WO2020240884A1

WO2020240884A1 - Medical simulator and method for evaluating procedure using medical simulator

Info

Publication number: WO2020240884A1
Application number: PCT/JP2019/040115
Authority: WO
Inventors: 智大下田; 正晃松岡; 福田　知治; 廉大田; 章米田; 賢植木; 政至藤井
Original assignee: 株式会社Ｍｉｃｏｔｏテクノロジー; 国立大学法人鳥取大学
Priority date: 2019-05-30
Filing date: 2019-10-10
Publication date: 2020-12-03
Also published as: JPWO2020240884A1; JP7378837B2

Abstract

A medical simulator that comprises a hollow organ model having flexibility, an organ housing part for housing the hollow organ model in a state of being topically fixed within an inner space thereof, and a detection means, wherein: the hollow organ model includes, at different positions in the longitudinal direction, a topically fixed region and a movable region that is displaceable within the inner space of the organ housing part by a trainee's operation of a target device; and the detection means is capable of detecting the displacement or deformation of a target site that is at least a part of the movable region of the hollow organ model within the inner space.

Description

Medical simulator and procedure evaluation method using medical simulator

The present invention relates to a medical simulator, in particular, a simulator capable of training a medical procedure for inserting a medical device such as an endoscope into a luminal organ, and a method for evaluating a procedure of a trainee using such a medical simulator. Regarding.

With the progress of medicine and the sophistication of medical technology in recent years, medical professionals are also required to have advanced skills, and it is required to enhance education for medical professionals. In particular, simulation education using a model that simulates a living body is attracting particular attention because it enables skill acquisition and training as if it were practiced.

Patent Document 1 below discloses an endoscopic training system that prevents perforation of an organ model and enables efficient training. In this system, the organ model into which the scope of the endoscope device is inserted is housed in the outer box body, the space between the outer box body and the organ model is filled with liquid, and the flow rate of the liquid flowing out from the outer box body to the outside. Is detected as the pressure acting on the organ model. As a result, it is possible to prevent the organ model from being perforated by alerting the user before the unnecessary pressure is applied to the organ model to perforate.

Japanese Unexamined Patent Publication No. 2012-8372

In the above training system, the amount of liquid outflow is detected as the pressure acting on the organ model, but since the organ model may be greatly displaced by endoscopic procedures, the amount of liquid outflow detects the pressure acting on the organ model. It cannot be said that it can be detected accurately. For example, a large displacement of the organ model may cause the liquid to flow out regardless of the pressure acting on the organ model.
The medical procedure of inserting a medical device such as an endoscope into a luminal organ is only tacit knowledge of a doctor, and the current situation is that the situation of such a medical procedure cannot be appropriately visualized.

The present invention has been made in view of such circumstances, and by appropriately visualizing the state of a medical procedure for inserting a medical device such as an endoscope into a luminal organ, the medical procedure can be made efficient. A medical simulator that enables training and a method for evaluating the procedure of a trainee using such a medical simulator are provided.
In the present specification, the term "medical device" includes not only medical devices but also devices and tools for medical technique training.

The medical simulator according to one aspect of the present invention adopts the following configuration in order to solve the above-mentioned problems. That is, the medical simulator related to this one aspect accommodates a tract organ model having flexibility and a shape imitating at least one tract organ and a tract organ model in a locally fixed state in an internal space. The tract organ model is provided with an organ accommodating part and a detecting means, and a local fixation area that can be fixed to the organ accommodating part at different positions in the longitudinal direction and an operation of the target device by the trainee. The detection means includes, at least during training, a displacement or deformation of a target site that is at least a part of the movable area of the tract organ model in the internal space, including a movable area that can be displaced within the internal space of the organ housing. Can be detected.
Here, the luminal organ model is a hollow tubular body simulating a luminal organ.
The target device is a medical device such as an endoscope.

Another aspect of the present invention is a luminal organ model that is flexible and has a shape that imitates at least one luminal organ, an organ accommodating portion that accommodates the luminal organ model in an internal space, and a luminal organ model. The present invention relates to a procedure evaluation method using a medical simulator executed by a control unit that controls a medical simulator including at least a plurality of sensors provided at different positions in the longitudinal direction of the lumen. Based on the detection signals from the plurality of sensors, this method determines that the site of the target device has passed through a plurality of checkpoints provided at different positions in the longitudinal direction in the tract of the tract organ model. Includes obtaining the dwell time of the above site between two checkpoints and using at least the obtained dwell time to evaluate the trainee's procedure.
Further, as another aspect, it may be a computer program that causes a control unit that controls the medical simulator to execute the procedure evaluation method, or a storage medium that can be read by a computer that records such a program. Good. This storage medium includes non-temporary tangible media.

According to the present invention, a medical simulator that enables efficient training of the medical procedure by appropriately visualizing the status of the medical procedure for inserting a medical device such as an endoscope into a luminal organ and such. It is possible to provide a method of evaluating the procedure of a trainee using a medical simulator.

It is a figure which conceptually shows the whole structure of the medical simulator which concerns on this embodiment. It is a perspective view which shows the appearance of the human body model part of the medical simulator which concerns on this embodiment. It is a schematic diagram which shows the internal structure of the organ accommodating part which concerns on this embodiment. It is sectional drawing which cut the anal holding part by the plane orthogonal to the anteroposterior direction. FIG. 5 (a) is a diagram showing a state of the large intestine model 30 in a state where the organ holding portion is arranged at a position relatively close to the anus holding portion, and FIG. It is a figure which shows the state of the large intestine model 30 in the state which is arranged at the position relatively far from the holding part. FIG. 6A is a diagram showing the internal configuration of the organ accommodating portion and the motor accommodating portion in the supine position, and FIG. 6B is an internal configuration of the organ accommodating portion and the motor accommodating portion in the left lateral decubitus position. It is a figure which shows. It is a figure which conceptually shows the control structure in the medical simulator which concerns on this embodiment. It is a block diagram which conceptually shows the software structure realized by a control part. It is a figure which shows the display example at the time of training in the medical simulator which concerns on this embodiment. It is a figure which shows the display example of the training evaluation in the medical simulator which concerns on this embodiment. It is a figure which shows the inner wall surface of the large intestine model in this embodiment. It is a perspective view which shows the appearance of the human body model part which concerns on a modification. It is an exploded view which separated the organ accommodating part and the light-shielding part in the human body model part which concerns on a modification. It is a figure which shows a part of the display at the time of training in a modification.

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

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

FIG. 2 is a perspective view showing the appearance of the human body model portion 1 of the medical simulator according to the present embodiment.
As shown in FIG. 2, the human body model unit 1 is mainly composed of an organ accommodating unit 2, a motor accommodating unit 7, and a base 9.
Hereinafter, in order to specify the relative positional relationship of each part of the human body model part 1, the vertical direction and the horizontal direction shown in FIG. 2 are conveniently used, and the direction orthogonal to them is referred to as the front-back direction. .. However, although the details will be described later, the organ accommodating portion 2 is not only in the orientation shown in FIG. 2 (hereinafter, may be referred to as a supine position), but also in the orientation shown in FIG. , It may be described as a left lateral decubitus position), but in the explanation of the organ accommodating portion 2, the left-right direction and the anteroposterior direction shall be fixedly set regardless of the orientation of the organ accommodating portion 2. Therefore, the left-right direction and the front-rear direction used in the explanation of the organ accommodating portion 2 in the left lateral decubitus position are different from the left-right direction and the anteroposterior direction used in the explanation of the motor accommodating portion 7 and the base 9.
As described above, the direction described in the present specification may not coincide with the vertical direction in the direction of gravity, and does not limit the usage mode of the medical simulator.

The organ accommodating portion 2 is a substantially rectangular parallelepiped box body, and internally accommodates the large intestine model 30 described later. Specifically, the organ accommodating portion 2 is covered on all sides by a lower wall portion 21, an upper wall portion 22, a right side wall portion 23, and a left side wall portion 24 erected on the peripheral edge of the back side wall portion toward the ventral side. It is a hollow box that is closed by a window 25 on the ventral side. The right side wall portion 23 and the left side wall portion 24 extend from the dorsal side to the ventral side, respectively, and are curved in a direction in which a part of the ventral end edge approaches each other. Therefore, the ventral side of the organ accommodating portion 2 is closed by a part of the ventral end edge of the right side wall portion 23 and the left side wall portion 24 and the window portion 25 (corresponding to the abdominal wall cover portion).

Two cameras 6 are installed outside the organ accommodating portion 2. Specifically, two camera support plates 61 extend diagonally forward from the lower wall portion 21 and the left wall portion 24 of the organ accommodating portion 2, respectively, and two cameras 6 are provided near the upper ends thereof. Has been done.
Each camera 6 is supported by the camera support plate 61 at an angle at which the large intestine model 30 housed inside the organ accommodating portion 2 can be imaged through the window portion 25. As a result, each camera 6 is installed in a direction orthogonal to each other in a plan view of the organ accommodating portion 2 in the supine position as viewed from the ventral side. In the following description, when the term "plan view" is simply used, it means a plan view of the organ accommodating portion 2 in the supine position as viewed from the ventral side.
Each camera 6 may be a device capable of capturing an image, and the images (including still images and moving images) captured by each camera 6 include not only visible light images but also infrared rays, ultraviolet rays, X-rays, and the like. It goes without saying that such an image of invisible light may be used.

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

Although the details of the organ accommodating portion 2 will be described later (see FIG. 6), the upper end side of the organ accommodating portion 2 is supported by the motor accommodating portion 7 via the output shaft 75, and the back side is ventral side of the base 9 via a plurality of tire portions. It is supported by the support surface 91.
The

tire portions

20a, 20b and 20c are rotatably provided in the organ accommodating portion 2. Specifically, the tire portion 20a is provided so that a part of the tire portion 20a projects outward at the center in the vertical direction of the corner connecting the right side wall portion 23 and the back side wall portion, and the tire portion 20b is provided on the upper wall. A part of the tire portion 20c is provided so as to project outward at the right end portion of the dorsal end portion of the upper surface of the portion 22, and a part of the tire portion 20c is provided outward at the upper end portion of the right end portion of the upper surface portion of the upper wall portion 22. It is provided so as to protrude. A plurality of tire portions are also provided in locations not shown in FIG. 2, and the plurality of tire portions rotate while abutting on the ventral support surface 91 of the base 9, thereby accommodating the organ. Reference numeral 2 is swingably supported on the ventral support surface 91 of the base 9.
The details of such swinging of the organ accommodating portion 2 will be described later.

As described above, the base 9 supports the organ accommodating portion 2 from the back side and holds the motor accommodating portion 7. The base 9 and the motor accommodating portion 7 may be integrally molded or may be separately molded so as to be connected.
The motor accommodating portion 7 is arranged adjacent to the upper part of the organ accommodating portion 2, and is a box body that accommodates the posture change motor 71 (see FIG. 7) that realizes the swing of the organ accommodating portion 2. Details of the motor accommodating portion 7 will be described later.

Hereinafter, the internal configuration of the organ accommodating portion 2 will be described with reference to FIG.
FIG. 3 is a schematic view showing the internal configuration of the organ accommodating portion 2 according to the present embodiment. FIG. 3 shows a state in which the organ accommodating portion 2 is viewed in a plan view.
The large intestine model 30 is a hollow tubular body simulating a large intestine consisting of a cecum, an ascending colon, a transverse colon, a descending colon, a sigmoid colon, and a rectum. Therefore, the large intestine model 30 can be said to be a luminal organ model. The large intestine model 30 includes a rectal region corresponding to the rectum, an ascending colon region corresponding to the ascending colon, a transverse colon region corresponding to the transverse colon, a descending colon region corresponding to the descending colon, and a sigmoid colon region corresponding to the sigmoid colon. And the rectal region corresponding to the colon.

Each part of the large intestine model 30, such as the cecal region and the ascending colon region, is shaped so that the shape of the inner wall defining the lumen is as close as possible to the shape of each part of the large intestine of the living body imaged by the endoscope. Has been done.
For example, in an endoscopic image of the large intestine of a living body, a change in color tone occurs due to contact with other organs in splenic curve and liver curve. Veteran doctors and others with advanced endoscopic techniques may grasp the position in the large intestine by the change in color tone.
Therefore, the hepatic curve region corresponding to the hepatic curve and the splenic curve region corresponding to the splenic curve in the large intestine model 30 are colored in the splenic curve region and the hepatic curve region in the endoscopic image taken in the lumen of the large intestine model 30. It is preferable to include a color change region that causes a change. This color change occurs because the color tone reflected in the endoscopic image is different from the surrounding wall surface in the hepatic curve region and the splenic curve region.
The color tone change region of the large intestine model 30 can be realized by various methods. For example, it can be realized by coloring the outer surface or the inner surface of the large intestine model 30 in the color tone change region with a color different from other parts. This coloring may be realized by a paint, or may be realized by superimposing materials having different colors. Further, even if the colors are the same, it can be realized by changing the wall thickness of the large intestine model 30 only in the color tone change region. Further, it may be realized by irradiating a light source having an appropriate color such as an LED (Light Emitting Diode) toward the outer surface of the large intestine model 30.
Further, it is preferable that a dentate line is simulated on the inner wall of the anal side end of the large intestine model 30.

The large intestine model 30 is molded from a flexible material such as silicone rubber. The present embodiment does not limit the material of the large intestine model 30, but it is preferable that the large intestine model 30 is molded so as to have flexibility close to that of the large intestine of an actual living body.
Further, it is preferable that the large intestine model 30 is integrally molded without any joint.
In this way, the feel when the endoscope is inserted into the lumen of the large intestine model 30 can be made closer to the real thing, and by extension, a realistic endoscope procedure simulation becomes possible.

In the large intestine model 30, each part such as the ascending colon region and the transverse colon region was locally (partially) fixed to the internal space of the organ accommodating portion 2 so as to be equal to the arrangement of the large intestine in the abdominal cavity of the human body. It is housed in a state. The large intestine model 30 has a locally fixed region that can be fixed to the organ accommodating portion 2 at different positions in the longitudinal direction, and endoscopy by a person trained using this simulator (denoted as a trainee). It can be described as including a movable region that can be displaced (movable) in the internal space of the organ accommodating portion 2 by operating the mirror.
Here, "the state of being fixed to the organ accommodating part 2" means not only that it is completely fixed to the inside of the organ accommodating part 2 but also that it is fixed to the organ accommodating part 2. It means that it can be both in the other state.
In the present embodiment, the locally fixed region of the large intestine model 30 is an anal side end region held by the anal holding portion 31, a region held by the organ holding portion 32, a splenic curve region corresponding to the splenic curve, and a liver curve. The corresponding hepatic curve region and cecal region, and the other regions are defined as movable regions. However, the fixed portion for the organ accommodating portion 2 in the large intestine model 30 is not limited to the location shown in the present embodiment.

Further, inside the organ accommodating portion 2, a plate (not shown) that divides the internal space into a ventral side and a dorsal side is provided. That is, the internal space of the organ accommodating portion 2 is divided into a ventral internal space and a dorsal internal space by this plate, and the large intestine model 30 is accommodated in the ventral internal space. Since this plate forms the dorsal wall of the ventral internal space in which the large intestine model 30 is housed, it is hereinafter referred to as the dorsal plate.
In the dorsal internal space, as will be described later, a group of motors that realize sliding of the organ holding portion 32, the first slide wall portion 35, the second slide wall portion 34, etc., and power conversion and deceleration of each motor are provided. It is equipped with various mechanisms to perform.
The shape of the dorsal plate is not limited, and may have, for example, a flat plate shape or may be curved.

In addition, in the present embodiment, as shown in FIG. 3, a plurality of marker rings 43 are arranged in the axial direction of the large intestine model 30 in the region between the anal holding portion 31 and the organ holding portion 32 in the large intestine model 30. They are located at separate positions. These marker rings 43 will be described in detail later, but are provided for detecting the displacement or deformation of the target portion of the large intestine model 30.
In the present specification, the “displacement of the target portion” means a change in the position of the target portion.
In addition, "deformation of the target part" means a change in the shape of the target part, and bending deformation, expansion / contraction deformation (extension deformation or shortening deformation of the length in the longitudinal direction), and twist deformation (rotation about the longitudinal direction). It shall include any one or more of twisting (twisting like squeezing a cloth), loop deformation (deformation forming a loop shape in the longitudinal direction), and the like.
Each marker ring 43 is wound around the outer side of the large intestine model 30 in a circular manner, and a part of the inner surface of each marker ring 43 and a part of the outer surface of the large intestine model 30 are adhered to each other. By partially joining each marker ring 43 to the outer surface of the large intestine model 30 in this way, it is possible to prevent the elasticity of the large intestine model 30 from being hindered by each marker ring 43.

Further, markers are arranged on the outer surface of each marker ring 43. In the present embodiment, a predetermined pattern image (also referred to as an AR (Augmented Reality) marker) is used as the marker. However, the marker may be a mark that can be recognized from the image captured by the camera 6, and may be a characteristic structure, shape, color, illuminant, or the like provided on the outer surface of the large intestine model 30.
Furthermore, in the present embodiment, a plurality of markers are arranged in a row on the outer surface of each marker ring 43 over the entire circumference. As a result, the marker can be reliably recognized from the image even when the large intestine model 30 is twisted in the endoscopic procedure. However, only one marker may be arranged in each marker ring 43, or two or more markers may be arranged only in a part of the entire circumference.

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

Further, in the present embodiment, a marker ring 43 in which a plurality of markers are arranged in a circular array is provided around the outer side of the large intestine model 30, but the plurality of markers may be printed on the outer surface of the large intestine model 30. It may be affixed individually. That is, it can be described that a plurality of markers are arranged at positions separated in the axial direction of the large intestine model 30 on at least a part of the outer peripheral or outer surface surface of the movable region of the large intestine model 30.
In addition, in the present embodiment, markers (holding portions markers 41 and 42) are also provided on the upper surfaces of the anal holding portion 31 and the organ holding portion 32, respectively.
A method for detecting the displacement or deformation of the target portion of the large intestine model 30 using such a marker will be described later.

The anus holding portion 31 is attached to the inner surface (upper surface) of the lower wall portion 21 at the center in the left-right direction and near the dorsal side in the front-back direction. The anus holding portion 31 is molded of a material having a hardness higher than that of the large intestine model 30 such as plastic, has a substantially cubic shape with rounded corners, and its lower surface is the inner surface of the lower wall portion 21. It is attached to the organ accommodating portion 2 in a contact state.
When the direction is indicated in the description of the anus holding portion 31, the direction in which the anus holding portion 31 is attached to the organ accommodating portion 2 is used.

FIG. 4 is a cross-sectional view of the anal holding portion 31 cut along a plane orthogonal to the anterior-posterior direction.
The anus holding portion 31 has a through hole 310 penetrating in the vertical direction. On the other hand, a through hole (not shown) is also provided in the lower wall portion 21 of the organ accommodating portion 2, and the through hole of the lower wall portion 21 is provided in a state where the anal holding portion 31 is attached to the organ accommodating portion 2. And the through hole 310 of the anal holding portion 31 communicate with each other.

The large intestine model 30 is held by the anal holding portion 31 with the anal side end region inserted through the through hole 310. The large intestine model 30 is held by the anal holding portion 31 by joining the outer peripheral surface of the anal side end region inserted through the through hole 310 and the inner wall surface of the anal holding portion 31 defining the through hole 310. It may be held by the anal holding portion 31 by another method. For example, a flange lid projecting from the outer peripheral surface of the large intestine model 30 is provided at the anal side end of the large intestine model 30, and the anal side end region of the large intestine model 30 is a through hole 310 of the anal holding portion 31 and organ accommodation. It may be inserted through the through hole of the lower wall portion 21 of the portion 2 so that the flange lid portion engages with the outer surface (lower surface) of the lower wall portion 21 of the organ accommodating portion 2. When it is held in this way, it can be called an anal holding portion 31 including the lower wall portion 21 of the organ accommodating portion 2. As described above, the holding structure of the anal side end region of the large intestine model 30 by the anal holding portion 31 is not limited at all.

The inner wall surface defining the through hole 310 in the anal holding portion 31 partially includes the tapered wall surface portion 311 as shown in FIG.
The tapered wall surface portion 311 is formed so that the cross-sectional area of the through hole 310 gradually expands upward (upper surface of the anal holding portion 31).
The "cross-sectional area of the through hole 310" here means the area of the through hole 310 when it is assumed that the through hole 310 is cut in a plane orthogonal to the axial direction, and the area of the through hole 310 is anus holding. It is defined by the inner wall surface of the portion 31.
In the present embodiment, the inner wall surface of the anus holding portion 31 includes an inner wall surface that does not become tapered in a slight range upward from the lower opening 312 of the through hole 310, but all of the inner wall surface is the tapered wall surface portion. It may be 311.

The tapered wall surface portion 311 has a steeper slope from the lower end (wall surface lower end portion 313) to the upper end (wall surface upper end portion 314) of the tapered wall surface portion 311 than the first wall surface portion 316 and its first wall surface portion 316. Includes a gentle second wall surface portion 315.
The first wall surface portion 316 and the second wall surface portion 315 are present at least at positions facing each other in the axial direction of the through hole 310. Specifically, the first wall surface portion 316 exists on the left side of the tapered wall surface portion 311 and the second wall surface portion 315 exists on the right side of the tapered wall surface portion 311.
As a result, it is possible to prevent the endoscope inserted into the lumen of the large intestine model 30 from the anus in a direction different from the direction in which the large intestine extends (counterclockwise), so that the endoscopic procedure can be performed. Training is not unnecessarily difficult and enables efficient training.

The organ holding portion 32 is formed of a material having a higher hardness than the material of the large intestine model 30, such as plastic. Further, the organ holding portion 32 has a through hole in the vertical direction, and holds a region of the large intestine model 30 inserted through the through hole. Specifically, the large intestine model 30 is formed by joining the outer peripheral surface of the region inserted through the through hole of the organ holding portion 32 in the large intestine model 30 and the inner wall surface of the organ holding portion 32 defining the through hole. The region of the organ is held by the organ holding portion 32.
The region held by the organ holding portion 32 in the large intestine model 30 may be a part of the range of the descending colon region and the sigmoid colon region. In this embodiment, the region near the anus in the descending colon region is held by the organ holding portion 32. Therefore, in the present embodiment, the region held by the organ holding portion 32 of the large intestine model 30 may be referred to as a descending colon holding region.

The organ holding portion 32 is slidably supported by the organ accommodating portion 2. Specifically, the organ holding portion 32 is slidable along the extending direction of the guide rail 33 provided on the inner surface of the right side wall portion 23 of the organ accommodating portion 2, and the support mechanism provided on the inner surface (FIG. Not shown). The support mechanism of the organ holding portion 32 is not limited in any way. The organ holding portion 32 may be supported by being slidably engaged with the guide rail 33.
Here, the guide rail 33 extends in the vertical direction along the inner surface of the right side wall portion 23. Therefore, the linear distance from the organ holding portion 32 to the anal holding portion 31 changes due to the sliding of the organ holding portion 32. Further, in a plan view of the organ holding portion 2 (see FIG. 3), the inner surface of the lower wall portion 21 to which the lower end surface of the anal holding portion 31 joins and the straight line connecting the anal holding portion 31 and the organ holding portion 32 are formed. The angle (hereinafter referred to as the angle of the anal holding portion 31 and the organ holding portion 32) has also changed.

FIG. 5 is a diagram showing the relationship between the distance between the anal holding portion 31 and the organ holding portion 32 and the state of the large intestine model 30 between them. FIG. 5 (a) shows a state in which the organ holding portion 32 is arranged at a position relatively close to the anal holding portion 31, and FIG. 5 (b) shows the organ holding portion 32 relative to the anus holding portion 31. Shows the state of being placed at a distant position.
The linear distances D1 and D2 from the organ holding part 32 to the anal holding part 31 are changed by the slide of the organ holding part 32, while the length from the anal side end region to the descending colon holding region in the large intestine model 30 (longitudinal direction). (Length) L1 and L2 are constant. That is, although the distances D1 and D2 are different from each other, the lengths L1 and L2 of the large intestine model 30 are the same.
In addition, the angles of the anal holding portion 31 and the organ holding portion 32 are also changed by sliding the organ holding portion 32.
Therefore, as shown in FIG. 5, the slide of the organ holding portion 32 changes the linear distance, the angle, or both, and is between the anal side end region and the descending colon holding region in the large intestine model 30. The degree of slack or the degree of bending changes.
Here, if the degree of slack or the degree of flexion of the large intestine model 30 is small, the endoscope in the lumen of the large intestine model 30 becomes relatively easy to operate, and conversely, if the degree of slack or the degree of flexion is large, the endoscope is said to be the endoscope. Mirror operation becomes relatively difficult.
That is, according to the above configuration, the difficulty of training the endoscopic procedure can be changed.

Here, the slide range of the organ holding portion 32 is the length from the anal side end region in the large intestine model 30 to the region held by the organ holding portion 32 (L1, L2, etc. in FIG. 5) from the anal holding portion 31. It is preferable to include a position that is twice the distance to the organ holding portion 32 (D1, D2, etc. in FIG. 5). Further, the ratio of the length from the anal end region to the region held by the organ holding portion 32 to the length from the anal end region to the splenic curve region in the large intestine model 30 is more than half and 10 minutes. It is preferably 7 or less.
The present inventors, including a veteran doctor with advanced endoscopic techniques, have repeated the trial production of the organ accommodating portion 2 and the verification of the prototype by the veteran doctor, thereby forming the organ holding portion 32 and the anal holding portion 31. In the relationship between the distance between them and the state of the large intestine model 30 between them, we found the above-mentioned relationship that is close to the sensation obtained by the endoscopic procedure for the actual human body.
That is, by including the above-mentioned position in the slide range of the organ holding portion 32, the sensation of the endoscopic procedure for the human body is realistically reproduced while the difficulty level of the training of the endoscopic procedure is variable, and the accuracy is high. Training can be made possible.

In the present embodiment, the slide of the organ holding portion 32 is realized by using the power of the motor housed in the dorsal internal space of the organ accommodating portion 2. The slide of the organ holding portion 32 can be realized by, for example, the following configuration. The rotation axis of the motor extends in a direction orthogonal to the extending direction of the guide rail 33, and a toothed drive pulley is directly or indirectly attached to the rotation axis, and the toothed drive pulley is rotatably supported. A toothed timing belt is hung between the driven pulley and its driving pulley in parallel with the extending direction of the guide rail 33. The organ holding portion 32 is directly or indirectly attached to the engaging member that engages with a part of the timing belt. According to this configuration, the rotational power of the motor is converted into the power of linear motion in the extending direction of the guide rail 33, so that the organ holding portion 32 can slide along the guide rail 33.
Therefore, the organ holding portion 32 is slidable with respect to the anal holding portion 31 and the organ holding portion 32 holding the anal side end region of the large intestine model 30, and is fixed to the organ accommodating portion 2. It can be said that it is provided so that it can be switched between states.

However, the configuration for realizing the sliding of the organ holding portion 32 is not limited to such a configuration, and any configuration may be used as long as the rotational power of the motor is converted into the power of linear motion in the extending direction of the guide rail 33.
The details of the control related to the slide of the organ holding portion 32 will be described later.
Further, in the present embodiment, the sliding of the organ holding portion 32 is realized by using the power of the motor, but it may be performed manually. In this case, the organ holding part 32 is slidable with respect to the organ holding part 2 (including the anal holding part 31 fixed to the organ holding part 2) and fixed to the organ holding part 2. It suffices if it is provided so as to be switchable to a fixed state. For example, the organ holding portion 32 may be fixed to the organ accommodating portion 2 by the locking mechanism, and the organ holding portion 32 may be slidable to the organ accommodating portion 2 by releasing the locking mechanism.

Further, the organ accommodating portion 2 is provided with a first slide wall portion 35 formed of a hard material such as plastic in the ventral internal space.
The first slide wall portion 35 is a substantially central portion in the lateral and vertical directions in the ventral internal space of the organ accommodating portion 2, and is below the accommodating position of the transverse colon region of the large intestine model 30 and the anal holding portion 31 and the anus holding portion 31. It is located above the rectal region of the large intestine model 30 and is slidably supported by the dorsal plate in the vertical direction. Specifically, the first slide wall portion 35 is a support mechanism provided on the ventral side surface of the dorsal plate so as to be slidable along the extending direction of the guide rail 36 provided on the ventral side surface of the dorsal plate. (Not shown). The support mechanism of the first slide wall portion 35 is not limited in any way. The first slide wall portion 35 may be supported by a support mechanism slidably engaged with the guide rail 36.
Here, the guide rail 36 extends in the vertical direction along the ventral side surface of the dorsal plate. Therefore, the first slide wall portion 35 can slide in the direction approaching the anus holding portion 31 and in the direction away from the anus holding portion 31.

When insertion is difficult in the procedure of colonoscopy, a caregiver such as a nurse may press the abdomen to support the insertion of the endoscope (also called manual compression method). In this embodiment, the first slide wall portion 35 is provided to simulate this abdominal compression. Therefore, the first slide wall portion 35 can also be called an auxiliary wall portion.
The first slide wall portion 35 has at least a downward wall surface having a curved shape in which the center in the left-right direction protrudes upward when viewed from the ventral side, and holds the anus when simulating abdominal compression. It is fixed at a position close to the portion 31. As a result, a part of the sigmoid colon region (for example, the apex called S-top) of the large intestine model 30 in which the endoscope is inserted into the lumen and linearized upward is directed downward by the first slide wall portion 35. The insertion direction of the endoscope is guided by abutting against the wall surface of the endoscope.
On the other hand, when the abdominal compression is not performed, the first slide wall 35 is fixed at a position away from the anus holding portion 31 so that the first slide wall 35 is in a position where it is difficult to contact the large intestine model 30. Can be placed.
As described above, according to the present embodiment, it is possible to simulate abdominal compression (manual compression) by a caregiver.

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

However, the configuration for realizing the sliding of the first slide wall portion 35 is not limited to such a configuration, and may be a configuration in which the rotational power of the motor is converted into the power of linear motion in the extending direction of the guide rail 36. ..
The control contents related to the slide of the first slide wall portion 35 will be described later.
Further, in the present embodiment, the slide of the first slide wall portion 35 is realized by using the power of the motor, but it may be performed manually. In this case, the first slide wall portion 35 is provided so as to be switchable between a slide state in which the distance to the anal holding portion 31 changes and a fixed state in which the organ accommodating portion 2 is fixed. You just have to. For example, the first slide wall portion 35 is fixed to the organ accommodating portion 2 by the lock mechanism, and the first slide wall portion 35 is slidable to the organ accommodating portion 2 by releasing the lock mechanism. Can be said.

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

In the present embodiment, the first wire member 37 does not realize a variable length with its own material, but has a variable length as a set with a wire reel (not shown) for winding the first wire member 37. It has been realized. Therefore, the first wire member 37 and the wire reel correspond to the variable length member. That is, in the present embodiment, the organ accommodating portion 2 includes a wire reel (not shown) for winding the first wire member 37. In the wire reel, the state of the first wire member 37 that is delivered in the state where the wire connecting portion of the sigmoid colon region of the large intestine model 30 is present at the initial position is set to the maximum winding state, and the wire reel is further delivered from the maximum winding state. The first wire member 37 is urged by a spring member so as to be wound up to the maximum winding state.

Further, the wire reel is provided with a sensor (for example, a displacement meter or the like) for detecting the rotation amount of the wire reel from the maximum winding state, and the details will be described later, but the rotation amount detected by this sensor. This makes it possible to detect the displacement of the wire connecting portion of the sigmoid colon region of the large intestine model 30.
In this way, the region including the wire connecting portion of the sigmoid colon region of the large intestine model 30 connected to the first wire member 37 is tensioned so as to return to the initial position while being displaceable without being fixed. Therefore, it can also be called a specific movable region of the large intestine model 30.

Further, the organ accommodating portion 2 is provided with a second slide wall portion 34 formed of a hard material such as plastic in the ventral internal space.
As shown in FIG. 3, the second slide wall portion 34 is erected with a downward wall surface further above the accommodation position of the transverse colon region of the large intestine model 30 in the ventral internal space of the organ accommodation portion 2. Has been done. The second slide wall portion 34 is supported by the organ accommodating portion 2 in a state where it can slide downward along the extending direction of the guide rails provided on the inner surface of the right side wall portion 23 and the inner surface of the left side wall portion 24, respectively. There is. The second slide wall portion 34 is supported by a support mechanism (not shown) provided on the inner surface of the right side wall portion 23 and the inner surface of the left side wall portion 24. However, the support mechanism of the second slide wall portion 34 is not limited in any way. The second slide wall portion 34 may be supported by a support mechanism slidably engaged with guide rails provided on the inner surface of the right side wall portion 23 and the inner surface of the left side wall portion 24, respectively. Good.

Similar to the abdominal compression described above, when it is difficult to insert a colonoscope, it may be easier to insert the endoscope by having the subject (patient) take a deep breath. Taking a deep breath lowers the diaphragm, resulting in lower hepatic and splenic curvature. In the present embodiment, the second slide wall portion 34 is provided in order to simulate the state of the transverse colon when the subject takes a deep breath.
The second slide wall portion 34 has at least a downward wall surface that is wide in the left-right direction from the vicinity of the inner surface of the right side wall portion 23 to the vicinity of the inner surface of the left side wall portion 24. The left and right ends of this wall surface of the second slide wall portion 34 are curved downward.
The second slide wall portion 34 slides downward when simulating a deeply inhaled state, and is arranged upward in other cases.
As a result, as the second slide wall portion 34 is slid downward, at least the spleen-curved region and the hepatic-curved region of the large intestine model 30 are also displaced downward. Therefore, according to the present embodiment, the test is performed. It is possible to realistically simulate the movement of the large intestine while the person is deeply inhaled.

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

Further, in the present embodiment, the slide of the second slide wall portion 34 is realized by using the power of the motor housed in the dorsal internal space of the organ accommodating portion 2. The slide of the second slide wall portion 34 can be realized, for example, with the same configuration as that of the first slide wall portion 35. Therefore, although detailed description is omitted, the extension direction of the guide rail (provided on the inner surface of the right side wall portion 23 and the inner surface of the left side wall portion 24) in the engaging member in which the rotational power of the motor engages with the timing belt By being converted into the power of linear motion, the second slide wall portion 34 can slide downward along the guide rail.
With such a configuration, the second slide wall portion 34 can be switched between a sliding state that can slide downward with respect to the organ accommodating portion 2 and a fixed state that is fixed to the organ accommodating portion 2. I can say.

However, the configuration for realizing the sliding of the second slide wall portion 34 is not limited to such a configuration, and any configuration may be used as long as the rotational power of the motor is converted into the power of linear motion in the vertical direction.
The control contents related to the slide of the second slide wall portion 34 will be described later.
Further, in the present embodiment, the slide of the second slide wall portion 34 is realized by using the power of the motor, but it may be performed manually. In this case, if the second slide wall portion 34 is provided so as to be switchable between a sliding state that can slide downward with respect to the organ accommodating portion 2 and a fixed state that is fixed to the organ accommodating portion 2. Good. For example, the second slide wall portion 34 is fixed to the organ accommodating portion 2 by the lock mechanism, and the second slide wall portion 34 is slidable to the organ accommodating portion 2 by releasing the lock mechanism. Can be said.

As shown in FIG. 3, a second wire member 38 is connected to the outer surface of the transverse colon region of the large intestine model 30. In the present embodiment, the second wire member 38 is connected to the central periphery of the transverse colon region of the large intestine model 30 in the longitudinal direction, and plays a role of pulling the connecting portion downward. The site to which the second wire member 38 of the large intestine model 30 is connected may be referred to as a wire connecting site in the transverse colon region.
The second wire member 38 pulls the central portion of the transverse colon region of the large intestine model 30 in the longitudinal direction downward even in the normal state where the second slide wall portion 34 is located above, so that the curvature of the transverse colon in the living body Can be realistically reproduced.

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

By the way, a variable length member such as the first wire member 37 may be connected to the outer surface of the large intestine model 30 other than the wire connecting portion described above.
For example, a variable length member may be connected to a site corresponding to the sigmoid colon descending colon transition portion (hereinafter referred to as SDJ) in the large intestine model 30. In this way, the site can be returned to the initial position while allowing the displacement of the site corresponding to the SDJ in the large intestine model 30. Further, the displacement of the portion corresponding to the SDJ can be detected.

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

It is preferable that the large intestine model 30 is removable from the organ accommodating portion 2. In this way, when a plurality of types of large intestine models 30 having different shapes and sizes or diseases such as polyps are provided so that the large intestine of a living body also has individual differences such as length and thickness, the organs A plurality of types of large intestine models 30 can be exchanged and used for the accommodating portion 2. As a result, it is possible to perform colonoscopy training assuming various subjects.
In this case, the anus holding part 31 and the organ holding part 32 may be detachable from the organ holding part 2 together with the large intestine model 30, and the anus holding part 31 and the organ holding part 32 may be left in the organ holding part 2. , Only the large intestine model 30 may be removable.

Next, the internal configuration of the motor accommodating portion 7 and the swing of the organ accommodating portion 2 will be described with reference to FIG.
FIG. 6 is a diagram showing the internal configuration of the motor accommodating portion 7 and the swing of the organ accommodating portion 2, and FIG. 6A shows the internal configuration of the organ accommodating portion 2 in the supine position and the internal configuration of the motor accommodating portion 7. FIG. 6B shows the internal configuration of the organ accommodating portion 2 and the motor accommodating portion 7 in the left lateral decubitus position.

As shown in FIGS. 6A and 6B, the motor accommodating portion 7 internally supports the motor holding portion 72.
The motor holding portion 72 holds the posture changing motor 71, and the output shaft 75 driven by the rotational power of the posture changing motor 71 projects from the motor holding portion 72.
The output shaft 75 projects from the shaft hole 78 of the adjacent wall portion 77 (lower wall portion) of the motor accommodating portion 7 toward the organ accommodating portion 2, and the tip thereof is the upper surface of the upper wall portion 22 of the organ accommodating portion 2. It is fixed in the center.
As a result, the organ accommodating portion 2 has a plurality of tire portions (20a, 20b, 20c) rotatably provided in the organ accommodating portion 2 when the output shaft 75 is driven by the rotational power of the posture change motor 71. Etc.), while being supported by the ventral support surface 91 of the base 9, swinging together with the output shaft 75. As a result, the organ accommodating portion 2 has the

tire portions

20a and 20b (in other words, the right wall portion 23) rotating on the ventral support surface 91 of the base 9 from the supine position shown in FIG. 6A. It rotates 90 degrees around the boundary edge (corner portion) with the back side wall portion, and transitions to the left lateral decubitus state shown in FIG. 6 (b). In the left lateral decubitus position, the

tire portions

20a, 20b and 20c are in contact with the ventral support surface 91 of the base 9 (not shown).
As described above, according to the present embodiment, the organ accommodating portion 2 that imitates the abdomen of the human body can be swung to simulate the postural change.
Further, since the organ accommodating portion 2 is supported upward by the output shaft 75 and the side surfaces (dorsal side and right side surface) are supported by the ventral support surface 91 of the base 9 via the plurality of tire portions. It is possible to realize a stable swing of the organ accommodating portion 2, and it is possible to suppress the occurrence of damage or failure due to the swing of the organ accommodating portion 2. The control content of the posture change motor 71 that simulates such posture change will be described later.

Here, when the organ accommodating portion 2 swings on the ventral support surface 91 of the base 9 as described above, the output shaft 75 fixed by the upper end wall portion 22 of the organ accommodating portion 2 is organ accommodating. By the swinging power of the part 2, it moves at least in the front-rear direction shown in FIG. In the present embodiment, since the output shaft 75 is rotatably held by the motor holding portion 72, the organ accommodating portion 2 swings from the supine position to the left lateral decubitus state by driving the output shaft 75. The motor holding portion 72 moves at least forward, and the motor holding portion 72 moves at least backward as the organ accommodating portion 2 swings from the left lateral decubitus position to the supine position by driving the output shaft 75.
Therefore, in the present embodiment, the motor accommodating portion 7 internally supports the motor holding portion 72 so as to be slidable in the front-rear direction, as shown in FIGS. 6 (a) and 6 (b). Specifically, the motor accommodating portion 7 has a pair of guide rails 73 extending in the front-rear direction inside, and the motor holding portion 72 is provided via engaging members provided on both left and right side surfaces. It is slidably engaged with the pair of guide rails 73.
Since the motor holding portion 72 that holds the posture change motor 71 and the output shaft 75 is supported inside the motor accommodating portion 7 so as to be slidable in the front-rear direction, the organ accommodating portion 2 can be smoothly swung. be able to.

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

The control unit 10 has a CPU (Central Processing Unit) 11, a memory 12, an input / output interface (I / F) unit 13, and the like as a hardware configuration.
The CPU 11 may be one or more general CPUs or MPUs (Micro Processing Units), and may be replaced with or together with an integrated circuit (ASIC) for a specific application, a DSP (Digital Signal Processor), and a GPU (Graphics Processing). Unit), FPGA (Field Programmable Gate Array), etc. may be used.
The memory 12 is a RAM (Random Access Memory) and a ROM (Read Only Memory), and may include an auxiliary storage device (hard disk or the like).
The input / output I / F unit 13 is a device that controls the input or output of a signal to be processed or processed by the CPU 11, and is a user interface device such as an input / output panel 15, a microphone 16, a motor group 17, and a sensor group 18. Etc. are connected. Further, the input / output I / F unit 13 may include a communication unit that communicates with another computer or device, and may be connected to a portable recording medium or the like.
The control unit 10 may include hardware elements (not shown in FIG. 7), and the hardware configuration of the control unit 10 is not limited.

The input / output panel 15 includes a display device for displaying a training menu, an operation mode, an evaluation result, and the like, and an input device for operating a screen displayed on the display device. The input / output panel 15 may be realized as a touch panel in which a display device and an input device are integrated.
In the present embodiment, the content displayed on the input / output panel 15 is not limited at all. In the present embodiment, for example, an operation button that allows selection of start and stop of training, a display of the elapsed time of training, a menu for selecting the difficulty level of training, an evaluation result, and the like are displayed. A display example output to the input / output panel 15 will be described later.
The microphone 16 is a microphone and converts the collected sound into an electric signal.

The motor group 17 includes at least three motors that realize the slides of the organ holding portion 32, the first slide wall portion 35, and the second slide wall portion 34, and the posture change motor 71.
Each motor included in the motor group 17 may be an electric motor that converts electric energy into mechanical energy, may be a DC motor, may be an AC motor, or may be another motor. Good. Hereinafter, each motor included in the motor group 17 may be collectively referred to as a motor 17 without distinction.

The sensor group 18 is a plurality of various sensors provided inside or outside the modeling (outer surface or inner wall surface) of the large intestine model 30 or in other configurations, and detects the state of the endoscopic procedure at each position. ..
For example, an object detection sensor provided in the locally fixed region (anal side end region, descending colon holding region, splenic curve region, hepatic curve region, cecal region) in the large intestine model 30 and detects the presence of an endoscope is the sensor group. 18 is included. In the present embodiment, a photoelectric sensor as an object detection sensor is installed in the anal holding portion 31, the organ holding portion 32, and the holding mechanism (not shown) for holding the cecal region, respectively. However, if the object detection sensor can detect the presence of an endoscope passing through the lumen of the large intestine model 30, its specific type and detection principle are not limited, and its installation location is also not limited. ..
Further, the sensor group 18 may include a pressure sensor that detects pressure on the downward wall surface of the first slide wall portion 35 or the second slide wall portion 34.
Further, the sensor group 18 may include a barometric pressure sensor that detects the barometric pressure in the lumen of the large intestine model 30.

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

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

The detection module 101 detects the displacement or deformation of the target site which is at least a part of the movable region of the large intestine model 30 housed in the organ accommodating portion 2. In the present embodiment, the region between the anal holding portion 31 and the organ holding portion 32 in the large intestine model 30 is the target site.
Here, the "displacement of the target portion" detected by the detection module 101 means a change in the position of the target portion as described above. Therefore, in "detection of displacement of the target part", either the acquisition of the three-dimensional position or the two-dimensional position of the target part or the detection of the position change in the three-dimensional space or the two-dimensional space of the target part is performed. One or both are included.
As for "deformation of the target part", as described above, bending deformation, expansion / contraction deformation (extension deformation or shortening deformation of the length in the longitudinal direction), and twist deformation (rotational twist about the longitudinal direction) of the target part. (Twisting like squeezing a rag)), loop deformation (deformation forming a loop shape in the longitudinal direction), etc., any one or more is included.

In the present embodiment, the detection module 101 acquires the image data in the organ accommodating portion 2 imaged by the two cameras 6, and recognizes the marker image from the image data to obtain the bent state of the target portion. It is possible to detect any one or more of the stretched state, the twisted state, and the loop state.
Here, the "bent state" means a state of bending deformation, and may be indicated by, for example, the degree of bending, the bending angle, the number of bending points, and the like.
"Expandable state" means a state of extensional deformation or shortening deformation of length in the longitudinal direction, for example, the degree of extension or shortening and the extension rate or shortening rate (ratio of the changed length to the original length). It can be indicated by the number of stretched or shortened parts.
The "twisted state" means a state of twisted deformation, and is based on the degree of rotational twist (twist that squeezes a rag) and the number of twists (rotational speed) about the longitudinal direction of the large intestine model 30. Can be shown.
The “loop state” means a state of loop deformation forming a loop shape in the longitudinal direction of the large intestine model 30, and can be indicated by the type of loop shape, the number of loops, the size of the loop, and the like. Here, in the procedure of colonoscopy, when inserting an endoscope into a sigmoid colon, a transverse colon, or the like, there is a technique of forming a loop shape and inserting the endoscope. As such a loop shape, there may be a type of loop shape called α loop, inverse α loop, γ loop, inverse γ loop, N loop, M loop and the like. The detection module 101 may detect such a loop shape type as a loop state.

In the present embodiment, since the posture parameters of the two cameras 6 can be accurately held, the three-dimensionality of each marker can be obtained by using a stereo imaging method or the like known from the images captured by the two cameras 6. The original position information can be acquired. As a result, the three-dimensional positions of each marker ring 43 can be acquired, and as a result, shape information such as a bent state, a stretched state, a twisted state, and a loop state can be detected with respect to the target portion.
However, even if the three-dimensional position information of each marker is not acquired, the bent state, the stretched state, the twisted state, the loop state, etc. of the target portion can be detected. For example, markers of different colors or shapes are arranged on the front surface, the back surface, and the middle of the target site of the large intestine model 30 in the state of being housed in the organ storage unit 2. Thereby, the bent state, the stretched state, the twisted state, the loop state, and the like of the target portion can be detected based on the reflected state of each marker in the images captured by the two cameras 6. The pattern of the number of recognized markers indicating the front surface, the number of recognized markers indicating the back surface, and the number of recognized markers indicating the middle in the captured image, and the bent state, stretched state, twisted state, loop state, etc. of the target portion. You may use this relationship by preserving the relationship with.
Furthermore, in the present embodiment, the holding

portion markers

41 and 42 are also provided in the anal holding portion 31 and the organ holding portion 32. As a result, the position can be calculated from the holding

portions markers

41 and 42, so that the distance between the anal holding portion 31 and the organ holding portion 32 can also be calculated.

However, there may be a marker ring 43 in which a marker cannot be detected due to a blind spot caused by deformation or displacement of the large intestine model 30 accompanying the endoscopic procedure.
Therefore, the detection module 101 detects the length of the variable length member including the first wire member 37 or the second wire member 38, and further uses the length to detect the displacement or deformation of the target portion. It may be. For example, the detection module 101 can detect the feed amount (length) of the first wire member 37 based on the detection signal from the sensor that detects the rotation amount of the wire reel that winds the first wire member 37. As a result, the displacement or the amount of displacement of the wire connecting portion of the sigmoid colon region of the large intestine model 30 can be detected. The detection module 101 is a displacement or displacement amount of the wire connecting portion detected with respect to the length of the first wire member 37, and by supplementing the three-dimensional position information of the target portion detected by using the above-mentioned marker, tentatively. Even when a part of the marker ring 43 cannot be detected, the displacement or deformation (bent state, stretch state, twist state, loop state, etc.) of the target portion can be detected without deterioration of accuracy.

As described above, in the present embodiment, the region between the anal holding portion 31 and the organ holding portion 32 in the colon model 30 is the target site, but the detection module 101 is the other region of the colon model 30 ( For example, displacement or deformation of the transverse colon region, etc.) may be detected. In this case, a plurality of markers may be provided in the transverse colon region and, if necessary, the length information of the second wire member 38 may be used.

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

Further, the mode management module 102 determines the position of the organ holding unit 32 according to the training difficulty level indicated by the acquired training mode information, controls the corresponding motor, and controls the corresponding motor to the organ holding unit 32 at the determined position. Slide. The training difficulty level can be specified by a predetermined number of steps (for example, 5 steps), and the position of the organ holding portion 32 may be determined for each step number of the training difficulty level. In this case, the higher the training difficulty level, the closer the organ holding portion 32 is to the anal holding portion 31. The slide of the organ holding portion 32 to the determined position may be controlled by using the rotation amount of the motor, or may be controlled by using the detection signal from the position sensor (photo sensor or the like).

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

Further, the utterance processing module 103 can specify one or more predetermined utterances uttered by the trainee among a plurality of predetermined predetermined utterances based on the acquired utterance information.
In the colonoscopy procedure, the physician may instruct the caregiver to compress the abdomen to support endoscopic insertion, as described above. The utterance corresponding to the abdominal compression instruction may be held in the utterance processing module 103 as a predetermined predetermined utterance. In this case, as the predetermined utterance, for example, partial utterance information such as "abdominal compression" and "compression support" is held, and the utterance processing module 103 includes such predetermined utterance in the acquired utterance information. Whether or not it is possible to identify a predetermined utterance made by the trainee.
Similarly, the utterance corresponding to the instruction to release the abdominal compression may be held in the utterance processing module 103 as a predetermined predetermined utterance. In this case, as a predetermined utterance, partial utterance information such as "release of compression" and "stop compression" may be retained.

In addition, as described above, the doctor may ask the subject (patient) to take a deep breath in order to smoothly insert the endoscope. The utterance corresponding to this deep breathing request may be held in the utterance processing module 103 as a predetermined predetermined utterance. In this case, as predetermined utterances, for example, utterance information such as "please take a deep breath" and "please take a breath and stop" is held, and the utterance processing module 103 has such predetermined utterance information. By determining whether or not the utterance is an utterance, it is possible to identify a predetermined utterance uttered by the trainee.
After such a request, the doctor asks you to return to normal breathing. The utterance corresponding to the request to return to normal breathing may be held in the utterance processing module 103 as a predetermined predetermined utterance. In this case, utterance information such as "you may exhale" or "return to normal breathing" may be retained as predetermined utterances.

In addition, the doctor may request the subject (patient) or a caregiver to change the position in order to smoothly insert the endoscope. The utterance corresponding to the request for the position change may be held in the utterance processing module 103 as a predetermined predetermined utterance. In this case, partial utterance information such as "backward" or "sideways" is held as the predetermined utterance, and the utterance processing module 103 determines whether or not the acquired utterance information includes such a predetermined utterance. Therefore, it is possible to identify a predetermined utterance uttered by the trainee.
In this way, the utterance processing module 103 can also be called the utterance specifying means. However, the predetermined utterance to be specified in this embodiment is not limited to such an example. Further, the utterance processing module 103 may hold various variations as each predetermined utterance. The voice recognition process can be a process using any existing recognition method.

When the utterance processing module 103 identifies a predetermined utterance corresponding to the slide of the first slide wall portion 35 or the second slide wall portion 34 among a plurality of predetermined types of predetermined utterances, the utterance processing module 103 controls the corresponding motor. Then, the first slide wall portion 35 or the second slide wall portion 34 is slid.
In the present embodiment, when a predetermined utterance including "abdominal compression" is specified, the utterance processing module 103 slides the first slide wall portion 35 downward to specify the predetermined utterance including "stop compression". If so, the first slide wall portion 35 is slid upward to return to the original position. Further, when a predetermined utterance such as "Please take a deep breath" is specified, the utterance processing module 103 slides the second slide wall portion 34 downward and says "You may exhale." When the predetermined utterance is specified, the second slide wall portion 34 is slid upward to return to the original position.

Further, when the utterance processing module 103 identifies a predetermined utterance corresponding to the posture change, the utterance processing module 103 controls the posture change motor 71 to swing the organ accommodating portion 2. For example, the utterance processing module 103 operates the body position change motor 71 so that the organ accommodating portion 2 swings from the left lateral decubitus position to the supine position when a predetermined utterance including "supine position" is specified. When a predetermined utterance including "sideways" is specified, the organ accommodating portion 2 operates the posture change motor 71 so as to swing from the supine position to the left lateral position.
As described above, in the present embodiment, the first slide wall portion 35 and the second slide wall portion 34 are slid and the organ accommodating portion 2 is swung by voice recognition, but these are the input / output panel 15. It may be executed by the operation input to the display.
Further, the utterance processing module 103 holds a correspondence relationship between the position where the tip of the endoscope exists and the predetermined utterance that the doctor should utter at that position, and the tip of the endoscope is located at the target position. If a predetermined utterance to be uttered at that position is not specified within a predetermined time even though the utterance exists, the slide of the first slide wall portion 35 or the second slide wall portion 34 or the organ accommodation is voluntarily performed. The swing of the part 2 may be executed. In this way, the trainee can be assisted, so that the trainee who is unfamiliar with the operation of the endoscope can easily continue the training while receiving support.

The measurement module 104 acquires time information related to the endoscopic procedure. As described above, in the present embodiment, object detection sensors are provided in the anal holding portion 31, the organ holding portion 32, and the holding mechanism for holding the anal region, respectively, and according to the detection signals from the respective object detection sensors, It is possible to detect that the tip of the endoscope has passed the position where the object detection sensor is provided in the large intestine model 30. Therefore, the position where each object detection sensor is provided in the large intestine model 30 can be described as a checkpoint, and a plurality of measurement modules 104 provided at different positions in the lumen of the large intestine model 30 in the longitudinal direction. It can be described as determining that the tip of the endoscope has passed the checkpoint of.

Based on the above determination, the measurement module 104 acquires the time spent at the tip of the endoscope between the two checkpoints. In the present embodiment, the measurement module 104 measures the time from the region held by the anal holding portion 31 in the large intestine model 30 to the region held by the organ holding portion 32, and is held by the organ holding portion 32. Measure the time it takes to reach the cecal area from the area.
Here, the colonoscopy procedure is a series of procedures from inserting the endoscope from the anus to the area around the cecum and then pulling it out from the anus.
Therefore, the measurement module 104 sets the first stay time from passing the first checkpoint to passing the second checkpoint and the first checkpoint after passing the second checkpoint. Obtain the second stay time and the time to pass. In the present embodiment, the measurement module 104 further measures the time from the cecal region in the large intestine model 30 to the region held by the organ holding portion 32, and from the region held by the organ holding portion 32 to the anal holding portion. The time required to reach the region held at 31 is further measured.
The measurement module 104 can measure not only the partial stay time as described above but also the total time of the colonoscopy procedure. That is, the measurement module 104 can measure the total time from inserting the endoscope from the anus to the periphery of the cecum and then pulling it out from the anus.

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

Further, the evaluation module 105 may evaluate the staying time related to the insertion procedure of the endoscope and the staying time related to the returning procedure of the endoscope by separate evaluation methods. That is, the evaluation module 105 sets the first stay time from passing the first checkpoint to passing the second checkpoint and the first checkpoint after passing the second checkpoint. Each may be evaluated by a separate evaluation method for the second stay time until passing.
For example, when inserting, a point is added when the staying time is shorter than the standard staying time as described above, and when returning, a predetermined time width is set for the standard staying time, and the staying time is that time. It may be an evaluation method in which whether or not a base score is given is determined depending on whether or not it fits within the range. Further, at the time of returning, if the staying time is shorter than the shortest standard staying time in the predetermined time width, points may be deducted.

Generally, in an endoscopic procedure, the evaluation viewpoint of the procedure differs between the time of insertion and the time of return. Since it is important to insert the endoscope to the destination as quickly and gently as possible at the time of insertion, the evaluation viewpoint is the quality of the endoscope operation. On the other hand, it is more important to observe closely when returning, so whether or not the observation is performed properly is the evaluation point of view.
As described above, by evaluating the staying time related to the insertion procedure of the endoscope and the staying time related to the returning procedure of the endoscope by different evaluation methods, a high score is obtained when the operation can be performed quickly at the time of insertion. When returning, a high score will be given if the patient can be observed by spending an appropriate amount of time, so that the evaluation can be made from an appropriate viewpoint based on the time related to the endoscopic procedure.

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

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

The evaluation module 105 can also evaluate the procedure of the trainee based on the atmospheric pressure information in the lumen of the large intestine model 30 indicated by the detection signal of the atmospheric pressure sensor. In the colonoscopy procedure, there is a procedure in which air is supplied from the endoscope in order to expand the lumen of the large intestine for easy observation. However, excessive insufflation causes the lumen of the large intestine to expand too much, which is a burden on the subject (patient).
Therefore, for example, the evaluation module 105 presets an appropriate barometric pressure threshold value for each checkpoint in advance, and the cavity measured when the tip of the endoscope stays between the two checkpoints. The procedure of the trainee may be evaluated by further using the comparison result between the internal pressure and the pressure threshold.

Further, the evaluation module 105 further uses one or more of the bent state, the stretched state, the twisted state, and the loop state of the target portion of the large intestine model 30 detected by the detection module 101. You can also evaluate the trainee's technique. For example, when the detection module 101 detects the degree of expansion and contraction of the target part, the evaluation module 105 detects the expansion and contraction of the target part when the tip of the endoscope stays between the two checkpoints. May be held for each checkpoint, and points may be added or deducted to the evaluation points based on the comparison between the degree of expansion and contraction of the target part between checkpoints and the reference degree of expansion and contraction. .. Further, the evaluation module 105 may also evaluate the degree of bending, the number of loops, the type of loop shape, the degree of twist, and the like.

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

In the example of FIG. 9, the elapsed time from the detection of the passage of the tip of the endoscope by the object detection sensor provided in the anal holding portion 31 is displayed in the area DS1 and extends from the lower wall portion 21. The image captured by the camera 6 supported by the camera support plate 61 is displayed in the area DS2.
Further, in the area DS2, mark displays MK1, MK2, MK3 and MK4 including numbers are arranged at each position of the four marker rings 43 detected by the detection module 101. At the same time, the line display connecting each mark display is also displayed, so that the deformation and shape information of the large intestine model 30 is presented.
Further, the degree of expansion and contraction between the mark display MK1 and the mark display MK2 is displayed as a bar in the area DS3, and the degree of expansion and contraction between the mark display MK2 and the mark display MK3 is displayed as a bar in the area DS4. In the area DS5, the degree of expansion and contraction between the mark display MK3 and the mark display MK4 is displayed as a bar.
By operating the operation button OP of "test stop", training mode information indicating training stop is generated.

In the example of FIG. 10, a character string indicating the evaluation result of the procedure of the trainee is displayed in the area DS10. The string contains a string that gives advice to the trainee according to the evaluation result (for example, "let's make an appropriate call to have the patient take a breath when inserting it into the transverse colon").
In the area DS11, an evaluation point of 71 points out of 100 points is displayed.
A radar chart for five evaluation items is displayed in the area DS12. The evaluation item of communication shows the evaluation result (“D” in FIG. 10) based on the information on the predetermined utterance specified by the utterance processing module 103, and the evaluation item of the load on the organ is the evaluation based on the load information. The result (“A +” in FIG. 10) is shown, and the evaluation result (“B +” in FIG. 10) based on the time when the endoscope is inserted, which is acquired by the measurement module 104, is shown in the evaluation item of the procedure time. The evaluation item of the observation shows the evaluation result (“C +” in FIG. 10) based on the time when the endoscope is returned, which is acquired by the measurement module 104, and the evaluation item of the insufflation is the large intestine model. The evaluation result (“A +” in FIG. 10) based on the pressure in the lumen of 30 is shown.

However, the display content at the time of training and the display content of the training evaluation displayed by this simulator are not limited to the examples shown in FIGS. 9 and 10.
For example, a graph display showing the change in the number of loops of the target part of the large intestine model 30 in time series or a graph display showing the change in the degree of expansion and contraction of the target part of the large intestine model 30 in time series are displayed during training. Alternatively, a graph display showing changes in load over time may be included. In addition, the display of the training evaluation may include the evaluation result regarding the expansion and contraction of the target portion of the large intestine model 30. Further, the evaluation result based on each of the five evaluation items may be scored numerically instead of a symbol.

In addition, the detected loop shape type (α loop, inverse α loop, γ loop, inverse γ loop, N loop, M loop, etc.) may be displayed in real time in the display during training. At this time, depending on the type of the detected loop shape, advice regarding the operation of the endoscope for breaking the loop may also be displayed. For example, if an α loop is detected as the type of loop shape, an advice such as "Turn the endoscope counterclockwise to release the loop" is displayed, and if a γ loop is detected, May display advice such as "Turn the endoscope clockwise to break the loop."
In this case, the detection module 101 holds in advance the correspondence between each type of loop shape and the advice character string information corresponding to that type, and corresponds to that type according to the detected loop shape type. The advice character string may be displayed on the input / output panel 15.
Such real-time advice during training may be output not only by display but also by voice.

[Modification example]
The above embodiment is an example. The medical simulator is not limited to the above-mentioned configuration, and may be partially appropriately modified as long as it has at least a part of the above-mentioned configuration.

For example, in the above embodiment, the large intestine model 30 is exemplified as the tract organ model, but a model simulating the digestive tract such as the esophagus, stomach, duodenum, ureter, blood vessel, etc. is adopted as the tract organ model. May be done.
Therefore, in the above-described embodiment, the training of the colonoscopy examination technique is mainly described, but the medical procedure that can be trained by the present simulator is not limited to such a procedure. It is possible to train procedures related to colonoscopy treatment, as well as procedures related to examination and treatment of other luminal organs and intubation.
In addition, an endoscope has been exemplified as a target device (medical tool) used for training, but in this simulator, a medical device other than the endoscope such as an vascular endoscopic catheter may be used. Training-specific tools or equipment may be used.

For example, the medical simulator may include at least a luminal organ model, an organ accommodating portion that accommodates the luminal organ model in a locally fixed state in an internal space, and a detection means. In this case, the tract organ model is displaced in the internal space of the organ containment part by the operation of the target device by the trainee and the local fixation area that can be fixed to the organ accommodation part at different positions in the longitudinal direction. The detecting means may be capable of detecting the displacement or deformation of the target site which is at least a part of the movable area of the luminal organ model in the internal space, at least during training, including the possible movable area.
Therefore, in order to detect the displacement or deformation of the target portion of the luminal organ model, only the marker may be used, or only the variable length member may be used.
Furthermore, displacement or deformation of the target site of the luminal organ model may be detected without using either the marker or the variable length member. For example, a plurality of images showing various states in any one or more of the bent state, stretched state, twisted state, and loop state of the target part are prepared as teacher images, and for each teacher image. A machine-learned trained model is generated based on a plurality of teacher data associated (tagged) with each state information. The detection means (detection module 101) gives an image captured from the camera 6 to the trained model, so that the target portion is in a bent state, an expanded / contracted state, a twisted state, or a loop state. Multiple can be detected (estimated).
Further, in order to improve the detection accuracy, a plurality of captured images captured from different directions by two or more cameras 6 are input, and the target portion is in a bent state, a stretched state, a twisted state, or a loop state. It is preferable to use a trained model that outputs one or more of the above. In this case, a plurality of captured images captured from different directions indicating one state of the target site are prepared as teacher images, and in the teacher data, the one state is set with respect to the captured images. It suffices if the indicated state information is associated.
When such a trained model is used, a marker may or may not be arranged at a target site of the luminal organ model.
When a marker is placed, the image is characterized by the marker, so that the detection accuracy can be expected to be improved. In this case, it is not necessary to recognize the marker itself from the captured image, but since it can be said that the marker image is used, the bent state, stretched state, and twisted state of the target portion are based on the marker image included in the captured image. It can be described that the state or the loop state can be detected.
Further, any one or more of the organ holding portion 32, the first slide wall portion 35, or the second slide wall portion 34 may be fixed so as not to slide. In this case, the corresponding motor is also unnecessary.
Similarly, the position change may be performed manually, in which case the position change motor 71 becomes unnecessary.

Further, in the above-described embodiment, the two cameras 6 are provided at positions separated from the lower side and the left side of the organ accommodating portion 2 toward the ventral side (see FIG. 2), but the number and arrangement of the cameras 6 Is not limited to the examples of the above-described embodiments. When the three-dimensional position of the target part is acquired by image recognition of the marker provided on the target part of the large intestine model 30, two or more cameras including two cameras 6 facing orthogonal directions in a plan view. It is preferable that 6 is provided. Further, when displaying an image of the entire colon model 30 as illustrated in FIG. 9, one camera 6 for capturing the bird's-eye view image may be further provided. Further, only one camera 6 may be provided. In this case, since the blind spot increases, it is preferable that the detection of the deformation or displacement of the large intestine model 30 is supplemented by the detection of the length of the variable length member.
Further, at least the lens portion of the camera 6 is arranged at a position closer to the window portion 25 of the organ accommodating portion 2 than the position shown in FIG. 2 although it is inside the organ accommodating portion 2 or outside the organ accommodating portion 2. May be good. In this case, since the lens portion of the camera 6 is close to the large intestine model 30, it is preferable to use a wide-angle lens.
Further, the simulator may be provided with a lighting material such as an LED on the inside or outside of the organ accommodating portion 2 or both, assuming use in a dark room. When the lighting material is provided inside the organ accommodating portion 2, in order to suppress surface reflection on the inner surface of the window portion 25, a film or material that suppresses surface reflection is also provided on the inner surface of the window portion 25. There may be an agent.
One of the specific modifications of the configuration for imaging the large intestine model 30 will be described later.

Further, in the above-described embodiment, it is illustrated that the posture change between the supine position and the left lateral position is simulated by swinging the organ accommodating portion 2, but further, the supine position and the right lateral position are described. It is also possible to simulate the repositioning between. This is done, for example, when the

tire portions

20a, 20b and 20c provided on the right side wall portion 23 are symmetrically provided on the left side wall portion 24 and the organ accommodating portion 2 is in the supine position. This can be achieved by rotating the output shaft 75 in the direction opposite to that of the transition to the position state.

Since the thickness (diameter) of endoscopes differs depending on the manufacturer of the endoscope, a mechanism for changing the luminal cross-sectional area of the large intestine model 30 is provided in the anal holding portion 31 to support a plurality of types of endoscopes. You may do so. In this case, as a mechanism for changing the cross-sectional area of the cavity, an air pump capable of intake and exhaust can be mentioned. When a flange lid portion protruding from the outer peripheral surface of the large intestine model 30 is provided at the anal side end of the large intestine model 30, the flange lid portion and the outer surface of the lower wall portion 21 of the organ accommodating portion 2 An intermediate plate having a through hole through which the anal side end region of the large intestine model 30 can be inserted is interposed between the lower surface) and the outside of the flange lid portion of the large intestine model 30 and the lower wall portion 21 of the organ accommodating portion 2. Engage with the sides. Then, a plurality of types of intermediate plates having different sizes of through holes corresponding to the thickness (diameter) of each endoscope may be replaceable.
Further, the difficulty level of the training may be lowered by injecting air into the lumen of the lumen organ model with an air pump or the like. This is because the injection of air into the lumen of the luminal organ model causes the luminal organ model to swell, making it easier to insert the endoscope. In this case, it is selected to add a configuration that allows air to be injected into the lumen of the luminal organ model from the air pump via the air tube, and to reduce the difficulty of training by input operation for the display on the input / output panel 15, for example. If this happens, the operation of the air pump should be started.

Further, as in the present embodiment, when the degree of elongation of the target part of the luminal organ model can be detected, when the degree of elongation exceeds the first threshold value, a growl voice indicating a painful state to the speaker ( For example, it is possible to output a voice called "Woo". Further, when the degree of elongation further exceeds the second threshold value larger than the first threshold value, an error sound may be output to indicate damage to the organ.
Further, since the above-mentioned measurement module 104 can detect that the tip of the endoscope stays at a certain place for a certain period of time by the above-mentioned method, when such a detection is made, the control unit 10 Automatically swings the first slide wall portion 35, the second slide wall portion 34, or the organ holding portion 32, or the organ accommodating portion 2 by operating a corresponding motor such as the posture change motor 71. It may be executed to automatically support the insertion of the endoscope.
In this way, it becomes easy for the trainee who is unfamiliar with the operation of the endoscope to continue the training while receiving support.

In addition, the luminal organ model of the large intestine model 30 described above may be further provided with an injection portion for feeding the lubricating fluid into the lumen. This injection includes a microinjection hole that penetrates the lumen from the outside of the tract organ model. It is preferable that the injection hole is small enough to allow a nozzle or tube connected to the lubricating liquid container to be inserted and to prevent the lubricating liquid injected into the lumen from leaking to the outside. Further, when the lubricating liquid is injected into the lumen from the lubricating liquid container via the liquid feeding tube, a tube connecting portion connected to the end portion of the liquid feeding tube may be attached to the injection portion.
The lubricating liquid may be any agent that improves the sliding in the lumen of the luminal organ model, and for example, a volatile silicone release agent is used.
By making it possible to inject a lubricating liquid such as a silicone release agent into the tract organ model from the outside in this way, the inside of the tract of the tract organ model can be brought closer to the real thing, and when an endoscope is inserted. You can realistically reproduce the feel of. Furthermore, by using a volatile release agent as the lubricating liquid to be injected, it is possible to reduce the maintenance load of the luminal organ model because it volatilizes after use if it is injected only at the time of use.

Further, when the lubricating fluid is injected into the lumen of the tract organ model as described above, the tract organ model has the lubricating fluid injected into the lumen on the inner wall surface defining the lumen. It is preferable to have a plurality of micro-grooves capable of retaining the water. The width of the micro-groove may be such that the lubricating liquid can stay longer than the inner wall surface without the groove, and must be at least smaller than the diameter of the endoscope, preferably less than 1 mm. .. Further, the width of the micro-groove may be a size that can reduce the friction area between the inserted endoscope and the inner wall surface of the luminal organ model.
FIG. 11 is a diagram showing an inner wall surface of the large intestine model 30 in the present embodiment.
P1 of FIG. 11 schematically shows the inner wall surface of the large intestine model 30, and P2 shows a schematic view of an enlarged inner wall surface. In P2, the ultrafine concave groove and the base surface of the inner wall are shown in an uneven shape. As described above, in the example of FIG. 11, a plurality of linear ultrafine concave grooves extending in a direction substantially orthogonal to the longitudinal direction of the large intestine model 30 are provided substantially in parallel on the inner wall surface of the large intestine model 30.
Such a linear concave groove may be provided over the entire area of the inner wall surface of the large intestine model 30, or may be provided only in a specific area of the inner wall surface.
Further, such linear micro-grooves can be formed as stacking marks on the inner wall surface by molding the inner wall surface of the luminal organ model using a core. Further, even if a core having a minute convex shape on the surface is used, a minute groove on the inner wall surface of the large intestine model 30 can be formed. As described above, the method for forming the minute groove is not limited in any way.
Further, in the example of FIG. 11, the micro-groove is formed linearly, but may be formed as a hole.
By providing such a minute groove on the inner wall surface of the large intestine model 30, the frictional area between the medical device inserted into the lumen and the inner wall surface is reduced, or the lubricating liquid stays in the minute groove. It is possible to reduce unnecessary resistance when inserting and returning (removing) the medical device.

When the upper gastrointestinal tract model is applied as the luminal organ model, the checkpoints from which time information is acquired by the measurement module 104 are set at the esophageal entrance, the junction (cardia), the duodenum, etc. It should be done. Further, the load information acquired by the evaluation module 105 may be a pressure value to the pharynx. When the pharyngeal reflex or ambiguity is simulated in the medical simulator, the evaluation module 105 may deduct evaluation points each time the pharyngeal reflex or ambiguity is performed. When the barometric pressure sensor detects the barometric pressure in the lumen of the luminal organ model, the barometric pressure from the start until the tip of the endoscope is inserted into the duodenum, from the duodenum to the tip. The air pressure after being removed from the joint, the air pressure after being removed from the joint (cardia), and the like may be evaluated. In addition, the evaluation module 105 "take a breath", "hold a breath", and "please relax" when the tip of the endoscope is present around the joint (cardia). It is also possible to evaluate whether or not a set of predetermined utterances "" is specified by the utterance processing module 103.

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

The light-shielding portion 210 has a substantially rectangular parallelepiped shape and is detachably attached to the ventral side of the organ accommodating portion 200. The light-shielding portion 210 covers the window portion 201 from the ventral side in the worn state, and together with the lower wall portion 21, the upper wall portion 22, the right side wall portion 23, and the left side wall portion 24 of the organ accommodating portion 200, the inside of the organ accommodating portion 200. Shield the space from outside light. As a result, the image of the camera 6 that captures the large intestine model 30 in the organ accommodating portion 200 can be prevented from being affected by external light.
The light-shielding portion 210 has a lower wall portion 221 and an upper wall portion 222 (not shown in FIG. 13), a right side wall portion 223, a left side wall portion 224, and a ventral side wall portion 225, which cover the upper, lower, left, right, and ventral sides. On the other hand, the back side is open.
The dorsal edges of the right wall 223 and the left wall 224 of the light-shielding portion 210 and the ventral edge of the right wall 23 and the left wall 24 of the organ accommodating portion 200 extend linearly in the vertical direction, respectively. It has a structure that can be engaged with each other. As a result, by sliding the light-shielding portion 210 in the vertical direction with respect to the organ accommodating portion 200, the light-shielding portion 210 can be attached to and detached from the organ accommodating portion 200. By making the light-shielding portion 210 detachable from the organ accommodating portion 200 in this way, it is possible to facilitate the replacement work of the large intestine model 30 and the maintenance work in the organ accommodating portion 200.

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

The partition plate is formed of a light-shielding region 211 and a light-transmitting region 212.
The light-shielding region 211 is formed of a member or material capable of blocking light from the light emitting unit 215 provided in the ventral space of the light-shielding portion 210 so as not to be transmitted to the dorsal space side as much as possible. For example, the light-shielding region 211 may be formed by attaching a light-shielding film to the ventral surface of the partition plate, or the light-shielding agent may be applied to the ventral surface of the partition plate. It may be formed as a partial plate formed of a material having a light-shielding property.
The light transmitting region 212 is formed of a member or material capable of transmitting light from the light emitting unit 215 provided in the ventral space of the light shielding portion 210 to the dorsal space side.
The arrangement of the light-shielding region 211 and the light-transmitting region 212 is such that the light from the light-emitting unit 215 can indirectly illuminate the internal space of the organ accommodating unit 200 in order to suppress the surface reflection of the window unit 201. And it may be decided according to the position of the camera 6. Therefore, the light-shielding region 211 and the translucent region 212 of the partition plate are provided between the light source (light emitting unit 215) and the window portion 201, and the internal space of the organ accommodating portion 200 is indirectly provided by the light from the light source. It can be described as an indirect lighting unit that illuminates.

In the example of FIG. 13, the light-shielding area 211 and the light-transmitting area 212 are connected in the vertical direction to form a partition plate, and the light-transmitting area 212 is about 1/5 to 1/6 of the light-shielding area 211. The light-shielding region 211 is located below (anal side) and above as the remaining region of the partition plate. Further, two light emitting units 215 are provided on the left and right inner wall surfaces of the ventral space of the light emitting unit 210, and the light emitting region 211 is arranged at a position covering the back side of the light source of the two light emitting units 215, and is transparent. The light region 212 is arranged at a position where the light emitting unit 215 does not have a light source.
In this way, the light-shielding unit 210 shields the internal space of the organ-containing unit 200 from outside light, and the inside of the organ-containing unit 200 is indirectly illuminated by the light from the light emitting unit 215 provided in the internal space of the light-shielding unit 210. By illuminating the space, it is possible to appropriately image the large intestine model 30 in the internal space of the organ accommodating portion 200 while suppressing the surface reflection and reflection of the window portion 201. As a result, the image recognition accuracy of the large intestine model 30 can be maintained.
However, if the position and number of the light emitting units 215 and the arrangement of the light shielding region 211 and the light transmitting region 212 can indirectly illuminate the internal space of the organ accommodating portion 200 with the light from the light emitting unit 215, the example of FIG. It is not limited to, and can be appropriately deformed.
Further, in the present modification, the window portion 201 may or may not include a member or material that suppresses surface reflection.

Further, the inner wall surface of the organ accommodating portion 200 may also include a member or material that suppresses surface reflection. Furthermore, of the inner wall surface of the organ accommodating portion 200, at least the region around the target portion of the large intestine model 30 whose deformation or displacement is to be detected may include a member or material that suppresses surface reflection. .. By doing so, it is possible to suppress surface reflection of the inner wall surface due to indirect illumination, and it is possible to maintain the image recognition accuracy of the large intestine model 30.
Further, not only the inner wall surface of the organ accommodating portion 200, but also the anal holding portion 31, the organ holding portion 32, the first slide wall portion 35, the second slide wall portion 34, and the holding portion provided in the internal space of the organ accommodating portion 200. The pillar 39 and the like may also include a member or material that suppresses surface reflection.

In the human body model unit 1 according to the present modification shown in FIGS. 12 and 13, in addition to the camera 6 provided in the light-shielding unit 210 and capturing a plan view image of the internal space of the organ accommodating unit 200, mainly. Another camera 6 (not shown) that images the sigmoid colon region of the large intestine model 30 from the side is provided in the organ accommodating portion 200. The latter camera 6 is provided, for example, toward the left side near the inner surface on the right side in the organ accommodating portion 200, or facing the right side near the inner surface on the left side in the organ accommodating portion 200. By providing the latter camera 6 in this way, it is possible to detect displacement and deformation of the large intestine model 30 in the anteroposterior direction (ventral dorsal direction).

FIG. 14 is a diagram showing a part of the display at the time of training in the modified example.
When the training is started, the evaluation module 105 may display the display as shown in FIG. 14 on the input / output panel 15 in addition to or in place of the display shown in FIG.
In the example of FIG. 14, the plan view image captured by the camera 6 in the shading unit 210 is displayed in the area DS21, and the side view image captured by the camera 6 in the organ accommodating unit 200 is displayed in the area DS22. The endoscopic image captured by the endoscope handled by the trainee is displayed in the area DS23, and the image of the trainee captured by an external camera (not shown) is displayed in the area DS24. By displaying various images in this way, it is possible to evaluate and analyze the endoscopic procedure of the trainee from various angles.
Further, the degree of expansion and contraction of the large intestine model 30 shown in the regions DS3, DS4 and DS5 in the example of FIG. 9 is displayed in the region DS25 as the elongation of the sigmoid colon in the example of FIG. In addition, in the example of FIG. 14, the degree of pressure detected by the pressure sensor provided on the downward wall surface of the first slide wall portion 35 is displayed in the area DS26 as the pressure on the compression wall. Further, the difficulty level of the training during execution (beginner level in FIG. 14) and the posture at that time (left lateral decubitus position in FIG. 14) are also displayed at the upper part.

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

Further, the evaluation module 105 may further use the detection result by the detection module 101 to evaluate the technique of the trainee. For example, the evaluation module 105 detects when it is detected that at least a part of the movable area of the large intestine model 30 exceeds the evaluation position, or when the area of the movable area beyond the evaluation position becomes a predetermined area or more. , Deduct evaluation points. Further, the evaluation module 105 may increase the number of points to be deducted according to the time when at least a part of the large intestine model 30 exceeds the evaluation position, or at least a part of the large intestine model 30 exceeds the evaluation position. Evaluation points may be deducted by the number of points corresponding to the number of times. Further, the detection module 101 may increase the number of points to be deducted according to the detected area and the detection time, or the number of times that the area of the movable area beyond the evaluation position becomes equal to or more than a predetermined area. Evaluation points may be deducted by the number of corresponding points.
Further, the evaluation module 105 can also display the lines DS211 and DS221 indicating the evaluation position superimposed on the plan view image or the side view image, as displayed in the area DS21 and the area DS22 in FIG.
According to such an evaluation, it is possible to evaluate whether or not the endoscopic procedure performed by the trainee puts an excessive burden on the large intestine. In addition, by displaying a line indicating the evaluation position, it is possible to make it easier for the trainee to grasp the status of his / her own procedure.

The contents of each of the above-described embodiments can also be specified as follows.
(Appendix 1)
A tract organ model that is flexible and has a shape that mimics at least one tract organ,
An organ accommodating part that accommodates the luminal organ model in an internal space in a locally fixed state,
Detection means and
With
The luminal organ model has a locally fixed region that can be fixed to the organ accommodating portion at different positions in the longitudinal direction, and within the internal space of the organ accommodating portion by the operation of the target device by the trainee. Including displaceable movable area
The detecting means can detect displacement or deformation of a target site which is at least a part of the movable region of the luminal organ model in the internal space, at least during training.
Medical simulator.
(Appendix 2)
A plurality of markers are arranged at positions separated in the axial direction of the tract organ model on at least a part of the outer periphery or the outer surface of the movable region of the tract organ model.
The detection means acquires an image of the inside of the organ accommodating portion captured by a camera, and detects a bent state, a stretched state, a twisted state, or a loop state of the target site based on a marker image included in the image. It is possible,
The medical simulator described in Appendix 1.
(Appendix 3)
The organ accommodating portion includes an abdominal wall cover portion that seals the internal space from the ventral side while accommodating the luminal organ model.
The abdominal wall cover includes at least a transparent window so that the model of the luminal organ in the interior space is visible.
The window portion includes a member or material that suppresses surface reflection of the window portion in order to prevent a decrease in recognition accuracy of the luminal organ model in an image captured by the camera.
The medical simulator according to

Appendix

1 or 2.
(Appendix 4)
A shading unit that is detachably attached to the organ accommodating portion and shields the internal space of the organ accommodating portion from outside light in the attached state.
With more
The organ accommodating portion includes an abdominal wall cover portion that seals the internal space of the organ accommodating portion from the ventral side while accommodating the luminal organ model.
The abdominal wall cover portion includes a transparent window portion and includes a transparent window portion.
The light-shielding portion is provided between the camera, a light source, and the light source and the window portion, which are installed at a position and orientation in which the tract organ model can be imaged through the window portion. Including an indirect lighting unit that indirectly illuminates the internal space of the organ accommodating portion with light from the organ.
The medical simulator according to

Appendix

1 or 2.
(Appendix 5)
Of the inner wall surface of the organ accommodating portion, at least the region around the target portion of the luminal organ model to be detected by the detection means includes a member or material that suppresses surface reflection.
The medical simulator according to Appendix 3 or 4.
(Appendix 6)
The movable region of the tract organ model includes a specific movable region connected to a variable length member.
The detecting means can detect the displacement or deformation of the target portion by detecting the length of the variable length member.
The medical simulator according to any one of Appendix 1 to 5.
(Appendix 7)
The tract organ model is a large intestine model that imitates the shape of the large intestine.
The organ accommodating portion is switched between an anal holding portion holding the anal side end region of the large intestine model and a sliding state slidable with respect to the organ accommodating portion and a fixed state fixed with respect to the organ accommodating portion. Including the organ holding part provided as possible,
The local fixation region of the large intestine model includes the anal side end region held by the anal holding portion and the region held by the organ holding portion.
The region held by the organ holding portion of the large intestine model is a region corresponding to a part of the range from the descending colon to the sigmoid colon.
The slide of the organ holding portion changes the degree of flexion between the anal side end region and the region held by the organ holding portion in the large intestine model.
The medical simulator according to any one of Appendix 1 to 6.
(Appendix 8)
In the slide range of the organ holding portion, the length from the anal side end region to the region held by the organ holding portion in the large intestine model is twice the distance from the anal holding portion to the organ holding portion. Including the position
The medical simulator described in Appendix 7.
(Appendix 9)
The tract organ model is a large intestine model that imitates the shape of the large intestine.
The local fixation region of the luminal organ model includes the anal side end region of the large intestine model.
The movable region of the luminal organ model includes a transverse colon region corresponding to the transverse colon in the large intestine model and a rectal region corresponding to the rectum in the large intestine model.
The organ accommodating portion is located below the accommodating position of the transverse colon region of the large intestine model and above the accommodating position of the anal holding portion holding the anal side end region and the rectal region of the large intestine model. Including auxiliary walls with downward walls,
The medical simulator according to any one of Appendix 1 to 8.
(Appendix 10)
The auxiliary wall portion can be switched between a sliding state in which the distance to the anal holding portion changes and a fixed state in which the auxiliary wall portion is fixed to the organ accommodating portion.
The medical simulator described in Appendix 9.
(Appendix 11)
The tract organ model is a large intestine model that imitates the shape of the large intestine.
The large intestine model includes a transverse colon region corresponding to the transverse colon, a splenic curve region corresponding to splenic curvature, and a hepatic curvature region corresponding to hepatic curvature.
The organ accommodating portion is erected with a downward wall surface above the internal space, and is provided so as to be switchable between a sliding state that can slide downward and a fixed state that is fixed to the organ accommodating portion. Including the sliding wall
At least the splenic curve region and the liver curve region of the large intestine model are displaced downward as the slide wall portion slides downward.
The medical simulator according to any one of Appendix 1 to 10.
(Appendix 12)
The large intestine model includes a splenic curve region corresponding to a splenic curve and a liver curve region corresponding to a liver curve.
The spleen-curved region and the hepatic-curved region of the large intestine model are color tone-changing regions that cause a color change in the spleen-curved region and the hepatic-curved region in an endoscopic image taken in the lumen of the large intestine model. Including,
The medical simulator according to Appendix 11.
(Appendix 13)
With the motor
A motor accommodating portion accommodating the motor and
An output shaft driven by the rotational power of the motor and
A base for holding the motor housing and
With more
The organ accommodating portion further includes an upper end wall portion that seals the upper part of the internal space and fixes one end of the output shaft, and when the output shaft is driven by the rotational power of the motor, the base. Alternatively, it swings together with the output shaft while being supported by the ventral support surface of the base via a tire portion rotatably provided in the organ accommodating portion.
The medical simulator according to any one of Appendix 1 to 12.
(Appendix 14)
The tract organ model is a large intestine model that imitates the shape of the large intestine.
The organ containment includes an anal retainer that holds the anal side end region of the large intestine model.
The local fixation region of the large intestine model includes the anal lateral end region held by the anal holding.
The anal holding portion includes a through hole through which the anal side end region of the large intestine model is inserted, and a tapered wall surface portion in which the cross-sectional area of the through hole gradually expands upward.
The tapered wall surface portion includes a first wall surface portion having a steep slope from the lower end to the upper end of the tapered wall surface portion and a second wall surface portion having a gentler slope than the first wall surface portion.
The first wall surface portion and the second wall surface portion are present at least at positions facing each other in the axial direction of the through hole.
The medical simulator according to any one of Appendix 1 to 13.
(Appendix 15)
The luminal organ model has a plurality of microgrooves on the inner wall surface that defines the lumen, which can retain the lubricating fluid injected into the lumen.
The medical simulator according to any one of Appendix 1 to 14.
(Appendix 16)
A determination means for determining that the site of the target device has passed a plurality of checkpoints provided at positions different from each other in the longitudinal direction in the tract of the tract organ model.
A time acquisition means for acquiring the staying time of the part between two checkpoints, and
An evaluation means for evaluating the procedure of the trainee using at least the acquired staying time, and
The medical simulator according to any one of Appendix 1 to 15, further comprising.
(Appendix 17)
The time acquisition means includes the first stay time from passing the first checkpoint to passing the second checkpoint, and the first checkpoint after passing the second checkpoint. Get a second stay time and each until you pass
The evaluation means evaluates the first staying time and the second staying time by separate evaluation methods.
The medical simulator according to Appendix 16.
(Appendix 18)
A load acquisition means for acquiring load information applied to a predetermined site of the tract organ model,
With more
When the acquired load information indicates a load exceeding the threshold value, the evaluation means deducts points corresponding to the load information from the evaluation points scored using the acquired stay time. Calculate the evaluation points of the trainee's procedure,
The medical simulator according to

Appendix

16 or 17.
(Appendix 19)
The utterance acquisition means for acquiring the utterance information of the trainee, and
An utterance specifying means capable of identifying one or more predetermined utterances uttered by the trainee among a plurality of predetermined utterances based on the acquired utterance information.
With more
The evaluation means calculates the evaluation points by adding or deducting points based on the combination of one or more specified predetermined utterances.
The medical simulator according to Appendix 18.
(Appendix 20)
A measuring means for measuring the air pressure in the lumen of the luminal organ model,
With more
The evaluation means evaluates the procedure of the trainee by further using the comparison result between the atmospheric pressure and the atmospheric pressure threshold value measured while the part of the target device is staying between the two checkpoints.
The medical simulator according to any one of Appendix 16 to 19.
(Appendix 21)
When the detecting means can detect the bent state, the stretched state, the twisted state, or the loop state of the target portion, the evaluation means detects the bent state, the stretched state, the twisted state, or the loop state. To evaluate the procedure of the trainee, using
The medical simulator according to any one of Appendix 16 to 20.
(Appendix 22)
The detection means detects that at least a part of the movable region of the luminal organ model exceeds the evaluation position in the anteroposterior direction or the evaluation position in the vertical direction in the internal space of the organ accommodating portion at least during training. ,
The evaluation means further uses the detection result of the detection means exceeding the evaluation position to evaluate the procedure of the trainee.
The medical simulator according to any one of Appendix 16 to 21.
(Appendix 23)
A luminal organ model that is flexible and has a shape that imitates at least one luminal organ, an organ accommodating portion that accommodates the luminal organ model in an internal space, and a longitudinal direction in the lumen of the luminal organ model. It is a procedure evaluation method using a medical simulator executed by a control unit that controls a medical simulator having at least a plurality of sensors provided at different positions.
Based on the detection signals from the plurality of sensors, it is determined that the site of the target device has passed through a plurality of checkpoints provided at different positions in the longitudinal direction in the tract of the tract organ model.
Get the time spent at the site between the two checkpoints
The trainee's procedure is evaluated using at least the acquired dwell time.
A procedure evaluation method using a medical simulator including that.
(Appendix 24)
The first staying time from passing the first checkpoint to passing the second checkpoint, and the first from passing the second checkpoint to passing the first checkpoint. Including getting each of the two staying times
In the evaluation, the first staying time and the second staying time are evaluated by separate evaluation methods.
A procedure evaluation method using the medical simulator described in Appendix 23.
(Appendix 25)
Obtaining load information applied to a predetermined part of the tract organ model,
When the acquired load information indicates a load exceeding the threshold value, the trainee is trained by deducting points corresponding to the load information from the evaluation points scored using the acquired stay time. Calculate the evaluation points of the procedure,
The procedure evaluation method using the medical simulator according to

Appendix

23 or 24, further comprising the above.
(Appendix 26)
Acquire the utterance information of the trainee and
Based on the acquired utterance information, one or more predetermined utterances uttered by the trainee are specified among a plurality of predetermined utterances.
Including that
In the calculation of the evaluation points, the evaluation points are calculated by adding or deducting points based on the combination of one or more specified predetermined utterances.
A procedure evaluation method using the medical simulator described in Appendix 25.
(Appendix 27)
Measuring the air pressure in the lumen of the luminal organ model,
Including that
In the evaluation, the procedure of the trainee is evaluated by further using the comparison result between the atmospheric pressure and the atmospheric pressure threshold value measured while the part of the target device is staying between the two checkpoints.
The procedure evaluation method using the medical simulator according to any one of Appendix 23 to 26.
(Appendix 28)
Detecting a bent state, a stretched state, a twisted state, or a loop state of a target site of the luminal organ model in the internal space.
Including that
In the evaluation, the procedure of the trainee is evaluated by further using the detected bending state, stretching state, twisting state, or loop state.
The procedure evaluation method using the medical simulator according to any one of Appendix 23 to 27.
(Appendix 29)
It is detected that at least a part of the luminal organ model exceeds the evaluation position in the anteroposterior direction or the evaluation position in the vertical direction in the internal space of the organ accommodating portion.
Including that
In the evaluation, the procedure of the trainee is evaluated by further using the result of the detection that at least a part of the luminal organ model exceeds the evaluation position.
The procedure evaluation method using the medical simulator according to any one of Appendix 23 to 28.
(Appendix 30)
A computer program for causing the control unit to execute a procedure evaluation method using the medical simulator according to any one of Appendix 23 to 29.

Claims

A tract organ model that is flexible and has a shape that mimics at least one tract organ,
An organ accommodating part that accommodates the luminal organ model in an internal space in a locally fixed state,
Detection means and
With
The luminal organ model has a locally fixed region that can be fixed to the organ accommodating portion at different positions in the longitudinal direction, and within the internal space of the organ accommodating portion by the operation of the target device by the trainee. Including displaceable movable area
The detecting means can detect displacement or deformation of a target site which is at least a part of the movable region of the luminal organ model in the internal space, at least during training.
Medical simulator.
A plurality of markers are arranged at positions separated in the axial direction of the tract organ model on at least a part of the outer periphery or the outer surface of the movable region of the tract organ model.
The detection means acquires an image of the inside of the organ accommodating portion captured by a camera, and detects a bent state, a stretched state, a twisted state, or a loop state of the target site based on a marker image included in the image. It is possible,
The medical simulator according to claim 1.
A shading unit that is detachably attached to the organ accommodating portion and shields the internal space of the organ accommodating portion from outside light in the attached state.
With more
The organ accommodating portion includes an abdominal wall cover portion that seals the internal space of the organ accommodating portion from the ventral side while accommodating the luminal organ model.
The abdominal wall cover portion includes a transparent window portion and includes a transparent window portion.
The light-shielding portion is provided between the camera, a light source, and the light source and the window portion, which are installed at a position and orientation in which the tract organ model can be imaged through the window portion. Including an indirect lighting unit that indirectly illuminates the internal space of the organ accommodating portion with light from the organ.
The medical simulator according to claim 1 or 2.
Of the inner wall surface of the organ accommodating portion, at least the region around the target portion of the luminal organ model to be detected by the detection means includes a member or material that suppresses surface reflection.
The medical simulator according to claim 3.
The tract organ model is a large intestine model that imitates the shape of the large intestine.
The organ accommodating portion is switched between an anal holding portion holding the anal side end region of the large intestine model and a sliding state slidable with respect to the organ accommodating portion and a fixed state fixed with respect to the organ accommodating portion. Including the organ holding part provided as possible,
The local fixation region of the large intestine model includes the anal side end region held by the anal holding portion and the region held by the organ holding portion.
The region held by the organ holding portion of the large intestine model is a region corresponding to a part of the range from the descending colon to the sigmoid colon.
The slide of the organ holding portion changes the degree of flexion between the anal side end region and the region held by the organ holding portion in the large intestine model.
The medical simulator according to any one of claims 1 to 4.
In the slide range of the organ holding portion, the length from the anal side end region to the region held by the organ holding portion in the large intestine model is twice the distance from the anal holding portion to the organ holding portion. Including the position
The medical simulator according to claim 5.
The tract organ model is a large intestine model that imitates the shape of the large intestine.
The local fixation region of the luminal organ model includes the anal side end region of the large intestine model.
The movable region of the luminal organ model includes a transverse colon region corresponding to the transverse colon in the large intestine model and a rectal region corresponding to the rectum in the large intestine model.
The organ accommodating portion is located below the accommodating position of the transverse colon region of the large intestine model and above the accommodating position of the anal holding portion holding the anal side end region and the rectal region of the large intestine model. Including auxiliary walls with downward walls,
The medical simulator according to any one of claims 1 to 6.
The tract organ model is a large intestine model that imitates the shape of the large intestine.
The large intestine model includes a transverse colon region corresponding to the transverse colon, a splenic curve region corresponding to splenic curvature, and a hepatic curvature region corresponding to hepatic curvature.
The organ accommodating portion is erected with a downward wall surface above the internal space, and is provided so as to be switchable between a sliding state that can slide downward and a fixed state that is fixed to the organ accommodating portion. Including the sliding wall
At least the splenic curve region and the liver curve region of the large intestine model are displaced downward as the slide wall portion slides downward.
The medical simulator according to any one of claims 1 to 7.
The large intestine model includes a splenic curve region corresponding to a splenic curve and a liver curve region corresponding to a liver curve.
The spleen-curved region and the hepatic-curved region of the large intestine model are color tone-changing regions that cause a color change in the spleen-curved region and the hepatic-curved region in an endoscopic image taken in the lumen of the large intestine model. Including,
The medical simulator according to claim 8.
With the motor
A motor accommodating portion accommodating the motor and
An output shaft driven by the rotational power of the motor and
A base for holding the motor housing and
With more
The organ accommodating portion further includes an upper end wall portion that seals the upper part of the internal space and fixes one end of the output shaft, and when the output shaft is driven by the rotational power of the motor, the base. Alternatively, it swings together with the output shaft while being supported by the ventral support surface of the base via a tire portion rotatably provided in the organ accommodating portion.
The medical simulator according to any one of claims 1 to 9.
The tract organ model is a large intestine model that imitates the shape of the large intestine.
The organ containment includes an anal retainer that holds the anal side end region of the large intestine model.
The local fixation region of the large intestine model includes the anal lateral end region held by the anal holding.
The anal holding portion includes a through hole through which the anal side end region of the large intestine model is inserted, and a tapered wall surface portion in which the cross-sectional area of the through hole gradually expands upward.
The tapered wall surface portion includes a first wall surface portion having a steep slope from the lower end to the upper end of the tapered wall surface portion and a second wall surface portion having a gentler slope than the first wall surface portion.
The first wall surface portion and the second wall surface portion are present at least at positions facing each other in the axial direction of the through hole.
The medical simulator according to any one of claims 1 to 10.
The luminal organ model has a plurality of microgrooves on the inner wall surface that defines the lumen, which can retain the lubricating fluid injected into the lumen.
The medical simulator according to any one of claims 1 to 11.
A determination means for determining that the site of the target device has passed a plurality of checkpoints provided at positions different from each other in the longitudinal direction in the tract of the tract organ model.
A time acquisition means for acquiring the staying time of the part between two checkpoints, and
An evaluation means for evaluating the procedure of the trainee using at least the acquired staying time, and
The medical simulator according to any one of claims 1 to 12, further comprising.
The time acquisition means includes the first stay time from passing the first checkpoint to passing the second checkpoint, and the first checkpoint after passing the second checkpoint. Get a second stay time and each until you pass
The evaluation means evaluates the first staying time and the second staying time by separate evaluation methods.
The medical simulator according to claim 13.
A load acquisition means for acquiring load information applied to a predetermined site of the tract organ model,
With more
When the acquired load information indicates a load exceeding the threshold value, the evaluation means deducts points corresponding to the load information from the evaluation points scored using the acquired stay time. Calculate the evaluation points of the trainee's procedure,
The medical simulator according to claim 13 or 14.
The utterance acquisition means for acquiring the utterance information of the trainee, and
An utterance specifying means capable of identifying one or more predetermined utterances uttered by the trainee among a plurality of predetermined utterances based on the acquired utterance information.
With more
The evaluation means calculates the evaluation points by adding or deducting points based on the combination of one or more specified predetermined utterances.
The medical simulator according to claim 15.
A measuring means for measuring the air pressure in the lumen of the luminal organ model,
With more
The evaluation means evaluates the procedure of the trainee by further using the comparison result between the atmospheric pressure and the atmospheric pressure threshold value measured while the part of the target device is staying between the two checkpoints.
The medical simulator according to any one of claims 13 to 16.
When the detecting means can detect the bent state, the stretched state, the twisted state, or the loop state of the target portion, the evaluation means detects the bent state, the stretched state, the twisted state, or the loop state. To evaluate the procedure of the trainee, using
The medical simulator according to any one of claims 13 to 17.
The detection means detects that at least a part of the movable region of the luminal organ model exceeds the evaluation position in the anteroposterior direction or the evaluation position in the vertical direction in the internal space of the organ accommodating portion at least during training. ,
The evaluation means further uses the detection result of the detection means exceeding the evaluation position to evaluate the procedure of the trainee.
The medical simulator according to any one of claims 13 to 18.
A luminal organ model that is flexible and has a shape that imitates at least one luminal organ, an organ accommodating portion that accommodates the luminal organ model in an internal space, and a longitudinal direction in the lumen of the luminal organ model. It is a procedure evaluation method using a medical simulator executed by a control unit that controls a medical simulator equipped with at least a plurality of sensors provided at different positions.
Based on the detection signals from the plurality of sensors, it is determined that the site of the target device has passed through a plurality of checkpoints provided at different positions in the longitudinal direction in the tract of the tract organ model.
Get the time spent at the site between the two checkpoints
The trainee's procedure is evaluated using at least the acquired dwell time.
A procedure evaluation method using a medical simulator including that.