WO2014186853A1

WO2014186853A1 - Human torso and simulator system for training in surgical procedures

Info

Publication number: WO2014186853A1
Application number: PCT/BR2013/000280
Authority: WO
Inventors: Átila VARELA VELHO
Original assignee: Varela Velho Átila
Priority date: 2013-05-23
Filing date: 2013-07-31
Publication date: 2014-11-27
Also published as: BR102013012787B1; BR102013012787A2

Abstract

The present invention aims to overcome known drawbacks in existing simulators, by proposing a male human torso that is accommodated completely on a platform or base to which it is hermetically fixed. This torso (09) is provided with seven windows: one (15) in the anterior cervical region; bilaterally two opposite windows (14) located in the anterior-superior second intercostal space; one (12) at the xiphoid process of the sternum; two opposite windows (13) located in the region of the fifth intercostal space at the anterior axillary fold; and one abdominal, infraumbilical, window (11). Over said windows are fitted removable, repositionable components (31) through which the procedures are performed. The body (9), furthermore, is clad in a material known as artificial skin, which is composed of three pre-moulded elastomer layers. Thus, in addition to looking and feeling similar to human skin, said material adapts perfectly to the surface relief and to the particular features thereof. The simulator mannequin also has an alert system to indicate the level of skill involved in the procedures performed and the completion thereof.

Description

HUMAN TRUNK AND SIMULATOR SYSTEM FOR TRAINING

SURGICAL PROCEDURES

Technological sector of the invention

In general, the present invention pertains to the medical equipment technology sector and more specifically relates to a male human torso facsimile designed for medical training of surgical procedures in emergency situations.

Known prior art

Several forms and methods are currently being developed for the study and development of surgical techniques. In order to make known to students and health professionals, simulating dummies are developed, which faithfully reproduce parts of the human body.

These simulators are intended for knowledge of the dispositions of organs in the human organism, making it clearer for students to understand, as it is often a facsimile reproduction. In addition, the use of simulators is increasingly being present in study environments for surgical practices.

As surgical procedures usually present a high degree of difficulty, since patients may be exposed to fatal injuries, should a technical error occur, it is essential that the professional has good training. These trainings promote a dummy simulation of various medical procedures. Thus, the professional acquires greater knowledge as well as security to perform such procedures.

That is, surgical procedures are complex mysteries and require repetition and training for their proper assimilation until they can be safely performed. The use of simulators made up of models of the human body or its parts is an alternative that efficiently meets these needs. These devices, in addition to allowing the required amount of repetitions, enable close supervision by the mentor teacher until a minimum of skills are trained, developed and finally systematized and acquired by the student. Because of its likelihood to the human body, the use of torso-shaped surgical simulators generates self-confidence in users and allows them to become familiar with the handling of specialized instruments and the dynamics that involve performing these procedures, without the risks of learning 5 in the surgical field. . Own and other risks.

Since the human body is one, with no possibility of significant anatomical variations, there are no alternatives when it is necessary to reproduce the anatomy of the human body with likelihood, so there are many documents on the subject that differ less in shape and more in diversity. of the materials used in their construction and the techniques and resources developed for the purpose that ultimately lend them their own characteristic and give them individuality, as in the present case.

In order to provide a solution closer to the actual procedures, 15 as described in MU8801696-0, a simulated manikin for surgical procedures with the proper likelihood of the human body was proposed. However, such a solution does not predict and alert the professional to a possible trauma suffered by the patient. Moreover, such a dummy is limited as to the organs available for training, and the representative fittings of the 20 organs, as they are specific parts, can be damaged by overuse by students and training professionals. This obviously implies a higher cost for replacing such parts.

Novelties and objectives of the invention

In order to eliminate the drawbacks already known in the prior art, the present invention relates to a new arrangement of a simulator for surgical procedures. Such a simulator model allows the proper training of students and medical professionals in various types of surgical procedures, which often require the surgeon to master the operation, often during urgent care, especially when 30 of severe trauma victims. .

One of these procedures is the approach of the airway through the intercricothyroid space in the anterior cervical region, either by needle puncture. coated with a plastic catheter or through a surgical section called cricothyroidostomy, which allows the insertion of a tracheostomy plastic cannula that keeps the air passage clear.

Another procedure is the puncture of the chest with a needle covered with a plastic catheter called relief thoracentesis, which is used to allow the removal of pleural fluids or effusions or, mainly, to allow air to escape into the pleural space, which prevents adequate pulmonary expansion. .

Closed thoracic drainage is the most immediate solution for thoracentesis that has only a temporary effect, it occurs with all the prerequisites of a surgical procedure performed with local anesthesia, from skin section to penetration into the affected pleural space, forming a tunnel through which a plastic drain is inserted and fixed at this location to allow decompression of the thoracic cavity until complete pulmonary expansion occurs.

Placement of a plastic-catheter-coated needle to evacuate fluid leakage that impedes normal cardiac dynamics, called pericardiocentesis, is achieved by percutaneously introducing the instrument at the level of the left xiphocostal junction until aspiration of bloody fluid is achieved. enough to significantly improve cardiac efficacy.

Diagnostic peritoneal lavage performed just below the umbilical scar in a vertical direction is a surgical procedure performed with local anesthesia, obtained by incision of the abdominal planes and placement of a multiperforated polyethylene catheter to check for blood. free or organic content within the peritoneal cavity that indicates the need for immediate surgery.

These are all procedures for imminently life-threatening situations. Thus, it is extremely important that the professional has conviction and complete mastery of the area to which such procedure will be performed.

Brief Description of the Attached Drawings

In order for the present invention to be fully understood and practiced by any person skilled in the art, it will be described in detail. clearly, concisely and sufficiently, based on the accompanying drawings, which illustrate and subsidize the following:

Figure 1 represents the panoramic view of the anterior face of the platform or base and its parts.

Figure 2 represents the detail view of the rear face of the platform or base.

Figure 3 represents the view of the rear face of the platform.

Figure 4 represents the view of the anterior surface of the torso with its relief and surface characteristics, having in a two-dimensional plane the internal structures, presenting the main constructive details.

Figure 5 is a side detail view of the airway and lungs assembly.

Figure 6 represents the detailed view of the heart forming assembly.

Figure 7 represents the perspective view of the disposable part,

Figure 8 represents the view of the disposable part in exploded view.

Figure 9 depicts the sheath and its fenestrations corresponding to those of the torso.

Figure 10 represents the graphical scheme of the general model that extends to all of the simulator electronics except the remote control.

Detailed Description of the Invention

The present invention aims to propose a corresponding dummy doll, more specifically, the anterolateral part of a male human trunk intended for training practices for medical procedures. Such a human trunk faithfully obeys the anatomical contour of the region, but not its relation with its cavities, so that the conducts to be trained can be repeated without damage to the permanent material and, at the same time, disposable parts can be adapted to the which training will be performed without compromising the rest of the simulator.

Thus, the solution is designed to prepare professionals without the need to employ human or living animal corpses, avoiding the difficulties and technical, legal and operational inconveniences that usually involve their use. The torso structure (9) itself consists of a hollow, rigid body with bony reliefs (10) and muscle-cutaneous contour that are necessary for the accurate identification of the anatomical points by the students. It corresponds to the anterior part of the human body and its surface characteristics as described above and is still properly secured to a platform (2) by means of fasteners.

The torso (9) fits into the platform (2), where there is a low relief wait (3), which is provided with table-like lateral extensions with adjustable support feet (1), a work window (4) ), a receptacle for the electronic boards, a receptacle for the power supply, a hole for connection to the pericardium, and a hole for depletion of the abdominal cavity. The platform (2), which seals the back of the torso (9), has a rectangular shape and is composed of a flat plate, preferably of thermoplastic material, whose surface is the contour of the low relief torso (3) and with edges. (5), which facilitates its accommodation, gives finishing, support, protection and seals the set.

The window (4) is situated near the center of the workpiece, which measures, with the largest transverse axis, which is filled by a lid (34) of the same size, fixed in place by two structured plastic couplings and a lock. preferably slot-type metal, which allows for cleaning, handling and replacement of parts without opening and full exposure of the interior of the simulator, except for technical maintenance.

Both the skin and the torso (9) present on their convexity phenomena (11), (12), (13), (14), (15) intended to receive disposable parts (31). The fenestra placed in the center of the anterior cervical region (15) is intended for the practice of needle puncture cricothyroidostomy or surgical technique. There are two opposite fenestras (14), in the second anterosuperior intercostal space, in the midline of the clavicles, which cause relief thoracentesis. Another, which is located near the xiphoid appendix (12), is intended for the practice of periocardiocentesis. Two other opposing fenestras (13) in the region of the fifth intercostal space, along the anterior axillary lines, give rise to closed pleural drainage. Finally, there is one in the infraumbilical region (11), in the midline of the abdomen, used for the training of diagnostic peritoneal lavage.

The fenestras of the anterior cervical region (15) and abdomen (11) are larger, with the largest dimension in the longitudinal direction of the torso. The fenestras of the anterior superior thoracic region (14) have larger dimension in the transverse axis. The xiphoid region fenestra (12) has a quadrangular shape with internal angular projection that serves to simulate the xifocostal angle. The anterolateral thoracic fenestras are frankly horizontal and with a wide predominance of the transverse axis. All fenestras have walls perpendicular to the trunk, forming a step (21) on the inner face, which serves as a support and fit for disposable parts.

Under the fenestra located in the abdomen (1) a dome-shaped structure (20) is fixed representing the abdominal cavity, which is coupled to the trunk with the aid of adhesive material, preferably silicone glue, since the complete sealing is required. In addition to accumulating fluid, the structure (20) may be filled with plastic or other serpentine structures to simulate intra-abdominal viscera. There is also an extractor (22) in its lower portion to which is attached a silicone drain that is externalized through a hole in the base and serves to fill, retain and evacuate liquids to provide realism to the procedure.

Under the xiphoid region fenestra (12) is a heart-shaped structure (32) made up of an elastomeric vault (25) and a rigid base (6) that together form a single piece whose cavity (26) is capable of storing enough artificial "blood" to functionally simulate the blood-filled pericardial membrane. This cavity (26) connects to a catheter (27) extending through the base (6) of the workpiece and the platform (2), through suitable holes for this purpose, to an externally located artificial "blood" pouch that allows to replace the blood drawn by the constant punctures and aspirations performed.

The heart (32) is fixed to the torso (9) by cylinders (19), preferably of nylon, and by a central metal pin that allows its rotation about its own axis (35). Coupled to the base of the heart (6) is a gear system connected a micro servo motor with traction capacity of up to one and a half kilograms and a CPU that also allows its activation by remote control. This ensures that after each puncture, the heart performs a few degrees rotation about its central axis to avoid repeated punctures in the same place and its consequences. This procedure increases the life of the part, delaying its disposal, reducing the cost of the procedure and providing an important sense of training realism.

Under the fenestra of the anterior cervical region (15) is a representative structure of the thyroid cartilage (16), with all its anatomical attributes. On the inner face of the body (9), a support (24) is attached to the trachea (17), consisting of a convex, curved wall laminar part with cavities where the thyroid cartilage (16) and the upper part fit together. of the trachea (17). The frame (16) is connected to a rigid annular tube (17) whose first protruding ring simulates the crinoid cartilage, bifurcating at its distal end (18) to simulate the trachea (17) and its source bronchi. to which are coupled two collapsed bodies (23) that inflate and deflate simulating the lungs. The structure of the thyroid cartilage (16) is attached to this tubular structure by means of traction metal spirals and elastic fixators which aim to limit distensibility but allow some movement to the cartilage in the anterior-posterior direction.

In the region lateral to the space delimited by the thyroid cartilage (16) and the tracheal tube (17) there are two electronic boards that contain infrared LED micro sensors, symmetrically facing each other, to form a constant and unbroken beam of light. When the beam is interrupted by the interposition of some artifact between the sensors, a noise emission resembling the air outlet to the outside through the trachea is triggered. This effect can be stopped by remote control or by removing the artifact. If not stopped, the effect will cease within 30 seconds. This feature aims to mimic the escape of the trachea as occurs in procedures performed in real situation.

At the upper end of the trachea (17) there are two elastic couplings and two metal traction spirals, in diametrically opposite positions, laterally arranged on either side of the piece to join it to another piece having the shape and anatomical attributes of the thyroid cartilage (16). This configuration gives elasticity to the thyroid cartilage (16) and allows its cranial movement when polyethylene catheter puncture is performed.

5 or the introduction of a tracheostomy cannula into the tracheal space located over the cervical fenestra, similar to what occurs during the "in vivo" procedure.

Under the fenestras located in the anterolateral thoracic region (13) for closed pleural drainage, on both sides is fixed a rigid, smooth, semi-cylindrical piece called a fairing, whose bottom base is closed by a latex membrane of consistency. similar to the diaphragm, which can be palpated by the student providing tactile sensation similar to that originally existing. Related to the right fairing, it is possible to palpate a structure that mimics the tactile sensation of the covered collapsed right lung.

15 by bloody discharge. Related to the left fairing is possible to palpate, in addition to the diaphragm, a structure that mimics the tactile sensation of the stomach when there is a diaphragmatic hernia on the left.

Internally, under the fenestras located in the region. anterosuperior thoracic view of the torso (14), where thoracentesis is practiced, there are two

20 symmetrical electronics, one on each side, positioned face to face, coupled to infrared LED sensors to form a constant and unbroken beam. When the beam is interrupted due to the interposition of some artifact between the sensors, such as a needle larger than five tenths of a millimeter in diameter, this triggers a sound that is

25 resembles that of the pressure air outlet through the vent generated in the chest wall. This effect can be stopped by remote control or by removing the artifact. If not stopped, the effect will cease within 30 seconds. This feature aims to mimic the air outlet under pressure through the chest wall as it occurs when the procedure is performed "in vivo".

30 Each disposable part (31) consists of its own hollow, split plastic frame (28) with a jagged internal surface, the portions of which are firmly sandwich-shaped to receive and secure between themselves. elastic parts that simulate human tissues. All are specifically shaped, preferably quadrilateral, and project a small extrusion (30) from their sides that fit, fit and fit tightly into corresponding hollow areas located on the perpendicular walls and

5 steps (21) of the fenras (11), (12), (13), (14), (15), with the support of the floor of the fenras formed from their internal projection in order to give stability to the side fittings and firmly holding disposable parts without, however, preventing quick and simple removal of the parts with the aid of a puller suitable for this purpose.

Between the two hollow parts of the frames 28 are attached layers of tissues 29 which simulate the stratigraphy of the human thoracic and abdominal walls, their color and their consistency. All layers may vary, in a controlled manner, in their constitution and thickness depending on the objective to be achieved. The skin that lines the pieces has the same elastomeric structure as the trunk lining layer (9), the fat is composed preferably of latex or similar foam that mimics the adipose tissue, the muscle is composed of filamentary elastomeric layers, according to the musculature to be reproduced. Still the serosa is made of a natural rubber blade. These tissues allow you to practice incision, traction and suturing as is

20 made "in vivo" and simulate the most diverse layers of tissues in the human body, given their similarity to the original structures. Some parts even contain pockets of artificial "blood" in order to add small bleeding to the procedure giving it greater realism.

The pericardium is covered by sensor columns that are coupled to

25 an electronic system that emits a light signal via an infrared LED inserted externally into the body of the sternum whenever the pericardium contacts an object such as a cylindrical needle larger than five tenths in diameter . This effect occurs just before the penetration of the needle or catheter into the pericardial cavity and serves as a

30 guidance to the student regarding the correct positioning of the needle at the time of puncture and for tactile discrimination of the process to be recorded in memory. The use of disposable parts (31), located in the topography where skills training is performed, as well as their quick removal and replacement, allows for more repetitions without cost, being small and replaceable and accommodating. Firmly over the torso (9) and lining fenestrates make training more dynamic and less expensive.

The artificial torso lining (9) presents moisture, distensibility, ductibility, touch and palpation response, cut and suture response, similar to those of human tissues, generating realism that qualifies professionals' training. This so-called artificial skin coating, made up of three layers of pre-molded elastomers, has a visual and tactile appearance similar to that of human skin and adapts perfectly to the surface relief and its peculiarities.

Thus, on the inner surface of the trunk (9) are fixed elements (31) that simulate some of the thoracic internal organs and allow some additional effects such as palpation of the lungs and the presence of traumatic diaphragmatic hernia, situations that should be described and resolved. by the student in training. Also transit the interior of the torso: fasteners, wiring, electronic boards, sensors, batteries and plugs for electrical connection and others.

The proposed simulator also has a system of infrared light barriers that detect a metallic object. Embedded electronics are made up of four printed circuit boards (PCI), which are controlled by three independent processors and one CPU processor, which aims to communicate with each other.

The CPU that processes and executes all radiated information from the plates positioned near the inside of the cervical, anterior thoracic, lateral thoracic, xiphoid, and abdominal fenestras, which receives the signals from the sensors installed there and controls the effects related to each procedure, as well as their activation and interruption by remote control.

PCIs operate through a processor that controls an infrared light barrier and an infrared receiver barrier. Over time, this processor sends a scan pulse to the light barrier in order to to check if something interrupted the light path. In case of interruption, the processor will send a command informing the CPU and will send a warning signal to the professional. Thus, for the Heart PCI sensor, a command is given to raise a conventional infrared LED that will inform the instrument's tone in the pericardium, while for the tracheal PCI sensor and the chest sensor PCIs, audible alerts are issued.

CPU PCI: This card's processing depends on the other PCIs from which it receives the command pulses. For certain commands the central processor will beep, for a particular type of command will trigger a conventional infrared LED to demonstrate that the instrument has touched the pericardium.

In addition to peripheral signal processing, the CPU has in its layout a rechargeable battery for off-grid use with autonomy of approximately two hours of uninterrupted use. The CPU also has a PS2 standard input for the remote control that has as functions: enable and disable the trachea sound signal; enable and disable the chest beeps; activate and deactivate the pericardial ringing light; Rotate the heart and adjust the audio volume.

Thus, from the implementation of the system it is possible to: detect the penetration of a needle in the anterior cervical region, the trachea zone, the anterior superior thoracic region, at the level of the second intercostal space and the lateral thoracic region, at the level of the fifth intercostal space , and sound a beep; detect the touch of a surgical instrument in the pericardium and trigger a light signal that will indicate this touch.

The figures and description made do not limit the embodiments of the inventive concept proposed here, but rather illustrate and make understandable the conceptual innovations disclosed in this invention, so that the descriptions and images must be interpreted in an illustrative and non-illustrative manner. There may be other equivalent or analogous forms of implementation of the inventive concept disclosed herein that do not escape the protective spectrum outlined in this invention. This report describes a peculiar and original human trunk simulator for training surgical procedures, endowed with novelty, inventive activity, descriptive sufficiency and industrial application and, consequently, covered with all the essential requirements for granting the claimed privilege. .

Claims

CLAIMS:

1 - HUMAN TRUNK SIMULATOR FOR TRAINING SURGICAL PROCEDURES consisting of torso structure (9), representative organ fittings, outer covering representing the skin,

5 fenestras (11), (12), (13), (14), (15) and fat and muscle layers characterized by electronic procedures monitoring system and representative parts of disposable organs (31).

HUMAN TRUNK SIMULATOR FOR TRAINING SURGICAL PROCEDURES according to claim 1, characterized in that it has in the fenestra (11) a structure (20) filled with serpentine structures, preferably plastic, and an exhaust (22).

SIMULATOR HUMAN BODY FOR TRAINING SURGICAL PROCEDURES according to claim 1 characterized in that the structure of the heart (32) comprises an elastomeric vault (25), a rigid base (6) with a cavity (26).

HUMAN TRUNK SIMULATOR FOR TRAINING SURGICAL PROCEDURES according to claims 1 and 3 characterized in that the gear system connected to a micro motor is coupled to the base of the heart (32).

20 5 - HUMAN TRUNK SIMULATOR FOR TRAINING

SURGICAL PROCEDURES according to claim 1, characterized in that it has two electronic boards equipped with infrared LED micro sensors in the region between the thyroid cartilage (16) and the tracheal tube (17) and in the anterosuperior thoracic region of the torso (14).

25 6 - HUMAN TRUNK SIMULATOR FOR TRAINING

SURGICAL PROCEDURES according to claim 1, characterized by having sensor columns in the pericardium.

7 - HUMAN TRUNK SIMULATOR FOR TRAINING

SURGICAL PROCEDURES according to claim 1, characterized in that the disposable parts (31) consist of a plastic frame (28), tissue layers (29) and an extrusion (30). 8 - Electronic Snoring System for Surgical Procedures Training characterized by having at least 4 printed circuit boards (PCI) controlled by independent processors and at least one CPU processor.

9 - ELECTRONIC SYSTEM FOR TRUNK SIMULATOR FOR

SURGICAL PROCEDURE TRAINING according to claim 8, further characterized in that the printed circuit boards (PCI) through an independent processor provide an infrared light barrier and an infrared receiver barrier.

10 - ELECTRONIC SYSTEM FOR TRUNK SIMULATOR FOR

SURGICAL PROCEDURE TRAINING as claimed in claim 8, further characterized by the CPU having a PS2 standard input for the system remote control.

11 - SIMULATOR PROCESS FOR TRAINING SURGICAL PROCEDURES characterized by comprising the following steps:

(a) the individual processor commanding an infrared light barrier is infrared receivers;

b) Send a scan pulse to the light barrier;

c) Detect the presence of a material by interrupting the passage of light;

d) Send a command to the CPU; and

e) Resume with a warning signal to the professional.

A SIMULATOR PROCESS FOR TRAINING SURGICAL PROCEDURES as claimed in claim 11 and further characterized by interruption of light emission in the heart sensor PCI resume with a signal ascending an infrared LED.

A SIMULATOR PROCESS FOR TRAINING SURGICAL PROCEDURES according to claim 11 and further characterized by the interruption of light emission in the tracheal sensor PCI and the chest sensor PCIs sound an alert.