JP7378837B2 - Medical simulator and procedure evaluation method using the medical simulator - Google Patents

Description

The present invention relates to a medical simulator, and in particular, a simulator that enables training in medical techniques for inserting a medical instrument such as an endoscope into a hollow organ, and a method for evaluating a trainee's technique using such a medical simulator. Regarding.

BACKGROUND OF THE INVENTION With the recent advances in medicine and the sophistication of medical technology, medical personnel are now required to have advanced skills, and there is a need for enhanced education for medical personnel. Among these, simulation education using models that simulate living organisms is attracting particular attention because it enables skill acquisition and training just like in real life.

Patent Document 1 listed below discloses an endoscopic training system that prevents perforation of an organ model and enables efficient training. This system houses the organ model into which the scope of the endoscope is inserted in the outer box body, fills the space between the outer box body and the organ model with liquid, and the flow rate at which the liquid flows out from the outer box body. is detected as pressure acting on the organ model. This makes it possible to prevent perforation of the organ model by alerting the user before unnecessary pressure that perforates the organ model is applied.

Japanese Patent Application Publication No. 2012-8372

In the training system described above, the amount of fluid flowing out is detected as the pressure acting on the organ model, but in endoscopic procedures, the organ model may be displaced significantly, so the amount of fluid flowing out is detected as the pressure acting on the organ model. It cannot be said that it can be detected accurately. For example, a large displacement of the organ model may cause fluid to flow out regardless of the pressure acting on the organ model.
Medical techniques for inserting medical instruments such as endoscopes into hollow organs are only tacit knowledge of doctors, and the current situation is that it is not possible to appropriately visualize the status of such medical techniques.

The present invention was made in view of the above circumstances, and aims to improve the efficiency of the medical procedure by appropriately visualizing the status of the medical procedure in which a medical device such as an endoscope is inserted into a hollow organ. A medical simulator that enables training and a method for evaluating a trainee's technique using such a medical simulator are provided.
In this specification, "medical equipment" includes not only medical equipment but also equipment and tools for medical technique training.

A medical simulator according to one aspect of the present invention employs the following configuration in order to solve the above-mentioned problems. That is, the medical simulator according to this aspect includes a hollow organ model that is flexible and has a shape imitating at least one hollow organ, and a hollow organ model that is housed in an internal space in a locally fixed state. The luminal organ model has local fixation areas that can be fixed to the organ accommodation part at different positions in the longitudinal direction, and a movable region that is displaceable within the internal space of the organ storage section, and the detection means detects displacement or deformation of a target region that is at least a part of the movable region of the hollow organ model within the internal space, at least during training. can be detected.
Here, the hollow organ model is a hollow tubular body that simulates a hollow organ.
The target device is a medical device such as an endoscope.

Other aspects of the present invention include a hollow organ model that is flexible and has a shape imitating at least one hollow organ, an organ storage section that accommodates the hollow organ model in an internal space, and a hollow organ model. The present invention relates to a procedure evaluation method using a medical simulator that is executed by a control unit that controls a medical simulator that includes at least a plurality of sensors provided at mutually different positions in the longitudinal direction in a lumen of the body. This method determines, based on detection signals from the plurality of sensors, that a region of the target device has passed through a plurality of checkpoints provided at mutually different positions in the longitudinal direction of the lumen of the hollow organ model. , obtaining the dwell time of the region between two checkpoints, and evaluating the trainee's technique using at least the obtained dwell time.
In addition, as another aspect, it may be a computer program that causes a control unit that controls the medical simulator to execute the procedure evaluation method, or it may be a computer-readable storage medium that records such a program. good. The storage medium includes non-transitory tangible media.

According to the present invention, a medical simulator and such a medical simulator that enables efficient training of a medical procedure by appropriately visualizing the situation of the medical procedure of inserting a medical instrument such as an endoscope into a hollow organ, and the like are provided. A method for evaluating a trainee's technique using a medical simulator can be provided.

1 is a diagram conceptually showing the overall configuration of a medical simulator according to the present embodiment. FIG. 2 is a perspective view showing the appearance of a human body model section of the medical simulator according to the present embodiment. FIG. 2 is a schematic diagram showing the internal configuration of the organ storage unit according to the present embodiment. FIG. 3 is a cross-sectional view of the anus holding part taken along a plane perpendicular to the front-rear direction. FIG. 5(a) is a diagram showing the state of the large intestine model 30 in a state where the organ holding part is located relatively close to the anus holding part, and FIG. FIG. 3 is a diagram showing a state of the large intestine model 30 in a state where it is disposed at a position relatively far from the holding part. FIG. 6(a) is a diagram showing the internal configuration of the organ accommodating part and the motor accommodating part in the supine position, and FIG. 6(b) is a diagram showing the internal configuration of the organ accommodating part and the motor accommodating part in the left supine position. FIG. FIG. 2 is a diagram conceptually showing a control configuration in the medical simulator according to the present embodiment. FIG. 2 is a block diagram conceptually showing a software configuration realized by a control unit. It is a figure showing an example of a display at the time of training in a medical simulator concerning this embodiment. It is a figure showing an example of a display of training evaluation in a medical simulator concerning this embodiment. FIG. 3 is a diagram showing the inner wall surface of the large intestine model in this embodiment. FIG. 7 is a perspective view showing the appearance of a human body model section according to a modification. FIG. 7 is an exploded view of an organ accommodating part and a light shielding part in a human body model part according to a modified example, separated from each other. It is a figure which shows a part of display at the time of training in a modification.

Embodiments of the present invention will be described below with reference to the drawings. The embodiments listed below are illustrative, and the present invention is not limited to the configurations of the following embodiments.

FIG. 1 is a diagram conceptually showing the overall configuration of a medical simulator according to this embodiment.
The medical simulator according to the present embodiment (hereinafter sometimes abbreviated as the present simulator) mainly includes a human body model section 1 and a simulator control section 10, and is capable of training techniques related to colonoscopy. do.
The simulator control unit 10 is configured to control a medical simulator, and may be a so-called computer such as a PC (Personal Computer), an embedded system, or a control board. The detailed configuration of the simulator control unit 10 will be described later.

FIG. 2 is a perspective view showing the appearance of the human body model section 1 of the medical simulator according to the present embodiment.
As shown in FIG. 2, the human body model section 1 mainly includes an organ accommodating section 2, a motor accommodating section 7, and a base 9.
Hereinafter, in order to specify the relative positional relationship of each part of the human body model part 1, the vertical direction and horizontal direction shown in FIG. 2 will be used for convenience, and the direction perpendicular to these directions will be referred to as the front-back direction. . However, although the details will be described later, the organ storage section 2 can be oriented not only in the orientation shown in FIG. 2 (hereinafter sometimes referred to as supine position) but also in the orientation shown in FIG. In the description of the organ storage section 2, the left-right direction and the front-back direction are fixed regardless of the orientation of the organ storage section 2. Therefore, the left-right direction and the front-back direction used in the description of the organ storage unit 2 in the left lateral position are different from the left-right direction and front-back direction used in the description of the motor storage unit 7 and the base 9.
As described above, the directions described in this specification may not correspond to the upper and lower directions of the gravity direction, and do not limit the manner in which the medical simulator is used.

The organ storage section 2 is a box shaped like a substantially rectangular parallelepiped, and stores therein a large intestine model 30, which will be described later. Specifically, the organ storage section 2 is covered on all sides by a lower wall section 21, an upper wall section 22, a right side wall section 23, and a left side wall section 24, which are erected from the periphery of the dorsal side wall toward the ventral side. It is a hollow box whose vent side is closed with a window 25. The right side wall part 23 and the left side wall part 24 each extend from the dorsal side to the ventral side, and a part of the ventral side edge is curved in a direction in which both sides approach each other. Therefore, the ventral side of the organ storage section 2 is closed by a portion of the ventral side edges of the right side wall 23 and the left side wall 24 and a window 25 (corresponding to an abdominal wall cover).

Two cameras 6 are installed outside the organ housing section 2. Specifically, two camera support plates 61 extend obliquely forward from the lower wall 21 and left side wall 24 of the organ storage section 2, and the two cameras 6 are installed near their upper ends. It is being
Each camera 6 is supported by a camera support plate 61 at an angle that allows it to image the large intestine model 30 housed inside the organ housing section 2 through the window section 25. As a result, the cameras 6 are installed in directions perpendicular to each other in a plan view of the organ accommodating section 2 in the supine position viewed from the ventral side. In the following description, when simply written as "planar view", it means a planar view of the organ accommodating section 2 in the supine position viewed from the ventral side.
Each camera 6 may be any device that can capture images, and the images captured by each camera 6 (including still images and moving images) are not limited to visible light images, but also include infrared rays, ultraviolet rays, X-rays, etc. It goes without saying that the image may be an image of non-visible light.

The window portion 25 is formed using a transparent material so that the large intestine model 30 inside the organ housing portion 2 can be visually recognized from the outside. Thereby, the large intestine model 30 can be imaged through the window section 25 with the two cameras 6 provided outside the organ storage section 2 .
Here, it is preferable that a film capable of suppressing surface reflection be attached to the outer surface of the window portion 25. However, instead of using such a film, the window portion 25 may contain a material capable of suppressing surface reflection, or the outer surface of the window portion 25 may be coated with an agent capable of suppressing surface reflection. . Any known film, material, or agent can be used as long as it can suppress the reflection and reflection of external light while maintaining the visibility of the large intestine model 30 from the outside.
By including the member or material that suppresses surface reflection in the window section 25 in this way, reflection of external light, reflection, etc. at the window section 25 is suppressed in the image captured by the camera 6 through the window section 25. Therefore, it is possible to prevent the recognition accuracy of the large intestine model 30 from decreasing in the image.

Although the details will be described later (see FIG. 6), the organ accommodating section 2 has an upper end supported by the motor accommodating section 7 via an output shaft 75, and a dorsal side connected to the ventral side of the base 9 via a plurality of tire sections. It is supported by a support surface 91.
The tire parts 20a, 20b, and 20c are rotatably provided in the organ storage part 2. Specifically, the tire part 20a is provided at the vertical center of the corner where the right side wall part 23 and the back wall part connect so that a part of the tire part 20b protrudes outward. The tire portion 20c is provided at the right end of the back side end of the upper surface of the upper wall portion 22 so that a portion thereof protrudes outward, and the tire portion 20c is provided at the upper end of the right end portion of the upper surface of the upper wall portion 22 with a portion thereof protruding outward. It is set to protrude. A plurality of tire parts are also provided at locations not shown in FIG. 2 is swingably supported on the ventral side support surface 91 of the base 9.
The details of such rocking of the organ accommodating section 2 will be described later.

As described above, the base 9 supports the organ accommodating part 2 from the dorsal side and also holds the motor accommodating part 7. Note that the base 9 and the motor accommodating portion 7 may be integrally molded or may be separately molded so as to be connectable.
The motor accommodating section 7 is a box that is arranged above and adjacent to the organ accommodating section 2 and houses a body position changing motor 71 (see FIG. 7) that realizes the rocking of the organ accommodating section 2. Details of the motor accommodating portion 7 will be described later.

Hereinafter, the internal configuration of the organ storage section 2 will be explained using FIG. 3.
FIG. 3 is a schematic diagram showing the internal configuration of the organ accommodating section 2 according to this embodiment. FIG. 3 shows a state in which the organ accommodation section 2 is viewed from above.
The large intestine model 30 is a hollow tubular body that simulates the large intestine and includes the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. Therefore, the large intestine model 30 can also be called a luminal organ model. The large intestine model 30 includes a cecum region corresponding to the cecum, an ascending colon region corresponding to the ascending colon, a transverse colon region corresponding to the transverse colon, a descending colon region corresponding to the descending colon, a sigmoid colon region corresponding to the sigmoid colon, and the rectal region corresponding to the rectum.

Each part of the large intestine model 30, such as the cecum region and the ascending colon region, is shaped so that the shape of the inner wall defining the lumen is as close as possible to the shape of each part of the living body's large intestine imaged by the endoscope. has been done.
For example, in an endoscopic image of a living body's large intestine, color tone changes occur in the splenic curvature and hepatic curvature due to contact with other organs. Veteran doctors with advanced endoscopic techniques may be able to determine the location within the large intestine based on changes in color tone.
Therefore, the color tone of the hepatic curvature area corresponding to the hepatic curvature and the splenic curvature area corresponding to the splenic curvature in the large intestine model 30 is different from the color tone in the splenic curvature area and the hepatic curvature area in the endoscopic image captured within the lumen of the large intestine model 30. It is preferable to include a tone change area that causes a change. This color tone change occurs because the color tone reflected in the endoscopic image is different in the hepatic curvature region and the splenic curvature region from the surrounding wall surface.
The color tone changing region of the large intestine model 30 can be realized by various methods. For example, this can be achieved by coloring the outer surface or inner surface of the large intestine model 30 in the color tone change region in a different color from the other parts. This coloring may be achieved with paint or by overlapping materials of different colors. Furthermore, even if the color is the same, it can be realized by changing the thickness of the wall of the large intestine model 30 only in the color tone change area. Alternatively, it may be realized by irradiating the outer surface of the large intestine model 30 with a light source of an appropriate color such as an LED (Light Emitting Diode).
Further, it is preferable that a dentate line is simulated on the inner wall of the anal end of the large intestine model 30.

The large intestine model 30 is molded from a flexible material such as silicone rubber. Although the present embodiment does not limit the material of the large intestine model 30, it is preferable that the large intestine model 30 be molded to have flexibility close to that of an actual living body's large intestine.
Moreover, it is preferable that the large intestine model 30 is integrally molded without any joints.
In this way, the feel when the endoscope is inserted into the lumen of the large intestine model 30 can be made closer to the real thing, and as a result, realistic endoscopic technique simulation is possible.

The large intestine model 30 is locally (partially) fixed in the internal space of the organ housing part 2 so that each region, such as the ascending colon region and the transverse colon region, is arranged in the same manner as the large intestine in the abdominal cavity of the human body. It is housed in the condition. The large intestine model 30 has local fixation areas that can be fixed to the organ storage part 2 at different positions in the longitudinal direction, and internal observation by a person (referred to as a trainee) who receives training using this simulator. It can be described as including a movable region that can be displaced (operated) within the internal space of the organ storage section 2 by operating the mirror.
Here, "can be in a state of being fixed to the organ containing part 2" means not only being completely fixed inside the organ containing part 2, but also being fixed to the organ containing part 2. This is a meaning that includes the possibility of being in both a state where this is not the case.
In this embodiment, the locally fixed regions of the large intestine model 30 include an anal end region held by the anus holding part 31, a region held by the organ holding part 32, a splenic curvature area corresponding to the splenic curvature, and a hepatic curvature. These are the corresponding hepatic curvature region and cecal region, and the other regions are considered to be movable regions. However, the locations where the large intestine model 30 is fixed to the organ storage section 2 are not limited to the locations shown in this embodiment.

Furthermore, a plate (not shown) is provided inside the organ housing section 2 to divide the internal space into a ventral side and a dorsal side. That is, the internal space of the organ housing section 2 is divided by this plate into a ventral internal space and a dorsal internal space, and the large intestine model 30 is accommodated in the ventral internal space. Since this plate forms the dorsal wall of the ventral internal space in which the large intestine model 30 is accommodated, it will be hereinafter referred to as a dorsal plate.
As will be described later, in the dorsal internal space, there are a group of motors that realize the sliding of the organ holding part 32, the first sliding wall part 35, the second sliding wall part 34, etc., as well as power conversion and deceleration of each motor. It is equipped with various mechanisms to do this.
Note that the shape of the back plate is not limited, and for example, it may have a flat plate shape or may be curved.

In addition, in this embodiment, as shown in FIG. 3, a plurality of marker rings 43 are arranged in the axial direction of the large intestine model 30 in the region between the anus holding part 31 and the organ holding part 32 in the large intestine model 30. They are placed in separate locations. These marker rings 43 are provided to detect displacement or deformation of the target region of the large intestine model 30, although the details will be described later.
As used herein, "displacement of a target site" means a change in the position of a target site.
In addition, "deformation of the target region" means a change in the shape of the target region, including bending deformation, stretching deformation (extension deformation or shortening deformation in the longitudinal direction), and torsional deformation (rotation around the longitudinal direction). It shall include one or more of twisting (twisting like squeezing a rag), loop deformation (deformation forming a loop shape in the longitudinal direction), etc.
Each marker ring 43 is wound around the outside of the large intestine model 30 in a circumferential manner, and a portion of the inner surface of each marker ring 43 and a portion of the outer surface of the large intestine model 30 are adhered. By partially bonding each marker ring 43 to the outer surface of the large intestine model 30 in this manner, it is possible to prevent each marker ring 43 from inhibiting the elasticity of the large intestine model 30.

Further, a marker is arranged on the outer surface of each marker ring 43. In this embodiment, a predetermined pattern image (also called an AR (Augmented Reality) marker) is used as the marker. However, the marker may be any mark that can be recognized from the image captured by the camera 6, and may be a characteristic structure, shape, color, light emitting body, etc. provided on the outer surface of the large intestine model 30.
Furthermore, in this embodiment, on the outer surface of each marker ring 43, a plurality of markers are arranged in a line over the entire circumference. Thereby, even if the large intestine model 30 is twisted during an endoscopic procedure, the marker can be reliably recognized from the image. However, only one marker may be arranged in each marker ring 43, or two or more markers may be arranged only in a part of the entire circumference.

Further, the plurality of markers arranged on one marker ring 43 may be different markers. According to this embodiment, the plurality of markers placed on one marker ring 43 may have different pattern images. In this way, the twisted state and looped state of the large intestine model 30 can be determined from the image in which the marker is captured.

Further, in the present embodiment, the marker ring 43 in which a plurality of markers are arranged in a circular line is provided around the outside of the large intestine model 30; however, the plurality of markers may be printed on the outer surface of the large intestine model 30. Alternatively, they may be attached individually. That is, it can be written that a plurality of markers are arranged at positions spaced apart in the axial direction of the large intestine model 30 on the outer periphery or outer surface of at least a portion of the movable region of the large intestine model 30.
In addition, in this embodiment, markers (holding section markers 41 and 42) are also provided on the upper surfaces of the anus holding section 31 and the organ holding section 32, respectively.
A method of detecting displacement or deformation of a target region of the large intestine model 30 using such a marker will be described later.

The anus holding portion 31 is attached to the inner surface (upper surface) of the lower wall portion 21 at the center in the left-right direction and toward the back side in the front-back direction. The anus holding part 31 is made of a material such as plastic that is harder than the material of the large intestine model 30, and has a substantially cubic shape with rounded corners, the lower surface of which is the inner surface of the lower wall part 21. It is attached to the organ accommodating part 2 in a state of being in contact with it.
When indicating the direction in the description of the anus holding part 31, the direction in which the anus holding part 31 is attached to the organ accommodating part 2 will be used.

FIG. 4 is a cross-sectional view of the anus holding part 31 taken along a plane orthogonal to the front-rear direction.
The anus holding part 31 has a through hole 310 that penetrates in the vertical direction. On the other hand, a through hole (not shown) is also provided in the lower wall part 21 of the organ accommodating part 2, and when the anus holding part 31 is attached to the organ accommodating part 2, the through hole of the lower wall part 21 is formed. and the through hole 310 of the anus holding part 31 are in communication.

The large intestine model 30 is held in the anus holding section 31 with the anus end region inserted into the through hole 310 thereof. The large intestine model 30 is held in the anus holding part 31 by joining the outer peripheral surface of the anus-side end region inserted into the through hole 310 and the inner wall surface of the anus holding part 31 that defines the through hole 310. or may be held in the anal holding part 31 by other methods. For example, a flange lid part protruding from the outer peripheral surface of the large intestine model 30 is provided at the anus side end of the large intestine model 30, and the anal side end area of the large intestine model 30 is connected to the through hole 310 of the anus holding part 31 and the organ storage. The flange lid portion may be inserted into a through hole in the lower wall portion 21 of the organ storage portion 2 so as to engage with the outer surface (lower surface) of the lower wall portion 21 of the organ storage portion 2 . When held in this manner, the lower wall portion 21 of the organ accommodating portion 2 can also be referred to as an anus holding portion 31. In this way, the structure for holding the anus-side end region of the large intestine model 30 by the anus holding section 31 is not limited in any way.

The inner wall surface defining the through hole 310 in the anus holding part 31 includes a part of the tapered wall surface part 311, as shown in FIG.
The tapered wall portion 311 is formed such that the cross-sectional area of the through hole 310 gradually increases upward (toward the upper surface of the anus holding portion 31).
The "cross-sectional area of the through-hole 310" here means the area of the through-hole 310 when the through-hole 310 is cut along a plane perpendicular to the axial direction, and the area of the through-hole 310 is It is defined by the inner wall surface of the section 31.
In this embodiment, the inner wall surface of the anus holding part 31 includes an inner wall surface that is not tapered in a small range upward from the lower opening 312 of the through hole 310, but all of the inner wall surface is a tapered wall surface. 311.

The tapered wall portion 311 has a first wall portion 316 that has a steeper slope from the lower end (lower wall end portion 313) to the upper end (upper wall end portion 314) of the tapered wall portion 311, and the slope thereof is steeper than that of the first wall portion 316. includes a gentle second wall surface portion 315.
The first wall portion 316 and the second wall portion 315 are at least located at opposing positions in the through hole 310 when viewed in the axial direction. Specifically, the first wall portion 316 is present on the left side of the tapered wall portion 311, and the second wall portion 315 is present on the right side of the tapered wall portion 311.
This makes it possible to prevent the endoscope inserted from the anus into the lumen of the large intestine model 30 from moving in a direction different from the direction in which the large intestine extends (counterclockwise), thereby improving endoscopic procedures. To enable efficient training without making training unnecessarily difficult.

The organ holding part 32 is made of a material that is harder than the material of the large intestine model 30, such as plastic. Furthermore, the organ holding section 32 has a through hole in the vertical direction, and holds the region of the large intestine model 30 that is inserted through the through hole. Specifically, the outer peripheral surface of the region of the large intestine model 30 that is inserted into the through hole of the organ holding part 32 and the inner wall surface of the organ holding part 32 that defines the through hole are joined, so that the large intestine model 30 That area is held in the organ holding part 32.
The area held by the organ holding part 32 in the large intestine model 30 may be part of the descending colon area and the sigmoid colon area. In this embodiment, an area near the anus in the descending colon area is held by the organ holding part 32. Therefore, in this embodiment, the area held by the organ holding part 32 of the large intestine model 30 may be referred to as a descending colon holding area.

The organ holding part 32 is slidably supported by the organ accommodating part 2. Specifically, the organ holding part 32 is slidable along the extending direction of the guide rail 33 provided on the inner surface of the right side wall part 23 of the organ holding part 2, using a support mechanism (see FIG. (not shown). The support mechanism of the organ holding part 32 is not limited at all. The organ holding part 32 may be supported by being slidably engaged with the guide rail 33.
Here, the guide rail 33 extends in the vertical direction along the inner surface of the right side wall portion 23. Therefore, as the organ holding part 32 slides, the straight line distance from the organ holding part 32 to the anus holding part 31 changes. In addition, in a plan view of the organ storage section 2 (see FIG. 3), the line formed between the inner surface of the lower wall section 21 to which the lower end surface of the anus holding section 31 joins and the straight line connecting the anus holding section 31 and the organ holding section 32 The angle (hereinafter referred to as the angle of the anus holding part 31 and the organ holding part 32) is also changing.

FIG. 5 is a diagram showing the relationship between the distance between the anus holding part 31 and the organ holding part 32 and the state of the large intestine model 30 therebetween. 5(a) shows a state in which the organ holding part 32 is arranged relatively close to the anus holding part 31, and FIG. 5(b) shows a state in which the organ holding part 32 is arranged relatively close to the anus holding part 31. indicates that it is located far away.
While the linear distances D1 and D2 from the organ holding part 32 to the anus holding part 31 change due to the sliding of the organ holding part 32, the length from the anal side end area to the descending colon holding area in the large intestine model 30 (in the longitudinal direction L1 and L2 are constant. That is, although the distances D1 and D2 are different from each other, the lengths L1 and L2 of the large intestine model 30 are the same.
Moreover, the angles of the anus holding part 31 and the organ holding part 32 also change as the organ holding part 32 slides.
Therefore, as shown in FIG. 5, by sliding the organ holding part 32, the linear distance, the angle, or both change, and the distance between the anal end area and the descending colon holding area in the large intestine model 30 changes. The degree of slack or degree of bending changes.
Here, if the degree of slackness or degree of curvature of the large intestine model 30 is small, the endoscope inside the lumen of the large intestine model 30 will be relatively easy to operate; Mirror operation becomes relatively difficult.
That is, according to the above-described configuration, the difficulty level of endoscopic technique training can be changed.

Here, the sliding range of the organ holding part 32 is defined as the length from the anal end area of the large intestine model 30 to the area held by the organ holding part 32 (L1, L2, etc. in FIG. 5) from the anus holding part 31. It is preferable to include a position that is twice the distance to the organ holding part 32 (D1, D2, etc. in FIG. 5). Further, the ratio of the length from the anal end region to the region held by the organ holding part 32 to the length from the anal end region to the splenic curvature region in the large intestine model 30 is 1/2 or more and 10 minutes. It is preferable that the number is 7 or less.
The present inventors, including a veteran doctor with advanced endoscopic techniques, have repeatedly manufactured a prototype of the organ holding part 2 and verified the prototype by the veteran doctor, thereby improving the relationship between the organ holding part 32 and the anus holding part 31. They have found the above-mentioned relationship between the distance between them and the state of the large intestine model 30 between them, which approximates the sensation obtained by endoscopic procedures on an actual human body.
In other words, by including the above-mentioned positions in the sliding range of the organ holding part 32, the difficulty level of training for endoscopic procedures can be varied, while realistically reproducing the feeling of endoscopic procedures on the human body and achieving high precision. Training can be made possible.

In this embodiment, the sliding of the organ holding part 32 is realized using the power of a motor housed in the dorsal internal space of the organ holding part 2. The sliding of the organ holding part 32 can be realized, for example, by the following configuration. A rotating shaft of the motor extends in a direction perpendicular to the extending direction of the guide rail 33, and a toothed drive pulley is attached directly or indirectly to the rotating shaft, and a toothed drive pulley is rotatably supported. A toothed timing belt is stretched between the driven pulley and its driving pulley in parallel to the direction in which the guide rail 33 extends. The organ holding part 32 is attached directly or indirectly to the engaging member that engages with a part of the timing belt. According to this configuration, the rotational power of the motor is converted into power for linear movement in the extending direction of the guide rail 33, so that the organ holding part 32 can slide along the guide rail 33.
For this reason, the organ holding part 32 is in a sliding state in which it can slide relative to the anus holding part 31 and the organ holding part 32 that hold the anus end area of the large intestine model 30, and in a fixed state in which it is fixed to the organ holding part 2. It can be said that the state is switchable between the two states.

However, the structure for realizing the sliding of the organ holding part 32 is not limited to such a structure, and any structure may be used as long as the rotational power of the motor is converted into the power for linear movement in the extending direction of the guide rail 33.
Note that the control details regarding the sliding of the organ holding section 32 will be described later.
Further, in this embodiment, the sliding of the organ holding part 32 is realized using the power of a motor, but it may be performed manually. In this case, the organ holding part 32 is in a sliding state in which it is slidable relative to the organ holding part 2 (including the anus holding part 31 fixed to the organ holding part 2) and fixed to the organ holding part 2. It suffices if it is provided so that it can be switched between the fixed state and the fixed state. For example, the organ holding part 32 is fixed to the organ accommodating part 2 by the locking mechanism, and the organ holding part 32 can be made slidable relative to the organ accommodating part 2 by releasing the locking mechanism.

Furthermore, the organ storage section 2 includes a first slide wall section 35 molded from a hard material such as plastic in the ventral internal space.
The first sliding wall portion 35 is located approximately in the center of the ventral internal space of the organ storage portion 2 in the horizontal and vertical directions, and is located below the storage position of the transverse colon region of the large intestine model 30 and between the anus holding portion 31 and the anus holding portion 31 . It is located above the storage position of the rectal region of the large intestine model 30, and is supported by the dorsal plate so as to be slidable in the vertical direction. Specifically, the first slide wall portion 35 is slidable along the extending direction of a guide rail 36 provided on the ventral surface of the dorsal plate. (not shown). The support mechanism for the first slide wall portion 35 is not limited at all. The first slide wall portion 35 may be supported by a support mechanism that is slidably engaged with the guide rail 36.
Here, the guide rail 36 extends in the vertical direction along the ventral surface of the dorsal plate. Therefore, the first slide wall portion 35 is slidable in the direction approaching the anus holding portion 31 and in the direction away from the anus holding portion 31.

When insertion becomes difficult during a colonoscopy procedure, a caregiver such as a nurse may support the insertion of the endoscope by compressing the abdomen (also called manual compression). In this embodiment, a first sliding wall portion 35 is provided to simulate this abdominal compression. For this reason, the first slide wall portion 35 can also be called an auxiliary wall portion.
The first sliding wall portion 35 has at least a downwardly facing wall surface having a curved shape in which the center in the left and right direction protrudes upward when viewed from the ventral side, and when simulating abdominal compression, the first sliding wall portion 35 has an anus support. It is fixed at a position close to the section 31. As a result, a part of the sigmoid colon region (for example, the top called S-top) of the large intestine model 30, which has been straightened upward by inserting the endoscope into the lumen, is directed downward to the first slide wall 35. By coming into contact with the wall of the endoscope, the insertion direction of the endoscope is guided.
On the other hand, in a state where abdominal compression is not performed, the first slide wall 35 is fixed in a position separated from the anus holding part 31, so that the first slide wall 35 is placed in a position where it is difficult to come into contact with the large intestine model 30. can be placed.
As described above, according to the present embodiment, abdominal compression (manual compression) by an assistant can be simulated.

In this embodiment, the sliding of the first sliding wall portion 35 is realized using the power of a motor housed in the dorsal internal space of the organ accommodating portion 2 . The sliding of the first sliding wall portion 35 can be realized, for example, with a configuration similar to that of the organ holding portion 32. A rotating shaft of the motor extends in a direction perpendicular to the extending direction of the guide rail 36, and a toothed drive pulley is attached directly or indirectly to the rotating shaft, and a toothed drive pulley is rotatably supported. A toothed timing belt is stretched between the driven pulley and its driving pulley in parallel to the direction in which the guide rail 36 extends. The first sliding wall portion 35 is attached directly or indirectly to the engaging member that engages with a portion of the timing belt. According to this configuration, the rotational power of the motor is converted into power for linear movement in the extending direction of the guide rail 36, so that the first slide wall portion 35 can slide along the guide rail 36.
Even in such a configuration, the first sliding wall part 35 can be switched between a sliding state in which it can slide in a direction in which the distance to the anus holding part 31 changes and a fixed state in which it is fixed to the organ storage part 2. It can be said that it has become.

However, the configuration for realizing the sliding of the first slide wall portion 35 is not limited to such a configuration, and any configuration may be used as long as the rotational power of the motor is converted into power for linear movement in the extending direction of the guide rail 36. .
Note that the control details regarding the sliding of the first sliding wall portion 35 will be described later.
Further, in this embodiment, the sliding of the first sliding wall portion 35 is realized using the power of a motor, but it may be performed manually. In this case, the first sliding wall portion 35 is provided so as to be switchable between a sliding state in which it can slide in a direction in which the distance to the anus holding portion 31 changes and a fixed state in which it is fixed to the organ storage portion 2. All you have to do is stay there. For example, the first sliding wall portion 35 is fixed to the organ accommodating portion 2 by the locking mechanism, and the first sliding wall portion 35 is slidable relative to the organ accommodating portion 2 by releasing the locking mechanism. It can be said that

Here, a first wire member 37 is connected to the outer surface of the sigmoid colon region of the large intestine model 30. In this embodiment, the first wire member 37 is connected to a position corresponding to the top (S-top) of the sigmoid colon region of the large intestine model 30, and plays the role of returning the top to the initial position. The region of the large intestine model 30 to which the first wire member 37 is connected may be referred to as the wire connection region of the sigmoid colon region.
The first wire member 37 may be any variable length member that can return the connecting portion (S-top) to the initial position while allowing displacement of the connecting portion (S-top) with the large intestine model 30. The first wire member 37 may be made of a stretchable material or may be made of a non-stretchable material.

In this embodiment, the first wire member 37 does not realize a variable length with its own material, but with a set with a wire reel (not shown) that winds the first wire member 37. It has been realized. Therefore, the first wire member 37 and the wire reel correspond to variable length members. That is, in this embodiment, the organ storage section 2 includes a wire reel (not shown) that winds up the first wire member 37. The wire reel is set in a state in which the first wire member 37 is fed out when the wire connection site in the sigmoid colon region of the large intestine model 30 is at the initial position, and is in the maximum winding state, and is further fed out from the maximum winding state. The spring member urges the first wire member 37 to be wound up to the maximum winding state.

Furthermore, the wire reel is equipped with a sensor (such as a potentiometer) that detects the amount of rotation of the wire reel from the maximum winding state.As will be described in detail later, the amount of rotation detected by this sensor This makes it possible to detect the displacement of the wire connection site in the sigmoid colon region of the large intestine model 30.
In this way, the area including the wire connection site in the sigmoid colon area of the large intestine model 30 that is connected to the first wire member 37 is not fixed and can be displaced, but tension is applied so as to return to the initial position. Therefore, it can also be called a specific movable region of the large intestine model 30.

Furthermore, the organ storage section 2 includes a second sliding wall section 34 formed of a hard material such as plastic in the ventral internal space.
As shown in FIG. 3, the second sliding wall section 34 is erected with a downward wall surface above the accommodation position of the transverse colon region of the large intestine model 30 in the ventral internal space of the organ accommodation section 2. has been done. The second slide wall section 34 is supported by the organ storage section 2 in a state in which it can slide downward along the extending direction of guide rails provided on the inner surface of the right side wall section 23 and the inner surface of the left side wall section 24, respectively. There is. The second slide wall portion 34 is supported by support mechanisms (not shown) provided on the inner surface of the right side wall portion 23 and the inner surface of the left side wall portion 24. However, the supporting mechanism of the second slide wall portion 34 is not limited at all. The second slide wall portion 34 may be supported by a support mechanism that is slidably engaged with guide rails provided on the inner surface of the right side wall portion 23 and the inner surface of the left side wall portion 24, respectively. good.

Similar to the abdominal compression described above, when inserting a colonoscope becomes difficult, having the subject (patient) take a deep breath may make it easier to insert the endoscope. By having the patient take a deep breath, the diaphragm lowers, resulting in lower hepatic and splenic curvatures. In this embodiment, the second sliding wall portion 34 is provided to simulate the state of the transverse colon when the subject takes a deep breath.
The second slide wall portion 34 has at least a downward wall surface that is wide in the left-right direction from the vicinity of the inner surface of the right side wall portion 23 to the vicinity of the inner surface of the left side wall portion 24 . This wall surface of the second slide wall portion 34 is curved in a downwardly convex manner at both left and right ends.
The second sliding wall portion 34 slides downward when simulating a state of taking a deep breath, and otherwise is disposed upward.
Accordingly, as the second slide wall portion 34 is slid downward, at least the splenic curvature region and the hepatic curvature region of the large intestine model 30 are also displaced downward. It is possible to realistically simulate the movement of the large intestine while a person takes a deep breath.

By the way, in this embodiment, the outer surfaces of the splenic curvature region and the hepatic curvature region of the large intestine model 30 are fixed to the downward wall surface of the second slide wall portion 34. For example, the outer surfaces of the splenic curvature region and hepatic curvature region and the wall surface of the second slide wall portion 34 may be connected and fixed with a connecting member such as a hook-and-loop fastener or a snap button, or may be bonded with an adhesive or the like. You can.
With this configuration, the splenic curvature region and hepatic curvature region of the large intestine model 30 can be reliably displaced downward together with the sliding of the second slide wall portion 34.
However, if the splenic curvature region and hepatic curvature region of the large intestine model 30 can be displaced downward as the second slide wall section 34 slides, they will not be fixed to the wall surface of the second slide wall section 34 in this way. Good too.

Furthermore, in this embodiment, the sliding of the second sliding wall portion 34 is realized using the power of a motor housed in the dorsal internal space of the organ accommodating portion 2 . The sliding of the second sliding wall portion 34 can be realized, for example, by a configuration similar to that of the first sliding wall portion 35. For this reason, detailed explanation will be omitted, but the rotational power of the motor is applied in the extending direction of the guide rail (provided on the inner surface of the right side wall portion 23 and the inner surface of the left side wall portion 24) in the engaging member that engages with the timing belt. By converting the power into linear motion, the second slide wall portion 34 can slide downward along the guide rail.
With this configuration, the second sliding wall 34 can be switched between a sliding state in which it can slide downward relative to the organ accommodating section 2 and a fixed state in which it is fixed relative to the organ accommodating section 2. I can say it.

However, the configuration for realizing the sliding of the second sliding wall portion 34 is not limited to such a configuration, and any configuration may be used as long as the rotational power of the motor is converted into the power for linear movement in the vertical direction.
Note that the control details regarding the sliding of the second sliding wall portion 34 will be described later.
Further, in this embodiment, the sliding of the second sliding wall portion 34 is realized using the power of a motor, but it may be performed manually. In this case, the second sliding wall 34 is provided so as to be switchable between a sliding state in which it can slide downward relative to the organ accommodating section 2 and a fixed state in which it is fixed relative to the organ accommodating section 2. good. For example, the second sliding wall portion 34 is fixed to the organ accommodating portion 2 by the locking mechanism, and the second sliding wall portion 34 is slidable relative to the organ accommodating portion 2 by releasing the locking mechanism. It can be said that

A second wire member 38 is connected to the outer surface of the transverse colon region of the large intestine model 30, as shown in FIG. In this embodiment, the second wire member 38 is connected to the longitudinal center of the transverse colon region of the large intestine model 30, and plays the role of pulling the connected portion downward. The region of the large intestine model 30 to which the second wire member 38 is connected may be referred to as a wire connection region in the transverse colon region.
The second wire member 38 pulls the central part of the transverse colon region of the large intestine model 30 downward in the longitudinal direction even in the normal state where the second slide wall part 34 is located upward, so that the curvature of the transverse colon in the living body is can be realistically reproduced.

The second wire member 38 may not be a variable length member or may be a variable length member. When the second wire member 38 is a variable length member, it may have the same configuration as the first wire member 37. That is, the first wire member 37 may be made of a stretchable material or may be made of a non-stretchable material. Further, the organ storage section 2 may include a wire reel for winding up the second wire member 38, and the wire reel and the second wire member 38 may form a variable length member. The configuration of the wire reel is as described above. When the second wire member 38 is a variable length member, similarly to the first wire member 37, the displacement of the wire connection site in the transverse colon region of the large intestine model 30 can be detected based on the amount of rotation of the wire reel detected by the sensor. It may be .

Incidentally, a variable length member such as the first wire member 37 may be connected to the outer surface of the large intestine model 30 at a location other than the wire connection site described above.
For example, a variable length member may be connected to a portion of the large intestine model 30 that corresponds to the sigmoid colon descending colon transition region (hereinafter referred to as SDJ). In this way, it is possible to return the part corresponding to the SDJ in the large intestine model 30 to the initial position while making it possible to displace the part. Furthermore, displacement of a portion corresponding to the SDJ can be detected.

The cecum region of the large intestine model 30 is also a locally fixed region and is fixed to the organ housing section 2. For example, the cecal region may be fixed via a holding mechanism supported by the dorsal plate of the organ storage section 2, or the cecal region and the dorsal plate may be connected by a hook-and-loop fastener, snap button, or the like. They may be connected and fixed with a member, or may be bonded with an adhesive or the like.

It is preferable that the large intestine model 30 is removable from the organ housing section 2 . In this way, when multiple types of colon models 30 with different shapes and sizes or diseases such as polyps are provided, just as the colons of living organisms have individual differences in length and thickness, the organ A plurality of types of large intestine models 30 can be exchanged and used for the storage section 2. As a result, it is possible to train colonoscopy techniques for various subjects.
In this case, the anus holding part 31 and the organ holding part 32 may also be made detachable from the organ holding part 2 together with the large intestine model 30, or the anus holding part 31 and the organ holding part 32 may be left in the organ holding part 2 while remaining in the organ holding part 2. , only the large intestine model 30 may be removable.

Next, the internal structure of the motor accommodating section 7 and the swinging of the organ accommodating section 2 will be described using FIG. 6.
FIG. 6 is a diagram showing the internal structure of the motor accommodating part 7 and the rocking of the organ accommodating part 2, and FIG. FIG. 6(b) shows the internal structure of the organ accommodating part 2 and the motor accommodating part 7 in the left lateral recumbent position.

As shown in FIGS. 6(a) and 6(b), the motor accommodating portion 7 supports a motor holding portion 72 therein.
The motor holding part 72 holds the body position changing motor 71, and an output shaft 75 that is driven using the rotational power of the body position changing motor 71 protrudes from the motor holding part 72.
The output shaft 75 protrudes from a shaft hole 78 in an adjacent wall 77 (lower wall) of the motor accommodating part 7 toward the organ accommodating part 2, and its tip is connected to the upper surface of the upper wall 22 of the organ accommodating part 2. It is fixed approximately in the center.
As a result, when the output shaft 75 is driven by the rotational power of the body position changing motor 71, the organ accommodating section 2 has a plurality of tire sections (20a, 20b, 20c) rotatably provided in the organ accommodating section 2. etc.), while being supported by the ventral support surface 91 of the base 9, it swings together with its output shaft 75. As a result, the organ storage section 2 is moved from the supine position shown in FIG. 6A to the tire sections 20a and 20b (in other words, the right side wall section 23 and The patient rotates 90 degrees around the boundary edge (corner) with the dorsal wall, and transitions to the left lateral decubitus position shown in FIG. 6(b). In the left lateral position, the tire portions 20a, 20b, and 20c are in contact with the ventral support surface 91 of the base 9 (not shown).
As described above, according to the present embodiment, it is possible to simulate a change in body position by swinging the organ accommodating section 2 that simulates the abdomen of a human body.
Furthermore, since the organ storage section 2 is supported upwardly by the output shaft 75, and its side surfaces (dorsal side and right side) are supported by the ventral support surface 91 of the base 9 via a plurality of tire sections, Stable rocking of the organ housing section 2 can be realized, and occurrence of damage or failure due to rocking of the organ housing section 2 can be suppressed. Note that the control details of the body position change motor 71 that simulates such a body position change will be described later.

Here, when the organ accommodating section 2 swings on the ventral support surface 91 of the base 9 as described above, the output shaft 75 fixed on the upper end wall 22 of the organ accommodating section 2 The swinging power of the section 2 causes it to move at least in the front-rear direction shown in FIG. In this embodiment, since the output shaft 75 is rotatably held by the motor holding part 72, as the organ storage part 2 swings from the supine position to the left lateral position due to the drive of the output shaft 75, , the motor holding part 72 moves at least forward, and as the organ storage part 2 swings from the left supine position to the supine position by the drive of the output shaft 75, the motor holding part 72 moves at least backward.
Therefore, in this embodiment, the motor accommodating part 7 supports a motor holding part 72 slidably in the front and rear directions inside thereof, as shown in FIGS. 6(a) and 6(b). Specifically, the motor accommodating part 7 has a pair of guide rails 73 extending in the front-rear direction inside, and the motor holding part 72 is connected to the motor holding part 72 through engagement members provided on both left and right sides. It is slidably engaged with the pair of guide rails 73.
In this way, the motor holding part 72 that holds the body position changing motor 71 and the output shaft 75 is supported inside the motor housing part 7 so as to be slidable in the front-back direction, thereby realizing smooth rocking of the organ housing part 2. be able to.

[Control configuration]
Next, the control configuration in this simulator will be explained using FIG. 7.
FIG. 7 is a diagram conceptually showing a control configuration in the medical simulator according to this embodiment.
As shown in FIG. 7, this simulator has a simulator control unit (hereinafter abbreviated as control unit) 10, an input/output panel 15, a microphone 16, a motor group 17, a sensor group 18, etc. as components related to control. However, as described above, the control of this simulator is executed by the control unit 10. However, this simulator may have other control configurations not shown in FIG. 7.

The control unit 10 has a CPU (Central Processing Unit) 11, a memory 12, an input/output interface (I/F) unit 13, and the like as a hardware configuration.
The CPU 11 may be one or more general CPUs or MPUs (Micro Processing Units), or alternatively or together with them, may be application specific integrated circuits (ASICs), DSPs (Digital Signal Processors), or GPUs (Graphics Processing Units). unit), FPGA (Field Programmable Gate Array), etc.
The memory 12 is a RAM (Random Access Memory) and a ROM (Read Only Memory), and may include an auxiliary storage device (such as a hard disk).
The input/output I/F unit 13 is a device that controls the input or output of signals to be processed or processed by the CPU 11, and includes an input/output panel 15, user interface devices such as a microphone 16, a motor group 17, and a sensor group 18. etc. Furthermore, the input/output I/F unit 13 may include a communication unit that communicates with other computers and devices, and may also be connected to a portable recording medium or the like.
The control unit 10 may include hardware elements not shown in FIG. 7, and the hardware configuration of the control unit 10 is not limited.

The input/output panel 15 includes a display device for displaying training menus, operation modes, evaluation results, etc., and an input device for operating the screen displayed on the display device. The input/output panel 15 may be realized as a touch panel in which a display device and an input device are integrated.
In this embodiment, the content displayed on the input/output panel 15 is not limited in any way. In this embodiment, for example, operation buttons that allow selection of start and stop of training, a display of elapsed time of training, a menu for selecting the difficulty level of training, evaluation results, etc. are displayed. Display examples output to the input/output panel 15 will be described later.
The microphone 16 is a microphone and converts the collected sound into an electrical signal.

The motor group 17 includes at least three motors for realizing each slide of the organ holding part 32, the first sliding wall part 35, and the second sliding wall part 34, and a body position changing motor 71.
Each motor included in the motor group 17 may be an electric motor that converts electrical energy into mechanical energy, and may be a DC motor, an AC motor, or any other motor. good. Hereinafter, each motor included in the motor group 17 may be collectively referred to as the motor 17 without being distinguished from each other.

The sensor group 18 is a plurality of various sensors provided inside the model 30, outside the model (outer surface or inner wall surface), or other configurations, and detects the state of the endoscopic procedure at each position. .
For example, the sensor group includes an object detection sensor that is provided in a locally fixed region (anal end region, descending colon holding region, splenic curvature region, hepatic curvature region, and cecum region) in the large intestine model 30 and detects the presence of an endoscope. Included in 18. In this embodiment, photoelectric sensors as object detection sensors are installed in the anus holding part 31, the organ holding part 32, and the holding mechanism (not shown) that holds the cecum region, respectively. However, as long as the object detection sensor can detect the presence of an endoscope passing through the lumen of the large intestine model 30, there are no limitations on its specific type or detection principle, and there are no limitations on its installation location. .
Further, the sensor group 18 may include a pressure sensor that detects pressure against the downward wall surface of the first slide wall portion 35 or the second slide wall portion 34.
Furthermore, the sensor group 18 may include an atmospheric pressure sensor that detects the atmospheric pressure within the lumen of the large intestine model 30.

By executing the control program stored in the memory 12 by the CPU 11, the control unit 10 receives input signals from the sensor group 18 and the microphone 16, and controls the motor group 17, the display control of the input/output panel 15, etc. I do.
The control program may be stored in advance at the time of shipment, or may be transmitted from a portable recording medium such as a CD (Compact Disc), a memory card, etc. or from another computer on the network via the input/output I/F unit 13. It may also be installed and stored in the memory 12.

FIG. 8 is a block diagram conceptually showing the software configuration realized by the control unit 10. As shown in FIG.
By executing the control program stored in the memory 12 by the CPU 11, the control unit 10 realizes a software configuration as shown in FIG. Specifically, the control unit 10 includes, as a software configuration, an organ state detection module (hereinafter sometimes abbreviated as a detection module) 101, a mode management module 102, a speech processing module 103, a measurement module 104, and an evaluation module 105. etc.
However, since each software component shown in FIG. 8 is conceptually shown separately for convenience of explanation, the software configuration realized by the control unit 10 is as shown in FIG. It does not have to be clearly divided into each component.

The detection module 101 detects displacement or deformation of a target region that is at least a part of the movable region of the large intestine model 30 housed in the organ housing section 2 . In this embodiment, the region between the anus holding part 31 and the organ holding part 32 in the large intestine model 30 is the target region.
Here, the "displacement of the target region" detected by the detection module 101 means a change in the position of the target region, as described above. Therefore, "detection of displacement of the target part" includes either acquiring the three-dimensional position or two-dimensional position of the target part, or detecting a change in the position of the target part in three-dimensional space or two-dimensional space. Either or both are included.
In addition, as mentioned above, "deformation of the target region" includes bending deformation, stretching deformation (extension deformation or shortening deformation in the longitudinal direction), and torsion deformation (rotational twisting around the longitudinal direction) of the target region. (twisting like squeezing a rag)), loop deformation (deformation forming a loop shape in the longitudinal direction), etc.

In this embodiment, the detection module 101 acquires image data inside the organ storage section 2 captured by the two cameras 6, and recognizes a marker image from this image data, thereby determining the bending state of the target region. Any one or more of a stretched state, a twisted state, and a looped state can be detected.
Here, the "bent state" means a state of bending deformation, and can be indicated by, for example, the degree of bending, the bending angle, the number of bent parts, etc.
"Stretching state" means a state of stretching deformation or shortening deformation in the length in the longitudinal direction, such as the degree of stretching or shortening, the stretching rate or shortening rate (ratio of the changed length to the original length), It can be indicated by the number of points that are elongated or shortened, etc.
"Twisted state" means a state of torsional deformation, which is determined by the degree of rotational twisting (twisting like squeezing a rag) about the longitudinal direction of the large intestine model 30, the number of twists (rotation speed), etc. can be shown.
The "loop state" means a state of loop deformation that forms a loop shape in the longitudinal direction of the large intestine model 30, and can be indicated by the type of loop shape, the number of loops, the size of the loop, etc. Here, when inserting an endoscope into the sigmoid colon, transverse colon, etc. in a colonoscopy procedure, there is a procedure in which a loop shape is created and the endoscope is inserted. Such loop shapes may include types of loop shapes called α loops, reverse α loops, γ loops, reverse γ loops, N loops, M loops, and the like. The detection module 101 may detect such a type of loop shape as a loop state.

In this embodiment, since the posture parameters of the two cameras 6 can be accurately maintained, the three-dimensional image of each marker is Original location information can be obtained. As a result, the three-dimensional position of each marker ring 43 can be obtained, and as a result, shape information such as a bent state, a stretched state, a twisted state, a looped state, etc. can be detected regarding the target region.
However, even if the three-dimensional position information of each marker is not acquired, it is possible to detect the bent state, expanded/contracted state, twisted state, looped state, etc. of the target region. For example, markers of different colors or shapes are placed on the front surface, the back surface, and the middle of the target region of the large intestine model 30 housed in the organ housing section 2, respectively. Thereby, based on the reflected state of each marker in the captured images from the two cameras 6, it is possible to detect the bent state, expanded/contracted state, twisted state, looped state, etc. of the target region. Patterns of the number of recognized markers indicating the front side, the number of recognized markers indicating the back side, and the number of recognized markers indicating the middle in the captured image, as well as the bending state, stretching state, twisting state, loop state, etc. of the target region. It is also possible to hold the relationship in advance and use this relationship.
Furthermore, in this embodiment, holding section markers 41 and 42 are also provided on the anus holding section 31 and the organ holding section 32. Thereby, since the position can be calculated from the holding part markers 41 and 42, the distance between the anus holding part 31 and the organ holding part 32 can also be calculated.

However, due to deformation or displacement of the large intestine model 30 associated with an endoscopic procedure, a blind spot may occur, and there may be a marker ring 43 in which the marker cannot be detected.
Therefore, the detection module 101 detects the length of the variable length member including the first wire member 37 or the second wire member 38, and further uses the length to detect displacement or deformation of the target region. You may also do so. For example, the detection module 101 can detect the amount of feed (length) of the first wire member 37 based on a detection signal from a sensor that detects the amount of rotation of a wire reel that winds the first wire member 37. Furthermore, the displacement or amount of displacement of the wire connection site in the sigmoid colon region of the large intestine model 30 can be detected. The detection module 101 supplements the three-dimensional position information of the target region detected using the above-mentioned marker with the displacement or displacement amount of the wire connection region detected with respect to the length of the first wire member 37. Even if some of the marker rings 43 cannot be detected, the displacement or deformation (bent state, stretch state, twisted state, loop state, etc.) of the target region can be detected without deterioration of accuracy.

As described above, in this embodiment, the area between the anus holding part 31 and the organ holding part 32 in the large intestine model 30 is set as the target area, but the detection module 101 detects other areas of the large intestine model 30 ( For example, displacement or deformation of the transverse colon region, etc.) may be detected. In this case, a plurality of markers may be provided in the transverse colon region, and length information of the second wire member 38 may be used as necessary.

The mode management module 102 acquires training mode information in this simulator. For example, by receiving a signal from the input/output panel 15 via the input/output I/F unit 13, the mode management module 102 determines whether the start of training is specified or the cancellation of training is specified by the operation on the input/output panel 15. The training difficulty level that has been set or specified can be acquired as the training mode information.
When the acquired training mode information indicates the start of training or the discontinuation of training, the mode management module 102 notifies the measurement module 104 and the evaluation module 105 to that effect.

Furthermore, the mode management module 102 determines the position of the organ holding part 32 according to the training difficulty level indicated by the acquired training mode information, and controls the corresponding motor to move the organ holding part 32 to the determined position. Slide. The training difficulty level can be specified in a predetermined number of stages (for example, five stages), and the position of the organ holding part 32 may be determined for each training difficulty level. In this case, the higher the training difficulty level, the closer the organ holding part 32 should be to the anus holding part 31. The sliding of the organ holding part 32 to a determined position may be controlled using the amount of rotation of the motor, or may be controlled using a detection signal from a position sensor (photo sensor, etc.).

The utterance processing module 103 acquires utterance information of the trainee. For example, the speech processing module 103 receives the speech signal obtained from the microphone 16 via the input/output I/F unit 13, and applies speech recognition processing to the speech signal to generate speech information of the trainee. can be obtained. The utterance processing module 103 may or may not identify the trainee, and may use the obtained utterance information as the utterance information of the trainee. From the above, the speech processing module 103 can be expressed as speech acquisition means.

Furthermore, the utterance processing module 103 can specify one or more predetermined utterances uttered by the trainee among a plurality of predetermined utterances based on the acquired utterance information.
In a colonoscopy procedure, as described above, a doctor may instruct an assistant to compress the abdomen in order to support insertion of an endoscope. The utterance corresponding to this abdominal compression instruction may be held in the utterance processing module 103 as a predetermined utterance. In this case, partial utterance information such as "abdominal compression" and "compression support" is held as the predetermined utterance, and the utterance processing module 103 determines whether such predetermined utterances are included in the acquired utterance information. The predetermined utterance uttered by the trainee can be specified depending on whether the utterance is uttered by the trainee or not.
Similarly, an utterance corresponding to an instruction to release abdominal compression may be held in the utterance processing module 103 as a predetermined utterance. In this case, as the predetermined utterance, for example, partial utterance information such as "release pressure" or "stop pressure" may be retained.

Furthermore, as described above, the doctor may ask the subject (patient) to take a deep breath in order to smoothly insert the endoscope. The utterance corresponding to this request to take a deep breath may be held in the utterance processing module 103 as a predetermined utterance. In this case, utterance information such as "Please take a deep breath" or "Please take a deep breath and hold it" is held as the predetermined utterance, and the utterance processing module 103 stores the obtained utterance information as such predetermined utterance. By determining whether the utterance is an utterance, it is possible to specify the predetermined utterance uttered by the trainee.
After such a request, the doctor will ask you to return to normal breathing. The utterance corresponding to this request to return to normal breathing may be held in the utterance processing module 103 as a predetermined utterance. In this case, as the predetermined utterance, for example, utterance information such as "You can exhale" or "Please return to normal breathing" may be retained.

In addition, the doctor may ask the subject (patient) or an assistant to change their body position in order to smoothly insert the endoscope. The utterance corresponding to this request for body position change may be held in the utterance processing module 103 as a predetermined utterance. In this case, partial utterance information such as "on your back" or "on your side" is held as the predetermined utterance, and the utterance processing module 103 determines whether the obtained utterance information includes such a predetermined utterance. , the predetermined utterance uttered by the trainee can be specified.
In this way, the utterance processing module 103 can also be called utterance specifying means. However, the predetermined utterance to be specified in this embodiment is not limited to such an example. Further, the utterance processing module 103 may maintain various variations as each predetermined utterance. The speech recognition process can be performed using any existing recognition method.

When the utterance processing module 103 identifies a predetermined utterance that corresponds to the sliding of the first slide wall section 35 or the second slide wall section 34 among a plurality of predetermined predetermined utterances, the utterance processing module 103 controls the corresponding motor. Then, the first slide wall portion 35 or the second slide wall portion 34 is slid.
In this embodiment, the speech processing module 103 slides the first slide wall portion 35 downward when the predetermined utterance including "abdominal compression" is specified, and the predetermined utterance including "stop pressing" is specified. If it is, the first slide wall portion 35 is slid upward and returned to its original position. Furthermore, when a predetermined utterance such as "Please take a deep breath" is identified, the speech processing module 103 slides the second slide wall portion 34 downward, such as "You can exhale deeply." When the predetermined utterance is specified, the second sliding wall portion 34 is slid upward and returned to its original position.

Further, when the utterance processing module 103 specifies a predetermined utterance corresponding to a body position change, the utterance processing module 103 controls the body position change motor 71 to swing the organ accommodating section 2 . For example, when a predetermined utterance including "lay on your back" is specified, the utterance processing module 103 operates the body position change motor 71 so that the organ storage unit 2 swings from the left lateral position to the supine position, When a predetermined utterance including "sideways" is specified, the body position changing motor 71 is operated to cause the organ storage unit 2 to swing from the supine position to the left lateral position.
As described above, in the present embodiment, the sliding of the first sliding wall 35 and the second sliding wall 34 and the rocking of the organ storage section 2 are performed by voice recognition, but these are performed by the input/output panel 15. It may also be executed by inputting an operation to the display.
Furthermore, the speech processing module 103 maintains a correspondence relationship between the position where the distal end of the endoscope exists and a predetermined utterance to be uttered by the doctor at that position, and places the distal end of the endoscope at the target position. If a predetermined utterance to be uttered at that position is not specified within a predetermined time even though there is a The portion 2 may be rocked. In this way, the trainee can be helped, so that even the trainee who is unaccustomed to operating an endoscope can easily continue training while receiving support.

The measurement module 104 acquires time information regarding endoscopic procedures. As described above, in this embodiment, object detection sensors are provided in the anus holding part 31, the organ holding part 32, and the holding mechanism that holds the anus area, and according to the detection signals from each object detection sensor, It is possible to detect that the distal end of the endoscope has passed through the position in the large intestine model 30 where the object detection sensor is provided. Therefore, the position where each object detection sensor is provided in the large intestine model 30 can be referred to as a checkpoint, and the measurement module 104 is connected to a plurality of measurement modules provided at mutually different positions in the longitudinal direction in the lumen of the large intestine model 30. It can be written as determining that the tip of the endoscope has passed the checkpoint.

The measurement module 104 obtains the stay time of the endoscope tip between the two checkpoints based on the above determination. In the present embodiment, the measurement module 104 measures the time it takes for the large intestine model 30 to reach the area held by the anus holding part 31 from the area held by the organ holding part 32, and measures the time taken to reach the area held by the organ holding part 32. Measure the time it takes to reach the cecum area from the area where the
The colonoscopy procedure consists of a series of procedures in which an endoscope is inserted from the anus to the vicinity of the cecum, and then withdrawn from the anus.
Therefore, the measurement module 104 measures the first stay time from passing the first checkpoint to passing the second checkpoint, and the time spent from passing the second checkpoint to passing the first checkpoint. and the second stay time until passing, respectively. In the present embodiment, the measurement module 104 further measures the time from the cecum region of the large intestine model 30 to the region held by the organ holding part 32, and measures the time from the region held by the organ holding part 32 to the anus holding part. The time taken to reach the area held in 31 is further measured.
The measurement module 104 can measure not only the partial stay time as described above but also the total time of the colonoscopy procedure. That is, the measurement module 104 can measure the total time from inserting the endoscope from the anus to around the cecum to pulling it out from the anus.

The evaluation module 105 evaluates the trainee's technique using time information regarding the endoscopic technique acquired by the measurement module 104, information regarding the predetermined utterance specified by the utterance processing module 103, and the like.
For example, the evaluation module 105 sets a standard stay time between two checkpoints in advance, and compares the stay time between the two checkpoints acquired by the measurement module 104 with the standard stay time. Evaluation points can be calculated for each interval between two checkpoints. In this case, if the stay time is longer than the standard stay time, a base score will be given, and if the stay time is shorter than the standard stay time, a score corresponding to the shortened time will be added to the base score. Evaluation points may be calculated. The evaluation points calculated for each checkpoint in this way are totaled.

Furthermore, the evaluation module 105 may evaluate the stay time related to the endoscope insertion procedure and the stay time related to the endoscope return procedure using separate evaluation methods. That is, the evaluation module 105 calculates the first stay time from passing the first checkpoint to passing the second checkpoint, and the first stay time from passing the second checkpoint to passing the first checkpoint. The second stay time until passing may be evaluated using separate evaluation methods.
For example, for insertion, an evaluation method is used in which points are added if the stay time is shorter than the standard stay time as described above, and for return, a predetermined time range is set for the standard stay time, and the stay time is An evaluation method may be used in which it is determined whether or not a base score is given depending on whether or not the score falls within the range. Furthermore, when returning, points may be deducted if the stay time is shorter than the shortest standard stay time in the predetermined time range.

Generally, in an endoscopic procedure, the evaluation points of the procedure are different depending on the time of insertion and the time of return. During insertion, it is important to insert the endoscope to the target point as quickly and gently as possible, so the evaluation is based on how well the endoscope is operated. On the other hand, it is even more important to carefully observe the animal when it is returned, so whether or not the observation is being carried out appropriately is the point of evaluation.
As mentioned above, by evaluating the dwell time related to the endoscope insertion procedure and the dwell time related to the endoscope return procedure using separate evaluation methods, a high score will be given if the endoscope can be operated quickly during insertion. A high score will be obtained if an appropriate amount of time is spent for observation during return, so it is possible to evaluate from an appropriate perspective based on the time involved in the endoscopic procedure.

Furthermore, the evaluation module 105 determines whether the combination of one or more predetermined utterances has been correctly uttered based on the information regarding the predetermined utterances specified by the utterance processing module 103, and further takes this determination result into consideration. It is also possible to evaluate the trainee's technique. For example, evaluation points may be added or subtracted depending on whether a predetermined utterance corresponding to an instruction for abdominal compression to the caregiver and a predetermined utterance corresponding to an instruction to release the abdominal compression are performed as a set. Points may be added if the two sets of predetermined utterances are made, and points may be deducted if only one of the utterances is made.
Similarly, it may be evaluated whether a predetermined utterance corresponding to a request to take a deep breath and a predetermined utterance corresponding to a request to return to normal breathing are performed as a set.
In addition, the evaluation module 105 maintains a correspondence relationship between the position where the tip of the endoscope exists and a predetermined utterance that the doctor should utter at that position, and outputs the detection signal from the object detection sensor at each position and the utterance. Based on the predetermined utterance specified by the processing module 103, it may be evaluated whether the doctor has uttered the utterance that should be uttered at each position. If the utterance that should be uttered at each position is made, evaluation points may be added, and if the utterance is not made, the evaluation points may be deducted.
In this way, the endoscopic technique can be evaluated from the viewpoint of communication between the doctor and the patient.

Furthermore, the evaluation module 105 acquires load information on a predetermined region of the large intestine model 30, and when the acquired load information indicates a load exceeding a threshold value, the evaluation module 105 uses the residence time acquired as described above to evaluate the load. The evaluation points for the trainee's maneuver may be calculated by subtracting points corresponding to the load information from the scored evaluation points.
Load information on a predetermined portion of the large intestine model 30 can be detected by the large intestine model 30 itself, a holding mechanism that holds the large intestine model 30, or a pressure sensor provided on a wall surface that can come into contact with the large intestine model 30. It can also be calculated from the elongation length of a variable length member (first wire member 37, etc.) connected to a predetermined portion of the model 30.
In this embodiment, a pressure sensor is provided on the downward wall surface of the first slide wall 35 or the second slide wall 34, and the evaluation module 105 acquires a detection signal from the pressure sensor and uses the detection signal to While the indicated pressure value exceeds a threshold value, the pressure value may be accumulated, and when the pressure cumulative value exceeds a predetermined threshold value, the evaluation points may be deducted.
The load placed on organs such as the large intestine places a burden on the subject (patient), and if the load is too large, the organ may be damaged. As described above, by evaluating the trainee's technique according to the load information on a predetermined portion of the large intestine model 30, it is possible to appropriately evaluate the endoscopic technique.

Furthermore, the evaluation module 105 can also evaluate the trainee's technique based on the atmospheric pressure information in the lumen of the large intestine model 30, which is indicated by the detection signal of the atmospheric pressure sensor. In colonoscopy procedures, there is a procedure in which air is supplied through an endoscope in order to widen the lumen of the large intestine for easier observation. However, excessive air supply will expand the lumen of the large intestine too much, which will be a burden on the subject (patient).
Therefore, the evaluation module 105 sets appropriate pressure thresholds in advance for each checkpoint, and calculates the lumen value measured when the distal end of the endoscope is staying between two checkpoints. The results of the comparison between the internal pressure and the pressure threshold may also be used to evaluate the trainee's technique.

The evaluation module 105 further uses any one or more of the bent state, stretched state, twisted state, or looped state of the target region of the large intestine model 30 detected by the detection module 101 to It is also possible to evaluate the trainee's technique. For example, when the detection module 101 detects the degree of expansion and contraction of the target region, the evaluation module 105 detects the degree of expansion and contraction of the target region detected while the tip of the endoscope is staying between two checkpoints. The degree of expansion and contraction may be maintained for each checkpoint, and points may be added or subtracted from the evaluation points based on a comparison between the degree of expansion and contraction of the target part between each checkpoint and the degree of expansion and contraction that serves as a reference. . The evaluation module 105 may also evaluate the degree of bending, the number of loops, the type of loop shape, the degree of twist, and the like.

FIG. 9 is a diagram showing a display example during training in the medical simulator according to the present embodiment, and FIG. 10 is a diagram showing a display example of training evaluation in the medical simulator according to the present embodiment.
The evaluation module 105 causes the input/output panel 15 to display a display as shown in FIG. 9 when the training mode information acquired by the mode management module 102 indicates the start of training.

In the example of FIG. 9, the elapsed time since the passage of the tip of the endoscope is detected by the object detection sensor provided in the anus holding part 31 is displayed in the area DS1, and An image captured by the camera 6 supported by the camera support plate 61 is displayed in the area DS2.
Further, in the area DS2, mark displays MK1, MK2, MK3, and MK4 including numbers are arranged at each position of the four marker rings 43 detected by the detection module 101. At the same time, a line display connecting each mark display is also displayed, thereby presenting information on the deformation and shape of the large intestine model 30.
Further, in the area DS3, the degree of expansion and contraction between the mark display MK1 and the mark display MK2 is displayed as a bar, and in the area DS4, the degree of expansion and contraction between the mark display MK2 and the mark display MK3 is displayed as a bar. The degree of expansion and contraction between mark display MK3 and mark display MK4 is displayed as a bar in area DS5.
By operating the "Test Cancellation" operation button OP, training mode information indicating training cancellation is generated.

In the example of FIG. 10, a character string indicating the evaluation result of the trainee's technique is displayed in the area DS10. The character string includes a character string indicating advice to the trainee in accordance with the evaluation result (for example, "Speak appropriately to the trainee to take a breath when inserting the tube into the transverse colon").
In the area DS11, an evaluation point of 71 points out of 100 points is displayed.
In area DS12, a radar chart regarding five evaluation items is displayed. The communication evaluation item shows an evaluation result (“D” in FIG. 10) based on the information regarding the predetermined utterance specified by the speech processing module 103, and the evaluation item of organ load shows an evaluation result based on the load information. The result ("A+" in FIG. 10) is shown, and the evaluation item for procedure time shows the evaluation result ("B+" in FIG. 10) based on the time at which the endoscope was inserted, which is obtained by the measurement module 104. The evaluation item for observation shows the evaluation result based on the time taken when the endoscope is returned (“C+” in FIG. 10) obtained by the measurement module 104, and the evaluation item for air supply shows the evaluation result based on the time taken to return the endoscope. The evaluation results ("A+" in FIG. 10) based on the atmospheric pressure in the lumen of No. 30 are shown.

However, the display contents during training and the display contents of training evaluation displayed by this simulator are not limited to the examples shown in FIGS. 9 and 10.
For example, during training, a graph display that shows changes in the number of loops in the target region of the large intestine model 30 over time, or a graph display that shows changes in the degree of expansion and contraction of the target region of the large intestine model 30 over time. It may also include a graph display showing changes in load over time. Furthermore, the display of the training evaluation may include evaluation results regarding the expansion and contraction of the target region of the large intestine model 30. Furthermore, the evaluation results based on each of the five evaluation items may be scored using numbers instead of symbols.

Furthermore, in the display during training, the type of detected loop shape (α loop, reverse α loop, γ loop, reverse γ loop, N loop, M loop, etc.) may be displayed in real time. At this time, advice regarding operation of the endoscope to release the loop may also be displayed depending on the type of the detected loop shape. For example, if an alpha loop is detected as the loop shape type, advice such as "Turn the endoscope counterclockwise to release the loop" will be displayed, and if a gamma loop is detected, may display advice such as ``Turn the endoscope shaft clockwise to release the loop.''
In this case, the detection module 101 stores in advance the correspondence between each type of loop shape and the advice character string information corresponding to that type, and depending on the type of the detected loop shape, the detection module 101 determines the correspondence to that type. The advice character string may be displayed on the input/output panel 15.
Such real-time advice during training may be output not only by display but also by voice.

[Modified example]
The embodiment described above is an example. The medical simulator is not limited to only the above-described configuration, and may be partially modified as appropriate as long as it has at least part of the above-described configuration.

For example, in the above-described embodiment, the large intestine model 30 was exemplified as the luminal organ model, but models simulating the digestive tract such as the esophagus, stomach, and duodenum, the ureter, blood vessels, etc. are employed as the luminal organ model. may be done.
Therefore, although the above-described embodiment mainly describes training for colonoscopy examination techniques, the medical techniques that can be trained with this simulator are not limited to such techniques. Techniques related to colonoscopy treatment can also be trained, as well as techniques related to examination and treatment of other hollow organs, and intubation.
Furthermore, although an endoscope was exemplified as a target device (medical device) used for training, in this simulator, medical devices other than endoscopes such as vascular endoscopic catheters may be used. Training-specific equipment or equipment may also be used.

For example, the medical simulator only needs to include at least a hollow organ model, an organ accommodating section that accommodates the hollow organ model in an internal space in a locally fixed state, and a detection means. In this case, the luminal organ model has local fixation areas that can be fixed to the organ storage part at different positions in the longitudinal direction, and local fixation areas that can be displaced within the internal space of the organ storage part by the trainee's operation of the target device. It is sufficient that the detecting means is capable of detecting displacement or deformation of a target region that is at least a part of the movable region of the hollow organ model within the internal space, at least during training.
Therefore, in order to detect the displacement or deformation of the target region of the hollow organ model, only the marker or only the variable length member may be used.
Furthermore, the displacement or deformation of the target region of the hollow organ model may be detected without using either a marker or a variable length member. For example, a plurality of images showing various states of the target region in one or more of a bent state, a stretched state, a twisted state, or a looped state are prepared as teacher images, and each teacher image is A learned model is generated by machine learning based on a plurality of pieces of training data that are associated (tagged) with each state information. The detection means (detection module 101) provides the learned model with the captured image from the camera 6, and determines whether the target region is in any one of a bent state, a stretched state, a twisted state, a twisted state, or a looped state. Multiple objects can be detected (estimated).
In addition, in order to improve the detection accuracy, it is possible to input a plurality of captured images taken from mutually different directions by two or more cameras 6, and detect the bending state, stretching state, twisting state, or loop state of the target region. It is preferable to use a trained model that outputs one or more of the following. In this case, a plurality of captured images taken from mutually different directions showing one state of the target region are prepared as teacher images, and the training data is used to describe the one state for these captured images. It suffices if the status information shown is associated.
When such a trained model is used, a marker may or may not be placed at the target site of the luminal organ model.
When a marker is placed, the image is characterized by the marker, so an improvement in detection accuracy can be expected. In this case, although it is not necessary to recognize the marker itself from the captured image, it can be said that the marker image is used, so based on the marker image included in the captured image, the bending state, expansion/contraction state, and torsion of the target region are determined. It can be written that a loop state or a loop state can be detected.
Moreover, any one or more of the organ holding part 32, the first sliding wall part 35, and the second sliding wall part 34 may be fixed so as not to be slidable. In this case, a corresponding motor is also not required.
Similarly, the body position change may be performed manually, and in this case, the body position change motor 71 is not required.

Further, in the above-described embodiment, the two cameras 6 were provided at positions spaced apart from the lower side and the left side of the organ storage section 2 toward the ventral side (see FIG. 2), but the number and arrangement of the cameras 6 is not limited to the example embodiments described above. When the three-dimensional position of the target region is acquired by image recognition of a marker provided at the target region of the large intestine model 30, two or more cameras including two cameras 6 facing orthogonal directions in a plan view are used. 6 is preferably provided. Furthermore, in the case of displaying a bird's-eye view of the entire large intestine model 30 as illustrated in FIG. 9, one camera 6 may be further provided to capture the bird's-eye view. Further, only one camera 6 may be provided. In this case, the blind spot increases, so it is preferable that the detection of the deformation or displacement of the large intestine model 30 be supplemented by the detection of the length of the variable length member.
Furthermore, at least the lens portion of the camera 6 is located inside the organ storage section 2 or outside the organ storage section 2, but at a position closer to the window section 25 of the organ storage section 2 than the position shown in FIG. Good too. In this case, since the lens portion of the camera 6 will be close to the large intestine model 30, it is preferable to use a wide-angle lens.
Furthermore, this simulator is also intended to be used in a dark room, and illumination materials such as LEDs may be provided inside or outside the organ housing section 2, or both. When the lighting material is provided inside the organ housing section 2, in order to suppress surface reflection on the inner surface of the window section 25, a film or material that suppresses surface reflection is also provided on the inner surface of the window section 25. There may be an agent.
One specific modification of the configuration for imaging the large intestine model 30 will be described later.

In addition, in the above-described embodiment, it has been exemplified that the body position change between the supine position and the left lateral position is simulated by the rocking of the organ accommodating part 2; It is also possible to simulate body changes during For example, when the tire parts 20a, 20b, and 20c provided on the right side wall part 23 are also provided symmetrically on the left side wall part 24, and the organ storage part 2 is in the supine position, This can be achieved by rotating the output shaft 75 in the opposite direction of rotation to the direction of rotation when transitioning to the position state.

Since endoscopes have different thicknesses (diameters) depending on the manufacturer, by providing the anus holding part 31 with a mechanism that changes the lumen cross-sectional area of the large intestine model 30, it is possible to accommodate multiple types of endoscopes. You can do it like this. In this case, as a mechanism for making the cross-sectional area of the lumen variable, an air pump that can take in and exhaust air can be used. In addition, if a flange lid protruding from the outer circumferential surface of the large intestine model 30 is provided at the anus-side end of the large intestine model 30, the flange lid and the outer surface of the lower wall 21 of the organ storage section 2 ( An intermediate plate having a through hole through which the anal end region of the large intestine model 30 can be inserted is interposed between the flange cover of the large intestine model 30 and the outer side of the lower wall 21 of the organ storage section 2. engage the sides. A plurality of types of intermediate plates having different sizes of through holes may be replaceable depending on the thickness (diameter) of each endoscope.
Furthermore, the difficulty level of the training may be reduced by injecting air into the lumen of the hollow organ model using an air pump or the like. This is because by injecting air into the lumen of the hollow organ model, the hollow organ model expands, making it easier to insert the endoscope. In this case, it is preferable to add a configuration that allows air to be injected into the lumen of the luminal organ model from an air pump via an air tube, and to reduce the difficulty of training by inputting information to the display on the input/output panel 15, for example. The air pump only needs to start operating when the

In addition, as in this embodiment, when the degree of elongation of the target part of the hollow organ model can be detected, if the degree of elongation exceeds the first threshold, the speaker will hear a humming sound ( For example, it is also possible to output a sound such as "woooo". Furthermore, if the degree of elongation further exceeds a second threshold value that is larger than the first threshold value, an error sound may be output to indicate damage to the organ.
Furthermore, since the measurement module 104 described above can detect by the method described above that the tip of the endoscope remains in a certain place for a certain period of time, when such a detection is made, the control unit 10 By operating the corresponding motor such as the body position changing motor 71, the first sliding wall 35, the second sliding wall 34, or the organ holding part 32 can be slid, or the organ accommodating part 2 can be swung automatically. The program may be executed to automatically support insertion of an endoscope.
In this way, even trainees who are unaccustomed to operating an endoscope can easily continue their training while receiving support.

In addition, the luminal organ model of the large intestine model 30 described above may further be provided with an injection part for feeding lubricant into the lumen. This injection part includes an extremely thin injection hole that penetrates into the lumen from the outside of the hollow organ model. This injection hole is preferably thin enough to allow insertion of a nozzle or tube connected to the lubricant container and to prevent the lubricant injected into the lumen from leaking to the outside. Moreover, when injecting lubricating liquid into the lumen from the lubricating liquid container via the liquid feeding tube, a tube connecting part that connects to the end of the liquid feeding tube may be attached to the injection part.
The lubricating liquid may be any agent that improves the sliding inside the lumen of the hollow organ model, and for example, a volatile silicone mold release agent may be used.
By making it possible to inject a lubricant such as a silicone mold release agent into the hollow organ model from the outside, it is possible to make the inside of the hollow organ model more similar to the real thing, and when an endoscope is inserted, It is possible to realistically reproduce the feel of Furthermore, by using a volatile mold release agent as the lubricating liquid to be injected, if it is injected only when it is used, it will volatilize after use, so the maintenance load on the hollow organ model can be reduced.

Furthermore, when the lubricating liquid is injected into the lumen of the hollow organ model as described above, the lubricating liquid injected into the lumen of the hollow organ model is applied to the inner wall surface that defines the lumen. It is preferable to have a plurality of micro grooves in which the particles can be retained. The width of the minute groove may be such that the lubricant can stay there longer than the inner wall surface without the groove, and it must be at least smaller than the diameter of the endoscope, preferably less than 1 mm. . Further, the width of the minute groove may be any size that can reduce the friction area between the inserted endoscope and the inner wall surface of the hollow organ model.
FIG. 11 is a diagram showing the inner wall surface of the large intestine model 30 in this embodiment.
P1 in FIG. 11 schematically shows the inner wall surface of the large intestine model 30, and P2 shows an enlarged schematic diagram of the inner wall surface. In P2, an extremely thin groove and a base surface of the inner wall are shown in an uneven shape. As described above, in the example of FIG. 11, a plurality of substantially parallel linear extremely thin grooves extending in a direction substantially perpendicular to the longitudinal direction of the large intestine model 30 are provided on the inner wall surface of the large intestine model 30.
Such a linear groove may be provided over the entire region of the inner wall surface of the large intestine model 30, or may be provided only in a specific region of the inner wall surface.
Further, such linear minute grooves can be formed as lamination marks on the inner wall surface of the hollow organ model by making a mold of the inner wall surface using a core. Furthermore, the micro grooves on the inner wall surface of the large intestine model 30 can also be formed using a core whose surface has a micro convex shape. In this way, there are no limitations on the method of forming the micro grooves.
Further, in the example of FIG. 11, the minute grooves are formed in a linear shape, but they may be formed as holes.
By providing such micro grooves on the inner wall surface of the large intestine model 30, the friction area between the medical device inserted into the lumen and the inner wall surface is reduced, or the lubricating fluid stays in the micro grooves. Unnecessary resistance during insertion and return (extraction) of the medical device can be reduced.

In addition, when an upper gastrointestinal tract model is applied as a luminal organ model, the checkpoints at which time information is acquired by the measurement module 104 are set at the esophagus entrance, junction (cardium), duodenum, etc. It is fine if it is done. Further, the load information acquired by the evaluation module 105 may be a pressure value to the pharynx. When a gag reflex or ambiguity is simulated in a medical simulator, the evaluation module 105 may deduct evaluation points each time a gag reflex or an ambiguity is performed. In addition, when the atmospheric pressure inside the lumen of the luminal organ model is detected by the atmospheric pressure sensor, the atmospheric pressure from the time when the tip of the endoscope is inserted into the duodenum, and from the duodenum to the tip The evaluation target may be the atmospheric pressure after the gas is discharged from the joint, the atmospheric pressure after the gas is discharged from the joint (cardia), etc. Furthermore, when the tip of the endoscope is present around the junction (cardiac region), the evaluation module 105 will respond with messages such as "Please breathe in," "Please hold your breath," and "Please take it easy." The evaluation can also be made based on whether or not a set of predetermined utterances such as "" has been identified by the utterance processing module 103.

Hereinafter, a configuration for imaging the internal space of the organ storage section 2 (including the camera 6) and a modified example of the organ storage section 2 will be described using FIGS. 12 and 13.
FIG. 12 is a perspective view showing the external appearance of the human body model section 1 according to the modification, and FIG. 13 is an exploded view showing the organ storage section 200 and the light shielding section 210 separated in the human body model section 1 according to the modification. be.
In this modification, the organ accommodating part 200 differs from the organ accommodating part 2 in the above-described embodiment in its ventral side structure, and is the same as the organ accommodating part 2 in other structures.
The organ housing section 200 is a box shaped like a substantially rectangular parallelepiped, and its ventral side is closed off with a window section 201 formed of a transparent material. According to this window section 201, not only can the large intestine model 30 inside the organ storage section 200 be imaged by the camera 6 from outside the organ storage section 200, but also the peritoneum of a human body can be simulated.

The light shielding part 210 has a substantially rectangular parallelepiped shape and is detachably attached to the ventral side of the organ accommodating part 200. In the attached state, the light shielding part 210 covers the window part 201 from the ventral side and protects the interior of the organ storage part 200 together with the lower wall part 21, the upper wall part 22, the right side wall part 23, and the left side wall part 24 of the organ storage part 200. Shade the space from outside light. Thereby, it is possible to prevent the image of the camera 6 that images the large intestine model 30 inside the organ housing section 200 from being affected by external light.
The light shielding part 210 has a lower wall part 221, an upper wall part 222 (not shown in FIG. 13), a right side wall part 223, a left side wall part 224, and an abdominal wall part 225, which cover the upper, lower, right, left, and abdominal sides. On the other hand, the dorsal side is open.
The dorsal edges of the right side wall 223 and left side wall 224 of the light shielding section 210 and the ventral edges of the right side wall 23 and left side wall 24 of the organ storage section 200 extend linearly in the vertical direction, respectively. They have a structure that allows them to engage with each other. Thereby, by sliding the light shielding part 210 vertically with respect to the organ housing part 200, the light shielding part 210 can be attached to and detached from the organ housing part 200. In this way, by making the light shielding section 210 detachable from the organ storage section 200, it is possible to facilitate the replacement work of the large intestine model 30 and the maintenance work inside the organ storage section 200.

The light shielding part 210 divides the internal space defined by the lower wall part 221, the upper wall part 222, the right side wall part 223, the left side wall part 224, and the ventral side wall part 225 into an open dorsal space and a ventral space. It further includes a partition plate. The partition plate is fixed by connecting upper, lower, left, and right edge portions to a lower wall portion 221, an upper wall portion 222, a right side wall portion 223, and a left side wall portion 224.
A light emitting unit 215 is provided on the inner wall surface of the ventral space defined by the partition plate. The light emitting unit 215 extends for a predetermined length. Each light emitting unit 215 may be formed by a plurality of light sources such as LEDs (Light Emitting Diodes) arranged in a row, or may be formed by one long light source.
Further, the camera 6 is installed approximately in the center of the partition plate so that the lens portion of the camera 6 is exposed toward the space on the back side of the light shielding portion 210. As a result, the dorsal space of the light shielding section 210 is open, so it can be said that the camera 6 is installed at a position and in a direction that allows it to image the large intestine model 30 through the window section 201 of the organ storage section 200.

The partition plate is formed of a light-blocking area 211 and a light-transmitting area 212.
The light shielding region 211 is formed of a member or material capable of blocking light from the light emitting unit 215 provided in the ventral space of the light shielding part 210 so as not to pass through to the dorsal space as much as possible. For example, the light-shielding region 211 may be formed by applying a light-shielding film to the ventral surface of the partition plate, or by applying a light-shielding agent to the ventral surface of the partition plate. or may be formed as a partial plate made of a light-shielding material.
The light-transmitting region 212 is made of a member or material that can transmit light from the light-emitting unit 215 provided in the ventral space of the light shielding part 210 to the dorsal space.
The light-shielding region 211 and the light-transmitting region 212 are arranged so that the light-emitting unit 215 can indirectly illuminate the internal space of the organ storage section 200 with light from the light-emitting unit 215 to suppress surface reflection of the window section 201. and the position of the camera 6. Therefore, the light-shielding region 211 and the light-transmitting region 212 of the partition plate are provided between the light source (light-emitting unit 215) and the window section 201, and the light from the light source indirectly illuminates the internal space of the organ storage section 200. It can be described as an indirect lighting section that illuminates the area.

In the example of FIG. 13, a partition plate is formed by vertically connecting a light-shielding region 211 and a light-transmitting region 212, and the light-transmitting region 212 has a width of about 1/5 to 1/6 of the light-shielding region 211. The light-shielding region 211 is arranged at the upper side as the remaining region of the partition plate. Further, two light emitting units 215 are provided on the left and right inner wall surfaces of the ventral space of the light shielding part 210, and the light shielding area 211 is placed at a position covering the back side of the light sources of the two light emitting units 215, and is transparent. The light area 212 is arranged at a position where there is no light source of the light emitting unit 215.
In this way, the interior space of the organ housing section 200 is shielded from external light by the light shielding section 210, and the interior of the organ housing section 200 is illuminated by indirect illumination using light from the light emitting unit 215 provided in the interior space of the light shielding section 210. By illuminating the space, it is possible to appropriately image the large intestine model 30 in the internal space of the organ housing section 200 while suppressing surface reflections and reflections of the window section 201. As a result, image recognition accuracy regarding the large intestine model 30 can be maintained.
However, the position and number of the light-emitting units 215 and the arrangement of the light-blocking area 211 and the light-transmitting area 212 can be changed to the example shown in FIG. It is not limited to this and can be modified as appropriate.
Further, in this modification, the window portion 201 may or may not include a member or material that suppresses surface reflection.

Furthermore, the inner wall surface of the organ accommodating section 200 may also include a member or material that suppresses surface reflection. Furthermore, among the inner wall surfaces of the organ housing section 200, at least the area around the target region of the large intestine model 30 whose deformation or displacement is to be detected may include a member or material that suppresses surface reflection. . In this way, surface reflection on the inner wall surface caused by indirect illumination can be suppressed, and image recognition accuracy regarding the large intestine model 30 can be maintained.
In addition to the inner wall surface of the organ storage section 200, the anus holding section 31, the organ holding section 32, the first slide wall section 35, the second slide wall section 34, and the holding section provided in the internal space of the organ storage section 200 are also provided. The pillars 39 and the like may also include a member or material that suppresses surface reflection.

In the human body model section 1 according to the present modification shown in FIGS. 12 and 13, in addition to the camera 6 that is provided in the light shielding section 210 and captures a planar view image of the internal space of the organ storage section 200, Another camera 6 (not shown) that images the sigmoid colon region of the large intestine model 30 from the side is provided in the organ housing section 200. The latter camera 6 is provided, for example, in the vicinity of the right inner surface of the organ storage section 200 facing leftward, or in the vicinity of the left inner surface of the organ storage section 200 with its right side facing. By providing the latter camera 6 in this manner, displacement and deformation of the large intestine model 30 in the anteroposterior direction (ventral and dorsal directions) can also be detected.

FIG. 14 is a diagram showing a part of the display during training in a modified example.
When training is started, the evaluation module 105 may cause the input/output panel 15 to display a display as shown in FIG. 14 in addition to or in place of the display shown in FIG.
In the example of FIG. 14, a planar view image taken by the camera 6 in the light shielding part 210 is displayed in the area DS21, a side view image taken by the camera 6 in the organ storage part 200 is displayed in the area DS22, An endoscopic image captured by an endoscope handled by the trainee is displayed in area DS23, and an image of the trainee captured by an external camera (not shown) is displayed in area DS24. By displaying various images in this way, it is possible to evaluate and analyze the endoscopic technique of the trainee from various angles.
Furthermore, the degree of expansion and contraction of the large intestine model 30, which was indicated by areas DS3, DS4, and DS5 in the example of FIG. 9, is displayed as an extension of the sigmoid colon in area DS25 in the example of FIG. In addition, in the example of FIG. 14, the degree of pressure detected by the pressure sensor provided on the downward wall surface of the first sliding wall portion 35 is displayed in the area DS26 as the pressure on the compression wall. Furthermore, the difficulty level of the training being executed (beginner in FIG. 14) and the body position at that time (left lateral decubitus position in FIG. 14) are also displayed at the top.

In this modification, the detection module 101 acquires image data of a planar view image and a side view image captured by each camera 6 in the light shielding part 210 and the organ storage part 200, and from this image data, the large intestine model 30 By recognizing this, it may be detected that at least a portion of the movable region of the large intestine model 30 has exceeded a predetermined evaluation position. Recognition of the large intestine model 30 can be realized based on color characteristics and the like using well-known image recognition technology.
For example, in a plan view image, the evaluation position is set as a line extending in the left-right direction at a predetermined position in the vertical direction of the internal space of the organ storage unit 200, and in a side view image, the evaluation position is set as a line extending in the front-back direction (abdominal direction) of the internal space of the organ storage unit 200. It is set as a line extending in the vertical direction at a predetermined position in the lateral/dorsal direction). The detection module 101 holds the evaluation position (evaluation line) for each of the planar view image and the side view image in advance, and detects when at least a part of the recognized image area of the large intestine model 30 exceeds the evaluation position. Detect that.
Furthermore, in addition to detecting that at least a portion of the movable region of the large intestine model 30 has exceeded the evaluation position, the detection module 101 may also calculate the area of the movable region that has exceeded the evaluation position. .

Furthermore, the evaluation module 105 may further use the detection result by the detection module 101 to evaluate the trainee's technique. For example, when it is detected that at least a part of the movable region of the large intestine model 30 has exceeded the evaluation position, or when the area of the movable region beyond the evaluation position has exceeded a predetermined area, the evaluation module 105 , deduct evaluation points. Furthermore, the evaluation module 105 may increase the number of points to be deducted depending on the time during which at least a portion of the large intestine model 30 exceeds the evaluation position, or may increase the number of points deducted depending on the time during which at least a portion of the large intestine model 30 exceeds the evaluation position. The evaluation points may be deducted by the number of points corresponding to the number of times. Further, the detection module 101 may increase the number of points deducted according to the detected area and the detection time, or increase the number of points deducted according to the detected area and the detection time, or increase the number of points that the area of the movable area that exceeds the evaluation position becomes equal to or larger than a predetermined area. The evaluation points may be deducted by the corresponding number of points.
Furthermore, the evaluation module 105 can also display lines DS211 and DS221 indicating the evaluation position superimposed on the planar view image or the side view image, as shown in the area DS21 and the area DS22 in FIG.
According to such an evaluation, it is possible to evaluate whether the endoscopic procedure performed by the trainee is placing too much burden on the large intestine. Furthermore, by displaying a line indicating the evaluation position, it is possible to make it easier for the trainee to grasp the status of his/her own procedure.

The contents of each embodiment described above can also be specified as follows.
(Additional note 1)
a hollow organ model that is flexible and has a shape imitating at least one hollow organ;
an organ accommodating section that accommodates the luminal organ model in an internal space in a locally fixed state;
detection means;
Equipped with
The luminal organ model has local fixation regions that can be fixed to the organ storage section at different positions in the longitudinal direction, and local fixation regions that can be fixed to the organ storage section by the trainee's operation of the target device within the internal space of the organ storage section. a movable area that can be displaced;
The detection means is capable of detecting displacement or deformation of a target region that is at least a part of the movable region of the hollow organ model within the internal space, at least during training.
Medical simulator.
(Additional note 2)
A plurality of markers are arranged on the outer periphery or outer surface of at least a portion of the movable region of the hollow organ model at positions spaced apart in the axial direction of the hollow organ model,
The detection means acquires an image of the interior of the organ storage section captured by a camera, and detects a bent state, a stretched state, a twisted state, or a looped state of the target region based on a marker image included in the image. It is possible,
The medical simulator described in Appendix 1.
(Additional note 3)
The organ accommodating section includes an abdominal wall cover section that seals off the internal space from the ventral side while accommodating the luminal organ model,
The abdominal wall cover portion includes a transparent window portion so that at least the hollow organ model within the internal space is visible;
The window includes a member or material that suppresses surface reflection of the window in order to prevent a decrease in recognition accuracy of the luminal organ model in an image captured by the camera.
The medical simulator according to supplementary note 1 or 2.
(Additional note 4)
a light-shielding part that is detachably attached to the organ-accommodating part and shields an internal space of the organ-accommodating part from external light in the attached state;
further comprising;
The organ accommodating part includes an abdominal wall cover part that closes off an internal space of the organ accommodating part from the ventral side while accommodating the luminal organ model,
The abdominal wall cover part includes a transparent window part,
The light shielding section is provided between the camera, which is installed in a position and direction in which the luminal organ model can be imaged through the window, a light source, and the light source and the window, and the light source is provided between the light source and the window. an indirect lighting section that indirectly illuminates the internal space of the organ storage section with light from the
The medical simulator according to supplementary note 1 or 2.
(Appendix 5)
Of the inner wall surface of the organ storage section, at least a region around the target region of the luminal organ model that is a detection target of the detection means includes a member or material that suppresses surface reflection.
The medical simulator according to appendix 3 or 4.
(Appendix 6)
The movable region of the hollow organ model includes a specific movable region connected to a variable length member,
The detection means is capable of detecting displacement or deformation of the target region by detecting the length of the variable length member.
The medical simulator according to any one of Supplementary Notes 1 to 5.
(Appendix 7)
The luminal organ model is a large intestine model imitating the shape of the large intestine,
The organ accommodating part is switched between a sliding state in which it is slidable relative to an anus holding part that holds an anal end region of the large intestine model and the organ accommodating part, and a fixed state in which it is fixed to the organ accommodating part. including an organ-retaining part that is capable of being provided;
The locally fixed area of the large intestine model includes the anal end area held by the anus holding part and the area held by the organ holding part,
The area held by the organ holding part of the large intestine model is an area corresponding to a part of the range from the descending colon to the sigmoid colon,
The degree of curvature between the anal side end region and the region held by the organ holder in the large intestine model changes by sliding the organ holder;
The medical simulator according to any one of Supplementary Notes 1 to 6.
(Appendix 8)
The sliding range of the organ holding part is such that the length from the anal end region of the large intestine model to the area held by the organ holding part is twice the distance from the anus holding part to the organ holding part. including the position of
The medical simulator described in Appendix 7.
(Appendix 9)
The luminal organ model is a large intestine model imitating the shape of the large intestine,
The local fixation region of the luminal organ model includes an anal end region of the large intestine model,
The movable region of the luminal organ model includes a transverse colon region corresponding to the transverse colon in the large intestine model and a rectal region corresponding to the rectum in the large intestine model,
The organ accommodating part is located below the accommodating position of the transverse colon region of the large intestine model and above the accommodating position of the anus holding part that holds the anal end region and the rectal region of the large intestine model. Including auxiliary walls with downward facing walls,
The medical simulator according to any one of Supplementary Notes 1 to 8.
(Appendix 10)
The auxiliary wall part is switchable between a sliding state in which the auxiliary wall part is slidable in a direction in which the distance to the anus holding part changes, and a fixed state in which the auxiliary wall part is fixed to the organ accommodating part.
The medical simulator described in Appendix 9.
(Appendix 11)
The luminal organ model is a large intestine model imitating the shape of the large intestine,
The large intestine model includes a transverse colon region corresponding to the transverse colon, a splenic curvature region corresponding to the splenic curvature, and a hepatic curvature region corresponding to the hepatic curvature,
The organ accommodating section is erected above the internal space with a wall facing downward, and is switchable between a sliding state in which it can slide downward and a fixed state in which it is fixed to the organ accommodating section. including a sliding wall section,
At least the splenic curvature region and the hepatic curvature region of the large intestine model are displaced downward as the sliding wall portion slides downward;
The medical simulator according to any one of Supplementary Notes 1 to 10.
(Appendix 12)
The large intestine model includes a splenic curvature region corresponding to a splenic curvature and a hepatic curvature region corresponding to a hepatic curvature,
The splenic curvature region and the hepatic curvature region of the large intestine model are color tone change regions that cause a color tone change in the splenic curvature region and the hepatic curvature region in an endoscopic image captured within the lumen of the large intestine model. include,
The medical simulator according to appendix 11.
(Appendix 13)
motor and
a motor accommodating portion that accommodates the motor;
an output shaft driven using the rotational power of the motor;
a base that holds the motor accommodating section;
further comprising;
The organ accommodating section further includes an upper end wall that closes off an upper part of the internal space and fixes one end of the output shaft, and when the output shaft is driven by the rotational power of the motor, the base or rocking together with the output shaft while being supported by the ventral support surface of the base via a tire portion rotatably provided in the organ accommodating portion;
The medical simulator according to any one of Supplementary Notes 1 to 12.
(Appendix 14)
The luminal organ model is a large intestine model imitating the shape of the large intestine,
The organ storage section includes an anus holding section that holds the anal end region of the large intestine model,
The local fixation region of the large intestine model includes the anal end region held by the anal holding part,
The anus holding part includes a through hole through which the anal end region of the large intestine model is inserted, and a tapered wall portion in which the cross-sectional area of the through hole gradually increases upward;
The tapered wall portion includes a first wall portion having a steep slope from the lower end to the upper end of the tapered wall portion and a second wall portion having a gentler slope than the first wall portion,
The first wall portion and the second wall portion are at least located at opposing positions when viewed in the axial direction of the through hole.
The medical simulator according to any one of Supplementary Notes 1 to 13.
(Appendix 15)
The luminal organ model has a plurality of micro grooves on the inner wall surface defining the lumen, which can retain the lubricating fluid injected into the lumen.
The medical simulator according to any one of Supplementary Notes 1 to 14.
(Appendix 16)
determining means for determining whether a region of the target device has passed through a plurality of checkpoints provided at mutually different positions in the longitudinal direction of the lumen of the luminal organ model;
time acquisition means for acquiring the stay time of the part between two checkpoints;
evaluation means for evaluating the trainee's technique using at least the acquired residence time;
The medical simulator according to any one of Supplementary Notes 1 to 15, further comprising:
(Appendix 17)
The time acquisition means includes a first stay time from passing the first checkpoint to passing the second checkpoint, and a first stay time from passing the second checkpoint to the first checkpoint. and the second stay time until passing through, respectively.
The evaluation means evaluates the first stay time and the second stay time using separate evaluation methods, respectively.
The medical simulator according to appendix 16.
(Appendix 18)
load acquisition means for acquiring load information on a predetermined part of the luminal organ model;
further comprising;
When the acquired load information indicates a load exceeding a threshold, the evaluation means deducts points corresponding to the load information from the evaluation points scored using the acquired residence time, calculating an evaluation point for the trainee's technique;
The medical simulator according to appendix 16 or 17.
(Appendix 19)
utterance acquisition means for acquiring utterance information of the trainee;
utterance identifying means capable of identifying one or more predetermined utterances uttered by the trainee among a plurality of predetermined types of predetermined utterances based on the acquired utterance information;
further comprising;
The evaluation means calculates the evaluation points by adding or subtracting points based on the specified combination of one or more predetermined utterances.
The medical simulator according to appendix 18.
(Additional note 20)
a measuring means for measuring the atmospheric pressure within the lumen of the luminal organ model;
further comprising;
The evaluation means further evaluates the trainee's technique using a comparison result between the atmospheric pressure measured when the target device part stays between two checkpoints and an atmospheric pressure threshold.
The medical simulator according to any one of appendices 16 to 19.
(Additional note 21)
The evaluation means detects the detected bending state, stretching state, twisting state, or loop state when the detecting means is capable of detecting a bent state, a stretched state, a twisted state, or a loop state of the target region. further evaluating the trainee's technique using
The medical simulator according to any one of appendices 16 to 20.
(Additional note 22)
The detection means detects, at least during training, that at least a part of the movable region of the luminal organ model exceeds an evaluation position in an anteroposterior direction or an evaluation position in an up-down direction in an internal space of the organ storage section. ,
The evaluation means further uses a detection result by the detection means that the evaluation position has been exceeded to evaluate the technique of the trainee.
The medical simulator according to any one of appendices 16 to 21.
(Additional note 23)
a hollow organ model that is flexible and has a shape imitating at least one hollow organ; an organ accommodating section that accommodates the hollow organ model in an internal space; and a longitudinal direction in the lumen of the hollow organ model. A procedure evaluation method using a medical simulator executed by a control unit controlling a medical simulator including at least a plurality of sensors provided at mutually different positions,
Based on detection signals from the plurality of sensors, determining that the part of the target device has passed through a plurality of checkpoints provided at mutually different positions in the longitudinal direction of the lumen of the hollow organ model;
Obtain the residence time of the part between two checkpoints,
evaluating the trainee's technique using at least the obtained residence time;
A procedure evaluation method using a medical simulator that includes
(Additional note 24)
The first stay time from passing the first checkpoint until passing the second checkpoint, and the first stay time from passing the second checkpoint to passing the first checkpoint. and further comprising obtaining a second residence time, respectively;
In the evaluation, the first stay time and the second stay time are evaluated using separate evaluation methods.
Procedure evaluation method using a medical simulator according to appendix 23.
(Additional note 25)
Obtaining load information on a predetermined part of the luminal organ model,
When the acquired load information indicates a load that exceeds a threshold value, the trainee's Calculate the evaluation points for the procedure,
The procedure evaluation method using a medical simulator according to appendix 23 or 24, further comprising:
(Additional note 26)
obtaining utterance information of the trainee;
identifying one or more predetermined utterances uttered by the trainee among a plurality of predetermined types of predetermined utterances based on the acquired utterance information;
further including,
In calculating the evaluation points, the evaluation points are calculated by adding or subtracting points based on the specified combination of one or more predetermined utterances.
Procedure evaluation method using a medical simulator according to appendix 25.
(Additional note 27)
measuring the atmospheric pressure within the lumen of the luminal organ model;
further including,
In the evaluation, the procedure of the trainee is further evaluated using a comparison result between the atmospheric pressure measured when the target device part stays between two checkpoints and an atmospheric pressure threshold.
A procedure evaluation method using the medical simulator according to any one of appendices 23 to 26.
(Additional note 28)
detecting a bent state, a stretched state, a twisted state, or a looped state of a target part of the hollow organ model in the internal space;
further including,
In the evaluation, the detected bending state, stretching state, twisting state, or loop state is further used to evaluate the procedure of the trainee.
A procedure evaluation method using the medical simulator according to any one of appendices 23 to 27.
(Additional note 29)
detecting that at least a portion of the luminal organ model has exceeded an evaluation position in an anteroposterior direction or an evaluation position in an up-down direction in the internal space of the organ storage section;
further including,
In the evaluation, the result of the detection that at least a part of the luminal organ model has exceeded the evaluation position is further used to evaluate the procedure of the trainee.
A procedure evaluation method using the medical simulator according to any one of appendices 23 to 28.
(Additional note 30)
A computer program that causes the control unit to execute the procedure evaluation method using a medical simulator according to any one of appendices 23 to 29.

Claims (20)

a hollow organ model that is flexible and has a shape imitating at least one hollow organ;
an organ accommodating section that accommodates the luminal organ model in an internal space in a locally fixed state;
detection means;
Equipped with
The luminal organ model has local fixation regions that can be fixed to the organ storage section at different positions in the longitudinal direction, and local fixation regions that can be fixed to the organ storage section by the trainee's operation of the target device within the internal space of the organ storage section. a movable area that can be displaced;
At least during training, the detection means acquires an image of the interior of the organ storage section taken by a camera, and uses the acquired image to detect at least one of the movable regions of the hollow organ model within the internal space. It is possible to detect displacement or deformation of the target region, which is the
Medical simulator. A plurality of markers are arranged on the outer periphery or outer surface of at least a portion of the movable region of the hollow organ model at positions spaced apart in the axial direction of the hollow organ model,
The detection means is capable of detecting a bent state, a stretched state, a twisted state, or a looped state of the target region based on a marker image included in the acquired image.
The medical simulator according to claim 1. a light-shielding part that is detachably attached to the organ-accommodating part and shields an internal space of the organ-accommodating part from external light in the attached state;
further comprising;
The organ accommodating section includes an abdominal wall cover section that seals off an internal space of the organ accommodating section from the ventral side while accommodating the luminal organ model,
The abdominal wall cover part includes a transparent window part,
The light shielding section is provided between the camera, which is installed in a position and direction in which the luminal organ model can be imaged through the window, a light source, and the light source and the window, and the light source is provided between the light source and the window. an indirect lighting section that indirectly illuminates the internal space of the organ storage section with light from the
The medical simulator according to claim 1 or 2. Of the inner wall surface of the organ storage section, at least a region around the target region of the luminal organ model that is a detection target of the detection means includes a member or material that suppresses surface reflection.
The medical simulator according to claim 3. a hollow organ model that is flexible and has a shape imitating at least one hollow organ;
an organ accommodating section that accommodates the luminal organ model in an internal space in a locally fixed state;
detection means;
Equipped with
The luminal organ model has local fixation regions that can be fixed to the organ storage section at different positions in the longitudinal direction, and local fixation regions that can be fixed to the organ storage section by the trainee's operation of the target device within the internal space of the organ storage section. a movable region that can be displaced;
The detection means is capable of detecting displacement or deformation of a target region that is at least a part of the movable region of the hollow organ model within the internal space, at least during training;
The luminal organ model is a large intestine model imitating the shape of the large intestine,
The organ accommodating part is switched between a sliding state in which it is slidable relative to an anus holding part that holds an anal end region of the large intestine model and the organ accommodating part, and a fixed state in which it is fixed to the organ accommodating part. including an organ-retaining part that is capable of being provided;
The locally fixed area of the large intestine model includes the anal end area held by the anus holding part and the area held by the organ holding part,
The area held by the organ holding part of the large intestine model is an area corresponding to a part of the range from the descending colon to the sigmoid colon,
The degree of curvature between the anal side end region and the region held by the organ holder in the large intestine model changes by sliding the organ holder;
Medical simulator. The sliding range of the organ holding part is such that the length from the anal end region of the large intestine model to the area held by the organ holding part is twice the distance from the anus holding part to the organ holding part. including the position of
The medical simulator according to claim 5. a hollow organ model that is flexible and has a shape imitating at least one hollow organ;
an organ accommodating section that accommodates the luminal organ model in an internal space in a locally fixed state;
detection means;
Equipped with
The luminal organ model has local fixation regions that can be fixed to the organ storage section at different positions in the longitudinal direction, and local fixation regions that can be fixed to the organ storage section by the trainee's operation of the target device within the internal space of the organ storage section. a movable area that can be displaced;
The detection means is capable of detecting displacement or deformation of a target region that is at least a part of the movable region of the hollow organ model within the internal space, at least during training;
The luminal organ model is a large intestine model imitating the shape of the large intestine,
The local fixation region of the luminal organ model includes an anal end region of the large intestine model,
The movable region of the luminal organ model includes a transverse colon region corresponding to the transverse colon in the large intestine model and a rectal region corresponding to the rectum in the large intestine model,
The organ accommodating part is located below the accommodating position of the transverse colon region of the large intestine model and above the accommodating position of the anus holding part that holds the anal end region and the rectal region of the large intestine model. Including auxiliary walls with downward facing walls,
Medical simulator. a hollow organ model that is flexible and has a shape imitating at least one hollow organ;
an organ accommodating section that accommodates the luminal organ model in an internal space in a locally fixed state;
detection means;
Equipped with
The luminal organ model has local fixation regions that can be fixed to the organ storage section at different positions in the longitudinal direction, and local fixation regions that can be fixed to the organ storage section by the trainee's operation of the target device within the internal space of the organ storage section. a movable region that can be displaced;
The detection means is capable of detecting displacement or deformation of a target region that is at least a part of the movable region of the hollow organ model within the internal space, at least during training;
The luminal organ model is a large intestine model imitating the shape of the large intestine,
The large intestine model includes a transverse colon region corresponding to the transverse colon, a splenic curvature region corresponding to the splenic curvature, and a hepatic curvature region corresponding to the hepatic curvature,
The organ accommodating section is erected above the internal space with a wall facing downward, and is switchable between a sliding state in which it can slide downward and a fixed state in which it is fixed to the organ accommodating section. including a sliding wall section,
At least the splenic curvature region and the hepatic curvature region of the large intestine model are displaced downward as the sliding wall portion slides downward;
Medical simulator. The large intestine model includes a splenic curvature region corresponding to a splenic curvature and a hepatic curvature region corresponding to a hepatic curvature,
The splenic curvature region and the hepatic curvature region of the large intestine model are color tone change regions that cause a color tone change in the splenic curvature region and the hepatic curvature region in an endoscopic image captured within the lumen of the large intestine model. include,
The medical simulator according to claim 8. a hollow organ model that is flexible and has a shape imitating at least one hollow organ;
an organ accommodating section that accommodates the luminal organ model in an internal space in a locally fixed state;
detection means;
motor and
a motor accommodating portion that accommodates the motor;
an output shaft driven using the rotational power of the motor;
a base that holds the motor accommodating section;
Equipped with
The luminal organ model has local fixation regions that can be fixed to the organ storage section at different positions in the longitudinal direction, and local fixation regions that can be fixed to the organ storage section by the trainee's operation of the target device within the internal space of the organ storage section. a movable area that can be displaced;
The detection means is capable of detecting displacement or deformation of a target region that is at least a part of the movable region of the hollow organ model within the internal space, at least during training;
The organ accommodating section further includes an upper end wall that closes off an upper part of the internal space and fixes one end of the output shaft, and when the output shaft is driven by the rotational power of the motor, the base or rocking together with the output shaft while being supported by the ventral support surface of the base via a tire portion rotatably provided in the organ accommodating portion;
Medical simulator. a hollow organ model that is flexible and has a shape imitating at least one hollow organ;
an organ accommodating section that accommodates the luminal organ model in an internal space in a locally fixed state;
detection means;
Equipped with
The luminal organ model has local fixation regions that can be fixed to the organ storage section at different positions in the longitudinal direction, and local fixation regions that can be fixed to the organ storage section by the trainee's operation of the target device within the internal space of the organ storage section. a movable region that can be displaced;
The detection means is capable of detecting displacement or deformation of a target region that is at least a part of the movable region of the hollow organ model within the internal space, at least during training;
The luminal organ model is a large intestine model imitating the shape of the large intestine,
The organ storage section includes an anus holding section that holds the anal end region of the large intestine model,
The local fixation region of the large intestine model includes the anal end region held by the anal holding part,
The anal holding part includes a through hole through which the anal end region of the large intestine model is inserted, and a tapered wall portion in which the cross-sectional area of the through hole gradually increases upward;
The tapered wall portion includes a first wall portion having a steep slope from the lower end to the upper end of the tapered wall portion and a second wall portion having a gentler slope than the first wall portion,
The first wall portion and the second wall portion are at least located at opposing positions when viewed in the axial direction of the through hole.
Medical simulator. a hollow organ model that is flexible and has a shape imitating at least one hollow organ;
an organ accommodating section that accommodates the luminal organ model in an internal space in a locally fixed state;
detection means;
Equipped with
The luminal organ model has local fixation regions that can be fixed to the organ storage section at different positions in the longitudinal direction, and local fixation regions that can be fixed to the organ storage section by the trainee's operation of the target device within the internal space of the organ storage section. a movable region that can be displaced;
The detection means is capable of detecting displacement or deformation of a target region that is at least a part of the movable region of the hollow organ model within the internal space, at least during training;
The luminal organ model has a plurality of linear micro- grooves on the inner wall surface defining the lumen, which can retain the lubricating fluid injected into the lumen;
The width of each of the plurality of linear minute grooves is less than 1 mm (millimetre),
Medical simulator. a hollow organ model that is flexible and has a shape imitating at least one hollow organ;
an organ accommodating section that accommodates the luminal organ model in an internal space in a locally fixed state;
detection means;
Judgment means;
a time acquisition means;
evaluation means,
Equipped with
The luminal organ model has local fixation regions that can be fixed to the organ storage section at different positions in the longitudinal direction, and local fixation regions that can be fixed to the organ storage section by the trainee's operation of the target device within the internal space of the organ storage section. a movable region that can be displaced;
The detection means is capable of detecting displacement or deformation of a target region that is at least a part of the movable region of the hollow organ model within the internal space, at least during training;
The determining means determines that the part of the target device has passed through a plurality of check points provided at mutually different positions in the longitudinal direction of the lumen of the hollow organ model ,
The time acquisition means acquires the stay time of the part between two checkpoints,
The evaluation means evaluates the trainee's technique using at least the acquired residence time.
Medical simulator. The time acquisition means includes a first stay time from passing the first checkpoint to passing the second checkpoint, and a first stay time from passing the second checkpoint to the first checkpoint. and the second stay time until passing through, respectively.
The evaluation means evaluates the first stay time and the second stay time using separate evaluation methods, respectively.
The medical simulator according to claim 13. load acquisition means for acquiring load information on a predetermined part of the luminal organ model;
further comprising;
When the acquired load information indicates a load exceeding a threshold, the evaluation means deducts points corresponding to the load information from the evaluation points scored using the acquired residence time, calculating an evaluation point for the trainee's technique;
The medical simulator according to claim 13 or 14. utterance acquisition means for acquiring utterance information of the trainee;
utterance identifying means capable of identifying one or more predetermined utterances uttered by the trainee among a plurality of predetermined types of predetermined utterances based on the acquired utterance information;
further comprising;
The evaluation means calculates the evaluation points by adding or subtracting points based on the specified combination of one or more predetermined utterances.
The medical simulator according to claim 15. a measuring means for measuring the atmospheric pressure within the lumen of the luminal organ model;
further comprising;
The evaluation means further evaluates the trainee's technique using a comparison result between the atmospheric pressure measured when the target device part stays between two checkpoints and an atmospheric pressure threshold.
A medical simulator according to any one of claims 13 to 16. The evaluation means detects the detected bending state, stretching state, twisting state, or loop state when the detecting means can detect the bent state, stretched state, twisted state, or loop state of the target region. further evaluating the trainee's technique using
Medical simulator according to any one of claims 13 to 17. The detection means detects, at least during training, that at least a part of the movable region of the luminal organ model exceeds an evaluation position in the front-back direction or an evaluation position in the up-down direction in the internal space of the organ storage section. ,
The evaluation means further uses the detection result of the evaluation position being exceeded by the detection means to evaluate the technique of the trainee.
A medical simulator according to any one of claims 13 to 18. a hollow organ model that is flexible and has a shape imitating at least one hollow organ; an organ accommodating section that accommodates the hollow organ model in an internal space; and a longitudinal direction in the lumen of the hollow organ model. A procedure evaluation method using a medical simulator executed by a control unit controlling a medical simulator including at least a plurality of sensors provided at mutually different positions,
Based on detection signals from the plurality of sensors, a part of the target device operated by the trainee has passed through a plurality of checkpoints provided at mutually different positions in the longitudinal direction of the lumen of the hollow organ model. determine that,
Obtain the residence time of the part between two checkpoints,
evaluating the trainee's technique using at least the obtained residence time;
A procedure evaluation method using a medical simulator that includes

Images