DE102014103706B4 - Device for simulating gynecological operations - Google Patents

Abstract

Apparatus for simulating gynecological operations, comprising an artificial female pelvis having pelvic orifices for the urethra, vagina, rectum and pelvic floor muscles, obturator and sciatic foramen being occluded, and an artificial rectum, artificial bladder, artificial urethra in the pelvis artificial ureters, an artificial small intestine, artificial vessels, artificial ligaments, an artificial vagina and an artificial nerve plexus, the pelvis being lined with a layer of artificial adipose tissue, leaving spaces for surgical inlays, and provided via an artificial peritoneum; characterized in that gynecological surgical inlays are insertable into the spaces of the pelvis, wherein coagulable vessels are formed from umbilical cords of animals, the ureter being adapted to move slowly upon contact and means for det ektieren an areawise overheating of the ureter are provided, the coagulable vessels are filled with a mixture of water and food coloring and sealed on both sides and wherein by means of meat glue coagulated muscles is formed.

Description

The invention relates to a device for simulating gynecological operations, wherein an artificial female pelvis with pelvic openings for the urethra, the vagina and the rectum and the pelvic floor muscles is provided, obturator and sciatic foramen are closed and in the pelvis an artificial rectum, an artificial bladder , an artificial urethra, artificial ureters, an artificial small intestine, artificial vessels, artificial ligaments, an artificial vagina and an artificial nerve plexus, wherein the pelvis is lined with a layer of artificial adipose tissue leaving free spaces for surgical inlays and an artificial peritoneum is provided.

From the DE 42 12 908 A1 is a surgical simulation model is known, which is designed so that in an artificial, anatomical body cavity on the open stomach or minimally invasive training and surgery can be. This is achieved in that the shape and area of the inside of a human or animal body cavity corresponding to the respective layers are anatomically and topographically replicated according to that in the body cavity objects, artificial organ replicas or organic implants can be introduced and / or implanted that parts of Digestive tract, parts of the bloodstream, parts of the bronchial system and lines for electricity, liquids, gas, light or the like are provided.

The DE 20 2009 018 667 U1 describes an anatomical training model for surgical treatment methods comprising a first, hard tissue-simulating layer and a second, soft tissue-simulating layer attached thereto, wherein between the first and the at least one second layer a firmly adhering to the first layer and releasably adhering to the second layer boundary layer is provided.

From the DE 20 2013 100 701 U1 is a simulator for simulating surgical procedures, in particular in cardiac and thoracic surgery, known, which has a frame with a first wall and a second wall, wherein in the first wall, a passage opening is arranged, wherein on the second wall at least one variable wall can be arranged in at least two different positions and wherein the variable wall has at least one opening and wherein preferably at least one artificial body part is provided for insertion into the opening of the variable wall.

The US 2013/0177890 A1 describes an anatomical model with a fluid-tight hollow organ with resectable tissue or tissue portions for surgical operation training on liquid-filled artificial organs or fluid-filled cavities, in particular for the training of endoscopic operations.

From the US 2009/0068627 A1 For example, the use of conductive elastomeric circuits in physiological structures, such as tissues and organs, is described to provide feedback on the success of a task being performed.

The training of surgical techniques on human corpses is problematic in that they no longer run any physiological processes, e.g. a perfusion of the tissue and also a threat to the surgeon, for example due to infections (HIV, hepatitis, etc.) is possible. On fixed corpses (for example with formalin), it is not possible to carry out certain partial steps of operations (coagulation, etc.). In addition, the fixative changes the organ consistency, so that, for example, the haptic is no longer comparable to the intraoperative situation. There is a need, therefore, to provide devices for simulating gynecological surgery to enable physicians to learn established diagnostic and surgical techniques as well as to test new diagnostic and surgical techniques.

The object of the present invention is to provide a device for simulating gynecological operations, which allows the most realistic possible simulation.

This object is achieved in that gynecological surgical inlays are inserted into the spaces of the pelvis, wherein coagulable vessels are formed from umbilical cords of animals, wherein the ureter is formed so that it moves slowly when touched and means for detecting a piecewise Overheating of the ureter are provided, wherein the coagulable vessels are filled with a mixture of water and food coloring and sealed on both sides and wherein by means of meat glue coagulated muscles is formed.

There is thus an artificial female pelvis on which surgical techniques can be practiced or tested realistically.

By means of such a device can be lowered correction procedures, such as sacropexy, pectopexy, lateral repair, incontinence operations, such as the endo-Burch and gynecological operations on the organs of the pelvis (uterus, ovaries, vagina, bladder with urethra and urethra, large intestine and rectum including the corresponding intervertebral spaces with peritoneum, adipose tissue, obturation lobe, paracervical tissue, cavum retzii, spatium rectovaginal, lymph node, etc.) with complete or partial uterine removal, operations on the ovaries and fallopian tubes, endometriosis at all stages, etc. Selected examples presented are artificial sacropexy and pectopexy, which are methods for correcting vaginal descensus, and artificial supracervical hysterectomy (LASH), which is a routine procedure in gynecological departments.

For this purpose, the pelvis can be provided with special gynecological surgical inlays, for example for lowering operations, organ removal or partial removal, organ preserving or restoring operations and incontinence operations.

The surgical inlays are each made specifically for a specific type of surgery and removed from the pelvic model after surgery.

It is part of the invention that the surgical inlays in the space provided for this purpose in the basin can be inserted and fastened.

It is advantageous that the surgical inlays can be fastened by means of locking pins, needles or nails.

A preferred embodiment of the invention is that the artificial female pelvis is introduced into a simulation doll.

As a result, the operation is even more realistic, because the body contour and the skin can be simulated by means of the simulation doll.

In this context, it is particularly advantageous that the legs of the simulation doll are designed to be movable.

This makes it possible to arrange the simulation doll on an operating table, as would be the case with a patient. Furthermore, the spreadability of the legs is a necessary prerequisite for the digital vaginal control of certain gynecological surgeries (e.g., Burch-OP or lateral repair, TLH).

In the context of the invention it is provided that the vessels A. Iliaca com, Iliaca ext., A. iliaca int, aorta and V. cava inf. are. Depending on the surgical inlay, additional or different vessel variations may be used to simulate pathologies, particularly one or more of A. uterina, A. ovarica, T. tubarus, r. ovaricus, r. communicans and A. sacralis mediana.

It is according to the invention that the ligaments Lig. Longitudinale ant. and Lig. iliopectineum. Again, optionally, additional or other bands, in particular one or more of Lig. Latum, lig. ovarii proprium, lig. rotundum, lig. sacrouterinum and lig. suspensory ovarii present.

A preferred embodiment of the invention is that human adipose tissue is modeled in the body by means of spherical structures in combination with a gel-like substance.

It has been found within the scope of the invention that, with the aid of spherical structures such as sago combined with a gel-like substance such as silicone, human adipose tissue can be mimicked very well in terms of its consistency.

It is also within the scope of the invention that body-like structures are formed from the combination of silicone-like materials with textile-like materials.

From the combination of silicone-like materials (silicone, acrylic) and textile-like materials, ribbons, fascia, tendons, muscle / connective tissue and hollow organs (e.g., bladder, intestine, etc.) can be modeled.

A preferred embodiment of the invention is that artificial nerves are arranged with an electrical conductor in the basin.

This allows the detection of an injury to one of the nerves.

Finally, it is advantageous that the blood flow through the vessels by means of a pump is simulated.

For simplicity, blood flow through the vessels in a different direction than the anatomically correct one can be simulated, as in surgery, only the visibility of the pulsations or filling of the pelvis with interchangeable, potentially vulnerable structures arrives, so that the surgeon has similar stress has as under real conditions. When an additional complete venous system is introduced, an anatomically correct blood flow can also be modeled.

The invention will be explained in more detail with reference to two embodiments.

Exemplary embodiment 1: sacropexy / pectopexy

For the sacropexy and pectopexy models, there is preferably a reusable part (a) and a part that is newly made for each operation (part b).

The production of both parts is explained below:

Part A:

From plastic, a bony female pelvis with the corresponding pelvic openings is first produced, which fits exactly into the corresponding simulation doll (real simulator). Alternatively, cast models of plastic, e.g. from the company 3 B Scientific. The pelvic floor muscles as well as the M. piriformis are made using templates made of 5 mm thick felt. The muscles are siliconized with transparent silicone (hardware store). The center tendineum and sinew transition areas are modeled with triple-folded compresses, which are impregnated with silicone. The individual parts are sewn together with thread and anchored with screws in the basin. Three openings (for the urethra, the vagina and the rectum) remain in the typical places.

The following simulated structures are introduced into the basin thus prepared: rectum, bladder, urethra, ureters, A.Iliaca com, Iliaca ext., A. iliaca int, aorta, V. cava inf., Small intestine, Lig. Longitudinals ant., Lig , Iliopectinum, vagina with or without cervical stump, nerve plexus and peritoneum. It is of course possible to introduce only those of these structures in the basin, which are relevant for the respective operation.

The structures are e.g. made as follows:

rectum:

Drawing a 25 cm long fabric tube (eg Stülpa tube) on a plastic tube with 3 -4 cm diameter, then applying liquid silicone mixture (eg SF 00 from Silicon Factory, each 25 ml 1 and 2) with 1 g of iron oxide and 3 g Skin color (eg, skin tone color paste from the company Silikonfabrik) (this mixture is hereinafter referred to as "mixture 1").

Let dry for 24 hours, "deglaze" (reduce the stickiness) with cornstarch. Fill the hose with filling wadding and kneading pieces (diameter approx. 1 cm). Sew on the ends. Insertion in the pelvic model with one end exiting through the pelvic floor.

Small bowel segments:

Drawing an 80 cm long fabric tube (e.g., Stülpa tube) onto a plastic tube (e.g., sanitary area) 3-4 cm in diameter, then applying mixture 1.

Let dry for 24 hours, "deglaze" (reduce the stickiness) with cornstarch. Fill the hose with filling wadding and kneading pieces (diameter approx. 1 cm). Sew on the ends.

For the meso of the small intestine segment, an unfolded compress is spread on a plastic board (breakfast board of appropriate size) and mixture 1 is applied. After a drying process of 24 h, the margins are sutured to the intestine segment along with twisted thread. Possibly. seams with mixture 1 are finished.

Urethra:

From a wet wipe (for example, wet wipes for babies of the company Aldi), a tube about 10 cm long with a diameter of about 8 mm is made. Mounting this hose on a correspondingly thick plastic tube. Then siliconize with mixture 1. Allow to dry for 24 hours.

Bladder:

Wet wipe (such as Aldi baby wipes) (or similar tissue) and siliconize with Mixture 1. If necessary, repeat the process the next day. When the fabric is dry, cut out the bubble twice according to the template. Place ureters (e.g., DK 10 Chariere children or 3-4 mm diameter alternative silicone tubing) on one of the bladder parts at the typical location and suture by slitting material and inserting ureter. Then sew both bladder parts together (with thread or similar) and sew in the urethra. Possibly. After-siliconise visible seams with a little mixture 1. After drying, deglaze with cornstarch.

The ureters are placed in the pelvic model on pressure sensors / switches, above and below the intersection of the A. Iliaca comm. were fastened. Caudalward (towards the bladder), the artificial ureter is then each on a miniature camshaft with a nose. By triggering one of the pressure sensors / switches, a slow-running engine (less than 60 revolutions per minute) is set in motion for a limited time, which moves the ureters in this area via the nose of the camshaft with each revolution. The movement imitates the natural so-called "worming" movement of the ureters to a stimulus and serves the surgeon to identify the ureter.

Vessels (Aorta, A. iliaca comm, A. iliaca ext., A. iliaca int, V. cava inf.)

Cut soft silicone tubes (Aorta 12 mm, remaining tubes 8 mm, wall thickness 1 mm, for example from Lindemann) and connect with y connectors. In contrast to blood flow in humans, blood flow can be simplified by simulating it with the aid of a pulsating pump as follows: Aorta, A. iliaca comm. right, A. Iliaca ext. and int. right, A. liliaca ext. and int. left, A. iliaca comm. left, V. cava inf.

As a result, although the flow in the left iliac vessels in the wrong direction, but it is in the operations only to the visibility of the pulsations or to fill the pelvis with interchangeable, potentially vulnerable structures so that the surgeon has similar stress as under real conditions. When an additional complete venous system is introduced, an anatomically correct blood flow can also be modeled.

Obturator vessels and nerve:

These are not perfused and are presented by means of colored tubes with a diameter of 1 mm for the artery (red) and vein (blue) and a conductor cable (yellow, diameter 0.5 mm) for the nerve.

bands:

Unfold the compress 10 x 10 cm completely and fold it so that 12 layers are on top of each other. The resulting ligament should have a dimension of 3 cm x approx. 14 cm for the sacropexy (ligamentum longitudinal anterior) and a measure of approx 15 cm x 1.6 cm (half compress). At the edge, which is open, the bands are sewn together along with white thread and then acrylic acrylated with hardware store. Glue tapes with the hot glue gun in the appropriate places (longitudinal ligament anterior: median above the spine to the sacral area, ligament ileopectinum: inside of the pecten ossis pubis) in the pelvic model.

sacralis mediana / small rami communicans:

In contrast to large vessels, these vessels should be able to be coagulated, as they should in principle be obtained intraoperatively, but they should also be injured more frequently in human surgery and then coagulated or repositioned. For this reason, it is important that these vessels behave as faithfully as possible. In humans, in the event of injury, some blood would leak which is not critical to blood loss, but interferes with intraoperative vision. For this reason, the vessels do not need to be perfused, but should contain a blood equivalent that leaks when injured.

For the simulation, preprocessed umbilical arteries and / or veins are used. These could theoretically also originate from humans, but carry the risk of transmissible diseases to humans, e.g. HIV. For this reason, we have preferred vessels of animal origin from growers, as these are very well monitored in Germany. For the required vessel caliber size of about 1 mm, the umbilical vessels of pigs can be used very well. Depending on the vessel caliber, both types of vessels can be used, since it is only important that the vessels have a diameter of about 1 mm. The prepared vessels are unilaterally with twine or other cotton threads or similar. ligated (also a coagulation with electricity, clips or similar is possible), filled with a mixture of water and food coloring and then the other side closed (ligature, power, clips, etc.). For each operation, the vessels are positioned as follows and fixed with miniature screws, needles or pins above and below: for sacropexy about 12 cm long median on the Lig. Longitudinale anterior, for Pectopexie about 5 cm long running transversely at the level of the intersection of the Lig. Rotundum (this then moves into the inguinal canal and represents a landmark for the opening site of the peritoneum).

Alternatively, even small-caliber silicone tubes with a diameter of 1-2 mm can be used. These are then not coagulable, but they do not need to be replaced unless they are violated.

sheath:

Cut the compress in half, roll it up tightly and sew it with a few stitches with white twine so that it remains stable, then sew it into tubular fabric (eg Stülpa hose) on one side so that 2 cm can be seen at the top. Put the tube compress on a plastic tube with a diameter of 3-4 cm and coat with silicone mixture 1. Let it dry for 24 hours, turn it to the left and repeat the procedure. "Degrading" (reduction of stickiness) with cornstarch. Attach holding threads for insertion into the real simulator (simple twine on plastic beads or discs). The vagina is fixed in the real simulator in the typical place on the holding threads and with the cervix stump flexible (since an incident is simulated) introduced into the pelvis.

spinal nerves:

These are modeled on 11-gauge catheters and placed in the sacral or lumbar exit holes. Under the artificial nerves small pressure sensors / switches can be introduced, which trigger an acoustic or optical signal when touched.

After inserting the organs, the pelvic model is lined with a 5 mm thick layer of transparent DIY silicone mixed with Haldi (turmeric, for the typical yellowing of fatty tissue). At the places where the inlays are introduced no lining takes place. About the "fatty tissue layer" comes a very thin layer "Peritoneum", consisting of building cosmetics mixed with skin color and iron oxide.

Alternatively, materials from the make-up area may be used.

Part b (interchangeable surgical inlays):

For the sacropexy and pectopexy inlays, specific, standardized plastic models have been produced which fit exactly into the reusable pelvic models (part a). The replaceable inlays can either be used immediately after production, stored in the refrigerator for up to 3 weeks (qualitatively identical) or frozen (then kept for months, but the artificial fat tissue becomes a bit more friable). To prevent the sago silicone from drying out, the models should be stored in freezer bags.

Adipose tissue:

From spherical structures in combination with a gel-like substance, human adipose tissue can be modeled. The artificial adipose tissue is made of sago and silicone: 90 g of sago in 630 ml of boiling water, add ¼ teaspoon Haldi (turmeric). Boil for 2 minutes bubbly then reduce heat and cook until the sago is even (so no longer white). Stir constantly. Wash 1/2 of the sagomass under running water in the colander until it is no longer viscous. Then mix with 25 ml red and 25 ml blue silicone additive (s.o.) and process quickly.

(Note: the Haldizusatz gives on the one hand the bold color, on the other hand it obviously helps together with the washing of the sago and the siliconizing, which is diminished / prevented a macroscopically visible mildew.When the water portion is increased, the fatty tissue becomes stickier and depends on the operations - Instruments, the proportion of water is reduced, the sago is not even.A higher proportion of silicone causes intraoperatively, the fatty tissue is too gummy and can not be pushed away as normal, but always slips back and ultimately must be completely removed).

Peritoneum:

The artificial peritoneum is prepared from dried and then siliconized wet wipes as follows: Allow wet wipes to dry and cut to size according to a special template. Sagogemisch in Model fill, wet wipe put on, siliconizing with a mixture of 20 ml of silicone red and 20 ml of silicone blue with 0.1 g of iron oxide III and 3 g skin liquid.

The inlays are inserted for the operation in part a and fixed at predetermined locations with locking pins. Alternatively, needles, nails, etc. can be used.

As a result, a quick replacement of the inlays is possible, so that no long change times result.

Operational results:

The artificial peritoneum behaves when pulling up as peritoneum behaves in the human body. The haptic is completely preserved due to the three-dimensionality, i. Through the underlying fatty tissue one feels the Promontorium (1st surgical step of the sacropexy).

The peritoneum can be opened at the promontory and the Lig. Longitudinale anterior be exposed. The artificial tissue is tear-resistant, so that as in nature a continuous seam can be introduced to the closure.

Embodiment 2: LASH

For the LASH models, there is preferably a reusable part (a) as well as a part that is newly manufactured for each operation (part b).

Part A:

From plastic, a bony female pelvis with the corresponding pelvic openings is first produced, which fits exactly into the corresponding simulation doll (real simulator). Alternatively, casting models made of plastic, for example from 3 B Scientific, can also be used. The pelvic floor muscles as well as the M. piriformis are made using templates made of 5 mm thick red felt. The muscles are siliconized with transparent silicone (hardware store). The Centrum tendineum and sinew transition areas are modeled with triple-folded compresses, which were impregnated with silicone. The individual parts are sewn together with thread and anchored with screws in the basin. Three openings (for the urethra, the vagina and the rectum) remain in the typical places.

The following simulated structures are introduced into the pelvis thus prepared: bladder, urethra, ureters, rectum, ovaries, ligamentous suspensory ovarii.

Optionally, the following structures can be introduced to fill the pelvis and, through the generation of pulsations, to simulate the operation more realistically:
A. Iliaca com, A. Iliaca ext., A. iliaca int, Aorta, V. cava inf., Small intestine.

The structures are e.g. made as follows:

Mandatory structures:

rectum:

Drawing a 25 cm long fabric tube (eg Stülpa tube) on a plastic tube with 3 -4 cm diameter, then applying liquid silicone mixture (eg SF 00 from Silicon Factory, each 25 ml 1 and 2) with 1 g of iron oxide and 3 g Skin color (eg, skin tone color paste from the company Silikonfabrik) (this mixture is hereinafter referred to as "mixture 1").

Let dry for 24 hours, "deglaze" (reduce the stickiness) with cornstarch. Fill the hose with filling wadding and kneading pieces (diameter approx. 1 cm). Sew on the ends. Insertion in the pelvic model with one end exiting through the pelvic floor.

Urethra:

From a wet wipe (for example, wet wipes for babies of the company Aldi), a tube about 10 cm long with a diameter of about 8 mm is made. Mounting this hose on a correspondingly thick plastic tube. Then siliconize with mixture 1. Allow to dry for 24 hours.

Bladder:

Wet wipe (such as Aldi baby wipes) (or similar tissue) and siliconize with Mixture 1. If necessary, repeat the process the next day. When the fabric is dry, cut out the bubble twice according to the template. Place ureters (such as DK 10 Chariere children or 3-4 mm diameter alternative silicone tubing) on one of the bladder parts in a typical location and suture by slitting material and inserting the ureters. Then sew both bladder parts together (with thread or similar) and sew in the urethra. Possibly. After-siliconise visible seams with a little mixture 1. After drying, deglaze with cornstarch.

The ureters are placed in the pelvic model on pressure sensors / switches, above and below the intersection of the A. Iliaca comm. were fastened. Caucomatously (in the direction of the bladder), the artificial ureter also lies on a miniature camshaft with a nose. By triggering one of the pressure sensors / switch, a slow-running engine (less than 60 revolutions per minute) is set in motion for a limited time, which moves the ureter in this area via the nose of the camshaft with each revolution. The movement mimics the natural so-called "worming" movement of the urethra to a stimulus and serves the surgeon to identify the ureter.

Note: For the TLH, temperature gauges / wires are placed at the subcrossings of the uterine vessels, which cause a visual or audible signal from a value of 38 degrees Celsius. This warns against thermal damage to the ureters during coagulation of the deep uterine vessels.

ovaries:

Made of stainless steel a 3 cm long rod, at the ends of each a round eyelet lies. To make the steel out of DIY Acrylic an oval ovary. Let it dry for 24 hours.

Lig. Jockstrap Ovarii:

Cut a 4 mm wide and 4 cm long strip from a damp cloth (such as Aldi) and acrylate. Firmly tie this to an eyelet of the ovary and fix it to the side of the pelvic wall with a screw.

Optional structures:

Vessels (Aorta, A. iliaca comm, A. iliaca ext., A. iliaca int, V. cava inf.)

Cut soft silicone tubes (Aorta 12 mm, remaining tubes 8 mm, wall thickness 1 mm, eg Lindemann) and connect with y connectors. In contrast to blood flow in humans, blood flow can be simplified by simulating it with the aid of a pulsating pump as follows: Aorta, A. iliaca comm. on the right, A. Iliaca ext. and int. right, A. liliaca ext. and int. left, A. iliaca comm. left, V. cava inf.

As a result, although the flow in the left iliac vessels in the wrong direction, but it is in the operations only to the visibility of the pulsations or to fill the pelvis with interchangeable, potentially vulnerable structures so that the surgeon has similar stress as under real conditions. When an additional complete venous system is introduced, an anatomically correct blood flow can also be modeled.

Small bowel segments:

Draw an 80 cm long fabric tube (e.g., Stülpa tube) onto a plastic tubing (e.g., sanitary) 3-4 mm in diameter, then apply mixture 1.

Let dry for 24 hours, "deglaze" (reduce the stickiness) with cornstarch.

Fill the hose with filling wadding and kneading pieces (diameter approx. 1 cm). Sew on the ends.

For the meso of the small intestine segment, an unfolded compress is spread on a plastic board (breakfast board of appropriate size) and mixture 1 is applied. After a drying process of 24 h, the edges are cut to size and sewn longitudinally with twine to the intestinal segment. Possibly. seams with mixture 1 are finished.

After inserting the organs, the pelvic model is lined with a 5 mm thick layer of transparent silicone (hardware store) mixed with Haldi (turmeric, for the typical yellowing of fatty tissue). At the places where the inlays are introduced no lining takes place. About the "fatty tissue layer" comes a very thin layer "Peritoneum", consisting of building cosmetics mixed with skin color and iron oxide.

Alternatively, materials from the make-up area may be used.

Part b (interchangeable surgical inlays):

The replaceable part contains the following structures:

Uterus (with or without pathologies) Lig. Latum, A. uterina, additional pathological vessels, R. tubarius, fallopian tube, Lig.rotundum, lig. Ovary Proprii, lig. sacrouterinum

Uterus and fibroids:

From beef fillet, first cut a basic matrix according to the silicone models of the desired model (normal uterus, large uterus myomatosus, uterus with fibroid). Attach the halo (8 twine evenly distributed) to the fillet portion corresponding to the cervix. Connection possibility (screw connection with connecting cable, company Bowa, custom-made for the models) for monopolar electricity in the tip (cervix) of beef fillet screw.

Mix minced beef tenderloin with meat glue (10: 1 ratio), fill in the bottom of the model, fill in the meat, cover with meat glue and place on top of the model. Press with screw clamps and let rest for 24 h in the refrigerator.

Day 2:

Secure prepared uterine vessels and if necessary pathological vessels (individual myoma vessels) with Histoacrylkleber on the side of the uterus. Lig. Ovarium proprii, tubes and lig. Pull the rotundum through the fundus from right to left, lig. Pass the sacrouterinum caudally to the border of the isthmus (this is more likely to anchor in the pelvis and is not as well visible in the body as on the model).

Glue the Lig. Latum to the back of the uterus with the uterus. Front leaf of the lig. Put on the Latum and glue it (on the uterus and laterally with beaten and softened egg white of chickens, edges with Histoacrylkleber).

Introduction into the pelvic model:

Attachment of Lig. Rotundum and lig. Sacrouterinum on lateral pelvic wall (pass through the solid silicone and the pelvic bone at pre-drilled points and knot together outside)

Fixing lig. Ovarium proprium: Knot at the eyelet of the ovary and cut off the supernatant) Fixing the tube ends: Stick to the ovary with Histoacrylkleber

Attachment Cervix: Attach threads to holding device of Realsimulator Connection of vessels: On perfusion set and bag with NaCl with red food coloring. Monopolar connection: Via plug into the corresponding socket of the HF device

uterine:

These vessels must be coagulatable. For this reason, it is important that these vessels behave as faithfully as possible. In humans, in the event of an injury, blood would leak out, which could affect the intraoperative vision and be life-threatening from about 2 liters. For this reason, the vessels must contain a blood equivalent, which escapes in case of injury.

For the simulation, preprocessed umbilical veins are used. These could theoretically also originate from humans, but carry the risk of transmissible diseases to humans, e.g. HIV. For this reason, we have preferred vessels of animal origin from growers, as these are very well monitored in Germany (for example, on swine flu). For the required vascular caliber size of about 3-4 mm, the umbilical vein veins of pigs can be used very well. The prepared vessels are mounted on adapters and unilaterally with twine or other cotton threads or similar. ligated (also a coagulation with electricity, clips or similar is possible). About the adapter, the connection to commercially available infusion set is possible.

Tubes and Tubular Vessels:

For this, the remnants of the umbilical cord with the arteries still contained are used.

Lig. Rotundum, lig. ovarium proprii, lig. sacrouterinum and lig. latum:

With the help of Wurstpellen Wurstpelle for sausages, individual coagulable and preparable fascia and layered structures in the body can be modeled. For the lat. Ligament, the sausage patties are sliced lengthwise and smoothed.

Claims (7)

Apparatus for simulating gynecological operations, comprising an artificial female pelvis having pelvic orifices for the urethra, vagina, rectum and pelvic floor muscles, obturator and sciatic foramen being occluded, and an artificial rectum, artificial bladder, artificial urethra in the pelvis artificial ureters, an artificial small intestine, artificial vessels, artificial ligaments, an artificial vagina and an artificial nerve plexus, the pelvis being lined with a layer of artificial adipose tissue, leaving spaces for surgical inlays, and provided via an artificial peritoneum; characterized in that gynecological surgical inlays are insertable into the spaces of the pelvis, wherein coagulable vessels are formed from umbilical cords of animals, wherein the ureter is formed so that it moves slowly when touched and means for De tektieren an areawise overheating of the ureter are provided, the coagulable vessels are filled with a mixture of water and food coloring and sealed on both sides and wherein by means of meat glue coagulated muscles is formed. Device according to Claim 1 , characterized in that the surgical inlays can be fastened by means of locking pins, needles or nails. Device according to one of the Claims 1 or 2 , characterized in that the artificial female pelvis is insertable into a simulation doll. Device according to Claim 3 , characterized in that the legs of the simulation doll are designed to be movable. Device according to one of the Claims 1 to 4 , characterized in that the vessels A. Iliaca com, Iliaca ext., A. iliaca int, aorta and V. cava inf. are. Device according to one of the Claims 1 to 5 , characterized in that the ligaments Lig. longitudinal ant. and Lig. iliopectineum. Device according to one of the Claims 1 to 6 , characterized in that body-like structures are formed from the combination of silicone-like materials with cloth-like materials.