JP2004348095A - Training system - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a training system in which using a real or mockup medical instrument where various sensors are attached or incorporated, or which is monitored with various sensors, training of minimally invasive medical operation such as an endoscopic operation is conducted on a manikin where various sensors are attached or incorporated or which is monitored with various sensors, information is acquired through the various sensors during the training, and the operation history during training can be recorded and reproduced one by one on site or at a remote place. <P>SOLUTION: By using a real or mockup medical instrument where various sensors are attached or incorporated, or which is monitored with various sensors, training of minimally invasive medical operation such as an endoscopic operation is conducted on a manikin where various sensors are attached or incorporated or which is monitored with various sensors, information is acquired through the various sensors during the training, and the operation history during training can be recorded and reproduced one by one on site or at a remote place. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

[0001]
TECHNICAL FIELD OF THE INVENTION
TECHNICAL FIELD The present invention relates to an operation training system in a field in which a precision operation is required or a simulation before operation in training or training of operation operation. In addition, this system is used for preoperative planning and simulation of surgical procedures using actual surgical instruments. This makes it possible to compare and examine a plurality of procedures before surgery.
[0002]
[Prior art]
Various techniques are known for training in surgery (for example, see Patent Documents 1 to 9).
[0003]
[Patent Document 1]
JP 2001-005377 A [Patent Document 2]
JP-A-11-262542 [Patent Document 3]
JP-A-11-249548 [Patent Document 4]
Japanese Patent Publication No. 2002-510069 [Patent Document 5]
JP 2001-137384 A [Patent Document 6]
JP 2001-005378 A [Patent Document 7]
JP-A-11-231770 [Patent Document 8]
Japanese Patent Application Laid-Open No. 06-105877 [Patent Document 9]
Japanese Unexamined Patent Publication No. Hei 08-500021
As a more specific product, an emergency treatment simulator manufactured by Koken Co., Ltd. is known. In addition, as described in Patent Document 7, particularly in recent years, development of a training system using the VR technology has been active.
[0005]
[Problems to be solved by the invention]
Endoscopic surgery is desirable because it is less invasive and has less physical burden on patients, but doctors are required to have high technical skills. Thus, surgical skills training is very important, but the training environment is inadequate. Currently, training is conducted in the actual operating room under a supervising physician, but the risk is also high, and it is difficult for patients to understand.
[0006]
On the other hand, pigs can be used for the abdominal cavity in training with animals, but there are many parts that cannot be used because the shape is too different from the human body. Furthermore, surgery training using animals requires the same equipment as human surgery, such as operating rooms and anesthesia, and has a problem that it is expensive because it is necessary to secure living animals. In addition, from the viewpoint of animal welfare, it has become difficult to use it for surgical training.
[0007]
Training with donations is highly desirable, but donations are rare each year and training opportunities are limited. At the American Society of Arthroscopy, elaborate models are used in training courses for surgical training, but the current phantoms have few variations and cannot respond to individual patients. Also, models are generally expensive and durable, but they are too durable and do not break when subjected to the force of breaking down a living body, making them unsuitable for training in destructive operations.
[0008]
The VR system is currently undergoing a great deal of research, and is considered to be useful for basic training in laparoscopic surgery. This is because, in laparoscopic endoscopic surgery, basically, the contact is limited to two points, that is, a part where a surgical instrument such as forceps enters the body (trocar) and a tip part of the instrument for performing a surgical operation. This is because there is an advantage in the construction of the system that it is sufficient to calculate the force at a point, but there are many issues regarding the quality of force feedback (display of tactile sensation). Specifically, it is difficult to calculate and display the multipoint contact between the surgical instrument and the patient's body in real time, and the expression of “hardness” is limited. In addition, there is a problem that the surgical instruments to be used are limited to those unique to the system. Furthermore, individual patient data has not been captured in the system for the purpose of pre-operative simulation.
[0009]
Therefore, an inexpensive and high-quality surgery planning / preoperative simulation system using personal data of a patient is demanded, and a training system capable of evaluating a surgical skill level is more desirable.
[0010]
[Means for Solving the Problems]
As a result of diligent studies aimed at satisfying this problem and new needs, the present invention has been completed. In other words, using medical instruments or simulated medical instruments with various sensors attached / built-in or monitored by various sensors, a human body model with various sensors attached / built-in or monitored by various sensors is used for endoscopic surgery. Training of minimally invasive medical practice such as operation is performed, information is acquired by various sensors during training, and various operation histories during training can be recorded and played back on the spot or at a remote location. Has completed a training system that can determine and display an indication of whether technology is good or bad.
[0011]
This system has the following flow.
(1) A medical image such as a CT of a patient is taken before the operation, and personal data of the patient is collected.
(2) Specify the required part on the image.
(3) Create a three-dimensional detailed model that can be destroyed by a rapid prototyping device.
(4) This detailed model is set on a human model with a sensor.
(5) Using the set human model with the sensor, planning of the operation route and the like and simulation in advance are performed before the operation.
(6) Thereby, the safety of the operation can be improved, and the burden on the patient can be reduced.
With this system, the skill level of the operator can be evaluated, and the efficiency of surgical training and the quality of preoperative simulation can be improved.
[0012]
The present invention uses medical instruments or simulated medical instruments to which various sensors are attached / built-in or monitored by various sensors, and to endoscope a human body model to which various sensors are attached / built-in or monitored by various sensors. Training in minimally invasive medical practices such as mirror surgery, acquiring information with various sensors during training, and recording and playing back various operation histories during training, either on the spot or at remote locations Provide a minimally invasive medical practice training system.
[0013]
In addition, the history and various operation histories during training recorded based on the history can be reproduced and reproduced and observed. In addition, during or after training, the various sensor information acquired and the various actions during training recorded based on them can be recorded on the spot or at a remote location, using the sensor information and operation history previously recorded. Can be displayed in comparison with.
[0014]
In addition, the recorded actions during the training can be determined and displayed based on sensor information and operation histories recorded and created before that, and evaluation indices obtained by processing them, to thereby determine the quality of the actions. In addition, a function for determining the skill level of the trainee can be provided based on good or bad criteria. Furthermore, a function of selecting and displaying a training menu and a training program according to the determined skill level of the trainee can be provided.
[0015]
The present invention includes a first unit provided with a sensor and an actuator, a second unit provided with a sensor and an actuator, and a control / information processing unit that controls and processes information on the sensor and the actuator. A training system characterized by the following is provided.
[0016]
The present invention also provides a human phantom equipped with a sensor and an actuator, instrument means provided with a sensor and an actuator, and a control / information processing unit for controlling and processing information on the sensor and the actuator, Training the medical action on the phantom using means, the control / information processing unit acquires information from the sensor during the training, and records and reproduces the operation history during the training one by one. Provide a training system characterized by what can be done.
[0017]
The training system can include an information display unit that can display the operation during the training during or after the training by comparing the operation during the training with a previously recorded operation history. In addition, the training system can determine and display a measure of good or bad by illuminating the operation during training with an evaluation index recorded in advance.
[0018]
Also, the training system can include means for determining the skill level of the trainee based on good or bad, and a training menu and a training program are set according to the skill level of the trainee determined by the determination means. Means for selecting and displaying can also be provided. Further, the training system can be used as a training system for minimally invasive medical practices such as endoscopic surgical operations.
[0019]
BEST MODE FOR CARRYING OUT THE INVENTION
Hereinafter, embodiments of a training system according to the present invention will be described with reference to the drawings. FIG. 1 shows a schematic diagram of a training system. In FIG. 1, reference numeral 100 denotes an operator, such as a trainee (trainee) or a doctor performing a surgery simulation. Reference numeral 110 indicates an information display unit. The information display unit 110 mainly includes a patient (human or animal) model (real model) 111, real or simulated medical operation (surgery) instruments 113, and information display means (information display device) 115 such as an external monitor. In preparation. Reference numeral 116 indicates additional external sensors, which can be provided, for example, to acquire a state during operation of the operator 100 as a video image. The real model 111 is provided with sensors or actuators 112 added or incorporated therein. Further, sensors and actuators 114 are added to or incorporated in the real or simulated medical operation (surgery) instruments 113. Reference numeral 120 indicates a control and information processing unit. The control and information processing unit 120 mainly includes a patient model data unit 121, a medical operation history data unit 122, a medical operation evaluation unit 123, and a training menu management unit 124. , 114, and 116 for collecting, recording, processing, displaying information through the information display unit 110, and controlling and driving the sensors and actuators 112 and 114.
[0020]
The operator 100 can perform a medical operation on the physical model 111 using the instruments 113. The data of the operation applied to the real model 111 at the time of this operation is sent to the medical operation history data unit 122 by the sensors and actuators 112 and recorded as operation history data in the medical operation history data unit 122. The operation data added to the instruments 113 by the operator 100 using the instruments 113 at the time of this operation is sent to the medical operation history data section 122 by the sensors and actuators 114, and the medical operation history data section 122 Is recorded as operation history data. The medical operation history data section 122 is for recording the current operation and the past operation. The patient model data section 121 stores patient model data created based on medical images and shape data based on the real model 111 as described later. The medical operation evaluation unit 123 is sent to the medical operation evaluation unit 123 together with the two operation history data, and based on these data, the medical operation evaluation unit 123 evaluates the skill of the operator 100, the degree of invasion of the patient model (real model) 111, and the like. . The evaluation result evaluated by the medical operation evaluation unit 123 is displayed to the operator through the information display device 115. The information display device 115 is also capable of displaying operation information of the operator 100 and information such as the direction and position of the instruments 113. Further, an instruction for training (eg, description of an operation to be performed next) to the operator 100, current operation data, past operation history data recorded in the medical operation history data unit 122, and the like can be displayed. It has become. As a display method, a method according to each sensory modality such as sight, hearing, touch, etc. can be considered. Further, an appropriate training menu is selected from the training menus stored in advance in the training menu management unit 124 in accordance with the evaluation result and displayed to the operator 100. The training menu management unit 124 stores training procedure data and the like.
[0021]
FIG. 2 shows an example of a training system applied to endoscopic sinus surgery. This system can also be applied to surgical training other than endoscopic sinus surgery. In FIG. 2, reference numeral 20 denotes patient model data displayed on the information display device (in this case, the image information display device) 115 in computer graphics. A thick dotted line indicated by reference numeral 21 indicates medical operation history data displayed on the information display device (in this case, the image information display device) 115 by computer graphics, and is represented by an operator other than the operator (eg, a skilled doctor). It is also possible to display medical operation history data as the operation trajectory. The thin broken line indicated by reference numeral 22 indicates the operation trajectory of the operator 100, which is one of the medical operation history data displayed on the information display device (in this case, the image information display device) 115 by computer graphics, Reference numeral 23 indicates the direction / position of the instruments 113 operated by the operator 100, which is one of the medical operation history data. By displaying the operation trajectory 22 of the operator 100 so as to overlap the trajectory 21 of the skilled doctor, the operator 100 can quickly learn the operation of the skilled doctor. Further, after the training task is completed, the recorded medical operation history data 22 of the operator 100 can be superimposed and displayed on the operation and labor data 21 of the skilled doctor to "reproduce" the operation. This not only assists the independent learning of the operator 100, but also enables an instructor who is not present to replay and observe the operation of the operator 100, so that appropriate guidance can be provided. Reference numeral 24 indicates a range of devices that need to be set at the time of operation at the same place as the operator.
[0022]
The trainee (operator) 100 performs a surgical operation on the real model 111 having the sensors and actuators 112 using the instruments 113 having the sensors and actuators 114. Note that an external sensor (for example, an image recording device or a position recording device) 116 may be provided. The operation target site of the real model 111 is a precise model 111-1, and data such as the shape of the precise model 111-1 is stored in the patient model data section 121 as patient model data. The patient model data is displayed on the information display device (in this case, the image information display device) 115 in computer graphics (indicated by reference numeral 20), and at the same time, the position and direction of the instruments 113 are displayed on the information display device (computer graphics). In this case, it is displayed on the image information display device 115 (indicated by reference numeral 23). The operation trajectory of the operator 100 indicated by a thin broken line indicated by reference numeral 22 and the position and direction of the instruments 113 indicated by reference numeral 23 are redrawn in real time based on information from sensors and actuators 112 and 114, and The difference between the position of the actual model 111 in the precision model 111-1 and the trajectory (or planned route) of the expert can be grasped on the spot. Using the trajectory of an expert as an example, it is possible to learn three-dimensional surgical instrument operation techniques.
[0023]
The control and information processing unit 120 displays the degree of skill of the operator 100 and the degree of invasion of the patient model 111 evaluated by the medical operation evaluation unit 123 on the information display device 115, or the sensors and actuators. By operating 112 and 114, a warning is issued or the operator 100 is instructed. Specifically, it is conceivable to give advice or a warning about the degree of invasion or the traveling direction by voice, or to convey an excessive approach to a dangerous part by vibration.
[0024]
Next, the display of information at a remote location and guidance from a remote location will be described with reference to FIG. Reference numeral 24 (see FIG. 2) indicates the range of devices that need to be set at the time of operation at the same place as the operator, but the components indicated by reference numeral 24 are used directly or by the control and information processing unit 120. The instructor 30 can be connected to the operator via a network line, and the instructor 30 located at a remote place from the operator can also use the information display device 115 ′ and the control and information processing unit 120 ′ to be stored in the control and information processing unit 120. Information can be observed and reproduced. In addition, the instructors 31 at a plurality of remote locations can receive the information and provide guidance using the information display device 115 ′ and the control and information processing unit 120 ′ (not shown).
[0025]
FIG. 4 shows another example of the information presentation. In FIG. 4, reference numeral 115-1 denotes a point on the operation trajectory (polyline) of the instruments 113 at which the force applied to the patient model is large and the magnitude and direction of the force at that time by an arrow 41 by computer graphics. It is an example of expressing and superimposing. As a result, it is possible to accurately know where the surgical tool hit the patient's body and invaded the patient. This is possible in any case of real-time display and history data reproduction. Reference numeral 115-2 is an example in which the same information as described above is displayed in chronological order. Generally, data accumulated as operation history data (not shown) is a collection of such combinations of (measurement time, sensor value).
[0026]
FIG. 5 shows an example of a training system applied to a preoperative simulation of endoscopic sinus surgery. This system can be applied to operations other than endoscopic sinus surgery. In FIG. 5, reference numeral 51 denotes medical image data of a patient photographed before the operation, and based on the medical image data 51, three-dimensional precise patient details that can be destroyed and have mechanical characteristics similar to a living body The data of the model (precision model) 111-1 and the patient model (real model) 111 are created. More specifically, first, a medical image (for example, an X-ray CT image) used as the medical image data 51 is captured. Then, a necessary part is selected from the medical image. In this example, the face surface, the nasal cavity, and the paranasal sinuses are extracted, and data of a three-dimensional precise patient detailed model (precision model) 111-1 is created by the patient model data unit 121. At the time of this creation, the above data is created in a shape that can be mounted on the patient model main body 111. From this data, a three-dimensional precise patient detailed model (precision model) 111-1 which is destructible and has mechanical characteristics similar to a living body is created using a rapid prototyping device or the like.
[0027]
As described above, the sensors 113 and the actuators 114 are mounted on the instruments 113 used by the operator (in this case, a doctor performing an operation). Further, additional external sensors 116 for observing the operator 100, the patient model main body 111, and the instruments 113 from outside are provided. The external sensors 116 include, for example, an image recording device, an audio recording device, a position recording device based on images, and a temperature recording device.
[0028]
Next, the detailed model 111-1 of the affected part is mounted on the patient model main body 111 equipped with the sensors and actuators 112, and a plurality of assumed surgical methods (procedures) are actually performed. It is acquired by the operation history data unit 122. This is a preoperative simulation of the operation. Information from the sensors 112, 114, and 116 is collected in the control and information processing unit 120, and is stored in the medical operation history data unit 122 as operation history data. The accumulated (acquired) operation history data is evaluated by the medical operation evaluation unit 123 for each procedure, and the information display device 115 displays an evaluation result (evaluation result of operation history data by a plurality of surgical procedures) 115-b. (Enumerated display). The evaluation result 115-b is an example in which evaluation results of operation history data by a plurality of surgical procedures are enumerated and displayed, and data (operation time, operation force information, and the like) of a surgical simulation result by different procedures and routes are displayed. I have. As a result, it is possible to compare and select a surgical technique / path to be actually employed in the surgery, and also to grasp the skill level of the operator in the technique. Further, as shown by reference numeral 115-a, the operation history data is also displayed (displayed) by the information display device 115. That is, the data (simulation time, operation force information, etc.) of the result of the simulation using the different procedures / paths adopted in the simulation is displayed by the information display device 115. An example indicated by reference numeral 115-a is the shape data 20 of the detailed model 111-1, the medical operation history data 21 of the instruments 113, the direction / position 23 of the instruments 113, and the force applied to the detailed model 111-1. The position, direction, and size 41 are displayed.
[0029]
FIG. 6 shows an actual surgical training system with sensors. A precise human nasal cavity model 111 of the patient is created by a rapid prototyping technique, and a 6-axis force / torque sensor (Nitta: IFS-67M25A 50-I40) 112 is provided on the bottom and an optical 6-degree-of-freedom is provided on the head. A position sensor (Northern Digital Inc., USA: Hybrid Polaris) 114 was attached. Further, a 6-DOF optical position sensor 114 'was attached to a surgical endoscope (Shinko Kogaku Seisakusho Co., Ltd .: rigid endoscope for nose, 4 mm in diameter). Information from the sensor is displayed as an image on the monitor 115 via the information processing unit and the image display unit 120.
[0030]
7 and 8 show examples of the training screen displayed on the monitor 115. FIG. The center of the screen is the image of the endoscope, and the lower right is the magnitude of the force 201 and the torque 202 applied to the patient model 111 drawn by computer graphics and the model measured by the sensor. Lines 204 drawn at both ends of the screen represent horizontal lines of the image of the endoscope, and are required to be kept horizontal with respect to the patient model. That is, it is a correct state of the endoscope that the image horizontal line 204 overlaps with the horizontal line 203. Performing a surgical operation without noticing that the horizontal line of the image is deviated from its original position may cause damage to unexpected organs, which is very dangerous, but this is a problem often encountered by beginners. .
[0031]
Indices derived from sensor measurement values such as the integrated value of force and torque, the length of the endoscope tip trajectory, and the frequency distribution of the endoscope tip speed when the same surgical operation is performed using this experimental system As a result of conducting an experiment to measure, it was confirmed that there was a large difference between a skilled physician and a non-medical worker in each index. In addition, medical professionals commented that the feedback of the horizontal line of the endoscope image and the force / torque image is effective for training of beginners.
[0032]
【The invention's effect】
According to the present invention, the following effects can be obtained.
(1) Since preoperative planning and simulation can be performed in a three-dimensional space, reliability and skill in patient treatment can be increased as compared with simulation using only images.
(2) It is possible to know whether or not an excessive force is applied to the patient from various sensor values during the surgery simulation, and it is possible to compare and examine a plurality of surgical procedures. Therefore, by using this system, the safety of the operation is improved and the operation time can be expected to be shortened.
(3) By the training by the present system, it is possible to reach a certain technical level before performing “training” with an actual patient, and to reduce medical accidents.
(4) Since the skill level evaluation is possible in this system, the trainees' self-learning rate is increased, the training time of trainees by trained doctors etc. is reduced, training efficiency is improved, and costs are reduced. You.
(5) Since data on the shapes and cases of a large number of patients can be accumulated, typical cases can be extracted from those data, and variations of models for training systems can be enriched. The technical level at the time can be greatly improved.
[Brief description of the drawings]
FIG. 1 is a conceptual diagram of a system.
FIG. 2 is a diagram showing a training system for endoscopic sinus surgery.
FIG. 3 is a diagram showing information display to a remote place and guidance from a remote place;
FIG. 4 is a diagram showing another example of information display.
FIG. 5 is a diagram showing a preoperative simulation of endoscopic sinus surgery.
FIG. 6 is a diagram showing an example of a surgical training system with a sensor.
FIG. 7 is a diagram illustrating an example of a training screen.
FIG. 8 is a diagram illustrating an example of a training screen.
[Explanation of symbols]
Reference Signs List 100 Operator 110 Information display unit 111 Patient (human or animal) model 112 Sensors and actuators 113 Real or simulated medical operating instruments 114 Sensors and actuators 115 Information display device 116 Additional sensors 120 Control unit And information processing unit 121 patient model data 122 medical operation history data 123 medical operation evaluation unit 124 training menu management unit

Claims (7)

First means provided with a sensor and an actuator;
Second means provided with a sensor and an actuator;
A training system comprising: a control / information processing unit that controls and processes information on the sensor and the actuator. A human body model provided with sensors and actuators,
Instrument means provided with sensors and actuators;
A control / information processing unit that controls and processes information on the sensors and actuators,
Using the instrument means to train the human body model for medical practice, the control / information processing unit acquires information from the sensors during the training, and records and reproduces the operation history during the training one by one. A training system characterized by being able to. The training system according to claim 2,
A training system, comprising: an information display unit capable of displaying an operation during the training during or after the training and comparing the operation during the training with an operation history recorded in advance. The training system according to claim 2 or 3,
A training system characterized in that an action during training can be determined and displayed based on an evaluation index recorded in advance and an indication of the quality of the action. The training system according to claim 4,
A training system comprising means for determining a skill level of a trainee based on the standard of the quality. The training system according to claim 5,
A training system comprising means for selecting and displaying a training menu and a training program according to the trainee's skill level determined by the determining means. The training system according to any one of claims 2 to 6, wherein the training system is used as a training system for minimally invasive medical practice.

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