• 专利附录
  • 专利说明
  • 权利要求
  • 类似技术
  • 同族专利
  • 引用文献
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  • 优先权
    • 专利摘要:
    The training device (1) for doctors comprises a column (3) on which at least two pivot arms (9) are pivotably attached, on which the receptacles (11) for surgical instruments are attached. Both the distance of the recordings from the column and the vertical position can be set and adjusted. A support plate (15) for simulated body parts is also attached to the column (3). The support plate (15) is elastically supported in all three dimensions.
    公开号:CH717179A1
    申请号:CH00468/20
    申请日:2020-04-21
    公开日:2021-08-31
    发明作者:Zadnikar Marcel；Hidber Franziskus；Janouschek Georg；Janouschek Jan
    申请人:Jano Tech Gmbh Feinmechanik Und Entw；Zadnikar Marcel；
    IPC主号:
    专利说明:

    The invention relates to a training device for the training of minimally invasive doctors according to the preamble of claim 1.
    [0002] Laparoscopy (= laparoscopy) is generally understood to mean a method for examining the abdominal cavity (ancient Greek: lapara = abdomen (cavity)). It is used for diagnostics and for performing minimally invasive operations, i.e. operations using keyhole technology. Laparoscopy is performed with a laparoscope or an endoscope. Originally, the abdominal cavity was inspected directly via a tube with a lens system (optics). Today it is a video camera system in which images from the abdominal cavity are digitally transmitted to a monitor. "Skopie" (ancient Greek: skopia = to observe) can also be performed in other body cavities and regions (e.g. chest cavity: thoraco-scopy, etc.)In minimally invasive surgery (MIS) or (especially for the abdominal cavity) laparoscopic surgery (MIS under video-assisted laparoscopy), both the camera (endoscope) and required (especially long) surgical instruments are inserted through sleeves (trocars) through small incisions introduced the abdominal cavity.
    Operating using these specially long instruments under video monitoring is a considerable challenge for every surgeon and therefore requires lengthy and intensive training. The following difficulties must be overcome and appropriate compensation mechanisms learned:Fine and targeted work using elongated instruments: After the handle, a mechanical translation in a mostly 33cm long shaft leads to different tools at the tip of the instrument (clamps, scissors, spreading tool, etc.).Greatly changed haptics: The sensory perception of the hand and the fingers to tissues and organs (also via classic “short” instruments that are held directly in the hand) differs markedly from the sensory perception via laparoscopic instruments. It is greatly reduced or decreased in laparoscopic surgery. changes. The feeling of tissue and layers is also significantly restricted.Stereotactic, 3-dimensional seeing, experiencing and acting: The basic problem of the new laparoscopic surgical technique is that a 3-dimensional body and, in principle, a 3-dimensional handicraft is represented by a 2-dimensional video image. This makes stereotactic vision with the eyes impossible. Substitute compensation mechanisms must be developed and learned in order to be able to compensate for this deficit.
    Analogous to this, the 3-dimensional experience and action is extremely difficult due to the lack of visual control and requires intensive training. The “feeling / sensing” in which 3-dimensional position a body is currently in the abdominal cavity and how such a body should be moved 3-dimensional, optimally vectorially, is initially very poor and requires long training. Ultimately, a good surgeon can recognize how a body is positioned in space and in which vectorial direction (3-dimensional sum vector of the x, y, z-plane) he has to move this body for optimal surgical preparation (rotation, translation).Overview and orientation (macro signals): The area during a laparoscopic operation that is shown on the monitor usually only corresponds to a fraction of the entire abdominal cavity. The target region should be optimally represented by the enlargement effect of the camera system like a magnifying glass. However, the overview is resp. the general overview is limited. This can impair the orientation because of the missing landmarks (fixed points) and the ability to receive “macro signals”. “Macro signals” are impressions that are unconsciously received, analyzed and passed on to the brain with the appropriate priority. “Receiving macro signals” is a learned subconscious ability to “keep an eye on the whole” and to react to certain stimuli. Alarm signals are also detected subconsciously at the edge of the field of vision and alert the surgeon if something is not right outside of his focus.Reduced space / space: In some cases, extreme positions of the patient are necessary (head up / down position) in order to obtain sufficient space for the operation. The mobile intestine is relocated to deeper areas of the abdominal cavity due to the force of gravity.Physical laws: In laparoscopic surgery z. T New physical laws relevant or known have a new, different degree of effectiveness: leverage, hypomochlion, shear / friction forces, Fulcrum effect (pivot point effect), triangulation, working and manipulation angle, coaxial and lateral position to the patient, degrees of freedom of the instruments, Interference, etc.). All of these influences initially make the operation more difficult and must be relearned and implemented in the surgical procedure.
    Basic medical-technical specifications:
    In order not to learn these abilities and skills first on the patient, special training is required. The setting and the possibilities of such a technical training unit should cover as many of these criteria as possible: 1. Bi-manual training 2. Training of eye-hand coordination 3. Adaptation of the new relevant physical conditions in laparoscopic handling 4. Training of sensorimotor skills Compensation mechanisms. Mastery of fine and targeted work despite overly long instruments. Be familiar with the changed feel. 5. Training in 3-dimensional seeing, experiencing (imagining) and acting. 6. Orientation and adequate ability to act under limited space. Training of laparoscopic handling even with limited space / space and cramped conditions.
    This results in basic technical specifications:
    The training device itself should technically make it possible to optimally train the medical-technical criteria mentioned under points 1. - 6.. This requires the following adaptation, installation and setting options:
    In general, the training device should contain the following components:
    1. a central fixation for modular application of training elements, 2. at least two holding devices for trocars for the insertion of laparoscopic instruments, which any point of a training element (from both instruments) in an intersection of usually optimally a maximum radius of 15 -20cm (rarely up to 25cm on one side) (central, side, top, bottom), 3. Optional (but desirable) a "video camera monitor" system.
    In order to gain basic knowledge of the laparoscopic surgical procedure and in the course of a high level of expertise in the necessary skills and sensory-motor skills / skills, devices are already known with which the surgeon can train the activities required during the operation outside the human body. In the simplest form of such devices, two surgical instruments are each inserted through a hole into a box in which an artificial sample organ can be processed on the screen using the image capture with a camera (WO 99/42978, WO 2005/037057). However, such exercise devices are unsatisfactory.
    Most of the training devices available on the market have (in some form) more or less great restrictions on the actual need for a training device for surgeons. The following list reflects the current reality:Training units or (artificial) organs to be worked on are often fixed on a fixed plate in a horizontal or inclined plane, so that it is not possible to feel a resistance on the instruments as it is in realityMost of the time there are only options to plan to use 2-dimensional training unitsIn most devices, the instruments are stored in spherical bushings or the like in the wall or the lid of a box, so that their position is fixed once.The holding devices for the instruments in the boxes practically never correspond to the situation when instruments are passed through the elastic abdominal wall and receive resistance there against longitudinal displacement as well as with regard to rotating or swiveling movements depending on the position.Most of the time there is a fixed direction of work with the instruments, since the training box is on a table: = the instruments run from top to bottom. However, this contradicts many and very frequent operations (e.g. the operation of the gallbladder, the hernia, the rectum, etc .: here, due to the extreme position of the patient, the direction of the overlong instruments often runs from bottom to top.Most training boxes are closed box systems without direct control and supervision of the training element. There are seldom open systems, but then without the possibility of camera monitor training.If a camera is available, the setting options are extremely limited. The most common camera position in a box only allows one viewing direction: obliquely from top to bottom, in the middle.A training tool can practically never be adjusted from the height of the work level in such a way that it would also be optimal for very small or very large people, which is always possible in the operating room (with the height-adjustable tables).
    An object of the present invention is to create a new, innovative, needs-adapted and optimal training device (tools) for training minimally invasive surgical techniques for the fields of surgery, gynecology, urology, thoracic surgery, orthopedics, etc., which the surgeon essentially provides realistic conditions that he will later find again when used on the patient.
    In detail: a. The tool must be sufficiently stable and heavy to be able to withstand tensile forces during training. b. The dimensions of the tool must be large enough that different training modules of different sizes and shapes can be used. c. The tool must take into account the geometric locations (effective radius of the laparoscopic instruments or their working length: max. 33 cm). d. The working height of the tool (basic training level) must be adjustable so that it is easy to use for people of different sizes e. The tool must have a fixation system that allows different training units to be implemented and used in a modular manner. f. The tool must be provided for training units that are designed in 2-dimensional (i.e. plan) and 3-dimensional (i.e. spatial, physical) ways. G. The tool must be designed in such a way that the following elements can be set and fixed as required: • Basic training level (target (= exercise / training unit) and trocar holder): Must move forwards / downwards or downwards. be tiltable up / back • Trocar holder: adjustable in height to the basic training level, in the lateral (horizontal) angles right and left to the target, in the inclination (vertical) to the target and in the distance to the target • Training unit holder (target): Must forwards / downwards resp. be tiltable at the top / back h. (Optional) video camera monitor system: A training tool can be closed (then a camera system is required) or open (= training can be viewed / observed directly). It is ideal if both options are available in one training device (at the beginning a direct stereotactic view of the training activity, later training via a monitor: 2D image is transferred to a 3D activity and observation). When using a camera system, it is extremely important that this camera can be used extremely flexibly. In this way, it must be ensured that with an optimal training device (including 3-dimensional training units) the camera can display the training from any perspective: from above, from both sides, from below and from all inclined directions in between. The camera should not obstruct the laparoscopic instruments or be in the way. It must also not obstruct the view of the training element (as a direct visual 3D control) or of the monitor.
    This object is achieved by a training device according to the features of claim 1. Advantageous embodiments of the training device are defined in the dependent claims.
    The basic medical-technical and apparatus-technical specifications described in the introduction have largely been implemented in the present invention.
    The training device is characterized by its unique selling point in the implementation of all the relevant needs of a surgeon for a realistic training simulation of a minimally invasive operation. He achieves this through a combination of all relevant setting options for the training units, the instrument holder, the camera positioning and the working level, as well as the implementation and realization of the didactically important possibility of knowledge-relevant training units both in plan, 2-dimensional form, as well as in physical, 3 -dimensional form to be able to implement. All of this is monitored by a highly flexible camera system with the highest image quality and almost real-time transmission.Thus, all relevant sensory-motor skills can be trained realistically through the corresponding training units.
    During training on the present training device, the surgeon is given the feeling and thus the routine to be able to train relevant sensory-motor skills on the one hand and, on the other hand, in a figurative sense, a non-rigid object (an organ or a tissue according to the conditions in a real operation).In order to be able to set a suitable realistic angular position between two surgical instruments, the instruments are mounted on swivel arms, the mutual angular position of which can be adjusted. Both the angle between the two swivel arms and the position of the swivel arms with respect to the standing position of the surgeon can be adjusted. For this purpose, the swivel arms are swivel-mounted on a common axis or on axes lying next to one another.Furthermore, the resistance to the axial displacement of the surgical instruments can be set, i.e. the resistance to the axial displacement, as occurs on the human body through the abdominal wall, can be set.Furthermore, the pivoting of the surgical instruments can also be adapted to reality on the articulated axial guide of the surgical instruments, i.e. pivoting is not possible without resistance, but suitable means are provided to adapt the pivoting forces to the realistic conditions.Another advantage of the training device according to the invention is that the position of the fastening and guidance of the surgical instruments can be adjusted to the distance to the training units (to the body part to be operated on), here to the training units fastened on the carrier plate. It is therefore also possible to adapt to the individual size relationships of the patient, such as the thickness of the abdominal wall to be penetrated.The carrier plate can also be tilted to allow the surgeon to perform operations from different angles, as is often the case inside the body.
    A three-dimensionally movable mounting of the carrier plate for the training unit to be processed makes it possible to realistically specify the conditions as they exist when operating organs in the abdominal cavity. In particular, the non-rigid mounting of the training units to be processed (simulated body parts) provides the surgical instruments or the surgeon with real spatial conditions and counteracts corresponding forces. For example, during training (corresponding to a preparation on an organ), parts of the training tool (organ / tissue) can try to evade the manipulation so that the surgeon has to follow the evasive part. This is not only done in the axial direction to the surgical instruments, but also in three dimensions, as the tools are not held on a rigid plate.To achieve this, the carrier plate is mounted on a ball joint, for example, or the connection between the carrier plate and a carrier arm for the carrier plate is made of an elastic material such as rubber, so that it is deflected in all directions by the force exerted on the body by the surgical instrument . If two instruments are used, as is customary, forces are introduced by both instruments which always lead to a displacement or evasion of the object to be operated.
    The training device is described below using an illustrated embodiment. The figures show: FIG. 1 a perspective view of a training device for training surgeons, FIG. 2 a perspective view of the training device with the omission of the carrier plate and the camera, FIG adjustable and adjustable elements, FIG. 5 a perspective detailed view of the carrier plate with a fictitious body part on a tripod and FIG. 6 a vertical section through the carrier plate in FIG.
    Reference number 1 denotes a training device. This comprises a column 3 which is fastened on a base plate 5. Two swivel arms 9 are fastened to the column 3 with a displaceable clamp 7. The pivot arms 9 are arranged pivotably on separate pivot axes or preferably on a common axis A. The swivel arms 9 carry receptacles 11 for surgical instruments 13 at their ends. Furthermore, a support plate 15 is attached directly to the column 3 or to the bracket 7. A camera arm 17 can be arranged at the upper end of the column 3, at the end of which a camera 19 or a mirror, which guides an image to a camera not shown in the figures, is attached.
    The support plate 15 rests on a tripod 21 which carries the support plate 15 at its upper end and at its lower end on a base 23 which is pivotably mounted and lockable about a horizontal pivot axis B. The base 23 can be pivoted and locked in the set position by a first lever 25. The base 23 is also guided on a further horizontally extending axis C on a circular path section. For this purpose, the axis C is arranged in a shaft 27 to which two guide plates 29 are attached as a pair of supports. The base 23 is fastened to these guide plates 29. The shaft 27 can be pivoted and locked by a second lever 31. With the guide plates 29, the height of the base 23 and thus of the carrier plate 15 attached to it with respect to the base plate 5 can consequently be adjusted.
    A bore 33 is formed in the base 23, in which the stand 21 for the carrier plate 15 is received. The articulated mounting of the carrier plate 15 at the upper end of the stand 21 is carried out by a bearing element 35 with which the carrier plate 1 is pivotably mounted in all directions.The bearing element 35 can for example consist of a ball on the upper end of the stand 21 and a socket on the underside of the carrier plate 15. Of course, these two elements can also be arranged the other way round, i.e. the socket is seated on the stand 21 and the ball is connected to the carrier plate. Alternatively, the bearing element 35 can also be constructed from a rod section made of rubber or an elastic plastic (not shown). In addition, there is preferably a connecting element 53 between the edge area of the carrier plate 35 and the stand 21 in order to hold it in a basic position, for example at right angles to the stand 21, when no forces act on the surface of the carrier element 35. The connecting element 53 can consist of rubber ropes or bands which are fastened to the support plate 15 and to the stand 21 (FIGS. 5, 6).Of course, the three-dimensional pivotability of the carrier element 35 could also be achieved by a universal joint as the bearing element 35.
    The carrier plate 15 serves as a support for training models such as tubes as an imitation of blood vessels, three-dimensional structures with different strength or hardness simulate, for example, other body parts in the human body on which operations must be carried out with the surgical instruments. These bodies generally simulate body parts to be operated on, in order to create cuts and to practice seams for closing the cuts, but also for scorching areas of body parts such as small veins or processing them with laser light and so on. The simulated body parts 55 on the carrier plate 15 can be firmly connected to it and the entire carrier plate 15 is exchanged for each practice or the body parts 55 can be individually removed and are temporarily held on the surface of the carrier plate 15 with fastening means such as screws, Velcro or other elements during the surgical treatment .
    The position or the pressure angle between the two or further surgical instruments 13 can be set and adjusted more or less as desired. The swivel arms 9 can be swiveled about the axis or axes A and the respectively suitable swivel position or the angle between the swivel arms 9 can be determined individually and is reproducible if, for example, the locking and guide element 37 consists of a partially circular plate 41. This can, as shown in FIGS. 1 to 3, be T-shaped, with a slot 44 being formed in the arcuate leg 43 through which locking screws 45 can be passed.
    In addition, the receptacles 11 for the surgical elements 13 are articulated on a slide 47 which is arranged such that it can be moved and locked radially along the pivot arms 9. The receptacles 11 are carried by support arms 49 which are attached to the slide 47 in a pivotable and lockable manner with a joint 51. A corresponding scale can be printed on the support arms 49 for reproducible swivel arm alignment. The joint 51 on the slide 47 is mounted pivotably about a vertical axis D.The receptacle 11 for the surgical instrument 13 can also be pivoted about an essentially horizontal axis E at the upper end of the support arm 49. Furthermore, the surgical instrument 13 can be axially displaced in the receptacle 11. This means that the surgical instrument 13 can be pivoted on the pivot arm 9 about the horizontal axis A, on the pivot arm 9 radially, pivotable on the slide 47 about a vertical axis D and pivotable about a horizontal axis at the joint 51 and further about the axis E at the end of the support arm is pivotably mounted. This means that the surgical element 13 can essentially assume any desired position and thus the surgeon can also carry out all the necessary work on the interior of the human body with two instruments. During an operation, only the pivotability of the pivot arms and the support arms 49 is preferably preset.
    Both the carrier plate 15 with its bearing element 35 and the swivel arms 9 can be displaced together with the clamp 7 in the vertical direction on the column 3 and the height can thereby be adjusted. All of this enables the surgeon to train all surgical interventions occurring on the human body on the training device.
    The training device 1 can, as shown in the figures, be used "on sight", i.e. the surgeon can directly see the position of the instruments with which he is simulating operations. Of course, the view of the carrier plate 15 can also be covered so that the simulated operation is recorded with a camera 19 and transmitted on a screen not shown in the figures, as is the case with real operations on humans.
    Legend of the reference symbols
    1 training device 3 column 5 base plate 7 clamp 9 swivel arms 11 receptacle 13 surgical instrument 15 support plate 17 camera arm 19 camera 21 stand 23 base 25 1st lever 27 shaft 29 guide plates 31 2nd lever 33 bore 35 bearing element 37 locking and guide element 39 Plate 41 Leg 43 Scale 44 Slot 45 Locking means 47 Slide 49 Support arm 51 Joint 53 Connection element 55 Body part
    权利要求:
    Claims (14)
    [1]
    1. Training device for the training of minimally invasive doctors (surgeons, gynecologists, urologists, etc.) in the handling of laparoscopic surgical instruments, comprising a carrier plate for supporting exercise elements (simulation of organs and tissues), several at a distance from the Support plate arranged pivotably mounted receptacles for guiding through and for fastening surgical instruments,characterized in thatthe receptacle (11) for the surgical instruments (13) are arranged on a column (3) such that they can be moved in the x, y and z directions and can be locked in the claimed set position.
    [2]
    2. Training device according to claim 1, characterized in that the receptacles (11) for the instruments (13) are arranged on the ends of pivot arms (9) and that the pivot arms (9) are pivotable about a vertically extending axis.
    [3]
    3. Training device according to claim 2, characterized in that the pivot arms (9) have a common pivot axis or separate pivot axis A.
    [4]
    4. Training device according to one of claims 2 or 3, characterized in that the angle between the pivot arms (9) can be set and locked.
    [5]
    5. Training device according to claim 4, characterized in that the set angle between the swivel arms (9) can be locked on a locking and guide element (37) with locking means (45) and adjustable on a scale (43).
    [6]
    6. Training device according to one of claims 1 to 5, characterized in that the distance between the receptacles (11) can be adjusted radially with respect to the column (3) with a slide (47).
    [7]
    7. Training device according to claim 6, characterized in that each receptacle (11) is fastened at the upper end of a support arm (49), which support arm (49) is connected at its lower end to the slide (47).
    [8]
    8. Training device according to claim 7, characterized in that the connection of the support arm (49) to the slide (47) takes place through a joint (51), the joint (51) being pivotable about a vertically extending axis D on the slide (47) is hinged.
    [9]
    9. Training device according to one of claims 8 or 9, characterized in that the support arm (49) is articulated and lockable on the joint (51) about a horizontally extending axis.
    [10]
    10. Training device according to one of claims 7 to 9, characterized in that the receptacle (11) is connected to the support arm (49) in an elastically movable manner.
    [11]
    11. Training device according to one of claims 1 to 10, characterized in that the carrier plate (15) is mounted so as to be movable in three dimensions for receiving fictitious body parts.
    [12]
    12. Training device according to claim 11, characterized in that the carrier plate (15) is mounted on a ball joint or on an elastically pivotable support arm.
    [13]
    13. Training device according to claim 12, characterized in that the ball joint is rigidly attached to a pivotable support arm.
    [14]
    14. Training device according to claim 13, characterized in that the support arm is axially adjustable.
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    同族专利:
    公开号 | 公开日
    CH717146A2|2021-08-31|
    引用文献:
    公开号 | 申请日 | 公开日 | 申请人 | 专利标题
    US5368487A|1992-07-31|1994-11-29|Medina; Marelyn|Laparoscopic training device and method of use|
    DE102016116677B3|2016-09-06|2017-12-14|Universität Duisburg-Essen|Surgical simulation device|
    法律状态:
    优先权:
    申请号 | 申请日 | 专利标题
    CH00175/20A|CH717146A2|2020-02-17|2020-02-17|Training device for training surgeons.|DE102021201174.8A| DE102021201174A1|2020-02-17|2021-02-09|Training device for training minimally invasive doctors|
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