JP2006078579A - Trocar insertion training system - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To develop a system that enables a simulated trocar insertion training with high reality without using a human body nor an animal. <P>SOLUTION: The trocar insertion training system comprises a sensor which measures, for example, the attitude and operation of a trocar, a reaction force presenting device equipped with an actuator presenting a reaction force from an object, a computation algorithm which finds deformation of a part where the trocar is inserted and a reaction force to the trocar, a control section which controls the reaction force presenting device, an image generation section which generates images of an endoscope inserted into the trocar, and an image presentation section. Various reaction forces and images are presented according to operations of the trocar to realize a trocar insertion training without using a human body nor an animal which has high reality or is more effective than an actual training. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The present invention relates to a training system capable of simulating an operation of inserting a trocar used in laparoscopic surgery without using a human body or an animal.

In order to perform medical procedures such as incision with a scalpel, insertion of a needle, cutting with a forceps, and peeling operation, specialized qualifications such as a doctor are required. In addition, even if you have the necessary qualifications, unskilled medical practices cannot be trained with patients.
For this reason, in order for medical students before acquiring a doctor's qualification or doctors who are not proficient in skill to perform medical practice training, training using models or animals is performed. However, the model is difficult to deal with various situations and has insufficient reality. In addition, training using animals is difficult to implement from an ethical point of view such as animal welfare.
Therefore, in recent years, training systems using robotics, mechatronics, information engineering, virtual reality technology, etc. have been developed.
JP-A-2003-210386 “Endoscope Simulator System” Laparoscopic surgery is used in many surgeries in recent years because it places less burden on patients. However, compared to open surgery, the burden on the doctor is greater and requires advanced skills. For this reason, an apparatus and a system for training how to operate surgical instruments such as forceps have been developed. Japanese Patent Laid-Open No. 2002-287613 “Operation Training Device”

Currently, to perform laparoscopic surgery, it is necessary to insert a trocar before inserting forceps into the abdomen. As a method for inserting a trocar, there are an open method in which the abdomen is inserted by making a small incision with a scalpel, and a closed method in which the trocar is inserted after inserting into the pneumoperitoneum tip. Although the open method can be inserted safely and reliably, there are problems such as time consuming, bleeding due to incision, and difficulty in maintaining airtightness. In addition, the closed method is unlikely to cause organ damage by the trocar, but the insertion procedure takes time, and there is a risk of damage to the organ with the pneumoperitoneum needle.
On the other hand, the optical method using a combination of a blade rest locker and an endoscope is low in manpower, so it does not take time for the insertion procedure, and is inserted while viewing the image, so it is highly safe. In addition, since the tissue is not cut with a metal blade, there is almost no bleeding, and it is easy to keep airtight because it does not easily come off the abdominal wall. However, there is a problem that it is difficult to learn the insertion technique because it requires skill to operate the trocar when inserting the trocar by the optical method and to view the endoscopic image.
Therefore, the present invention realizes a system capable of training a highly realistic blade rest rocker optical insertion method without using a human body or an animal.
Also, during actual surgery, you can experience how much force and movement will cause trocar insertion failure, and what kind of images will be presented when trocar insertion fails. It is difficult and requires a lot of experience to master the insertion technique.
Therefore, the present invention makes it possible to virtually experience the failure of the trocar insertion technique, and to realize a video and reaction force in a situation that cannot actually occur, in which effective training can be performed.

  In order to solve the above problems, the present inventors have developed a system for training a trocar insertion operation. The system shown in FIG. 1 includes a sensor unit 1 that measures the posture and movement of a trocar, a reaction force presentation device 3 that includes an actuator unit 2 that presents a reaction force from an object, a deformation of a part where the trocar is inserted, The computer 6 includes a calculation algorithm 4 for obtaining a reaction force to the trocar and a control unit 5 for controlling the reaction force presentation device. As the trocar 7, an actual trocar or a simulated trocar can be used, and the trainer trains the appropriate degree of force when inserting the trocar while operating the trocar 7.

  In addition to the system shown in FIG. 1, the system shown in FIG. 2 includes an endoscope 8, an image generation unit 9 that generates an endoscope image when a trocar is inserted, and an image presentation unit 10. The endoscope 8 can be an actual endoscope or a simulated endoscope. The trainee operates the trocar 7 into which the endoscope 8 is inserted, and while viewing the image presented on the image presentation unit 10, the trainee applies the appropriate force when inserting the trocar and how to view the displayed image. To train.

  In addition, in the presentation of reaction force and images at the time of training in the present invention, in addition to the realistic situation close to the actual procedure, the video and reaction force of the situation at the time of failure and the situation that cannot actually occur are presented. By doing this, virtual training that is more effective than actual training becomes possible.

By using the system developed in the present invention, it is possible to train a trocar insertion operation before the operation in a highly realistic situation similar to an actual operation without using a human body or an animal.
In addition, by presenting the experience of failure to insert the trocar, video and reaction force of situations that cannot actually occur, and experiencing during training, effective training can be performed in a shorter time than actual training.

  1 shows one embodiment of a trocar insertion training system according to the present invention. FIG. 3 shows an embodiment of the mechanism of the reaction force presentation device in the system of FIG. 1 or FIG. An actuator 16 and an encoder 11 are attached to the ball screw 17 and drive a parallel link mechanism including links 8a, 8b, 8c, and 8d. Since the attitude of the trocar changes by the gimbal mechanism 19, the attitude of the trocar is measured using the encoders 12, 13, and 14. The gimbal mechanism 19 is supported by force sensors 15a and 15b, and the force applied to the trocar by the trainee is measured by the force sensors 15a and 15b. An endoscope is inserted into the trocar.

In addition, a computer that controls the reaction force presentation device, calculates deformation and force sense of the abdominal wall, and an image presentation system that presents endoscopic images are required, but this can be replaced with a general computer and monitor. Therefore, it is omitted.
In the present invention, a sensor that measures a general rotation angle, such as a rotary encoder or a potentiometer, can be used as the sensor that detects the attitude of the trocar.
As an actuator of the reaction force presentation device, an AC servo motor and other actuators generally used for robots can be used.
The trocar can be a real or a model.
The endoscope can be a real object or a model.
As a mechanism used in the force sense presentation system, in addition to the pantograph mechanism and the gimbal mechanism, the parallel mechanism and the like have three degrees of freedom in posture at the tip of the trocar, the position is one degree of freedom, two degrees of freedom, three degrees of freedom A mechanism having the above degrees of freedom can be used.

  The reaction force presented in the reaction force presentation unit and the image presented in the image presentation unit are very close to the reaction force and image when the trocar is inserted into the human body, the reaction force and image when the trocar fails to be inserted, Various characteristics such as reaction force calculated by the same model as the human body, reaction force calculated by a different model, one that is smaller or larger than the actual human body, one that is easy or difficult to insert Situation reaction force and images can be presented.

  Since the trocar insertion training system of the present invention enables highly realistic insertion training without using a human body or animals, medical students and doctors who are not skilled in technology should perform trocar insertion training in advance. Can do. In addition, since various reaction forces and images can be presented, effective training can be performed in a shorter time than actual training.

It is a block diagram of the trocar insertion training system comprised by the reaction force presentation apparatus and computer by this invention. It is a block diagram of the trocar insertion training system comprised by the reaction force presentation apparatus, the computer, and the image presentation system by this invention. It is the top view and front view which show the outline of the mechanism of the reaction force presentation apparatus using the pantograph mechanism and the gimbal mechanism by one Example of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Sensor part, 2 ... Actuator part, 3 ... Reaction force presentation part, 4 ... Calculation algorithm, 5 ... Control part, 6 ... Computer, 7 ... Trocar, 8・ ・ ・ Endoscope, 9 ... Image generation unit, 10 ... Image presentation unit, 11, 12, 13, 14 ... Encoder, 15a, 15b ... Force sensor, 16 ... Actuator, 17 ... Ball screw, 18a, 18b, 18c, 18d ... Link, 19 ... Gimbal mechanism

Claims (6)

A sensor unit that measures the posture and motion of the trocar, a reaction force presentation unit that includes an actuator unit that presents the reaction force from the object, and a calculation algorithm that calculates the deformation of the part where the trocar is inserted and the reaction force to the trocar A trocar insertion training system comprising a computer for controlling the reaction force presentation unit. 7. A trocar insertion training system comprising: the system according to claim 1; an endoscope; an image generation unit that generates an endoscopic image when the trocar is inserted; and an image presentation unit. The image generation unit in the system according to claim 2, wherein an actual image captured when the trocar is actually inserted is used as an endoscopic image to be presented, and is presented in correspondence with the operation of the trocar during training. And trocar insertion training system. The image generation unit in the system of claim 2 presents, as an endoscopic image to be presented, a CG image created based on an actual video taken when the trocar is actually inserted, in association with the operation of the trocar during training A trocar insertion training system characterized by: In the system according to claims 1 to 4, by using a pantograph mechanism and a gimbal mechanism as a reaction force presentation device, one degree of freedom of translation and three degrees of freedom of rotation are realized as the operation of the trocar during training. A trocar insertion training system characterized by As an image or reaction force to be presented to the trainer during training, an image or reaction force in a failed situation that should not be caused during actual surgery is presented, or an image or reaction force of a characteristic or situation that cannot actually occur The trocar insertion training system according to claim 1, wherein virtual training that is more effective than actual training is performed by presenting.