JP4866816B2 - Endoscopic surgical training instrument - Google Patents

Description

  The present invention relates to an endoscopic surgical training apparatus for simulating a procedure such as suturing in an endoscopic surgical operation performed while viewing a camera image.

  In recent years, endoscopic surgery is generally performed because of its low invasiveness and shortening of postoperative recovery, but unlike open surgery, it has a limited view of the camera image and is special. Since the surgery is performed using a long instrument, the difficulty of the technique is high, and experience is necessary to acquire the technique. Therefore, an instrument for training the technique has been required.

Conventionally, as this training instrument, there are at least two instrument insertion openings (for right-handed operation and insertion) for inserting a surgical instrument on the same surface of the instrument front surface (operation side) and a photographing window provided with a camera mounting portion. A box-type instrument with a left-hand operation) is sold, and according to this instrument, a camera is installed in a mounting part near the camera shooting window, and a training sample (in a predetermined position inside the box) For example, a technique such as suturing can be trained while viewing the camera image with a surgical instrument such as a forceps inserted through the surgical instrument insertion port.
In addition, as a device using two mirrors instead of using a camera, the substrate that supports the virtual anatomical structure and the direct view of the trainee on the virtual structure are cut off. Basically composed of a shield plate with two surgical instrument insertion ports and a reflection assembly (the two mirrors) that reflects the image of the hypothetical tissue body beyond the shield to be seen by the trainee. Surgical training instruments have also been proposed in which a person performs similar training by inserting instruments from two surgical instrument insertion ports while looking at the mirror. (Patent Document 1)
Special Table 2000-512027

However, in the conventional instrument, the two insertion openings (for right hand operation and left hand operation) of the surgical instrument are set at predetermined positions in the same plate of the instrument, and training is always performed under the same conditions. Will be done. On the other hand, in an actual operation, the incision holes (positions where the trocar is mounted) for inserting the surgical instrument are not always placed at regular intervals, and may be set at various positions depending on conditions. However, there is a problem that training in various situations is not always possible in accordance with actual surgery.
In particular, the box-type instrument has a problem that the device is large and expensive, and the instrument using a mirror is different from the operation using an actual camera image. There is a concern that the position (direction and angle) of the image and the appearance of the image are not accurately reflected.

  Therefore, the present invention is a compact endoscopic surgery that can perform training more in line with actual endoscopic surgery by setting the two insertion ports of the surgical instrument at various positions. The task was to provide surgical training equipment.

  The endoscopic surgical training apparatus of the present invention includes a board having a sample stage on which a training sample is placed on a plate-like member, and a plate-like member separated into two pieces to be attached to the board. A set of plates each provided with an insertion port for inserting a surgical instrument, and a camera installation section or installation base for mounting a camera, provided at a position where the sample can be photographed, Each of the board and the plate is provided with a mounting portion on which the plate can move, and can be set at a desired position of the mounting portion when the plate is mounted on the board.

As a specific means of the mounting part having the function, the mounting part provided on the board is provided on one edge of the board, while the mounting part provided on the plate is provided on the lower part of the plate, and the mounting part of the plate is provided on the board. The plate is slidable along the mounting portion, and the plate is movable so as to be rotatable about the mounting portion, and is fixed at a desired position and angle.
More specifically, either the mounting portion provided on the edge of one side of the board or the mounting portion provided on the lower portion of the plate is a horizontally long straight groove or hole provided along the edge or the lower portion. The other is formed by engaging and sliding with the groove or hole, and a movable means capable of rotating and a fixing means for locking the movement.
As a specific example of the moving means and the fixing means of the mounting portion, a screw portion is provided, the shaft of the screw portion is engaged with the groove or the hole, and the movable portion and the fixed portion are adjusted by tightening. Configured to be.

  The board and the plate are preferably detachable.

  Further, the mounting portion provided at the lower portion of the plate is formed as a plate-like member that can be bent at an arbitrary angle with the plate main body and can be fixed. Specifically, the plate main body and the mounting portion are connected to the torque hinge. Connected and configured.

Moreover, it is preferable that each part is set as the following structure.
-The board sample stage is formed of a cork board.
The insertion port of the surgical instrument on the plate is formed around the insertion port with a flexible resin having elasticity.
-The camera installation part or installation base is installed between two plates.

(Function)
According to this means, during training for endoscopic surgery, a plate having a surgical instrument insertion port for right hand operation and a plate having a surgical instrument insertion port for left hand operation are separated, and each The plate can be freely set to a desired position on the board as follows by the board and each mounting portion, and thus the following effects can be obtained.
First, the mounting portion of either the board or the plate is formed as a horizontally long straight groove or hole, and the other is provided with a screw or the like that engages with the groove or hole so that the plate slides on the board. The two plates can be freely set by sliding. For example, the distance between the sample and the sample can be set freely, and one can be set close to the sample and one can be set far away.
In addition to the sliding movement, the plate and the mounting portion provided on the plate can be freely rotated and locked and fixed to the board. Thus, the approach angle of the surgical instrument with respect to the sample can be freely set. For example, the two plates can be positioned in a straight line, or can be positioned in a reverse C shape as viewed from the operator.
Furthermore, the plate mounting part is a plate-like member that is separate from the plate body, and can be bent and fixed at any angle by a torque hinge, etc., so that the plate can be tilted in the depth direction with respect to the board. Can be set. For example, the material can be set proximally and the tilt can be set deep, or can be set distally and the tilt can be set shallow.
As described above, desired training conditions can be set by setting the two plates at any position on the board.
In endoscopic surgery, it is ideal that two instruments (such as forceps) operated with the right hand and left hand are operated at an angle of 90 degrees. It is ideal to maintain this angle, but according to the present instrument, it is possible to train to maintain this condition in various situations of the assumed incision hole position.

  In addition, since the plate mounting part can be bent freely with the plate body, it can be folded when not in use, and the board and plate and the camera installation part or installation base can be attached and detached. In particular, it can be stored compactly when not in use, and is easy to carry.

Furthermore, the following actions can be expected.
If the sample stage is made of a flexible material such as a cork board, the sample (rubber member such as a finger sack) can be easily fixed on the board with a pin or the like.
-If the periphery of the insertion port of the surgical instrument on the plate is formed of a flexible resin having elasticity, the trocar can be fixed and a certain amount of movement can be secured when the trocar is inserted into the insertion port. The feeling of use of a surgical instrument such as forceps to be inserted and operated can also be a feeling close to an actual operation.
・ If the camera installation unit or installation table is installed between two plates, images between the right hand and left hand are provided, so the simulated surgical site (the state of the tip of a forceps, etc.) is the most It can be confirmed well, and the visual field of the simulated surgical site can be shielded by the installation part or the installation table.

According to the endoscopic surgical training instrument of the present invention, as described in the means and action, the right hand and left hand two plates for inserting the surgical instrument can be freely set at desired positions, It is possible to train under various conditions that are more consistent with actual endoscopic surgery.
Also, it can be disassembled or folded to keep it compact when not in use, and for easy portability, the camera can be installed on a personal computer or other monitor (for example, a Web camera) If it is a place with a personal computer or a monitor, it is possible to train by moving to a desired place.

Hereinafter, an example of an endoscopic surgical training apparatus (hereinafter, training apparatus) according to the present invention will be described in detail with reference to the drawings.
FIG. 1 is an overall configuration diagram of a training apparatus according to the present embodiment, FIG. 2 is an enlarged view of a mounting portion of a board 1 and a plate 2 of the training apparatus, and FIG. 3 is movable in the vertical direction of the plate of the apparatus. The side view explaining a state is shown.
The training apparatus of this example includes a cork board 12 for retaining a pseudo sample for training (for example, a rubber finger sack) with a pin or the like, and a plate serving as a base on which a plate 2 and a camera base 3 to be described later are mounted. A board 1 formed of a member, and a set of two plate-like members for right-hand operation and left-hand operation, each having an insertion slot 211 for a trocar 5 into which a surgical instrument is inserted. The side mounting portion 13 includes a plate 2 movably installed by a plate side mounting portion 22 and a camera mounting portion, and is basically configured by a camera base 3 disposed on the board 1.

Next, each part will be described in detail.
The board 1 includes a board main body 11 and a cork board 12 disposed on the surface of the board main body 11. The board main body 11 is formed of a resin or metal plate-like member, and is sized for ease of use and portability. In consideration of the above, it is preferable that the width is 200 mm to 400 mm and the vertical width is 150 mm to 300 mm (in this example, the horizontal width is 300 mm, the vertical width is 210 mm), and the board side mounting portion for mounting the plate 2 to be described later on one side edge 13 is configured by providing two horizontally long linear slide holes 13 (hole lengths in this example, each 100 mm) penetrating the board.
The cork board 12 is preferably installed in a wide range on the surface of the board body 11 (in this example, a rectangular range of 250 mm in width and 150 mm in length) so that the sample for simulated surgery can be set at any position. In this example, a recess is provided in the installation range, and a cork board is fitted into the recess. By installing the cork board 12, the sample can be easily retained on the board by pins or the like. In this example, a cork board is used, but any known one can be used as long as the sample can be retained and fixed easily.

The plate 2 of this example is composed of two sets for right-hand operation and left-hand operation, each of which includes a plate body 20 and a plate-side mounting portion (hereinafter referred to as a mounting plate) 22 serving as a mounting portion for the board 1. The plate body 20 and the torque hinge 24 that connects the mounting plate 22 are basically configured. The plate body 20 is a plate-like member formed of resin, and the size is a width in consideration of ease of use and portability. It is preferably about 40 mm to 150 mm and a height of 100 mm to 220 mm (in this example, a width of 70 mm and a height of 190 mm), and a trocar insertion port 211 for inserting a trocar 5 for inserting a surgical instrument such as forceps onto the plate surface. And provided with an elastic port 21 made of a flexible resin having elasticity (in this example, a silicone resin). By providing the elastic port 21, a feeling close to that of the human skin in actual surgery can be obtained during training. In this example, the trocar 5 is attached to the instrument, but since it is designed in consideration of the outer diameter of a general-purpose trocar, it can be used without problems even if another trocar is used.
The mounting plate 22 is a plate-like member formed of the same resin as that of the plate main body 20, and is movable on the surface of the mounting plate 22 by being engaged with the slide hole 13 serving as the board-side mounting portion. Thus, a bolt 23 serving as a slide side mounting portion that can be fixed at a desired position is provided. The means for attaching the bolt 23 to the board 1 will be described in detail. Insert the screw 2 into the cap nut-shaped bolt screw receiver 233 and turn the bolt head 232 with your fingers to tighten or loosen, so that the plate 2 can be mounted, fixed, or movably released on the board 1 can do. Furthermore, the board 1 and the plate 2 can be disassembled.
The torque hinge 24 is a well-known hinge type hinge and will not be described in detail. However, one side is attached to the edge of the plate body 20 and the other is attached to the edge of the mounting plate 22, and both are connected. Thus, the angle formed by the plate main body 20 and the mounting plate 22 can be freely set by a hinge, and can be fixed at the set position. In addition, when completely stowed, the board 1 and the plate 2 are in a parallel state and do not become bulky.

According to the board 1 and the plate 2 configured as described above, the screw shaft 231 of the bolt 23 of the mounting plate 22 engages and slides in the slide hole 13 of the board 1, thereby sliding within the range of the slide hole 13 (a The plate 2 can be set at a freely movable position, and can be fixed by tightening the bolts 23. Furthermore, since the right-hand operation and the left-hand operation are separated, the interval between the plates 2 can be set freely.
Further, by engaging the screw shaft 231 of the bolt with the slide hole 13 as described above, the plate 2 can be rotated (b) on the board 1 with the screw shaft 231 as a fulcrum. Can be freely set, and can be fixed by tightening the bolt 23. Further, since the plates 2 are separated, the relative angle between the two plates 2 can be freely set.
Further, since the plate body 21 and the mounting plate 22 of the plate 2 are connected by the torque hinge 24, the angle between the main plate 21 and the mounting plate 22 can be freely bent (c) to be set and fixed. The angle in the depth direction of the plate body 21 with respect to the board 1 can be freely set.
As described above, since the position of the plate 2 with respect to the board 1 can be freely set, it is possible to perform training with an approach adapted to actual surgery.

FIG. 3 is a schematic diagram showing an example of the camera base of this example, where A is a front view and B is a side view.
The camera base 3 of this example is formed on the assumption that the camera base 3 is used for a Web camera 4 that is mounted on a personal computer or the like and includes a camera body 40, a fixed shaft 41 for holding the camera, and a fixed ball 42. However, it may be changed depending on the camera used, and is not specified in this example.
The camera base 3 for the web camera 4 (hereinafter simply referred to as a camera) of this example is composed of a camera base body 30, a fastening bolt 32, and a leg 33, and the camera 4 is attached to the front side of the camera base body 30. (Removal) is provided with a vertically long mounting groove 31 that can be expanded and contracted in the width direction and whose inside (broken line in the drawing) is slightly larger than the entrance portion (solid line in the drawing). By installing the camera 4 and tightening the tightening bolt 32 provided on the side surface, the fixed shaft 41 and the fixed ball 42 of the camera 4 are clamped in the groove, held and fixed, and fixed by releasing the tightening of the bolt 32. Is allowed to move in the mounting groove 31 of the camera 4, and the camera can be removed.
In addition, on the front side, the angle (photographing position) of the camera lens with respect to the board 1 changes depending on the mounting position of the camera 4 in the mounting groove 31 (forms a shallow angle in the upper part and projects the distal part of the board, and deep in the lower part) It is formed as a circular arc shape with the bottom protruding (to form an angle and reflect the board proximal).
When the camera base 3 is mounted on the board 1, it is not particularly fixed, and the front side of the camera base 3 is placed between two plates such as between the two slide grooves 13 of the board 1. The rear portion can be stably installed in parallel by providing the camera base 3 with the legs 33 set at the same height as the board 1.

According to the mounting groove 31 of the camera base 3 having the above configuration, the fixed shaft 41 and the fixed ball 42 of the camera 4, the camera 4 can be slid within the range of the mounting groove 31 of the camera base 3 and set to a free position. It is also possible to rotate the camera 4 about the fixed shaft 41 as a fulcrum and set the angle freely. Further, since the front side of the camera base body 30 has an arc shape, the tilt angle of the camera changes depending on the mounting position of the camera 4 in the mounting groove 31, and the perspective position on the board 1 that the camera shoots changes. The range from the proximal to the distal of the board can be covered. Furthermore, since the camera base 3 is not fixed on the board 1, it can be freely placed at a desired position and angle.
With the above operation, the range that can be photographed by the camera 4 extends over a wide range, so that the range on the board where the sample can be placed can be set wide.

1 is an overall configuration diagram of an endoscopic surgical training instrument according to an embodiment of the present invention. The enlarged view which shows the mounting part of the board and plate of the said instrument. The side view which shows the movable state of the plate of the said instrument. The schematic diagram which shows the camera stand of the said instrument.

Explanation of symbols

1. Board 11. Board body 12. Cork board 13. Slide hole (board side mounting part)
2. Plate 20. Plate body 21. Elastic port 211. Trocar insertion slot 22. Mounting plate (plate side mounting part)
23. Bolt 231. Bolt screw shaft 232. Bolt head (tightening knob)
233. Bolt screw receiver 24. 2. Torque hinge Camera stand 30. Camera stand body 31. Mounting groove 32. Tightening bolt 33. Leg 4. Web camera 40. Camera body 41. Fixed shaft 42. Fixed ball 5. Trocar

Claims (10)

A board having a sample stage for placing a training sample on a plate-like member;
A set of plates each provided with an insertion port for inserting a surgical instrument in a plate-like member separated into two pieces to be attached to the board;
The sample is provided at a position where the sample can be photographed, and includes a camera installation unit or installation base for attaching a camera.
The board and the plate are provided with a mounting portion on which the plate can move, and can be set at a desired position of the mounting portion when the plate is mounted on the board. Surgical training equipment.   The mounting portion provided on the board is provided on one edge of the board, while the mounting portion provided on the plate is provided at a lower portion of the plate, the mounting portion of the plate is slidable along the mounting portion of the board, and the plate The endoscopic surgical training apparatus according to claim 1, wherein the endoscope is pivotally movable about an attachment portion and is fixed at a desired position and angle.   Either the mounting part provided on the edge of one side of the board or the mounting part provided on the lower part of the plate includes a horizontally long straight groove or hole provided along the edge or the lower part, The endoscopic surgical training apparatus according to claim 1 or 2, further comprising: a slide that engages with the groove or the hole, and a movable means that can be rotated and a fixing means that locks the movement.   The movable means and the fixing means of the mounting portion include a screw portion, and the shaft of the screw portion is movable by engaging with the groove or the hole. Endoscopic surgical training instrument.   The endoscopic surgical training apparatus according to any one of claims 1 to 4, wherein the board, the plate, and the camera installation unit or installation table are detachable.   The endoscopic surgical training apparatus according to any one of claims 1 to 5, wherein the mounting portion provided at the lower portion of the plate is formed of a plate-like member that is foldable and fixable to an arbitrary angle with the plate body. .   7. The endoscopic surgical training apparatus according to claim 6, wherein the plate body and the mounting portion can be bent and fixed by connecting the plate main body and the mounting portion with a torque hinge.   The endoscopic surgical training apparatus according to any one of claims 1 to 7, wherein the board sample stage is formed of a cork board.   The endoscopic surgical training instrument according to any one of claims 1 to 8, wherein the insertion port of the surgical instrument of the plate is formed around a flexible resin having elasticity.   The endoscopic surgical training apparatus according to any one of claims 1 to 9, wherein the camera installation unit or installation table is installed between two plates.

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