WO2024181572A1 - Organ model fixture - Google Patents

Abstract

Provided is an organ model fixture that reproduces the tensile stress or the elastic stress generated from the structure of the tissue surrounding an actual organ in an organ model. The present invention comprises a fixture body 2, a bladder model fixing section 3, a urethra model fixing section 4, and a mounting section 6. The fixture body 2 is configured from a support section 21, a pubic bone section 22, and a grip section 23. The support section 21 supports the pubic bone section 22 and the bladder model fixing section 3. The urethra model fixing section 4 is provided to the foot side of the pubic bone section 22. The grip section 23 is used for gripping when mounting the organ model fixture 1 to an assembled abdominal cavity simulator. The bladder model fixing section 3 is for mounting a bladder model, and the urethra model fixing section 4 is for mounting a urethra model. The mounting section 6 serves as a mounting site to a fixing section of the assembled abdominal simulator. An elastic section 5 is connected with the bladder model fixing section 3 and reproduces the elastic force generated from tissue surrounding the bladder when the bladder is pulled by forceps or the like during urethrovesical anastomosis.

Description

Organ model fixture

The present invention relates to a fixture for fixing an organ model to a simulator that mimics the human body.

Laparoscopic surgery is widely used in gastrointestinal and urological surgery because it leaves small scars and allows for quick postoperative recovery. However, laparoscopic surgery is difficult and has the problem of being prone to differences in the skill of the surgeon.
In addition, robot-assisted surgery has the advantage of being able to reach areas that are difficult to reach using open or laparoscopic surgery, and of compensating for camera shake, so in recent years, robot-assisted surgery has been increasing nationwide.
Therefore, there is a need for technology that can effectively provide training for laparoscopic surgery and robotic-assisted surgery.

The inventors have already proposed a collapsible abdominal cavity simulator that allows for diverse and realistic procedural training and is easy to store and carry, as a technology for effective procedural training (see Patent Document 1). This does not precisely reproduce the entire inside of the body cavity, but rather arranges appropriate organ model fixing tools according to the training content and precisely reproduces the inside of the body cavity to the extent necessary for training, making it possible to easily perform diverse and realistic procedural training.

On the other hand, in order to perform training using an organ model for urethral and bladder reconstruction surgery for prostate cancer, which accounts for the majority of robotic surgeries, it is necessary to be able to reproduce the procedure of pulling and anastomosing the remaining organ after resection. In order to reproduce the state in which the organ is pulled, it is also important to adjust the material, thickness, length, etc. of the organ model. In actual surgery, the tensile stress when an organ is pulled using forceps, etc., and the degree and speed of contraction when the organ is released are not only due to the organ itself, but are also influenced by surrounding tissues such as other organs connected to the organ. In order to create a configuration that takes into account the influence of surrounding tissues, there is a limit to simply devising the material, etc. of the organ model. On the other hand, since training using an organ model is effective when performed repeatedly, there is also a need to produce organ models at low cost.
Therefore, there is a demand for an organ model fixing tool that can reproduce not only the organ that is the subject of surgery, but also the effects of the tissue structure surrounding the organ, and that can produce an organ model at low cost.

A known technology for reproducing the tissue structure around an organ is an elastic deformation mechanism for soft materials that includes a target member made of an elastically deformable soft material, a connector connected to the target member, and a drive device for displacing the connector, in which the connector is made of an elastically deformable soft material and has a Young's modulus set to be greater than that of the target member (see Patent Document 2). When the target member is elastically deformed by the displacement of the connector, the target member is elastically displaced according to the magnitude of the external force applied to the target member, regardless of the state of the target member. However, the soft material elastic deformation mechanism of Patent Document 2 elastically deforms the target member by driving a motor, and has the problem of being not a simple structure and being expensive to manufacture.

For example, in a prostate cancer surgery, the bladder and urethra are reconstructed by connecting them, but in an actual procedure, it is necessary to connect the bladder to the urethra while pulling a part of the bladder. As a training device focusing on such a procedure, a medical simulator is known that is equipped with a force sensor that measures compressive or tensile forces in three orthogonal axial directions on the organ model on an arm member that holds the organ model, and an evaluation means that evaluates the procedure in the surgical procedure based on the measured values by the sensor (see Patent Document 3).
However, although the medical simulator of Patent Document 3 can measure compressive and tensile forces applied to an organ model, it does not reproduce the influence of the tissue structure surrounding the organ.

Patent No. 7101320 JP 2014-52480 A International Publication No. 2017/204311

In light of this situation, the present invention aims to provide an organ model fixing device that reproduces the tensile stress or elastic stress that arises from the structure of the tissue surrounding the organ model.

In order to solve the above problems, the organ model fixing device of the present invention is a fixing device for fixing an organ model for training in which an organ model is housed in a simulator simulating the human body and used for anastomosis, the fixing device comprising a first organ model fixing part for fixing a first organ model and a second organ model fixing part for fixing a second organ model, and at least one of the organ model fixing parts is provided with an elastic part consisting of an elastic body and a damper mechanism, and by pulling or compressing the organ model in the direction of expansion and contraction of the elastic body, the damper mechanism absorbs the impact force of vibration in the expansion and contraction direction associated with the elastic deformation of the elastic body.
The organ model is made of soft resin. By providing the elastic part in addition to the elastic force of the organ model itself, the tensile stress generated by the structure of the tissue surrounding the organ model and the contraction speed against the tensile force can be reproduced more accurately in the training for anastomosis of the first organ model and the second organ model.
A known spring or damper is used for the elastic body or damper mechanism constituting the elastic part. By making the elastic part appropriately adjustable or by making the member replaceable, adjustment according to the needs of the user is possible. The elastic part may be provided on only one of the first organ model fixing part and the second organ model fixing part, or on both. In addition, the organ model fixing device of the present invention may be provided with an organ model fixing part other than the first organ model fixing part and the second organ model fixing part. When three or more organ model fixing parts are provided, an elastic part may be provided on each of the three or more organ model fixing parts. Furthermore, a plurality of elastic parts may be provided on each fixing part.
Regarding "tensile force" and "pressure", it is acceptable for one fixed part to be provided with an elastic part corresponding to either "tensile force" or "pressure", or for one fixed part to be provided with a plurality of elastic parts that function in opposite directions. In addition, even if one fixed part is provided with one type of elastic part, it is also intended to include the meaning that there are cases where the force acts as a tensile force or a pressing force depending on the direction in which the force is applied.

The organ model fixing device of the present invention may have an elastic part provided on either the first organ model fixing part or the second organ model fixing part. The elastic part does not necessarily have to be provided on both fixing parts, because there are cases where sufficiently realistic training is possible if an elastic part is provided on only one of the fixing parts.

It is preferable that the organ model fixing device of the present invention further comprises an adjustment mechanism that can adjust the tensile stress of the elastic part and the contraction speed against tension according to the tensile stress on the surrounding tissue of the actual organ of the organ model and the contraction speed against tension.
For example, even if the tensile stress or elastic stress generated by the organ or the tissue surrounding the organ is reproduced based on an average human being, there are individual differences in human organs, and there are also individual differences in the tensile stress or elastic stress generated by the tissue surrounding the organ. Therefore, by providing an adjustment mechanism, the tensile stress in the elastic part and the contraction speed against the tension can be adjusted according to the tensile stress on the surrounding tissue of the actual organ of the organ model and the contraction speed against the tension. As an adjustment mechanism, for example, a member for holding the organ model can be separated into two, one of the two members is provided with a long hole and the other is provided with a female screw part, and the combination position of the two members can be changed steplessly and fixed using a screw. With such a structure, the user can fine-tune the fixing position, so that when a part of the organ model is grasped with forceps or the like and released from the pulled state, the user can search for and adjust the contraction position in the same way as when the actual organ is released. For example, in training for urethrovesical reconstruction surgery for prostate cancer, the procedure of pulling and anastomosis of the remaining organ after resection can be realistically reproduced.

The organ model fixing device of the present invention may further include an adjustment mechanism that can adjust the elastic stress of the elastic part and the expansion speed in response to pressure according to the elastic stress on the surrounding tissue of the actual organ of the organ model and the expansion speed in response to pressure. This makes it possible to more accurately reproduce the elastic stress arising from the structure of the surrounding tissue of the organ model and the expansion speed in response to pressure, in addition to the elastic force of the organ model itself.

The organ model fixing device of the present invention may further include an adjustment mechanism that can adjust the tensile stress and contraction speed against tension of the elastic part according to the tensile stress and contraction speed against tension applied to a portion extended on an actual organ of the organ model.
For example, in training for total gastrectomy, when anastomosing the esophagus and jejunum remaining after resection, if an organ model were used to accurately reproduce the esophagus and small intestine, the small intestine would become long and expensive.By using the organ model fixing device of the present invention, even if the entire small intestine is not reproduced, a jejunum model that reproduces part of the jejunum can be attached to the organ model fixing part, and the procedure of anastomosing the esophagus while pulling the jejunum can be realistically reproduced.

In the organ model fixing device of the present invention, the training is urethrovesical anastomosis training in radical prostatectomy, and the first organ model and the second organ model are an organ model simulating the bladder and an organ model simulating the urethra, respectively, and may further include an adjustment mechanism that can adjust the tensile stress of the elastic part and the contraction speed in response to tension according to the tensile stress on the actual surrounding tissue of the bladder and the contraction speed in response to tension, and can adjust the elastic stress of the elastic part and the expansion speed in response to pressure according to the elastic stress on the actual surrounding tissue of the bladder and the expansion speed in response to pressure. This allows effective training in radical prostatectomy by robotic surgery. Note that the surrounding tissue here refers to, for example, fat and membrane structures.

In the organ model fixing device of the present invention, the training is training for digestive tract reconstruction surgery in total gastrectomy, and the first organ model and the second organ model are organ models simulating the esophagus and the jejunum, respectively, and the length of each tube of each organ model may be shorter than the actual length. This enables realistic training without reproducing the entire organ model, and reduces costs.
In the organ model fixing device of the present invention, the elastic force and impact force of the elastic part are preferably adjusted according to the doctor's empirical tactile sensation. The adjustment according to the doctor's empirical tactile sensation is determined by having a plurality of doctors repeatedly perform operations such as gripping, pulling, and releasing a part of the organ model with forceps or the like while the organ model is attached to the elastic part.
The organ model fixing part in the organ model fixing device of the present invention may include a movable part having a hinge, and the movable part may engage and fix the inner surface of the organ model. Also, the organ model fixing part in the organ model fixing device of the present invention may include a rod-shaped member, and the organ model may be inserted into the rod-shaped member to fix the organ model.

The organ model fixing device of the present invention has the effect of accurately reproducing the tensile stress or elastic stress arising from the structure of the tissue surrounding the actual organ in the organ model. It also has the effect of reducing the production cost of the organ model to be used.

FIG. 1 is a perspective view of the organ model fixing device of the first embodiment; FIG. 2 is a perspective view of the organ model fixing device of the first embodiment; FIG. 1 is a plan view of an organ model fixing tool according to a first embodiment; FIG. 1 is a bottom view of the organ model fixing tool of Example 1. FIG. 1 is an external view of the bladder model according to the first embodiment. External view of the urethra model External perspective view of the assembled abdominal cavity simulator Flow diagram of use of the organ model fixing tool of Example 1 Urethral model installation image Image of the bladder model attached in Example 1 A perspective view of the organ model fixture with the organ model attached An explanatory diagram of the attachment of the organ model fixing tool of the first embodiment to the assembly-type abdominal cavity simulator. Image of the attachment of the organ model fixture of Example 1 to the assembly-type abdominal cavity simulator Image of the organ model fixing tool used in Example 1 (1) Image of the organ model fixing tool used in Example 1 (2) Image of the organ model fixing tool used in Example 1 (3) FIG. 1 is an explanatory diagram of an elastic portion according to a first embodiment of the present invention; FIG. 10 is an explanatory diagram of an organ model fixing tool according to the second embodiment. Illustrative diagram of an elastic portion according to another embodiment FIG. 1 is a perspective view of the organ model fixing device according to the third embodiment; FIG. 2 is a perspective view of the organ model fixing device according to the third embodiment; FIG. 11 is a plan view of the organ model fixing tool of the third embodiment. FIG. 3 is an external view of the bladder model of Example 3. Image of the bladder model attached in Example 3 FIG. 13 is an external perspective view of an organ model fixing tool to which a bladder model of Example 3 is attached. Image of the organ model fixing device in use in Example 3 (1) Image of the organ model fixing tool used in Example 3 (2) Image of the organ model fixing device in use (3) FIG. 11 is an explanatory diagram of an elastic portion according to a third embodiment. Diagram of the adjustment mechanism (1) Diagram of the adjustment mechanism (2)

Below, an example of an embodiment of the present invention will be described in detail with reference to the drawings. Note that the scope of the present invention is not limited to the following examples and illustrated examples, and many modifications and variations are possible.

The organ model fixing tool of Example 1 is an instrument used for training urethral vesical anastomosis when performing radical prostatectomy. FIG. 1 is an external perspective view of the organ model fixing tool of Example 1, showing a perspective view from the head side of the human body. As shown in FIG. 1, the organ model fixing tool 1 of Example 1 is composed of a fixing tool main body 2, a bladder model fixing part 3, a urethral model fixing part 4, and an attachment part 6. The fixing tool main body 2 is composed of a support part 21, a pubic part 22, and a grip part 23. The support part 21 supports the pubic part 22 and the bladder model fixing part 3. The pubic part 22 reproduces the pubic bone, and the urethral model fixing part 4 is provided on the foot side of the pubic part 22. The grip part 23 is used by gripping when attaching the organ model fixing tool 1 to the assembly type abdominal cavity simulator 10 (see FIG. 7). The bladder model fixing part 3 is for attaching the bladder model 7 (see FIG. 5), and the urethra model fixing part 4 is for attaching the urethra model 8 (see FIG. 6). The attachment part 6 is the attachment site to the fixing part of the assembled abdominal cavity simulator 10.

FIG. 2 is an external perspective view of the organ model fixing device of Example 1, showing a perspective view from the foot side. As shown in FIG. 2, the urethra model fixing part 4 includes a movable part 41, a hinge part 42, and a fastener 43. When attaching the urethra model 8 to the urethra model fixing part 4, the fastener 43 is removed, the movable part 41 is opened around the hinge part 42 as the axis center, and the urethra model 8 is attached.

Fig. 3 shows a plan view of the organ model fixing tool of Example 1. As shown in Fig. 3, the bladder model fixing part 3 is composed of a movable part 31, a hinge part 32, a non-movable part 33, an elastic member 34, and a holding part 35. The bladder model fixing part 3 is connected to an elastic part 5.
The elastic portion 5 reproduces the elastic force generated from the tissue surrounding the bladder when the bladder is pulled by forceps or the like during urethrovesical anastomosis.

Figure 4 shows a bottom view of the organ model fixing tool of Example 1. As shown in Figure 4, an attachment part 6 is provided at the bottom of the organ model fixing tool 1. The attachment part 6 is composed of a movable part 61, a hinge part 62, a fastener 63, and a recess 64. By removing the fastener 63 and opening the movable part 61, it is possible to attach or detach the simulator to or from the fixed part.

Figure 5 shows the external appearance of the bladder model of Example 1, with (1) being a front view, (2) being a plan view, and (3) being a bottom view. As shown in Figure 5 (1), the bladder model 7 is made of a bladder model main body 71 and an edge portion 72. The material of the bladder model main body 71 is PVA (polyvinyl alcohol). As shown in Figure 5 (2), five openings (73a to 73e) are provided in the bladder model main body 71, and when attaching the bladder model 7 to the bladder model fixing part 3, the fixing direction can be changed to allow multiple anastomosis training sessions. As shown in Figure 5 (3), a hollow portion 74 is formed inside the bladder model main body 71. The edge portion 72 is thicker than the bladder model main body 71, and when attaching it to the bladder model fixing part 3, the edge portion 72 is expanded and then engaged with the bladder model fixing part 3 for attachment.

6A and 6B are external views of the urethra model, where (1) is a plan view and (2) is a front view. As shown in Fig. 6A and 6B, the urethra model 8 is a tubular member made of PVA (polyvinyl alcohol).
The urethra model 8 has the same diameter from the end 8a through the body 8c to the end 8b, and the end 8a and the end 8b have the same shape, so that either end can be used for anastomosis training.

The organ model fixing tool 1 is attached to an abdominal cavity simulator for use. Here, an assembly type abdominal cavity simulator 10 will be taken as an example of the abdominal cavity simulator to which the organ model fixing tool 1 is attached. FIG. 7 shows an external perspective view of the assembly type abdominal cavity simulator. As shown in FIG. 7, the assembly type abdominal cavity simulator 10 is made up of a base 11, side plate members (12a, 12b), an insufflation cover 13, and fasteners 14. In the assembly type abdominal cavity simulator 10 shown in FIG. 7, the side plate members (12a, 12b) are attached onto the base 11 and fixed using the fasteners 14, and then the insufflation cover 13 is attached to the side plate members (12a, 12b).
The base 11 is provided with fixing parts (15a to 15c). The fixing parts (15a to 15c) are one fixing part 15a on one side of the base 11 in the longitudinal direction and two fixing parts (15b, 15c) on the other side, which allows for the attachment of a variety of organ model fixing tools, and the organ model fixing tool 1 of this embodiment is attached to the fixing part 15a for use. The base 11 and the side plate members (12a, 12b) are fixed together by fitting a recess (not shown) provided on the base 11 into a protrusion (not shown) provided on the side plate members (12a, 12b), and are further fixed together using four fasteners 14.

The pneumoperitoneum cover 13 is composed of a pneumoperitoneum 13a and a frame 13b. The pneumoperitoneum 13a is made of soft resin, and realistically reproduces the abdomen of a patient in a pneumoperitoneum state. The frame 13b is made of hard resin. The pneumoperitoneum 13a has multiple port holes 13c, which allow for the insertion of endoscopes, forceps, etc. from various positions and angles for procedural training. The frame 13b has recesses (not shown) on the back surface at the four corners, and is structured to be able to fit into protrusions (not shown) provided on the side plate members (12a, 12b).

Next, a method of using the organ model fixing tool 1 of Example 1 will be described. Fig. 8 shows a flow diagram of using the organ model fixing tool of Example 1. When using the organ model fixing tool 1, first, an organ model is attached to the organ model fixing tool 1. Specifically, as shown in Fig. 8, first, a urethra model 8 is attached to the urethra model fixing part 4 (step S01). Next, a bladder model 7 is attached to the bladder model fixing part 3 (step S02).
With the urethra model 8 and bladder model 7 attached to the organ model fixing tool 1, the organ model fixing tool 1 is attached to the base 11 of the assembly type abdominal cavity simulator 10 (step S03). The assembly type abdominal cavity simulator 10 may have the side plate members (12a, 12b) attached to the base 11 before attaching the organ model fixing tool 1, or the side plate members (12a, 12b) may be attached after attaching the organ model fixing tool 1. Finally, the pneumoperitoneum cover 13 is attached to the side plate members (12a, 12b) (step S04). In this state, anastomosis training of the bladder and urethra is performed.
The order of steps S01 and S02 may be reversed. Also, it is possible to attach the bladder model 7 and the urethra model 8 after attaching the organ model fixing tool 1 to the assembly type abdominal cavity simulator 10.
The installation method and function of each component will be explained in detail below.

FIG. 9 is an image diagram of the attachment of the urethra model, (1) shows the state before the urethra model is placed, and (2) shows the state after the urethra model is placed. As shown in FIG. 9(1), the urethra model fixing part 4 is composed of a urethra model fixing part main body 44, a movable part 41, a hinge part 42, and a fastener 43. When attaching the urethra model 8 to the urethra model fixing part 4, the fastener 43 is removed, and the movable part 41 is opened with the hinge part 42 as the axis center. A through hole 22a for attaching the urethra model 8 is formed in the pubic part 22, and one of the ends (8a, 8b) of the urethra model 8 is inserted into the through hole 22a to finely adjust the fixing position. In this embodiment, the end 8a of the urethra model 8 is inserted into the through hole 22a (see FIG. 14).
After adjusting the position of the end 8a of the urethral model 8 to be placed, the trunk 8c is placed in the recess 44a provided in the urethral model fixing part main body 44. Thereafter, the movable part 41 is closed to clamp the urethral model 8 between the urethral model fixing part main body 44 and the movable part 41, and fixed using the fastener 43.

10 is an image diagram of the attachment of the bladder model of Example 1, where (1) shows the state before the bladder model is attached and (2) shows the state after the bladder model is attached. As shown in Fig. 10(1), the bladder model fixing part 3 is composed of a movable part 31, a hinge part 32, a non-movable part 33, an elastic member 34 and a holding part 35, and is structured so that the bladder model 7 is attached by engaging with the movable part 31 and the non-movable part 33. The movable part 31, the hinge part 32, the non-movable part 33 and the elastic member 34 are provided on the holding part 35.
The movable part 31 is movable in the direction of the arrow in Fig. 10(1) by the hinge part 32. The hinge part 32 has an elastic mechanism, and when a force is applied to the movable part 31 in the direction of the arrow, the movable part 31 moves, but when the force is no longer applied, the movable part 31 returns to the state shown in Fig. 10(1). Therefore, when attaching the bladder model 7 to the bladder model fixing part 3, one end of the edge part 72 is engaged with the non-movable part 33, and then the movable part 31 is moved in the direction of the arrow while the other end of the edge part 72 is engaged with the movable part 31. When the hand supporting the movable part 31 is released, the bladder model 7 is stably fixed to the bladder model fixing part 3 by the elastic mechanism of the hinge part 32, as shown in Fig. 10(2). The elastic member 34 shown in Fig. 10(1) is made of sponge (EPDM foam) and maintains the shape of the bladder model 7.

Figure 11 shows an external perspective view of the organ model fixture with the organ model attached. As shown in Figure 11, the organ model fixture 1 is attached to the bladder model 7 and urethra model 8, and then attached to the assembled abdominal cavity simulator 10.

Figure 12 is an explanatory diagram of the attachment of the organ model fixing tool of Example 1 to the assembly type abdominal cavity simulator, (1) shows a planar image before attachment, and (2) shows a planar image after attachment. As shown in Figure 12 (1), when attaching the organ model fixing tool 1 to the assembly type abdominal cavity simulator 10, the fastener 63 is removed and the movable part 61 is opened. In this state, the recess 64 (see Figure 4) of the organ model fixing tool 1 is fitted into the fixed part 15a from the side of the base 11. After the recess 64 is fitted into the fixed part 15a, the movable part 61 is closed and fixed using the fastener 63 as shown in Figure 12 (2). When removing the organ model fixing tool 1 from the assembly type abdominal cavity simulator 10 after use, the fastener 63 is removed and the movable part 61 is opened, and the organ model fixing tool 1 is slid to the side of the base 11 to release the engagement between the recess 64 and the fixed part 15a.

Figure 13 is an image diagram of the attachment of the organ model fixing tool of Example 1 to the assembled abdominal cavity simulator, (1) shows the state before the insufflation cover is attached, and (2) shows the state after the insufflation cover is attached. In this example, as shown in Figure 13 (1), the side plate members (12a, 12b) are already attached to the base 11, and as shown in Figure 13 (2), the preparation for training is completed by attaching the insufflation cover 13 to the side plate members (12a, 12b).

Figures 14 to 16 are conceptual diagrams of the use of the organ model fixing tool of Example 1, with Figure 14 showing a state in which the bladder model is not brought close to the urethra model, and Figure 15 showing a state in which the bladder model is brought close to the urethra model. Figures 14(1) and 15(1) are perspective views, and Figures 14(2) and 15(2) are left side views. Figure 16(1) shows a plan view of the state in which the bladder model is brought close to the urethra model, and Figure 16(2) shows a plan view of the state in which the bladder model is not brought close to the urethra model. Note that, for the sake of convenience, the pubic bone 22 is partially omitted from Figures 14 to 16.
14(1) or 14(2), when no force is being applied to the bladder model 7, the opening 73a of the bladder model 7 and the end 8a of the urethra model 8 are separated from each other. The opening 73a of the bladder model 7 and the end 8a of the urethra model 8 imitate the opening of the bladder and the end of the urethra that are formed when the entire prostate is removed in a radical prostatectomy.

In actual training, a medical instrument such as forceps is inserted through the port hole 13c of the pneumoperitoneum cover 13 shown in FIG. 13(2), and the opening 73a is pulled toward the urethra model 8 to perform anastomosis.
15(1), (2) or 16(1) show that the bladder model 7 is pulled toward the urethra model 8, so that the opening 73a of the bladder model 7 and the end 8a of the urethra model 8 are brought into close proximity to each other. If the opening 73a is suddenly released during the anastomosis, the elastic force of the elastic part 5 causes the bladder model 7 to move to its original position shown in FIG. 16(2).

Here, the structure of the elastic part 5 will be described. Fig. 17 is an explanatory diagram of the elastic part of Example 1, where (1) shows a state in which the bladder model is not brought close to the urethra model, and (2) shows a state in which the bladder model is brought close to the urethra model. As shown in Fig. 17 (1) or (2), the elastic part 5 is composed of an elastic part main body 51, a shock absorber 52 as a damping mechanism, and a coil spring 53 as an elastic body. The shock absorber 52 and the coil spring 53 are publicly known shock absorbers and coil springs, respectively.
The bladder model 7 is fixed to the bladder model fixing part 3, and the bladder model fixing part 3 is connected to the elastic part main body 51. When the bladder model 7 is pulled toward the urethra model 8 from the state shown in FIG. 17(1) as shown in FIG. 17(2), the elastic part main body 51 moves from left to right. Depending on the direction in which the bladder model 7 is held with forceps or the like, the movement may not necessarily be a pulling movement but a pressing movement. Here, the shock absorber 52 and the coil spring 53 reproduce the tensile stress caused by the tissues surrounding the actual bladder. In particular, the coil spring 53 is provided to realistically reproduce the tensile stress caused by the tissues surrounding the actual bladder for the pulling movement. The maximum movable range R of the elastic part main body 51 from the reference position shown in FIG. 17(1) is 35 mm.

When the gripped state of the bladder model 7 is released from the state shown in Fig. 17(2), the elastic part main body 51 moves from right to left. Here, the elastic part main body 51 automatically returns to the position shown in Fig. 17(1) by the shock absorber 52 and the coil spring 53, but in particular, by providing the shock absorber 52 for the returning operation, the shock absorber 52 absorbs the impact force of the vibration in the expansion and contraction direction accompanying the elastic deformation of the coil spring 53. This makes it possible to prevent the coil spring 53 from suddenly expanding, and the contraction speed due to the presence of surrounding tissue in an actual bladder is realistically reproduced.
The elastic force here is determined based on the force applied when the opening of the actual bladder is grasped and pulled to the end of the urethra. The speed at which the opening 73a returns to its original position when it is released is also determined based on the speed at which the opening returns to its original position when it is released from the state where the opening of the actual bladder is grasped and pulled to the end of the urethra. Specifically, it is adjusted according to the doctor's empirical tactile sensation. This allows for realistic training close to the actual procedure, reproducing the elastic force generated by the tissues around the bladder.

The organ model fixing tool of the present invention is also useful for reducing the manufacturing cost of the organ model. For example, in the case of total gastrectomy, an operation to connect the ends of the esophagus and the jejunum may be performed, but in such a case, if an attempt is made to accurately reproduce an organ model of the jejunum, the organ model will become long, which will result in a problem of high manufacturing costs.
18 is an explanatory diagram of an organ model fixing tool of Example 2, where (1) shows an organ model fixing tool of Example 2 and (2) shows an explanatory diagram of an organ model fixing tool of the prior art. Note that both of these are different from actual fixing tools and have deformed shapes.
As shown in Fig. 18 (2), the conventional organ model fixing tool 101 has organ model fixing parts (30b, 40b) on a base 11b. One end of a jejunum model 70b is attached to the organ model fixing part 30b, and one end of an esophagus model 80b is attached to the organ model fixing part 40b. In order to train in digestive tract reconstruction surgery that connects the ends of the esophagus and jejunum, it is necessary to anastomose the other end of the jejunum model 70b and the other end of the esophagus model 80b. Here, in order to reproduce a more realistic state, in the conventional technology, it was necessary to ensure the length _L3 of the jejunum model 70b, taking into account the length _L1 over which the jejunum expands and contracts.

In contrast, in the organ model fixing tool 100 of the second embodiment, as shown in FIG. 18(1), the organ model fixing parts (30a, 40a) are provided on the base 11a, and the organ model fixing part 30a is connected to the elastic part 50. One end of the jejunum model 70a is attached to the organ model fixing part 30a, and one end of the esophagus model 80a is attached to the organ model fixing part 40a. In order to perform training for digestive tract reconstruction surgery, it is necessary to anastomose the other end of the jejunum model 70a and the other end of the esophagus model 80a. However, the length _L2 of the jejunum model 70a and the elastic force and contraction speed of the elastic part 50 are determined in consideration of the length _L1 of the jejunum stretching and contracting. Therefore, when the other end of the jejunum model 70a is grasped using forceps or the like, a similar feeling can be obtained as when the other end of the jejunum model 70b of the organ model fixing tool 101 is grasped. Furthermore, when the other end of the jejunum model 70a is released from the gripped state, the model contracts at approximately the same speed, so the cost of producing the jejunum model can be significantly reduced compared to conventional techniques.

The organ model fixing device of Example 3 is an instrument used for training urethral vesical anastomosis when performing radical prostatectomy. Figure 20 is an external perspective view of the organ model fixing device of Example 3, showing a perspective view from the head side of the human body. As shown in Figure 20, the organ model fixing device 1a of Example 3 is composed of a fixing device main body 2a, a bladder model fixing part 3a, a urethral model fixing part 4a, and an attachment part 6. The fixing device main body 2a is composed of a support part 21a, a pubic part 22b, and a grip part 23a. The support part 21a supports the pubic part 22b and the bladder model fixing part 3a. The pubic part 22b reproduces the pubic bone, and the urethral model fixing part 4a is provided on the foot side of the pubic part 22b. The pubic part 22b can be opened and closed to the urethral model fixing part 4a side via a hinge part 24. The gripping part 23a is used by gripping when attaching the organ model fixing tool 1a to the assembly type abdominal cavity simulator 10 (see FIG. 7). The bladder model fixing part 3a is used to attach the bladder model 7a (see FIG. 23), and is structured to be inserted from the side and attached, unlike the bladder model fixing part 3 of Example 1, which is attached by covering the bladder model 7 from above. The urethra model fixing part 4a is used to attach the urethra model 8 (see FIG. 6). The attachment part 6 is a mounting part to the fixing part of the assembly type abdominal cavity simulator 10. The structure of the attachment part 6 and the attachment to the abdominal cavity simulator are the same as in Example 1, and it can be attached to the assembly type abdominal cavity simulator 10.

FIG. 21 is an external perspective view of the organ model fixing device of Example 3, showing a perspective view from the foot side. As shown in FIG. 21, the urethra model fixing part 4a has a movable part 41a, a hinge part 42a, and a fastener 43a. When attaching the urethra model 8 to the urethra model fixing part 4a, the fastener 43a is removed, the movable part 41a is opened around the hinge part 42a as the axis center, and the urethra model 8 is attached. This structure is the same as the organ model fixing device 1 of Example 1.

Figure 22 shows a plan view of the organ model fixing tool of Example 3. As shown in Figure 22, the bladder model fixing part 3a is composed of a holding part 35a and an engagement part 36. The elastic part 54 reproduces the elastic force generated by the tissues surrounding the bladder when the bladder is pulled by forceps or the like during urethro-vesical anastomosis.

Figure 23 shows the external appearance of the bladder model of Example 3, where (1) is a right side view, (2) is a front view, and (3) is a perspective view. As shown in Figures 23 (1) to (3), bladder model 7a has a substantially ellipsoidal shape and is provided with two openings (73f, 73g) for attachment to engaging portion 36 and four openings (73h to 73k) used for anastomosis training. Bladder model 7a is made of PVA (polyvinyl alcohol).
Since four openings (73h to 73k) are provided for anastomosis training, when attaching the bladder model 7a to the bladder model fixing part 3a, the openings (73f, 73g) can be rotated about 90° around the axis to change the fixing direction, allowing multiple anastomosis training sessions. As shown in Figure 23 (1) or (3), a hollow part 74a is formed inside the bladder model main body 71. When attaching to the bladder model fixing part 3a, the two openings (73f, 73g) are inserted into the locking part 36 for attachment.

Fig. 24 is an image diagram of the attachment of the bladder model of Example 3, (1) shows the state before the bladder model is attached, and (2) shows the state after the bladder model is attached. In Fig. 24, the pubic part 22b is opened by using the hinge part 24 in order to attach the bladder model 7a.
The locking part 36 shown in Fig. 22 has a shape in which a rod-shaped member curved from the end 36a is folded inward at the folded-back part 36c, and is curved to the end 36b along the curved shape before folding, as shown in Fig. 24(1). When attaching the bladder model 7a, first, the openings (73f, 73g) are inserted into the gap between the end 36a and the end 36b, and one of the openings (73f, 73g) is fitted from the end 36b to the folded-back part 36 to attach it. Here, as shown in Fig. 24(2), it is inserted from the opening 73f. The locking part 36 has a structure in which the bladder model 7a is inserted from the side, so that not only is it easy to attach and remove the bladder model 7a, but it is also possible to stably reproduce the tensile stress caused by the actual bladder and its surrounding tissues. Furthermore, the curved shape of the engaging portion 36 is formed to match the ellipsoidal shape of the bladder model 7a, so that once attached, the bladder model 7a will not easily fall off even if it is pulled from the foot side.

Figure 25 shows an external perspective view of the organ model fixture to which the bladder model of Example 3 is attached. As shown in Figure 25, the organ model fixture 1a is attached to the assembled abdominal cavity simulator 10 with the bladder model 7a and urethra model 8 attached.

Figures 26 to 28 are conceptual diagrams of the use of the organ model fixing tool of Example 3, where Figure 26 shows a state in which the bladder model is not brought close to the urethra model, and Figure 27 shows a state in which the bladder model is brought close to the urethra model. Figures 26(1) and 27(1) are perspective views, and Figures 26(2) and 27(2) are left side views. Figure 28(1) shows a plan view in which the bladder model is brought close to the urethra model, and Figure 28(2) shows a plan view in which the bladder model is not brought close to the urethra model. Note that in Figures 26 to 28, for convenience of explanation, the pubic bone 22b is partially omitted.
26(1) or 26(2), when no force is being applied to bladder model 7a, opening 73k of bladder model 7a is separated from end 8a of urethra model 8. Opening 73k of bladder model 7a and end 8a of urethra model 8 mimic the opening of the bladder and the end of the urethra that are formed when the entire prostate is removed in radical prostatectomy.

In actual training, a medical instrument such as forceps is inserted through the port hole 13c of the pneumoperitoneum cover 13 shown in FIG. 13(2), and the opening 73k is pulled toward the urethra model 8 to perform anastomosis.
27(1), (2) or 28(1) show that bladder model 7a is pulled toward urethra model 8, bringing opening 73k of bladder model 7a into close proximity with end 8a of urethra model 8. If opening 73k is suddenly released during anastomosis, bladder model 7a moves to its original position shown in FIG. 28(2) due to the elastic force of elastic part 54.

Here, the structure of the elastic part 54 will be described. Fig. 29 is an explanatory diagram of the elastic part of Example 3, (1) shows a state where the bladder model is not close to the urethra model, and (2) shows a state where the bladder model is close to the urethra model. As shown in Fig. 29 (1) or (2), the elastic part 54 is composed of an elastic part main body 55, an adjustment part 56, a screw 57, a shock absorber 52 as a damper mechanism, and a coil spring 53 as an elastic body. The adjustment part 56 is fixed to the elastic part main body 55 by using the screw 57, and the elastic part main body 55 is structured to slide left and right together with the adjustment part 56 and the screw 57. The shock absorber 52 and the coil spring 53 are known shock absorbers and coil springs, respectively.
Bladder model 7a is fixed to bladder model fixing part 3a, and bladder model fixing part 3a is connected to elastic part main body 55, so that when bladder model 7a is pulled from the state shown in Fig. 29(1) towards urethra model 8 as shown in Fig. 29(2), elastic part main body 55 moves from left to right. Here, shock absorber 52 and coil spring 53 reproduce the tensile stress caused by the tissues surrounding the actual bladder, and in particular, the provision of coil spring 53 allows the tensile stress caused by the tissues surrounding the actual bladder to be realistically reproduced for the pulling action.

When the gripped state of bladder model 7a is released from the state shown in Fig. 29(2), elastic part main body 55 moves from right to left. Here, elastic part main body 55 automatically returns to the position shown in Fig. 29(1) by shock absorber 52 and coil spring 53, but in particular, by providing shock absorber 52 for the returning movement, shock absorber 52 absorbs the impact force of vibration in the expansion and contraction direction accompanying elastic deformation of coil spring 53. This makes it possible to prevent sudden expansion of coil spring 53, and realistically reproduces the contraction speed caused by the presence of surrounding tissue in an actual bladder.
The elastic force here is determined based on the force applied when the opening of the actual bladder is grasped and pulled to the end of the urethra. The speed at which the opening 73k returns to its original position when it is released is also determined based on the speed at which the opening returns to its original position when it is released from the state where the opening of the actual bladder is grasped and pulled to the end of the urethra. Specifically, it is adjusted according to the doctor's empirical tactile sensation. This allows for realistic training close to actual procedures, reproducing the elastic force generated by the tissues around the bladder.

In addition, the elastic portion 54 is provided with a mechanism that can adjust the elastic force. Figures 30 and 31 are explanatory diagrams of the adjustment mechanism, with Figure 30 showing a case where it is adjusted to the basic position, Figure 31 (1) showing a case where it is adjusted to bring the distance from the urethra model closer, and Figure 31 (2) showing a case where it is adjusted to move the distance from the urethra model farther away. Note that, for the sake of convenience of explanation, the illustrations are shown upside down, unlike the plan views of Figures 22 and the like.
30, an elongated hole 58 is formed in the adjustment part 56, and a female screw part (not shown) is formed in the elastic part main body 55. After positioning the adjustment part 56, a screw 57 is inserted into the elongated hole 58 and screwed into the female screw part, thereby fixing the adjustment part 56 to the elastic part main body 55. In other words, a part of the elastic part main body 55, the adjustment part 56, and the screw 57 form an adjustment mechanism.
In Fig. 30, the bladder model 7a is positioned at position _P2 , which is the basic position, and the screw 57 is fixed thereto. Position _P2 , which is the basic position, is a position that reproduces the tensile stress or elastic stress generated by the tissues around the bladder, based on an average human, and the distance from the through-hole 22a to the opening 73k of the bladder model 7a is distance _D2 . Therefore, when performing training, it is sufficient to basically position the bladder model 7a at position _P2 and fix the screw 57 thereto.

However, there are individual differences in human organs, and there are also individual differences in the tensile stress or elastic stress generated by the tissues surrounding the organs. Therefore, the structure is designed to be able to change the position at which the adjustment part 56 is fixed on the elastic part main body 55. For example, if it is desired to weaken the tensile stress, as shown in FIG. 31 (1), the position at which the screw 57 is fixed can be adjusted and fixed closer to the position _P3 of the long hole 58. This allows the distance from the through hole 22a to the opening 73k to be set to a distance _D3 that is shorter than the distance _D2 . On the other hand, if it is desired to strengthen the tensile stress, as shown in FIG. 31 (2), the position at which the screw 57 is fixed can be adjusted and fixed closer to the position _P1 of the long hole 58. This allows the distance from the through hole 22a to the opening 73k to be set to a distance _D1 that is longer than the distance _D2 . Since the distance between positions _P1 and _P2 , or between positions _P2 and _P3 , is approximately 20 mm, it can be adjusted within a range of approximately 20 mm forward or backward from position _P2 , and the distance from through hole 22a to opening 73k can also be adjusted within a range of approximately 20 mm forward or backward from distance _D2 . In this way, in the elastic portion 54 of Example 3, a mechanism for adjusting the fixed position of adjustment portion 56 is provided, thereby enabling a variety of training according to needs.

Other Examples
19 is an explanatory diagram of an elastic part of another embodiment, where (1) shows a state where the bladder model is not close to the urethra model, and (2) shows a state where the bladder model is close to the urethra model. As shown in FIG. 19(1) or (2), the elastic part 5a is different from the elastic part 5 of the first embodiment in that the shock absorber 52 and the coil spring 53 are provided coaxially. The other configurations are the same as those of the first embodiment. In this way, the shock absorber 52 and the coil spring 53 only need to be connected to the elastic part main body (5, 5a), and the shock absorber 52 and the coil spring 53 may be provided on different axes or may be provided on the same axis.

The present invention is useful as a technology that enables realistic procedural training using organ models, and is particularly useful for training in robotic surgery.

DESCRIPTION OF SYMBOLS 1, 1a, 100, 101 Organ model fixing tool 2, 2a Fixing tool main body 3, 3a Bladder model fixing part 4, 4a Urethral model fixing part 5, 5a, 50, 54 Elastic part 6 Attachment part 7, 7a Bladder model 8 Urethral model 8a, 8b End part 8c Torso part 10 Assembled abdominal cavity simulator 11, 11a, 11b Pedestal 12a, 12b Side plate member 13 Insufflation cover 13a Insufflation area 13b Frame part 13c Port hole 14, 43, 43a, 63 Fastener 15a to 15c Fixing part 21, 21a Support part 22, 22b Pubic part 22a Through hole 23, 23a Grip part 24 Hinge part Description of the Related Art 30a, 30b, 40a, 40b Organ model fixing part 31, 41, 41a, 61 Movable part 32, 42, 42a, 62 Hinge part 33 Non-movable part 34 Elastic member 35, 35a Holding part 36 Locking part 36a, 36b End part 36c Folded part 44 Urethral model fixing part main body 44a, 64 Recess 51, 55 Elastic part main body 52 Shock absorber 53 Coil spring 56 Adjustment part 57 Screw 58 Slot 70a, 70b Jejunum model 80a, 80b Esophagus model 71 Bladder model main body 72 Edge 73a to 73k Opening 74, 74a Hollow part D ₁ to D ₃ distance L ₁ to L ₃ length P ₁ ~P ₃ position R Maximum movable range

Claims (10)

A fixture for fixing an organ model for training in anastomosis of an organ model housed in a simulator simulating a human body, comprising:
a first organ model fixing unit that fixes the first organ model, and a second organ model fixing unit that fixes the second organ model;
An organ model fixing device characterized in that at least one of the organ model fixing parts is provided with an elastic part consisting of an elastic body and a damper mechanism, and by pulling or pressing the organ model in the extension/contraction direction of the elastic body, the damper mechanism absorbs the impact force of vibration in the extension/contraction direction associated with the elastic deformation of the elastic body. The organ model fixing device according to claim 1, characterized in that the elastic part is provided on either the first organ model fixing part or the second organ model fixing part. The organ model fixing device according to claim 1, further comprising an adjustment mechanism that adjusts the tensile stress of the elastic part and the contraction speed in response to the tensile stress and the contraction speed in response to the tensile stress on the surrounding tissue of the actual organ of the organ model. The organ model fixing device according to claim 3, further comprising an adjustment mechanism that adjusts the elastic stress of the elastic part and the expansion speed in response to pressure according to the elastic stress on the surrounding tissue of the actual organ of the organ model and the expansion speed in response to pressure. The organ model fixing device according to claim 1, further comprising an adjustment mechanism that adjusts the tensile stress of the elastic part and the contraction speed in response to tension according to the tensile stress of the elastic part and the contraction speed in response to tension at the part of the actual organ of the organ model. The training is urethrovesical anastomosis training in radical prostatectomy,
the first organ model and the second organ model are an organ model simulating a bladder and an organ model simulating a urethra, respectively;
The organ model fixing device according to claim 3 or 4, further comprising an adjustment mechanism that can adjust the tensile stress of the elastic part and its contraction speed in response to tension in accordance with the tensile stress on the actual surrounding tissue of the bladder and its contraction speed in response to tension, and can adjust the elastic stress of the elastic part and its expansion speed in response to pressure in accordance with the elastic stress on the actual surrounding tissue of the bladder and its expansion speed in response to pressure. The training is training in digestive tract reconstruction in total gastrectomy,
6. The organ model fixing device according to claim 5, wherein the first organ model and the second organ model are an organ model simulating the esophagus and an organ model simulating the jejunum, respectively, and the length of each tube of each organ model is shorter than the actual length. The organ model fixing device according to claim 1 or 2, characterized in that the elastic force of the elastic part and the impact force are adjusted according to the doctor's empirical tactile sensation. The organ model fixing device according to claim 1, characterized in that the organ model fixing part includes a movable part having a hinge, and the movable part engages and fixes the inner surface of the organ model. 2. The organ model fixing tool according to claim 1, wherein the organ model fixing portion comprises a rod-shaped member, and the organ model is inserted into the rod-shaped member to fix the organ model.