JP5397898B2 - Prostatic hypertrophy model and prostate surgery simulation model - Google Patents

Description

  The present invention relates to a prostatic hypertrophy model and a prostate surgery simulation model for learning a surgical technique for treating benign prostatic hyperplasia.

  Currently, about 80% of Japanese men are said to have benign prostatic hyperplasia by the age of 80. In the case of prostatic hypertrophy, if treatment cannot be improved by drug treatment, surgical treatment is necessary.

  The most standard surgical method is a method called transurethral prostatectomy (TUR-P), in which resection is performed while viewing the affected area with an endoscope.

  Specifically, an endoscope is inserted from the urethral outlet, moved toward the bladder, and the prostate in front of the bladder is displayed on the monitor. The enlarged prostate that is projected bulges toward the inside of the urethra, so that the urethra of that part appears to be thinner.

  Next, as shown in FIG. 8, the prostate (inner gland) 51 bulging in front of the bladder 50 is excised with an electric knife 52 to expand the urethral stricture portion.

  The above TUR-P has an advantage that the abdomen is not damaged because it is performed using an endoscope. On the other hand, since the operation is performed while slicing the enlarged portion with an electric knife, there is a lot of bleeding in a large hypertrophy. There is a drawback.

  In general, since a liquid not containing an electrolyte is used as the reflux liquid, the reflux liquid may enter the circulatory system from the vein and cause hyponatremia. In particular, since α1 blockers are the first choice in recent years and the period of medical treatment has been prolonged, very large prostate hypertrophy is often the target of surgery, and the complications of these TUR-Ps are It has become a big problem.

  Under such circumstances, a completely different method has been developed as the concept of endoscopic surgery. That is holmium laser enucleation of the prostate (HoLEP).

  Previous prostate enucleation has been performed by the method of subcapsular resection by laparotomy, but HoLEP exfoliates the surgical capsule and adenoma under the endoscope, and enucleates the prostate gland. .

  Therefore, conventionally, even for large prostate cases of 100 g or more for which laparotomy is selected, this is a technique that can be safely performed with low risk of blood transfusion, is highly useful, and is a minimally invasive alternative to laparotomy. It has attracted attention as an operation. Furthermore, the hospitalization period may be shorter than the conventional TUR-P, and it is becoming popular as a patient-friendly treatment method.

  In this way, HoLEP surgery is a very good surgical method for benign prostatic hyperplasia, but the actual situation is that skill is being improved while performing actual surgery under the guidance of a skilled doctor. is there.

  Conventionally, as an endoscope training method, a method of preparing an intestinal model or an organ model, and performing training by inserting an endoscope into the model (see, for example, Patent Document 1) is known. Cross-sectional models are also commercially available.

JP 2003-180612 A

  However, there is no simulation model that can reproduce a special surgical method like the HoLEP operation described above, and there is a demand for the development of a realistic simulation model as a training means for training doctors performing the HoLEP operation.

  The present invention has been made in consideration of the above-mentioned problems in conventional prostate disease surgery, and provides a prostatic hypertrophy model and a prostate surgery simulation model that can faithfully reproduce and train HoLEP surgery. It is.

The present invention is a prostatic hypertrophy model that three-dimensionally reproduces an enlarged prostate and surrounding tissue,
A hollow bladder model part simulating the bladder;
A urethra model part extending from the bladder model part and imitating the urethra;
The urethral model part is provided so as to surround the urethra, and has an enlarged prostate part that forms a ureteral stenosis part,
The enlarged prostate component is arranged at the boundary between the inner gland component imitating the enlarged inner gland, the outer gland membrane component covering the outer peripheral surface of the inner gland component, and the inner gland component and the outer gland membrane component An adhesive layer, and the adhesive layer is a prostatic hypertrophy model configured to be cut by a holmium yag laser while immersed in an electrolytic solution such as water or physiological saline.

  According to the above-mentioned prostatic hypertrophy model, the inner gland component simulating the enlarged inner gland is connected to the outer gland membrane component via the adhesive layer, so that the inner gland and the outer gland are similar to those in the actual HoLEP operation. By finding the boundary and excising the boundary layer, that is, the adhesive layer, using a holmium yag laser, it is possible to simulate the enucleation of the inner gland.

  The prostatic hypertrophy model has a right lobe component that imitates the right lobe, a left lobe component that imitates the left lobe, and a middle lobe component that imitates the middle lobe as the inner gland component, and each component is connected by the adhesive layer It is preferable.

  The prostate hypertrophy model can be filled with an electrolytic solution such as water or physiological saline.

The present invention comprises a lower abdomen model that three-dimensionally reproduces the lower abdomen, and a prostatic hypertrophy model having the above configuration that is detachably mounted in the lower abdomen model,
The lower abdominal model is provided with a passage imitating the ureter and a recess for mounting the prostatic hypertrophy model.
It is a simulation model for prostate surgery provided with a connection part for connecting the urethral model part of the prostatic hypertrophy model arranged in the recess to the passage.

  In the simulation model for prostate surgery, the prostate hypertrophy model can be filled with water or an electrolyte such as physiological saline.

  The prostatic hypertrophy model and the prostate surgery simulation model of the present invention have the advantage that the HoLEP surgery can be faithfully reproduced and trained.

It is the longitudinal cross-sectional view which showed the prostate and its surrounding tissue for demonstrating the prostate surgery which concerns on this invention. It is a principal part enlarged view which shows the enlarged prostate. It is a perspective view which shows the whole structure of the simulation model for prostate surgery which concerns on this invention. It is a longitudinal cross-sectional view which shows the connection state of the prostatic hypertrophy model of FIG. (a) is the top view to which the A section of FIG. 4 was expanded, (b) is the side view. It is an enlarged view which shows the structure of the prostatic hypertrophy model connection part of FIG. (a)-(d) is process drawing explaining the training method by the prostate surgery simulation model concerning this invention. It is explanatory drawing which shows the surgery method of the conventional prostate.

  Hereinafter, the present invention will be described in detail based on the embodiments shown in the drawings.

  In FIG. 1, the prostate 1 exists so as to surround the urethra 3 in the vicinity of the exit of the bladder 2, and has a two-layer structure having the actual size of a walnut. The inner part is called the inner gland 1a and the outer part is called the outer gland 1b. Under normal conditions, the thicknesses of the inner gland and the outer gland are almost the same. In the figure, 4 is a seminal vesicle and 5 is a urethral sphincter.

  When the prostate enlarges, as shown in the enlarged view of the main part of FIG. 2, the inner gland 1a expands to become an adenoma, while the outer gland 1b expands, as if the contents of the mandarin orange (inner gland 1a) and the skin (outer gland) The shape is as in 1b).

  When prostatic hypertrophy occurs, the inner gland 1a enlarges and presses on the urethra 3 to cause difficulty in urination and frequent urination, so that the inner gland 1a portion is removed in a surgical treatment.

  FIG. 3 is a perspective view showing the overall configuration of a simulation model for prostate surgery (hereinafter, abbreviated as a simulation model) according to the present invention.

  In the figure, a simulation model 10 is composed of a lower abdomen model 11 formed by filling a mold with a resin such as vinyl chloride resin, silicon resin, polyurethane resin or the like.

  11a of the lower abdomen model 11 is an abdomen model part corresponding to the abdomen, 11b is a right leg part model part corresponding to a part of the right leg, 11c is a left leg part model part corresponding to a part of the left leg, and 11d is a penis. The penis model part corresponding to is shown.

  The abdomen model portion 11a is formed with an ellipsoidal recess 11e as viewed from above, and a prostatic hypertrophy model 12 integrated with the prostate and its peripheral structure is detachably disposed in the recess 11e. Can be done.

  The prostatic hypertrophy model 12 is used as a material in accordance with applications such as PVA (polyvinyl alcohol), wax, rubber, chicken and other biological materials in addition to the same material as the lower abdomen model 11.

  FIG. 4 is a longitudinal sectional view showing a state in which the prostatic hypertrophy model 12 is arranged in the recess 11e.

  In the figure, the prostatic hypertrophy model 12 is connected to the lower abdomen model 11 via a prostatic hypertrophy model connecting portion 11f described later.

  A passage 11g extending toward the leg side from the prostatic hypertrophy model connecting portion 11f imitates the urethra and communicates with the outlet portion 11h of the penis model portion 11d while being curved.

  The prostatic hypertrophy model 12 includes a hollow bladder model portion 12a simulating a bladder and a hollow enlarged prostatic component housing portion 12b that accommodates an enlarged prostate component, and the bladder model portion 12a and the enlarged prostate component housing portion 12b. Is determined based on a database accumulated from actual cases.

  The bladder model portion 12a is provided with pores 12c for venting air when filling the prostate enlargement model 12 and the bladder model portion 12a with an electrolyte such as water or physiological saline.

  An enlarged prostate part 13 is accommodated in the enlarged prostate part accommodating part 12b. The bladder model part 12a is filled with an electrolyte W such as water or physiological saline, and further, the enlarged prostate model 12 and the recess 11e. The electrolyte solution W is also filled in between.

  FIG. 5 is an enlarged view of a part A in FIG. 4, (a) is a front view of the enlarged prostate part 13, and (b) is a side view thereof.

  In FIG. 5 (a), the enlarged prostate part 13 has three parts: a right lobe part 13a simulating the right lobe, a left lobe part 13b simulating the left lobe, and a middle lobe part 13c simulating the middle lobe. Simulates the inner gland.

  The right side wall 13d of the right lobe component 13a is connected to the membranous outer gland membrane component 13e via the first adhesive layer 14 simulating mucous membranes.

  The left side wall 13f of the left lobe component 13b is connected to the membranous outer gland membrane component 13e via the second adhesive layer 15 simulating mucous membranes.

  As shown in FIG. 5 (b), the middle lobe component 13c disposed below the right lobe component 13a and the left lobe component 13b is connected to the outer gland membrane component 13e via the third adhesive layer 16 simulating mucous membranes. And connected to the right lobe component 13a and the left lobe component 13b via the fourth adhesive layer 17.

  The enlarged prostate part 13 imitates the expanded internal gland, that is, the right lobe part 13a, the left lobe part 13b, and the middle lobe part 13c, and thereby the neck of the bladder model part 12a in the passage 11g imitating the urethra. A narrow portion 11i is intentionally formed (see FIG. 5A). In the figure, 11j is a urethral model portion extending from the bladder model portion 12a.

  Further, the enlarged prostate part 13 is assembled so as to surround the passage 11g, and then immersed in the electrolyte W filled in the bladder model portion 12a.

  The pressure-sensitive adhesive material forming each of the pressure-sensitive adhesive layers 14 to 17 is a material that cannot be easily removed mechanically, but can be cut with a holmium yag laser in the electrolyte W, such as a resin adhesive, a wax, Biomaterials such as latex rubber and chicken and mixed materials thereof can be used.

  In forming the pressure-sensitive adhesive layers 14 to 17, the pressure-sensitive adhesive material can be formed by applying a pressure-sensitive adhesive material in a film shape, or can be formed by applying it in a streak shape. Or it can also form by sticking what was formed in net shape. Moreover, about each adhesion layer 14-17, what can distinguish the trace cut | disconnected with the holmium yag laser clearly from another adhesion layer is preferable.

  An operator who trains in HoLEP surgery experiences a sensation of gradually peeling off the right lobe component 13a from the outer gland membrane component 13e, for example, by burning the first adhesive layer 14 in a specific direction using a holmium yag laser. It can be done.

  FIG. 6 is an enlarged view showing the configuration of the prostatic hypertrophy model connecting portion 11f shown in FIG.

  The prostatic hypertrophy model connecting portion 11f is connected to the end of the passage 11g and is provided in a state protruding from the side wall of the recess 11e, and the end of the prostatic hypertrophy model 12 opposite to the bladder model portion 12a. A female connection part 18b that is provided and can be fitted to the male connection part 18a.

  The male connecting part 18a and the female connecting part 18b are respectively provided with annular magnets 18c and 18d in a hook shape, and annular packings 18e and 18f are mounted on the connection side of the magnets 18c and 18d. ing.

  Therefore, if the insertion cylinder part 18g of the male connection part 18a is inserted into the cylinder hole part 18h of the female connection part 18b, the connection parts 18a and 18b are firmly connected by the attractive force of the magnets 18c and 18d. The packings 18e and 18f are in close contact with each other.

  Thus, since the prostatic hypertrophy model 12 is configured to be detachable from the prostatic hypertrophy model connecting portion 11f, if a plurality of prostatic hypertrophy models 12 are prepared, the HoLEP surgery training can be repeated many times. it can.

  Next, a surgical training method for prostate treatment using the simulation model will be described with reference to the process diagrams of FIGS. 4, 5, and 7.

  1) In FIG. 7 (a), the HoLEP endoscope 20 is inserted from the outlet 11h (see FIG. 4) of the penis model portion 11d and inserted into the bladder model portion 12a through the passage 11g simulating the urethra. .

  2) Observe the enlarged prostate part 13, the urethral sphincter model (not shown), and the bladder model part 12a. The reflux liquid is the electrolyte W as described above.

  3) The internal gland of the prostate is composed of three parts, a right lobe component 13a, a left lobe component 13b, and a middle lobe component 13c. First, when performing enucleation training, the middle lobe is enucleated.

  4) Next to the seminal vesicle, the fourth adhesive layer 17 in the enlarged prostate part 13 is incised by a holmium yag laser (see FIG. 5B), and the boundary between the inner gland and the outer gland membrane part 13e in the enlarged prostate part 13 is obtained. Find the layer.

  The holmium yag laser has a high absorption rate in water or saline and other electrolytes, and the tissue can be excised at a distance of 2.0 mm or less, and at the same time, hemostasis is performed by burning the tissue. If the tip of the tube is separated from the tissue by 5.0 mm, the tissue is not affected.

  In the simulation model of the present invention, since the first adhesive layer 14 to the fourth adhesive layer 17 are provided as mucous membranes to be excised by the holmium yag laser, the tip of the holmium yag laser fiber is brought close to the mucous membrane layers and excised. By performing the work, it is possible to experience almost the same operation as the enucleation in actual surgery.

  5) Enter the back side of the middle lobe component 13c along the found boundary layer, and peel off toward the bladder model portion 12a so as to turn up the middle lobe component 13c.

  6) The fourth mucosal layer 17 is incised on both sides of the middle lobe component 13c from the bladder neck of the bladder model part 12a, and the incision is advanced to the boundary layer.

  7) At this time, since the middle lobe component 13c is attached only at the bladder neck, the attached portion is cut off, and the middle lobe component 13c is released into the bladder model portion 12a, whereby the middle lobe cored training is performed. Is completed.

  8) Next, the right lobe is enucleated. Enucleation training may be performed from the left lobe.

  By irradiating the boundary layer with the holmium yag laser 21, the right lobe component 13a is separated from the outer gland membrane component 13e (see FIG. 7B). Specifically, peeling is performed from the sphincter 18 side dorsal side toward the bladder model portion 12a side and the abdominal side.

  9) When a certain degree of peeling is achieved, the first adhesive layer 14 on the ventral side is cut open. The first adhesive layer 14 on the sphincter side of the right lobe component 13a is cut open.

  10) At the urethral sphincter side, peel the boundary layer between the outer and inner glands, that is, the adhesive layer, along the outline of the inner gland from the ventral side to the dorsal side or from the dorsal side to the ventral side. The peeling part is made continuous.

  11) The layer between the outer and inner glands connected from the ventral side to the dorsal side is evenly stripped from the urethral sphincter to the bladder neck. As this separation progresses, the right lobe component 13a is attached only at the bladder neck (see FIG. 7 (c)).

  12) The bladder neck is cut off, the right lobe component 13a is released, and the right lobe enucleation training is completed (see FIG. 7 (d)).

  13) The left lobe enucleation training is performed in the same way as the right lobe enucleation training, and the inner gland enucleation training is completed.

  14) A nephroscope (Struts) is inserted through the passage 11g, and the nucleated gland is minced and collected using a molcerator.

  15) Training is completed by placing a urinary catheter of about 20 Fr from the passage 11g.

10 simulation model 11 lower abdomen model 11a abdomen model part 11b right leg part model part 11c left leg part model part 11d penis model part 11e recessed part 11f prostatic hypertrophy model connection part 11g passage 11h outlet part 11i stenosis part 11j urethral model part 12 prostatic hypertrophy Model 12a Bladder model part 12b Enlarged prostate part accommodating part 13 Enlarged prostate part 13a Right lobe part 13b Left lobe part 13c Middle lobe part 14 First adhesive layer 15 Second adhesive layer 16 Third adhesive layer 17 Fourth adhesive layer 18a Male connection Component 18b Female connection component 20 Endoscope 21 Holmium Yag Laser

Claims (5)

A prostatic hypertrophy model that three-dimensionally reproduces an enlarged prostate and surrounding tissues,
A hollow bladder model part simulating the bladder;
A urethra model part extending from the bladder model part and imitating the urethra;
The urethral model part is provided so as to surround the urethra, and has an enlarged prostate part that forms a ureteral stenosis part,
The enlarged prostate component is arranged at the boundary between the inner gland component imitating the enlarged inner gland, the outer gland membrane component covering the outer peripheral surface of the inner gland component, and the inner gland component and the outer gland membrane component An adhesive layer, and the adhesive layer is configured to be cut by a holmium yag laser in a state of being immersed in an electrolytic solution such as water or physiological saline. .   The prostate according to claim 1, wherein the inner gland component has a right lobe component imitating a right lobe, a left lobe component imitating a left lobe, and a middle lobe component imitating a middle lobe, and each component is connected by the adhesive layer. An enlarged model.   The prostatic hypertrophy model according to claim 1 or 2, wherein the prostatic hypertrophy model is filled with an electrolyte such as water or physiological saline. A lower abdomen model that three-dimensionally reproduces the lower abdomen,
The prostatic hypertrophy model according to claim 1 or 2, which is detachably mounted in the lower abdomen model,
The lower abdominal model is provided with a passage imitating the ureter and a recess for mounting the prostatic hypertrophy model.
A simulation model for prostate surgery, comprising a connection portion for connecting a urethral model portion of the prostatic hypertrophy model disposed in the recess to the passage.   The simulation model for prostate surgery according to claim 4, wherein the prostatic hypertrophy model is filled with an electrolyte such as water or physiological saline.