DE19716341A1 - Model of human torso with simulated organs for surgical training - Google Patents

Abstract

Instructional aid in the form of a human torso is designed to improve surgical skills by training under simulated real-life conditions. A range of artificial organs which exhibit similar characteristics to live tissue in their response to standard surgical practices and each model comprises a hollow plastic exterior housing the simulated tissue. The interior is made up from a moulding mix containing a hydrogel of variable composition together with an electrolyte and a combustible fibrous material. The method is suitable for the insertion of an endoscope and surgical resection is able to be performed on typical replica organs e.g. bladder, colon, prostate etc., using laser, HF or plasma technology.

Description

The invention relates to a training model, in particular torso, a liquid-tight hollow organ and the use of a Training model with such a hollow organ for surgical operation training, especially training endoscopic operations. In addition, the Invention an artificial, resectable tissue for a Training model or hollow organ for surgical operations training.

Artificial organs, organ parts or organ systems for sub Legal anatomy has been used for many decades knows. However, there are no artificial organs, organ parts or organ systems to which special diagnostic  and / or interventional, such as. B. HF surgical procedures or the like can be trained.

Training on artificial organs, parts of organs or organs systems is especially in the rigid as in the fle xiblen endoscopy is extremely important to a safe Learn to use endoscopic instruments.

As is known, include surgical procedures of endoscopy, such as endoscopic polypectomy and transurethral resection of the prostate relatively many variables and interdependent parameters so that it is safe to use and to avoid complications with appropriate operational procedure proves to be an urgent need comprehensive training.

An important parameter in all operational procedures, at to those of high frequency surgery and in general the resect tion is used, the RF power, its intensity both is crucial when coagulating as well as cutting. The Setting the respective performance and running the Operative instruments require experience and skill that can only be learned through training.

The application of high-frequency electri biological alternating current for local endogenous heating understood tissue, the heating up to a Temperature takes place at which intra- and extracellular col loidal tissue components from the sol to a gel state pass over. Additional heating of the coagulated tissue leads to dry out, d. H. to desiccation, causing the tissue vo lumen shrinks. Another warming of the dried out Tissue leads to carbonization, i.e. H. for combustion. The three aforementioned thermally caused necrosis stages under differ only in the necessary for this Amount of heat.

From this it is already clear that there is great experience must lie in order to successfully apply the desired technique to be able to. For example, in some cases one is sufficient  efficient hemostasis, d. H. Hemostasis, the coagulation, in others the desiccation. For cutting with Electrosurgical procedures require energy in this way to deliver that targeted and quick endogenous heating of the biological tissue up to a temperature at which the intra- and extracellular water evaporates so quickly, that here the cell membranes by the sudden vapor pressure be torn apart.

Additional difficulties arise when in the Gastroenterology with the help of endoscopic instruments Argon-plasma coagulations are to be performed. Training on organs is particularly problematic Liquid filling, e.g. B. perform a prostate resection to be able to.

DE 43 45 020 A1 is a training module made of plastic as well as an electrosurgical cutable plastic knows. The plastic disclosed there is addition-crosslinked or condensation-crosslinked polyxyloxanes, for example silicone. The silicone material becomes an electrical conductive substance, for example metal in the form of Metal shavings or a salt added. Through these additions the plastic can be used for electrosurgical preparation medical training devices are used. Problems regarding an effective, realistic training arise, however, when thermal effects are simulated to become more organic Tissue components match.

The medical training manikin according to US Pat. No. 5,314,339 forms largely replaces a human body and is intended to end education of medical personnel. The Training manikin shows appropriate extremities and Body openings. There is also an opening, for example to insert a tracheostomy tube. For the Education or training in handling surgical Surgical techniques are those shown in U.S. Patent 5,314,339 However, doll is not suitable.

It is therefore an object of the invention to develop a training model liquid-tight hollow organ and an artificial resect to indicate capable tissue in an effective manner realistic training and handling training surgical, in particular endoscopic, surgical techniques enable, taking the characteristics of the training model should be largely adapted to natural conditions and that these natural conditions last for a long time maintains space.

The object of the invention is achieved with a trai ningsmodell according to its definition according to claim 1, with a liquid-tight hollow organ according to the features Claim 2 and with an artificial resectable Fabric according to claim 4.

In addition, to achieve the object of the invention Use of a training model or a liquid dense hollow organ as defined in claim 3 ver grasslands.

The first basic idea of the invention is a trai ningsmodell, in particular to specify a torso that min at least comprises a liquid-tight hollow organ, the Hollow organ made of resectable artificial tissue and / or a hollow plastic body with resec attached inside capable artificial tissue. In addition, that at least one hollow organ at least one opening for insertion endoscopic instruments.

According to a second basic idea of the invention, there is liquid-tight hollow organ made of resectable artificial Fabric and / or a hollow plastic body with be inside strengthened resectable artificial tissue, the Hollow organ at least one opening for endoscopic insertion Instruments, e.g. B. for training a prostate resection points.  

According to a third basic idea of the invention, there is Resectable artificial tissue used for surgery surgical training from a malleable mixture a hydrogel, an electrolyte and flammable fibers, the hydrogel containing agar and water. Alternatively the hydrogel may contain gelatin and water.

According to the invention, a hydrophilic, watery soluble polymer can be used. The electrolyte of the artificial Tissue is sodium chloride, potassium chloride or calcium chloride. The flammable fibers are made of cotton and linen or Kämmling, an admixture of dyes for color reproduction of natural tissue is conceivable.

The use of the training model, in particular torso, or the liquid-tight hollow organ is used for surgical purposes Surgical training on fluid-filled hollow organs or fluid-filled cavities, especially the training of endoscopic operations such as B. prostate resection, Rectal resection, transurethral resection or the like.

The artificial tissue used has, as shown briefly above placed an appropriate electrical conductivity so that the physical effects of cutting in HF surgery allow to enter. The fabric also has Water, which can evaporate, and also means, which solid organic tissue components are equivalent, so that a combustion of the same as natural tissue is possible.

The artificial tissue according to the invention can be shaped so that reproduced natural organs, organ parts or organ systems can be. For this, the aforementioned shape-retaining Hydrogels used. Through different mixing ratios of the components mentioned can be within a complex fabric structure different artificial tissues different material mixtures combined be, so that appropriate structures or structure distributions can be replicated.  

The mixture to form the artificial resectable Tissue can be a hygroscopic agent, such as glycerin be added so that an early, undesirable end drying is prevented. In addition, the glycerin-be improved mix the combustion of the fibers contained in the fabric. There is also an admixture from food chemistry known preservatives to prevent mold education beneficial.

According to the invention, the hollow organs containing artificial resectable tissue, not just an anatomical shape are given, but there are pathological changes representable, especially for training surgical Interventions can be used.

This enables the surgeon, on the one hand, the respective pathological changes, e.g. B. polyps, tumors, Ulcera and so on to recognize, and secondly about it in addition by an appropriate method of operation Surgically treat pathological changes in training or remove.

In a special embodiment of the invention assumed that in the artificial tissues vascular structures, but also body cavities can be molded, which with Kon traction agents, concrements, liquids or gases can be filled are to diagnostic procedures, such as imaging bende procedures as well as combined procedures, such as to train the papillotomy or the stone extraction. A Such an artificial body cavity is used in particular for task-based training of endoscopic procedures.

All in all, the invention succeeds in training model, in particular a torso, comprising liquid-tightness Specify hollow organs with artificial resectable tissue which is an effective especially surgical endosko pical training allows the effects that occur largely those in the treatment of natural man correspond to the fabric.  

So due to the electrical conductivity of the artificial Tissue, the possibility that HF current can flow, which creates endogenous heat. This in turn will Vapor formation and consequently desiccation reached. Since the turned set hydrogels from gel to gel at higher temperatures Override sol state, d. H. melt, and on the other hand the beige mixed flammable fibers can only be cut if the RF voltage is sufficiently high that a electrical arc between cutting electrode and tissue trained, effects are achieved that are more fixed to the behavior orient organic tissue components.

The invention is illustrated below with the aid of an embodiment be explained in more detail.

A training model according to an embodiment, esp especially an abdominal torso, comprises at least one liquid cavity-tight hollow organ, consisting of resectable artificial Lich tissue, and / or a hollow plastic body with im Fixed resected artificial tissue inside.

The hollow organ can, for example, take the form of a urinary bladder, Colon bladder, a uterus, a cervix uteri, a cavitas uteri or a corpus uteri, at least one There is an opening for inserting endoscopic instruments.

Such a patient's torso is used for the Opera tion training, especially the execution of endoscopic surgery rations under liquid, e.g. B. under water.

The basic unit is therefore a liquid-tight hollow organ, which either consists entirely of resectable synthetic material or which comprises a hollow plastic body, in the interior thereof the resectable material is attached.

As stated, the training model will include a flow liquid-tight hollow organ with appropriate resectionable Tissue or tissue components for surgical operation training  on liquid-filled artificial organs or fluid-filled cavities, especially for training endoscopic operations such as the prostate resection mentioned, Rectal resection or the like is used.

The artificial tissue used, from which natural Or gane or resectable sections formed in the hollow organ according to the exemplary embodiment consists of a water-containing material, in particular a hydrogel, which an electrolyte, for example sodium chloride, potassium chloride or the like. In addition, the mixture contains which the artificial tissue is made of, flammable Fibers, for example cotton, linen or comb, which in the production of sheep's wool.

For example, a mixture is used as a dimensionally stable hydrogel from 4% agar and 96% water (93.5% water and 2.5% Gly zerin) or 20.8% gelatin and 75.2% water.

Other gels are also analog, i. H. of liquids and gases rich disperse systems consisting of at least two components reversible, which is a solid, colloidal substance and water have as dispersants.

It is advantageous to use the agar agar mentioned, one gel-forming heteropolysaccharides, the production of which com is operated commercially. Agar agar still forms in 1% solution a firm gel that melts between 80 ° and 100 °, and therefore can be used advantageously. The hydrogels used combine on one side hydrophilic, on the other side but water-insoluble properties and ensure that Desired shape maintenance inside the hollow organ. The the The added electrolyte serves to preserve the desired electrical conductivity and the existing ones According to the natural, fibers form a mechanical one Resistance when cutting the tissue, which is only overcome can be when the energy, e.g. B. the RF voltage so high is that there is an arc between the cutting electrode and  Forms tissue and the fibers in the arc burn.

The electrical conductivity given by the electrolyte allows the flow of rf current in artificial tissue where created by endogenous heat. The heat leads to the formation of steam and desiccation of the artificial tissue. As mentioned, will be flammable fibers attached to the artificial tissue to make one Achieve cutting effect of HF surgery in natural human tissue, where solid organic Tissue components melt away without force Prevent cutting electrode.

In a further embodiment for the used artificial tissues there are different tissue structures reproduced by taking individual tissue components under different mixing ratios between hydrogel and fiber share and electrolytes, so that different physical properties can be simulated. In addition, you can the different mixed artificial tissues different colors are added to the fabric structure even when viewed endoscopically do.

It has been shown that the addition of hygroscopic agents, For example, glycerin or the like. An early drying of the artificial tissue prevented, so that its storage and Ein ability to compete is guaranteed over a longer period of time. In addition, the Gylzerin admixture improves during the Cutting the combustion of the fibers. As a conserve Rungstoff can for example 0.1% sorbic acid (trans-trans-hexadyen-2,4-acid) or 0.3% PHB ester mixture (0.21% p-hydroxybenzoic acid methyl ester and 0.09% propyl p-hydroxybenzoate) are added.

Due to the malleability of the mixture, artificial organs, but also organ parts or organ systems, with anatomical and / or pathological abnormalities or findings are formed so that appropriate surgical inter  vention, especially the endoscopic task Techniques can be trained. Especially for the endo scopic surgical technique can the artificial organs, Organ parts or organ systems molded body cavities point so that diagnostic procedures and surgical Surgical techniques can be tried and learned.

The artificial tissues can also provide bone-like support have structures so that there are opportunities for learners further improve and train surgical techniques.

The described artificial tissue as well as the training model, which uses such a fabric is therefore for the Simulation of endoscopic interventions preferred net. It offers an imitation of the anatomical, mechanical and specific electrical properties of various natural tissue representing the application of mechanical Applicators, of different laser types and all forms radio frequency energy including argon plasma coagulation allowed and leads to the same effects as in vivo. The the effects obtained are reproducible and standardized, which makes training the surgeon much easier. The special anatomical conditions can be determined by the Very easy to reproduce the pourability of the original substance and for both physiological and pathological disorders use. So different types of polyps, different Papilla variants and different tumor configurations be replicated. The artificial tissue used or Training models allow realistic simulation for the first time endoscopic interventions such as polypectomy or sphincterotomy with reproducible effects and is therefore ideal for that Learn these interventions or develop new ones Methods. The described artificial tissue enables Replication of simple to complicated lesions related Localization, shape, structure, pathomophology, more specific Fabric properties and so on. This allows training Reproducible models with defined levels of difficulty will be realized. So are training models for beginners provided, which primarily for training the operation of  Endoscopes and instruments as well as the safe application of the relevant effects of intervention procedures, e.g. B. RF Chi rurgy, laser surgery, plasma surgery and so on are suitable. Advanced training models are for the operative training of sufficient routine with standard-in interventions provided. However, models for experts are for training complicated or risky interventions designed, e.g. B. difficult localization, difficult application or difficult morphology. It is particularly preferably carried out with the training model the simulation of HF surgical cutting edge procedure using the example of transurethral resection of the Prostate. From the artificial tissue normal and patho logical prostates are replicated and transformed into suitable ones Training models, d. H. Interchangeable urogenital phantoms be inserted. Because the transurethral resection of the prostate done under rinsing liquid is the artificial tissue designed accordingly. During the resection, the specific electrical resistance of the tissue due to electrolyte dew flooding can be very different. To overcome these difficulties To be able to train, the prostate is removed in the training model artificial materials with different electrical Replica of resistors.

Claims (13)

l. Training model, especially torso, comprehensive at least one liquid-tight hollow organ, consisting of resectable artificial tissue and / or an art fabric hollow body with resectable attached inside artificial tissue, the hollow organ at least one Opening for inserting endoscopic instruments or the like having. 2. Liquid-tight hollow organ consisting of resection capable artificial tissue and / or a hollow plastic body with resectable artificial attached inside Tissue in the form of a urinary bladder, colon, colon bladder, uterus, Cervix uteri, Cavitas uteri, Corpus uteri or the like.   3. Use of a training model according to claim 1 or a liquid-tight hollow organ according to claim 2 for surgical operation training on fluid-filled Organs or fluid-filled cavities, in particular training endoscopic operations such as B. trans urethral resection, prostate resection, rectal resection or the like. 4. Artificial, resectable tissue for a training session model or a hollow organ according to claim 1 or 2, marked by a malleable mixture of a hydrogel, an electrolyte as well as flammable fibers. 5. Artificial fabric according to claim 4, characterized, that the hydrogel contains agar and water. 6. Artificial tissue according to claim 4, characterized, that the hydrogel contains gelatin and water. 7. Artificial fabric according to claim 4, characterized, that the hydrogel is a hydrophilic, water-insoluble polymer is. 8. Artificial tissue according to one of claims 4 to 7, characterized, that the electrolyte is sodium chloride, potassium chloride, calcium chloride or the like. 9. Artificial tissue according to one of claims 4 to 8, characterized, that the flammable fibers of cotton, linen, noose or the like.   10. Artificial tissue according to one of claims 4 to 9, characterized by the addition of dyes to the color imitation of natural tissue. 11. Artificial tissue according to claim 10, characterized, that the dyes in the temperature range between 50 ° and 100 ° C. have one or more color changes. 12. Artificial tissue according to one of claims 4 to 11, marked by different mixing ratios and putting together of several fabrics of different mixing ratios Formation of a tissue structure with different properties create. 13. Artificial tissue according to one of claims 4 to 12, marked by Admixture of a hygroscopic agent, in particular Glycerin for preservation.