DE4105892A1 - Simulation training appts. for surgery - comprises sealed housing and cover releasably connected to housing, excess pressure being formable in housing, and having flat insert in cover top side opening - Google Patents

Abstract

In an opening (34) in the upper side (33) of the housing (31, 32) a flat insert (35) is fitted which is made of material simulating human skin, pref. neoprene, and is of the two layer type. The housing (31) has a cover (32) which tightly closes it, but is releasably connected to it, the insert opening actually being formed in the cover. The top side of the cover has the shape of the human abdominal wall, and the insert is exchangeable, being connected to a pressure plate which is screwed to the cover. In the pressure plate is a fixation point which extends into the insert. The housing floor (36) is provided with a trough (38) and a fixture ring, and in one or more housing side walls a door is tightly fitted. On the housing is a connection for a power cable, and inside it is a neutral electrode. A training module employed consists of a baseplate with screws arranged in a circle. USE/ADVANTAGE - For surgical operative technique training in carrying out laparoscopy.

Description

The invention relates to a training device (simulation training device) for laparoscopic surgical technique.

Laparoscopy is a surgical opera tion technology, both for diagnosis and for Thera pie is applicable. The main areas of application are the laparosko typical appendectomy, laparoscopic cholecystectomy and laparoscopic adhesiolysis.

The laparoscopic appendectomy takes place in one conventional equipped operating room on laparotomy standby. In addition to the surgeon, there is an assistant and an instrumentator sister and a jumper required.

After initiation of intubation anesthesia and storage of the patient stone cut position combined with a Trendelenburg style and slight left side position, the Opera is covered area and thorough disinfection of the carefully cleaned navel. Preoperative antibiotic administration is not a reason additionally required. Every patient is cetered once, about visual impairment and risk of injury from a full bladder to avoid. After a stab incision on the caudal umbilicus and Transumbilical puncture of the abdominal cavity with the Veress needle becomes a C02 pneumoperitoneum with intra-abdominal pressure  of 12-14 mmHG (adults) or 10-12 mmHG (children).

Before gas insufflation, the correct position of the Veress needle checked by several tests. In addition to the injection, Aspira tion and manometer test is the so-called slurp test guided: A river applied to the cone of the Veress needle Liquid drop is removed by the ent when the abdominal wall is raised standing vacuum sucked in.

After removing the Veress needle, the optical trocar (11 mm for Adults, 7 mm for children) in the Z described by SEMM or scenery technology introduced. A diagnostic overview to the exclusion of iatrogenic injuries is done by the hop kins straight optics with flanged-on video camera.

Then a 5.5 mm instrument is inserted trocars under endoscopic control through a stab incision in the left lower abdomen. The search for a vascular poor area for the trocar puncture is done with the help of diaphanoscopy.

The assistant fixes the trocar sleeves to the surgeon Introduce and operate the instruments to facilitate and a to avoid unintentional pulling out.

Supported by an atraumatic stylus, the entire abdominal cavity to be inspected. For this are location Changes (head-low, links, etc.) are helpful.

The magnification of the magnifier of the endoscope allows the assessment of the Stage of appendicitis. The 11 mm trocar for the appendix extract The goal sleeve is visible at the level of the anterior iliac spine superior in the right lower abdomen through a small skin incision stabbed.

The surgeon pulls the appendix tip into the Extractor so that the mesenteriolum is stretched like a sail  becomes. Then the gradual skeletonization of the Appendix through mutual use of the HF bipolar forceps and the scissors for coagulation of the mesenteric membrane including the Appendicular artery and tissue dissection in the coagula tion zone.

After reaching the base, the appendix is ligated with a pre-knotted Seralon loops. The one used Knot pusher allows safe placement and tightening of the Knot. With a safety distance of 5-7 mm distal to the The appendix is coagulated by ligature. This leads to Welding of the lumen caused by the resulting heat (<130 ° C) is germ-free in the area of the coagulation zone. The Worm process is severed in the coagulation zone and without Contact to the abdominal wall removed by the extractor.

In order to be able to perform the laparoscopic surgical technique, the surgeon must be able to practice or train this technique. Although the surgical techniques of preparation, suturing, etc. in laparoscopic surgery does not fundamentally differ from Distinguishing those on the open stomach requires their implementation manual dexterity and constant practice.

The object of the invention is therefore to provide a training device create that as a simulation training device for the lapa roscopic surgical technique is particularly useful.

According to the invention, this object is achieved by a training device for the laparoscopic surgical technique according to claim 1 solved. The training device consists of a sealed housing, in that a positive pressure can be introduced, and one in an opening in provided on the top of the housing, sheet-like insert from a material that simulates human skin, preferably wise neoprene. The training device according to the invention is closed sen and sealed, so that a realistic work with Overpressure is possible. C02 can be inserted into the device.  

But it is also possible to use a different gas or liquid, in particular water or saline solution gene.

Advantageous further developments are in the dependent claims wrote.

The insert can consist of two-layer neoprene. By this material will simu human skin particularly well liert. Furthermore, when using two-layer neo pren the so-called Z-technique for inserting the trocars well trainable.

The housing can have a lid that - the housing is sealed in conclusion - can be detachably connected to the housing. Hereby the device can be opened if necessary, for example Training modules or objects to be practiced on insert the housing. Then the housing can the lid must be tightly closed.

The sheet-like insert, which is preferably made of two layers ten-neoprene can be provided in the lid. The opening in the top of the housing or cover, in which the flä Chen-shaped insert is preferably in the shape of human abdominal wall.

The sheet-like insert (made of two-layer neoprene) is in front exchangeable. This must be done after about three exercises can be exchanged.

The use with one on the top is advantageous the pressure plate provided on the housing or cover. The pressure plate can be screwed to the housing or cover be. The screw connection is preferably carried out by a screw with wing nut. The insert can be between the housing or Cover and the pressure plate must be clamped. This allows him to  quickly disassembled and reassembled or replaced will. In the printing plate are preferably used protruding fixing tips are provided, which are used against Secure moving and secure well.

The housing base can be provided with a trough. In these Trough can be objects, such as matches with which those for the laparoscopic opera required dexterity can. A mounting ring can also be attached to the housing base be provided. In this mounting ring, for example a balloon simulating the gallbladder is attached.

According to a further advantageous development, one or several housing side walls sealingly inserted a door. This door can be opened to items in this way to be able to insert into or remove from the device.

Can on the housing, preferably on a housing side wall a connection for a power line may be provided. Through this Connection can be a neutral electrode provided in the housing be electrically connected to the outside of the device. The The neutral electrode is preferably flat; they is preferably on the bottom of the housing. It serves for that Training with organs, such as the liver or intestines, if with monopolar HF current is used, e.g. B. using a hook electrode or a monopolar coagulator.

The edges of the sheet-like insert are preferably receiving opening in the top of the housing or cover rounded upwards. This is a dam Prevention of use (made of two-layer neoprene) and a good seal in one due to the internal overpressure guaranteed curvature of the insert guaranteed upwards.

The upper edge of the housing can have a circumferential groove,  in which a seal can be inserted. The seal has preference have a round (circular) cross-section. The bottom edge the cover can have a circumferential front corresponding to the groove own jump. This creates an additional cover fixation or position security and position management achieved. Groove and lead can also on the opposite building len be provided: The groove can also be on the lid are located; the protrusion is then provided on the housing.

A releasable connecting element can be provided on the housing base preferably a Velcro fastener, for releasable attachment different training modules can be provided. However, it is also possible to fix the training modules firmly to the case bottom connect.

Such a training module can be made from a base plate Screws exist, for example pan head screws, which are preferably arranged in a circle. The screws can but also have a groove to accommodate rubber rings can. During training, rubber rings are spaced over two Screws.

Another training module consists of a base plate with spaced hooks pointing in opposite directions. For example, four spaced rectangles Be arranged hook. One can be placed between two hooks or several eyelets can be provided. Can between two hooks a hose and / or rubber bands can be stretched. The hoses then simulate the vessels on the gallbladder. Through the rubber the surrounding tissue is simulated. During training the tubes representing the vessels must be recognized and iso be lated.

Another training module consists of a base plate on of the two foam panels protruding upwards in a roof shape are required. At the diagonally opposite ends  seams can be attached to the foam panels; it can so the seam technique can be practiced.

The training device preferably has the shape of a human open torsos. As a result, the trainee will later in present an optical impression that actually occurs in practice animals.

Embodiments of the invention are described below with reference to the Drawing explained in detail. In the drawing shows

Fig. 1, the exercise machine in a side view;

Fig. 2 shows the training apparatus in view of a further sides,

Fig. 3, the training apparatus, in a section along the line 3-3 in Fig. 1

Fig. 4, the training device in a view from above,

Fig. 5 shows a part of the pressure plate in a view from above,

Fig. 6 shows a section through a fixing tip taken along the line 6-6 in Fig. 5,

Fig. 7 shows a section through a fastening screw along the line 7-7 in Fig. 5,

Fig. 8, the exercise machine from the side with a closable door in the housing side wall,

Fig. 9 is a side view of the housing with an electrically connectable neutral electrode,

Fig. 10 in Fig. 9 illustrated neutral electrode, in a view from above

Fig. 11 is a section through the use of neoprene-receiving opening in the housing cover taken along the line 11-11 in Fig. 4,

Fig. 12 is a section through the upper edge of the housing,

Fig. 13 is a training module with screws and plugs in a view from above,

Fig. 14 is a section through the training module of FIG. 13 taken along line 14-14,

Fig. 15 another screw for the training module of FIG. 13 in a side view;

Fig. 16 is a training module with four hooks and four eyelets in a view from above,

Fig. 17, training module shown in FIG. 16 in a side view;

Fig. 18 in Fig. Training module 16 shown, in a further side view

Fig. 19, another training module with two roof-shaped upstanding foam boards in a view from above,

Fig. 20 in Fig. Training module 19 shown in a view from the front

Fig. 21 shown in FIGS. Training module shown 19 and 20 in a side view with the upper at its ends sewn foam sheets and

Fig. 22 is a training device in the shape of a human torso.

The training device shown in FIGS. 1 to 4 (simulation training device) for the laparoscopic surgical technique consists of a rectangular, rectangular housing 31 and a cover 32 located thereon, the top 33 of which has a cylindrical curvature 33 . Between the upper edge of the housing 31 and the lower edge of the cover 32 , a circumferential seal is inserted, which can be designed in cross section as shown in Fig. 12 and which causes the entire device consisting of the housing 31 and cover 32 in the closed Condition is completely tight. An overpressure can be introduced into the device. For example, air or CO2 can be introduced into the device under excess pressure. But it is also "aquarium" possible, so an operation with a liquid speed such as water or saline.

In the top 33 of the lid 32 there is an opening 34 before, which has the shape of the human abdominal wall. Within this opening 34 there is a sheet-like insert 35 made of a material that simulates human skin, namely two-layer neoprene.

Below the building floor 36 four feet 37 are seen easily. The floor 36 also has an approximately circular trough 38 , into which objects such as peas, matches and the like can be inserted for skill training. On the bottom surface 36 , a Velcro closure 39 is also introduced, on which various training modules can be detachably attached. A fastening ring 40 , which is attached to a fastening block 41 connected to the housing base 36 , serves as a fixation point for various exercise devices, for example for a balloon, which can be connected to the fastening ring 40 via a chain and which simulates the gallbladder. Furthermore, hoses, cotton balls (for simulating adhesions) and the like can be connected to the fastening ring 40 . A similar fastening ring can be provided on the underside of the cover 32 (not shown in the drawing). The opening 35 has arcuate boundaries 42 similar to the human costal arch and oblique boundaries 43 similar to the human pelvic vane.

The cover 32 is connected to the housing 31 via latches 44 . For this purpose, in the lower region of the cover 32 hooks 45 projecting upward are provided, in each of which a tensioning strap 46 engages, the other end of which is connected to a lever tensioner 47 . By turning the lever tensioner 47 down, the cover 32 is pressed over the tensioning belt 46 and the lugs 45 with its lower edge against the upper edge of the housing 31 . On the other hand, the cover 32 can be removed quickly and easily if required.

In the edge region of the opening 34 , a pressure plate 48 is provided below the top 33 of the cover 32 , which is screwed to the top 33 of the cover 32 . FIG. 5 shows a part of the pressure plate 48 in a view from above. Holes 49 for the passage of screws 50 are provided in the pressure plate 48 . Furthermore, there are fixing tips 51 projecting upwards in the pressure plate, which can be connected to the pressure plate 48 in one piece ( FIG. 6). The height of the fixing tips 51 (it is also possible to provide fixing hooks) is slightly less than the thickness of the two-layer neoprene.

Fig. 7 shows a section along the line 7-7 in Fig. 5. The fastening screw 50 has a screw head 52 , which is made in a corresponding recess (countersink) in the top 33 of the cover 32 , and at its other end Thread 53 , on which a wing nut 54 is screwed. This wing nut 54 allows the two-layer neoprene of the insert 35 to be clamped between the pressure plate 48 and the top 33 of the cover 32 . Between the two-layer neoprene of the insert 35 and the top 33 of the lid 32 , a film 55 is also provided, which shows a human skeleton representation. So that this is visible, the top 33 of the lid 32 is made of plexiglass. But it is also possible to use a body-colored, opaque plastic. The fixing tips 51 protrude into the two-layer neoprene of the insert 35 and thereby bring about a reliable securing of the insert 35 against lateral displacement.

Fig. 8 shows a pre in a side wall of the housing 31 provided with a door 56 disposed in the middle handle button 57. The door 56 has a circumferential seal with which it rests on the side wall of the housing. The attachment takes place via two opposite claws 58 , which can be screwed onto the housing by means of screws 59 . After loosening the screws 59 , the claws 58 can be pivoted away and the door 56 can be removed. This provides simple and quick access to the interior of the housing without the need to remove the cover 32 .

Fig. 9 shows a training device with a connection for a neutral electrode 60 which lies on the bottom 36 of the housing 31 . The neutral electrode 60 is flat. It can be 15 cm long and 10 cm wide. The corners are beveled. The neutral electrode 60 has in the middle of a narrow side a connection block 61 for connecting an electrical line 62 , which is guided to a connection block 63 seen in a housing side wall, from which a further line 64 starts. The neutral electrode is used for training with organs such as the liver (for the practice of removing gallbladder) or the intestine (for the practice of removing the appendix) when working with monopolar HF current, for example using a hook electrode or using a monopolar Coagulators.

FIG. 11 shows a section along the line 11-11 in FIG. 4 through the edge of the opening 34 in the upper side 33 of the cover 32 . The edge of the opening 34 has a rounding 65 on its underside, to which the two-layer neoprene of the insert 35 can put on when this insert 35 is arched upwards under the excess pressure prevailing in the device. In Fig. 11 this upwardly curved position of the insert 35 is drawn by drawn; the starting position (without overpressure) of a sentence 35 is drawn in dashed lines. The rounding 65 ensures a good seal even when the insert 35 is warped upwards. Furthermore, damage to the insert 35 in the region of the edge of the opening 34 is prevented.

Fig. 12 shows a section through the upper edge of Gehäu ses 31 and the lower edge of the lid 32 thereon. The upper edge of the housing 31 has a circumferential groove 66 in which there is a seal 67 with a circular cross section. The lower edge of the cover 32 has a corresponding projection 68 , so that the seal 67 is surrounded on all sides. The projection 68 is also used for additional cover fixing or securing the position. By closing the lever locks 44 ( FIGS. 1 and 2), the cover 32 is pressed onto the housing 31 , and the seal 67 seals reliably.

The first training module 71 shown in FIGS. 13, 14 and 15 consists of a base plate 72 with six screws 74 which are arranged in a circle 75 . The screws 74 are designed as lens head screws. For exercise purposes, rubber bands (rubber rings) 76 can each be stretched between two or more screws 74 . The base plate 72 of the first training module 71 has on its underside a Velcro tape 73 ( FIG. 14), by means of which it can be detachably connected to the corresponding Velcro tape 39 ( FIG. 1) on the bottom 36 of the housing 31 .

Fig. 15 shows another Ausführungsfom a screw 74, which in this case has a groove 77 between two larger diameter areas 78 and 79. A rubber band 76 can be inserted into the groove 77 .

In Figs. 16, 17 and 18, a second training module 81 is shown which is arranged a base plate 82 and four in the rectangular hook is 83, and four eyes 84th Two equally spaced eyelets 84 are provided between two opposite, spaced hooks 83 . The eyelets consist of a lower, rectilinear part, with which they are connected to the Grundplat te 82 , and an approximately circular ("actually" Chen) eyelet. The hook ends 85 of two opposing hooks 83 each point away from one another, as can be seen in FIG. 18. A thin hose 86 is stretched between two opposing hooks 83 . Each hose 86 runs through the two associated eyelets 84 . Furthermore, the hoses can be connected to a storage container (not shown in the drawing) in order to be able to introduce a liquid, which can be colored, into the hoses 86 .

The tubes 86 can be used to simulate the vessels on the gallbladder, that is to say the artery and a vessel receiving the bile. For this purpose, one of the tubes 86 can be filled with olive oil or another yellow liquid, the other tube 86 with a red liquid. With the training module shown in FIGS . 16 to 18, the application of a catheter for radiological bile duct imaging can be practiced, that is to say the introduction of X-ray contrast medium into the tube 86 that holds the bile (“olive oil”). The tubes 86 can be surrounded by tensioned rubber cords in order to be able to practice the preparation of the vessels. The rubber cords (not shown in the drawing) are also between the hooks 83 , surrounding the hoses parallel, stretched. In this way, the preparation of the vessels (tubes), ie the recognition and exposure of the tissue and vessel structures, can be practiced.

The Fig. 19, 20 and 21 show a third training module 91, which consists of a base plate 92 on which two Schaumstoffplat 93 th roof-shaped manner are fixed to projecting upwards. The foam plates 93 (instead of foam, another material can be used) are firmly connected to the base plate 92 , for example clamped. They point in the initial state, which is shown in FIG. 20, at an angle of approximately 45 ° upwards. The upper ends of the foam sheets 93 can be connected to one another by seams 94 . The training module 91 thus serves to practice the seam technique. After the seams 94 have been attached and tightened, the foam sheets 93 assume the position shown in FIG. 21. The ends of the foam sheets 93 then face each other "butt".

Fig. 22 shows a training device which has the shape of a human torso. The top of the training device is designed like the human body, from the neck area to the beginning of the thigh. The sheet-like insert 35 is located in the place of the human abdominal wall.

Claims (27)

1. Training device for laparoscopic surgical technique, consisting of
a sealed housing ( 31 , 32 ) into which an overpressure can be brought,
and a sheet-like insert ( 35 ) made of a material that simulates human skin, preferably neoprene, provided in an opening ( 34 ) in the top ( 33 ) of the housing ( 31 , 32 ). 2. Training device according to claim 1, characterized in that the insert ( 35 ) consists of two-layer neoprene. 3. Training device according to claim 1 or 2, characterized in that the housing ( 31 ) has a cover ( 32 ) which the housing ( 31 ) is sealingly releasably connectable to the housing ( 31 ). 4. Training device according to claim 3, characterized in that the sheet-like insert ( 35 ) is provided in the lid ( 32 ). 5. Training device according to one of the preceding claims, characterized in that the opening ( 34 ) in the upper side ( 33 ) of the housing ( 31 ) or cover ( 32 ) has the shape of the human abdominal wall. 6. Training device according to one of the preceding claims, characterized in that the insert ( 35 ) is replaceable. 7. Training device according to one of the preceding claims, characterized in that the insert ( 35 ) with a on the top ( 33 ) of the housing ( 31 ) or cover ( 32 ) provided pressure plate ( 48 ) is connected. 8. Training device according to claim 7, characterized in that the pressure plate ( 48 ) with the housing ( 31 ) or cover ( 32 ) is screwed ( 50 ). 9. Training device according to claim 7 or 8, characterized in that the insert ( 35 ) between the housing ( 31 ) or cover ( 32 ) and the pressure plate ( 48 ) is clamped. 10. Training device according to one of claims 7 to 9, characterized by marked in the pressure plate ( 48 ) provided in the insert ( 35 ) projecting fixing tips ( 51 ). 11. Training device according to one of the preceding claims, characterized in that the housing base ( 36 ) is provided with a recess ( 38 ). 12. Training device according to one of the preceding claims, characterized in that a fastening ring ( 40 ) is provided on the housing base ( 36 ). 13. Training device according to one of the preceding claims, characterized in that a door ( 56 ) is inserted sealingly in one or more housing side walls. 14. Training device according to one of the preceding claims, characterized in that a connection ( 63 ) for a power line ( 62 , 64 ) is provided on the housing ( 31 ). 15. Training device according to claim 14, characterized in that a neutral electrode ( 60 ) is provided in the housing ( 31 ). 16. Training device according to one of the preceding claims, characterized in that the edges of the flat-shaped insert ( 38 ) receiving opening ( 34 ) in the top ( 33 ) of the housing or cover ( 32 ) are rounded up (65) . 17. Training device according to one of claims 3 to 16, characterized in that the upper edge of the housing ( 31 ) has a circumferential groove ( 66 ) into which a seal ( 67 ) can be inserted. 18. Training device according to claim 17, characterized in that the lower edge of the cover ( 32 ) has a circumferential projection ( 68 ) corresponding to the groove ( 66 ). 19. Training device according to one of the preceding claims, characterized in that a releasable connecting element, preferably a Velcro fastener ( 39 ), is provided on the housing base ( 36 ) for releasably fastening various training modules ( 71 , 81 , 91 ). 20. Training device according to claim 19, characterized in that a training module ( 71 ) consists of a base plate ( 72 ) with screws ( 74 ). 21. Training device according to claim 20, characterized in that the screws ( 74 ) are arranged in a circle ( 75 ). 22. Training device according to claim 20 or 21, characterized in that the screws have a groove ( 77 ). 23. Training device according to claim 19, characterized in that a training module ( 81 ) consists of a base plate ( 82 ) with spaced, pointing in opposite directions hooks ( 83 ). 24. Training device according to claim 23, characterized in that one or more eyelets ( 84 ) are provided between two hooks ( 83 ). 25. Training device according to claim 23 or 24, characterized in that between a hook ( 83 ) a hose ( 86 ) and / or rubber bands) are stretched. 26. Training device according to claim 19, characterized in that a training module ( 91 ) consists of a base plate ( 92 ) on which two foam plates ( 93 ) are attached projecting roof-shaped upwards. 27. Training device according to one of the preceding claims, there characterized by that it is the shape of a human Has torsos.