WO2017204311A1 - Simulateur médical - Google Patents

Simulateur médical Download PDF

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Publication number
WO2017204311A1
WO2017204311A1 PCT/JP2017/019618 JP2017019618W WO2017204311A1 WO 2017204311 A1 WO2017204311 A1 WO 2017204311A1 JP 2017019618 W JP2017019618 W JP 2017019618W WO 2017204311 A1 WO2017204311 A1 WO 2017204311A1
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WO
WIPO (PCT)
Prior art keywords
force
force sensor
evaluation
medical simulator
unit
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Application number
PCT/JP2017/019618
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English (en)
Japanese (ja)
Inventor
直 ▲秦▼野
Original Assignee
直 ▲秦▼野
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Publication date
Application filed by 直 ▲秦▼野 filed Critical 直 ▲秦▼野
Priority to JP2018519617A priority Critical patent/JPWO2017204311A1/ja
Publication of WO2017204311A1 publication Critical patent/WO2017204311A1/fr

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    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
    • G16H20/40—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
    • G—PHYSICS
    • G09—EDUCATION; CRYPTOGRAPHY; DISPLAY; ADVERTISING; SEALS
    • G09B—EDUCATIONAL OR DEMONSTRATION APPLIANCES; APPLIANCES FOR TEACHING, OR COMMUNICATING WITH, THE BLIND, DEAF OR MUTE; MODELS; PLANETARIA; GLOBES; MAPS; DIAGRAMS
    • G09B19/00—Teaching not covered by other main groups of this subclass
    • G—PHYSICS
    • G09—EDUCATION; CRYPTOGRAPHY; DISPLAY; ADVERTISING; SEALS
    • G09B—EDUCATIONAL OR DEMONSTRATION APPLIANCES; APPLIANCES FOR TEACHING, OR COMMUNICATING WITH, THE BLIND, DEAF OR MUTE; MODELS; PLANETARIA; GLOBES; MAPS; DIAGRAMS
    • G09B9/00—Simulators for teaching or training purposes
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/50—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for simulation or modelling of medical disorders
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H70/00—ICT specially adapted for the handling or processing of medical references
    • G16H70/20—ICT specially adapted for the handling or processing of medical references relating to practices or guidelines
    • G—PHYSICS
    • G09—EDUCATION; CRYPTOGRAPHY; DISPLAY; ADVERTISING; SEALS
    • G09B—EDUCATIONAL OR DEMONSTRATION APPLIANCES; APPLIANCES FOR TEACHING, OR COMMUNICATING WITH, THE BLIND, DEAF OR MUTE; MODELS; PLANETARIA; GLOBES; MAPS; DIAGRAMS
    • G09B23/00—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes
    • G09B23/28—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes for medicine

Definitions

  • the present invention relates to a medical simulator capable of objectively evaluating techniques in each procedure performed in various surgical operations and performing training for improving individual skills.
  • Patent Literature 1 includes a display unit that displays a training target object that simulates a training target and an instrument object that simulates an instrument on a screen, and a position detection unit that detects the position of the instrument held by a user.
  • a state detection unit for detecting a state of the instrument held by a user, and a position and a state of the instrument object corresponding to the detected position and the state, and the change causes the instrument object to be the training target.
  • An information processing unit that calculates an external force received from an object, a connection member attached to the instrument, and a transmission member that extends from the training device to the connection member and transmits a force in the pulling direction to the instrument via the connection member And a drive unit that generates a force in the pulling direction and applies the force to the transmission member, and a control unit that controls the drive unit. Kneading apparatus has been proposed. In this device, the driving unit generates a force in the pulling direction having a set magnitude as an initial force, and the external force calculated by the information processing unit is used as a tactile force sense as the connection member and By increasing or decreasing the initial force to be transmitted to the user via the instrument, skill training using instruments such as surgery can be realized in virtual space.
  • Patent Document 2 discloses a simulated body that is subjected to a predetermined treatment during surgical training, a holding body that holds the simulated body, a support body that operably supports the holding body, and the holding body and the support body. And a control unit for controlling the operation of the holding body, and the connection member is formed of a shape memory material that can contract with respect to the original shape when a current flows, and the control unit includes: There has been proposed a surgical training apparatus provided with drive signal generating means for supplying a current to the connecting member at a predetermined timing.
  • the driving signal generating means by controlling the operation of the holding body with a change in the shape of the connecting member by changing the current supply state to the connecting member, Assuming cardiac surgery, etc., training of various treatments such as anastomosis, ligation, and cutting can be performed on living tissue in a moving state.
  • Patent Document 3 includes a target part where an evaluation subject simulates a medical practice, a soft material that can be elastically deformed by a force acting around the target part, and an elastic deformation of the soft material.
  • a medical technique evaluation system including a sensor capable of measuring a state quantity in three orthogonal axes and a technique evaluation device for obtaining an evaluation value of a technique for the medical action based on a measurement value of the sensor. .
  • the system calculates the evaluation value by substituting a value based on each state quantity in the three orthogonal directions measured by the sensor into a preset evaluation function, and the sensor emits light
  • a reflection type photointerrupter including an element and a light receiving element, provided at a position where the light from the light emitting element is reflected by the soft material and can be received by the light receiving element, and changes a current passing through the light receiving element. Based on this, by obtaining a substitution value for the evaluation function, it is possible to objectively evaluate doctors and medical students' skills for various medical actions such as treatment during surgery.
  • the medical technique evaluation system described in Patent Document 3 measures a state quantity in three orthogonal directions accompanying the elastic deformation of the soft material using a reflective photo interrupter (also referred to as a photo reflector).
  • a reflective photo interrupter also referred to as a photo reflector.
  • the elastic deformation of the soft material to be measured is used for measuring the force, the degree of deformation differs depending on the measurement environment such as the flexibility, elasticity, or temperature of the material, and precise measurement is performed. It is difficult.
  • advanced techniques such as cardiac surgeons and general surgeons
  • quantitative measurement is required for the measurement of force in the measurement object, but the system can only perform qualitative measurements, and it is difficult to evaluate objectively. Problems arise.
  • the present invention has been proposed in view of the above circumstances, and can individually evaluate individual skills in evaluation subjects such as doctors and medical students, and can perform training for improving surgical techniques.
  • An object is to provide a medical simulator that can be performed.
  • a first aspect of the medical simulator according to the present invention includes a simulation member that performs a predetermined surgical procedure in a simulated manner during surgical training, an arm member that holds the simulation member, Based on a force sensor provided on the arm member for measuring the compressive force or tensile force in the orthogonal triaxial direction against the simulated member, and the measured value of the compressive force or tensile force in the orthogonal triaxial direction measured by the force sensor And an evaluation means for evaluating a procedure in the predetermined surgical procedure.
  • the compression force or tensile force in the orthogonal triaxial direction with respect to the simulated member is measured, and based on these measured values, the procedure in the surgical treatment of the evaluation subject such as a doctor or medical student It is possible to objectively evaluate individual skills by evaluating.
  • the second aspect of the medical simulator is characterized by comprising warning means for issuing a warning based on the evaluation result of the evaluation means.
  • an error in its own surgical procedure can be recognized in real time by the warning issued by the warning means.
  • the evaluation unit compares the measurement value of the compressive force or tensile force in the three orthogonal directions with the preset threshold value of the compressive force or tensile force.
  • a warning signal is output to the warning means when the value is outside the threshold range.
  • the third aspect of the medical simulator by comparing the measured value of the compressive force or tensile force in the orthogonal three-axis direction with respect to the simulated member with a preset threshold value of the compressive force or tensile force, it is possible to individually Can be objectively evaluated.
  • the fourth aspect of the medical simulator is characterized in that the warning means inputs the warning signal output from the evaluation means and issues a warning based on the signal.
  • the fourth aspect of the medical simulator it is possible to quantitatively recognize the degree of error in the surgical procedure by the warning issued by the warning means based on the warning signal from the evaluation means.
  • the fifth aspect of the medical simulator is characterized in that the evaluation means graphs the measured values of the compressive force or tensile force in the orthogonal three-axis directions and displays the graph on a display device.
  • each skill can be visualized by displaying the measured values of the compression force or tensile force in the orthogonal triaxial direction on the display device. Can be easily confirmed while training.
  • a sixth aspect of the medical simulator includes storage means for storing the measured values of the compressive force or tensile force in the three orthogonal directions measured by the force sensor and the graph created by the evaluation means. It is characterized by.
  • the measured value (data) of the compressive force or tensile force in the three orthogonal directions measured by the force sensor and the graph created by the evaluation unit are stored in the storage unit. Can call them at any time. In this way, by comparing each of the graphs created based on past data and expert data, and the graphs created based on your own data, you can check your progress in skill and achievement And objectively evaluate the results.
  • a seventh aspect of the medical simulator when the three orthogonal directions with respect to the simulation member are a first axial direction, a second axial direction, and a third axial direction, respectively, compression with respect to the first axial direction is performed.
  • a first force sensor for measuring force or tensile force
  • a second force sensor for measuring compressive force or tensile force with respect to the second axial direction
  • the first force sensor, the second force sensor, and the third force sensor are strain gauge type load cells, respectively.
  • the orthogonal triaxial directions can be easily made with a simpler configuration. Compressive force or tensile force can be measured.
  • the eighth aspect of the medical simulator includes a set of simulated members that are used to simulate a predetermined surgical procedure during surgical training, a set of arm members that respectively hold the set of simulated members, A fourth force sensor that is provided on at least one of the pair of arm members and measures a ligating force with respect to the pair of simulated members, and the evaluation means includes the three orthogonal directions measured by the force sensor.
  • the procedure in the predetermined surgical procedure is evaluated on the basis of the measured value of the compression force or tensile force and the measured value of the ligation force measured by the fourth force sensor.
  • the 8th aspect of the said medical simulator while being able to measure the compressive force or tensile force of the orthogonal triaxial direction with respect to a simulation member, it can also measure a ligation force, Therefore
  • the application range of the said medical simulator is expanded. be able to.
  • the ninth aspect of the medical simulator is characterized in that the fourth force sensor is a strain gauge type load cell.
  • the ligating force can be easily measured with a simpler configuration by using a strain gauge type load cell as the fourth force sensor.
  • FIG. 3 is a flowchart for explaining an example of the operation of the medical simulator according to the first embodiment. It is a flowchart explaining an example of the scoring method of the medical simulator concerning Embodiment 1.
  • FIG. It is a perspective view which shows an example of the medical simulator concerning Embodiment 2.
  • FIG. 3 It is a perspective view which shows an example of the usage condition of the medical simulator concerning Embodiment 3, (a) is a perspective view which shows the state before suture, (b) is a perspective view which shows the state at the time of a suture start, (C) is a perspective view showing a state during suturing, and (d) is a perspective view showing a state at the end of suturing. It is a perspective view which shows an example of the usage condition of the medical simulator concerning Embodiment 4.
  • X, Y, and Z represent three space axes orthogonal to each other.
  • the directions along these axes are defined as a first direction X (X direction), a second direction Y (Y direction), and a third direction Z (Z direction), respectively.
  • X direction and the Y direction represent the in-plane direction of each constituent member
  • Z direction represents the thickness direction or the height direction of each constituent member.
  • FIG. 1 is a perspective view illustrating an example of a medical simulator according to the first embodiment.
  • the medical simulator 1 includes a simulation member 20 simulating an artery, an arm member 30 holding the simulation member 20, and compression in three orthogonal directions with respect to the simulation member 20 on a base material 10 made of a metal plate.
  • a first force sensor 40a, a second force sensor 40b, and a third force sensor 40c that measure force or tensile force, respectively, are disposed at predetermined positions, which will be described later, and these force sensors 40a, 40b, and 40c are provided.
  • a base material 10 that is electrically connected to an interface unit 60 that controls the medical simulator 1 through wirings 50a, 50b, and 50c and on which these components are arranged is housed in a casing 70 that is a metal box. It is configured.
  • the housing 70 includes an accommodating portion 71 that accommodates the base material 10 on which each element is arranged, and a lid portion 72 that covers the upper portion and protects each element on the base material 10, and is covered with the lid portion 72. Then, a state in which a part of the simulation member 20 and the arm member 30 is exposed from the opening 721 formed in the upper portion of the lid 72 is maintained.
  • the fixing member 80 that fixes the interface unit 60 and the third force sensor 40 c on the base material 10 on both ends of the ⁇ X direction on the base material 10 accommodated in the housing 70. are fixed opposite to each other.
  • the simulation member 20 is provided so as to be supported via the force sensors 40a, 40b, and 40c. That is, the simulation member 20 is supported by the first force sensor 40a via the arm member 30, and the simulation member 20 and the first force sensor 40a are supported by the second force sensor 40b.
  • the first force sensor 40a and the second force sensor 40b are supported by the third force sensor 40c, and the simulated member 20, the first force sensor 40a, the second force sensor 40b, and the third force sensor 40c are It is supported by the fixing member 80. That is, in this embodiment, the simulation member 20 is supported by a sensor structure including the force sensors 40a, 40b, and 40c, and the structure including the simulation member 20 and the force sensors 40a, 40b, and 40c It is held and fixed by a fixing member 80 on the material 10.
  • the first force sensor 40a can compress or pull in the ⁇ Y direction among the three orthogonal directions relative to the simulated member 20.
  • the second force sensor 40b can measure the compressive force or tensile force in the ⁇ Z direction
  • the third force sensor 40c can measure the compressive force or tensile force in the ⁇ X direction. can do. That is, the force applied to the point (action point) where the simulated member 20 is treated can be measured by these force sensors 40a, 40b, and 40c.
  • the reason why the force sensors 40a, 40b, and 40c can be measured as described above to measure the compressive force or tensile force in the three-axis directions perpendicular to the simulated member 20 is that the force sensors 40a, 40b, and 40c In the configuration.
  • Each force sensor 40a, 40b, 40c has a shape in which a part of two circles are overlapped when viewed in plan, and has through holes 41a, 41b, 41c penetrating in the lateral direction. It has been.
  • a force is applied to the point (action point), and the force sensors 40a, 40b, and 40c are elastically deformed in a direction perpendicular to the penetration direction of the through holes 41a, 41b, and 41c.
  • each force sensor 40a, 40b, 40c can measure the same force even if it receives a force in the measuring direction at any position in the longitudinal direction. Therefore, if the force sensors 40a, 40b, and 40c are assembled with the measurement directions aligned in the three axial directions orthogonal to each other, the force in the three axial directions can be measured.
  • each force sensor 40a, 40b, 40c may be fixed in a predetermined direction at a predetermined position, and each force sensor 40a, Even if another rigid member is sandwiched between 40b and 40c, there is no problem without affecting the measurement accuracy.
  • the three force sensors 40a, 40b, and 40c are assembled through the fixing members described later.
  • the fixing method is not limited as long as it can be fixed firmly enough to transmit the force to be measured without loss. For example, a method such as adhesion or fastening can be applied.
  • the first force sensor 40a is arranged so that the penetration direction of the through hole 41a is parallel to the ⁇ Z direction, and one side surface in the short direction on the one end side in the longitudinal direction is connected to one end in the longitudinal direction of the arm member 30.
  • the screw 90a and 90b are screwed and fixed in a state in which they are in contact with the notch 31 provided by cutting out the part side.
  • the protruding portion of the fixing member 82 made of a metal rectangular body with the other side surface in the short side of the other end portion in the longitudinal direction in contact with one side surface of the fixing member 81 made of a metal column It is screwed and fixed with screws 91a and 91b in a state of being placed on one end side in the short direction on the surface of 821.
  • the first force sensor 40a is in a state where the one end side screwed and fixed to the arm member 30 floats in the air, and can measure the compressive force or tensile force in the ⁇ Y direction on the simulated member 20.
  • the fixing member 81 is fixed substantially at the center on the surface of the protruding portion 821 of the fixing member 82, but the width of the fixing member 81 in the short direction is larger than the width of the protruding portion 821 in the ⁇ Y direction. Since the width is formed to be small, a space for placing the first force sensor 40a is generated.
  • the fixing member 81 and the fixing member 82 are separate members, but they may be a single member.
  • the arrangement, the material, the shape, and the like of the fixing members 81 and 82 are not limited to the above.
  • the second force sensor 40b is arranged so that the penetration direction of the through hole 41b is parallel to the ⁇ Y direction, and one side surface in the short side direction on the one end side in the longitudinal direction is applied to the back surface side of the fixing member 82.
  • the screw 92a and 92b are screwed and fixed in contact with each other. Further, the other side surface in the short side direction on the other end side in the longitudinal direction is placed on the surface of the protruding portion 831 of the fixing member 83 made of a metal rectangular body material, and is screwed and fixed with the embedded screws 93a and 93b. Has been.
  • the upper surface 832 is located lower than the surface of the protruding portion 831 with respect to the Z direction.
  • the second force sensor 40b is in a state where the one end portion screwed and fixed to the fixing member 82 is suspended in the air, and can measure the compressive force or tensile force in the ⁇ Z direction with respect to the simulated member 20. .
  • the arrangement, material, shape, and the like of the fixing members 82 and 83 are not limited to the above.
  • the third force sensor 40c is arranged so that the penetration direction of the through hole 41c is parallel to the ⁇ Z direction, and one side surface in the short side direction on the one end side in the longitudinal direction is arranged on the protrusion portion 833 of the fixing member 83. On the other hand, it is screwed and fixed with embedded screws 94a and 94b in a state of being in contact with the side surface side. Further, the other side surface in the short side direction on the other end side in the longitudinal direction is cut out in one end portion on the side opposite to the base material 10 on the one side surface side in the short side direction of the fixing member 80 made of a metal rectangular body material. The screw 95a and 95b are screwed and fixed in a state of being placed on the cutout portion 801 provided.
  • the third force sensor 40c is in a state where one end portion screwed and fixed to the fixing member 83 is suspended in the air, and can measure the compressive force or tensile force in the ⁇ X direction on the simulated member 20. .
  • the arrangement, the material, the shape, and the like of the fixing members 80 and 83 are not limited to the above.
  • the front end surface 21 of the one-side axial direction of the simulation member 20 is bonded and fixed on the resin thin plate 100.
  • the arm member 30 is made of an aluminum L-shaped thin plate formed by bending one end portion in the longitudinal direction into an L shape.
  • the back surfaces of the aluminum L-shaped thin plates 101 and 102 formed by bending one end in an L shape are bonded and fixed with an adhesive or the like. Used.
  • the surface of the bent portion of the L-shaped thin plate 101 is bonded and fixed to the back surface side of the thin plate 100 with an adhesive or the like, and the back surface of the bent portion of the L-shaped thin plate 102 is screwed to the surface of the bent portion of the arm member 30 with a screw 96.
  • the simulation member 20 is fixed to the sensor structure including the force sensors 40a, 40b, and 40c via the arm member 30, and the compression force or tensile force in the orthogonal triaxial direction with respect to the simulation member 20, that is, the simulation member 20 is obtained. It is possible to measure the force applied to the point where the treatment is applied (the point of action).
  • the arrangement, materials, shapes, and the like of the arm member 30 and the L-shaped thin plates 101 and 102 are not limited to the above.
  • the simulation member 20 in the present embodiment is a cylindrical body made of an elastic material made of chloroprene rubber, which is modeled on a part of an artery for cardiac surgery.
  • the simulation member 20 that can be used in the medical simulator 1 is formed by imitating a part of a biological tissue such as a blood vessel, an intestinal tract, and skin, and a predetermined surgical procedure is simulated during surgical training. .
  • the simulated member 20 is made of an elastic rubber material such as latex or silicone so that the tactile sensation of each living tissue can be reproduced and effective surgical training can be performed.
  • the material of the simulated member 20 is not particularly limited as long as it can be formed and processed into the shape of each biological tissue and the tactile sensation of each biological tissue can be reproduced.
  • the above-described elastic material may be used in the form of sponge or foamed rubber in order to imitate living tissue. These can be made into a living tissue having an appropriate tactile sensation by selecting the foaming method, the size of the foam, the material, the plasticizer, the amount of addition thereof, and the like as necessary.
  • the predetermined surgical procedure is a doctor in the same manner as a general surgical operation that performs operations such as cutting, hemostasis, suturing, and anastomosis on internal organs such as blood vessels, intestinal tract, kidney, bladder, urethra, and liver.
  • an operation performed by the person to be evaluated such as a medical student or the like with respect to the simulated member 20, for example, threading, threading, clipping, heating, pinching, and the like.
  • the simulated member 20 is artificially applied with the same external force as when a surgical procedure is performed, and this force is measured by each of the force sensors 40a, 40b, and 40c.
  • An assessment can be made of the surgical procedure performed.
  • the procedure in the suturing treatment performed by the evaluation subject is evaluated using the simulated member 20 that is a cylindrical body simulating an artery. A specific evaluation method will be described later.
  • Each force sensor 40a, 40b, 40c in this embodiment is a strain gauge type load cell.
  • the load cell By applying the load cell to each force sensor 40a, 40b, 40c and assembling as a sensor structure as described above, ⁇ Y direction, ⁇ Z direction, and ⁇ X direction with respect to the simulated member 20, that is, three orthogonal directions The compressive force or tensile force of each can be measured.
  • strain gauge type load cells to these force sensors 40a, 40b, 40c, the device configuration of the medical simulator 1 can be simplified and the operability is excellent, so that measurement is performed more quickly and accurately. be able to.
  • the strain gauge type load cell has an advantage that it is relatively inexpensive and has a long life, and is excellent in terms of cost.
  • the senor is not limited to the strain gauge type load cell as long as the sensor can measure the external force when the simulated member 20 is subjected to the surgical treatment.
  • a sensor using a spring, piezo film, laser, air pressure, hydraulic pressure, a compression element, a displacement sensor, or the like may be used.
  • a magnetostrictive type load cell, a capacitance type load cell, a gyro type load cell, or the like may be used.
  • FIG. 2 is a diagram illustrating an example of a configuration of an interface unit and a processing unit of the medical simulator according to the first embodiment.
  • the medical simulator 1 can measure the compressive force or the tensile force in the orthogonal triaxial direction with respect to the simulation member 20 so as to measure the first force sensor 40a, the second force sensor 40b, and the third force sensor.
  • the force sensor 40c is arranged at a predetermined position (see FIG. 1), and these force sensors 40a, 40b, 40c and the interface unit 60 are electrically connected via the wirings 50a, 50b, 50c.
  • a processing unit 65 described later is electrically connected to the interface unit 60 through a wiring 50e.
  • the measurement value (analog signal) of the compressive force or tensile force in the three orthogonal directions measured by the force sensors 40a, 40b, and 40c is converted into a digital signal mainly in the interface unit 60 (A / D).
  • the present invention is not limited to this.
  • each process performed by the interface unit 60 and the processing unit 65 may be performed in one apparatus.
  • the interface unit 60 is screwed and fixed on the base material 10 with screws 97a and 97b (see FIG. 1), and compressive force or tensile force in the orthogonal triaxial direction measured by the force sensors 40a, 40b, and 40c. Based on the measurement value, a procedure in a predetermined surgical procedure is evaluated, a warning signal is created in a processing unit 65 described later based on the evaluation result, and the processing unit 65 electrically connected to the interface unit 60
  • the audio output unit 657 and the data display unit 658 (described later) are configured to output. Since such a warning signal is always created during training using the medical simulator 1, the voice output unit 657 and the data display unit 658 that have input the warning signal perform evaluation results for the evaluation target person by a predetermined method to be described later. Can be notified.
  • the interface unit 60 is configured by software and hardware, and includes a voltage detection unit 601, an A / D conversion unit 602, a noise processing unit 603, and a serial conversion unit 604, but other components as necessary. May be included.
  • the interface unit 60 amplifies analog signals from the first force sensor 40a, the second force sensor 40b, and the third force sensor 40c by the voltage detection unit 601, and the A / D conversion unit 602 converts the amplified analog signals.
  • the digital signal is converted into a digital signal, noise included in the digital signal is removed by the noise processing unit 603, the noise removal signal is serially converted by the serial conversion unit 604, and the serially converted data (serial data) is processed by the processing unit 65. Send to.
  • the processing unit 65 includes a data calculation unit 651, a past data recording unit 652, a data evaluation unit 653, a reference data storage unit 654, a time measurement unit 655, a warning signal creation unit 656, an audio output unit 657, and a data display unit 658. And other components may be included as necessary.
  • the processing unit 65 receives the serial data transmitted by the interface unit 60, creates a calculated value by converting the force (g) actually detected by the force sensors 40a, 40b, and 40c by the data calculating unit 651, The calculated value is recorded by the past data recording unit 652 and transmitted to the data evaluation unit 653, an evaluation target value is created based on the calculated value and the time measurement data from the time measuring unit 655, and is read from the reference data storage unit 654.
  • the evaluation signal is evaluated based on the evaluation result, an evaluation signal is generated and transmitted to the warning signal generation unit 656, and the warning signal generated based on the evaluation signal is output to the voice output unit 657 and the data display unit 658. And the evaluation result is notified to the evaluation target person by a predetermined method to be described later.
  • the voltage detection unit 601 amplifies a minute voltage from each of the force sensors 40a, 40b, and 40c to a value suitable for A / D conversion, and outputs the amplified analog signal (analog data) to the A / D conversion unit 602. .
  • a low-pass filter is used together to remove high-frequency components during amplification, but the present invention is not limited to this configuration as long as high-frequency components can be removed.
  • the A / D converter 602 receives the analog signal output from the voltage detector 601 and converts it into a digital signal (digital data), and outputs this signal to the noise processor 603.
  • the noise processing unit 603 receives the digital signal output from the A / D conversion unit 602, removes noise using a digital filter, and outputs the noise-removed digital signal to the serial conversion unit 604.
  • these processes are performed by the on-board CPU and dedicated software is used.
  • the present invention is not limited to this configuration as long as such processes can be performed.
  • the serial conversion unit 604 receives the noise-removed digital signal (noise cancel data) output from the noise processing unit 603 and performs serial conversion, and then converts the converted serial signal (serial data) to the data calculation unit 651 of the processing unit 65. Output.
  • these processes are performed by the on-board CPU.
  • the present invention is not limited to this configuration as long as such processes can be performed.
  • the data calculation unit 651 receives the serial signal (serial data from each force sensor 40a, 40b, 40c) serially converted by the serial conversion unit 604, and is actually detected by each force sensor 40a, 40b, 40c by calculation processing. It is converted into a force (g; load value) and a time series calculation value (time series calculation data) is created. For example, when the evaluation subject performs a suturing treatment, the voltage values obtained from the force sensors 40a, 40b, and 40c during the treatment are processed by the interface unit 60 as described above, and then the data calculation unit 651 performs the processing. Calculation values are created and output to the past data recording unit 652 and the data evaluation unit 653.
  • the past data recording unit 652 records the time-series calculated values output from the data calculating unit 651 in a form that can be read at a later date. With this function, the time series calculation values (time series calculation data) of the evaluation subject and the instructor (expert) can be recorded, and the graph and evaluation results can be displayed on the data display unit 658 at a later date. It becomes possible to grasp the degree of improvement and the difference with the leader.
  • the data evaluation unit 653 is configured to output the force sensors 40a, 40b, and the like at predetermined time intervals from the start to the end based on the calculation value output from the data calculation unit 651 and the time signal output from the time measurement unit 655 described later.
  • the calculated value of 40c is detected, and an evaluation target value (evaluation target data) is created. Or the calculated value of each force sensor 40a, 40b, 40c detected as needed is averaged for every predetermined time unit, and an average evaluation object value (average evaluation object data) is created.
  • the created evaluation target value or average evaluation target value is compared with a reference value (described later) stored and input in advance in the reference data storage unit 654, and the warning result is used as an evaluation signal (evaluation data).
  • the data is output to the creation unit 656.
  • the evaluation data may include, for example, a result of evaluating the maximum value or distribution of force (load value) within a certain time.
  • the reference data storage unit 654 inputs and stores a reference value (threshold value) that is an index of superiority or inferiority of the procedure in each procedure.
  • a reference value threshold value
  • each procedure using the medical simulator 1 is performed by an expert such as an experienced cardiac surgeon, for example, and the obtained value (calculated value) is determined by the superiority or inferiority of the procedure in each procedure.
  • An index and a reference value are input to the reference data storage unit 654.
  • the obtained reference value may be changed as appropriate, and another reference value may be set.
  • a leader who guides the evaluation subject using the medical simulator 1 can freely set the value with reference to the obtained reference value.
  • the newly set reference value can be freely stored or moved.
  • the reference value of the medical simulator 1 can be easily rewritten by carrying it in a USB memory or the like.
  • a reference value can be set according to the target level of each university hospital, research institution, etc., or if the target expert's technical level is too high, depending on the technical level of the evaluation subject A reference value can be set.
  • the instructor manually writes in the reference data storage unit 654 instead of being automatically input to the reference data storage unit 654.
  • This configuration may be changed. In this case, the calculated value by the expert becomes a reference value when the instructor sets the reference value.
  • the time measurement unit 655 outputs a time measurement signal (time data) to the data evaluation unit 653.
  • the time measurement signal is time data necessary when the data evaluation unit 653 creates an evaluation target value. For example, when the evaluation target person performs a suturing treatment, the start of such treatment (start of time measurement). It is time data from end to end. By transmitting this data to the data evaluation unit 653, an evaluation target value in each treatment performed by the evaluation target person can be created.
  • the warning signal creation unit 656 receives the evaluation signal output from the data evaluation unit 653, creates a warning signal based on the evaluation result of the data evaluation unit 653, and outputs the warning signal to the voice output unit 657 and the data display unit 658. Specifically, when the evaluation target value is outside the range of the reference value, a warning signal is generated and a warning signal is generated and output to the voice output unit 657 and the data display unit 658. If it is within the range of values, a continuation signal is created and output to the audio output unit 657 and the data display unit 658.
  • the warning signal means that the audio output unit 657 and the data display unit 658 notify the evaluation target person of the evaluation result that the evaluation target value is outside the range of the reference value by a predetermined method described later.
  • the continuation signal is a signal for notifying the evaluation subject of the evaluation result that the evaluation target value is within the range of the reference value.
  • the evaluation target person may be notified only when the evaluation target value is outside the range of the reference value without creating the continuation signal.
  • the audio output unit 657 is an audio output device such as a speaker.
  • the warning signal or the continuation signal output from the warning signal creation unit 656 is input, and sound is output based on the evaluation result of the data evaluation unit 653.
  • the content of the output is not particularly limited.
  • the evaluation result when a warning signal is input, the evaluation result is output in an easy-to-listen language such as “NO”, a high-pitched or low-pitched warning sound, or an imitation sound that makes it easy to imagine the evaluation result.
  • the evaluation result may be output in an easy-to-listen language such as “OK”, silence, or onomatopoeia.
  • the evaluation results may be output in ascending order or descending order (musical scale) according to the pitch according to the degree to which the evaluation target value deviates from the reference value.
  • the data display unit 658 is an image display device such as a display.
  • the warning signal or continuation signal output from the warning signal creation unit 656 is input, and the evaluation result of the data evaluation unit 653 is displayed on the image display device.
  • the display content is not particularly limited. For example, when a warning signal is input, a symbol such as “x” or a blinking light such as red is displayed as the evaluation result, and when the continuation signal is input, the evaluation result is displayed. You may make it display symbols, such as "(circle)", blinking lights, such as blue. Alternatively, depending on the degree to which the evaluation target value deviates from the reference value, the evaluation result may be displayed with symbols such as “O”, “ ⁇ ”, and “X”, and the intensity and color of the light emission may be gradually increased. You may display so that it may change. In the present embodiment, the warning signal and the continuation signal are always generated during the training using the medical simulator 1, but each signal may be output to the data display unit 658 after the training. .
  • evaluation target value is within a standard value range. Whether the evaluation target value is outside the range of the reference value) may be presented to the evaluation target person on a display screen, audio output, or the like.
  • a warning signal and a continuation signal are always generated during training using the medical simulator 1, and these signals are output to the voice output unit 657 and the data display unit 658.
  • it may be output to only one of the audio output unit 657 and the data display unit 658. In that case, it is preferable to output a warning signal and a continuation signal to the voice output unit 657 because the evaluation target person can easily recognize the evaluation result during training.
  • FIG. 3 is a perspective view showing an example of a usage mode of the medical simulator according to the first embodiment of the present invention.
  • FIG. 3 shows the simulated member 20 bonded and fixed to the thin plate 100, and other components of the medical simulator 1 are omitted.
  • the simulated member 20 is fixed to the arm member 30 as described above (see FIG. 1), and a suture needle 110, a suture thread 111, forceps, a forceps (tweezers), a needle holder, etc. (not shown) are prepared.
  • the suture needle 110 is used in which the suture thread 111 is threaded on the threaded portion (the end opposite to the needle tip).
  • the medical simulator 1 can perform an operation to simulate the suturing treatment on the simulation member 20 and evaluate the operation to train the arterial suturing treatment.
  • the medical simulator 1 can detect a force according to the insertion position and direction of the needle tip, and will be described in detail later. For example, orthogonality by insertion and withdrawal of the suture needle 110 shown by a solid line in FIG. Detects triaxial force (compression force or tensile force) and continues to detect orthogonal triaxial force due to insertion and withdrawal of the suture needle 110 indicated by an imaginary line (two-dot chain line) during the operation.
  • the voltage detection unit 601 in the interface unit 60 detects minute voltages from the first force sensor 40a, the second force sensor 40b, and the third force sensor 40c.
  • the time measuring unit 655 in the processing unit 65 starts timing at the start of work on the simulated member 20 and outputs a timing signal to the data evaluation unit 653.
  • the needle is moved in the bending direction of the suture needle 110, the portion far from the needle tip is gripped by the needle holder, and the suture needle 110 is pulled out.
  • a force compression force or tensile force
  • each force is applied according to the force.
  • the force sensors 40a, 40b, and 40c are elastically deformed.
  • the voltage values from the force sensors 40a, 40b, and 40c detected by the voltage detection unit 601 change according to the amount of change.
  • the configuration is not limited. As long as it does not deviate from the gist of the present embodiment, the data acquisition method may be changed as necessary. In each of the embodiments described later, the voltage is similarly detected from the start to the end of each process, but the configuration is not limited to these.
  • warning signal creation unit 656 when the change of each voltage value (evaluation target data) in the measurement graph is substantially equal to the reference value based on the input evaluation signal, or within a preset allowable range Then, a continuation signal is created and the signal is output to the audio output unit 657 and the data display unit 658.
  • the data display unit 658 displays the evaluation result of the data evaluation unit 653 on the screen based on the input continuation signal.
  • the voice output unit 657 outputs the evaluation result of the data evaluation unit 653 by voice based on the input continuation signal.
  • the evaluation subject confirms that his / her treatment is correct based on the visualized and voiced evaluation information, and continues the treatment using the suture needle 110. When this treatment is completed without any problem, the treatment using the suture needle 110 is similarly performed and evaluated.
  • a warning signal is generated and the warning signal is output to the audio output unit 657 and the data display unit 658.
  • the data display unit 658 displays the evaluation result of the data evaluation unit 653 on the screen based on the input warning signal.
  • the voice output unit 657 outputs the evaluation result of the data evaluation unit 653 by voice based on the input warning signal.
  • the purpose of surgery is achieved through operations such as organ connection, cutting, and hemostasis.
  • Such operations are made by applying external force artificially to internal organs such as blood vessels, intestinal tracts, kidneys, bladder, urethra, liver, etc., specifically, thread piercing, tying with thread, This is done by applying a clip, heating, or pinching.
  • an external force is applied to the internal organs, if a force exceeding a certain level is applied, the force cannot be withstood and the organ is destroyed and the purpose cannot be achieved. Therefore, the above operation needs to be performed by applying a force below a limit value that can exist without damaging the organ.
  • the above-described medical simulator 1 is used by an experienced surgeon (expert) and various treatments are performed on the simulated member 20 simulating various organs, whereby the limit value data can be easily acquired and stored.
  • the medical simulator 1 uses the first force sensor 40a, the second force sensor 40b, and the third force sensor 40c to measure the compressive force or tensile force in the orthogonal triaxial direction on the simulated member 20, respectively. It is possible to measure a force (limit value) applied to a point (action point) at which the simulation member 20 is treated by a skilled person, and store this as a reference value.
  • the medical simulator 1 when the medical simulator 1 is used by a surgeon or medical student (evaluation subject) who is poor in technology, the force (measured value) in the three-axis directions applied to the action point is measured. It is possible to evaluate whether or not the measured value is appropriate. Therefore, the evaluation subject can efficiently train without going to the actual site. In addition, by simulating the situation before performing an actual operation, an appropriate force can be grasped in advance, and the evaluation accuracy in the field is improved.
  • FIG. 4 is a flowchart for explaining an example of the operation of the medical simulator according to the first embodiment.
  • the medical simulator 1 when training the suture operation of an artery using the simulation member 20 as described above, first, the name of an organ to be trained (in this case, an artery) is input (step S1), training of a surgical procedure (in this case, a suturing procedure) is performed using the simulated member 20 (step S2), and the force (measured value) in the three-axis directions applied to the simulated member 20 is measured (step S3). Based on the obtained measurement value, it is scored whether or not the surgical treatment of the measurement subject is appropriate (step S4). As a result, the force in the three orthogonal directions (compression force or tensile force) applied to the simulated member 20 can be accurately measured. By measuring this force over time while simulating a surgical procedure, the objective can be obtained. Evaluation is possible.
  • a force applied to a target tissue (target tissue) during a surgical procedure changes with time, and several force peaks (hereinafter referred to as “peak values”) are generated.
  • peak values several force peaks
  • the structure is broken.
  • the weakness of the tissue increases if it is repeatedly applied even with a weak force that does not cause breakage. Therefore, this peak value is the most important factor in scoring in the medical simulator 1. That is, in the medical simulator 1, a plurality of measured values are obtained in step S3 during a predetermined training time, but in step S4, the strongest force applied during the measurement (hereinafter referred to as “maximum peak value”) is detected. And used for evaluation.
  • FIG. 5 is a flowchart for explaining an example of the scoring method of the medical simulator according to the first embodiment.
  • step S4 in FIG. 4 is further divided into a plurality of steps S41 to S49.
  • the maximum peak value is detected from the plurality of measured values obtained in step S3 (step S41). )
  • the basic score of the evaluation subject is determined from the detected maximum peak value (step S42), and further surgical treatment is performed.
  • the peak value is continuously detected (step S43), and the process proceeds to step S44.
  • the scoring table is a scoring score group created based on limit values (reference values) by experts.
  • deduction values determined according to the degree of deviation from the reference value are stored.
  • step S42 a deduction value is determined based on the scoring table according to the degree of deviation of the maximum peak value from the reference value, and a value obtained by subtracting the deduction value from the pass value is used as the basic score of the evaluation target person. Since the relationship between the maximum peak value and the basic score differs depending on the target tissue, a scoring table is stored in advance in the medical simulator 1 (past data recording unit 652 of the processing unit 65), and the deduction value of the scoring table is determined in step S42. refer. Note that the pass value can be appropriately set in advance according to the level of the person to be evaluated, and the scoring table is changed accordingly.
  • step S44 a deduction value is determined for the detected peak value with reference to the scoring table in the same manner as in step S42, and when the basic score of the evaluation subject is deducted (step S45; Yes). Subtracts the deduction value from the basic score to calculate a new basic score (step S46), notifies the evaluation target person of the contents of the deduction stored along with the scoring table (step S46), and goes to step S43 Return.
  • the contents of deductions vary depending on the target organization and are notified through screens and audio.
  • step S45; No the process proceeds to step S48.
  • step S48 it is determined whether or not it is the timing of the end of measurement.
  • the evaluation target person is notified of the scoring result from the final basic score based on the evaluation criteria stored in the scoring table (step S48).
  • scoring in step S4 is completed.
  • the evaluation standard is a total of several elements such as the maximum peak value during the treatment, the required time, and the ligation force, and can be appropriately changed as necessary.
  • step S46 when it is not the timing of the end of the measurement (step S46; No), the surgical procedure is continued. That is, in this case, the process returns to step S43.
  • the timing of the end of the measurement may be input by an evaluation subject or the like, or may be set so that the medical simulator 1 can automatically recognize the force in the three orthogonal directions (compressive force or tensile force).
  • FIG. 6 is a perspective view illustrating an example of a medical simulator according to the second embodiment.
  • the medical simulator 2 includes a set of terminators 210a and 210b each provided with a set of pins 200a and 200b for ligation treatment training, and a set of arms that hold the set of terminators 210a and 210b.
  • Embodiment 1 is provided except that members 220a and 220b and a fourth force sensor 40d for measuring the ligating force of the pair of pins 200a and 200b are provided, and these members are respectively arranged at predetermined positions described later.
  • the medical simulator 1 has the same configuration. Therefore, in this embodiment, a configuration different from that of the medical simulator 1 will be mainly described, and description of other components will be omitted as appropriate.
  • a space is formed by the base material 10, the interface unit 60, and the fixing member 80, and one set is substituted for the simulated member 20 of the medical simulator 1 in the space.
  • a pair of terminators 210a and 210b provided with respective pins 200a and 200b are supported via a first force sensor 40a, a second force sensor 40b, a third force sensor 40c, and a fourth force sensor 40d.
  • These force sensors 40a, 40b, 40c, and 40d are electrically connected to an interface unit 60 that controls the medical simulator 2 through wirings 50a, 50b, 50c, and 50d.
  • the one set of terminators 210a and 210b is supported by the first force sensor 40a and the fourth force sensor 40d via the one set of arm members 220a and 220b, and the one set of terminators 210a and 210b and the first force sensor.
  • the 40a and the fourth force sensor 40d are supported by the second force sensor 40b, and one set of terminators 210a and 210b, the first force sensor 40a, the fourth force sensor 40d, and the second force sensor 40b are:
  • a pair of terminators 210a and 210b, a first force sensor 40a, a fourth force sensor 40d, a second force sensor 40b, and a third force sensor 40c supported by the third force sensor 40c are fixed members 80. It is supported by.
  • the set of terminators 210a and 210b is supported by the sensor structure including the force sensors 40a, 40b, 40c, and 40d, and further, the set of terminators 210a and 210b and the force sensors 40a,
  • the structure including 40b, 40c, and 40d is held and fixed by the fixing member 80 on the base material 10.
  • the first force sensor 40a can compress or pull in the ⁇ Y direction against one terminator 210a.
  • the fourth force sensor 40d can measure a compressive force or a tensile force in the ⁇ Y direction with respect to the other terminator 210b, and the second force sensor 40b includes a set of terminators 210a, The compressive force or tensile force in the ⁇ Z direction with respect to 210b can be measured, and the third force sensor 40c can measure the compressive force or tensile force in the ⁇ X direction with respect to the set of terminators 210a and 210b. That is, these force sensors 40a, 40b, 40c, and 40d measure the force applied to a point (action point) where a set of pins 200a and 200b is treated via a set of terminators 210a and 210b. Can do.
  • the medical simulator 2 can measure the ligating force with respect to the pair of pins 200a and 200b by including the fourth force sensor 40d.
  • the ligating force is a force applied to the body part or the medical device by the suture when the body part or the medical device used during the surgical procedure is fixed with the suture thread. is there.
  • a treatment for connecting organs there is a suture with a needle.
  • a treatment for connecting the urethra and the bladder is required, and the treatment is performed by suturing them.
  • the urethra and bladder are soft and fragile, and if extra force is applied when the needle is passed through, the urethra and bladder are torn off.
  • the suture is made with too weak force, the urethra and the bladder are not in close contact with each other, and urine leaks from the gap. Therefore, it is necessary to sew with an appropriate force.
  • suturing is required to connect various organs, but the optimum force differs depending on the type of organ and the surgical procedure.
  • the medical simulator 2 can evaluate the ligation force according to the organ type and the surgical technique by ligating a pair of pins 200a and 200b and performing training of the ligation treatment. Training can be performed.
  • it is necessary to measure not only the compression force or the tensile force in the orthogonal triaxial direction with respect to the pair of pins 200a and 200b but also the ligation force with respect to them. Therefore, by providing a fourth force sensor 40d in addition to the first force sensor 40a, the second force sensor 40b, and the third force sensor 40c, the ligating force on the pair of pins 200a and 200b is measured. Can do.
  • the fourth force sensor 40d has a shape in which a part of two circles are overlapped when viewed in a plan view, and penetrates in the lateral direction.
  • the strain gauge load cell is provided with a through hole 41d.
  • the fourth force sensor 40d is arranged in parallel with the first force sensor 40a so that the penetration direction of the through hole 41d is parallel to the ⁇ Z direction, and the short direction on one end side in the longitudinal direction thereof
  • One side surface is screwed and fixed with a set of screws (not shown) in a state where the side surface is in contact with a notch portion 221b provided by notching one end side in the longitudinal direction of the arm member 220b.
  • the other side surface in the short side direction on the other end side in the longitudinal direction is in contact with one side surface of the fixing member 81 and is placed on the one end side in the short side direction on the surface of the protruding portion 821 of the fixing member 82. In the placed state, it is screwed and fixed with a set of screws (not shown). Thereby, the fourth force sensor 40d is in a state where the end portion screwed and fixed to the arm member 220b is suspended in the air, and can measure the compressive force or tensile force in the ⁇ Y direction with respect to the other terminator 210b. .
  • one end of the first force sensor 40a is screwed and fixed to the notch 221a of the arm member 220a, and the other end is attached to one side surface of the fixing member 81. Screwed and fixed. That is, since the first force sensor 40a and the fourth force sensor 40d are connected and fixed to the fixing member 82 via the fixing member 81, a ligation treatment is applied to the pair of pins 200a and 200b. As a result, the first force sensor 40a measures the force in the Y direction applied to the one pin 200a, and the fourth force sensor 40d measures the force in the -Y direction applied to the other pin 200b. These force sensors 40a and 40d can measure the ligation force with respect to the pair of pins 200a and 200b.
  • the fixing member 81 is fixed substantially at the center on the surface of the protruding portion 821 of the fixing member 82, but the width of the fixing member 81 in the short direction is larger than the width of the protruding portion 821 in the ⁇ Y direction. Since the width is formed to be small, there is a space for placing the fourth force sensor 40d on the side facing the first force sensor 40a.
  • Each set of terminators 210a and 210b is made of a metal truncated triangular prism body, and a plate-like body extending toward the short side of the bottom surface is bent in an L-shape to form a set of arm members 220a, Contact portions 211a and 211b that contact 220b are formed.
  • a pair of pins 200a and 200b in which the surface of a thin metal column is covered with a resin coating material is provided at the approximate center of the cut heads 212a and 212b of the pair of terminators 210a and 210b. As will be described in detail later, this covering material serves as a slip stopper for the suture when ligating the pair of pins 200a and 200b.
  • such a terminator 210a provided with one pin 200a is screwed and fixed by a screw 96a in a state where the terminator 210a is in contact with the L-shaped end surface side of one arm member 220a.
  • the terminator 210b provided with the other pin 200b was screwed and fixed with a screw (not shown).
  • the medical simulator 2 is in a state where a set of pins 200a and 200b and a set of terminators 210a and 210b are partly exposed from the opening 721 of the lid 72 of the housing 70. With this configuration, a ligation treatment can be performed on the pair of pins 200a and 200b.
  • the medical simulator 2 has an interface unit 60 and a processing unit 65 as in the medical simulator 1.
  • the analog signals of the orthogonal three-axis directions (compression force or tensile force) and ligation force detected by the force sensors 40a, 40b, 40c, and 40d are amplified, converted into digital signals, and noise is converted.
  • the removed signal is serial-converted and then sent to the processing unit 65.
  • the processing unit 65 receives the serially converted force data in the orthogonal triaxial direction, and the data calculation unit 651 performs an arithmetic process to convert it into an actual orthogonal triaxial direction force (g: load value).
  • An operation value is created and output to the data evaluation unit 653 to create an evaluation target value.
  • the obtained value is used as an evaluation target value, a technique in a predetermined ligation treatment is evaluated, and a warning signal is created by the warning signal creation unit 656 based on the evaluation result. It is configured.
  • ligation force data is added as reference data that is an index of superiority or inferiority of the procedure, but the other points are the same as the medical simulator 1.
  • the stump of the blood vessel is often stopped with forceps.
  • the surgeon uses the suture to tie (knot) the yarn.
  • the forceps stops bleeding from the stump of the blood vessel until the ligation is completed, and prevents the blood vessel from slipping, making it easier for the surgeon to ligate.
  • a set of terminators 210a and 210b provided with a set of pins 200a and 200b is used instead of the forceps.
  • the apparatus configuration is not limited as long as the ligation force on the blood vessel can be measured.
  • one pin may be provided on one terminator to measure the ligation force on the blood vessel, or the suture thread may slip and slip. If a pin made of a difficult material is used, the surface of the pin may not be covered with a covering material.
  • a set of terminators 210a and 210b provided with a set of pins 200a and 200b is fixed to a set of arm members 220a and 220b, and a suture (not shown) is prepared.
  • the suture is wound around the pair of pins 200a and 200b. This point is the start of ligation.
  • each analog signal from the first force sensor 40a, the second force sensor 40b, the third force sensor 40c, and the fourth force sensor 40d is amplified in the interface unit 60, converted into a digital signal, noise, The signal from which the signal is removed is serially converted and then transmitted to the processing unit 65.
  • the time measuring unit 655 in the processing unit 65 outputs a timing signal to the data evaluation unit 653 so as to start the evaluation at the start of the ligation treatment for the pair of pins 200a and 200b. Further, the data evaluation unit 653 performs evaluation at predetermined time intervals based on the time signal output from the time measurement unit 655 and outputs evaluation target data to the warning signal creation unit 656. At this time, the timing signal for starting the evaluation may be automatically generated along with the start of ligation, or may be manually input using a keyboard, a foot switch, or the like.
  • the suture is tied by a predetermined ligation method.
  • the predetermined ligation method can be appropriately changed according to the purpose of the ligation treatment. For example, training for making knots such as half-knots, male knots, female knots, surgical knots, and ligation techniques such as two-hand knots, one-hand knots, instrument knots, deep knots, and microscopic knots can be performed. .
  • ligation techniques such as two-hand knots, one-hand knots, instrument knots, deep knots, and microscopic knots can be performed.
  • a forceps such as a Pean, a needle holder, or a jig such as a deep ligation rod.
  • it is possible to perform training related to the number of ligations such as single ligation and multiple ligation.
  • the medical simulator 2 adds to the force. Accordingly, the force sensors 40a, 40b, 40c, 40d are elastically deformed. When each force sensor 40a, 40b, 40c, 40d is elastically deformed, each voltage value detected by the voltage detection unit 601 changes according to the amount of change.
  • the warning signal creation unit 656 performs evaluation in the same manner as in the first embodiment based on the input evaluation signal, creates a continuation signal or a warning signal, and outputs these signals to the audio output unit 657 and the data display unit 658. . Thereby, the evaluation object person can perform training, confirming the evaluation result of own ligation treatment, or correcting the treatment according to the evaluation result, as in the first embodiment.
  • FIG. 7 is a perspective view showing an example of a usage mode of the medical simulator according to the third embodiment of the present invention, (a) is a perspective view showing a state before suturing, and (b) is a state at the start of suturing. (C) is a perspective view showing a state during suturing, and (d) is a perspective view showing a state at the end of suturing. 7C and 7D, only the suture 111 is shown, and the suture needle 110 is omitted.
  • a pair of simulated members 300a and 300b formed by imitating a part of the skin has resin thin plates 310a and 310b bonded and fixed to the bottom side thereof.
  • the set of simulated members 300a and 300b is fixed to each force sensor via the set of arm members 220a and 220b, and forces (compressive force or tensile force) in the orthogonal triaxial direction against the set of simulated members 300a and 300b. Force) and ligation force can be measured.
  • one set of simulation members 300a and 300b is fixed to one set of arm members 220a and 220b, and a suture needle 110, a suture 111, forceps and a tweezer (tweezers) are used.
  • a needle holder (not shown) is prepared.
  • the suture needle 110 in which the suture thread 111 is threaded on the threaded portion (the end opposite to the needle tip) is used.
  • FIG. 7B a portion of 1/3 to 1/2 of the distance from the sutured portion of the suture needle 110 to the needle tip is held by a needle holder,
  • the needle tip of the suture needle 110 is inserted into the end edge portion 301a on the one end side in the short direction (this time is assumed to be suturing and ligation start)
  • the sensor 40a, the second force sensor 40b, and the third force sensor 40c are elastically deformed.
  • FIG. 7 (c) the needle is moved toward the bending direction of the suture needle 110 shown in FIG. 7 (a), and a portion far from the needle tip is held by a needle holder and the suture needle 110 is pulled out. .
  • the force depends on the force.
  • the first force sensor 40a, the second force sensor 40b, and the third force sensor 40c are elastically deformed.
  • the needle tip of the suturing needle 110 is inserted into the end edge portion 301b on the other end side in the short side direction of the other simulation member 300b, the needle is moved in the bending direction of the suturing needle 110 and pulled out.
  • a force (compression force or tensile force) in a three-dimensional direction is applied to the (action point), and the first force sensor 40a, the second force sensor 40b, the third force sensor 40c, and the fourth force are applied according to the force.
  • the sensor 40d is elastically deformed.
  • the suture needle 110 that has been pulled out is started to tie a suture according to a predetermined ligation method
  • the first force sensor 40a, the second force sensor 40b, the third force sensor 40c, and the 4 force sensor 40d is elastically deformed.
  • the first force sensor 40a, the second force sensor 40b, the third force sensor 40c, and the fourth force sensor 40d Each analog signal is amplified in the interface unit 60, converted into a digital signal, and the signal from which noise is removed is serially converted and then transmitted to the processing unit 65.
  • the time measurement unit 655 in the processing unit 65 outputs a time measurement signal to the data evaluation unit 653 so as to start the evaluation at the start of the suturing treatment and the ligation treatment for the pair of simulation members 300a and 300b.
  • the data calculation unit 651 creates a time-dependent change graph (measurement graph) of each voltage value (time-series calculation data) in each operation with respect to one set of the simulated members 300a and 300b, and simultaneously sends the data to the data evaluation unit 653.
  • the data evaluation unit 653 compares the measurement graph (evaluation target data graph) with the reference values of the suture treatment and the ligation treatment stored in the reference data storage unit 654, and uses the evaluation result as an evaluation signal as a warning signal generation unit 656.
  • the timing signal for starting the evaluation may be automatically generated when the treatment is started, or may be manually input by a keyboard, a foot switch, or the like.
  • the warning signal creation unit 656 performs evaluation in the same manner as in the first embodiment based on the input evaluation signal, creates a continuation signal or a warning signal, and outputs these signals to the audio output unit 657 and the data display unit 658. .
  • a score (evaluation) is comprehensively given to the actions performed by the evaluation subject during the ligation treatment. ) May be presented to the evaluation subject via a display screen, voice output, etc., whether or not the evaluation is acceptable (the evaluation target value is within the reference value range).
  • the person to be evaluated can perform training in the same manner as in the first embodiment while confirming the evaluation results of his own suturing treatment and ligation treatment, or correcting the treatment based on the evaluation results.
  • FIG. 8 is a perspective view showing an example of a usage mode of the medical simulator according to the fourth embodiment of the present invention.
  • an operation for connecting the urethra and the bladder hereinafter referred to as “anastomosis”
  • the apparatus configuration is the same as that of the third embodiment except that a simulation member 400 simulating a part of the urethra and a simulation member 500 simulating a part of the bladder are applied.
  • the suture needle 110 having the suture thread 111 attached to the threaded portion (the end opposite to the needle tip) is used. However, in FIG. 8, only the suture thread 111 is illustrated. The suture needle 110 is omitted.
  • the simulation member 400 in the present embodiment is a cylindrical body made of an elastic material made of chloroprene rubber that imitates a part of the urethra, and a part of the outer peripheral portion is placed on the thin plate 310a, It is bonded and fixed with an adhesive.
  • the simulation member 500 is made of an elastic material made of chloroprene rubber and imitating a part of the bladder, and is a bag-like body tapered toward the obstruction portion side.
  • the obstruction portion side (one end portion side) ) Is formed with a circular opening 501 to be connected to the opening 401 on one end side of the simulation member 400, and an opening 502 is formed on the other end side.
  • the simulation member 500 is bonded and fixed with an adhesive or the like in a state where a part of the outer peripheral portion on the side where the circular opening 501 is not formed is placed on the thin plate 310b. Thereby, the simulation member 400 and the simulation member 500 are fixed to each force sensor via a pair of arm members 220a and 220b, and compressive force or tensile force and ligation in the orthogonal triaxial direction with respect to the simulation member 400 and the simulation member 500 are applied. It becomes possible to measure.
  • the simulation member 400 and the simulation member 500 are fixed to a pair of arm members 220a and 220b, and a suture needle (not shown) to which a suture 111 is threaded, a forceps, a forceps (tweezers), and a holding needle Prepare a container (not shown).
  • a portion of 1/3 to 1/2 of the distance from the sutured portion of the suture needle to the needle tip is held by a needle holder, and the needle of the suture needle is attached to the end edge portion 402 of the opening 401 of the simulation member 400. Insert the tip. This point is the start of anastomosis.
  • the needle is moved in the bending direction of the suture needle, the part far from the needle tip is gripped by the needle holder, the suture needle is pulled out, and the force (compression force or tensile force) is applied to that part (working point). ),
  • the first force sensor 40a, the second force sensor 40b, and the third force sensor 40c shown in FIG. 6 are elastically deformed according to the force.
  • the portion (action point) is three-dimensional.
  • a direction force compression force or tensile force
  • the first force sensor 40a, the second force sensor 40b, the third force sensor 40c, and the fourth force sensor 40d shown in FIG. Is elastically deformed.
  • the suture needle that has been pulled out is started to be tied with a suture according to a predetermined ligation method
  • the force sensor 40d is elastically deformed.
  • the first force sensor 40a, the second force sensor 40b, and the third force sensor are inserted from the insertion of the suture needle to the end of the ligation operation (when the knot is finished), that is, until the anastomosis treatment is completed.
  • Each analog signal from the force sensor 40c and the fourth force sensor 40d is amplified in the interface unit 60, converted into a digital signal, and the signal from which noise has been removed is serially converted and then transmitted to the processing unit 65.
  • the time measuring unit 655 in the processing unit 65 outputs a timing signal to the data evaluation unit 653 so as to start the evaluation when the anastomosis treatment for the simulated member 400 and the simulated member 500 is started.
  • the data calculation unit 651 creates a temporal change graph (measurement graph) of each voltage value (time-series calculation data) in each operation on the simulation member 400 and the simulation member 500 and simultaneously outputs the data to the data evaluation unit 653.
  • the data evaluation unit 653 compares the measurement graph (evaluation target data graph) with the reference value of the anastomosis treatment stored in the reference data storage unit 654, and outputs the evaluation result to the warning signal generation unit 656 as an evaluation signal. to continue.
  • the timing signal for starting the evaluation may be automatically generated when the treatment is started, or may be manually input by a keyboard, a foot switch, or the like.
  • the warning signal creation unit 656 performs evaluation in the same manner as in the first embodiment based on the input evaluation signal, creates a continuation signal or a warning signal, and outputs these signals to the audio output unit 657 and the data display unit 658. .
  • the action performed by the evaluation subject during the anastomosis procedure is comprehensively scored (evaluated) and passed (the evaluation target value is within the reference value range). Whether the evaluation target value is outside the range of the reference value may be presented to the evaluation target person on a display screen, audio output, or the like. Thereby, the evaluation subject can perform training while confirming the evaluation result of his / her anastomosis treatment or correcting the treatment based on the evaluation result in the same manner as in the first embodiment.
  • the basic configuration of the present invention is not limited to the above.
  • the components shown in the drawings that is, the thickness, width, relative positional relationship, and the like of the simulation member and each force sensor may be exaggerated in explaining the present invention.
  • the term “upper” in the present specification does not limit that the positional relationship between the constituent elements is “directly above”.
  • the expression “simulated member on the mounting surface of a set of arm members” does not exclude the case where other components are included between the mounting surface of the set of arm members and the simulated member. .
  • the medical simulator of the present invention can be applied to learning of operations in robotic surgery in addition to the above-described usage modes.
  • robotic surgery for performing in-body surgery by remote control has become widespread.
  • the robot By using the robot, it is possible to perform the operation as if the surgeon (robot operator) has entered the patient's body as the internal organs appear enlarged in front of the eyes.
  • the sense of touching the organ is poor, making operation difficult to that extent.
  • the medical simulator of the present invention can measure even the force applied by the robot, it is possible to perform a safer and higher quality operation by training in advance using the medical simulator of the present invention. For example, it is also possible to evaluate by applying a robot during the above-described vesicourethral anastomosis.
  • the output image (evaluation result) of the medical simulator of the present invention can be displayed on a part of the divided operation screen of the robot operator, or can be displayed as an overlay on the operation screen. . Thereby, the surgeon can see the evaluation screen of the medical simulator of the present invention while operating the robot.
  • the simulated member, the pin, and the arm member are fixed by screwing in the above-described usage mode, but the present invention is not limited to this.
  • the structure is such that the simulated member and the pin can be replaced.
  • the attachment / detachment mechanism at this time is not limited to the screw, and for example, a magnet or a spring structure may be used.
  • the medical simulator of the present invention performs the treatment without providing any obstacle to the simulated member or the pin, but is not limited thereto.
  • the pelvis actually blocks the surgical field, a very advanced technique is required to ligate the stumps of the blood vessels.
  • the ligation is usually performed twice or more, but during this time, the ligation should not be loosened, and finally a necessary and sufficient ligation force is required.
  • an excessive force is applied during yarn knotting, the blood vessel is easily broken.
  • the medical simulator of the present invention has a configuration in which the simulated member and the pin are not driven at the time of training, but is not limited to this. Training may be performed.
  • the medical simulator of the present invention may be installed on a swing mechanism such as a camera tripod.
  • the present invention is intended for evaluation subjects such as doctors, medical students, etc., or other medical personnel or research equipment developers such as medical device manufacturers as necessary, such as blood vessels, intestinal tract, kidney, bladder, urethra, liver, etc. This is extremely useful when training general surgical operations for operations such as cutting, hemostasis, suturing, and anastomosis for organs.

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Abstract

La présente invention concerne un simulateur médical (1) qui comprend : un élément fictif (20) sur lequel un traitement chirurgical prescrit fictif est réalisé pendant un apprentissage d'opération chirurgicale ; un élément bras (30) qui tient l'élément fictif (20) ; un premier détecteur de force (40a), un deuxième détecteur de force (40b), et un troisième détecteur de force (40c) qui sont fournis à l'élément bras (30) et qui mesurent respectivement les forces de traction ou les forces de compression appliquées à l'élément fictif (20) dans trois directions axiales orthogonales ; et un moyen d'évaluation destiné à évaluer la technique dans le traitement chirurgical prescrit sur la base des valeurs mesurées des forces de traction ou des forces de compression dans les trois directions axiales mesurées au moyen des détecteurs de force (40a, 40b, et 40c).
PCT/JP2017/019618 2016-05-27 2017-05-25 Simulateur médical WO2017204311A1 (fr)

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CN110085082A (zh) * 2019-05-14 2019-08-02 天津宣捷智讯科技有限公司 外科止血打结训练系统
CN110570731A (zh) * 2019-09-19 2019-12-13 西华大学 一种拉伸试验类比演示仪
RU2717071C1 (ru) * 2019-08-20 2020-03-17 Федеральное государственное бюджетное образовательное учреждение высшего образования "Смоленский государственный медицинский университет" министерства здравоохранения Российской Федерации Тренажер по освоению мануальных навыков при формировании хирургических узлов
CN113456158A (zh) * 2021-07-29 2021-10-01 复旦大学 一种动物坐骨神经结扎装置
KR102666938B1 (ko) * 2020-12-31 2024-05-17 주식회사 후본 확장현실 기반의 가상 훈련 제공 방법 및 시스템

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JP5083776B2 (ja) * 2006-09-29 2012-11-28 学校法人早稲田大学 医療用手技評価システム
JP2015534119A (ja) * 2012-09-21 2015-11-26 ゼット−メディカ，エルエルシー 出血制御トレーニングを提供するシステム及び方法
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Publication number Priority date Publication date Assignee Title
CN110085082A (zh) * 2019-05-14 2019-08-02 天津宣捷智讯科技有限公司 外科止血打结训练系统
CN110085082B (zh) * 2019-05-14 2023-12-19 天津信仁科技发展有限公司 外科止血打结训练系统
RU2717071C1 (ru) * 2019-08-20 2020-03-17 Федеральное государственное бюджетное образовательное учреждение высшего образования "Смоленский государственный медицинский университет" министерства здравоохранения Российской Федерации Тренажер по освоению мануальных навыков при формировании хирургических узлов
CN110570731A (zh) * 2019-09-19 2019-12-13 西华大学 一种拉伸试验类比演示仪
CN110570731B (zh) * 2019-09-19 2021-11-02 西华大学 一种拉伸试验类比演示仪
KR102666938B1 (ko) * 2020-12-31 2024-05-17 주식회사 후본 확장현실 기반의 가상 훈련 제공 방법 및 시스템
CN113456158A (zh) * 2021-07-29 2021-10-01 复旦大学 一种动物坐骨神经结扎装置
CN113456158B (zh) * 2021-07-29 2022-07-29 复旦大学 一种动物坐骨神经结扎装置

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