EP2212876A2

EP2212876A2 - Training device and test substrate for resectoscopic surgeries

Info

Publication number: EP2212876A2
Application number: EP08847976A
Authority: EP
Inventors: Klaus Forke
Original assignee: Samed Mobile Urologie GmbH
Current assignee: Samed Dresden GmbH
Priority date: 2007-11-10
Filing date: 2008-11-10
Publication date: 2010-08-04
Also published as: WO2009060099A3; WO2009060099A8; WO2009060099A2; DE102008056550A1

Abstract

The invention relates to a training device for resectoscopic surgeries, comprising a hollow member that accommodates a test substrate and has an opening for introducing a resectoscope. The aim of the invention is to be able to practice surgery techniques in realistic conditions while using inexpensive material. Said aim is achieved by designing the hollow member as a receptacle with an interior that can be filled with water and arranging the opening within the receptacle wall. A tubular instrument holder is arranged on the external face of the wall. Said instrument holder can be swiveled towards the opening and has a holder opening that is aligned with the opening along an axis of alignment in the central position of the instrument holder. Furthermore, a clamping mechanism is placed in the interior. Said clamping mechanism encloses a clamping space receiving a test substrate and has a first through-hole that lies on the axis of alignment on a side facing the opening.

Description

Training device and test substrate for resectoscopic surgery

The invention relates to a training device for resectoscopic operations with a hollow substrate receiving a test substrate, which has an opening for insertion of a resectoscope.

The invention also relates to a test substrate for resectoscopic surgery.

In urology or gynecology resektoskopische Ope ^¬ rations are performed. It involves manipulation into existing body orifices, such as the urethra or vagina, for example for the purpose of transurethral Prostatare ^¬ section or transvaginal Hysteroscopy using a resectoscope.

Usually, the first use of a resectoscope takes place directly on the diseased patient. The surgeon then collects the experience through a plurality of operations. It is disadvantageous that at least, is the first installation very hesitant pre ^¬ addressed which may have a minor operation success or a prolonged surgical time result. Also, operational errors can not be ruled out due to poor experience or lack of operating safety.

To address this problem, a training device of the type mentioned is described in DE 197 16 341 C2. This is hen verse- with a torso formed as hollow plastic body, in whose interior resektionsfähiges artificial tissue is buildin ^¬ Untitled. This artificial tissue is designed so that it can be modeled after various forms of organs, where then endoscopic examinations and operations can be simulated.

On the one hand, the use of artificial tissue is a cost-intensive choice of materials. On the other hand, this becomes artificial Tissue only partially reproduce the material properties of real body tissue, so that the training has significant differences from reality. With respect to the mechanical construction to ^¬ not closer is carried out in this document.

The invention is based on the object of specifying a training ^¬ device and test substrate for resectoscopic surgery, with which the surgical techniques can be practiced under realistic conditions and cost-effective use of materials.

This object is achieved according to the invention on the one hand by the fact that the hollow body is designed as a container with a bottom and a wall extending from the bottom up wall, the bottom and wall include a wasserbefüllbaren interior. In the wall, the opening is arranged. On a side facing away from the interior of the outside of the wall, a tubular instrument receptacle which can be pivoted to the opening is arranged with a receiving opening aligned with the opening in an alignment axis in the middle position of the instrument receptacle. Furthermore, a clamping device is arranged in the interior space, which encloses a clamping space receiving a test substrate and which has a first passage opening located on the side facing the opening on the alignment axis. In the clamping device can now be simulated tissue of meat-like consistency, such as animal meat, as a test substrate or a test substrate according to the invention. This represents a low-cost simulation tissue and comes very close to the material properties of human tissue, so that good training conditions are created. The use of real tissue, for example in the form of animal meat is, on the other hand possible in that the chip space, in which the meat is clamped, located in the interior of the container filled with water ^¬ the can, which at least drying of Simulation tissue prevented and thus the good training conditions ^¬ can be maintained over long periods. The water then also absorbs escaping blood.

By the instrument receiving a resectoscope may then be ^¬ inserted, wherein the instrument holder serves as a guide and, so to speak, imitating the urethra. This is made ^¬ light that the instrument holder is designed to swivel, so that the movements, as they are also made possible by the Membrum virile with the inserted resectoscope may also be performed.

The resectoscope can now be inserted through the opening and through the passage opening in the test substrate. There, for example, a prostate resection can then be simulated. Is the so-simulated operation is completed, it is easy to then take out the test substrate to cut at the Operati ^¬ onsstelle and so to take the operation result in eye ^¬ translucent.

In one embodiment of the invention, it is provided that a visible trainer consisting of a solid body can be used as the test substrate, which is provided with a longitudinally extending urethra cavity simulating the urethra and aligned with the first passage opening. This classifying trainer is intended for learning instrument operation and assessing or evaluating the field of view. For this purpose, the resectoscope is inserted into the sight trainer clamped in the clamping space. Thus, with a completely neutral test substrate and with known viewing conditions, the manner of presentation by the resectoscope can be tested.

In particular, the urethra cavity can be formed as a urethra hole. Such a urethra hole has a very clear and well-known inner appearance, the image of which can then be compared very well with reality.

Visual training can be improved by providing the urethra cavity with markings distributed over the circumference. Thus, the trainee can accurately test the Wirkun ^¬ gen of adjustments on the resectoscope and its representation.

The markings can be designed as radially encircling degree lines and / or as rulers extending in the longitudinal direction.

The degree lines or the rulers can be used to display angle adjustments or the penetration depth of the resectoscope. A further embodiment of the invention provides that the test substrate consists of a body with a simulation opening simulating the interior of the urethra or the prostate, which is provided with anatomically relevant points, in particular for the visualization thereof. This allows the exerciser to experience the presentation of the real medical or a pathological situation.

A further embodiment of the invention provides that the test substrate is a simulation fabric consisting of a mass of a mixture heated at a core temperature of 68 ° C.

45-55% by weight minced muscle meat with a fat content of 60-80% by weight of stored fat, 18-22% by weight of animal fat, 22.5-27.5% by weight of water and 4.5-5.5% by weight -% contains cooking or preserving salt.

Such a simulation fabric comes very close to human tissue for this simulation and is compatible with conventional technologies, e.g. Making sausage production in a simple manner, so that even with frequent exercise no significant costs.

The simulation fabric can also be packaged very well in that the test substrate consists of a simulation fabric enveloped by an outer metal sheath exposed to the opening (6). The packaging may even remain in the training device during use. It is thus very easy to use and also removable.

A particularly favorable form has been found when the Metallman ^¬ tel is hollow cylindrical. This is an application of a per se known can in the form of a so-called tin so that the production cost by using other conventional technologies can further reduce.

However, in addition to practicing the use of a resectoscope in the pure organic material, the test substrate can also be used to simulate work in different tissue structures. For example, the prostate is surrounded by an external closing prostatic capsule provided. In a prostate resection, the prostatic capsule is not visible but only with great attention felt. To be able to simulate the presence of such prostatic capsule or similar tissue differences, may be provided that the test substrate is a toward the opening open hollow body made of flexible material, the hollow space is filled with a Simulationsge ^¬ weave. The inside then simulates the protatic capsule.

Also, this hollow body can be part of a test substrate with metal sheath by being enveloped with an open to the opening outer metal sheath.

Also in this embodiment can be provided that the metal shell is hollow cylindrical. Thus, an application of a known per se in the form of a so-called tin can also be considered, so that the manufacturing cost can be further reduced by using other conventional technologies.

In one embodiment of the invention it is provided that the clamping device on a first side of the clamping space a first clamping cheek and on a first side opposite the second side of the clamping space has a second clamping cheek, both clamping cheeks to each other have a first distance and are designed to be movable relative to each other , Thus, the tensioning device forms a kind of vise. Between the two clamping cheeks, the test substrate can be clamped, with the relati ve ^¬ mobility of the two clamping cheeks can be exploited for the tensioning operation.

In order to be able to simulate surgical sites with different sizes, for example different sized prostates, it is provided that the first distance can be varied. This allows various ^¬ the large pieces of simulation tissue, for example pieces of meat, the size of the simulated organ size is used to ^¬. For easy clamping of the test substrate is provided that both clamping cheeks are biased with a mutually acting clamping force. The two clamping cheeks can also be arranged in separate clamping parts, which means that the clamping device has a first clamping cheek, which is provided with the passage opening containing the first clamping part and a second clamping cheek second clamping part and the first clamping part with a first part of Wall and the second clamping part is connected to a first part of the wall opposite the second part of the wall. If the connection with the wall designed detachable, both clamping parts can be removed from the container in a simple manner. This improves the

Possibilities of cleaning and / or drying the components after their use.

In order to realize a bias voltage and for automatic actuation of the test substrate with a clamping force is provided in that the first clamping part has a connectable with the wall Spann ^¬ plate to which the first clamping beam is arranged in parallel to extend retaining bolt between the clamping plate and clamping cheek, on which the first clamping cheek is slidably mounted, and between the clamping plate and the clamping cheek a tension spring is tensioned. The tension springs press the first clamping cheek in Rich ^¬ tion to the second clamping cheek and thus a test substrate is clamped spring loaded.

Conveniently, the tension springs are arranged so that zwi ^¬ 's clamping plate and the first clamping cheek each one a retaining pin surrounding rubber spring, consisting of an elastic tension material, is stretched. This train material is very easy to clean and replace in case of consumption.

A higher clamping force than with a rubber spring can be achieved by tensioning a coil spring surrounding a retaining bolt between the clamping plate and the first clamping cheek.

The test substrate, in particular of meat-like consistency, for example, from animal meat, is clamped by the arrangement according to the invention, which takes place by a pure traction. However, the mechanical stability is increased when the pure frictional connection is supplemented by a form fit, by on the first side of the clamping space facing side of the first clamping cheek and / or on the second side of the clamping space facing side of the second clamping cheek are each arranged perpendicular to the respective side retaining mandrels.

For the use of a test substrate, which is provided with a metal jacket, it is expedient that on the first side of the clamping space facing side of the first clamping cheek and / or on the second side of the clamping space facing side of the two ^¬ th clamping cheek each with the cylindrical jacket ^{korrespondie ¬-} saving form-locking rings are arranged. Thus, the cylindri ^¬ cal metal shell after removal of the lid and / or Bodenseiti- gene closure in a simple manner can be used in the training device and keeps it safe.

A particularly simple realization is the fact that annular grooves are arranged as a form-fitting rings into which the cylindrical shell can be inserted.

In order to test a monopolar electroresection, in which the resectoscope forms an electrode which is biased against a second (large-area) electrode fixed to the patient, it is provided that an electrode is arranged within the form-fitting ^ring . By means of this electrode, the simulation tissue can be exposed to the counterpotential to the resectoscope, whereby the electrical resection is made possible.

It is particularly expedient that the electrode is formed as a circular disk ^¬ shaped surface electrode. After removal of the bottom-side closure, the test substrate can then be used and contacted over a large area and thus securely.

It is also possible here that the form-fitting elements are on an auxiliary clamping device, namely a first and a second auxiliary clamping cheek, which clamp the test substrate, angeord ^¬ net and the test substrate is then used with this auxiliary sspannvorrich- processing in the chip space.

In addition to the simulation, for example of a prostate environment, it is expedient to include other organs in the simulation as well, eg the Vesica urinaria. For this purpose, in a Ausgestal ^¬ processing of the invention behind the test substrate, for example, the vesica urinary is simulated by the exercise device DA is configured by that the second clamping cheek is arranged with a two ^¬ th distance to the wall and the second clamping part comprises spacer elements which extend between the second clamping cheek and the wall.

This also makes it possible for the first distance to be variable by setting the second distance.

The distance variation can be realized by using different spacer elements of different sizes.

For example, the Vesica urinaria behind the actual

To simulate test substrate more precisely, it is provided that in the second clamping cheek, a second passage opening is placed, which lies on the alignment axis.

In a further embodiment of a training ningsvorrichtung invention is provided that the tensioning device a

Clamping housing with its own clamping housing wall, consisting of a front wall facing the opening, a rear wall facing away from the opening and extending between the front and rear wall side walls, which include the clamping space has up. This clamping housing takes on a first clamping cheek leg ^¬ holding first clamping part and the second clamping cheek. The first clamping part has an elastic element, via which the first clamping cheek is connected to the clamping housing wall in such a way that the first clamping cheek can be tensioned against the second clamping cheek in a clamping direction running longitudinally between the front wall and the rear wall.

Such a separate clamping housing makes it possible to clamp outside the container, the test substrate and then insert together with the clamping jaws in the container.

In one embodiment, it is provided that the first

Clamping cheek is provided with first lugs, which pass through slots in the side walls of the clamping housing wall, which extend parallel to the clamping direction, pass through. The clamping space facing away from the outside of the clamping housing wall is provided with second lugs. It is between the first noses and corresponding second lugs at least one spring each ge ^¬ clamped on each side wall. With this design, the springs are completely out of the area used for testing.

The spring can also be used as an easy to clean and easy to replace rubber spring made of an elastic tensile material.

The first clamping cheek can be manufactured very simply by the fact that the first clamping cheek is designed as a clamping rod running transversely to the clamping direction, which passes through the longitudinal holes in the form of the first lugs. This rod can ge ^¬ währleisten at the same time that the resectoscope is free to extend through the first clamping beam, without a passage opening is to be introduced.

With the longitudinal bore and a locking opening may be connected, in which the first lugs federbe ^¬ utilized at full release of the chip space into place. This makes it possible to fix the first clamping cheek in a spring-loaded position in which engage the first lugs in the locking opening. Specifically, characterized the handle lo ^¬ environment greatly simplifies the use of the test substrate.

Also in this embodiment, organs other than the prostate can be included in the simulation, e.g. the Vesica urinaria. For this purpose, it is provided that the second clamping cheek is connected at a second distance from the rear wall with the clamping housing wall and has a passage opening which lies on the alignment axis.

To avoid slippage of the test substrate is provided that on the side facing the first side of the clamping space side of the first clamping cheek and / or on the second side of the clamping space facing side of the second clamping cheek each directed perpendicular to the respective side holding thorns are arranged.

In the execution of a training device with its own clamping housing wall, the use of a test substrate according to the invention with a metal shell can be assisted by the fact that on the first side of the clamping space facing side of the first clamping cheek and / or on the second side of the Spannrau- mes facing side of the second clamping cheek are each arranged with the zy ^¬- cylindrical shell form-fitting rings. Thus, even in this embodiment, the cylindrical metal shell can be used after removal of the lid and / or bottom-side closure in a simple manner in the training device and keeps it safe.

The form-fitting rings can be realized in a simple manner in that ring-shaped grooves are arranged as form-fitting rings into which the cylindrical shell can be inserted. These grooves can also be made in this embodiment by simple milling.

Regardless of the configuration of the form-locking rings can be provided for testing a monopolar electroresection in which the resectoscope forms an electrode which is biased against a patient attached to the second (large-area) electrode, that within the form-fitting ring an electrode is ^¬ arranged.

On the one hand, the mobility of the instrument holder is fully guaranteed and, on the other hand, water is prevented from escaping by sealing the outside of the instrument holder against the outside of the wall with an elastic sleeve.

The cuff can be meaningfully used to pivot the instrument holder in the elastic sleeve.

The pivoting of the instrument holder can also be realized in that with the outside of the wall an elas ^¬ table movable disc is connected spaced and the Instru ^¬ mentenaufnahme is flanged by means of a Flanschfußes to the movable Schei ^¬ be.

The authenticity of the simulation can also be increased by that the instrument holder consists of a flexible flexible tube or a tube, which is much closer to the characteristics of the membrum virile.

To ensure that no water of the container penetrates to the outside is provided that the instrument holder with a

Cap is closable. This makes it possible, at a working ^¬ break, in which the resectoscope is not used in the instrument holder to leave the water in the container to continue in due course with the work or at a later time to control the simulation result. Also, it is quite possible to use a liquid other than water, which is better suited for certain simulations, but possibly much more expensive. Due to the closure option, this fluid can also be left in the training device for several resectoscopic simulations.

In a further embodiment of the invention it is provided that the container is provided with a WasserablaufÖffnung. Thereby, a removal of the water can be made without removing the training device from its position and turn over for the purpose of emptying. This may prove particularly useful ^¬ default when various peripheral devices, such as external monitoring equipment correspond to the training device. This also makes it easier to use the training device in teaching, for example, and to use the training device

Simulate simulation process on a screen or a screen. An adjustment of the observation devices - in this case for image transmission - then does not need to be repeated at each screening.

For the same or similar reasons, it can be provided in another embodiment of the invention that the container is provided with a water inlet opening.

If both water holes are present, it is still possible that water inlet and outlet openings are connected to a water circuit. This allows the container to be purged continuously, significantly improving the visibility conditions, and also allowing surgeries to be performed. be taken, can be simulated.

In particular for observing the result, it is provided that the container and / or the clamping parts are made of transparent plastic.

All embodiments discussed so far can also be configured in that the container can be closed in a pressure-tight manner and has a control opening. This makes it possible to simulate gynecological resectoscopic surgery or resectoscopic surgery in the bladder area. Both operations are usually carried out with a slight overpressure. Due to the design of a pressure vessel such slight overpressure conditions may set ^¬ to, thereby extending the scope of the training device is also possible in these operations also in the simulation.

A simple way of realizing a pressure vessel is because ^¬ possible that the container with a lid pressure-tight manner is closed, since the container is already made so tight as a result of waterproofness.

For this purpose, it can be expediently provided that the control opening is arranged in the cover.

The execution of the control port may also be further developed in that the inspection opening is provided with a hose connector piece ^¬.

It is also expedient that the inspection opening can be closed with an elastic closure.

The object according to the invention is also achieved by a test substrate for use in a training device in which a test substrate can be inserted in a cylindrical metal sheath. It is provided that a cylindrical metal shell, each having a bottom-side and a lid-side closure, of which a simulation fabric consisting of a mass of a heated at a core temperature of 68 ⁰ C mixture of 45-55% by weight minced muscle meat with a fat content of 60 to 80% by mass of stored fat, 18 to 22% by weight of animal fat, 22.5 to 27.5% by weight of water and

4.5-5.5% by weight of cooking or preserving salt.

On the one hand, such a test substrate offers optimum conditions for simulation, since it is a material that comes very close to the real patient tissue in terms of its properties and thus the trainee finds a tissue situation in which he can practice almost under real conditions. On the other hand, such a test substrate can be offered ready-made and it has a long shelf life. In one embodiment, it is provided that a commercially available cylindrical tin can be used. In such packaging, the testsub ^¬ strat on the one hand to store very well and to handle. On the other hand, therefore, the test substrate also has a shape that allows easy insertion of the test substrate into the training device.

In this embodiment, it is possible that both the bottom-side and the cover-side closure are each provided with a tear tab and can be removed by tearing by means of a predetermined breaking line. Thus, the can packaging can be easily opened and possibly the test substrate can be easily inserted into the training device even in the thus opened packaging.

The test substrate can also be designed such that a lid-side closure is arranged to toward ge ^¬ preopened hollow body of flexible material within half of the metal shell, the cavity of which is filled with the simulation tissue. This makes it possible to use the test substrate in addition to practicing the use of a rectoscope in the pure organic material also to simulate the work in different tissue structures with the prostatic capsule, which is not visible in a prostate resection but only with great attention is. Thus, the presence of such a prostatic capsule or similar tissue differences can now be simulated.

It is possible that the hollow body consists of silicone.

This is a particularly easy to manufacture version. However, all other suitable materials, especially organic materials can be used, which make the fabric structure differences noticeable.

A more cost-effective alternative to silicone is the use of PDD (PDD = poly (ophenylenediamine) or poly (m-phenylenediamine)) as a hollow body.

The invention will be explained in more detail with reference to an embodiment. In the accompanying drawings shows

1 is a partially sectioned plan view of a training device according to the invention in a first embodiment,

Fig. 2 is a plan view of an instrument holder of the first imple mentation form

3 is a plan view partially in section of a training device according to the invention in a second embodiment,

4 is a first perspective view of a erfindungsge ^¬ MAESSEN training device in the second embodiment,

5 shows a second perspective ^{view of} a training ^device according to the invention in the second embodiment,

Fig. 6 is a plan view of a third embodiment with a clamping housing

7 is a plan view of the third embodiment, ^{ausgebil ¬} det for an electrical resection,

Fig. 8 is a plan view of a chip housing of the third exporting ^¬ approximate shape without test substrate

Fig. 9 is a side view of the clamping housing from the third ^¬ guide die without test substrate

10 is a section along the line X-X in Fig. 8,

Fig. 11 is a plan view of the clamping housing with clamped test substrate

Fig. 12 is a side view of the clamping housing with clamped test substrate

13 is a section along the line XII-XII in Fig. 11,

14 is a perspective view of a Sichttrainers,

Fig. 15 is a perspective view of a punching tool for the urethra channel

16 is a perspective view of a training device with a pressure-tight container with inserted Resek- toskop,

17 shows a representation of a substrate with an anatomically formed inner shape in the assembled state,

18 is an illustration of the substrate with an anatomically shaped inner shape in the disassembled state,

19 is a perspective view of the training device with pressure-tight container and inserted round substrate,

FIG. 20 shows a prefabricated test substrate with a metal ^jacket . FIG

21 shows a prefabricated test substrate in one with homoge ^¬ ner filling of the metal shell along the sectional plane AA in Fig. 20

FIG. 22 shows a prefabricated test substrate with a simulated test substrate. FIG

Tissue difference along the section plane A-A in Fig. 20 and

FIG. 23 shows a prefabricated test substrate in an additional substrate holder. FIG.

The same reference numerals used in the various embodiments indicate components that are the same or exhibit the same function in the embodiments. As shown in FIGS. 1 and 3 to 5, a training device 1 for resectoscopic surgery comprises a container 2 with a bottom 3 and a wall 4 extending upwardly from the bottom 3. Floor 3 and wall 4 include a water-fillable interior 5 a. In the wall 4, an opening 6 is arranged. On a side facing away from the interior 5 outside 7 of the wall 4 a pivotable to the opening 6 tubular instrument receptacle 8 is arranged with an aligned in the middle position of the instrument holder 8 with the opening 6 in an alignment axis 9 receiving opening 10. Furthermore, a clamping device 11 is arranged in the interior 5, which includes a test substrate 12 receiving a clamping space 13 and which has a on the opening 6 facing side on the alignment axis 9 lying first passage opening 14. In the clamping device 11 can now simulation fabric, such as animal meat, eg

Pork, beef or poultry meat or meat-containing material such as Leberkäse or the like can be clamped as a test substrate.

By means of the instrument receptacle 8, a resectoscope (not shown) can be inserted, the instrument receptacle 8 serving as a guide.

According to FIG. 1, the instrument receptacle 8 is made pivotable in such a way that an elastically movable disc 15 is connected in a spaced manner to the outside 7 of the wall 4, and the instrument receptacle 8 is connected by means of a flange foot 16, as shown in FIG movable disk 15 is flanged by means of a mating flange 17.

According to the illustration in FIGS. 3 to 5, the mobility of the instrument receptacle 8 is ensured on the one hand and water is prevented from escaping to the outside by the outside 7 of the instrument receptacle 8 being sealed with an elastic sleeve 18 in the region of the opening 6 is, in which the instru ^¬ ment holder 8 is pivotally mounted.

The clamping device 11 itself is provided with a first clamping cheek 19 on a first side of the clamping space, in which the passage opening 14 is introduced. On one of the first side opposite the second side of the clamping space 13 is a second Clamping 20 arranged. Both clamping cheeks 19 and 20 have a first distance 21 to each other, so that between the two clamping cheeks 19 and 20, the test substrate 12 can be clamped.

The two clamping cheeks are arranged in separate clamping parts 22 and 23, one of the first clamping cheek 19-containing first clamping member 22 and the second clamping cheek 20-containing second clamping member 23 which are detachably connected and opposite each other with the wall 4.

The first clamping part 22 has a connectable to the wall 4 clamping plate 24, to which the first clamping cheek 19 is arranged in parallel ^¬ , with 19 clamping pins between clamping plate 24 and clamping cheek 25 extend, on which the first clamping cheek 19 is slidably mounted. These retaining bolts 25 are located on the outside and indeed at the corners of the clamping plate 24 and the first Spannwan- 19 arranged, since they are rectangular. Furthermore, 19 clamping springs in the form of coil springs 26 are tensioned between the clamping plate 24 and the first clamping cheek. The coil springs 26 surround the retaining bolts 25, whereby they are guided. The coil springs 26 press the first clamping cheek 19 in the direction of the second clamping cheek 20 and thus the test substrate 12 is spring-loaded clamped, which is done by a pure adhesion. The mechanical stability is increased by holding mandrels 27, which are arranged on the clamping space 13 facing side of the first clamping cheek 19 and / or on the clamping space facing side of the second clamping cheek 20 each perpendicular to the other side.

The second clamping cheek 20 is arranged at a second distance 28 to the wall 4. For this purpose, the second clamping part comprises 23 Dis ^¬ dance elements 29 which extend between the second clamping cheek 20 and the wall 4. To simulate the Vesica urinaria (bladder) behind the actual test substrate, it is provided that in the second clamping cheek 20, a second passage opening 30 is introduced, which lies on the alignment axis 9.

The spacers 29 are stored in a different size and used depending on the purpose. This makes it possible for the first distance 21 to be variable by setting the second distance 28. To ensure that no water enters the container 2 to the outside when no resectoscope turned ^¬ leads into the instrument holder 8, it is provided that the tool holder 8 can be closed with a cap 31st

For ease of emptying and cleaning the container 2 is provided with a closable WasserablaufOffnung 32.

In Fig. 6 to Fig. 13, a third embodiment of the invention is described. Herein, the clamping device 11 is provided with a clamping housing 33 with its own clamping housing wall 34. The tensioning housing wall 34 consists of a front wall 35 facing the opening 6, a rear wall 36 facing away from the opening 6, and side walls 37 extending between the front and rear walls 35 and 36. The tensioning housing wall 34 encloses the tensioning space 13.

This clamping housing 33 receives a first clamping cheek 19 bein ^¬ holding first clamping member 22 and the second clamping cheek 20. The first clamping part 22 has an elastic element 38, via which the first clamping cheek 19 is connected to the clamping housing wall 34 such that the first clamping cheek 19 against the second clamping cheek 20 in a longitudinal direction between the front wall 35 and rear wall 36 extending clamping direction can be tensioned.

Such a separate clamping housing 33 makes it possible to clamp the test substrate 12 outside the container 2 and then to insert it into the container 2 together with the clamping jaws 19 and 20.

As shown in FIGS. 6 to 13, the first clamping cheek 19 is formed by two clamping bars 39 arranged transversely to the clamping direction and arranged one above the other. The chip bars 39 engage as first lugs 40 through slots 41 in the side walls 37 of the clamping housing wall 34, which extend parallel to the clamping direction through. The clamping space 13 facing away from the outside of the clamping housing wall 34 is provided with second lugs 42. At least one spring 38 is clamped on each side wall 37 between the first lugs 40 and corresponding second lugs 42. With this design, the springs 38 are completely out of the range used for testing. The clamping Rods 39 are arranged at such a distance from each other and below and above the opening 6 that the resectoscope can pass unhindered through the first clamping cheek 19 without having to introduce a passage opening.

With the slots 41 each have a detent opening 43 is connected, in which the first lugs 40 engage spring-loaded at full release of the clamping space 13. This makes it possible to fix the first clamping ^¬ cheek 19 is spring-loaded in a position in which the ers ^¬ th lugs snap into the locking opening 43 40th In particular, the handling when using the test substrate 12 is considerably simplified.

Also in this embodiment, organs other than the prostate can be included in the simulation, e.g. the Vesica urinaria. For this purpose, it is provided that the second clamping cheek 20 is connected at a second distance 28 from the rear wall 36 with the clamping housing wall 34 and has a second passage opening 30 which lies on the alignment axis.

To avoid slippage of the test substrate 12 vorgese ^¬ hen that on the first side of the clamping space 13 facing side of the first clamping cheek 19 and / or on the second side of the clamping space facing side of the second clamping cheek 20 je ^¬ Weil perpendicular to the respective side directed holding pins 27 are arranged.

The training device according to the invention has essentially three objectives,

1. the learning of instrument operation and judgment or evaluation of the field of view,

2. learning and training the resection methodology and

3. learning and training specific anatomy-related techniques.

Essentially for the fulfillment of the first objective position, a visual trainer 44 consisting of a solid body can be used as the test substrate 12, as shown in FIG. 14 and which is equipped with a urethra simulating and with the first passage opening. tion 14 aligned longitudinally extended urethra bore 45 is provided. Such urethra-bore 46 has a very clear and be ^¬ kanntes inner appearance, its image can then be compared very well with reality. The urethra is provided with bore 45 on the peripheral surface as a radially distributed markings umlau ^¬ Fende longitude lines 46 and / or extending in the longitudinal extension rulers 47th Thus, the trainee can accurately test the Wirkun ^¬ gen of adjustments on the resectoscope and its representation. The degree lines 46 or the rulers 47 can be used to display angular displacements or the penetration depth of the resectoscope.

If the resectoscope is inserted into the sight trainer clamped in the clamping space 13, the manner of the display by the resectoscope can be tested in the case of a completely neutral test substrate 12 in the form of the sight trainer 44 and with known viewing conditions. To facilitate insertion of the classifying trainer 44 is provided on its side, which is to be facing the second clamping cheek 20, with recesses 48 which correspond to the holding mandrels 27. In addition, on the side to be facing the first clamping cheek, at least one groove 49 is introduced, in which a tension rod 39 can engage. Thus, the classifying trainer 44 is exactly fixed in position.

The training device according to the invention can also be used for the training of resection by means of bipolar or monopolar RF electro-resection or resection by means of laser vaporization or laser enucleation. FIG. 7 shows an embodiment for the bipolar RF electro-resection, in which the second clamping cheek 20 on the substrate side is provided with an electrode 50. This electrode 50 is connected to a pole of the resectoscope. The other pole is the resectoscope.

In any case, it is convenient to the urethral opening auszustan ^¬ zen, as is present in a real resection. For this purpose, a punching tool 51, as shown in Fig. 15 is used. This punching tool consists of a shaft 52 and a punched ^¬ part 53. It is introduced in particular with removed clamping housing 33 with its stamped part 53 through the first passage opening 14 in the test substrate 12. In this case, the stamped part 53 cuts out of the test substrate 12 a core, so that one of the Urethra corresponding opening remains.

In Fig. 16 and Fig. 17, another embodiment is shown, in which the container 2 is designed pressure-tight. This is described at this point as a separate embodiment, although it is possible to design all embodiments discussed so far also in this way.

In gynecological resectoscopic surgery or resectoscopic surgery for bladder area is in the operating room, for example in the bladder, working with a slight overpressure. In order to be able to simulate this operating environment as well, such a slight overpressure can be set in the training device according to the invention, as a result of which the scope of the training device is also possible for these operations.

For this purpose, the wall 4 is provided on its upper side with a circumferential seal 54. In this seal the cover plate 55 is placed with a sealing surface. The floor 3 is designed so that it projects laterally beyond the side walls 37. From the over ^¬ standing part of the bottom 3 clamping bolts 56 extend to the cover plate 55, penetrate this and are clamped on the top of the cover plate with clamping nuts 57 so that a clamping force acts on the seal 54. If the cover plate 55 tightly rests on the Obersei ^¬ te the wall 4, then the container 2 is pressure-tight, since the container 2 in itself is already made tight due to the waterproofness.

Via a connecting piece 58, liquid 2 can be supplied to the container 2, which liquid can flow off again via the water outlet opening 32. In that regard, the container 2 may be properly rinsed during the simulated operation. Also, an overpressure can be adjusted via inflow and outflow in the container 2. About the control opening 58 and the pressure can be controlled. This is important in this case, as it can also train the observance of the pressure during the simulation. Thus, a resection in the area of the uterus with detergent is carried out under light pressure. However, this pressure must not exceed a certain level, since otherwise the rinsing agent is undesirably pressed into a tuba uterina or into the abdomen. Furthermore, a control opening 58 may be arranged in the cover plate 55 or in a side wall 37. The execution of the inspection opening can be further developed in that the inspection opening is provided with a hose connecting piece 59.

However, this inspection opening can also be designed differently and arranged in the cover plate 55 and then conveniently closed with a membrane made of elastic material. Through this control opening a suprapubic derivative of the Vesica urinaria can be simulated. In fact, during the operation, rinsing agent usually passes through the resectoscope 60, which is discharged to the outside via an artificial opening in the vesica urinaria. This can be simulated so that the Memb is ^¬ ran pierced with a needle, much as is done in the manufacture of a suprapubic drainage.

In Fig. 16, the training device with an inserted

Resectoscope 60 and any test substrate 12 which may be formed by a, for example, square-cast substrate 61, as shown in Fig. 17 and Fig. 18. This substrate 61 consists of a body with a simulation opening 62 simulating the interior of the urethra or the prostate, which is provided with anatomically relevant points, in particular for the visualization thereof. To facilitate the demonstration, the substrate 61 is designed in two parts and has an upper mold 63 and a lower mold 64, in each of which a part a and b of the simulation opening 62 is introduced. This bie ^¬ tet to one the advantage of ease of manufacture. On the other hand, single anatomically interesting points can be demonstrated before a simulation. Finally, it is also possible to fill the simulation opening with an organic material, to assemble it and to punch a channel by means of the punching tool 51. Subsequently, a removal of the organic material in the training device can take place. To assess the result, the substrate 61 can then be removed from the training device, split and the simulation opening 62 can be shown in the open state.

FIG. 19 shows the use of a cylindrical substrate 12. This cylindrical test substrate 12 can on the one hand be replaced by a cylindrical substrate 12 Visual Trainer 44 are formed, as shown in Fig. 14.

However, the cylindrical substrate 12 may also be formed by a test ^¬ substrate 65 and in pre-assembled form, as shown in Fig. 20 to Fig. 22. This test substrate has a cylindrical metal shell 66, which is provided with a respective bottom-side and a cover-side closure 67. Both sides are provided with a tear tab 68 and corresponding desired ^¬ breaking points, so that the fasteners may be removed prior to use 67, wherein the metal jacket 66 and remain wrapped around the simulation tissue 69th In this case, the clamping housing 33 is designed so that the test substrate 65 can be used after removing the closures 67 by means of the respective tear tab 68 directly into the clamping space 13. In particular for prostate simulation, only the urethra channel is then punched out with the punching tool 51 shown in FIG. 15 and the simulation can be started.

The simulation fabric 69 consists of a mass of a heated at a core temperature of 68 ⁰ C mixture of 45 - 55% by weight minced muscle meat with a fat content of 60 to 80% by mass of stored fat,

18-22% by weight of animal fat, 22.5% to 27.5% by weight of ^water and ^4.5-5.5 % by weight of cooking or preserving salt.

On the one hand, such a test substrate 65 offers optimal conditions for simulation, since it is a material that comes very close to the real patient tissue in terms of its properties and thus the trainee finds a tissue situation in which he can practice almost under real conditions. On the other hand, such a test substrate can be offered ready-made and it has a long shelf life. Achieving a shelf life of at least 6 months is not a problem.

For example, to simulate resections on a prostate, the simulation tissue 69 is very similar to the adenoma tissue.

A test substrate 65 can be realized in two embodiments, which are illustrated in FIGS. 21 and 22. The test substrate of FIG. 21 is a non-specific ^¬ Trainingssub strat, which means that the metal casing is completely filled with tissue simulation 69 66, can be trained in the different ^¬ Resekti onstechniken.

The test substrate 65 as shown in Fig. 22 includes a replica 70 of the prostatic capsule made of a flexible material, the cavity of which is filled with the simulation tissue. This makes it possible to use the test substrate 65 in addition to practicing the use of a resectoscope in the pure organic material as the embodiment of FIG. 21 also to simulate the work in different tissue structures with the prostatic capsule, which is not visible in a prostate resection but only with great attention is noticeable.

It is possible that the hollow body consists of silicone. This is a particularly easy-to-manufacture version. However, all other suitable materials, in particular organic materials, for example PDD (PDD = poly (ophenylenediamine) or poly (m-phenylenediamine)) can be used, which make the tissue structure differences noticeable.

FIG. 23 shows a prefabricated test substrate 65 for the purpose of simulating an electrical resection in an additional substrate holder 72. Outside the training device, the opened test substrate 65 can be inserted into this additional substrate holder 72. In this case, the simulation fabric 69 is contacted on the side facing away from the observer with a surface electrode 50.

The substrate holder 72 equipped in this way can then be inserted directly into the clamping space 13 or instead of the clamping housing 33. The connection line 73 serves to produce a corresponding electrical connection of the surface electrode 50 with the opposite pole of the resectoscope. Training device and test substrate for resectoscopic surgery

LIST OF REFERENCE NUMBERS

1 training device

2 containers

3 floor

4 wall

5 interior

6 opening

7 outside

8 instrument recording

9 escape axis

10 receiving opening

11 clamping device

12 test substrate

13 clamping space

14 first passage opening

15 elastically movable disc

16 flange foot

17 against flange plate

18 cuff

19 first clamping cheek

20 second clamping cheek

21 first distance

22 first clamping part

23 second clamping part

24 clamping plate

25 retaining bolts

26 spiral spring

27 retaining pin

28 second distance

29 spacer element 30 second passage opening

31 cap

32 water drainage opening

33 clamping housing

34 Clamping housing wall

35 front wall

36 rear wall

37 side wall

38 tension spring

39 tension rod

40 first nose

41 slot

42 second nose

43 latching opening

44 sight coach

45 Urethra hole

46 degree lines

47 ruler

48 deepening

49 groove

50 electrode

51 punching tool

52 shaft

53 stamped part

54 seal

55 cover plate

56 clamping bolts

57 Clamping nut

58 inspection opening

59 Clip hose connection

60 resectoscope

61 Substrate with prostatic capsule

62 simulation opening

63 upper form

64 subform

65 test substrate in prefabricated form

66 metal jacket

67 closure

68 tear tab Simulation tissue replica of the prostatic capsule cavity additional substrate holder connecting lead

Claims

Training device and test substrate for resectoscopic operationspatents claims

1. Training device for resectoscopic operations with a test substrate receiving a hollow body having an opening for introducing a Resektroskops da ^¬ du rchgekennzeichnet that the hollow body as a container (2) with a bottom (3) and from the bottom (3) is formed above the extending wall (4), said bottom (3) and wall (4) include a wasserbefüllbaren interior (5) and in the wall (4) the opening (6) is arranged, that on a the interior (5) facing away outer side (7) of the wall (4) to the opening (6) pivotable bare tubular instrument holder (8) having an in with ^¬ telstellung the Instrumentenaufnähme (8) with the opening (6) in an alignment axis (9) aligned with the receiving opening (10 ), and that in the interior space (5) a Spannvor ^¬ direction (11) is arranged, which encloses a test substrate 12 receiving clamping space (13) and the one on ei ^¬ ner of the opening (6) facing Side on the alignment axis (9) lying first passage opening (14).

2. Training device according to claim 1, characterized in that a test body (12) consisting of a solid body classifying trainer (44) can be inserted, which is aligned with a urethra simulating and with the first passage opening (14) aligned elongated urethra Hollow (45) is provided.

3. Training device according to claim 2, characterized in that the urethra excavation as

Urethra bore (45) is formed.

4. Training device according to claim 2 or 3, since you rch in that the urethra cavity (45) is provided with markings (46; 47) distributed over the peripheral surface.

5. Training device according to claim 4, since you rchge - indicates that the markers are designed as radially umlau ^¬ fenden degree lines (46).

6. Training device according to claim 4 or 5, since you rchgekennzeichnet that the markings are formed as in the longitudinal ^¬ extending extending rulers (47).

7. Training device according to one of claims 2 to 6, since you rchgekennzeichnet that the test substrate (12) consists of a body (61) with a simulating the interior of the urethra or the prostate simulation opening (62) with anatomically relevant points, in particular to visualize the same, is provided.

8. Training device according to claim 1, characterized in that the test substrate (12) comprises a simulation fabric (69) consisting of a mass of a heated at a core temperature of 68 ° C mixture of 45-55% by weight minced muscle meat with a fat content of 60 contains up to 80% by mass of stored fat, 18-22% by weight of animal fat, 22.5-27.5% by weight of water and 4.5-5.5% by weight of cooking or preserving salt.

9. Training device according to claim 1 or 8, characterized in that the test substrate (12) consists of a simulation fabric (69) enveloped by an outer metal sheath (66) which is exposed to the opening (6).

10. Training device according to claim 9, characterized in that the metal casing (66) is hollow-cylindrical in shape.

11. Training device according to claim 1 or 8, characterized in that the test substrate consists of a nem to the opening (6) towards hollow body (70) made of flexible material, the cavity (71) is filled with a simulation fabric.

12. Training device according to claim 11, dadurchge - indicates that the hollow body (70) with ei ^¬ nem to the opening (6) towards the outer metal shell (66) is wrapped.

13. The training device according to claim 12, characterized in that the metal sheath (66) is hollow cylindrical in shape.

14. Training device according to one of claims 1 to 7, since you rchgekennzeichnet that the clamping device (11) on a first side of the clamping space (13) a first clamping cheek (19 and on a first side opposite lying second side of the clamping space ( 13) a second clamping cheek ^¬ (20), both clamping plates (19; 20) to each other a first distance (21) and are formed relative to each other movable.

15. Training device according to claim 14, characterized in that the first distance (21) can be varied.

16. Training device according to claim 14 or 15, characterized in that both clamping cheeks (19; 20) are prestressed with a clamping force acting on one another.

17. Training device according to claim 16, since you rchgekennzeichnet that the tensioning device (11) comprises a first clamping cheek (19), which is provided with the passage opening (14) containing the first clamping part (22) and the second clamping cheek (20) second clamping part (23) and the first clamping part (22) with egg ^¬ nem first part of the wall (4) and the second clamping part (23) with a first part of the wall (4) opposite the second part of the wall (4) connected is.

18. Training device according to claim 17, since you rchge - indicates that first and second clamping part (22; 23) are each detachably connected to the wall (4).

19. Training device according to claim 17, since you rchgekennzeichnet that the first clamping part (22) having a wall (4) connectable clamping plate (24) to which the first clamping cheek (19) is arranged in parallel, that between the clamping plate (24 ) and first clamping cheek (19) extend retaining bolts (25) on which the first clamping cheek (19) is slidably mounted, and between the clamping plate (24) and the first clamping cheek (19) a tension spring (26) is tensioned.

20. Training device according to claim 19, since you rchgekennzeichnet that between the clamping plate (24) and ers ^¬ ter clamping cheek (19) each one a retaining pin (25) surrounding rubber spring, consisting of an elastic tensile material is tensioned.

21. Training device according to claim 19, since you rchgekennzeichnet that between the clamping plate (24) and ers ^¬ ter clamping cheek (19) each have a retaining bolt (25) surrounding coil spring (26) is tensioned.

22. Training device according to one of claims 14 to 21, since you rchgekennzeichnet that on the first side of the clamping space (13) facing side of the first clamping cheek (19) and / or on the second side of the clamping space (13) facing side of second clamping cheek (20) each directed perpendicular to the respective side HaI- tedorne (27) are arranged.

23. Training device according to one of claims 14 to 21 and claim 10 or 13, since you rchgekennzeichnet that on the first side of the clamping space (13) side facing the first clamping cheek (19) and / or on the second side of the Clamping space (13) facing side of the second clamping cheek (20) are each arranged with the cylindrical shell corresponding form-locking rings.

24. Training device according to claim 23, dadurchge - indicates that as form-fitting rings ring- shaped grooves are arranged, in which the cylindrical Man ^¬ tel is used.

25. Training device according to claim 23 or 24, in that a electrode (50) is arranged within the form-fitting ring.

26. Training device according to claim 25, characterized in that the electrode (50) is designed as a circular disk-shaped WING ^¬ chenelektrode.

27. Training device according to one of claims 14 to 21 and claim 10 or 13, since you rchgekennzeichnet that the interlocking elements on an auxiliary tensioning device (72), namely therein on a first and a second auxiliary sspannwange that clamp the test substrate (65) ange ange ^{¬ are} arranged and the test substrate (65) is then used with this auxiliary clamping device (72) in the clamping space (13).

28. Training device according to one of claims 17 to 22, since you rchgekennzeichnet that the second clamping ^¬ cheek (20) with a second distance to the wall (4) is arranged and the second clamping part (23) spacer elements (29) which extend between the second clamping cheek (20) and the wall (4).

29. The exercise device according to claim 15, wherein the first distance can be varied by setting the second distance (28).

30. The exercise device according to claim 29, wherein a plurality of distance elements (29) with different sizes can be used.

31. Training device according to claim 28, since you rchgekennzeichnet that in the second clamping cheek (20) ei ^¬ ne second passage opening (30) is introduced, which lies on the axis of flight.

32. Training device according to claim 16, since you rchge - indicates that the tensioning device (11) has a tensioning housing (33) with its own tensioning housing wall (34) consisting of a front wall (35) facing the opening (6), a rear wall (36) facing away from the opening (6) and between Front (35) and rear wall (36) extending side walls (37), which include the clamping space (13), which receives a first clamping cheek (19) containing the first clamping part (22) and the second clamping cheek (20) and the first clamping part (22) has an elastic element (26) over which the first clamping cheek

(19) is connected to the clamping housing wall (34) such that the first clamping cheek (19) against the second clamping cheek

(20) in a longitudinal direction between the front wall (35) and rear wall (36) extending clamping direction is tensioned.

33. Training device according to claim 32, since you rchgekennzeichnet that the first clamping cheek (19) with Ers ^¬ th lugs (40) is provided by slots (41) in the side walls (37) of the clamping housing wall (34), which are parallel extending to the clamping direction, reach through, that the clamping space (13) facing away from the outside of the Spannge ^¬ housing wall (34) with second lugs (42) is provided, and that between the first lugs (40) and corresponding second lugs 42) on each side wall ( 37) at least one spring (38) is tensioned.

34. Training device according to claim 33, since it is possible to use a rubber spring consisting of an elastic tension material as the spring (38).

35. Training device according to claim 32 or 33, since the first clamping cheek (19) is designed as a transverse to the clamping direction extending tension rod (39) which passes through the elongated holes (41) in the form of the first lugs (40).

36. Training device according to claim 33 or 35, since it is not possible that with a slot (41) a

Latching opening (43) is connected, in which the first lugs (40) with full release of the clamping space (13) spring-loaded one rest.

37. Training device according to one of claims 32 to 36, since you rchgekennzeichnet that the second clamping ^¬ cheek (20) at a second distance (28) of the Hinterwan- fertil (36) with the clamping housing wall (34) is connected and a passage opening (30), which lies on the alignment ^¬ axis.

38. Training device according to one of claims 32 to 37, since you rchgekennzeichnet that on the first side of the clamping space (13) facing side of the first clamping cheek (19) and / or on the second side of the clamping space (13) facing side of second clamping cheek (20) each directed perpendicular to the respective side HaI- tedorne (27) are arranged.

39. Training device according to one of claims 32 to 37 and claim 10 or 13, since you rchgekennzeichnet that on the first side of the clamping space (13) facing ^¬ th side of the first clamping cheek (19) and / or on the second side of the Clamping space (13) facing side of the second clamping cheek (20) are each arranged with the cylindrical shell corresponding form-locking rings.

40. The exercise device of claim 39, characterized in that ring ^¬ shaped grooves are arranged as form-locking rings, in which the cylindrical Man- tel is used.

41. Training device according to claim 39 or 40, characterized in that within the form ^¬ closing ring an electrode (50) is arranged.

42. Training device according to claim 41, characterized marked, that the electrode (50) is formed as a circular disk-shaped WING ^¬ chenelektrode.

43. Training device according to one of claims 1 to 38, since you rchgekennzeichnet that the outside of the instrument holder (8) relative to the outside of the Wan düng (4) sealed with an elastic sleeve (18) is.

44. The exercise device according to claim 39, wherein the instrument holder (8) is pivotably mounted in the elastic sleeve (18).

45. Training device according to one of claims 1 to 44, since you rchgekennzeichnet that with the outside of the wall (4) an elastically movable disc (15) is connected spaced and the instrument holder (8) by means of a Flanschfußes (16) to the movable disc (15) is flanged.

46. Training device according to one of claims 1 to 45, since you rchgekennzeichnet that the instrument ^¬ recording (8) consists of a flexible flexible tube or a hose.

47. Training device according to one of claims 1 to 46, since you rchgekennzeichnet that the instrument ^¬ recording (8) with a cap (31) is closable.

48. Training device according to one of claims 1 to 47, a c h e c e n e s in that the container (2) is provided with a water drainage opening (32).

49. Training device according to claim 48, since you rchgekennzeichnet that the container (2) with a Was ^¬ sereinlauföffnung (59) is provided.

50. Training device according to claim 49, since you rchge - indicates that water inlet and water outlet ^¬ opening (32) are connected to a water cycle.

51. Training device according to one of claims 1 to 48, one of the claims c h e c e n e that the container (2) consists of transparent plastic.

52. Training device according to one of claims 1 to 51, since you rchgekennzeichnet that the clamping parts (22; 23) made of transparent plastic.

53. Training device according to one of claims 1 to 52, characterized in that the Be ^¬ container (2) is closed pressure-tight and has a control ^¬ opening (58).

54. Training device according to claim 53, characterized in that the container (2) can be closed pressure-tight with a cover plate (55).

55. Training device according to claim 54, characterized in that the control opening (58) is arranged in the cover plate (55).

56. Training device according to one of claims 53 to 55, characterized in that the control opening ^¬ (58) is provided with a hose connection piece.

57. Training device according to one of claims 53 to 55, characterized in that the con ^¬ troll opening (58) is closable with an elastic closure.

58. test substrate for use in a training apparatus according to one of claims 1, 10, 12, 13, 23 or 39, since ^¬ by in that a cylindrical ^¬ shaped metal jacket (66) each having a bottom and a lid-side closure (67), a simulation fabric (69), consisting of a mass of a temperature of 68 ⁰ C at a heated mixture Kerntem-

59. Test substrate according to claim 58, wherein a commercially available cylindrical can is used.

60. Test substrate according to claim 58, characterized shows that both the bottom-side and the cover-side closure (67) each provided with a tear tab (68) and can be removed by tearing by means of a predetermined breaking line.

61. test substrate according to claim 58 or 60, dadurchge ^¬ indicates that within the metal shell (66) to the lid-side closure (67) out open hollow body (70) is arranged made of flexible material of ^¬ sen cavity (71) with the simulation fabric ( 69) is filled.

62. test substrate according to claim 61, characterized in that the hollow body (70) is made of silicone be ^¬ .

63. Test substrate according to claim 61, characterized in that the hollow body (70) is made of PDD (= (po)

Iy (ophenylenediamine or poly (m-phenylenediamine)) be ^¬ stands.