RU2796314C2 - Device for acquiring skills in microneurosurgery while working in a deep surgical field - Google Patents

Abstract

FIELD: medical equipment.

SUBSTANCE: invention relates to devices used to help the students acquire microneurosurgical skills. The device for acquiring skills in microneurosurgery when working in a deep surgical field contains a head simulator with a burr window and an operated object located inside the head simulator. A skull simulator which has all the cranial structures, printed on a 3D printer is used. The device additionally has a substrate on which a skull simulator is installed. A planar cut is formed on one side of the skull simulator. On the opposite side of the skull simulator there is a trepanation window located at an angle of 30 to 90 degrees relative to the cut. The substrate consists of at least one module 0.9 cm high and has a cutout in the middle. The dimensions of the substrate are larger than the dimensions of a planar cut made on a skull simulator. The operated object is located in the cutout of the substrate, and the skull simulator is installed on the substrate with the side having a cut.

EFFECT: increasing the efficiency of training by bringing the conditions closer to operating ones.

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Description

The present invention relates to the field of medical technology, namely to devices that are used to teach neurosurgery skills and can be used to acquire microneurosurgery skills from students when working in a deep surgical field in conditions close to a real topographic anatomical environment.

Many devices are currently being developed for use in microneurosurgical training. However, such devices do not have the required depth of the surgical wound and the modeling of the angle of attack, and there is also no simulation of the unstable position of the hands in different parts of the skull, which makes the acquisition of skills less effective. Therefore, the development of devices that made it possible to practice skills in conditions as close as possible to the real operating environment is an urgent task.

A device for teaching microsurgical skills to work in a deep operating field is known, which is a plastic hand rest, which is located above the area of the operation. The plastic stop has a round hole with a diameter of 30 mm. It is installed above the operated object, and sets a depth of 30 mm to the operated object. As an operated object, both elements simulating vessels, such as plastic tubes, and laboratory animals are used. (Shurey S, Akelina Y, Legagneux J, Malzone G, Jiga L, Ghanem AM. The rat model in microsurgery education: classical exercises and new horizons. Archives of plastic surgery, 2014, 41(3):201.).

A significant disadvantage of the device is that it does not allow you to effectively form the skills of microneurosurgery when working in a deep surgical field, because. the plastic palm rest is flat, and therefore the surgeon's fingers rest on a flat surface, which is inconsistent with actual head surgery where the surgeon has to rest on uneven cranial structures with curvilinear surface geometry. The support is based on the "hand touch" technique, in which the fingers act as a support on the cranial structures. It is designed to stabilize the position of instruments and reduce hand strain. In this device, it is impossible to reproduce the muscle tension experienced by the surgeon.

In this technical solution, a plastic palm rest is used that sets a direct vertical angle to the operated object (angle of attack), which simplifies the conditions compared to a real neurosurgical operation, since the tilt of the head and the burr hole are the constituent elements of the formation of the angle of attack. In addition, it has a round hole through which the intervention is performed, which does not correspond to the shape of the burr window in real conditions, and also distorts the angle of attack.

All this reduces the effectiveness of acquiring the skills of microneurosurgery in students when working in a deep surgical field.

A device for teaching deep microsurgical skills is known, which is a mannequin head, in which a burr hole is formed in the required anatomical region. Balls with paint are placed inside the head, imitating the hemispheres, and objects imitating the vessels on which the operation is performed (chicken brachial artery). (Takeuchi M, Hayashi N, Hamada H, Matsumura N, Nishijo H, Endo S. A new training method to improve deep microsurgical skills using a mannequin head. Microsurgery: Official Journal of the International Microsurgical Society and the European Federation of Societies for Microsurgery , 2008, 28(3): 168-170.).

The disadvantages of the known device include the fact that the head does not have reliable fixation, and, consequently, the imitation of fixing the head with the Mayfield bracket is broken, which does not allow you to set the real angle of the patient's head, and also leads to excessive mobility, not typical for a real operation. In addition, the limited space inside the head of the mannequin does not allow for more complex training using laboratory animals. Accordingly, the student will not be able to acquire the skill of deep dissection and suture on living vessels. Also, the student will not have the opportunity to acquire the skill of performing hemostasis, after anastomosis, in a deep surgical field and work with bleeding in case of damage to blood vessels.

The objective of the present invention is to expand the arsenal of devices for acquiring microneurosurgery skills when working in a deep surgical field, creating a device for acquiring microneurosurgery skills, which makes it possible to increase the efficiency of acquiring microneurosurgical skills in students when working in a deep surgical field,

The claimed technical result is achieved due to the fact that the proposed device consists of a plastic skull printed on a 3D printer, a substrate and an operated object. On one side of the skull, a planar cut is formed parallel to the substrate, and on the opposite side of the skull there is a trepanation window, which is located at an angle of 10 to 170 degrees relative to the cut. The substrate consists of at least one module and has a cutout in the middle. In this case, the dimensions of the substrate are larger than the dimensions of the planar cut made on the side of the skull. The operated object is placed in the cutout of the substrate. Silicone tubes, chicken thigh, rat can be used as an operated object. The skull, with the side having a cut, is installed on the substrate. An even cut allows you to clearly fix the skull on a flat surface of the substrate.

Comparative analysis with the prototype showed that the proposed technical solution differs from the prototype in that a skull printed on a 3D printer is used as a head, while a trepanation window is located on one side of the skull, and a planar cut is made on the opposite side. In this case, the trepanation window is located at an angle of 10 to 170 degrees relative to the planar cut. In addition, the proposed device additionally has a substrate consisting of at least one module, the dimensions of which are larger than the dimensions of the side of the skull with a cut. In this case, the substrate has a cutout in the center, into which the operated object is placed. And the skull is installed on the substrate with the side having a cut. An even cut allows you to clearly fix the skull on a flat surface of the substrate.

Thus, the proposed technical solution meets the criterion of invention "novelty".

The analysis of the patent and scientific and technical literature showed that the proposed device differs not only from the prototype, but also from other technical solutions in this related field. Thus, the authors did not find devices for acquiring microneurosurgery skills when working in a deep surgical field that have the proposed design features. Namely, the design features make it possible to increase the effectiveness of teaching microneurosurgery skills by bringing the conditions as close as possible to operating rooms, to create conditions under which the tension of the hands when relying on cranial structures will be identical to natural ones, to obtain a more stable device with a predetermined inclination corresponding to the trepanation window, which allows performing arm training not only in the horizontal plane, but also in non-standard oblique planes close to real operational accesses, to provide the possibility of using not only silicone tubes to simulate blood vessels, but also the use of large objects, such as a chicken thigh or a rat. A flat cut made on the opposite side of the trepanation allows the skull to be placed on the substrate at an angle that imitates the angle of the patient's head fixed in the Mayfield 5 bracket.

The design features of the proposed device make it possible to effectively acquire microneurosurgical skills when working in a deep surgical field, improve the microneurosurgical skills of operating surgeons in a deep surgical field, and allow practicing a wide range of techniques: microsurgical dissection, hemostasis, microsurgical suture. An even cut allows you to clearly fix the skull on a flat surface of the substrate. Depending on the access chosen for testing and the height of the substrate, the distance from the trepanation window to the operated object changes, allowing you to adjust the skill level, the required depth of the surgical wound and modeling the angle of attack, which also increases the efficiency of microneurosurgical skills training.

The proposed device can be used to acquire the skills of microneurosurgery in students when working in a deep surgical field.

Thus, the proposed technical solution meets the criteria of "inventive step" and "industrial applicability".

On FIG. 1. shows a diagram of a device for acquiring skills in microneurosurgery when working in a deep surgical field, where 1 is the skull; 2 - trepanation window; 3 - substrate; 4 - operated object; 5 - planar cut; 6 - cutout of the substrate for the object; 7 - substrate module.

On FIG. Figures 2-6 show variants of the proposed device for acquiring microneurosurgery skills while working in a deep surgical field (depending on the acquired microneurosurgery skill).

In FIG. 2 shows a diagram of a device for acquiring skills in microneurosurgery when working in a deep surgical field (an option for practicing skills with a retrosigmoid approach), where 1 is the skull; 2 - trepanation window; 3 - substrate; 4 - operated object; 5 - planar cut; 6 - cutout of the substrate for the object; 7 - substrate module.

In FIG. 3 shows a diagram of a device for acquiring skills in microneurosurgery when working in a deep surgical field (an option for practicing skills with an occipital interhemispheric approach), where 1 is the skull; 2 - trepanation window; 3 - substrate; 4 - operated object; 5 - planar cut; 6 - cutout of the substrate for the object; 7 - substrate module.

In FIG. 4 shows a diagram of a device for acquiring skills in microneurosurgery when working in a deep surgical field (an option for practicing skills with frontal interhemispheric access), where 1 is the skull; 2 - trepanation window; 3 - substrate; 4 - operated object; 5 - planar cut; 6 - cutout of the substrate for the object; 7 - substrate module.

In FIG. 5 shows a diagram of a device for acquiring skills in microneurosurgery when working in a deep surgical field (an option for practicing skills with a lateral supraorbital approach), where 1 is the skull; 2 - trepanation window; 3 - substrate; 4 - operated object; 5 - planar cut; 6 - cutout of the substrate for the object; 7 - substrate module.

In FIG. 6 shows a diagram of a device for acquiring skills in microneurosurgery when working in a deep surgical field (an option for practicing skills with an extended parietal interhemispheric approach), where 1 is the skull; 2 - trepanation window; 3 - substrate; 4 - operated object; 5 - planar cut; 6 - cutout of the substrate for the object; 7 - substrate module.

The proposed device consists (see the appendix to the description of the application Fig. 1) of a plastic skull 1 printed on a 3D printer and having a burr window (burr hole) 2 in the required anatomical zone, a substrate 3 and an operated object 4. On one side of the skull a planar cut 5 is formed parallel to the substrate 3, and on the opposite side of the skull there is a trepanation window 2, which is located at an angle of 30 to 90 degrees relative to the cut 5. The substrate 3 consists of at least one module 7 and has a cutout 6 in the middle. the dimensions of the substrate 3 are larger than the dimensions of the planar cut 5 made on the side of the skull 1. The cutout 6 of the substrate 3 is used to place the operated object 4. Silicone tubes, a chicken thigh, or a rat can be used as the operated object. Skull 1, with the side having a cut 5, is installed on the substrate 3. An even cut 5 allows you to clearly fix the skull 1 on the flat surface of the substrate 3.

The device is made in the following way: A human head is scanned using a CT scanner. Scan data is exported to a file (DICOM) and converted to a STereoLithography (STL) file using Mimics 17.0 (Materialise NV). After that, the file is processed in a three-dimensional editor, getting rid of all unnecessary tissues, scanning errors and artifacts, restoring bone structures damaged as a result of scanning. Also, at the stage of computer processing, a planar cut and a trepanation window are formed, depending on the chosen neurosurgical approach. The cut on the skull is formed in such a way as to simulate the angle of the patient's head, fixed in the Mayfield bracket in accordance with the planned neurosurgical approach. The trepanation window is located at an angle of 30 to 90 degrees relative to the cut on the opposite side. The skull is then 3D printed.

The object to be operated on (silicone tubes, chicken thigh, rat) is placed in the cutout of the substrate and the skull is placed on the substrate. An even cut allows you to clearly fix the skull on a flat surface of the substrate. Depending on the access chosen for practicing and the height of the substrate, the distance from the trepanation window to the operated object changes, allowing you to adjust the skill level.

Since the objects to be operated on may be larger than the skull, they may not fit completely under it. If you try to install the skull on an uneven surface, the support and fixation of the skull will be broken. To solve this problem, a substrate was used. It is intended to level the surface on which the skull will be installed. The height of the substrate is selected in accordance with the operated object. For example, if the object is 4 cm high, the substrate should be at least 4 cm high. Since the objects on which the student can perform simulation operations may vary, the height of the substrate should change depending on the height of the object being operated on. In accordance with this, the substrate can consist of several modules to regulate the required height. In our example, one module of such a substrate has a height of 0.9 mm. For example, in order to level the surface during surgery on a chicken thigh, 3.1 cm high, it is necessary to use 4 substrate modules, with a total height of 3.6 cm. The substrate is made of an elastic, lightweight and elastic material so that it can perform its functions, namely : so that it does not sag under the skull, on which the student will create an emphasis, and so that the student can create a cutout in the substrate for the operated object. The substrate can be made, for example, from ethylene vinyl acetate.

In a real operating room environment, the position of the patient is one of the most important steps. Proper head positioning provides the most direct access to the surgical target and reduces the working distance for the surgeon. To simulate such an arrangement, a cut is formed on the skull, opposite which, at a certain angle, depending on the access, a trepanation window is formed. This creates the most direct access to the operated object, simulating a real surgical procedure. The skull, when installed on a substrate, should be located strictly above the operated object to create the most effective angle of attack.

Example 1. The proposed device was used to acquire the skills of microneurosurgery when working in a deep surgical field with retrosigmoid access (see Appendix to the description of Fig. 2). At the same time, on one side of the plastic skull 1 printed on a 3D printer, a cut 5 is formed parallel to the substrate 3. On the opposite side at an angle of 40-60 degrees relative to cut 5, a trepanation window 2 is formed on the right side. chicken thigh, which is placed in the cutout 6 of the substrate 3. In this case, the substrate consists of 4 modules. The skull 1 is placed on the substrate 3, with the side having a cut 5. The operated object 4 is located at a distance of 2-4 cm from the trepanation window 2. The device allows you to effectively train your skills through retro-sigmoid access.

Example 2. The proposed device was used to acquire the skills of microneurosurgery when working in a deep operating field with occipital interhemispheric access (see Appendix to the description of Fig. 3). At the same time, on one side of the plastic skull 1 printed on a 3D printer, a cut 5 is formed parallel to the substrate 3. On the opposite side at an angle of 60-70 degrees relative to the cut 5, a trepanation window 2 is formed on the left side. rat, which is placed in the cutout 6 of the substrate 3. The substrate 3 consists of 3 modules. The skull 1 is placed on the substrate 3, with the side having a cut 5. The operated object 4 is located at a distance of 5-7 cm from the burr window 2. The device allows you to effectively train skills through the occipital interhemispheric approach.

Example 3. The proposed device was used to acquire the skills of microneurosurgery when working in a deep surgical field with frontal interhemispheric access (see Appendix to the description of Fig. 4). At the same time, on one side of the plastic skull 1 printed on a 3D printer, a cut 5 is formed parallel to the substrate 3. On the opposite side at an angle of 50-70 degrees relative to the cut 5, a trepanation window 2 is formed on the right side. rat, which is placed in the cutout 6 of the substrate 3. The substrate consists of 3 modules. The skull 1 is placed on the substrate 3, with the side having a cut 5. The operated object 4 is located at a distance of 4-6 cm from the burr window 2. The device allows you to effectively train skills through the frontal interhemispheric access.

Example 4. The proposed device was used to acquire microneurosurgery skills when working in a deep operating field with lateral supraorbital access (see the appendix to the description of Fig. 5) a diagram of a device for acquiring microneurosurgical skills when working in a deep operating field is presented. At the same time, on one side of the plastic skull 1 printed on a 3D printer, a cut 5 is formed parallel to the substrate 3. On the opposite side at an angle of 30-60 degrees relative to cut 5, a trepanation window 2 is formed on the left side. Silicone tubes are used as an operated object4, which are placed in the cutout 6 of the substrate 3. The substrate consists of 2 modules. The skull 1 is mounted on the substrate 3, side having a cut 5. The operated object 4 is located at a distance of 2-4 cm from the trepanation window 2. The device allows you to effectively train skills through the lateral supraorbital access.

Example 5. The proposed device was used to acquire microneurosurgery skills when working in a deep surgical field with an extended parietal interhemispheric access (see the appendix to the description of Fig. 6) a diagram of a device for acquiring microneurosurgical skills when working in a deep surgical field is presented. At the same time, on one side of the plastic skull 1 printed on a 3D printer, a cut 5 is formed parallel to the substrate 3. On the opposite side at an angle of 80-90 degrees relative to the cut 5, a trepanation window 2 is formed on the left side. As the operated object 4, silicone tubes that are placed in the cutout 6 of the substrate 3. In this case, the substrate consists of 2 modules. The skull is mounted on the substrate 3, with the side having a cut. The operated object 4 is located at a distance of 4-6 cm from the trepanation window. The device allows you to effectively train work skills through an extended parietal interhemispheric access.

Thus, the proposed invention expands the arsenal of tools used to acquire the skills of microneurosurgery when working in a deep surgical field. The device makes it possible to increase the efficiency of teaching microneurosurgery skills due to the maximum approximation of conditions to operating rooms.

Claims (9)

1. A device for acquiring skills in microneurosurgery when working in a deep surgical field, containing a head simulator with a burr window and an operated object located inside the head simulator, characterized in that a skull simulator is used as a head simulator, which has all cranial structures, while the simulator of the skull is printed on a 3D printer, and the device additionally has a substrate on which the skull simulator is installed, while on one side of the skull simulator a planar cut is formed, and on the opposite side of the skull simulator there is a trepanation window, which is located at an angle of 30 to 90 degrees relative to the cut, while the substrate consists of at least one module 0.9 cm high and has a cutout in the middle, and the dimensions of the substrate are larger than the dimensions of a planar cut made on the skull simulator, and the operated object is located in the cutout of the substrate, and the skull simulator is installed on the substrate cut side. 2. The device according to claim 1, characterized in that silicone tubes are used as the operated object. 3. The device according to claim. 1, characterized in that a chicken thigh is used as an operated object. 4. The device according to claim 1, characterized in that a rat is used as an operated object. 5. The device according to claim 1, characterized in that the trepanation window is at an angle of 40-60 degrees relative to the planar cut. 6. The device according to claim. 1, characterized in that the trepanation window is at an angle of 60-70 degrees relative to the planar cut. 7. The device according to claim 1, characterized in that the trepanation window is at an angle of 50-70 degrees relative to the planar cut. 8. The device according to claim. 1, characterized in that the trepanation window is at an angle of 30-60 degrees relative to the planar cut. 9. The device according to claim 1, characterized in that the trepanation window is at an angle of 80-90 degrees relative to the planar cut.

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