WO2020031311A1

WO2020031311A1 - Organ fixing tool for abdominal cavity simulator

Info

Publication number: WO2020031311A1
Application number: PCT/JP2018/029847
Authority: WO
Inventors: 竹内　淳一; 宮本　貴文; 武志安楽; 昌巳岡本
Original assignee: 株式会社ファソテック
Priority date: 2018-08-08
Filing date: 2018-08-08
Publication date: 2020-02-13
Also published as: JPWO2020031311A1; JP6756947B2

Abstract

Provided is an organ fixing tool for an abdominal cavity simulator which can be arranged at an anatomically accurate three-dimensional position when a biological texture organ model is attached to the abdominal cavity simulator and which can produce a biological texture organ model at a low cost. In the organ fixing tool for arranging an organ model in a three-dimensional space of an abdominal cavity simulator lumen for laparoscopic skill learning, the abdominal simulator is composed of at least a pelvic part, a back part, and an abdomen part, the organ fixing tool is at least one of a stomach model fixing tool, a uterine model fixing tool, and an inguinal hernia model fixing tool, and when any of the fixing tools is attached to an organ model, the surface of the fixing tool itself is raised, depressed, or curved so that the three-dimensional arrangement position of the organ model in the abdominal cavity simulator lumen is an anatomically accurate position.

Description

Organ fixation device for abdominal cavity simulator

The present invention relates to an instrument for fixing a biological material organ model to an abdominal cavity simulator.

In recent years, since scars are small and post-operative recovery is quick, laparoscopic surgery is often performed in operations such as digestive organs and urology.
However, laparoscopic surgery has a problem that the difficulty of the operation is high, and the skill of the surgeon tends to be different. Therefore, a technique for effectively performing laparoscopic surgery technique training is desired.

As a technique for performing laparoscopic surgery technique training, an abdominal cavity simulator having a casing made of a member simulating a human body shape is known (see Patent Document 1).
In the abdominal cavity simulator disclosed in Patent Literature 1, a plurality of ports through which surgical instruments can be inserted are provided, and it is possible to repeatedly perform training. In addition, when a biomaterial organ model is mounted in the simulator, the position can be easily adjusted, and the simulator is highly convenient.
In order for training using such an abdominal cavity simulator to be performed effectively, the operative field obtained by the operator through the endoscope must be close to the actual operative field. It is necessary for the biomaterial organ model to be mounted inside to be mounted at an anatomically accurate three-dimensional position.
However, in the abdominal cavity simulator disclosed in Patent Document 1, a mechanism for attaching the biomaterial organ model to an anatomically accurate three-dimensional position is provided in the model gripper used for attaching the biomaterial organ model. Has not been fully disclosed.

As a technique for providing an anatomically accurate training model, an anatomical model including a plurality of layers is known (see Patent Document 2). This is a technique relating to a gallbladder model used especially for training in laparoscopic cholecystectomy, which comprises an anatomical part and a detachably connectable support.
However, although the anatomical model disclosed in Patent Document 2 is intended to more accurately reproduce an organ, there is a problem that the cost of producing the organ model is increased.

In addition, a hernia model for training in repair of an inguinal hernia is known (see Patent Document 3). This is a model for practicing transperitoneal preperitoneal (TAPP) and total extraperitoneal (TEP) procedures for laparoscopic hernia repair, and is assumed to have an anatomical structure.
However, the hernia model disclosed in Patent Literature 3 also has a problem that the cost of producing an organ model is high, as is the case with the anatomical model disclosed in Patent Literature 2.

International Publication Pamphlet WO2015 / 151504 JP-T-2016-523383 JP-T-2016-51863A

In order to perform effective technique training, it is necessary to accurately reproduce an organ according to an anatomical structure. However, on the other hand, since the training is performed repeatedly, it is desirable that the organ model be produced at low cost.
In view of such a situation, the present invention makes it possible to produce a biomaterial organ model at an anatomically accurate three-dimensional position when the biomaterial organ model is attached to the abdominal cavity simulator, and at low cost. It is an object of the present invention to provide a simple organ fixing device for abdominal cavity simulator.

In order to solve the above-mentioned problem, an organ fixing device for abdominal cavity simulator of the present invention is an organ fixing device for arranging an organ model in a three-dimensional space of a cavity of the abdominal cavity simulator for learning a laparoscopic technique. A pelvic part simulating the above, a back part having left and right abdominal parts and a spine ridge, and an abdomen provided with a plurality of ports through which surgical instruments used under laparoscopic procedures can be inserted, and an organ fixing tool Is at least one of a stomach model fixing device, a uterine model fixing device, and an inguinal hernia model fixing device. When any of the fixing devices is attached with an organ model, the three-dimensional arrangement of the organ model in the lumen of the abdominal cavity simulator. The surface of the fixture itself is raised, depressed, or curved so that the position is anatomically correct, and the gastric model fixture has at least three steps. A tray on which at least a stomach organ model having a part of the esophagus and the duodenum is placed, wherein the uterine model fixture is a flexible sheet-shaped uterus having uterus, ovary, and bladder organ models. The inferior inguinal hernia model fixture is attached to the inner wall of the pelvis and has a flexible sheet shape having two hernia tract organ models provided on the left and right sides. Can be attached to the back of the inguinal hernia model.

If you try to attach the organ model to the abdominal cavity simulator without using an organ fixture, it will be necessary to form the organ model itself in an anatomically correct shape. Is also precisely reproduced, which increases the manufacturing cost. In addition, there is a limit to accurate reproduction of the positional relationship between the organs and the fixed state only by devising the material and shape of the organ model.
By using the organ fixing device of the present invention, it is possible to separately design the organ model and the organ fixing device on the assumption that the organ model and the organ fixing device are combined, so that a flexible and high-quality design becomes possible. In other words, the organ fixing device enables accurate and stable fixing of the organ model, while the organ model can be designed in a substantially planar shape, for example, on the assumption of the state after attachment. Becomes
In addition, an important part in the procedure training can be precisely reproduced by an organ model, and a part that is not always important can be deformed by an organ fixture, so that an organ model can be produced at low cost.

In the organ fixture for abdominal cavity simulator of the present invention, the stomach model fixture has a back surface of the tray fitted into the spine ridge of the back, a side surface of the tray engaged with the left and right flank, and a center of the tray surface with the spine ridge. It is curved and protrudes along the center of the tray surface, and the right and left sides of the tray surface are plate-shaped. The three-level difference of the tray surface is the right plate viewed from the center, the head side, and the left plate viewed from the head side. It is preferable that the height difference is provided in this order.
With this configuration, it is possible to mount the stomach organ model in an anatomically correct position.

In the organ fixing device for an abdominal cavity simulator of the present invention, it is preferable that the stomach model fixing device is further provided with a means for holding and fixing the esophagus of the stomach organ model on the central head side of the tray surface.
In the organ fixing device for an abdominal cavity simulator of the present invention, the gastric model fixing device further includes a means for fixing the duodenum of the gastric organ model on the pelvis side of the right plate viewed from the head side of the tray surface. Is preferred.
The provision of the means for clamping and fixing the esophagus of the stomach organ model and the means for fixing the duodenum not only can stably maintain the three-dimensional arrangement position of the stomach organ model, but also can be used during training. Thus, the elasticity and the like when the stomach organ model is grasped can be accurately reproduced.

In the organ fixing device for abdominal cavity simulator of the present invention, the stomach model fixing device further includes a second ridge on which a stomach organ model is placed, on a ridge along a central spine ridge on the surface of the tray. It is preferred that
By providing the second raised portion, it is possible to arrange the organ model at a more accurate position.

In the organ fixture for abdominal cavity simulator of the present invention, it is preferable that the stomach model fixture is further provided with a depression for mounting an organ model of a spleen on the head side of the left plate viewed from the head side of the tray surface. .
Since the spleen is located at a position lower than the spine in the supine position, the provision of the depression makes it possible to arrange the spleen at a more accurate position.

In the organ fixing device for an abdominal cavity simulator of the present invention, it is preferable that the gastric model fixing device mounts a stomach organ model on a sheet-like model simulating an omentum mounted on a tray surface.
By placing the stomach organ model on the sheet model simulating the omentum, the stomach organ model is placed at an anatomically accurate position. It is preferable that the stomach organ model further includes a spleen, blood vessels around the stomach, lymph nodes, transverse colon, pancreas, and peritoneum. In that case, the transverse colon and pancreas are placed below a sheet model that simulates the omentum.

In the organ fixing device for an abdominal cavity simulator of the present invention, the uterine model fixing device is a member that substitutes for the pelvis or a member that can be fitted to the inner wall member or the inner wall of the pelvis, and the central back side of the fixing device is raised. However, when the back surface of the uterus model was attached to the fixed position, the unevenness of the curved surface of the inner wall was formed so that the three-dimensional arrangement position of the uterus, ovary and bladder would be anatomically correct. Is preferred.
With this configuration, the uterus model can be attached so as to be anatomically correct in a three-dimensional position.

In the organ fixing device for the abdominal cavity simulator of the present invention, the uterine model fixing device is provided so that the place where the uterus is arranged is provided high, and is provided so as to be lowered toward the place where the bladder is arranged, and the uterus is arranged. It is preferably formed in a substantially frustoconical shape in which the diameter decreases from the place where the bladder is arranged to the place where the bladder is arranged.
With this configuration, the shape of the pelvis can be reproduced more accurately, and the uterus model can be attached so as to be in a more anatomically correct three-dimensional position.

In the organ fixture for abdominal cavity simulator of the present invention, the uterus model attached to the uterus model fixture includes uterus, ovary and bladder organ models, as well as rectum, adipose tissue, ureter, external iliac artery, external iliac vein Preferably, at least one organ model selected from the circular ligament is further arranged.
By arranging an organ model such as a rectum, an operation field when viewed with an endoscope is more accurately reproduced, and effective training can be performed. It should be noted that the organ model such as the rectum is also provided so as to be in an accurate three-dimensional arrangement position when attached to the uterine model fixture.

In the organ fixing device for an abdominal cavity simulator of the present invention, when the inguinal hernia model is attached, the fixing device is applied to the back of the two hernias and the arteries, veins, and vas deferens running around the two inguinal hernia models. It is preferable that the shape of the fixture is formed so as not to touch.
Since the fixing tool is formed so as not to abut, it does not hinder the procedure in the procedure training, so that more realistic training can be performed.

In the organ fixing device for abdominal cavity simulator of the present invention, the inguinal hernia model attached to the inguinal hernia model fixing device has a sheet-like surface covered with a gel-like film having a texture of a peeling layer of a pre-peritoneal fascia. It is preferable that at least one organ model selected from a medial fold, a medial umbilical fold, an artery, a vein, a bladder, and a vas defer is further arranged in addition to the two hernia tract organ models.
By arranging the organ model such as the inner umbilical fold, the surgical field, particularly when viewed with an endoscope, is more accurately reproduced, and effective training can be performed. It should be noted that the organ model such as the inner umbilical fold is also provided so as to be in an accurate three-dimensional arrangement position when attached to the inguinal hernia model fixture.

In the organ fixing device for an abdominal cavity simulator of the present invention, it is preferable that the gel-like membrane covering the inguinal hernia model attached to the inguinal hernia model fixing device is re-usable by being replaced.
Since the technique training is generally performed repeatedly, the training can be performed at low cost by being reusable and reusable.

It is preferable that a foam-like fascia model or a foam-like loosely-coupled woven model is further provided between the organ models attached to the organ fixture for the abdominal cavity simulator of the present invention.
By providing a foam-like fascia model or a foam-like loosely-coupled woven model, not only is the surgical field viewed with an endoscope more accurate, but also the procedures such as peeling and incision are made more realistic. It can be carried out. In addition, loose connective tissue is also called loose connective tissue.

ADVANTAGE OF THE INVENTION According to the organ fixing tool for abdominal cavity simulator of this invention, when the biomaterial organ model is attached to the abdominal cavity simulator, it is arranged at an anatomically accurate three-dimensional position, and the biomaterial organ model is inexpensive. Has the effect of being able to produce

FIG. 3 is a perspective view of the gastric integrated model fixture of the first embodiment. FIG. 1 is an external view of a stomach integrated model fixture according to the first embodiment. External view 2 of stomach integrated model fixture of Example 1 FIG. 3 is an external view of the stomach integrated model fixture according to the first embodiment. Explanatory drawing of the tray of the gastric integrated model fixture Top view of stomach integrated model Image of installation of integrated stomach model Perspective view of the abdominal cavity simulator Image of attaching gastric integrated model fixture to abdominal cavity simulator Flow chart of use of the integrated gastric model fixture of Example 1 Perspective view of the uterine model fixture of the second embodiment FIG. 1 is an external view of a uterine model fixture according to a second embodiment. FIG. 2 is an external view of the uterine model fixture of the second embodiment. FIG. 3 is an external view of the uterine model fixture of the second embodiment. Top view of uterus model Installation illustration of the uterus model Image of installation of uterus model Image of attachment of uterine model fixture to abdominal cavity simulator Flow chart of use of the uterine model fixture of the second embodiment A perspective view of the inguinal hernia model fixture of the third embodiment. External view of inguinal hernia model fixture of Example 3 Appearance diagram 2 of inguinal hernia model fixture of Example 3 Appearance diagram 3 of inguinal hernia model fixture of Example 3 Top view of inguinal hernia model Installation illustration of inguinal hernia model Installation image diagram of inguinal hernia model Image of attachment of inguinal hernia model fixture to abdominal cavity simulator Flow chart of use of the inguinal hernia model fixture of Example 3

Hereinafter, an example of an embodiment of the present invention will be described in detail with reference to the drawings. It should be noted that the scope of the present invention is not limited to the following embodiments and illustrated examples, and various changes and modifications are possible.

FIG. 1 is a perspective view of the stomach integrated model fixture according to the first embodiment. 2 to 4 are external views of the stomach integrated model fixture according to the first embodiment. FIG. 2 (1) is a front view, FIG. 2 (2) is a rear view, FIG. 3 (1) is a plan view, FIG. 3B is a bottom view, FIG. 4A is a right side view, and FIG. 4B is a left side view.
As shown in FIGS. 3A and 3B, the integrated gastric model fixture 1 includes a tray 4 and mounting members (5a, 5b). The tray 4 is a place where the biological material organ model is arranged and fixed, and is composed of trays (4a, 4b). In this embodiment, a configuration is shown in which two trays (4a, 4b) are combined, but the trays (4a, 4b) may be integrally formed.
The attachment members (5a, 5b) serve as an adapter for attaching to an abdominal cavity simulator described later, and are manufactured according to the shape of the abdominal cavity simulator to be attached.
The tray 4a and the mounting members (5a, 5b) are fixed using two screws 51, respectively. Similarly, the tray 4b and the mounting members (5a, 5b) are similarly fixed using two screws 51, respectively. As described above, since the tray 4 and the attachment members (5a, 5b) are detachable by the screws 51, the attachment members (5a, 5b) can be replaced according to the size of the abdominal cavity simulator to be used. It is. Further, unlike this configuration, the tray 4 and the mounting members (5a, 5b) can be integrally formed.
As shown in FIGS. 4A and 4B, the mounting member 5a is provided with female screw portions (6a, 6b), and the mounting member 5b is provided with female screw portions (6c, 6d). 52 can be easily attached to the abdominal cavity simulator.

As shown in FIG. 1, the tray 4 is not a flat surface but has an uneven shape. The reason for this shape will be described with reference to FIG.
FIGS. 5A and 5B are explanatory diagrams of the tray of the stomach integrated model fixing device. FIG. 5A shows a case where a flat tray is used, and FIG. 5B shows a case where an uneven tray is used.
As will be described later in detail, the stomach integrated model 10 includes not only the stomach but also models of various organs such as the spleen and the transverse colon. These organ models originally exist with a height difference provided inside the human body. However, as shown in FIG. 5A, when the stomach integrated model 10 is placed on the tray 400, the height difference cannot be reproduced because the tray 400 has a planar shape. That is, when using a planar tray, it is necessary to provide a height difference in the integrated stomach model 10 itself. However, in order to produce an integrated stomach model that accurately reproduces a height difference, it is necessary to precisely produce a part that is not necessary for manual training, and there is a problem that the production cost is increased.
Therefore, as shown in FIG. 5 (2), by providing a height difference on the tray 4 itself, even when the integrated stomach model 10 made in a substantially planar shape is installed, an anatomically accurate three-dimensional position is obtained. It is possible to place an organ in the stomach.
That is, when it is desired to arrange the part 10b at a position higher than the part 10a and to arrange the part 10c at a position lower than the parts (10a, 10b), as shown in the tray 4 shown in FIG. By using the member in which the portion 4c, the lower portion 4d, and the raised portion 4e are formed, it is possible to reliably and easily produce a height difference. Note that the depressed portion 4f is not shown here for convenience of explanation.

As shown in FIG. 1, the tray 4 is provided with a mechanism for fixing the integrated stomach model 10, specifically, an esophageal fixing mechanism 7a, a duodenal fixing mechanism 7b, and a through hole 7c. . Two through-holes 7c are provided at the top and bottom, and after inserting the end of the duodenum 11b from above the tray 4 to the inside of the protruding portion 4e, it is turned back and further inserted through the inside of the protruding portion 4e onto the tray 4 to fix the duodenum. The mechanism 7b has such a shape that the end of the duodenum 11b can be fixed. Alternatively, a configuration may be adopted in which only one through hole 7c is provided, the end of the duodenum 11b is fixed in the duodenal fixing mechanism 7b, and the surplus portion is inserted from the through hole 7c to the inside of the raised portion 4e.

FIG. 6 shows a plan view of the integrated stomach model. The stomach integrated model 10, which is a bio-textured organ model, is an integrated reproduction of the stomach and the periphery of the stomach, and enables training of the stomach extraction and peripheral processing in a series of flows. Specifically, as shown in FIG. 6, the stomach 11, the spleen 12, the blood vessels 13 around the stomach 13, the lymph nodes 14, the transverse colon 15, the omentum 16, the pancreas 17, and the peritoneum 18.
The stomach 11 has not only the stomach but also an esophagus 11a at the cardia and a duodenum 11b at the pylorus. The stomach 11 has a configuration corresponding to delta anastomosis.
Further, as a material, polyvinyl alcohol (PVA) resin is used. Since the polyvinyl alcohol resin contains moisture, an electric knife or the like can be used.
In the following examples, the organ called “stomach” is not an actual organ but a biological material organ model.

FIG. 7 shows an attachment image diagram of the integrated stomach model. As shown in FIG. 7, the integrated stomach model 10 is disposed on the tray 4 of the fixture for integrated stomach model 1, and the esophagus 11a is sandwiched and fixed by the esophagus fixing mechanism 7a. The duodenum 11b is inserted into the two through holes 7c shown in FIG. 1, and the ends are fixed by the duodenum fixing mechanism 7b shown in FIG. As a result, a state in which the duodenum falls below the retroperitoneum and connected to the small intestine can be reproduced.
The tray 4 is provided with four height differences of an upper part 4c, a lower part 4d, a raised part 4e, and a depressed part 4f. Therefore, when the integrated stomach model 10 is arranged, for example, the central part of the stomach 11 becomes a raised shape, and is arranged higher than the stomach 11 arranged in the upper part 4c near the liver. Blood vessels and bile ducts connected to the liver run near the liver, but there is no depression. By using the stomach integrated model fixture 1, such a three-dimensional positional relationship can be accurately reproduced. Similarly, for the transverse colon 15, a height difference is provided according to the location where the upper part 4c, the raised part 4e, and the lower part 4d are arranged.
Further, since the spleen 12 is arranged in the depression 4f, it is arranged at the lowest position than other organs. Thereby, it is possible to reproduce a state in which the bottom of the spleen falls substantially to the back side.
In this way, simply by appropriately arranging the integrated stomach model 10 on the tray 4, an organ can be arranged at an anatomically accurate three-dimensional position.

FIG. 8 is a perspective view of the abdominal cavity simulator, (1) shows an assembled state, and (2) shows an exploded state. As shown in FIG. 8A, the abdominal cavity simulator 9 includes an abdomen 91, a pelvis part 92, and a back part 93. As shown in FIG. 8B, the back part 93 is provided with a lid part 94. I have.

FIGS. 9A and 9B are conceptual diagrams of the attachment of the integrated gastric model fixing device to the abdominal cavity simulator. FIG. 9A shows a state before the attachment and FIG.
As shown in FIG. 9A, the female screw portions (6a to 6d) provided on the integrated gastric model fixture 1 and the female screw portions (93a to 93d) provided on the back 93 of the abdominal cavity simulator 9 are formed. The positions are adjusted and fixed using screws 52 as shown in FIG. 9 (2). The raised portion 4e is attached so as to fit to the spine 93h, but has a function of adjusting the position of the integrated stomach model 10 to be placed thereon.
Here, for convenience of explanation, the gastric integrated model 10 is attached to the back 93 of the abdominal cavity simulator 9 in a state in which the gastric integrated model 10 is not fixed to the gastric integrated model fixture 1; After fixing the stomach integrated model 10 to the fixture 1, it is attached to the back 93.
A specific use flow of the gastric integrated model fixture will be described with reference to FIG. FIG. 10 is a flowchart showing the use of the integrated gastric model fixture according to the first embodiment.
As shown in FIG. 10, when the stomach integrated model fixture is used, first, the stomach integrated model 10 is placed on the tray 4 (step S01). Next, the esophagus 11a is fixed using the esophagus fixing mechanism 7a (step S02). The duodenum 11b is fixed using the duodenal fixing mechanism 7b (step S03). The stomach integrated model fixture 1 is attached to the back 93 of the abdominal cavity simulator 9 (step S04). Finally, the abdomen 91, which is an insufflation cover, is attached to the back 93 (step S05).

FIG. 11 is a perspective view of the uterine model fixture of the second embodiment. 12 to 14 are external views of the uterine model fixture of the second embodiment. FIG. 12 (1) is a front view, FIG. 12 (2) is a rear view, and FIG. 13 (1) is a plan view. 13 (2) is a bottom view, FIG. 14 (1) is a right side view, and FIG. 14 (2) is a left side view.
As shown in FIGS. 13A and 13B, the uterine model fixture 2 is composed of five components (2a to 2e), and is fixed by screws 51, respectively. Specifically, the component 2a and the component 2b are configured as shown in FIG. 11, and the component 2a and the component (2c, 2e) are configured with the component 2d as shown in FIG. 11 or 12 (1). The member 2e is fixed by screws 51 as shown in FIG. 14A, and the

constituent members

2c and 2d are fixed by screws 51 as shown in FIG.
As shown in FIG. 13A, the uterine model fixture 2 is provided with hook-and-loop fasteners (71a to 71c). The hook-and-loop fasteners (71a to 71c) are formed by hooks, and the base member 20a of the uterine model 20, which will be described later, can play the same role as the loop portion of the hook-and-loop fastener because of its material. Can be adjusted.
The uterine model fixture 2 is provided with a head side opening 8a and a foot side opening 8b, and the head side opening 8a is provided wider than the foot side opening 8b. As shown in FIGS. 12 (2) and 13 (1), the inside of the uterine model fixture 2 has a curved surface shape. Therefore, the inside of the uterine model fixture 2 is provided so as to be gradually narrowed from the head side opening 8a to the foot side opening 8b. When the uterine model is attached to the uterine model fixture 2, the organ model is attached along the curved surface shape, so that the organ is placed at an anatomically correct position.
In addition, as shown in FIG. 11, a protrusion 2i is provided in the head side opening 8a. As shown in FIG. 14, the protrusion 2i is provided with an inclination so as to gradually descend from the head side opening 8a to the foot side opening 8b as shown in FIG. By providing such a height difference, the organ is arranged at an anatomically correct position when the uterine model is attached.

FIG. 15 shows a plan view of the uterus model. As shown in FIG. 15, the uterus model 20 includes a uterus 21, a bladder 22, a rectum 23, an ovary 24, an adipose tissue 25, a ureter 26, an external iliac artery 27a, an external iliac vein 27b, an artery 27c, a vein 27d, It consists of a circular ligament 28 and a nerve 29.
Although not shown here, the uterus model 20 also accurately represents fascia such as bubbles and sparse connective tissues that are anatomically present between the organs. As a result, the training operation such as peeling can be visually and textured to enhance the training effect. The presence of foam-like fascia and loose connective tissue has become more and more clear with the advent of 3D high-definition cameras.

Looking at the overall shape, the uterine model produced on a flat surface is designed by deforming the internal structure such as blood vessel running, with the image of the three-dimensional structure after installation on the uterine model fixture 2. Therefore, in the state of the plane shown in FIG. 15, the three-dimensional position of each organ is not anatomically accurate. Therefore, a mechanism in which a three-dimensional position of an organ that is not accurate in a planar state becomes an accurate position by being attached to the uterine model fixture 2 will be described with reference to FIG.

FIGS. 16A and 16B are explanatory views of the attachment of the uterus model, wherein FIG. 16A shows a planar state, and FIG. As described above, the inside of the uterine model fixture 2 has a curved surface shape and is provided so as to be gradually narrowed from the head side opening 8a to the foot side opening 8b. Therefore, when attaching the uterine model 20 having the planar shape shown in FIG. 16A to the uterine model fixture 2, the uterine model 20 is rounded so that the upper right and left ends become narrow as shown in FIG. Will be arranged.
In addition, since the uterine model fixture 2 is provided with the protruding portion 2i, the center of the lower portion of the uterine model 20 rises and has a shape that gradually falls upward.

FIG. 17 shows an attachment image diagram of the uterus model. As shown in FIG. 17, the uterine model 20 is attached to the uterine model fixture 2.
In FIG. 15, the external iliac artery 27a and the external iliac vein 27b in the uterine model 20 are provided so as to expand left and right, but in FIG. 17, the curved surface provided in the uterine model fixture 2 is provided. Thus, the members are arranged so as to gather toward the center of the foot side opening 8b.
Thus, unlike the uterine model 20 shown in FIG. 15, it can be seen that the uterine model 20 is arranged at an anatomically correct three-dimensional position.

FIG. 18 shows an image of an attachment of the uterine model fixture to the abdominal cavity simulator. As shown in FIG. 18A, the uterine model fixture 2 and the back 93 of the abdominal cavity simulator 9 are provided on female threads (2f to 2h) provided on the uterus model fixture 2 and the back 93. The female screw portions (93e to 93g) are brought into contact with each other and fixed by using screws 52 as shown in FIG. Specifically, the female screw portion 2f and the female screw portion 93e, the female screw portion 2g and the female screw portion 93f, and the female screw portion 2h and the female screw portion 93g are fixed. Thus, attachment can be easily performed.

FIG. 19 is a flowchart showing the use of the uterine model fixture of the second embodiment. As shown in FIG. 19, when using the uterus model fixture 2, the uterus model 20 is first fixed to the uterus model fixture 2 (step S <b> 11), and then the uterus model is attached to the back 93 of the abdominal cavity simulator 9. The fixture 2 is attached (Step S12). Finally, the abdomen 91, which is an insufflation cover, is attached to the back 93 (step S13).
In FIG. 18, the uterine model 20 is attached to the back 93 of the abdominal cavity simulator 9 in a state where the uterine model 20 is not fixed to the uterine model fixture 2, but the uterine model 20 is fixed by hook-and-loop fasteners (71a to 71c). The uterus model 20 can be fixed after the uterine model fixing device 2 is attached to the back 93 in this manner because the uterine model 20 is attached and detached.

FIG. 20 is a perspective view of the inguinal hernia model fixture of the third embodiment. 21 to 23 are external views of the inguinal hernia model fixture of the third embodiment. FIG. 21 (1) is a front view, FIG. 21 (2) is a rear view, FIG. 22 (1) is a plan view, FIG. 22 (2) is a bottom view, FIG. 23 (1) is a right side view, and FIG. 23 (2) is a left side view.
As shown in FIGS. 21 (1) and (2), the inguinal hernia model fixture 3 is composed of three trays (3a to 3c), and the tray 3a and the tray 3b and the tray 3b and the tray 3c are fitted respectively. Glued.
Each of the trays (3a to 3c) is provided with a fixing portion (30a to 30c), and each of the fixing portions (30a to 30c) is provided with a hook-and-loop fastener (71d to 71f). The hook-and-loop fasteners (71d to 71f) are formed by hooks, and the gel film 47 of the inguinal hernia model 40, which will be described later, can play the same role as the loop portion of the hook-and-loop fastener due to its material. Can be adjusted freely.
Each of the trays (3a, 3c) is provided with a mounting mechanism (31, 32). The mounting mechanism 31 is provided with a female screw portion 31a, and the mounting mechanism 32 is provided with a female screw portion 32a.

FIG. 24 shows a plan view of the inguinal hernia model. As shown in FIG. 24, the inguinal hernia model 40 is a model of the inguinal hernia composed of the peritoneum 40a. The inguinal hernia model 40 is provided with two hernia portals 41, a medial umbilical fold 42, a median umbilical fold 43, an artery 44a, a vein 44b, a bladder 45, and a vas deferens 46. Is covered with a gel film 47 provided on the surface of the substrate.
The gel film 47 is a single layer of gel-like tissue, and reproduces the texture of the peeled layer of the pre-peritoneal fascia. Further, since the gel film 47 can be re-used after being repositioned, training costs can be reduced.
The arterial part 44a and the vein part 44b become Merck Marr in training, and can selectively reproduce the biological structures such as the artery part 44a, the vein part 44b, and the muscle.

A method for attaching the inguinal hernia model 40 to the inguinal hernia model fixture 3 will be described with reference to FIG. FIGS. 25A and 25B are explanatory diagrams of attachment of the inguinal hernia model, wherein FIG. As shown in FIG. 25A, before attachment, the inguinal hernia model 40 has a substantially planar shape. As shown in FIG. 22 (2) and the like, the inner surface of the inguinal hernia model fixture 3 has a curved surface shape. For this reason, as shown in FIG. 25 (2), the inguinal hernia model 40 is curved and attached along the curved surface shape of the inner surface of the inguinal hernia model fixture 3.

FIG. 26 shows a mounting image diagram of the inguinal hernia model. As shown in FIG. 26, the inguinal hernia model 40 is attached along the curved shape of the inner surface of the inguinal hernia model fixture 3. For this reason, for example, in FIG. 24, the interval between the inner umbilical folds 42 is provided so that the upper part is narrower and wider downward, but in FIG. 26, it is substantially parallel.
As described above, the inguinal hernia model 40 can be arranged at an anatomically correct three-dimensional position by being integrated with the inguinal hernia model fixture 3.

FIG. 27 shows an image diagram of attaching the inguinal hernia model fixture to the abdominal cavity simulator. As shown in FIG. 27, when attaching the inguinal hernia model fixture 3 to the pelvis 92 of the abdominal cavity simulator 9, the positioning protrusion 33 provided on the inguinal hernia model fixture 3 and the inside of the pelvis 92. The provided recess 34 is fitted. In this state, the female screw 32a provided on the inguinal hernia model fixture 3 and the female screw 92a provided inside the pelvis 92, and the female screw 31a and the female screw 92b are screwed (not shown). Fix it.
In this case, the inguinal hernia model fixture 3 is attached to the pelvis 92 before the pelvis 92 is connected to the back 93, but generally, the pelvis 92 is connected to the back 93. Attach the inguinal hernia model fixture 3. However, as shown in FIG. 27, the inguinal hernia model fixture 3 may be attached to the pelvis 92 first.

FIG. 28 is a flowchart showing the use of the inguinal hernia model fixture of the third embodiment. As shown in FIG. 28, when using the inguinal hernia model fixture 3, first, the pelvis 92 and the back 93 of the abdominal cavity simulator 9 are connected (step S21). Next, the inguinal hernia model fixture 3 is attached to the pelvis 92 (step S22). The inguinal hernia model 40 is fixed to the inguinal hernia model fixture 3 (step S23). Finally, the abdomen 91 of the abdominal cavity simulator 9 is attached to the back 93 (step S24).

(Other Examples)
When attaching a rectal model as a biomaterial organ model to the abdominal cavity simulator, a fixing tool that presses and fixes the rectal model from above may be used. This allows the rectal model to be placed and fixed in an anatomically correct three-dimensional position.

The present invention can be used as a fixture for an organ model for an abdominal cavity simulator.

DESCRIPTION OF SYMBOLS 1 Gastric integrated model fixing device 2 Uterine model fixing device 2a to 2e Constituent members 2f to 2h, 6a to 6d, 31a, 32a, 92a, 92b, 93a to 93g Female screw portion 2i Raised portion 3 Inguinal hernia model fixing device 3a to 3c , 4,4a, 4b, 400 tray 4c upper part 4d lower part 4e raised part 4f depressed

part

5a, 5b mounting member 7a esophagus fixing mechanism 7b duodenal fixing mechanism 7c through hole

8a head opening

8b foot opening 9 abdominal cavity simulator Reference Signs List 10 integrated stomach model 11 stomach 11a esophagus 11b duodenum 12 spleen 13 peri-stomach blood vessel 14 lymph node 15 transverse colon 16 omentum 17

pancreas

18,40a peritoneum 20 uterine model 20a base member 21

uterus

22,45 bladder 23 rectum 24 ovary 25 Tissue 26 Ureter 27a External iliac artery 27b External iliac vein 27c Pulse 27d Vein 28 Circular ligament 29 Nerve 30a-

30c Fixing part

31, 32 Attachment mechanism 33 Convex part 34 Recess 40 Inguinal hernia model 41 Hernia tract 42 Inner umbilical fold 43 Median umbilical fold 44a Artery 44b Vein 46 Sperm 47

Gel membrane

51,52 Screw 71a-71f Surface fastener 91 Abdomen 92 Pelvis 93 Back 93h Spine 94 Lid

Claims

In an organ fixing device for arranging an organ model in a three-dimensional space of a lumen of a laparoscopic simulator for learning a laparoscopic technique,
The abdominal cavity simulator includes a pelvic portion simulating a human body shape, a back portion having left and right lateral abdominal portions and a spine ridge, and an abdominal portion provided with a plurality of ports through which surgical instruments used under laparoscopic procedures can be inserted. At least configured,
The organ fixing device,
At least one of a stomach model fixing device, a uterine model fixing device, and an inguinal hernia model fixing device. When any of the fixing devices is attached with an organ model, the three-dimensional arrangement position of the organ model in the cavity of the abdominal cavity simulator is set. The surface of the fixture itself is raised, depressed, or curved so that it is in an anatomically correct position,
The gastric model fixing device has a height difference of at least three stages, a tray on which at least a stomach organ model having a part of the esophagus and the duodenum is placed,
The uterus model fixture, the back of a flexible sheet-shaped uterus model having a uterus, ovary and bladder organ model, can be attached to the curved inner wall,
The inguinal hernia model fixture is attached to the inner wall of the pelvis, and is capable of attaching the back surface of a flexible sheet-shaped inguinal hernia model having two hernia tract organ models provided on the left and right sides.
An organ fixing device for an abdominal cavity simulator.
The gastric model fixture,
The back of the tray fits into the spine ridge of the back,
The side of the tray engages with the left and right flank,
The center of the tray surface curves and protrudes along the spine ridge,
The left and right sides of the tray surface are plate-shaped,
2. The abdominal cavity simulator according to claim 1, wherein the three levels of height difference on the tray surface are provided in the order of a center, a right plate viewed from the head side, and a left plate viewed from the head side. 3. Organ fixation device.
The gastric model fixture,
3. The organ fixing device for abdominal cavity simulator according to claim 2, further comprising means for holding and fixing the esophagus of the stomach organ model at the center head side of the tray surface.
The gastric model fixture,
The organ fixing device for an abdominal cavity simulator according to claim 2 or 3, further comprising means for fixing the duodenum of the organ model of the stomach on the pelvis side of the right plate viewed from the head side of the tray surface. .
The gastric model fixture,
The second ridge for mounting the stomach organ model is further provided on a ridge along the spine ridge at the center of the tray surface. 4. The organ fixing device for an abdominal cavity simulator according to 1.
The gastric model fixture,
The organ for abdominal cavity simulator according to any one of claims 2 to 5, further comprising a depression for mounting a spleen organ model on the head side of the left plate viewed from the head side of the tray surface. Fixture.
The gastric model fixture,
7. The organ fixation device for an abdominal cavity simulator according to claim 2, wherein the stomach organ model is mounted on a sheet-like model simulating an omentum mounted on a tray surface.
The uterine model fixture,
A member that can replace the pelvis portion, or a member that can be fitted to the inner wall member or the inner wall of the pelvis portion, and the central back side of the fixture is raised,
When attaching the back of the uterus model to a fixed position,
8. The curved surface of the inner wall is formed with irregularities such that the three-dimensional arrangement of the uterus, ovaries and bladder is anatomically correct. Organ fixation tool for abdominal cavity simulator.
The uterine model fixture,
The place where the uterus is placed is provided high, is provided so as to be lowered toward the place where the bladder is placed, and the diameter decreases from the place where the uterus is placed toward the place where the bladder is placed. The organ fixing device for an abdominal cavity simulator according to claim 8, wherein the organ fixing device is formed in a truncated cone shape.
The uterine model attached to the uterine model fixture,
In addition to the uterus, ovary and bladder organ models,
10. The simulator for an abdominal cavity according to claim 8, wherein at least one organ model selected from rectum, adipose tissue, ureter, external iliac artery, external iliac vein, and circular ligament is further arranged. Organ fixation device.
When the inguinal hernia model fixing device is attached, the two inguinal hernia models and the arteries, veins, and vas deferens running around the two hernia portals have the shape of the fixing device so that the fixing device does not abut. The organ fixing device for an abdominal cavity simulator according to any one of claims 1 to 10, wherein the fixing device is formed.
The inguinal hernia model attached to the inguinal hernia model fixture,
The sheet-like surface is covered with a gel-like membrane having the texture of a peeling layer of the pre-peritoneal fascia,
In addition to the two hernia tract organ models,
The organ fixation for an abdominal cavity simulator according to claim 11, wherein at least one organ model selected from an inner umbilical fold, a median umbilical fold, an artery, a vein, a bladder, and a vas deferens is further arranged. Utensils.
The organ fixation device for abdominal cavity simulator according to claim 12, wherein the gel-like film is reusable after being replaced.
Between organ models,
14. The organ fixing device for an abdominal cavity simulator according to claim 1, further comprising a foamy fascia model or a foamy loosely-coupled woven model.