RU128762U1 - HYBRID MEDICAL SIMULATOR LAPAROSCOPY - Google Patents

Abstract

1. A hybrid medical laparoscopy simulator containing computers, simulators of laparoscopic instruments connected to a computer, trocar simulators connected to a computer, a visualization system connected to a computer, characterized in that a robot patient is introduced, simulators of laparoscopic devices connected to a computer, equipment operating, and each simulator of a laparoscopic instrument is made in the form of a real instrument containing a block of sensors, and is separated from simulators of trocars, which contain more than three installed in the trousers the cavity of the robot patient, each trocar simulator is connected to a corresponding displacement site of the trocar simulator, fixing the position and determining the position of the trocar simulator on the front wall of the abdominal cavity of the robot patient. 2. The medical simulator according to claim 1, characterized in that the simulators of laparoscopic devices are made in the form of a coagulator control unit, coagulator pedals, an aspirator-irrigator pedal, an endovideo camera control unit, an aspirator-irrigator control unit, an insufflator control unit with an insufflator tube. 3. The medical simulator according to claim 1, characterized in that the simulators of laparoscopic instruments are made in the form of simulators of laparoscopic clamps, simulators of an endoscope, simulators of an aspirator-irrigator, simulators of a coagulator, simulators of laparoscopic scissors, simulators of a dissector, simulators of a hook, simulators of a laparoscopic clip applicator. four. The medical simulator according to claim 1, characterized in that the operating room equipment is made in the form of an operating table, a surgical stand, an instrumental table.

Description

The utility model relates to manuals for training in medicine, in particular, it is used in the field of training and training of joint work of specialists of the operating team, and conducting endosurgical operations.

A well-known medical simulator LapSim (manufacturer Surgical Science, Gothenburg, Sweden) containing computers, three trocar simulators connected to a computer, three laparoscopic simulators connected to trocar simulators, a visualization system connected to a computer, coagulator pedals connected to a computer.

Closest to the proposed hybrid medical simulator of laparoscopy is “Computer simulator for the development of manual skills in endoscopic surgery and development of techniques for performing laparoscopic operations” (models “LAP MENTOR”, “LAP MENTOR Haptic”, “LAP MENTOR Express”, certificate of conformity ROSS IL. ML 13.B08453 dated July 21, 2011, manufacturer Simbionix, USA), which contains computers, three trocar simulators connected to a computer, three laparoscopic instruments simulators connected to trocar simulators, a simulator case containing a computer and connected to trocar simulators, a visualization system connected to a computer, coagulator pedals connected to a computer.

The simulator described above does not provide real actions and the real position of the surgical team relative to the patient robot and the surgical field; the ability to perform various options for laparoscopic access in complicated clinical situations; complicated access (at an angle, at a distance) depending on the selected position of the patient robot (American, French, etc.); training of operating and assisting surgeons, operating nurse to work in a team with various scenarios; comprehensive training of the operating team, starting with the decision to conduct surgery based on the data of the medical history and current complaints of the virtual patient, to practice actions in emergency situations during the intervention; the use of more than three trocar simulators, changing the number of trocar simulators, choosing the location of trocar simulators; the reality of various tool simulators, their introduction into trocar simulators and their change during operations.

The technical task to be solved is to ensure real actions and the real position of the surgical team relative to the patient robot and the surgical field; the ability to perform various options for laparoscopic access in complicated clinical situations; complicated access (at an angle, at a distance) depending on the selected position of the patient robot (American, French, etc.); training of operating and assisting surgeons, operating nurse to work in a team with various scenarios; comprehensive training of the operating team, starting with the decision to conduct surgery based on the data of the medical history and current complaints of the virtual patient, to practice actions in emergency situations during the intervention; the use of more than three trocar simulators, changing the number of trocar simulators, choosing the location of trocar simulators; the reality of various tool simulators, their introduction into trocar simulators and their changes during operations.

The technical problem to be solved in a hybrid medical laparoscopy simulator containing computers, simulators of laparoscopic instruments connected to a computer, simulators of trocars connected to a computer, a visualization system connected to a computer, is achieved by introducing a robot patient, simulators of laparoscopic devices connected to a computer, operating equipment, and , each simulator of a laparoscopic instrument is made in the form of a real instrument containing a block of sensors and is separated from simulators of trocars, which contain more three installed in an abdominal cavity of the patient-robot simulator trocar each connected to a respective node movement simulator trocar locking position and determining the position of the simulator trocar on the front wall of the abdominal cavity of the patient-robot. Simulators of laparoscopic instruments are made in the form of a coagulator control unit, coagulator pedals, aspirator-irrigator pedal, endovideo camera control unit, aspirator-irrigator control unit, insufflator control unit with an insufflator tube. Imitators of laparoscopic instruments are made in the form of imitators of laparoscopic clamps, imitators of an endoscope, imitators of an aspirator-irrigator, imitators of a coagulator, imitators of laparoscopic scissors, imitators of a dissector, imitators “hook”, imitators of a laparoscopic clip applicator. The operating room equipment is made in the form of an operating table, surgical stand, tool table.

Figure 1 presents a diagram of a hybrid medical simulator laparoscopy.

Figure 2 presents a drawing of a simulator of a laparoscopic clamp, which is a simulator of a laparoscopic instrument.

Figure 3 presents a drawing of a sensor block simulator of a laparoscopic instrument.

Figure 4 presents a drawing of a simulator of a trocar in a section (side view).

Figure 5 shows a drawing of a site for moving a trocar simulator connected to a trocar simulator (top view).

Figure 6 shows a drawing of a site of movement of a trocar simulator connected to a trocar simulator (front view).

Fig. 7 schematically shows a robot patient with trocar simulators located in his abdominal cavity.

On Fig shows a schematic diagram of the connection of the microcontroller of the sensor block simulator of a laparoscopic instrument with the sensors of the simulator of a laparoscopic instrument.

Figure 9 shows a schematic diagram of an interface unit connected to a computer, sensor units and control units.

Figure 10 presents a schematic diagram of the connection of microcontrollers nodes moving simulators of trocars to a computer.

Figure 11 shows a schematic diagram of a coagulator control unit connected to a sensor unit and an interface unit.

On Fig (12/1 and 12/2) shows a block diagram of a General algorithm for the operation of the computer processor.

On Fig shows a block diagram of the algorithm of operation of the microcontroller of the sensor block simulator of a laparoscopic instrument.

On Fig shows a block diagram of the algorithm of operation of the microcontroller of the interface unit.

On Fig shows a block diagram of the algorithm of the microcontrollers nodes moving simulators of trocars.

On Fig shows a block diagram of the algorithm of operation of the main microcontroller node movement simulator trocar.

On Fig shows a block diagram of the algorithm of operation of the microcontroller of the control unit of the coagulator, which is a simulator of a laparoscopic device.

On Fig presents a drawing of a simulator of an endoscope, which is a simulator of a laparoscopic instrument.

On Fig depicts a schematic diagram of a control unit of the endovideo camera connected to the sensor unit and the pairing unit.

In Fig.20 shows a schematic diagram of a control unit for an aspirator-irrigator connected to the interface unit.

On Fig depicts a schematic diagram of a control unit of an insufflator connected to a pairing unit.

On Fig shows a block diagram of the algorithm of operation of the microcontroller of the control unit endovideo camera.

On Fig shows a block diagram of the algorithm of operation of the microcontroller control unit of the aspirator-irrigator.

On Fig shows a block diagram of the algorithm of operation of the microcontroller control unit insufflator.

The hybrid medical simulator of laparoscopy, shown in the diagram of figure 1, contains: a patient robot 1, a computer 2 (electronic computer), simulators of laparoscopic clamps 3, which are simulators of laparoscopic instruments connected to a computer 2 through the interface unit 4, an endoscope simulator 5, which is a simulator of a laparoscopic instrument, connected to a computer 2 through an endovideo camera control unit 6 and a pairing unit 4, a simulator of an aspirator-irrigator 7, which is a simulator of a laparoscopic instrument, connected with a computer 2 through an aspirator-irrigator control unit 8 and an interface unit 4, an insufflator tube 9 connected to an insufflator control unit 10, trocar simulators 11, which can contain more than three (four in this version) installed in the abdominal cavity of a patient robot 1 and connected to a computer 2, a visualization system 12 connected to a computer 2, an interface unit 4 connecting the computer 2 to the simulators of laparoscopic clamps 3, the control unit of the coagulator 13, which is one of the simulators of laparoscopic devices, the control unit e dovideokameroy 6, one of the simulators laparoscopic instruments, control unit aspirator-irrigator 8, one of the simulators and laparoscopic instruments insufflator control unit 10, which is one of simulators laparoscopic instruments. The operating equipment is shown in Fig. 1 in the form of: an operating table 14, a surgical stand 15, an instrument stage 16. Laparoscopic instruments imitators are presented in the diagram of Fig. 1 in the form of: imitators of laparoscopic clamps 3, imitator of an endoscope 5, imitator of an aspirator-irrigator 7. Imitators laparoscopic devices are presented in the diagram of figure 1 in the form of: a control unit for an endovideo camera 6, a control unit for an aspirator-irrigator 8, a control unit for an insufflator 10 with a tube of an insufflator 9, a control unit coagulated rum 13, pedals of the coagulator 17, pedals of the aspirator-irrigator 18.

The trocar simulators 11 are located in the abdominal cavity of the robot patient 1, the robot patient 1 is located on the operating table 14, the imaging system 12 is connected to the computer 2, the interface unit 4 is connected to the computer 2, the simulators of the laparoscopic clamps 3 are connected to the interface unit 4, the endoscope simulator 5 is connected to the control unit of the endovideo camera 6, the simulator of the aspirator-irrigator 7 is connected to the control unit of the aspirator-irrigator 8, the tube of the insufflator 9 is connected to the control unit of the insufflator 10. Simulators of laparoscopic clamps 3, simulator end the osprey 5, the simulator of the aspirator-irrigator 7 and the tube of the insufflator 9 are located on the instrument stage 16. The coagulator control unit 13, the endovideo camera control unit 6, the aspirator-irrigator control unit 8 and the insufflator control unit 10 are connected to the interface unit 4. The coagulator pedals 17 are connected to the control unit of the coagulator 13, the pedal of the aspirator-irrigator 18 is connected to the control unit of the aspirator-irrigator 8.

Computer circuitry 2 can be implemented as an IntelCorei7 processor with a processor frequency of 3500 MHz, Kingston DDR3 RAM with 8 GB of memory, NVIDIA Ge Force GTX560 graphics card with 2 GB of memory, Seagate hard disk with 500 GB of memory. Operating system "Microsoft Windows 7 Professional". Computer 2 contains a manipulator that allows you to enter data into a program running in computer processor 2.

The patient 1 robot can be manufactured according to the model of the HPS robot simulator, supplied by Virtualmed LLC, www.virtumed.ru.

The visualization system 12 can be made according to the model type TS1716L-6 (S / U) 17 "LCD, monitor Neovo X-19AV White, supplied by ELLIPS Partner LLC.

Operating table 14 can be made according to the model of the StarTech 3008C type supplied by Delrus Kazan LLC.

Surgical stanchion 15 consists of five shelves; it can be made according to the model of Spya-O3-05-KMT type supplied by FinStar LLC.

Tool table 16 can be made according to the model of the type “Goose”, supplied by LLC “White furniture”.

The coagulator pedals 17 can be made according to the model of a two-key pedal to EHF A-001 supplied by ELLIPS Partner LLC.

The pedal of the aspirator-irrigator 18 can be made according to the model of the type of single-key pedal of the aspirator-irrigator supplied by ELLIPS Partner LLC.

The simulator of a laparoscopic clamp 3, which is a simulator of a laparoscopic instrument, shown in FIG. 2, comprises: jaws 19, a working tube 20, a sensor unit 21, a handle 22, a wing of a tool 23. The jaws 19 are connected to the working tube 20, the working tube 20 is connected to the sensor unit 21, the handle 22 is connected to the wing of the tool 23, the wing of the tool 23 is connected to the sensor block 21.

The sensor block 21 of the laparoscopic instrument simulator, shown in FIG. 3, comprises: a tool wing 23, an encoder 24, an encoder pulley 25, a sensor block housing 26, a pass 27, a tube 28, a bearing 29, a handle pulley 30, a lock ring 31, a thrust 32, stroke restriction cavity 33, magnetic head 34, magnetic Hall sensor 35, IR LED 36, microcontroller of the sensor block 37. Slots for mounting the encoder 24, magnetic Hall sensor 35, IR LED 36, the microcontroller of the block are provided in the housing of the sensor block 26 sensors 37, crank pulley 30, pc encoder 25 and bearing 29. The tube 28 is connected to the bearing 29, the rod 32 is compressed by the locking ring 31, the magnetic head 34 is fixed at the end of the rod 32, the handle pulley 30 is mounted on the tube 28, the encoder pulley 25 is mounted on the axis of the encoder 24. 25 encoder pulley and the handle pulley 30 are connected by a belt 27. Magnetic Hall sensor 35, encoder 24, IR LED 36, microcontroller of the sensor block 37 are connected to the housing of the sensor block 26. Encoder 24 can be made according to the model type LIR212A manufactured by SKB “IC” in St. Petersburg.

The simulator of a trocar 11, shown in FIG. 4 in section (side view), comprises: a housing of a simulator of a trocar 38, a receiver of a laparoscopic instrument 39, holding rollers 40, a shaft of the housing of a simulator of a trocar 41, a sensor for measuring longitudinal movement of the instrument 42, which can be manufactured according to a model of type EMS22 manufactured by Bourns, Columbia, www.bourns.com, a shaft of a sensor for measuring longitudinal displacements 43, a bearing of a shaft 44, a movable angle 45, a rotation sensor along the ordinate axis 46, which can be manufactured according to a model of type LIR212A, a locking sensor from the ordinate axis 47, the shaft of the movable angle 48, the rotation sensor on the abscissa axis 49, which can be manufactured according to the LIR212A type model, the bearing of the movable angle 50, the holding housing 51, the IR receiver 52, the trocar valve 53. The body of the trocar simulator 38 is connected with the receiver of the laparoscopic instrument 39, the housing of the trocar simulator 38 is connected to the holding rollers 40, the housing of the trocar simulator 38 is connected to the shaft of the trocar simulator 41, the housing of the trocar simulator 38 is connected to the sensor for measuring longitudinal movement of the tool 42, yes a longitudinal movement measuring sensor 42 is connected to a shaft of a longitudinal movement measuring sensor 43, a shaft bearing 44 is connected to a shaft of a trocar simulator 41, a shaft bearing 44 is connected to a movable corner 45, an ordinate rotation sensor 46 is connected to a shaft of a trocar simulator 41, a sensor rotation along the ordinate axis 46 is connected to the rotation sensor clamp on the ordinate axis 47, the rotation sensor clamp on the ordinate axis 47 is connected to the movable corner 45, the movable corner 45 is connected to the shaft of the movable corner 48, the shaft of the movable head 48 is connected to the rotation sensor along the abscissa 49, the shaft of the movable corner 48 is connected to the bearing of the moving corner 50, the holding housing 51 is connected to the bearing of the moving corner 50, the holding housing 51 is connected to the rotation sensor on the abscissa 49, the IR receiver 52 is connected to the body of the simulator of the trocar 38, the valve of the trocar 53 is connected to the housing of the simulator of the trocar 38.

The movement site of the trocar simulator connected to the trocar simulator 11 (top view and front view), shown in the drawing of FIG. 5 and 6, comprises: a guide 54, a longitudinal movement sensor, a guide 55, a longitudinal movement sensor lock 56, a jumper 57, a sensor the rotation of the guide 58, the guide pulley 59, the guide body retainer 60, the guide body 61, the rubber ring 62, the guide body retainer studs 63, the sensor pulley 64, the silicone shaft 65, the trocar simulator 11, the laparoscopic clamp simulator 3, microcontrol ep movement simulator trocar assembly 66 (66 ₁ -66 ₃ - microcontrollers nodes moving simulators trocars 66 ₄ - microcontroller core node movement simulator trocar) moving ram assembly 67. The simulator laparoscopic clip 3 put into the trocar simulator 11, the simulator 11 is connected to trocar guide 54, guide 54 is inserted into guide body 61, guide body retainer 60 is connected by pins of guide body retainer 63 to jumper 57, silicone shaft 65 is pressed against guide 54, sensor retainer is longitudinal of the displacement 56 is connected to the guide body 61, the longitudinal displacement sensor of the guide 55 is connected to the silicone shaft 65, the longitudinal displacement sensor of the guide 55 is connected to the latch of the longitudinal displacement sensor 56, the guide pulley 59 and the sensor pulley 64 are connected by a rubber ring 62, the guide pulley 59 is connected to the guide 54, the pulley of the sensor 64 is connected to the rotation sensor of the guide 58. The guide 54 is a hollow aluminum tube of square cross section, inside of the cavity of which are laid signal wires that connect the microcontroller unit movement simulator trocar 66 with the sensor measuring the longitudinal movement of the tool 42, the rotation sensor on the ordinate axis 46, the rotation sensor on the abscissa 49 and IR receiver 52.

The patient robot 1 with trocar simulators 11 located in its abdominal cavity, shown schematically in FIG. 7, contains: the patient robot 1, simulators of laparoscopic clamps 3, trocar simulators 11. Simulators of trocars 11 are located in the abdominal cavity of the robot patient 1, simulators of laparoscopic clamps 3 are introduced into simulators of trocars 11.

A schematic diagram of the connection of the microcontroller of the sensor unit 37 of the simulator of the laparoscopic instrument with the sensors of the simulator of the laparoscopic instrument, shown in Fig. 8, contains: the microcontroller of the sensor block 37, which can be performed according to a model of the AtMega8 type, is located in the sensor block 21, shown in Fig. 3, encoder 24, which can be performed according to the model of the LIR212 type, a magnetic Hall sensor 35, which can be performed according to the model of the SS49 type, IR LED 36, the microcontroller of the interface unit 68. The microcontroller of the sensor block s 37 is connected respectively with a magnetic Hall sensor 35, an encoder 24, the microcontroller interface unit 68 and the infrared LED 36.

Schematic diagram of the interface unit 4, connected to the sensor blocks 21 and the control units shown in Fig.9, contains: a computer 2, the sensor unit 21, the interface unit 4, the control unit of the coagulator 13, the control unit for the endovideo camera 6, the control unit for the aspirator-irrigator 8 , the insufflator control unit 10, n of the microcontrollers of the sensor unit 37 (n is the number of connected imitators of laparoscopic instruments), for example, n can take values equal to four, the microcontroller of the interface unit 68, which can be made in mode whether AtMega16 type, a microcontroller of the coagulator control unit 69, which can be made according to a model of the AtMega16 type, a microcontroller of the endovideo camera control unit 70, which can be made according to a model of the AtMega16, a microcontroller of the control unit of the aspirator-irrigator 71, which can be made according to a model of the AtMega16 type , the microcontroller of the insufflator control unit 72, which can be made according to a model of the AtMega16 type, the housing of the interface unit 73. The microcontroller of the interface unit 68 is connected respectively to n microcontrollers of the sensor unit 37, (Fig. 9 shows one microcontroller of the sensor unit 37), the microcontroller of the coagulator control unit 69, the microcontroller of the endovideo camera control unit 70, the microcontroller of the control unit of the aspirator-irrigator 71, the microcontroller of the control unit of the insufflator 72 and the computer 2. The microcontroller inside the interface unit 68 interface unit housings 73.

A schematic diagram of the connection of the microcontrollers of the nodes of the movement of simulators of trocars 66 to a computer 2, shown in Fig.10, contains: a computer 2, a microcontroller of the nodes of movement of the simulator of a trocar 66 (66 ₁ , 66 ₂ , 66 ₃ , 66 ₄ ), which can be performed according to the model type STM32 F100MB, tool for measuring longitudinal movement of the tool 42, rotation sensor for ordinate 46, rotation sensor for abscissa 49, sensor for longitudinal movement of guide 55, sensor for turning guide 58, IR receiver 52. Microcontroller of the trocar simulator movement unit 664 ene with a computer 2. The microcontroller unit trocar 66 movement simulator ₁ is connected with the sensor measuring the longitudinal displacement of the tool 42, the rotation sensor on the ordinate axis 46, the rotation sensor on the abscissa 49, longitudinal movement of the guide sensor 55, rotation sensor guide 58 and IR receiver 52 . Each MCU node movement simulator trocar 66 ₂ -66 ₄ is similar to the microcontroller simulated moving unit ₁ and the trocar 66 is connected respectively to the outputs of the probe longitudinal movement inst coagulant 42, rotation sensor 46 on the axis of ordinates, the rotation sensor on the abscissa 49, longitudinal movement of the guide sensor 55, rotation sensor guide 58 and IR receiver 52 (Figure 10 not shown).

Schematic diagram of the control unit of the coagulator 13 connected to the sensor unit 21 and the interface unit 4, shown in Fig. 11, contains: the control unit of the coagulator 13, the pedal of the coagulator 17, the microcontroller of the sensor unit 37, the microcontroller of the interface unit 68, the microcontroller of the control unit of the coagulator 69, coagulator current power regulator 74, coagulation mode switch 75, cutting mode switch 76, mixed mode switch 77, sensor unit 21, interface unit 4 and the body of the coagulator control unit 78. The microcontroller bl the control coagulator 69 is connected to the pedals of the coagulator 17, the coagulator current power regulator 74, the coagulation mode switch 75, the cutting mode switch 76, the mixed mode switch 77, the microcontroller of the coupler unit 68 and the microcontroller of the sensor unit 37. The coagulator current regulator 74, the coagulation mode switch 75, the cutting mode switch 76, the mixed mode switch 77 are installed on the housing of the coagulator control unit 78. The microcontroller of the coagulator control unit 69 is located inside the housing b coagulator control lock 78.

The endoscope simulator 5, which is a simulator of a laparoscopic instrument, shown in Fig. 18, comprises: a working tube 20, a sensor unit 21, a tool wing 23. A working tube 20 is connected to a sensor unit 21, a tool wing 23 is connected to a sensor unit 21.

Schematic diagram of the control unit of the video camera 6, connected to the sensor unit 21 and the interface unit 4, shown in Fig. 19, contains: the control unit of the video camera 6, the sensor unit 21, the interface unit 4, the microcontroller of the control unit of the video camera 70, the switch of the video camera 79, the color adjuster tones 80, dimmer 81, white balance 82, halogen light switch 83, xenon light switch 84, light brightness display 85, which can be made according to a model such as BAS6-11EWA, microcon the sensor unit scooter 37, the interface unit microcontroller 68 and the endovideo camera control unit body 86. The endovideo camera switch 79, the color tone adjuster 80, the dimmer 81, the white balance adjuster 82, the halogen light switch 83, the xenon light switch 84 and the light brightness display 85 are installed on the body of the control unit of the endovideo camera 86. The microcontroller of the control unit of the endovideo camera 70 is connected to the switch of the endovideo camera 79, the color tone control 80, the light control 81, the control torus white balance 82, a switch 83 halogen light, xenon light a switch 84, microcontroller sensor unit 37, the microcontroller interface unit 68 and the display brightness control endovideokameroy 85. The microcontroller 70 disposed within the control unit housing unit 86 endovideokameroy.

Schematic diagram of the control unit of the aspirator-irrigator 8 connected to the interface unit 4, shown in Fig.20, contains: the control unit of the aspirator-irrigator 8, the interface unit 4, the microcontroller of the control unit of the aspirator-irrigator 71, the pedal of the aspirator-irrigator 18, the switch on the aspirator -irrigator 87, switch for aspiration mode 88, switch for irrigation mode 89, switch for opening and closing 90, microcontroller of interface unit 68 and housing of control unit for aspirator-irrigator 91. The microcontroller of block is controlled the irrigation suction device 71 is connected to the pedal of the irrigation aspirator 18, the switch of the aspirator-irrigator 87, the switch of the aspiration mode 88, the switch of the irrigation mode 89, the opening and closing switch 90 and the microcontroller of the interface unit 68. The switch of the aspirator-irrigator 87, the switch of aspiration mode 88 , an irrigation mode switch 89, an opening and closing switch 90 are installed on the housing of the control unit of the aspirator-irrigator 91. The microcontroller of the control unit of the aspirator-irrigator 71 is located inside the housing Lok irrigator-aspirator 91 management.

Schematic diagram of the control unit of the insufflator 10 connected to the interface unit 4, shown in Fig.21, contains: the control unit of the insufflator 10, the interface unit 4, the microcontroller of the control unit of the insufflator 72, the microcontroller of the interface unit 68, the switch of the insufflator 92, the start button of the insufflation 93, pressure increase switch 94, pressure decrease switch 95 pressure storage switch 96, flow increase switch 97, flow decrease switch 98, flow memory switch 99, set pressure display 100 , a measured pressure display 101, a target flow display 102, a measured flow display 103 and an insufflator control unit housing 104. The microcontroller of the insufflator control unit 72 is connected to the outputs of the microcontroller of the interface unit 68, the insufflator switch 92, the insufflation start button 93, the pressure increase switch 94, the switch pressure reduction 95, pressure storage switch 96, flow increase switch 97, flow decrease switch 98, flow storage switch 99 and preset pressure display inputs 100, display I measured pressure 101, set flow display 102 and measured flow display 103. Insufflator switch 92, insufflation start button 93, pressure increase switch 94, pressure decrease switch 95, pressure storage switch 96, flow increase switch 97, flow decrease switch 98, switch memory flow 99, the display of the set pressure 100, the display of the measured pressure 101, the display of the set flow 102 and the display of the measured flow 103 are installed on the housing of the control unit of the insufflator 104. The microcontroller of the block control insufflator 72 is located inside the housing of the control unit insufflator 104.

Consider the work of the simulator of the laparoscopic clamp 3, which is a simulator of a laparoscopic instrument, shown in the drawing of figure 2, and the sensor block 21 of the simulator of a laparoscopic instrument, presented in the drawing of figure 3. The surgeon rotates the wing of the instrument 23 on the handle 22, the rotation is transmitted through the handle pulley 30 and the encoder pulley 25 to the encoder 24. Thus, the rotation of the working tube 20 of the laparoscopic clamp simulator 3 is monitored. The angle of the jaw 19 is monitored using a magnetic Hall sensor 35. Magnetic the Hall sensor 35 determines the position of the magnetic head 34 mounted on the rod 32. When using the handle 22, the rod 32 performs longitudinal movements, which are detected by the magnetic Hall sensor 35. The stroke of the handle 22 is limited to ax ring 31, which abuts against the walls of the cavity of the stroke restriction 33, thus simulating the actual limitation of the jaw 19. A detailed description of the manipulations of the surgeon using the simulator of laparoscopic clamp 3 and other imitators of laparoscopic instruments are discussed further on pages 22-43, which are considered in the work hybrid medical simulator of laparoscopy, presented in the diagram of figure 1 and in examples of training operations "cholecystectomy" and "adnexectomy".

Consider the simulator of the trocar 11, shown in the drawing of figure 4 in section (side view). A simulator of a laparoscopic instrument, for example, a simulator of a laparoscopic clamp 3, which is one of the simulators of a laparoscopic instrument, is inserted into the hole of the receiver of the laparoscopic instrument 39. The simulator of the laparoscopic clamp 3 is rotated along the abscissa and the ordinates, as in a real operation, respectively, the receiver of the laparoscopic instrument 39 , the body of the trocar simulator 38 and the rotation through the shaft of the body of the trocar simulator 41 is transmitted to the rotation sensor along the ordinate 46, also the rotation of the is given through the movable corner 45 and the shaft of the movable corner 48 to the rotation sensor on the abscissa 49. The rotation sensor on the ordinate 46 and the rotation sensor on the abscissa 49 track the position coordinates of the simulator of the laparoscopic clamp 3 in space. The laparoscopic clamp simulator 3 is in contact with the holding rollers 40 and the shaft of the longitudinal displacement measurement sensor 43 during insertion, thereby the longitudinal displacement measurement sensor 42 of the instrument registers the depth of entry of the laparoscopic clamp simulator 3 into the receiver of the laparoscopic instrument 39. A detailed description of the surgeon’s actions when installing trocar simulators 11 in the abdominal cavity of the robot patient 1 is discussed on pages 26 and 35, in examples of training operations "cholecystectomy" and "adnexectomy".

Consider the operation of the site of movement of the simulator of the trocar 11, connected to the simulator of the trocar 11 (top view and front view), shown in the drawings of figure 5 and 6. Guide 54 allows the surgeon to set the position of trocar simulators 11 necessary for operation. The surgeon loosens the lamb of the displacement unit 67, selects the rotation angle and the distance of the simulators of the trocars 11 from the unit, then tightens the lamb of the displacement unit 67. The rotation of the guide 54 is transmitted through the guide pulley 59 and the sensor pulley 64 on the rotation sensor of the guide 58. The longitudinal movement sensor of the guide 55 determines the longitudinal movement of the guide 54. Thus, the position of the trocar simulators 11 on p Independent user abdominal wall of the patient, the robot 1.

Consider the work of the patient robot 1 with trocar simulators 11 located in his abdominal cavity, schematically depicted in Fig.7. In the robot patient 1, simulators of trocars 11 are located in his abdominal cavity. This example of a hybrid medical laparoscopy simulator contains four movable trocar simulators 11. Depending on the type of endosurgical operation, different positions of the trocar simulators are set 11. Different types of simulators of laparoscopic instruments are used, such as: endoscope simulator 5, coagulator simulator, laparoscopic scissor simulator, laparoscopic simulator clamp 3, dissector simulator, hook simulator, laparoscopic clip applicator simulator, irrigator aspirator 7 simulator, etc. .d. The simulator of the coagulator is made similarly to the simulator of the laparoscopic clamp 3.

Consider in the work a schematic diagram of the connection of the microcontroller of the sensor unit 37 of the simulator of the laparoscopic instrument with the sensors of the simulator of the laparoscopic instrument, shown in Fig. 8. The operation algorithm of the microcontroller of the sensor unit 37 of the simulator of a laparoscopic instrument is shown in the block diagram of Fig. 13. Data from the encoder 24 and the magnetic Hall sensor 35, which track the coordinates of the opening angle of the jaws 19 and the rotation of the simulator of the laparoscopic clamp 3 shown in FIG. 2, is transmitted to the microcontroller of the sensor unit 37, which converts the data into information packets sent via the TWI interface to the microcontroller the interface unit 68, recognized by the microcontroller of the interface unit 68. From the microcontroller of the sensor unit 37, the data is fed to the IR LED 36, which transmits a signal with the instrument code to the IR receiver 52, which is located in the simulator of the trocar 11 shown in the drawing of figure 4 (thus, the system recognizes what kind of simulator of the laparoscopic instrument is introduced into a specific simulator of the trocar 11).

Consider in the work a schematic diagram of the interface unit 4, connected to the sensor blocks 21 and the control units, shown in Fig.9. The microcontrollers of the sensor unit 37 of the simulator of the laparoscopic instrument, the microcontroller of the coagulator control unit 69, which is located in the control unit of the coagulator 13, the microcontroller of the endocamera control unit 70, which is located in the endocamera control unit 6, the microcontroller of the control unit of the aspirator-irrigator 71, which is located in the control unit of the aspirator-irrigator 71, which is located in the control unit of the aspirator-irrigator 71, which is located in the control unit -irrigator 8 and microcontroller of the insufflator control unit 72, which is located in the insufflator control unit 10, via the TWI interface connected to the microcontroller of the interface unit 68, which is located in the interface unit 4. The algorithm of operation of the microcontroller of the interface unit 68 is shown in the block diagram of Fig.14. The microcontroller of the interface unit 68 sequentially polls the data via the TWI interface with n microcontrollers of the sensor unit 37 (n-number of connected imitators of laparoscopic instruments), the microcontroller of the control unit of the endovideo camera 70, the microcontroller of the control unit of the aspirator-irrigator 71, the microcontroller of the control unit of the control unit of the insufflator 72 and the microcontroller of the control unit of the control unit of the insufflator 72 and the microcontroller of the control unit of the control unit of the insufflator 72 and the microcontroller 69. The microcontroller of the interface unit 68 converts the received data into information packets recognized by the program on the EV 2. Data via RS232 serial port are transmitted to the computer 2.

Consider in the work a schematic diagram of the connection of microcontrollers nodes moving simulators of trocars 66 to the computer 2, presented in figure 10. The algorithm of operation of the microcontrollers of the nodes of the movement of the simulators of trocars 66 is shown in the block diagram of Figs. 15 and 16. Data from the sensor for measuring the longitudinal movement of the tool 42, the rotation sensor on the ordinate 46, the rotation sensor on the abscissa 49, the rotation sensor of the guide 58, the longitudinal movement sensor a guide 55 monitoring the change in position of the trocar simulators 11 in space, and an IR receiver 52, which receives a signal from the IR LED 36 and recognizes the form of the laparoscopic simulator introduced into the trocar 11 simulator the streams are fed to the microcontrollers of the nodes of the movement of simulators of trocars 66 (66 ₁ , 66 ₂ , 66 ₃ , 66 ₄ ), and for each microcontroller of the nodes of movement of the simulators of trocars 66 there is a similar set of the above sensors. In this example of a hybrid medical simulator of laparoscopy, four movable trocar simulators 11 are contained, respectively, four microcontrollers of the trocar simulator 66 displacement assembly shown in FIG. 10 are contained. The main microcontroller of the trocar simulator displacement unit 66 ₄ (master) sequentially polls data on the SPI interface from the other three microcontrollers of the trocar simulator displacement nodes 661-663, converts all the data received into one information packet recognized by the computer program 2 and transmits via the RS232 serial port data on the computer 2.

Consider in the work a schematic diagram of the control unit of the coagulator 13, connected to the sensor unit 21 and the interface unit 4, shown in Fig.11. The algorithm of operation of the microcontroller of the control unit of the coagulator 69, which is a laparoscopic device, is shown in the block diagram of Fig. 17. The microcontroller of the coagulator control unit 69 is located in the coagulator control unit 13. The data from the coagulator current power regulator 74, the coagulation mode switch 75, the cutting mode switch 76, the mixed mode switch 77 are fed to the microcontroller of the coagulator control unit 69. Data from the microcontroller of the sensor unit 37, which located in the simulator of the coagulator, which is a simulator of a laparoscopic instrument, through the TWI interface are supplied to the microcontroller of the coagulator control unit 69. Microcontroller b eye coagulator control 69 transmits the collected data on the TWI interface to the microcontroller interface unit 68, whose work is discussed on page 18.

Consider in the work a circuit diagram of the control unit of the endovideo camera 6, connected to the sensor unit 21 and the interface unit 4, shown in Fig.19. The algorithm of operation of the microcontroller of the control unit of the video camera 70 is shown in the block diagram of Fig. 22. The microcontroller of the endovideo camera control unit 70 is located in the endovideo camera control unit 6. Data from the endovideo camera switch 79, the color tone adjuster 80, the light dimmer 81, the white balance adjuster 82, the halogen light switch 83, the xenon light switch 84 are sent to the microcontroller of the endovideo camera 70 control unit. from the microcontroller of the sensor block 37, which is located in the simulator of the endoscope 5, which is a simulator of a laparoscopic instrument, are transmitted to the m via the TWI interface the microcontroller of the endovideo camera control unit 70. The microcontroller of the endovideo camera control unit 70 transmits the collected data via the TWI interface to the microcontroller of the interface unit 68. When you press the dimmer 81, the values of the current setting are displayed on the light brightness display 85.

Consider in the work the circuit diagram of the control unit of the aspirator-irrigator 8 connected to the interface unit 4, shown in Fig.20. The algorithm of operation of the microcontroller of the control unit of the aspirator-irrigator 71 is shown in the block diagram of Fig.23. The microcontroller of the control unit of the aspirator-irrigator 71 is located in the control unit of the aspirator-irrigator 8. Data from the switch of the aspirator-irrigator 87, the switch of the aspiration mode 88, the switch of the irrigation mode 89, the opening and closing switch 90, and the pedal of the aspirator-irrigator 18 are fed to the microcontroller of the control unit Aspirator-irrigator 71. The microcontroller of the control unit of the aspirator-irrigator 71 transmits the collected data via the TWI interface to the microcontroller of the interface unit 68.

Consider in the work the circuit diagram of the control unit of the insufflator 10 connected to the interface unit 4, shown in Fig.21. The algorithm of operation of the microcontroller of the insufflator control unit 72 is shown in the block diagram of Fig.24. The microcontroller of the insufflator control unit 72 is located in the insufflator control unit 10. Data from the insufflator switch 92, insufflation start button 93, pressure increase switch 94, pressure decrease switch 95, pressure storage switch 96, flow increase switch 97, flow decrease switch 98, memory switch flow 99 is supplied to the microcontroller of the insufflator control unit 72. The microcontroller of the insufflator control unit 72 transmits the collected data via the TWI interface to the microcontroller of the unit with voltage 68. The received data from the interface unit 68 is displayed on the measured pressure display 101 and the measured flow display 103. When the pressure increase switch 94, pressure decrease switch 95 and pressure memory switch 96 are pressed, the current setting values are displayed on the target pressure display 100. When the switch is pressed increase flow 97, switch reduce flow 98 and switch memory stream 99, the current settings are displayed on the display of the specified stream 102.

Consider the work of a hybrid medical simulator laparoscopy, presented in figure 1. After loading the operating system on the computer processor 2, the program algorithm shown in the block diagram of FIG. 12 starts to run (the block diagram of FIG. 12 is shown on two pages, on the first page under the name of FIG. 12/1, on the second - FIG. 12 / 2). The graphical display module according to the algorithm shown in the block diagram of FIG. 12 displays a menu in the visualization system 12 in which it is necessary to select an exercise, either a calibration mode or an exit from the program. The selection of menu items is carried out using the computer manipulator 2.

Manipulations by simulators of laparoscopic instruments, which are carried out by the surgeon, while rotating the wing of the instrument 23 and pressing the handle 22 are monitored by the encoder 24, the magnetic Hall sensor 35, shown in the drawing of figure 3. These sensors are connected to the computer 2 according to the schematic diagram of the connection of the microcontroller of the sensor block 37 of the simulator of the laparoscopic instrument with the sensors of the simulator of the laparoscopic instrument shown in Fig. 8, and according to the schematic diagram of the interface block 4, connected to the sensor blocks 21 and control units shown in Fig. 9. Data from these sensors is transmitted to the computer 2 according to the algorithm of operation of the microcontroller of the sensor unit 37 of the simulator of the laparoscopic instrument shown in the block diagram of Fig. 13, and the operation algorithm of the microcontroller of the interface unit 68, shown in the block diagram of Fig. 14.

Manipulations by trocar 11 simulators using the introduced laparoscopic simulators are monitored by: a tool for measuring the longitudinal movement of the tool 42, a rotation sensor on the ordinate 46, a rotation sensor on the abscissa 49. The movement of the trocar simulator 11 is tracked in the movement unit of the trocar simulator by the longitudinal movement sensor 55 and the sensor rotation of the guide 58. These sensors are connected to the computer 2 according to the schematic diagram of the connection of microcontrollers nodes moving troitel simulators 66 acres to the computer 2 shown in Figure 10. Data from these sensors is transmitted to the computer 2 according to the algorithm of operation of the microcontrollers of the nodes of the movement of simulators of trocars 66 ₁ -66 ₃ , shown in the block diagram of Fig.15, and the algorithm of the main microcontroller of the nodes of the movement of simulators of trocar 664, shown in the block diagram of Fig.16 .

The following describes the algorithm running on the computer processor 2, which links the manipulation of the surgical team with the image of the imaging system 12.

Consider the work of a hybrid medical simulator taking into account the running program on a computer processor 2. The graphic display module, according to the algorithm shown in the block diagram of FIG. 12, generates a signal with a dialog box image in the calibration system 12 in the visualization system, in which the calibrated sensors are listed : encoder 24, a sensor for measuring the longitudinal movement of the tool 42, a rotation sensor for the ordinate 46, a rotation sensor for the abscissa 49, a sensor for longitudinal movement of the guide 55, a sensor for rotating the guide 58. Enter the simulator of the laparoscopic instrument in the simulator of the trocar 11 and sequentially for each calibrated sensor record its minimum and maximum value. For example, to calibrate the sensor for measuring the longitudinal movement of the instrument 42, first, the laparoscopic instrument simulator is completely inserted (to the stop) into the simulator of the trocar 11, the computer 2 selects the appropriate mode for fixing the minimum position of this sensor in the dialog box, then, without removing it completely, the laparoscopic instrument simulator is pulled out from the simulator of trocar 11, select the appropriate mode for fixing the maximum value of this sensor in the dialog box. The values of the calibration coefficients are stored automatically by the program in the computer database 2 according to the algorithm shown in the block diagram of Fig. 12, and are used to normalize the values of the signals from the corresponding sensors. Calibration can be carried out repeatedly until the real movements of the tool simulators entered in the trocar simulators 11 coincide with the virtual instruments displayed in the exercises performed by the visualization system 12.

The actions of the operating team when working with the hybrid medical laparoscopy simulator are as follows: the nurse submits the instruments, picks up the instruments of the surgeon and his assistant at their request, if necessary connects the imitators of laparoscopic instruments to the appropriate control units, according to the surgeon sets up the equipment, provides support to the surgeon and his to the assistant. The surgeon directs the course of the operation, operates, makes important decisions. The assistant holds the endoscope simulator 5 with one hand, and the laparoscopic clamp simulator 3 with the other hand, which helps the surgeon to hold virtual organs for convenient operation. When other types of operating equipment, simulators of laparoscopic instruments and other instruments are introduced into the simulator, additional specialists may be involved. For example, with the introduction of an anesthetic stand simulator, the participation of an anesthetist is necessary.

Three-dimensional models of tissues and organs are modeled in the Autodesk 3ds Max system developed by Autodesk and entered into the computer database 2. The physics module according to the algorithm shown in the block diagram of FIG. 12 is software written using the PhysX SDK, which was developed nVidia company. The graphical display module according to the algorithm shown in the flowchart of FIG. 12 is software written using the DirectX SDK, which was developed by Microsoft.

The description of the process of training the operation "cholecystectomy" on a hybrid medical simulator, taking into account the program running on the computer processor 2, according to the algorithm in the exercise mode shown in the flowchart of Fig. 12, is as follows: the visualization system 12 displays a description of the clinical case of the selected virtual patient in the form of textual information. The clinical case description includes the medical history and current complaints of the virtual patient. For example: a woman of 29 years old, primary cholecystitis, a stone in the gall bladder, epigastric pain, extending to the right shoulder girdle; 43-year-old woman, acute pain in the right hypochondrium, after eating fatty foods, by ultrasound - an echogenic formation in the gall bladder; a 37-year-old man was delivered with paroxysmal abdominal pain that occurred 5 minutes after lunch; a 48-year-old woman was admitted with pain in the right hypochondrium, pain occurs periodically over the past few years, according to analysis - excess bilirubin levels; man, 52 years old, increased body weight, complaints of nausea, vomiting, palpation causes pain in the right hypochondrium, the liver is palpated; woman, 44 years old, increased body weight, complaints of nausea, pain over the past 12 hours, pain intensifies with movement and coughing; 46-year-old woman with constant pain in the right hypochondrium, dark urine, dark stool, sclera icteric; woman, 49 years old with fever and chills, with pain in the right hypochondrium, complaints of nausea in the last 24 hours, sclera and skin are icteric. Based on this information, the surgeon must decide on the location of the patient robot 1 on the operating table 14 and the placement of trocar simulators 11, for example, taking into account scarring from previous operations. Place the patient robot 1 on the operating table 14. Select the position of the first trocar simulator 11, into which the endoscope simulator 5 will be inserted, which is a simulator of the laparoscopic instrument, to do this, loosen the wing assembly 67, set the position of the trocar simulator 11 in the abdominal cavity of the robot patient 1 corresponding to the position of the trocar simulator 11 in the abdominal cavity of the robot patient 1 when performing a real operation, tighten the lamb of the displacement unit 67. The surgeon connects the tube of the insufflator 9 to the valve of the trocar 53 n and on the insufflator control unit 10, and the nurse (or surgeon) sets the pressure value by the pressure increase switch 94 and pressure decrease switch 95, being guided by the set pressure display 100, press the pressure memory switch 96. Enter the endoscope simulator 5, which is a simulator of a laparoscopic instrument. The introduced endoscope simulator 5 through the IR LED 36 sends a signal to the IR receiver 52 of the trocar simulator 11 with the instrument code. Data about the instrument code, data from position and orientation sensors (sensor for measuring longitudinal movement of the tool 42, rotation sensor for ordinate 46, rotation sensor for abscissa 49, sensor for longitudinal movement of guide 55 and rotation sensor for guide 58) of the trocar simulator 11 are received in computer 2 According to the instrument code, the program determines that an endoscope simulator 5 or another simulator of a laparoscopic instrument has been introduced. Data on the position and orientation of the trocar simulator 11 are normalized taking into account calibration coefficients, which must be determined in the calibration mode, according to the algorithm shown in the block diagram of Fig. 12.

After selecting the first simulator of the trocar 11 and installing the simulator of the endoscope 5, which imitates a laparoscopic instrument, the visualization system 12 displays the video information generated by the graphic display module according to the position of the virtual endoscope according to the algorithm shown in the block diagram of FIG. 12. The nurse adjusts the image quality on the control unit of the end-video camera 6. The surgeon examines the virtual organs. Based on this video information, the surgeon installs the remaining trocar simulators 11, transfers the endoscope simulator 5 to the assistant, for each trocar simulator 11 loosens the wing assembly 67, sets the desired position of the trocar simulator 11, fixes the movement node 67 wing and introduces the corresponding laparoscopic tool simulator. After the introduction of each simulator of the laparoscopic instrument into the simulator of the trocar 11, the physics module, according to the algorithm shown in the block diagram of Fig. 12, models the physical properties of the simulator of the laparoscopic instrument:

hardness, volume, electrical discharges, leaking fluids, cutting surfaces, forces, position in space, interaction with virtual organs and virtual tissues; the graphical display module, according to the algorithm shown in the block diagram of FIG. 12, generates a display of each virtual laparoscopic instrument among the virtual organs and virtual tissues, according to the location of the virtual laparoscopic instruments.

Depending on the selected virtual patient, the physics module, according to the algorithm presented in the block diagram of FIG. 12, models the physical properties of virtual organs similar to real ones, forms an anatomy option, including size, shape, color, location of the gallbladder, bile ducts, arteries, etc. For this, one of the variants of a three-dimensional computer model of organs, including a description of the surface of organs (the surface is defined by points in three-dimensional space, normals of points, relationships, is loaded from computer database 2) between points), textures (visual display of simulated organs superimposed on a three-dimensional surface), properties (elasticity, fragility and others). After that, the downloaded data is converted into the structures necessary for modeling deformations and cutting.

Training operations "cholecystectomy" can be carried out both in stages and in full.

Phased mode. Separate testing of the selected stage of the operation (traction, preparation of the Kahlo triangle, intersection and clipping of the cystic artery and cystic duct, mobilization of the gallbladder). The physics module according to the algorithm shown in the block diagram of FIG. 12, in the computer database 2 initializes the physical models of the organs in the states corresponding to the completed steps preceding the selected step and sends a signal to the graphic display module, which forms a three-dimensional picture of the virtual organs sent to visualization system 12. For this, the physics module, according to the algorithm shown in the block diagram of FIG. 12, modifies three-dimensional surfaces imitating organs (for example, traction performed is simulated or completed cuts and installed clips). Upon completion of all the actions provided for by the selected stage, an automatic exit from the exercise is performed.

Full operation mode. The physics module according to the algorithm shown in the block diagram of FIG. 12, in the computer database 2 initializes the physical models of virtual organs in the initial state (how they are located and deformed in a real person lying on the operating table), the graphic display module forms a three-dimensional picture, sent to the visualization system 12, taking into account the data obtained from the physics module and other modules shown in the block diagram of Fig. 12. The logic module according to the algorithm shown in the block diagram of Fig. 12 determines the signs of the beginning and end of the next stage, including determining the violation of the stages of the operation. The exercise ends when all stages of the operation are completed.

Stages of the operation:

Traction. Initially, the surgeon or assistant must traction - moving a virtual model of the gallbladder to provide access to the operated area. The assistant inserts the laparoscopic clamp simulator 3 into the trocar 11 simulator, manipulates the laparoscopic clamp simulator 3, which is displayed as a virtual instrument in the visualization system 12, captures the virtual gall bladder behind the bottom and moves the virtual gall bladder simulator 3, while the physics module according to the algorithm shown in the block diagram of FIG. 12 calculates the deformation of the three-dimensional surface of the virtual gallbladder and its impact on other virtual bodies. According to the algorithm shown in the block diagram of Fig. 12, several times per second, the physics module calculates the current state of the surfaces of virtual organs, the graphic display module according to the algorithm shown in the block diagram of Fig. 12 generates a signal supplied to the visualization system 12; as a result, a picture corresponding to the orientation of the inserted endoscope simulator 5, which is a simulator of a laparoscopic instrument, with the image of realistic mobility, smooth movement and mutual influence of virtual organs is imitated in the visualization system 12. The logic module, according to the algorithm shown in the block diagram of Fig. 12, determines the correct direction of traction (based on the calculated coordinates of the simulator of the laparoscopic instrument, a motion path is compiled, the trajectory is compared with the reference options stored in the computer database 2, allowable deviations are taken into account), correctness visualization of the operated area (based on the coordinates of the surface points of the virtual organs, the location of the virtual gall bladder, virtual vessels is calculated, compared with reference options stored in the computer database 2, allowable deviations are taken into account) the correct capture of virtual organs (the capture zone is simulated by imitators of laparoscopic instruments, the capture zone falls within acceptable boundaries; the tool code is compared with the tool codes stored in the computer database 2, which allowed to capture).

Preparation of the Kahlo triangle. The surgeon must carefully dissect the peritoneum and adipose tissue in order to isolate (visualize) the tubular formations (artery and duct) to be clipped and intersected. To do this, the surgeon introduces a simulator of one of the laparoscopic instruments, for example, a dissector simulator, a hook simulator, which are imitators of laparoscopic instruments, the nurse connects the power tool connector to the coagulator control unit 13, sets the appropriate switches (coagulation mode switch 75, cutting mode switch 76, switch mixed mode 77 and the current power regulator of the coagulator 74) the necessary mode and current power of the coagulator (according to the surgeon). The values of the mode and power of the coagulator current are transmitted to the computer 2. By manipulating the simulator of the laparoscopic instrument, the surgeon captures the virtual adipose tissue, pulls, then, by pressing the coagulator pedal 17, dissects (the signal about pressing the coagulator 17 pedal goes to computer 2 and the physics module according to the algorithm given 12, generates a virtual current flow through virtual tissues). The physics module according to the algorithm shown in the block diagram of FIG. 12 calculates, according to the coordinates of the virtual branches of the virtual instrument and the coordinates of the points of the surface of the virtual adipose tissue, which parts of the tissue are in contact with the virtual branches, and if the contact condition is met, the current flows through these sections tissue, in the visualization system 12, smoke and randomly moving particles of dissected tissue are displayed, for a time of about 1-3 seconds, a complete dissection of the contacting sections of the virtual tissue occurs, This visualization in the image system 12 are gradually disappearing. The logic module according to the algorithm shown in the block diagram of Fig. 12 determines the correct direction of the dissection (the trajectory is compiled from the averaged coordinates of sequentially dissected sections of virtual tissues and compares for similarities with the standard options for trajectories, allowable deviations are taken into account), compliance with safety precautions when working with a power tool (the direction of movement of the virtual branches of the virtual instrument is calculated from the capture of virtual tissue to the beginning of electrodissection ii, the direction is compared with the acceptable, allowable deviations are taken into account), etc.

Clipping and intersection of an artery and duct. The surgeon inserts the simulator of the laparoscopic clip applicator, which imitates the laparoscopic instrument, into the simulator of the trocar 11, manipulates it and moves the virtual instrument to get the desired section of the virtual vessel between the branches of the virtual clip applicator, sets the clip by holding the handle of the simulator of the laparoscopic clip applicator. The physics module according to the algorithm shown in Fig. 12 calculates the deformation of the vessel model, modifies the three-dimensional surface of the vessel, visualizes the installed virtual clip in the place of its imposition (for each clip, the position in the virtual space and the corresponding deformation of the virtual vessel are further calculated). After applying a sufficient number of clips, the surgeon introduces a simulator of laparoscopic scissors, which is a simulator of a laparoscopic instrument, manipulates them and moves the simulator of a laparoscopic instrument, brings the branches of the virtual scissors to the incision site of the virtual vessel, makes an incision. The physics module according to the algorithm shown in the block diagram of FIG. 12 calculates the change in the three-dimensional surface of the virtual vessel as a result of a virtual section (the graphic display module according to the algorithm shown in the block diagram of FIG. 12 displays the changes in the visualization system 12). The logic module according to the algorithm shown in the flowchart of Fig. 12 and the descriptions of the steps below determines the correctness of the places of overlapping clips (compares the overlay zone with the reference zone of permissible overlays), the number of clips, the correctness of the places of intersection of the tubular formations (compares the section zone with reference zone of permissible cutting zones).

Mobilization of the gallbladder. The surgeon must separate the gallbladder from the liver. To do this, the surgeon introduces a “hook” simulator, which imitates a laparoscopic instrument, the nurse connects the power tool connector to the coagulator control unit 13, sets the appropriate switches (coagulation mode switch 75, cutting mode switch 76, mixed mode switch 77 and coagulator current power regulator 74) necessary coagulator current mode and power (according to the surgeon). In the second simulator of trocar 11 (for the left hand), the surgeon inserts the simulator of the laparoscopic clamp 3, manipulates it, grabs and pulls the virtual gall bladder (the physics module according to the algorithm shown in the block diagram of Fig. 12, calculates the corresponding surface deformations of the virtual gall bladder, movement and deformation of other virtual organs under the influence of the movement of virtual laparoscopic instruments). The surgeon manipulates the simulators of laparoscopic instruments and brings the virtual “hook” tool to the place of adhesion of the virtual gallbladder with the virtual liver, presses the coagulator pedal 17. The physics module according to the algorithm shown in the block diagram of FIG. 12 calculates by the coordinates of the virtual instrument and the coordinates of the points surfaces of virtual organs, as well as along the coordinates of the adhesion points, whether the tissue is in contact with the electrode of the virtual instrument, and if the contact condition is met, then the flow is simulated and through the site of the contacting tissue, in the visualization system 12, smoke and randomly moving particles of the dissected tissue are displayed, in a time of about 1-3 seconds, the contacting tissue sections are completely dissected, the three-dimensional surfaces of the virtual liver and gall bladder are disconnected (disconnected), which is also visible in the visualization system 12. The logic module, according to the algorithm shown in the block diagram of FIG. 12, determines the correct impact of virtual instruments on virtual organs and virtual tissues neither during the manipulation of the surgeon with simulators of laparoscopic instruments - the exposure time (the logic module according to the algorithm shown in the block diagram of Fig. 12 compares the exposure time with the minimum and maximum, if the exposure time is less than the minimum threshold for a given power, then the virtual tissues are not disconnected, if the exposure time is greater than the maximum threshold for a given power, then extensive tissue necrosis is simulated), the site of exposure (physics module according to the algorithm shown in the block diagram of FIG. .12, calculates the current influence zone in three-dimensional coordinates, the logic module according to the algorithm shown in the block diagram of FIG. 12, checks the admissibility and advisability of using the tool in this zone), etc., the implementation of bleeding coagulation (logic module according to the algorithm, shown in the block diagram of Fig. 12, compares the impact zone with the database of virtual vessels under the surface of the virtual organs, blood is generated by piercing, cutting with virtual instruments or under the influence of the dissector echenie that is also displayed in the visualization system 12; in the presence of virtual bleeding, the fact of coagulation of power tools of bleeding places to stop it is checked), rinsing (the surgeon must introduce a simulator of an aspirator-irrigator 7, which imitates a laparoscopic instrument, manipulate it, direct a virtual stream of fluid to areas of the surface of virtual organs that require washing off blood, bile and dead tissue, the trajectory is calculated and the jet is displayed, the effect of the jet on the surface is calculated, the resulting surface is calculated stumble in bleeding calculating unit according to the algorithm given in Figure 12 flowchart, is determined by the washed away portion that is also displayed in the visualization system 12), and aspiration gallbladder bed and so forth. Abnormal situations. The logic module according to the algorithm shown in the block diagram of FIG. 12 generates abnormal situations, for example, cardiac arrest, etc. In this case, signals are sent that change the indications in the visualization system 12 and / or the audiovisual and mechanical vital signs of the robot patient 1. The surgical team must identify the emergency situation and respond accordingly. The logic module, according to the algorithm shown in the flowchart of Fig. 12, analyzes the subsequent actions of the surgical team (for example, when the heart stops, the surgeon and assistant must immediately stop the operation - if there is virtual bleeding, then it is necessary to coagulate the bleeding sites or to fix the damaged virtual vessels, after for this it is necessary to derive imitators of laparoscopic instruments for further resuscitation, according to the presence of introduced imitators of laparoscopic instruments and the presence of unstoppable bleeding, the correctness of actions is checked, the timeliness of actions is determined by the virtual timer).

The description of the process of training the operation "adnexectomy" (removal of the appendages of the uterus) on a hybrid medical simulator, taking into account the program running on the computer processor 2, according to the algorithm in the exercise mode shown in the flowchart of Fig. 12, is as follows: visualization system 12 displays a description of the clinical case of the selected virtual patient in the form of textual information. The clinical case description includes the medical history and current complaints of the virtual patient. For example, a woman, 43 years old, according to ultrasound, the presence of a tumor-like cavity formation, was admitted with sharp pains in the iliac region (a clinical case of torsion of an ovarian cyst); 30 years old woman, hospitalized with sharp pains in the left inguinal region of the lower abdomen, a history of diagnostic laparoscopy due to torsion of the left appendages, the left appendages were untwisted with their preservation. Based on this information, the surgeon must decide on the location of the patient robot 1 on the operating table 14 and the placement of trocar simulators 11, for example, taking into account scarring from previous operations. Place the patient robot 1 on the operating table 14. Select the position of the first trocar simulator 11, into which the endoscope simulator 5 will be inserted, which is a simulator of the laparoscopic instrument, to do this, loosen the wing assembly 67, set the position of the trocar simulator 11 in the abdominal cavity of the robot patient 1 corresponding to the position of the simulator of the trocar 11 in the abdominal cavity of the robot patient 1 when performing a real operation, tighten the lamb of the displacement unit 67. The surgeon connects the tube of the insufflator 9 to the valve of the trocar 53, and insufflator 10, and the nurse control unit (or surgeon) sets a switch pressure increase value 94 and a switch pressure reducing pressure 95, guided by the set pressure display 100, push pressure switch memory 96. Enter a dummy endoscope 5, which simulator LIA. The entered endoscope simulator through the IR LED 36 sends a signal to the IR receiver 52 of the trocar simulator 11 with the instrument code. Data about the instrument code, data from position and orientation sensors (sensor for measuring longitudinal movement of the tool 42, rotation sensor for ordinate 46, rotation sensor for abscissa 49, sensor for longitudinal movement of guide 55 and rotation sensor for guide 58) of the trocar simulator 11 are received in computer 2 According to the instrument code, the program determines that an endoscope simulator 5 or another simulator of a laparoscopic instrument has been introduced. Data on the position and orientation of the trocar simulator 11 are normalized taking into account calibration coefficients, which must be determined in the calibration mode, according to the algorithm shown in the block diagram of Fig. 12.

After selecting the first simulator of the trocar 11 and installing the simulator of the endoscope 5, which imitates a laparoscopic instrument, the visualization system 12 displays the video information generated by the graphic display module according to the position of the virtual endoscope according to the algorithm shown in the block diagram of FIG. 12. The nurse adjusts the image quality on the control unit of the end-video camera 6. The surgeon examines the virtual organs. Based on this video information, the surgeon installs the remaining trocar simulators 11, transfers the endoscope simulator 5 to the assistant, for each trocar simulator 11 loosens the wing assembly 67, sets the desired position of the trocar simulator 11, fixes the movement node 67 wing and introduces the corresponding laparoscopic tool simulator. After introducing each simulator of a laparoscopic instrument into a simulator of a trocar 11, the physics module according to the algorithm shown in the block diagram of Fig. 12 models the physical properties of the simulator of a laparoscopic instrument: hardness, volume, electrical discharges, leaking liquids, cutting surfaces, forces, position in space , interaction with virtual organs and virtual tissues; the graphical display module, according to the algorithm shown in the block diagram of FIG. 12, generates a display of each virtual laparoscopic instrument among the virtual organs and virtual tissues, according to the location of the virtual laparoscopic instruments.

Depending on the selected virtual patient, the physics module, according to the algorithm presented in the block diagram of FIG. 12, models the physical properties of virtual organs similar to real ones, forms an anatomy option, including size, shape, color, location of the uterus, fallopian tubes, ovaries, ligaments, mesosalpinx, etc. To do this, one of the variants of a three-dimensional computer model of organs is loaded from the computer database 2, including a description of the surface of organs (the surface is defined by points in three-dimensional space, normals of points, connections between points), textures (visual display of simulated organs superimposed on a three-dimensional surface), properties (elasticity, fragility and others). After this, the downloaded data is converted to the structures necessary for modeling deformations and cutting organs (tissues).

Training operations "adnexectomy" can be carried out both in stages and in full.

Phased mode. Separate testing of the selected stage of the operation (traction, coagulation of the mesosalpinx and its dissection, control of hemostasis). The physics module according to the algorithm shown in the block diagram of FIG. 12, in the computer database 2 initializes the physical models of the organs in the states corresponding to the completed steps preceding the selected step and sends a signal to the graphic display module, which forms a three-dimensional picture of the virtual organs sent to visualization system 12. For this, the physics module, according to the algorithm shown in the block diagram of FIG. 12, modifies three-dimensional surfaces imitating organs (for example, the executed traction or completed cuts and installed clips). Upon completion of all the actions provided for by the selected stage, an automatic exit from the exercise is performed.

Full operation mode. The physics module according to the algorithm shown in the block diagram of FIG. 12, in the computer database 2 initializes the physical models of virtual organs in the initial state (how they are located and deformed in a real person lying on the operating table), the graphic display module forms a three-dimensional picture, sent to the visualization system 12, taking into account the data obtained from the physics module and other modules shown in the block diagram of Fig. 12. The logic module, according to the algorithm shown in the block diagram of Fig. 12, determines the signs of the beginning and end of the next stage, including determining the violation of the stages of the operation. The exercise ends when all stages of the operation are completed.

Stages of the operation:

Traction. Initially, the surgeon or assistant must perform traction - the movement of virtual organs to provide access to the operated area. The assistant introduces the simulator of the laparoscopic clamp 3 into the simulator of the trocar 11, manipulates the simulator of the laparoscopic clamp 3, which is displayed in the visualization system 12 as a virtual instrument, captures the distal end of the fallopian tube with the simulator of the laparoscopic clamp 3, which imitates the laparoscopic instrument, lift it in the head direction and somewhat to the side. They study the location of the mesosalpinx, ligamentous apparatus of the ovary, identify approximately the course of the ureter (for this, by moving the simulator of the laparoscopic instrument, the virtual organs and tissues are gently moved, an image is obtained that makes it clear the structure of organs and tissues, while the physics module calculates the deformation of the three-dimensional surface, which is displayed by the module graphic display according to the algorithm shown in the block diagram of Fig.12, in the visualization system 12). The logic module according to the algorithm shown in the block diagram of Fig. 12 determines the correct direction of traction (based on the calculated coordinates of the simulator of the laparoscopic instrument, a motion path is compiled, the path is compared with the reference options stored in the computer database 2, the deviations are taken into account), rough or excessive movement of the virtual fallopian tube (based on a change in the coordinates of the simulator of the laparoscopic instrument arriving several times per second (20-50), the logic module uses the speed of movement, the length of the movement, while the physics module according to the algorithm shown in the block diagram of FIG. 12 calculates the deformation of the three-dimensional surface that is displayed by the graphic display module according to the algorithm shown in the block diagram of FIG. 12, in the visualization system 12, calculates the degree of stretching, the logic module compares with the reference values stored in the computer database 2), the incorrect imposition of the simulator of laparoscopic clamp 3 (based on the coordinates of the branches of the virtual laparoscopic clamp, the physics module according to the algorithm shown in the block diagram of FIG. 12 calculates the overlay zone, the logic module according to the algorithm shown in the block diagram of FIG. 12 compares with the reference allowable zones stored in the computer database 2), the wrong choice tool (the logic module according to the algorithm shown in the block diagram of Fig. 12 compares the tool code with the tool codes stored in the computer database 2, which are allowed to capture), when separating adhesions - damage to the peritoneum, ureter, arterial branch of a venous or venous vessel, damage to hollow organs, bladder, intestines (to determine damage, the physics module, according to the algorithm shown in the flowchart of FIG. 12, calculates the distance to various sections of the three-dimensional surface of virtual organs and tissues, the logic module according to the algorithm shown on the block diagram of FIG. 12 compares with a minimum distance threshold during operation of a virtual instrument; and also using the incoming coordinates of the simulators of laparoscopic instruments, it calculates the pressure of the virtual instrument on the three-dimensional surface of the virtual organs, compares it with the maximum allowable pressure value on this surface section; virtual damages are stored in the computer database 2 and fed to the bleeding calculation module and the logic module according to the algorithm shown in the block diagram of FIG. 12, which is also displayed by the graphic display module according to the algorithm shown in the block diagram of FIG. 12, in the visualization system 12).

Coagulation of mesosalpinx and its dissection. The surgeon must coagulate and dissect the virtual mesosalpinx, drawn using a virtual laparoscopic clamp placed on the tube, along the edge of the tube, the lateral and lower edges of the virtual ovary. To do this, the surgeon enters the simulator of the laparoscopic clamp 3 into one simulator of the trocar 11, and the simulator of the coagulator, which imitates the laparoscopic instrument, into the other. With the movement of a simulator of a laparoscopic clamp 3, the surgeon grabs and pulls the virtual mesosalpinx, puts the forceps of the virtual coagulator, presses the pedal of the coagulator 17 and holds for 1-2 s, the physics module according to the algorithm shown in the block diagram of Fig. 12, calculates the coagulation zone according to the coordinates of the virtual forceps, the logic module calculates the power and exposure time. The graphical display module according to the algorithm shown in the block diagram of FIG. 12 displays the yellowing or discoloration of the tissue around the forceps of the virtual coagulator and saves the changed properties of the virtual tissues into the computer database 2. After coagulation of each small area, the surgeon takes out the coagulator simulator and introduces a simulator instead laparoscopic scissors, brings jaws of 19 imitators of laparoscopic scissors, the actions of which are coordinated with virtual branches, on a coagulated section of virtual tissue and by pressing the handle 22, it cuts through this section, which is displayed in the visualization system 12 (the physics module calculates the section area based on the coordinates of the virtual branches at the time of the section, the corresponding changes are made to the three-dimensional surface, the data about the changes are saved in the computer database 2). Coagulate and cross your own ligament of the ovary and the funnel-ligamentous ligament (performed similarly to the coagulation of the mesosalpinx and its dissection described above). The logic module according to the algorithm shown in the flowchart of FIG. 12 calculates the incorrect identification of the formations of the virtual fallopian tube, the ovarian’s own ligament and the funnel-pelvic ligament (when signals about coagulation or cutting of sections of virtual tissue are received, the logic module calculates the impact zone and compares it with the reference options in computer database 2, if the areas of influence do not coincide with the standard, taking into account permissible deviations, generates a text message received through the graphic display module visualization system 12, indicating that the surgeon started the operation, incorrectly identifying the anatomical structures), coagulation too close to the pelvic walls (if the logic module, according to the algorithm shown in the block diagram of Fig. 12, recognizes the intersection of the coagulation section with the surface area recorded in computer database 2 as virtual walls of the pelvis, or if the distance to this area is less than the minimum acceptable value, then error data is stored in computer database 2), damage to the ureter (if the logic module agrees but the algorithm shown in the block diagram of Fig. 12 recognizes the intersection of the cutting area with the surface area under which the virtual ureter passes, then damage to the ureter is stored in the computer database 2, which is also displayed by the graphic display module according to the algorithm shown in the block diagram of Fig. 12, in the visualization system 12).

Control of hemostasis. With the movement of a virtual endoscope, the actions of which are coordinated with a real simulator of endoscope 5, the surgeon examines the entire surgical field. If damage is detected, it coagulates as described previously. The logic module according to the algorithm shown in the flowchart of FIG. 12 analyzes the surgeon's examination of the surgical field for bleeding (the virtual endoscope trajectory and stop time in each section of the surgical field are stored in the computer database 2, the logic module compares with the reference options in computer database 2, taking into account permissible deviations), damage to neighboring organs. In the presence of bleeding and damage, the logic module according to the algorithm shown in the flowchart of Fig. 12 checks the appropriate actions of the surgeon, for example, coagulation of bleeding (existing virtual injuries and bleeding are registered in the computer database 2 in accordance with the above process for detecting and recording damage, during coagulation near the coordinates of injuries at a distance less than the reference for 1-2 s, the “stop of bleeding” is saved in the computer database 2, if not all bleeding is coagulated saved "error").

Thus, based on the foregoing, the proposed hybrid medical simulator of laparoscopy in comparison with the prototype allows you to ensure the actual position of the surgical team relative to the robot patient 1 and the surgical field, the ability to perform various options for laparoscopic access in complicated clinical situations, depending on the selected position of the robot patient 1 , training of operating and assisting surgeons, operating nurse in team work with various development options events, the use of more than three trocar simulators 11, changing the number of trocar simulators 11, choosing the location of trocar simulators 11, the reality of various imitators of laparoscopic instruments and their introduction into trocar simulators 11.

Claims (4)

1. A hybrid medical laparoscopy simulator containing computers, simulators of laparoscopic instruments connected to a computer, trocar simulators connected to a computer, a visualization system connected to a computer, characterized in that a robot patient is introduced, simulators of laparoscopic devices connected to a computer, equipment operating, and each simulator of a laparoscopic instrument is made in the form of a real instrument containing a block of sensors, and is separated from simulators of trocars, which contain more than three installed in the trousers the cavity of the robot patient, each trocar simulator is connected to a corresponding node of the trocar simulator moving, fixing the position and determining the position of the trocar simulator on the front wall of the abdominal cavity of the robot patient. 2. The medical simulator according to claim 1, characterized in that the simulators of laparoscopic devices are made in the form of a coagulator control unit, coagulator pedals, aspirator-irrigator pedal, endocamera control unit, aspirator-irrigator control unit, insufflator control unit with an insufflator tube. 3. The medical simulator according to claim 1, characterized in that imitators of laparoscopic instruments are made in the form of imitators of laparoscopic clamps, imitators of an endoscope, imitators of an aspirator-irrigator, imitators of a coagulator, imitators of laparoscopic scissors, imitators of dissectors, imitators “hook”, imitators of laparoscopic clips applicator. 4. The medical simulator according to claim 1, characterized in that the operating equipment is made in the form of an operating table, surgical stand, tool table.

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