WO2009000939A1

WO2009000939A1 - Laparoscopic surgical simulator

Info

Publication number: WO2009000939A1
Application number: PCT/ES2007/000377
Authority: WO
Inventors: Jorge Potti Cuervo; Carlos G. Illana Alejandro; Bernardo Sierra Picon
Original assignee: Gmv, S.A.
Priority date: 2007-06-22
Filing date: 2007-06-22
Publication date: 2008-12-31

Abstract

The invention relates to a laparoscopic surgical simulator which is intended to reproduce accurately the real conditions facing a surgeon during this type of operation so that the surgeon can practice different techniques and develop precise skills. The invention essentially comprises: a physical model (1) of the patient, on which the kit of instruments (2) and a camera (4) are positioned; a monitor (5) displaying the simulation of the operation; a hinged operating table (6), the movement of which can be transmitted to the images of the patient's internal organs; a control unit (9) for controlling all of the parameters of the system; and connected peripherals for introducing data into the system.

Description

LAPAROSCOPIC SURGERY SIMULATOR

D E S C R I P C I Ó N

OBJECT OF THE! NVENTION

The present invention relates to a simulator for the training of laparoscopic surgery which aims at the faithful reproduction of the real conditions that a surgeon must face in an operation of this type in order to practice the different techniques, develop the skills precise, etc.

BACKGROUND OF THE INVENTION

For several decades there have been different techniques in the field of surgery that pursue the healing of the patient through interventions that, unlike the so-called open surgery, do not require making a large incision to the patient in order to act on the affected organs, thus allowing a rapid recovery of it, a shorter hospitalization time and a lower risk of infections.

One of these techniques, which are normally encompassed within the term "minimum invasion" or "minimally invasive surgery", is laparoscopy, which consists of performing surgical interventions without opening the patient, only making a small incision called the portal, where it will penetrate the instruments required to perform operations on a specific organ.

For the monitoring and control of the manipulation of the instruments a camera is used that is introduced into the patient, which shows, through an external screen, the images of the different operations and maneuvers that the surgeon performs internally.

This surgical technique, which offers obvious advantages, nevertheless needs a high degree of specialization and skill with respect to conventional open surgery, since the surgeon must get used to following the evolution of his intervention through a monitor, while at the same time His hands handle the instruments introduced in the patient through the mentioned portals.

Thus, prior training is absolutely necessary to ensure proper management of the system and an adaptation of the surgeon's skills to the skills that such systems need.

This training has sometimes been carried out using human corpses or even live animals, which, as is evident, has a high number of drawbacks.

To solve them, some years ago, physical models were used that tried to reproduce the working conditions, and that were structured from a closed box or envelope that simulated the human body, from which the corresponding instruments emerged, and that inside contained physical models of certain organs of the human body.

These first simulators, although effective from the point of view of acquiring certain manual skills and getting used to the presence of the camera, had many inconveniences, since they were still crude reproductions of the real conditions that the surgeon.

In order to solve these problems and provide greater Realism to training in recent years have appeared, thanks to the remarkable development of the software, virtual simulators capable of reproducing images of the interior of the body and its organs and the interaction of medical instruments operating on said organs. In other words, training systems capable of simulating multiple scenarios in which diseases can reproduce, problems that may arise during the intervention, etc. allowing, in turn, that through the movements that the surgeon prints to the simulator instruments, the system will be able to generate images of the effect that said movements would have on the organs also simulated by the system.

However, this new technique applied to the simulation, even solving the aforementioned drawbacks, can suffer in many occasions from lack of realism due to factors such as the incorrect position of the instrument in the physical model of the patient, the incorrect position or dimension of said physical model or even the excessive size of the haptic devices that collaborate with the instruments, which stand out from the physical model of the patient making it difficult to handle said instruments and ultimately preventing the surgeon from handling them as they would with those used in a real operation, that is, do not practice with real ergonomics.

To all this we must add the fact that the image generators of this type of simulators are limited to providing models of the internal organs in a certain position, without being able to reproduce the patient's movements and even the movements of their organs. interns on the occasion of said movement. However, this movement of patients is usually common in surgery operations, because on certain occasions the surgeon, helped by the operating table, tilts the patient's body so that one or more internal organs move relative to each other and that way you can have a better view of them, better access to certain areas, etc. - TO -

DESCRIPTION OF THE INVENTION

The laparoscopic surgery simulator described below solves the problems outlined above, since it allows a simulation that is faithful reproduction of the real conditions that the surgeon must face, including instruments of real size and location and the possibility of moving the patient on the table and thereby also move the internal organs of the body.

Specifically, the simulator object of the present invention basically comprises the following components:

- A physical model of the patient on which the appropriate instruments will be placed, such as tweezers, scissors, stapler, separator, etc. with its corresponding haptic device responsible for transmitting to the control unit the position thereof in the X, Y and Z axes, as well as producing a sense of touch through a feedback of forces that will be reflected in the instrument controls. All these devices will be integrated into the physical model of the patient, so that only those that in a real operation will be those that the surgeon finds, that is, the instrument itself and the camera, thus faithfully reproducing reality.

In addition, said instruments will faithfully reproduce all the characteristics of a real instrument, both in size and manageability and in the position they occupy between them and with respect to the patient, so that the simulation reproduces the same characteristics as a real operation. For this, in addition, the patient's physical model will also faithfully reproduce a human body, both in dimensions and in appearance, being also interchangeable and independent of the operating table (6) to be able to represent different patient models such as adults, children, etc. according to the occasion.

- A camera Ia which simulates a real one in shape, dimensions and functions, so that if the camera penetrates, the objective is close to the object and the virtual result is an approach to the image, otherwise, if the camera is displaced in the axes of coordinates X, Y, or there is a rotation of the Z axis, the latter corresponding to the penetration, the virtual representation reacts in the same dimension and direction in synchronism with the movements of the camera.

- A visualization system whose mission will be to represent on a screen the images virtually collected by the camera, as well as the images generated from the manipulation of the instruments.

- An articulated operating table, whose mission is to support the physical model of the patient, as well as on the one hand, incorporate the mechanisms responsible for positioning the board on which said patient model rests according to the surgeon's requirements, and on the other , incorporate the necessary means to measure the position in the space of said board and transmit it to the control unit so that it is in charge of sending the images of the organs to the visualization system as they are affected by the field plane gravitational in relation to the inclination of the tabletop.

- A specific software in charge of the simulation that, from the data provided by the instruments and the operating table, will generate the three-dimensional simulation position of the same with respect to the simulated three-dimensional scenario that will be represented in the visualization system. - A central processing unit or CPU, in charge of controlling all system parameters, housing the necessary databases such as those of anatomical and instrumental models, medical records, etc., as well as running the simulation software and Manage the operation of all devices connected to it.

- Finally, a series of peripherals to enter data into the system and / or reproduce various operations or functions that can be carried out by the surgeon and also exist in a real operating room.

Thus, based on the information stored in the databases used and the movements of the instruments, operating table or others, the system, through the specific software, is capable of generating virtual images that correspond to what would happen in reality. if said instrumental, table, etc. were used in that way, reproducing reality so faithfully and turning the system into a powerful training tool.

Finally, add that the system, through the appropriate databases and software, is able not only to reproduce in real time what the surgeon is doing, but also the effects that the surgeon causes on the organs of the body. patient, or even the simulation of any unexpected contingency and / or operative complication, as well as multiple factors that could influence the simulated operation.

DESCRIPTION OF THE DRAWINGS

To complement the description that is being made and in order to help a better understanding of the characteristics of the invention, according to a preferred example of practical implementation thereof, a set of drawings is accompanied as an integral part of said description. where, as an illustration and not limitation, the following has been represented:

Figure 1 shows a schematic view of the elements comprising the simulator of the present invention.

Figure 2.- Shows a perspective view in which a possible physical model of the patient is represented, which has both the camera and the instruments attached.

Figure 3 shows a bottom perspective view of the operating table of the simulator of the invention, on which the physical model of the patient has been located.

Figure 4.- Shows two elevational views of that of the operating table of the simulator of the invention.

Figure 5.- Shows a view 5a of the cavities on which the feet of the haptic devices are placed on the board of the operating table of the simulator of the invention and another 5b of detail of said feet.

Figure 6.- It shows a block diagram where the relationship between the different parts of the simulator managed by the software is schematically represented.

PREFERRED EMBODIMENT OF THE INVENTION

According to a possible embodiment of the invention, the simulator for laparoscopic surgery of the invention comprises a physical model (1) of the patient, capable of being exchanged for others of different morphology as it might correspond in real life, on which the instruments are located (2) adequate entering the patient through the corresponding portals (3), as well as the camera (4).

The system, from the movements in any of the three X, Y, Z or rotation axes of both the chamber (4) and the instruments (2), as well as the specific movements of cutting, clamping, etc. of the instrumental

(2) generates the virtual images corresponding to what would be said movement in reality, which can be seen through the monitor (5), which is also capable of incorporating a touch screen as a peripheral.

To position said physical model (1), an articulated operating table (6) is used, which incorporates means (7) to position the board (19) tilting it both transversely and longitudinally, that is, both in a left-right movement around the longitudinal axis as anterior - posterior around the transverse axis. Likewise, said operating table (6) has devices for measuring angular displacement, such as "encoders", position sensors, etc., which will measure the position of the table (6) to be transmitted to the control unit (9) so that the latter is responsible for sending to the monitor (5) the images of the organs as they are affected by the plane of the gravitational field, in relation to the inclination of the board of said table (9).

Thus, according to a preferred embodiment that can be seen in Figures 3, 4 and 5 the operating table (6) comprises a board (19) preferably made of a rigid material that has a plurality of cavities (20), of different depth , whose purpose is to house the foot (21) of the different haptic devices to place them in the correct position, height and orientation according to the use of the exercise being developed.

Said cavities (20) are made up of housing cylindrical on which another internal cavity (22) is placed in the form of a rectangular prism as a keyway that serves for the angular orientation of said foot (21) of the haptic device (13). The height situation of the haptic device (13) will be a function of the depth of the cavity itself (20), as can be seen in Figure 5 ^a , where cavities with different depths appear.

In addition, in said internal cavity (22) there is at least one presence sensor (23) or the like capable of detecting the occupation of the cavities (20) by a haptic device (13), and even identifying the latter.

Regarding the positioning of the operating table (6), it is supported by means of rotating supports (24) preferably located in the longitudinal axis to the board (19) and joined by its axes to a rocker (26) so that allow the rotation around said longitudinal axis, that is, the left-right rotation of said board. In at least one of said rotating supports (24) a device (25) for measuring angular displacement such as an encoder or the like capable of measuring the degree of lateral inclination of said board (19) is also coupled.

Likewise, the mechanical action of the longitudinal rotation is supplied by a first actuator (27) or servo tied by one of its ends to the pin (28) and by the other to a turning bridge (29) located on the rocker arm (26).

Said rocker (26) also incorporates a pin (31) that serves as a pivot point and mooring at one of the ends of the second actuator (32) or servo responsible for producing an angular displacement of said rocker (26) at the pivot points. (30) so as to allow rotation around the transverse axis of the board (19), that is, the anterior-posterior rotation of said board (19), said angular displacement being measured by a second device (29) integral with the rocker arm (26) and connected to the mentioned pivot points (30).

Thus, from the angular displacement measurements, which correspond to the changes in the position of the board (19), delivered to the control system by the devices (25, 29), said system translates that movement or displacement by sending the system of visualization (14) the images of the organs according to these are affected by the plane of the gravitational field in relation to the inclination of the board (19) of the table (6).

As for the control unit (9) or processing unit or CPU, it will be in charge of controlling all the system parameters, housing the necessary databases, running the simulation software and managing the operation of all the devices to It is connected, not only to those previously mentioned, but to any other peripherals connected to the system, such as a keyboard (10) to enter data into the system, navigate through menus or screens, or pedals (11) similar to those used in real surgery to be operated by the foot, being responsible for controlling functions such as cauterization, cutting, image capture, etc.

More specifically, and as can be seen in Figure 5, in which the block diagram of the system is shown schematically, it is necessary to:

The user (12) is the person who interacts with the simulator through the simulated physical instruments (2) and who receives visual responses through the visualization system (14) through the PC and haptic sensations through the haptic devices (13 ) real

Said display system (14), which includes both the camera (4) as the monitor (5) in turn comprises two functional software entities. One of them is the software application that allows the user (12) to interact with the system by planning the simulation in a visual, interactive and friendly way, counting among its functionalities with that of selecting the exercises, accessing the historical results, interacting with the tutorials and homework descriptions, etc.

The other functional software entity that incorporates the display system (14) is that of the graphics generator engine, which is a high performance library for the visualization of 3D graphics and the simulation sequence on the monitor (5).

Another element is, as already said, the simulated physical instrument (2) that mimics the surgical instruments: tweezers, probes, cameras and that is coupled to the haptic devices (13) through which they simulate their operational functionality, being said haptic devices (13) retracted or hidden completely within the physical model (1) so that they do not hinder the surgeon's task and faithfully reproduce a real situation.

The system also has a simulation core (15) whose function is to direct, control and manage the flow of the simulation at all levels: graphic, haptic and operational. That is, this module coordinates the rest of the remaining modules and elements and acts as an interface between the simulator and the software application that allows the user (12) to plan the simulation.

In order to achieve an appropriate realism of the simulator, the system also has a touch and sound software module (16) that converts the simulated user actions (12) into haptic and sound responses, that is, it acts as a bridge between the action user simulated (by example, milling) and the sensory response of the hardware (collision sensation of the milling cutter and noise of milling).

The set is completed with an evaluation system (17) that allows monitoring different aspects of the execution of the simulation exercises with the objective of being able to evaluate the actions of the users (12) in the execution of the different exercises.

Finally, there is a training case library (18) of static support for the simulation, that is, databases, XML files or similar, graphic models etc. such as anatomy and / or instrumental models, medical records, teaching sequence and objectives to be fulfilled within a training, etc.

Claims

R E I V I N D I C A C I O N E S

1 .- simulator for laparoscopic surgery comprising a physical model (1) on which the patient lies instruments (2) coupled to the corresponding haptic device (13); a camera (4) that simulates a real one; an operating table (6) with a board (19) on which said physical model (1) is located; a control unit (9) responsible for controlling all system parameters, hosting the necessary databases and execution software and managing all connected devices; peripherals to enter data into the system and / or reproduce existing functions in a real operating room; and a display system (14) responsible for representing on a monitor (5) the images generated by the control unit (9), characterized in that the operating table (6) comprises means ⁽ J) for tilting the board (19) both transversely and longitudinally, and devices (25, 29) to measure the angular displacement and / or the position of said board (19) and send said measurement to the control unit (9) so that it is processed and sent to the monitor (5) the images of the internal organs of the simulated body of the patient according to these are affected by the plane of the gravitational field, in relation to the inclination of said board (19).

2 .- simulator for laparoscopic surgery according to claim one , characterized in that the operating table (6) is supported by means of trunnions (24) connected by their shafts to a rocker (26) so that rotation of the board is allowed (19) around its longitudinal and / or transverse axis.

3 .- simulator for laparoscopic surgery according to Claim second, wherein at least one of the trunnions (24) a device (25) is coupled to measure the angular displacement or degree of tilt about the longitudinal axis of the board (19) . 4 .- simulator for laparoscopic surgery according to claim 2 or 3, characterized in that the axes of the trunnions (24) of the operating table (6) are located on the longitudinal axis of the board (19).

5 .- simulator for laparoscopic surgery according to previous claims, characterized in that the operating table (6) comprises a first actuator (27) tied by one of its ends the pin (28) and on the other to a bridge of rotation ( 29) located on the rocker (26).

6 .- simulator for laparoscopic surgery according to Claim second, characterized in that the rocker (26) includes a pin (31) serving as pivot point mooring and one end of a second actuator (32) responsible for producing a displacement angle of said rocker at the pivot points (30).

7 .- simulator for laparoscopic surgery according ^to claim 6 characterized in that secured to the rocker (26) and attached to the pivot points (30) a second device (29) is coupled to measure the angular displacement or degree of tilt about the axis cross section of the board (19).

8 .- simulator for laparoscopic surgery according to claim one , characterized in that the board (19) of the operating table (6) comprises a plurality of cavities (20) of different depth designed to house the foot (21) of the various devices haptics

9 .- simulator for laparoscopic surgery according to the eighth claim, wherein the cavities (20) are composed of accommodation cylindrical shape on which an internal cavity is located (22) as a keyway which serves for the angular orientation of said foot (21) of the haptic device (13). 10 .- simulator for laparoscopic surgery according to claim ninth, characterized in that the internal cavity (22) at least a presence sensor (23) is positioned to detect the occupation of the cavities (20) by the foot (21) of a haptic device (13) and / or identify the type or characteristics of the latter.

11 .- simulator for laparoscopic surgery according to claim one , characterized in that the control unit (9) comprises:

- a simulation core (15) that coordinates the rest of the modules and elements and acts as an interface between the simulator and the software application that allows the user (12) to plan the simulation;

- A touch and sound software module (16) that converts simulated user actions (12) into haptic and audible responses;

- an evaluation system (17) to monitor the execution of the exercises and evaluate the actions of the users (12); Y

- A library of training cases (18) of static support for the simulation.

12 .- simulator for laparoscopic surgery according to claim one , characterized in that the display system (14) includes Camera (4) and the monitor (5) and further comprises two functional software entities, one that allows the user (12) plan and interact with the system visually and another in charge of generating the 3D graphics and the simulation sequence on the monitor (5).

13 .- simulator for laparoscopic surgery according to claim one , characterized in that the different haptic devices (13) on which the instruments (2) is placed transmitted to the control unit (9) the position thereof in the X, Y and Z, and produce a sensation of touch by means of a feedback of forces that will be reflected in the controls of the instruments (2), and because they remain integrated within the physical model (1) of patient, so that only the instruments (2) that the user (12) would find in a real operation stand out.

14 .- simulator for laparoscopic surgery according to claim one wherein the peripheral comprises a keyboard (10) for inputting data to the system and / or pedals (11) responsible for controlling the operation of eigenfunctions.

15 .- simulator for laparoscopic surgery according to claim one , characterized in that the physical model (1) the patient is interchangeable and independent of Ia operating table (6) and faithfully reproduces the dimensions and appearance of the human body.