DE19716341C2 - Training model, especially torso - Google Patents

Description

The invention relates to a training model, in particular torso, for surgical operation training, especially training endoscopic operations.

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 Opera instruments require experience and skill, that only is to be learned through training.

The application of high-frequency electri biological alternating current for local endogenous heating understood tissue, the heating up to a tem temperature occurs 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 Ge webes leads to carbonization, d. H. for combustion. The three the aforementioned thermally caused necrosis stages the only by the amount of heat required for this. 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 an ef is sufficient efficient hemostasis, d. H. Hemostasis, the coagulation, in at whose desiccation. For cutting with HF surgery gic processes, it is necessary to supply energy in this way ren that targeted and rapid endogenous heating of the biolo Tissue takes place up to a temperature at which intra- and extracellular water evaporates so quickly that here the cell membranes are broken up by the sudden vapor pressure be torn.

Additional difficulties arise when in the gastro enterology with the help of endoscopic instruments Argon-plasma coagulations are to be performed. Especially training on organs under liquid is also problematic filling to z. B. perform a prostate resection can.

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 latex or added a salt. Through these admixtures, the Plastic for electrosurgical preparation at medical African training equipment can be used. Problems effective, realistic training however, when thermal effects are simulated which are caused by the combustion of organic tissue components equal.

The medical training manikin according to US Pat. No. 5,314,339 forms largely follows a human body and is intended for training medical personnel. The trai ningspuppe has appropriate extremities and bodies for this openings. In addition, for example, there is an opening for A tracheostomy tube is inserted. For the training training in the handling of surgical operations techniques, however, is the manikin shown in U.S. Patent 5,314,339 not suitable.

The German utility model G 93 20 422.1 shows a medical cal training device, which is especially for the diagnostic and surgical hysteroscopy was created. In a case which consists of an upper and lower part, a spe target training module. Inside the trai In turn, preparations can now be provided. Con kret is referred to so-called meat or model preparations sen. There is also the option of a gas or Simulate and adjust liquid outflow, e.g. B. Check fluid distension devices. The after published DE 195 40 656 A1 discloses an artificial Ge weave, consisting of a malleable mixture of a hydro gel, an electrolyte and flammable fibers, the ones there shown mixture for the reproduction of organs, organ parts or Organ systems can be used.  

In the simulation model for practicing training operations according to DE 42 12 908 A1, a human or animal body perave with respective layers at least in some areas ana Recreated according to tomography and topographically. The intended organs are gas or liquid-tight bar.

Ultimately, utility model G 94 08 749.0 is one Device for simulating human endoscopic interventions Lichen or animal body known, the device includes a thorax model, which is modeled anatomically is. One or more hollow bodies and organ are in the model Replicas and an implementation for an endoscope hen. The material of the organ model or the hollow body is different not specified yet.

It is therefore an object of the invention to provide a training model, in particular special torso to indicate that in an effective manner a realistic close training and training in handling surgical, enables in particular endoscopic surgical techniques, taking the characteristics of the training model largely should be adapted to natural conditions and these Preserve natural conditions over a longer period of time stay.

The object of the invention is achieved with a trai ningsmodell as defined in claim 1.

The basic idea of the invention is a training mo dell, in particular to specify a torso which is at least comprises a liquid-tight hollow organ, the hollow organ made of resectable artificial tissue and / or an art hollow fabric body with resectable attached inside artificial tissue. In addition, that points at least a hollow organ has at least one opening for endoscopic insertion instruments.  

The liquid-tight hollow organ consists of resectable artificial tissue and / or a hollow plastic body with im Inner attached resectable artificial tissue, being the hollow organ has at least one opening for endoscopic insertion shear instruments, e.g. B. for training a prostate resection having.

Furthermore, the resectable artificial is used Tissue for surgical surgical training from a malleable Mixture of a hydrogel, an electrolyte and combustible ren fibers, the hydrogel containing agar and water. Alternatively, the hydrogel can include gelatin and water.

A hydrophilic, water-insoluble polymer can be used as the hydrogel be used. The electrolyte of the artificial tissue is Sodium chloride, potassium chloride or calcium chloride. The Brennba Ren fibers consist of cotton, linen or comb, whereby an admixture of dyes for color reproduction na door fabric 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, rec tum 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 at the RF chir urgie enable to enter. Furthermore, the fabric has what water, which can evaporate, and also means which solid organic tissue components, so that a burn of the same is possible analogous to the natural tissue is.  

The artificial tissue can be shaped so that natural organs, Organ parts or organ systems can be simulated. Here the dimensionally stable hydrogels mentioned are used for this. By different mixing ratios of the mentioned ge named components can be within a more complex tissue structure different artificial tissues from different ones Mixtures of materials are interconnected so that ent talking structures or structure distributions can be reproduced are.

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 glycerine improves Admixture the combustion of the fibers contained in the fabric. Also an admixture of be from food chemistry knew about preservatives to avoid mold beneficial.

The hollow organs, containing artificial resectable Ge weave, can not only be given an anatomically correct shape, but pathological changes can be represented that especially for training surgical interventions can be detected.

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 Appropriate training used endoscopic procedures.

All in all, the invention is a training mo dell, in particular a torso, comprising liquid-tight Specify hollow organs with artificial resectable tissue which is an effective especially surgical endoscopy cal training allows, the effects occurring far going to those in treating natural human Match the fabric.

So due to the electrical conductivity of the artificial Tissue given the possibility that RF current can flow where created by endogenous heat. This in turn will Vapor formation and consequently desiccation reached. Since the turned set hydrogels at higher temperatures from gel to sol Pass condition, 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, in particular whose abdominal torso comprises at least one fluid dense hollow organ, consisting of resectable artificial Tissue, and / or a hollow plastic body with be inside strengthened resectable artificial tissue.

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 liquid filled cavities, especially for training endoscopic operations such as the aforementioned prostate resection, rectal Resection or the like is used.

The artificial tissue used, from which natural Or gane or resectable sections formed in the hollow organ can, according to the embodiment consists of what material containing water, in particular a hydrogel, which a Electrolyte, for example sodium chloride, potassium chloride or the like. were added. In addition, the mixture contains wel artificial tissue is made, flammable fibers, for example cotton, linen or noose, which at the Sheep wool production arises.

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 is coming is operated. 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 the ge wanted shape maintenance inside the hollow organ. The of the The added electrolyte serves to maintain the desired electrical conductivity and the existing fibers form a mechanical resistance in accordance with the natural Cutting the tissue, which can only be overcome if the energy, e.g. B. the RF voltage is so high that a Arc forms between cutting electrode and tissue and burn the fibers in the arc.

The electrical conductivity given by the electrolyte allows the flow of RF electricity in the 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 a powerless melting of the cutting prevent the 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 preservation 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 so that appropriate surgical interventions, especially the task-based endoscopic techniques trai can be renated. Especially for the endoscopic opera tion technology can be the artificial organs, organ parts or Organ systems have molded body cavities, so that diagno Tried and tested surgical procedures and surgical techniques and can be 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 Simu lation of endoscopic interventions preferred. It offers an imitation of anatomical, mechanical and special specific electrical properties of various natural Tissue that represents the application of mechanical applicators, of different types of lasers and all forms of high frequency Quench energy allowed including argon plasma coagulation and leads to the same effects as in vivo. The received Ef fects are reproducible and standardized, what the training of the surgeon is much easier. The special ana  tomic conditions can be determined by the pourability of the It is very easy to reproduce the original substance and both for physio use logical as well as pathological disorders. So can different types of polyps, different types of papillae and different tumor configurations are simulated. The allow the use of artificial tissue or the training model for the first time a realistic simulation of endoscopic interventions such as polypectomy or sphincterotomy with reproducible Ef and is therefore ideal for learning this intervention or for the development of new methods. The described artificial tissue enables the simulation to be simple to com localized lesions in terms of location, shape, structure, pa thomophology, specific tissue properties and so on. This allows training models with defined difficulty degrees can be realized reproducibly. So are training mo delle intended for beginners, who 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. HF surgery, laser surgery, plasma surgery and so on are further suitable. Training models for advanced users are sufficient routine at Stan for operative training dard interventions provided. However, models for experts are complex or risky interventions for training NEN designed, for. B. difficult localization, difficult appli cation or difficult morphology. This is particularly preferred with the training model the simulation of electrosurgical cutting de procedure using the example of transurethral resection of the Pro stata. From the artificial tissue can be normal and pathological prostate prostheses are reproduced and in suitable training models, d. H. Urogenitial phantoms interchangeably inserted the. Since the transurethral resection of the prostate under irrigation If there is liquid, the artificial tissue is corresponding designed. During the resection, the specific electrical Tissue resistance due to electrolyte leaching very much to be different. To train these difficulties too in the training model, the prostate becomes artificial  Materials with different electrical resistances replicated.

Claims (10)

1. Training model, especially torso for surgical, especially high frequency surgical endoscopic surgery on training, comprising at least one liquid-tight Hollow organ, consisting of resectable, artificial tissue and / or a hollow plastic body with attached inside resectable artificial tissue, the hollow organ min an opening for the insertion of endoscopic instruments has and wherein the resectable material is a moldable Mixture of a hydrogel, an electrolyte and combustible ren fibers. 2. Training model according to claim 1, characterized, that the hydrogel contains agar and water. 3. Training model according to claim 1, characterized, that the hydrogel contains gelatin and water. 4. Training model according to claim 1, characterized, that the hydrogel is a hydrophilic, water-insoluble polymer is. 5. Training model according to one of claims 1 to 4, characterized, that the electrolyte is sodium chloride, potassium chloride, calcium is chloride.   6. Training model according to one of claims 1-5, characterized, that the combustible fibers of cotton, linen and / or Noil exist. 7. Training model according to one of claims 1 to 6, characterized by the addition of dyes to the color Replica of natural tissue. 8. Training model according to claim 7, characterized, that the dyes in the temperature range between 50 ° and 100 ° C. have one or more color changes. 9. Training model according to one of claims 1 to 8, marked by different mixing ratios and putting together of several fabrics of different mixing ratios Formation of a tissue structure with different properties create. 10. Training model according to one of claims 1 to 9, marked by Admixture of a hygroscopic agent, in particular Glycerin for preservation.