ specification is based on the three-dimensional structure inside the organ, the amount of fat surrounding the biological textured organ, the membrane including the membrane, blood vessels, or the structure or physical properties of the nerve. It is determined according to the training scenario.
  • FIG. 10 is an explanatory diagram of a training difficulty level design table for living body texture organs, where (1) shows a patient individual information table and (2) shows an additional setting information table. As shown in FIG. 10, there are (1) a patient individual information table and (2) an additional setting information table as design factors of the living body texture organ.
  • the patient individual information table is a table for determining main specification characteristics of an organ based on patient-specific characteristics, and is used when designing a basic organ structure suitable for each of the beginner, intermediate and advanced training levels. As shown in FIG.
  • the individual attribute of the patient is a design factor.
  • BMI Body Mass Index
  • past medical history are design factors, and the influence of fat mass and surgical history on organ adhesion and color / texture of the organ is designed.
  • BMI is a physique index indicating the degree of obesity of a person based on the relationship between weight and height.
  • the past history for example, when the patient has a history of cholecystitis, the degree of difficulty becomes high.
  • the degree of difficulty increases because the organ is implanted or the field of view is narrowed.
  • the organ characteristics of the patient are also designed factors, and in particular, the lesion is the designed factor.
  • the lesion refers to a gallbladder lesion, a stone, or a related organ lesion.
  • the lesion of the gallbladder the presence or absence of anatomical variation of the bile duct and gallbladder duct, the presence or absence of inflammation such as cholecystitis, the hardness and thickness of the capsule, the softness of fat, and the like are considered.
  • the softer the fat the higher the difficulty of handling the female.
  • the position and number of stones are considered.
  • Cirrhosis makes bleeding easier during surgery and makes it difficult to stop bleeding.
  • the stone is designed and specified, and the influence on the running or texture characteristics of blood vessels and biliary tracts, and the color and texture of the gallbladder that is the target organ and the liver that is the background organ are designed and specified.
  • the additional setting information table in the training difficulty level design table for living body texture organs is a table that determines specification characteristics from patterns that are anatomically classified and predicted in advance.
  • an additional setting condition becomes a design factor.
  • the biliary tract / blood vessel running pattern and Merckmar setting.
  • the biliary tract / vessel running pattern is used as a design factor when designing the basic organ structure according to the training level of beginner, intermediate and advanced in the patient individual information table, but in the additional setting information table However, for the purpose of further fine-tuning the difficulty, biliary and vascular running within an anatomically correct range is used as a design factor.
  • the Merckmar setting is also used as a design factor for the purpose of fine-tuning the difficulty level. Specifically, it is possible to make it difficult to identify Merckmar by adjusting the number and color of Merckmar and adjusting the state of the Rubiere groove.
  • Additional setting conditions which are design factors in the additional setting information table, can be set in addition to the biliary tract / vessel running pattern and Merckmar setting. However, if too many other parameters are included, quality variations will increase. Increases noise. This will affect the credibility of the evaluation and the realization of statistical analysis. Therefore, it is preferable that the additional setting conditions, which are design factors in the additional setting information table, are the biliary tract / blood vessel running pattern and the Merckmar setting.
  • FIG. 6 shows the flow of laparoscopic cholecystectomy in Example 1.
  • S301 the anatomical positional relationship between the gallbladder and the liver is confirmed.
  • S302 The film is peeled off (S302).
  • a critical view is confirmed by peeling the hollow triangle (S303).
  • S304 The bile duct and blood vessel are separated (S304).
  • the gallbladder is removed (S305).
  • the detected degree of deformation of the living body texture organ is analyzed by a computer, and the surgical skill is quantitatively evaluated.
  • the evaluation data is accumulated in a database on the server, and it is possible to improve the training scenario based on the accumulated data.
  • the detection of the degree of deformation of the living body texture organ and the quantitative evaluation of the surgical skill are performed for each surgical process, and the numerical value of the degree of deformation of the body texture organ and the difference from the case where it is performed by an experienced operator are shown in FIG. 6 is displayed on a timely basis. Since the surgeon performs an operation while looking at the screen of the monitor 6, it is possible to perform training while confirming the evaluation.
  • the current video and the past surgical video may be combined and displayed, or text such as an instruction arrow, an instruction comment, and a caution point may be displayed.
  • instructions, advice, notes, explanations, etc. may be conveyed by voice.
  • a trajectory including a grasping force of a medical instrument, an operation speed of the medical instrument, a movement amount, and a movement direction in the operation of an experienced operator is stored in advance as an index. Evaluation is performed by comparison with the above-mentioned index.
  • FIG. 11 is a relationship diagram between a training scenario and device settings. (1) shows a case where training is performed from an already defined scenario, and (2) shows a case where a new technique is developed.
  • the design of the living body texture organ, the simulator setting, and the surgical training scenario to be performed are determined.
  • a surgical training scenario is determined, a simulator is set according to the contents, and a living body texture organ is designed.
  • FIG. 13 is a perspective view of the living body texture organ of the second embodiment.
  • the living body texture organ 11 of Example 2 is a model of an inguinal hernia including a peritoneum 16.
  • the living body texture organ 11 is provided with two hernia portals 12, an inner umbilical cord part 13, a midline umbilical part 14, an arterial part 15 a, a vein part 15 b, a bladder 16 and a vas deferens 17.
  • the gel film 18 is a one-layer gel-like tissue, and reproduces the texture of the release layer of the preperitoneal fascia. Further, since the gel film 18 can be re-used and reused, the training cost can be reduced.
  • the arterial portion 15a and the vein portion 15b become Merckmar in the training, and can select and reproduce the anatomy such as the arterial portion 15a, the vein portion 15b, and the muscle.
  • FIG. 14 is an attachment diagram of the biological textured organ of Example 2 to the abdominal cavity simulator, (1) is a perspective view, and (2) is a front view.
  • the abdominal cavity simulator 2 includes a pelvic part 42, a back part 43, a spine 46, and a model gripping part 50.
  • the living body texture organ 11 is provided with an attachment member for attachment to the abdominal cavity simulator 2. Since the living body texture organ 11 and the mounting member are integrated as a module, the anatomical positional relationship is ensured, the attachment / detachment is facilitated, and the time required to start training is reduced.
  • FIG. 15 shows the flow of laparoscopic inguinal hernia surgery of Example 2.
  • the port insertion position of the laparoscope is determined, and the port is inserted (S401).
  • the hernia gate and surrounding anatomical structures are confirmed (S402).
  • Pre-processing for mesh insertion is performed (S403).
  • a mesh is inserted (S404).
  • the peritoneum is closed (S405).
  • the pretreatment specifically refers to the following.
  • An incision is made in the peritoneum from about 3 cm outside the hernia portal to just before the medial umbilical cord. In the vicinity of the hernia gate, the lower abdominal wall arteriovenous, spermatic cord, and testicular arteriovenous are preserved on the wall side, and wrap around the dorsal and ventral sides.
  • An incision is made in the preperitoneal fascia inside the hernia and enters the preperitoneal cavity. The preperitoneal cavity is bluntly detached and the pubic bone, Cooper ligament, and rectus abdominis muscle are confirmed.
  • the mesh is inserted by the following method. A mesh is inserted into the abdominal cavity and deployed in the preperitoneal space to cover all the pubic foramen. The mesh is fixed to the Cooper ligament, rectus abdominis fascia, inferior abdominal wall arteriovenous, lateral abdominis fascia, etc. with a tacker. Closure is performed by closing the peritoneum with a continuous suture using an absorbent thread with a needle.
  • the surgical training system may further include means for changing an operation field space of an endoscopic technique including an abdominal cavity, a chest cavity, a pelvis, a joint, or a nasal cavity, or an open and thoracotomy technique.
  • a surgical training system is installed beside the experienced surgeon, and the trainer learns while witnessing the surgical procedure and decision-making process of the experienced surgeon in a form synchronized with the progress of the surgical process of the experienced surgeon. It is also possible to perform training with a sense of reality. Unlike the case where only surgical training is performed, training with a sense of urgency and realism is possible by performing training in a nearby place during actual surgery.
  • the present invention is useful as a system for surgical training or simulation using a laparoscope or thoracoscope.

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Abstract

La présente invention concerne un système d'apprentissage de la chirurgie faisant appel à un organe de modélisation à texture-bio qui est reproduit ou déformé conformément au scénario de chirurgie. La présente invention concerne un système destiné à réaliser l'apprentissage de la chirurgie ou la simulation d'une chirurgie au moyen d'un organe de modélisation à texture-bio dans lequel la texture et l'apparence externe d'un organe actuel sont reproduits ou déformés, le système comporte : un organe de modélisation à texture-bio qui est reproduit ou déformé conformément à un scénario de chirurgie qui sert à titre d'apprentissage ou de sujet de simulation ; un moyen de déterminer les succès/les échecs aux points de surveillance dans le scénario de chirurgie ; et un moyen d'accessibilité afin d'accéder aux compétences chirurgicales sur la base des résultats de détermination. Avec l'organe de modélisation à texture-bio, la texture ou la morphologie associée est déformée par changement, conformément au scénario de chirurgie, la structure tridimensionnelle de l'intérieur de l'organe, la quantité de matière grasse environnante à l'organe, et la structure ou les propriétés physiques des membranes comprenant la peau, celles des vaisseaux sanguins, ou des nerfs.
PCT/JP2016/089189 2016-01-19 2016-12-28 Apprentissage de la chirurgie et système de simulation faisant appel à un organe de modélisation à texture-bio Ceased WO2017126313A1 (fr)

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CN109003497A (zh) * 2018-07-19 2018-12-14 苏州敏行医学信息技术有限公司 气道管理训练方法及系统
WO2020031311A1 (fr) * 2018-08-08 2020-02-13 株式会社ファソテック Outil de fixation d'organe pour simulateur de cavité abdominale
US10810907B2 (en) 2016-12-19 2020-10-20 National Board Of Medical Examiners Medical training and performance assessment instruments, methods, and systems
JP2020190760A (ja) * 2020-08-27 2020-11-26 株式会社ファソテック 腹腔シミュレータ用臓器固定具

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WO2012151585A2 (fr) * 2011-05-05 2012-11-08 The Johns Hopkins University Procédé et système d'analyse d'une trajectoire de tâche
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WO2015151503A1 (fr) * 2014-03-31 2015-10-08 株式会社ファソテック Simulateur de la cavité thoracique

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EP1687790B1 (fr) * 2003-11-25 2017-03-01 Gaumard Scientific Company, Inc. Systeme d'education interactif pour enseigner des soins aux patients
US20160098943A1 (en) * 2012-11-13 2016-04-07 Eidos-Medicina Ltd Hybrid medical laparoscopic simulator

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WO2012151585A2 (fr) * 2011-05-05 2012-11-08 The Johns Hopkins University Procédé et système d'analyse d'une trajectoire de tâche
US20140248596A1 (en) * 2013-03-01 2014-09-04 Applied Medical Resources Corporation Advanced surgical simulation constructions and methods
WO2015114901A1 (fr) * 2014-01-30 2015-08-06 オリンパス株式会社 Système médical d'enregistrement et de lecture de vidéo, et dispositif médical d'enregistrement et de lecture de vidéo
WO2015151503A1 (fr) * 2014-03-31 2015-10-08 株式会社ファソテック Simulateur de la cavité thoracique

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10810907B2 (en) 2016-12-19 2020-10-20 National Board Of Medical Examiners Medical training and performance assessment instruments, methods, and systems
CN109003497A (zh) * 2018-07-19 2018-12-14 苏州敏行医学信息技术有限公司 气道管理训练方法及系统
WO2020031311A1 (fr) * 2018-08-08 2020-02-13 株式会社ファソテック Outil de fixation d'organe pour simulateur de cavité abdominale
JPWO2020031311A1 (ja) * 2018-08-08 2020-08-20 株式会社ファソテック 腹腔シミュレータ用臓器固定具
JP2020190760A (ja) * 2020-08-27 2020-11-26 株式会社ファソテック 腹腔シミュレータ用臓器固定具

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