WO2023213361A1

WO2023213361A1 - Surgical training system

Info

Publication number: WO2023213361A1
Application number: PCT/DE2023/100328
Authority: WO
Inventors: Stuart SCHMIDT
Original assignee: TrainOs GmbH
Priority date: 2022-05-06
Filing date: 2023-05-05
Publication date: 2023-11-09
Also published as: DE102022111299A1

Abstract

The present invention relates to a system (1) for surgical training, in particular for spinal surgery, comprising an anatomy model (3), in particular a bone model, composed of at least two components (2), and at least one display device (4), in particular in the form of VR or mixed-reality glasses, which mixes a natural perception by an observer or trainee (5) of the anatomy model (3) with the artificial perception of the anatomy model (3).

Description

Operation training system

The present invention relates to a system for surgical training, in particular for spinal surgery, comprising an anatomy model composed of at least two components, in particular a bone model, and at least one display device, in particular in the form of VR or mixed reality glasses, which enables a natural perception of the anatomy model a viewer or trainee is mixed with an artificial perception of the anatomy model.

The clinical environment is based primarily on anatomical training and teaching models. In spine surgery, there is an increasing prevalence of chronic back pain due to intervertebral disc degeneration, scoliotic deformities or fractures, which require surgical stabilization of the spine through, for example, the placement of pedicle screws. Also indications such as open fractures with soft tissue damage, comminuted fractures, dislocations (elbows, knees), arthrodeses, e.g. B. on the knee joint as a cross-joint external fixator, fractures of the cervical spine (halofixator) or callus distraction, possibly with segment transport. Bone fractures of the skeletal system require stabilization using an external fixator by passing pins through the skin into the bone.

Particularly in current thoracolumbar pedicle screw stabilization, which mainly uses freehand, fluoroscopic guidance and stereotactic navigation, the placement of thoracic pedicle screws is difficult due to the narrowest pedicles in height (T3-T9) and the reduced space between the medial Border of the pedicle and the spinal cord is associated with an extremely high risk for the patient. To make matters worse, the anatomy of the pedicle differs significantly from the normal anatomy for each patient, for example due to scoliosis or asymmetrical compression of the vertebrae can be changed, which presents a major challenge for screw placement. The same applies to anatomical misalignments of the entire skeletal system.

Vertebral fractures are currently stabilized using kyphoplasty as part of a minimally invasive procedure. There are two different procedures in two forms: substance-destroying balloon kyphoplasty (BKP) and substance-preserving radiofrequency kyphoplasty (RFK). In the substance-destroying technique, balloons are inserted into the fractured vertebra via cannulas. The collapsed vertebra is then partially straightened by filling the balloons with a contrast medium. The vertebra is then fixed by injecting bone cement into the resulting cavity, which hardens within a few minutes and thus stabilizes the fractured vertebra. In addition to the bone cement, other implants such as containers, stents, etc. may remain in the vertebra as additional foreign bodies. As a rule, only a monopedicular approach to the fractured vertebral body is necessary for the substance-preserving technique. The vertebral body is then prepared with a flexible (flexible) needle, with individual cement strips being created if necessary. Finally, a highly viscous, almost rubber-like bone cement is mechanically introduced into the vertebral body, which is distributed in a fan shape. The cement is distributed between the healthy, intact cancellous bone, surrounds it and straightens the vertebra like a stamp.

Surgeons have relatively little room for error, as misguided screws or drilling, particularly in the spine area, and straightening of the vertebral bodies using balloons or cement can injure the spinal cord and vessels. Using the standardized anatomical training and teaching models, anatomical misalignments of the skeletal system and in particular the spine cannot be adequately represented, which is why the well-known training and anatomy models are only suitable to a limited extent when preparing for a surgical procedure in which pins or screws are inserted through the skin into the bone or the vertebral bodies have to be straightened as part of the kyphoplasty. In addition, with the known anatomy models, their visualization and navigation during training is problematic, since the visualization is carried out using high-energy radiation and the training can only be followed, for example, on your own monitor, without the intervention or training being accompanied by, for example, computer-aided information is corrected. Alternative radiation-free training platforms lack sufficient haptics. With these, for example, an injection of cement into the vertebral body is merely animated.

Disclosure of the invention

It is therefore the object of the present invention to at least partially improve the known simulation models. In particular, it is the object of the present invention to create a system with which a surgical procedure can be individually planned and practiced by carrying out, for example, screws, cannulas or pins through the skin into the bone, or interventions in the bone substance, whereby in particular deformations of the skeletal system can be taken into account.

The above task is solved by a system for surgical training with the features of claim 1. Further advantages, features and details of the invention emerge from the subclaims, the description and the drawings.

The system according to the invention advantageously comprises a device for simulating, training, teaching and/or evaluating surgical techniques. For such a device, reference is made to the disclosure content of DE 10 2020 121 910.5 and this disclosure content is made the subject of the present description and thus the disclosure content of the present application. The system according to the invention for surgical training, in particular for spinal surgery, comprising an anatomy model composed of at least two components, in particular a bone model, and at least one display device, in particular in the form of VR or mixed reality glasses, which enables a natural perception of the anatomy model by a viewer or Exercisers mixed with an artificial perception of the anatomy model, according to claim 1, advantageously enables a surgeon, for example, to train without radiation exposure under conditions that are approximately identical to the planned operation on a patient. This is achieved on the one hand by the anatomy model composed of at least two components, which is advantageously individually modeled on the anatomy of the patient's skeletal system, and on the other hand, according to the invention, by means of the display device, which reproduces the natural perception of the anatomy model by the surgeon or generally the viewer with an artificial one The surgeon's perception of the anatomy model is mixed.

According to the present invention, in the sense of an “anatomy model” a bone model, for example a spinal model with or without intervertebral discs, is to be understood. The anatomy model is preferably created individually, namely based on imaging examination results on the patient, for example through MRI, CT, X-ray or scintigraphy examinations. Based on these examination results, the individual anatomy model or holographic images thereof can preferably be created, whereby deformations and misalignments of the skeletal system can of course be imaged.

Advantageously, the components of the anatomy model, in particular vertebral bodies, including fixation/holder for subsequent embedding in a matrix, are created as hollow bones or hollow vertebral bodies using the 3D printing process. The fixation or holder can advantageously include predetermined breaking points that are above or below the model and preferably are arranged on each component or each vertebral body. The predetermined breaking points can also be arranged between the facet joints of the vertebral bodies. The fixation also ensures that the individual components or vertebral bodies do not shift or twist during embedding in the matrix. As a result of the hardening of the matrix, the fixation or holder in the area of the predetermined breaking points can be released from the anatomy model. The fixation can advantageously remain completely or partially on the vertebral bodies of the model and protrude from the matrix and can preferably be used for optimal positioning and/or for camera-based tracking.

Preferably, each component or each vertebral body can have at least one hole, for example a drainage hole (above and/or laterally and/or below). On the one hand, the design enables 3D printing as hollow components or vertebral bodies and, on the other hand, the drainage holes can be used as “filling holes” during embedding to fill the hollow component or the hollow vertebral body. The model can be covered with various materials via the drainage holes. After filling the components or vertebral bodies, the drainage holes are either closed and then the model is embedded, or they are left open and are filled by the matrix material. In the open case, the liquid, unhardened matrix displaces the air in the vertebral body and fills it. The air can escape through the drainage hole. A different gel-like filling of the vertebral body is advantageous, for example to simulate a kyphoplasty. In addition, the spine model can be covered with a beneficial tint. Also conceivable is a transparent trabecular-like infill structure in the component or the vertebral body by means of gel infiltration through the drainage hole, which is then closed, with subsequent tinting of the component or the vertebral body with subsequent matrix embedding. The anatomy model can advantageously be created using a 3D printing process based on the image files from the imaging examinations and inserted into a tissue-mimicking matrix. The matrix can have different consistencies and/or material properties and can be created in several layers, so that, for example, an upper skin layer and an underlying tissue layer are imitated by the matrix in order to provide the surgeon or student with the different resistances between these layers when inserting. and the insertion of screws or pins, or the insertion of cannulas in the context of kyophoplasty, in a plastic manner, ie true to the original, namely in accordance with the feel of the patient to be operated on. Particularly advantageous as an anatomy model in the sense of the present invention is a 3D-printed bone model, in particular a spine, which advantageously has predetermined breaking points and particularly preferably hollow predetermined breaking points that lead into the vertebral body. Using these predetermined breaking points, the printed model can be fixed floating in a container. The container can advantageously be filled in a first step with a washing solution, for example isopropanol, or a coloring solution, for example TPM and colorant. These chemicals are used to clean (remove uncured resin) and color 3D prints at the same time. The model hangs so low in the container that the liquids reach up to the predetermined breaking points or the predetermined breaking points are partially covered. In this way, only the outer shell of the hollow model produced using the 3D printing process is colored. This advantageously creates a particularly realistic artificial X-ray image, since coloring the interior wall would result in a double-wall effect that would be visible through the camera. After the cleaning and/or coloring process, the model is fixed in a second step, floating in another container or in a mold. In this second step, the hollow predetermined breaking points are open and accessible at the top, which means that, for example, a transparent gel can be injected into the vertebral bodies. Preferably, the gel injected into the vertebral bodies has sufficient resistance to to hold instruments penetrating the body and is still advantageously flexible enough to allow access for a balloon or the injection of bone cement for training a fractured vertebral body straightening (kyphoplasty). In a third step, a liquefied cold- or hot-curing substance or mixture, which advantageously resembles human tissue, is poured into the mold around the spinal model. After hardening, the entire model, namely the anatomy model embedded in a matrix, can be removed from the mold and the predetermined breaking points can be removed. As already described for the fixation and the holders, the predetermined breaking points, advantageously in the form of rods, can be used as a positioning aid in order to be able to track the model using a camera. The gel injected into the vertebral bodies does not escape from the access hole of the predetermined breaking point when the entire model is turned over. The cavities created by removing the predetermined breaking points are not disturbingly noticeable under lateral fluoroscopy because they are located vertically underneath when viewed from the side. In a transilluminated top view (AP), the predetermined breaking points are also not visible because the anatomy closer to an upper camera is more clearly visible.

Preferably, extended virtual visualization and navigation aids are advantageously displayed to the surgeon, student or generally the trainee via the display device before, after and during the operation training. In the present case, the display device is advantageously understood to be VR or mixed reality glasses, which preferably replace the monitors used in the known systems. According to the invention, the anatomy model embedded in a matrix is combined, for example, with mixed reality glasses in such a way that the model interacts with virtual visualization and navigation aids before, after and during surgical training. These aids include, for example, the holographic overlap of the physical spine model with a virtual, identical anatomy or holographic navigation aids. A calibration unit can advantageously enable real and virtual anatomy to overlap. Furthermore, artificial fluoroscopy and CT images are displayed during training. Here, the artificial X-ray images from the model transillumination light and camera systems are visualized holographically placed anywhere in the room. The bone cement infiltration during kyphoplasty, for example, can be shown in real terms and not just simulated. In addition, the surgeon or trainee can receive automatic acoustic, visual and even realistic haptic feedback. For example, the number of artificial radiation-free X-ray effect images can be recorded during training and a value of the corresponding radiation dose can be output compared to the real scenario. Each user or trainee receives their own individual statistics in order to document their exercise progress and create further training incentives.

Using VR or mixed reality glasses, the trainee can advantageously place holograms of the anatomy model anywhere in the room, enlarge them, or have them displayed from different perspectives, for example by rotating or rotating them. The trainee can also have holographic navigation aids displayed on the glasses. A teaching mode in which the intervention or procedure is shown holographically over the physical model and integrated into the training can be advantageous, so that this can then be carried out, for example, with a real implant screwdriver etc. In research projects in which anatomy was blended with mixed reality, the anatomy was fixed. Although you can calculate a distance by externally tracking the surgical instruments and simulate the position of the pedicle screw, for example in the vertebral body, on the PC, this calculated animation does not correspond to the actual one when infiltrated with liquid substances such as bone cement infiltration (kyphoplasty). position match. These disadvantages can be overcome by the system according to the invention, since in this system the artificial perception of the anatomy model is advantageously independent of the position of the anatomy model in space. If the model has a fixed position on the training platform, then this takes place the tracking of the training platform through identifying features such as markers or markerless. Alternatively, the model itself can be tracked using identifying features. Surgical instruments can also be tracked using identifying features such as markers or without markers. If the lateral and AP X-ray views are to be displayed holographically, this is independent of the position of the anatomy model and no tracking is necessary. In the case of a computer-animated calculated axial view, the position of the anatomy model and the surgical instruments is required. The artificial lateral or anterior-posterior (Ap) X-ray effect is independent of the tracking. In addition to the application examples described, the device according to the invention can also be used, for example, for training in the context of vertebroplasty or facet joint infiltration.

In a particularly preferred manner, the viewer, i.e. the trainee, can be shown information on the display device in addition to the artificial representation of the anatomy model, which provides information about the surgical training and the training progress. For example, the information may come from a database in which previous training sessions have been stored. Information about standardized successful techniques may also be stored in the database, which is compared with current training. The database and the information can be stored independently of the training location and can be accessed, for example, via a data line or via the Internet.

In order to be able to display the guidance of the screws or pins or a cannula as part of the kyphoplasty training and the movement of the anatomy model during the trained procedure on a display device, identifying features such as markers are advantageously arranged on the components. In the case of a spinal anatomy model, there are identifying features such as markers on each individual bony component or on the entire bone model. These can be done with the anatomy model be embedded or partially protrude from the matrix. Alternatively, identification features can be located on the training platform if the position of the spine model together with the matrix is fixed relative to the training platform. The markers or other identification features are preferably detected by at least one optical detection system, so that a movement of the components, in particular in the event of a manual intervention in the anatomy model, is tracked via the detection system on the basis of the identification features such as the markers and on at least one display device, such as one VR or mixed reality glasses, a monitor or a display of a mobile device can be visualized. A depth camera system that can be used to track the movement of individual surgical instruments is advantageous. However, several depth cameras can also record images from different positions relative to the anatomy model and, in the sense of the present case, can be referred to as an optical detection system comprising at least two cameras or camera systems. The data obtained can be processed and visualized on the mobile device itself, advantageously on the VR or mixed reality glasses and/or a computer or via the Internet. The processed data can also be mirrored on an external monitor via cable, Wi-Fi or other data transmission methods. The computer can also advantageously be located in the training platform, which is part of the system according to the invention. It is also conceivable to use an external camera or depth camera system that is connected to a computer and is displayed on the computer's monitor or on a monitor of a computer connected to the computer via a network, which advantageously enables training or simulation can also be tracked via an external workstation on the device according to the invention. The device according to the invention can also be used without a marker to generate a three-dimensional physical x-ray image by fluoroscopy of the transparent spine in the transparent matrix. The X-ray effect can be further enhanced using software image post-processing or coloring or tinting of the matrix or spine model. If the matrix with the anatomy model is given a fixed position on the training platform, the entire training platform can advantageously be ticked and the position of the anatomy model relative to the stretched training platform can thereby be calculated.

Preferably, the anatomy model is also designed to be transparent, at least in sections, in order to be able to x-ray it, for example. The anatomy model is advantageously made of a transparent material or a combination of at least two materials, with at least one material being transparent. The materials that are particularly suitable for the anatomy model are materials for 3D printing such as ABS, FDM, polylactic acid or PLA, which, in contrast to ABS, is biodegradable because it is made from renewable raw materials (corn starch), PET, PETG, Polycarbonate (PC), nylon, hybrid materials, alumides, flexible materials or a combination of the materials not exhaustively listed here, i.e. all materials or combinations of materials that are suitable for 3D printing. However, for a marker or even a marker-free application in a colored or colorless matrix, it does not matter whether the swirl material is transparent, milky or colored, as every view can be reproduced virtually. UV-curing liquid plastics (=photopolymers) can also be used particularly advantageously to produce the anatomy model using the 3D printing process, since the models made with this material have significantly better transparency than the models made with the materials mentioned above. Of course, for standardized or individualized anatomy models using imaging for use in the device according to the invention, it is also conceivable that the models are produced using a mold casting process or, for example, in a milling process. In special cases, the anatomy model can be completely non-transparent, whereby the position of the vertebral bodies, instruments and implants can then be visualized on the VR or mixed reality glasses or on a screen using the marker or markerless tracking. In In such a special case, the matrix may not be transparent and fluoroscopy is not necessary. Depending on the application and design of the system according to the invention, additional cameras or camera systems can be used, which allow tracking of the instruments in all views of the anatomy model. For example, a camera can be arranged above the anatomy model, which tracks the movement of the surgical instruments and the model from above. The camera or camera system of the VR glasses or mixed reality glasses can be used for the same application, namely tracking the surgical instruments and the model. In a particularly preferred manner, the camera above the anatomy model and the camera or the camera system of the VR glasses or the mixed reality glasses can be used in combination to dry the surgical instruments and the model.

In the sense of the present invention, “tracking” should include both the drying of the anatomy model and the surgical instruments using a camera or camera system based on identification features such as markers or the markerless tracking of the anatomy model and the surgical instruments through machine learning or in general the use of artificial intelligence can be understood.

For the purposes of the present invention, the term “transparency” should preferably be understood physically in relation to the formation of the matrix and the anatomy model, with the permeability being understood in relation to electromagnetic waves, in particular light. In addition, the term “transparency” in the sense of the present invention should also be understood as translucent elements of an image file in a computer graphic. If, instead of or in addition to the optical detection system, an acoustic detection system is also used in the device according to the invention, which, for example, acoustically supports the setting of the screws or pins, in the sense of the present Invention, the feature “transparency” means the ability to distinguish between successive tones.

Advantageously, the device according to the invention comprises at least one light source, preferably an RGB LED light source, with which at least the transparent sections of the matrix or the transparent sections of the anatomy model can be illuminated. Due to the different refractive indices of the transparent sections of the anatomy model, the transparent sections of the matrix and due to the opacity of the implants and instruments used, a three-dimensional X-ray image of the anatomy model can advantageously be visualized without actually using X-rays. This enables a surgeon who is used to adding screws, cannulas or pins based on X-ray images to remain in his usual mode, or to prepare him for an operation using the device according to the invention, for example under a C-arm in the form of an X-ray C-arm usual operating environment using the device according to the invention, which enables an optical X-ray illusion of a tangible plastic 3D anatomy model, or to train the operation using the device. In addition to the RGB LED light source mentioned, other types of light sources, such as halogen lamps, neon tubes or other lighting devices that can have the entire color spectrum, i.e. white or colored light sources of any kind, can also be used to illuminate the anatomy model and the matrix.

In order to uniformly scatter the light rays introduced by the light source into the matrix and the anatomy model, at least one diffuser is advantageously arranged between the anatomy model embedded in the matrix and the light source. Using the diffuser, the light rays introduced can be evenly scattered and the model can therefore be optimally illuminated. A diffuser that has a large number is ideal as a diffuser has smaller scattering centers. If parallel light rays hit different parts of a diffuser, they are distributed in different directions and thus create diffuse light.

To enhance the optical X-ray effect, the visualization on the display device, namely the VR or mixed reality glasses, a monitor or display, can advantageously be further enhanced after previous image post-processing using a software solution. If an enhanced optical X-ray effect is to be visible in the anatomy model when it is fluoroscopy, the matrix is advantageously colored or tinted using colorants. In order to be able to faithfully imitate the known X-ray images, the matrix is particularly preferably blackened using a black colorant or colored using a blue colorant. Basically, all high-contrast, strong colors can be used to further enhance the X-ray effect. Particularly due to the software post-processing, any coloring or tinting of the matrix is conceivable, as the color can be recognized using the software and can easily be exchanged virtually. Colored areas of the matrix can also be hidden using the software and replaced with other image components or backgrounds.

A further inventive aspect of the present invention is a method for simulating, training, teaching and/or evaluating surgical techniques using the system according to the invention.

In order to avoid repetition here regarding the advantages of the method according to the invention, reference is made to the description of the advantageous embodiments of the system according to the invention and the disclosure through this description is used in full and vice versa. Preferred embodiments:

Further measures improving the invention are presented in more detail below with the description of preferred exemplary embodiments of the invention with reference to the figures. The features mentioned in the claims and in the description can be essential to the invention individually or in any combination. It should be noted that the exemplary embodiments shown in the figures are only descriptive and are not intended to limit the invention in any way.

Show it:

1 shows a schematic view of the use of the system according to the invention for kyphoplasty surgery training on a spinal anatomy model,

2 shows a schematic view of the use of the system according to the invention for placing pedicle screws in the vertebral body of a spinal anatomy model and

Fig. 3 shows a schematic view of the use of the system according to the invention for the holographic representation of a spinal anatomy model.

In the different figures, the same parts are always provided with the same reference numbers, which is why they are usually only described once. Fig. 1 shows a schematic view of the use of the system 1 according to the invention, a kyphoplasty operation training on a spinal anatomy model 3 in the form of a surgical training simulator 30. For the basic structure of the training simulator 30, reference is made to the device disclosed in DE 10 2020 121 910.5. In the embodiment shown, the system 1 in the form of a real training platform 100 includes the components as follows:

• a transparent/translucent anatomy model 3 in the form of a spine model, which is embedded in a tissue-like matrix 7,

• a double-sided lighting and camera system 70 (lateral view)

• a camera system 70.1 above the matrix (AP view)

• lighting below the Matrix 70.2 (AP view)

• Model housing and optional operating instruments 80 for kyphoplasty.

The trainee 5 shown in the figure can be, for example, a medical student, a prospective surgeon, a specialist or, for example, an experienced surgeon. According to the invention, the trainee 5 wears a display device 4 in the form of mixed reality glasses 40, which virtually images holograms 6, 60 and navigation aids and which mixes the natural perception of the anatomy model 3 by the trainee 5 with an artificial perception of the anatomy model 3. Based on this system 1, the trainee 5 can imagine a holographic, artificial X-ray effect with real-time output of the kyphoplasty, in the present case for the lateral and anterior-posterior view, in virtually generated views 6,60 via the VR glasses or the mixed reality glasses 40 (in the figure the far left and the middle display in the top row). In addition, the trainee can have an animated axial view of the vertebral bodies displayed in virtual views 6.60 via the VR glasses or the mixed reality glasses 40 (in the Figure the far right display in the top row). In the animated views 6.60 in the bottom row displayed via the VR glasses or the mixed reality glasses 40, the trainee is provided with 5 holographic, pre-generated CT and X-ray images with kyphoplasty animation for the axial, sagittal and anterior-posterior views ( holographically scrollable). In addition, the trainee 5 can have an animated spine model 30 displayed in the form of a hologram 6.60 in a view via the VR glasses or the mixed reality glasses 40. The hologram 6.60 of the spine 30 can be moved anywhere in space. A blending of the real spinal anatomy model 3 and the holographic spine 6,60,30 is also possible, whereby additional navigation aids when placing the surgical instruments 80 are displayed. One or more cameras 70, 70.1 additionally track the surgical instruments 80. This means that the procedure can also be depicted holographically in 3-dimensionally offset outside the spinal anatomy model 3. If necessary, another camera or the camera system of the VR bri Ile or the mixed reality glasses 40 can be used to track the surgical instruments 80 (surgical instruments), the matrix, the spine model or the training platform 100 (not shown here).

2 shows the system 1 shown in FIG. Based on this system 1, the trainee 5 can experience a holographic, artificial X-ray effect with real-time output of the pedicle screw procedure, in this case for the lateral and anterior-posterior view, in virtually generated views 6.60 via the VR bri Ile or the mixed reality glasses 40 (in the figure the far left and the middle display in the top row). In addition, the trainee 5 can have an animated axial view of the vertebral bodies displayed in virtual views 6.60 via the VR glasses or the mixed reality glasses 40 (in the figure, the far right display in the top row). In the about the VR glasses or the mixed reality glasses 40 animated views 6.60 in the bottom row show the trainee 5 holographic, pre-generated CT and X-ray images with pedicle screw animation for the axial, sagittal and anterior-posterior view (holographically scrollable). In addition, the trainee 5 can have an animated spinal model 30 displayed in the form of a hologram in a view 6.60 via the VR glasses or the mixed reality glasses 40. The spinal hologram 30 can be moved anywhere in space. It is also possible to blend the real spinal anatomy model 3 and the holographic spine 30, whereby additional navigation aids are displayed when placing the surgical instruments 80.

Finally, Figure 3 shows a schematic view of the view 6,60 of a spinal hologram 30, which is presented to the trainee 5 via the VR glasses or the mixed reality glasses 40. The image 6.60 of the spinal hologram 30 using the VR or mixed reality glasses 40 is advantageous for understanding anatomy, planning the operation or, for example, for patient education. The depicted spinal hologram 30 can advantageously be moved anywhere in space, which is relevant for understanding anatomy, surgical planning or, for example, patient education.

Claims

Patent claims

1 . System (1) for surgical training, in particular for spinal surgery, comprising an anatomy model (3), in particular a bone model, composed of at least two components (2), and at least one display device (4), in particular VR or mixed reality glasses, which a natural perception of the anatomy model (3) by a viewer or trainee (5) is mixed with an artificial perception of the anatomy model (3).

2. System (1) according to claim 1, characterized in that the display device (4) displays extended virtual visualization aids (6) and navigation aids before, after and during the operation training.

3. System (1) according to claim 1 or 2, characterized in that the artificial perception of the anatomy model (3) and the extended virtual visualization aids (6) are independent of the position of the anatomy model (4) in space.

4. System (1) according to one of the preceding claims, characterized in that the anatomy model (3) is embedded in a matrix (7) imitating human or animal tissue.

5. System (1) according to one of the preceding claims, characterized in that markers are arranged on the components (2) or the components (2) have identification features, on the display device (4) based on the stretched by a camera or a camera system Recognition features or markers track the movement of the components (2) or of surgical instruments (80) and/or the position of the optical detection or at least a different position can be visualized on the display device (4) as at least one image (60). DWSSP 002

6. System (1) according to one of the preceding claims, characterized in that the components (2) of the anatomy model (3) comprise holders with predetermined breaking points, which after embedding the anatomy model (3) in the matrix (7) from the components ( 2) can be solved or the predetermined breaking points remain on the components (2) of the anatomy model (3) and are used for tracking through detection or fixation on a training platform.

7. System (1) according to one of the preceding claims, characterized by at least one light source (70), which illuminates at least transparent sections of the matrix (7) or transparent sections of the anatomy model (3) in such a way that due to the different refractive indices of the transparent sections of the Anatomy model (3), the transparent sections of the matrix (7) and / or the opacity of implants and instruments (80) for the viewer or trainee (5) in the natural perception of the anatomy model (3) and for the viewer or trainee (5) a three-dimensional x-ray image of the anatomy model (3) is visualized by means of the display device in the artificial perception of the anatomy model (3).

8. System (1) according to claim 7, characterized in that a diffuser is arranged between the light source (70) and the anatomy model (3) embedded in the matrix (7), which evenly scatters the light rays introduced by the light source (70). .

9. System (1) according to one of the preceding claims, characterized in that the components (2) of the anatomy model (3) each have at least one material-permeable recess, in particular a hole, through which the component can be filled. DWSSP 002

10. System (1) according to one of the preceding claims, characterized in that the display device (4), in addition to the artificially visualized image of the anatomy model (3), displays information to the viewer or the trainee (5), information about the operation training and the training progress give.