RU203279U1 - Tympanic Cavity Bypass Trainer Used as a Teaching Tool - Google Patents

Abstract

The utility model relates to medical technology, namely to teaching aids in otorhinolaryngology. The simulator includes two cylindrical tubes 25 mm long inserted into one another, the diameters of which are selected in such a way that the outer diameter of the small tube fits tightly to the inner diameter of the large tube, simulating the outer a life-size ear canal, and an elastic insert stretched between the small and large tubes at one end of the structure, simulating an eardrum. The cylindrical tubes are 3D printed from polypropylene, and the elastic liner is made from latex rubber. The design is fixed in a three-point system. The proposed model on the same scale simulates the anatomy of the ear canal and provides an opportunity to learn basic skills for novice otosurgeons, both for working with endoscopic technique and with an operating microscope.

Description

The useful model relates to medical technology, namely to teaching aids in otorhinolaryngology.

The introduction of innovative teaching technologies in the educational process is currently an objective necessity. The need for an individual approach to education has increased [1]. Today, there are a great many innovative simulators for developing surgical skills - from the simplest (teaching otoscopy) to virtual simulators of temporal bone dissection. Undoubtedly, the introduction of such educational programs makes it possible to improve the training class of specialists and reduce the risk of "medical error" [2, 3].

Modern higher education has faced a number of limitations in the use of the traditional method of teaching "at the operating table". Until now, dissection is considered the standard of practical training of any operating doctor, however, the legislative framework of many countries prohibits the use of biomaterials of the deceased for training, including on the territory of the Russian Federation in accordance with the Federal Law "On Burial and Funeral" dated 12.01.1996 N 8- FZ [6]. To improve practical skills in the field of microsurgery, virtual simulators are currently used, which are complex technical means based on tactile sensors and sophisticated software. Such simulators are expensive equipment that require certain conditions of maintenance and operation. These simulators are intended for operating and qualified surgeons and are used primarily for practicing specific surgical procedures and skills (such as Voxel-Man ENT, Stanford Temporal Bone Surgical Simulator) [7-9].

Therefore, the goal of our work was to create an accessible and inexpensive model that allows beginners to master the basic skills of outpatient otorhinolaryngologists and otosurgeons.

The closest technical solution to the useful model developed by us is a minimally invasive surgery manual skills trainer developed by B.C. Kozlov. and Kudryashov SE, who is also represented by a cylindrical tube, a port for endoscopic equipment (including a monitor), rhinological instruments and a set of cartridges for practicing a certain number of manual skills [5]. However, the direction of application of this simulator is surgery of the nasal cavity.

Due to the fact that the size of the operating field in otosurgery is even more limited than in surgery of the nose and paranasal sinuses, our technical task was to create a model for training the skills of microscopic surgery in the area of the external auditory canal, including the tympanic membrane.

To solve this problem, a simulator was created that can simulate the external auditory canal, as well as the eardrum.

When creating the design of this model, attention was paid to mastering, tactile sensation and understanding of focal axes in micro- and endoscopy of the external auditory canal, as well as for performing minor surgical procedures using endoscopic techniques (paracentesis, tympanic membrane shunting). The product is a cylinder imitating the dimensions of the external auditory canal in full size, and the elastic membrane is the tympanic membrane.

The technical result of the developed model as a teaching aid is to provide the possibility of practicing manual skills of paracentesis and the peculiarities of the technique of installing a factory shunt into the simulated tympanic membrane, taking into account the small area and increased trauma of both the external auditory canal and the tympanic membrane. The use of the simulator leads to an increase in the effectiveness of training for novice otosurgeons (students, graduate students and residents) and the achievement of appropriate results due to sequential and separate training of microscopic and endoscopic surgery skills in the area of the external auditory canal and tympanic membrane. At the same time, the simulator has a low cost.

When working with a microscope in a confined space, the following technical difficulties arise:

the complexity of the microscope settings for the individual characteristics of the student (inter-optical and focal length),

the complexity of the sense of the depth of the anatomy of this area, as a result of which there is an erroneous understanding about the remoteness of the instruments to the place of surgical manipulation (paracentesis).

Based on this, an important point is the development of visual and fine motor skills in a student.

Brief description of the drawings.

Figure 1. Cylindrical tube # 1 (small).

1 - the length of the cylindrical tube No. 1 is 25 mm;

2 - outer diameter 10 mm;

3 - inner diameter 9 mm.

Figure 2. Cylindrical tube # 2 (large).

4 - inner diameter 11 mm;

5 - outer diameter 12 mm;

6 - the length of the cylindrical tube No. 2 is 25 mm.

Figure 3. Liner made of elastic material in the initial state.

7 - the diameter of the insert in the initial state is 50 mm;

8 - thickness of the liner in the initial state ≤1 mm.

Figure 4. Tympanic cavity shunting simulator assembly.

9 - cylindrical tube # 1 (small);

10 - liner (stretched);

11 - cylindrical tube # 2 (large);

12 - the working part of the liner - an elastic membrane.

Implementation of the utility model.

To obtain this useful model, the actions were carried out as follows.

It was assumed that the imitation of the ear canal is reproduced by cylindrical plastic tubes: small No. 1 (Fig. 1) and large No. 2 (Fig. 2). Used two tubes of the same length 25 mm, which corresponds to the average length of the external auditory canal in full size (according to the literature [4]). The technical principle of the "shaft" and "hole" system was used to manufacture plastic cylinders (tubes). Parts of plastic tubes were made of polypropylene in accordance with GOST 11710-66 for the manufacture of plastic products with the appropriate quality of accuracy and printed on a 3D printer. The inner diameter of the large tube was matched to the outer diameter of the small tube with a tolerance of 0.125 mm. Tolerances and fits, stated in GOST 11710-66, ensured a sufficiently tight sliding of a small tube along the inner diameter of a large one.

The next step was to use a liner made of elastic material (glove latex rubber). The pipes were connected by installing a small pipe into a large one - by sliding. At the time of the beginning of the connection of this structure, an elastic insert was installed between the tubes (Fig. 3). The liner was straightened during the installation of one tube into another. As a result, a complete model was obtained. The area of the stretched fragment of the insert (elastic membrane) at the end of the small tube was 10 mm ² , which corresponds to the area of the tympanic membrane in full size.

The resulting product imitated the ear canal (plastic cylindrical tube) and the tympanic membrane (stretched at one end of the tube - an elastic membrane) (Fig. 4).

At the next stage, a design that mimics the ear canal and the tympanic membrane was installed in a three-point system and fixed. The simulator is ready for the training process.

Procedure for performing the exercise using a microscope:

customization of the microscope for individual characteristics,

placing and holding the ear funnel with one hand,

determination of focal length,

examination of the simulator simulating the external auditory canal, which blindly ends with an elastic membrane,

holding the ear funnel with one hand, with the other hand holding the parecentesis needle (sickle scalpel), mentally dividing the elastic membrane into 4 quadrants, the student makes an incision of the membrane in the posterior lower quadrant,

installation of a shunt into the formed perforation.

The order of performing the exercise using an endoscope:

setting up the monitor connected to the endoscope,

white balance adjustment,

holding the endoscope with one hand and the instrument with the other (paracentesis needle),

adjustment of the focal length of the endoscope placed in the simulator for clear visualization of the elastic membrane,

holding the endoscope with one hand, the other - the parecentesis needle (sickle scalpel), mentally dividing the elastic membrane into 4 quadrants, the student makes a membrane incision in the posterior lower quadrant,

installation of a shunt into the formed perforation.

The proposed textbook is included in the educational program and is used in the State Budgetary Institution of Health "Research Clinical Institute of Otorhinolaryngology named after LI Sverzhevsky" of the Moscow Department of Health and at the Department of Otorhinolaryngology named after B.S. Preobrazhensky Faculty of Medicine N.I. Pirogov of the Ministry of Health of Russia in the training of graduate students, residents and students.

This tutorial can be used in medical universities throughout the Russian Federation.

Literature

1. Gaivoronskiy I.V. Innovative technologies in teaching the discipline "Human Anatomy" / I.V. Gaivoronsky, A.I. Gayoronsky // Medicine. XXI Century. - 2008. - No. 9. - S. 38-43.

2. Kovalev S.P., Mironov S.P., Arutyunov A.T. et al. Development of a system for the formation and assessment of professional medical skills and abilities using advanced simulation technologies. Kovalev, S.P. Mironov, A.T. Arutyunov et al. // Kremlin medicine. Clinical Bulletin. - 2011. - No. 2. - S. 97-102.

3. Kozlov B.C., Lazarevich I.L., Savlevich E.L. Modern simulation technologies in otorhinolaryngology / B.C. Kozlov, I.L. Lazarevich, E.L. Savlevich // Kremlin Medicine. Clinical Bulletin. - 2013.-№1. - S. 5-9.

4. Palchun V.T., Magomedov M.M., Luchikhin L.A. Otorhinolaryngology. Textbook 3rd edition, revised and enlarged. - 2014 .-- S. 330-337.

5. Patent RU 180078 dated 01.06.2018 Simulator for mastering skills in endonasal endoscopic surgery / Kozlov B.C., Kudryashov S.E.

6. Federal Law of 12.01.1996 N 8-FZ "On Burial and Funeral Business".

7. Musbahi, O., Aydin, A., Al Omran, Y., Skilbeck, CJ., Ahmed, K., JOURNAL OF SURGICAL EDUCATION. 2017; 74 (2); P. 203-215.

8. Rosen K., The history of medical simulation. J Crit Care. 2008; 23: 157-66.

9. Abou-Elhamd, KEA., Al-Sultan, AI., Rashad, UM., JOURNAL OF LARYNGOLOGY AND OTOLOGY. 2010; 124 (3), P. 237-241.

Claims (1)

Tympanic Bypass Trainer used as a teaching aid, including two cylindrical tubes to simulate the external ear canal, an elastic insert to simulate an eardrum, and a three-point fixation system to fix the cylindrical tubes, the cylindrical tubes are 25 mm long, 3D fabricated -printer made of polypropylene and inserted into one another by sliding with an elastic insert placed between them and expanded during installation, the outer diameter of the small tube and the inner diameter of the large tube are selected in such a way that they provide tension of the elastic insert between the tubes at one end, and the elastic the liner is made of latex rubber and has an area of the stretched fragment at the end of the small tube of 10 mm ² .

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