RU2801337C1 - Simulator for practicing basic surgical skills - Google Patents

Abstract

FIELD: teaching aids in medicine.

SUBSTANCE: simulator for mastering basic surgical skills includes a platform with suction cups, tools for mastering knitting surgical knots and tools for mastering the formation of surgical knots placed on the platform. Tools for mastering knitting surgical knots include tools for mastering knitting surgical knots on the plane and tools for mastering the imposition of surgical knots in the depth of the operating wound, tools for mastering knitting surgical knots on the plane include three metal hooks arranged in the form of an isosceles triangle, and a rubber tube with hardness of 45 Shore A passed through the holes made in the platform. Means for mastering the imposition of surgical knots in the depth of the surgical wound include a plastic tube fixed to the platform and a rubber tube. Means for mastering the formation of surgical sutures include two replaceable polyurethane rollers installed parallel to each other and perpendicular to the front face of the platform; a tape with plastic hooks, to which foam material is fixed for mastering continuous and nodal seams, and two clipboard clips, fixing rectangular patches of leatherette, foam rubber and polystyrene imitating skin, subcutaneous fat and muscles, respectively.

EFFECT: ensuring the development of basic manual skills in surgery.

1 cl, 9 dwg

Description

The simulator for practicing basic surgical skills refers to the educational process in medicine, namely, it serves to acquire and practice basic manual skills in surgery by students and residents studying at the surgical departments of higher educational institutions of medical education.

A portable simulation simulator for the development of manual skills in laparoscopic surgery is known from the prior art (Patent RU 2768590 C2 published: 03/24/2022 IPC G09B 23/28), which is represented by two working racks for laparoscopic instruments, a tripod for a webcam or a mobile phone, which are fixed using quick-clamp step-by-step F-shaped fixators, the first platform with tasks for the development of basic manual skills in laparoscopic surgery and the second platform for teaching the technique of laparoscopic suture. The prototype is the second platform for teaching the technique of laparoscopic suture of a portable simulation simulator for the development of manual skills in laparoscopic surgery, consisting of a transparent rectangular platform made of polymethyl methacrylate 16 × 16 cm in size and 0.5 cm thick, 4 suction cups are installed at the corners, which allow you to fix the platform to surfaces. The platform has 8 stainless steel metal columns 3 cm high and 0.2 cm in diameter. The columns are arranged symmetrically in two groups of 4 columns. On one of the groups there are 4 transparent silicone tubes and 4 transparent silicone rings. The second means for forming knots consists of three screw-hooks located in the form of vertices of an isosceles triangle, between which a rubber band is stretched. The third means for the formation of longitudinal and transverse seams is installed by 2 sealing lines, consisting of two polyurethane rollers. The fourth tool for practicing the laparoscopic suture skill is represented by a tape with small plastic hooks for fixing the material.

The second platform of the portable simulation simulator described above for developing manual skills in laparoscopic surgery has a number of disadvantages:

1. lack of opportunity to practice the basic skills of open surgery on the second platform due to its parameters and location of training facilities;

2. in the second tool for the formation of laparoscopic nodes, a rubber band is used, which is selected taking into account the situations of the formation of a laparoscopic node, however, when forming a surgical knot with the hands, imitating the suturing of a laparotomic wound, the rubber band does not create resistance comparable with the tissues of the anterior abdominal wall;

3. no possibility of knitting a surgical knot in the depth of the surgical wound;

4. lack of funds for working off the skin suture.

When developing this invention, the goal was to create a simulator for practicing basic surgical skills, which will be easy to manufacture, will allow you to repeatedly practice the skills of applying various types of surgical sutures, knitting surgical knots and have high economic profitability.

The result of the implementation of this goal is a simulator for practicing basic surgical skills, which includes a platform with dimensions of 30 * 40 * 2 cm, with four silicone suction cups with a diameter of 3 cm installed in the corners of the platform at a distance of 1 cm from the edges, on which three means for applying surgical sutures are placed and two tools for knitting surgical knots (Fig. 1).

A tool for practicing knitting a surgical knot on a plane, represented by three metal hooks arranged in the form of an isosceles triangle and a rubber tube with an outer diameter of 5 mm, with a wall thickness of 2 mm, an inner diameter of 3 mm, a hardness of 45 Shore A. Two metal hooks forming the base of an isosceles triangles, fixed on the platform 3 cm from the side face and 2 and 11 cm from the front face of the platform. The metal hook, which is the apex of the triangle, is mounted on the platform 10 cm from the front face and 12 cm from the side face. The rubber tube, mounted on metal hooks, forms an isosceles triangle with a base of 10 cm and a side length of 26 cm. Two zones 2 cm long are applied to the rubber tube, where the student must form a surgical knot. The first zone is marked 3 cm from the top of the formed triangle, the second zone is marked 7 cm from the base (Fig. 2).

The tool for practicing knitting a surgical knot on a plane simulates the matching of the layers of the anterior abdominal wall when suturing a laparotomic wound. The cadet is asked to form a surgical knot in the marked areas until the edges of the rubber tubes are aligned (Fig. 3).

A tool for practicing the application of surgical knots at the depth of the surgical wound, represented by a plastic tube with a diameter of 5 cm, a height of 10 cm, a wall thickness of 2 mm, which is fixed to the platform and a rubber tube with an outer diameter of 5 mm, with a wall thickness of 2 mm, an inner diameter of 3 mm, hardness 45 Shore A, 12 cm long. At a height of 5 cm from the surface of the platform, 2 holes with a diameter of 6 mm were formed through which a rubber tube was passed and fixed in tension on the front side of the plastic pipe using a clamp 5 * 1 * 1 cm (Fig. 4 ).

The cadet is offered to match the edges of the stretched rubber tubes without diastasis by tying a knot at the depth of the simulated wound (Fig. 5).

Means for working out the formation of surgical sutures is represented by two polyurethane seals 8 cm long, consisting of two polyurethane rollers 10 mm wide and 6 mm high, installed along the applied lines perpendicular to the front face. The first seal is installed 2 cm from the side face and 1 cm from the rear face. The second seal is placed 4 cm from the right side face and 2 cm from the rear face, parallel to the first seal. On this case, it is proposed to perform a continuous seam, a Donata seam, a Multanovsky-Reverden seam, a knotted seam along the entire length of the seal (Fig. 6). The quality of polyurethane imitates the physiological turgor of tissues and structures of the body, polyurethane has a moderate density and, with excessive pressure on it, the material is damaged, which helps the student to feel the degree of traumatization of body tissues during manipulations. The platform is fixed relative to the trainee both perpendicularly and horizontally, which allows you to work out the technique of forming longitudinal and transverse seams.

After the wear of the polyurethane seal, it is dismantled from the platform, a new section of the polyurethane seal is installed in this place along the guide line.

The tape and foam material are located on the platform 2 cm from the back edge and 12 cm from the side edge. A tape measuring 8*5 cm with plastic hooks is used to fix the foam material (Fig. 7). The proposed method allows you to fix the foam sponge to the content tape with the abrasive part down, which ensures fixation, without additional fixing elements. The possibility of fixing the foam sponge without additional devices provides convenience when practicing basic surgical skills, for example, to perform marginal continuous or interrupted sutures (Fig. 8).

Means simulating a skin flap with muscles are represented by two clamps for a 10 * 3 cm clipboard, installed 2 cm from the back side of the platform, 2 and 22 cm from the right side side, which fix materials that imitate the structure of the skin, subcutaneous fat and muscles (Fig. 9). To imitate the skin, a rectangular patch of leatherette 15 * 10 cm, 2 mm thick, flesh-colored is used. Subcutaneous fat is represented by yellow foam rubber 15 * 10 cm, 1 cm thick. The muscle imitates a red elastic material made of rectangular polystyrene 15 * 10 cm, 0.5 cm thick.

The cadet is offered to perform layer-by-layer dissection of tissues, layer-by-layer suturing of the wound, to work out options for suturing the skin using a single interrupted surgical suture, Donati suture, Algover suture, Halsted intradermal suture, it is also possible to perform plastic surgery with local tissues.

Using the simulator to practice basic surgical skills has the following advantages:

• allows you to work out a number of manual skills and operational techniques, such as: the skill of knitting a surgical knot while simulating tissue tension and knitting in the depth of the surgical wound; the formation of various types of surgical nodes; the skill of applying various modifications of the surgical suture; work out the stages of suturing the surgical wound; making plastic with local fabrics;

• has a high economic component;

• easy to manufacture.

The simulator for training basic manual skills can be widely used in teaching students and residents basic manual surgical skills, as it meets the basic modern principles of training, and is convenient to use when training students and young professionals.

Brief description of the drawings

Fig. 1 - Simulator for practicing basic surgical skills;

Fig. 2 - Means for practicing knitting a surgical knot on a plane;

Fig. 3 - Means for practicing knitting a surgical knot on a plane with matched tubes;

Fig. 4 - Means for working out the formation of a surgical site in the depth of the surgical wound;

Fig. 5 - Means for practicing the formation of a surgical node at the depth of the surgical wound with matched tubes;

Fig. 6 - Means for working out the formation of the formation of surgical sutures;

Fig. 7 - Tape with fixation of foam material;

Fig. 8 - Tape with superimposed seams on the foam material;

Fig. 9 - Means simulating a skin flap with muscles.

Claims (1)

A simulator for practicing basic surgical skills, including a platform with suction cups, tools for practicing knitting surgical knots and tools for practicing the formation of surgical knots placed on the platform, characterized in that the platform has dimensions of 30 * 40 * 2 cm and contains four silicone suction cups with a diameter of 3 cm, which are installed in the corners of the platform at a distance of 1 cm from the edges; means for practicing knitting of surgical knots include means for practicing knitting of surgical knots on the plane and means for practicing the imposition of surgical knots in the depth of the operating wound; means for practicing knitting of surgical knots on the plane include three metal hooks arranged in the form of an isosceles triangle and a rubber tube outer diameter 5 mm, wall thickness 2 mm, inner diameter 3 mm, hardness 45 Shore A, passed through the holes made in the platform; means for working out the imposition of surgical knots in the depth of the surgical wound include a plastic tube with a diameter of 5 cm, a length of 10 cm, a wall thickness of 2 mm, fixed to the platform, and a rubber tube with an outer diameter of 5 mm, a wall thickness of 2 mm, an inner diameter of 3 mm, a hardness of 45 Shore A, 12 cm long; tools for practicing the formation of surgical sutures include two replaceable polyurethane rollers 10 mm wide each and 6 mm high, installed parallel to each other and perpendicular to the front face of the platform; a tape 8*5 cm in size with plastic hooks, to which the foam rubber material is fixed for practicing the performance of continuous marginal and nodal sutures, and two clips for a clipboard 10*3 cm in size, fixing rectangular patches of leatherette, foam rubber and polystyrene, imitating the skin, respectively, subcutaneously adipose tissue and muscles.