CN103886797A - High-simulation laparoscopic surgery simulated training device - Google Patents

High-simulation laparoscopic surgery simulated training device Download PDF

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Publication number
CN103886797A
CN103886797A CN201410092602.4A CN201410092602A CN103886797A CN 103886797 A CN103886797 A CN 103886797A CN 201410092602 A CN201410092602 A CN 201410092602A CN 103886797 A CN103886797 A CN 103886797A
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simulation
liver
animal
laparoscopic surgery
interface
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CN103886797B (en
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吕毅
徐向华
杨桓
李建辉
马锋
史爱华
王浩华
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XI'AN MAGNETIC MEDICAL TECHNOLOGY Co.,Ltd.
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Xian Jiaotong University
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Abstract

A high-simulation laparoscopic surgery simulated training device comprises a simulated human abdomen unit, an animal liver and a simulated canal system, wherein the simulated human abdomen unit is used for simulating the human abdomen skin through silica gel and composed of anterior abdominal wall skin and back skin which can be separated from each other, the anterior abdominal wall skin and the back skin are connected through sealing buckles, and thus the seal performance of the whole simulated human abdomen is guaranteed; the animal liver is arranged in the simulated human abdomen unit; the simulated canal system is arranged in the simulated human abdomen unit and connected with the animal liver. According to the high-simulation laparoscopic surgery simulated training device, the abdominal skin is simulated through sealing silica gel, inflation is performed through a poking clip to form the pneumoperitoneum, the human blood circulation in the physiological state is achieved through a pumping set, the real animal liver is anastomosed with the postcava, the portal vein, the hepatic artery and the biliary tract of a human simulator training system through the postcava, the portal vein, the hepatic artery and the biliary tract, and thus various simple or complex laparoscopic surgery training items can be carried out.

Description

A kind of height emulation laparoscopic surgery simulation trainer
Technical field
The invention belongs to technical field of medical instruments, relate to a kind of laparoscope training aids, particularly a kind of height emulation laparoscopic surgery simulation trainer.
Background technology
From Frenchman PhilipeMouret in 1987 carries out first case Laparoscopic Cholecystectomy, the development that laparoscope has experienced more than 20 years has become a relatively independent subject, and has derived the Minimally Invasive Surgery modes such as thoracoscope, arthroscope, cranial cavity mirror.
Laparoscopic surgery is to make the otch about 2-5 1cm at the belly of human body and (or) waist, respectively inserts a pipe-like service aisle that is called " trocar ".Use laparoscope special equipment to perform the operation by trocar.Laparoscopic surgery wound is little, recovery is fast, has greatly reduced patient's misery, has shortened the hospital stays simultaneously, and the postoperative scar of leaving over is little, does not affect outward appearance, meets the development of modern minimally invasive surgery and the requirement that people likes to be beautiful.But, laparoscopically successful implementation is the operative technique skilled and consummate based on surgeon and a large amount of clinical experiences, the basic operations such as cutting, separation, ligation, hemostasis and traditional operation have larger change, operator also has significant change to spatial perception, and these all cause surgical learning curve to extend.
Existing more ripe Laparoscopy Training Exercise Using Simulator system has two kinds, and one is laparoscope simulator, and agent structure is a box body, in box body, placing the utensil for training, box surface is provided with trocar, and hand-held laparoscopic instrument puts in and box, carries out operation training from trocar; Another kind is virtual laparoscope simulation system, by advanced computer equipment and software simulation laparoscopic surgery.These two kinds of Laparoscopy Training Exercise Using Simulator systems are for intern, helpful to improving laparoscopic surgery technology, but respectively have its own shortcoming.Laparoscope simulator can only be simulated the basic operations such as simple cutting, separation, ligation, can not simulate the physiological environment of human body and the sight of performing the operation really; Virtual laparoscope simulation system energy sham operated sight, but true to nature not, the surgical environments that also can simulate relative complex, but operation perceptible feedback during to operation is inadequate, and expensive, limit it and promote the use of on a large scale.
Summary of the invention
In order to overcome the shortcoming of above-mentioned prior art, the object of the present invention is to provide a kind of height emulation laparoscopic surgery simulation trainer, utilize sealed silicon rubber moulding to intend skin of abdomen, inflate formation pneumoperitoneum from stamp card, recycling pump group realizes the blood circulation of human body under physiological status, real animals liver is passed through to inferior caval vein, portal vein, arteria hepatica, the inferior caval vein of biliary tract and dummy man training system, portal vein, arteria hepatica, biliary tract coincide respectively, above three parts form whole height emulation laparoscopic surgery simulation trainer, can realize whereby abdominal viscera (liver under laparoscope, stomach, intestines, pancreas, spleen etc.) operation, and can evaluate by amount of bleeding operator's technical ability, native system, by artery and the vein of each abdominal viscera of simulation, builds the blood circulation of internal organs separately, can simulate the surgical environments of each abdominal viscera, meets each surgery specialist's operative training needs, by simulating the combination of blood circulation and multiple internal organs of each internal organs, can carry out various simple or complicated laparoscopic surgeries training.
To achieve these goals, the technical solution used in the present invention is:
A kind of height emulation laparoscopic surgery simulation trainer, comprising:
Simulation people's belly unit, adopts silica gel simulation human abdomen skin, is made up of separable front abdominal skin 5 and skin of back, and two parts skin connects by seal buckle 23, ensures the sealing of whole simulation people belly;
Be arranged at the animal's liver in simulation people's belly unit;
Be arranged at the simulation piping system in simulation people's belly unit, described simulation piping system is connected with described animal's liver.
After described simulation people belly has sealed, in abdominal cavity, inflate, can form the required pneumoperitoneum environment of laparoscopic surgery.
After described simulation piping system is connected with described animal's liver, form an airtight circulation system, carry out liquid perfusion, utilize the peristaltic pump 6 being arranged in simulation piping system that liquid-circulating power is provided.
Described simulation piping system comprises:
Be used for connecting the inferior caval simulation inferior caval vein 1 of animal's liver;
Be used for connecting the hepatic arterial simulation arteria hepatica 2 of animal's liver;
Be used for connecting the pylic simulated main portal vein blood 3 of animal's liver;
For the pipeline 4 of drainage returned blood volume;
And for connecting the simulation biliary tract of animal's liver gall-bladder.
Described simulation inferior caval vein 1 has two, and one end of one arranges simulation inferior caval vein interface 1, for being connected with animal's liver inferior caval vein interface 1; Another one end arranges simulation inferior caval vein interface 2 16, for being connected with animal's liver inferior caval vein interface 2 15; One end of described simulation arteria hepatica 2 is provided with simulation arteria hepatica interface 18, for being connected with animal's liver arteria hepatica interface 17; One end of described simulated main portal vein blood 3 is provided with simulated main portal vein blood interface 20, for being connected with animal's liver portal vein interface 19.
Described each interface is provided with magnet ring 22.
The support 11 that is provided with abdominal skin 5 before supporting in described simulation people's belly unit, the position 12 of putting animal's liver is positioned at support 11 belows.
On described front abdominal skin 5, be provided with the main operation hole 7 being positioned under xiphoid-process, be positioned at the secondary handle hole 1 of right midclavicular line, be positioned at the secondary handle hole 2 10 of right anterior axillary line, and be positioned at the viewport 8 under navel.
When use, free animal's liver is retained to enough inferior caval veins, portal vein, arteria hepatica to be connected with inferior caval vein, portal vein, hepatic arterial port on simulation people by magnet ring, form an airtight circulation system, carry out liquid perfusion, evaluate the amount of bleeding in art by the amount lost of liquid in the monitoring circulation system.
Compared with prior art, the invention has the beneficial effects as follows:
1. the dirty surgical environments of reduction Control of Hemorrhage in Laparoscopic Liver, by the alternative Virtual Liver of animal's liver, operator is truer to the perception of laparoscopic surgery, can obviously shorten house surgeon's laparoscopic surgery learning curve;
2. simulation Human Physiology environment, has blood circulation system, can better evaluate by the amount of bleeding in art operator's technology, can be used as one of performance assessment criteria of house surgeon's laparoscopic surgery; Also can, by the simulation environment similar to patient disease, by the design in various laparoscopic surgeries path, find the modus operandi of optimum patient self-condition, improve the success ratio of laparoscopic surgery;
3. native system more can reduce surgical environments than laparoscope simulator, and more reality operation, can allow operator better know from experience the mode of operation under laparoscope; Compared with virtual simulator may, not only surgical environments is more approaching true, have good force feedback, and cost ratio virtual simulator may is lower, is more conducive in doctor's training, the training of each rank hospital and examines.
4. convert by simple pipeline path and the adjusting of flow velocity, can simulate the blood circulation of each internal organs of abdominal cavity, insert corresponding animal viscera, can complete the Laparoscopic operation of all internal organs in abdominal cavity.
Brief description of the drawings
Fig. 1 is height emulation laparoscopic surgery simulation trainer one-piece construction schematic diagram.
Fig. 2 is simulation belly front schematic view.
Fig. 3 is simulation belly schematic cross-sectional view.
Fig. 4 is simulation people abdominal cavity pipeline distribution schematic diagram.
Fig. 5 is that entity liver is put into schematic diagram after simulation people belly.
Fig. 6 is pipe joint schematic diagram.
Fig. 7 is belly and skin of back released state schematic diagram.
Fig. 8 is the view after belly and skin of back fastening.
Embodiment
Describe embodiments of the present invention in detail below in conjunction with drawings and Examples.
As shown in Figure 1, a kind of height emulation laparoscopic surgery simulation trainer, comprise: simulation people's belly unit, adopt silica gel simulation human abdomen skin, formed by separable front abdominal skin 5 and skin of back, two parts skin connects by seal buckle 23, ensures the sealing of whole simulation people belly; Be arranged at the animal's liver in simulation people's belly unit; Be arranged at the simulation piping system in simulation people's belly unit, simulation piping system is connected with animal's liver.Comprise: for connecting the inferior caval simulation inferior caval vein 1 of animal's liver; Be used for connecting the hepatic arterial simulation arteria hepatica 2 of animal's liver; Be used for connecting the pylic simulated main portal vein blood 3 of animal's liver; For the pipeline 4 of drainage returned blood volume; And for connecting the simulation biliary tract of animal's liver gall-bladder.Simulation people belly utilizes after seal buckle 23 fastening sealings, forms an environment relatively sealing in abdominal cavity, then inflates in abdominal cavity, can form the required pneumoperitoneum environment of laparoscopic surgery.After simulation piping system is connected with animal's liver, form an airtight circulation system, carry out liquid perfusion, utilize the peristaltic pump 6 being arranged in simulation piping system that liquid-circulating power is provided.
As shown in Figure 2, on front abdominal skin 5, be provided with the main operation hole 7 being positioned under xiphoid-process, be positioned at the secondary handle hole 1 of right midclavicular line, be positioned at the secondary handle hole 2 10 of right anterior axillary line, and be positioned at the viewport 8 under navel.
As shown in Figure 3, be provided with the support 11 of abdominal skin 5 before supporting in simulation people's belly unit, the position 12 of putting animal's liver is positioned at support 11 belows.
As shown in Figure 4 and Figure 5, simulation inferior caval vein 1 has two, and one end of one arranges simulation inferior caval vein interface 1, for being connected with animal's liver inferior caval vein interface 1; Another one end arranges simulation inferior caval vein interface 2 16, for being connected with animal's liver inferior caval vein interface 2 15; One end of simulation arteria hepatica 2 is provided with simulation arteria hepatica interface 18, for being connected with animal's liver arteria hepatica interface 17; One end of simulated main portal vein blood 3 is provided with simulated main portal vein blood interface 20, for being connected with animal's liver portal vein interface 19.In figure, the liver choledochus broken ends of fractured bone is connected to animal's liver inferior caval vein interface 2 15 places.
As shown in Figure 6, each interface of the present invention is provided with magnet ring 22, interface can be coupled together.
As shown in Figure 7, open the front abdominal skin 5 of training aids, animal's liver is inserted to upper right abdomen, animal's liver arteria hepatica interface 17 is connected with the simulation arteria hepatica interface 18 on simulation arteria hepatica 2, animal's liver portal vein interface 19 is connected with the simulated main portal vein blood interface 20 in simulated main portal vein blood 3, animal's liver inferior caval vein interface 1 is connected with the simulation inferior caval vein interface 1 on a simulation inferior caval vein 1, animal's liver inferior caval vein interface 2 15 is connected with the simulation inferior caval vein interface 2 16 on another simulation inferior caval vein 1, and connected mode is magnet ring and connects.So far the blood circulation of liver has just connected (as shown in Figure 5).Realize blood perfusion with peristaltic pump 6.Front abdominal skin 5 is put back to original position, fastening sealing button 23, organ and the preoperative preparation of filling system hybridization laparoscopic surgery training aids just complete (as shown in Figure 1).Then can need the operations such as punching, inflation according to operation, carry out the training of laparoscopic surgery.After operation finishes, by pouring into amount of liquid before operation in closed circulation system relatively and operation finishes the amount of liquid of emitting, the amount of liquid losing in estimation surgical procedure, and then evaluate operator's operative technique or the rationality of modus operandi.
Introduce the use of organ and filling system hybridization laparoscopic surgery training aids below by right half liver VIII section resection.
While using training aids Laparoscopic Liver Resection training system, first open front abdominal skin 5, entity liver is put into suitable position 12, animal's liver inferior caval vein interface 1 is connected with the simulation inferior caval vein interface 1 on a simulation inferior caval vein 1, animal's liver inferior caval vein interface 2 15 is connected with the simulation inferior caval vein interface 2 16 on another simulation inferior caval vein 1, as shown in Figure 6, can utilize magnet ring 22 to join, according to this magnet ring methods of anastomosis, animal's liver arteria hepatica interface 17 is connected with the simulation arteria hepatica interface 18 on simulation arteria hepatica 2, animal's liver portal vein interface 19 is connected with the simulated main portal vein blood interface 20 in simulated main portal vein blood 3, entity liver is fixed at back with gauze, so far, what entity liver was complete puts into training aids abdomen, build front abdominal skin 5, fastening sealing button 23, as shown in Figure 8, preoperative being ready to complete.
Training aids is dorsal position, routine disinfection visual area, paving aseptic towel.Diseased region is positioned at right half liver, and therefore belly position of opening as shown in Figure 2, is opened 4 holes altogether, wherein main operation hole 7 is positioned under xiphoid-process, secondary handle hole 1 and secondary handle hole 2 10 lay respectively at right midclavicular line and right anterior axillary line, and viewport 8 is positioned under navel, inserts corresponding operating theater instruments.
Laparoscopic approach diseased region, apart from focus edge 1~2cm mark hepatectomy line, after forward direction, from the superficial to the deep adopts the apparatuses such as ultrasound knife from disconnected liver parenchyma.For the vascular of diameter >3mm, titanium folder folder gives ultrasound knife again from disconnected, until complete resection focus after closing far and near end.Liver section oozing of blood stops blooding with argon-gas knife, and the active hemorrhage of liver section adopts 3-0 atraumatic suture Suture hemostasis.Liver section covers hemostatic material.Pack the sample cutting into disposable getting in thing bag, expand umbilical region, take out sample by umbilical notch cut.Check in abdominal cavity without after active hemorrhage and courage leakage, in liver section part placing peritoneal cavity drainage.Extract chamber mirror apparatus, close each acanthopore, art finishes.The postoperative liquid of emitting, compared with pouring into liquid before operation, the liquid reducing is the amount of bleeding in operation technique, can, using this index as an objective evaluation index to operation operator, evaluate operator's operative technique or the relative merits of Laparoscopic operation mode by the amount of bleeding in surgical procedure.

Claims (8)

1. a height emulation laparoscopic surgery simulation trainer, is characterized in that, comprising:
Simulation people's belly unit, adopts silica gel simulation human abdomen skin, is made up of separable front abdominal skin (5) and skin of back, and two parts skin connects by seal buckle (23), ensures the sealing of whole simulation people belly;
Be arranged at the animal's liver in simulation people's belly unit;
Be arranged at the simulation piping system in simulation people's belly unit, described simulation piping system is connected with described animal's liver.
2. height emulation laparoscopic surgery simulation trainer according to claim 1, is characterized in that, after described simulation people belly has sealed, in abdominal cavity, inflates, and can form the required pneumoperitoneum environment of laparoscopic surgery.
3. height emulation laparoscopic surgery simulation trainer according to claim 1, it is characterized in that, after described simulation piping system is connected with described animal's liver, form an airtight circulation system, carry out liquid perfusion, utilize the peristaltic pump (6) being arranged in simulation piping system that liquid-circulating power is provided.
4. height emulation laparoscopic surgery simulation trainer according to claim 1, is characterized in that, described simulation piping system comprises:
Be used for connecting the inferior caval simulation inferior caval vein of animal's liver (1);
Be used for connecting the hepatic arterial simulation arteria hepatica of animal's liver (2);
Be used for connecting the pylic simulated main portal vein blood of animal's liver (3);
For the pipeline (4) of drainage returned blood volume;
And for connecting the simulation biliary tract of animal's liver gall-bladder.
5. height emulation laparoscopic surgery simulation trainer according to claim 4, it is characterized in that, described simulation inferior caval vein (1) has two, and one end of one arranges simulation inferior caval vein interface one (13), for being connected with animal's liver inferior caval vein interface one (14); Another one end arranges simulation inferior caval vein interface two (16), for being connected with animal's liver inferior caval vein interface two (15); One end of described simulation arteria hepatica (2) is provided with simulation arteria hepatica interface (18), for being connected with animal's liver arteria hepatica interface (17); One end of described simulated main portal vein blood (3) is provided with simulated main portal vein blood interface (20), for being connected with animal's liver portal vein interface (19).
6. height emulation laparoscopic surgery simulation trainer according to claim 5, is characterized in that, described each interface is provided with magnet ring (22).
7. height emulation laparoscopic surgery simulation trainer according to claim 1, it is characterized in that, the support (11) that is provided with abdominal skin (5) before supporting in described simulation people's belly unit, the position (12) of putting animal's liver is positioned at support (11) below.
8. height emulation laparoscopic surgery simulation trainer according to claim 1, it is characterized in that, on described front abdominal skin (5), be provided with the main operation hole (7) being positioned under xiphoid-process, be positioned at the secondary handle hole one (9) of right midclavicular line, be positioned at the secondary handle hole two (10) of right anterior axillary line, and be positioned at the viewport (8) under navel.
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