Simulation model for laparoscopic foregut surgery
A surgeon training apparatus includes a cassette, which includes biological tissue re-purposed into a form consistent with the anatomical configuration of a foregut, affixed into an anatomically correct framework which replicates the abdominal anatomy. The framework positions the cassette in an anatomically correct position within the abdominal cavity, enabling surgeons to train using a properly positioned representation of the target anatomy, thus requiring the surgeon to properly use surgical tools to simulate surgical operations performed on a foregut. The cassette is formed by applying biologic tissue to a specially designed “plate,” which affixes the tissue block into the anatomic framework. The cassette can be positioned inside a mannequin, and can be used to train surgeons to perform surgeries using multiple techniques, including robot assisted and laparoscopic methods.
1. A cassette comprising:
a) biological tissue mimicking a foregut, and
b) a plate to which the tissue is adhered, wherein:
i) the plate is adapted to be connected to a mannequin, and to affix the tissue into a simulated anatomic framework that mirrors a human abdomen and/or foregut,
ii) the biological tissue comprises porcine tissue blocks that include two or more of the lungs, heart, aorta, esophagus, diaphragm, stomach, duodenum, liver, and spleen.
2. The cassette of claim 1 , wherein the biological tissue is adapted to be able to perfuse real or artificial blood.
3. The cassette of claim 1 , wherein the tissue blocks comprise a means for simulating a pulse.
4. The cassette of claim 1 , further comprising an esophageal conduit comprising a porcine esophagus, wherein the porcine esophagus is linked to the mannequin, and the esophageal conduit is adapted to allow for gastric intubation via nasogastric tube insertion and/or passage of esophageal dilators.
5. The cassette of claim 4 , wherein the porcine esophagus is intubated with tubing, wherein the esophagus and tubing are physically secured and/or or chemically adhered together.
6. The cassette of claim 1 , wherein the porcine tissue blocks comprise a diaphragm, and wherein the cassette further comprises a collapsible hoop to suspend the diaphragm,
wherein the diaphragm is suspended anteriorly by physically attaching, or chemically adhering, the diaphragm to the collapsible hoop, and
wherein the collapsible hoop is adapted to be secured to the plate or to a mannequin.
7. The cassette of claim 6 , wherein the tissue blocks comprise a means for simulating a pulse.
8. The cassette of claim 6 , wherein the biological tissue comprises lungs, and wherein the cassette further comprises a means for simulating respiration.
9. The cassette of claim 8 , wherein the means for simulating respiration comprises pneumatic balloon insufflation.
10. A surgeon training apparatus comprising:
a) a mannequin, and
b) the cassette of claim 1 .
11. The cassette of claim 1 , wherein the biological tissue further comprises a length of porcine small intestine with intact mesentery, measuring between approximately 6 and approximately 8 feet in length.
12. The cassette of claim 1 , wherein the biological tissue further comprises a segment of a small bowel, and wherein the segment of the small bowel is fixed to the plate.
13. The cassette of claim 12 , wherein the small bowel is adhered to the plate by drilling two or more holes in the plate, and suturing the small bowel to the plate and/or adhering the small bowel to the plate.
14. The cassette of claim 12 , wherein the model re-creates the ligament of Treitz, thus allowing a user to measure and choose the appropriate site for division of the small bowel and creation of the gastric limb and entero-enterostomy.
15. A surgeon training apparatus comprising:
a) a mannequin, and
b) the cassette of claim 12 .
16. The surgeon training apparatus of claim 15 , further comprising one or more of a) a disposable plastic bag placed beneath the tissue block and plate prior to placement in the mannequin, b) a silicone drape placed inside the mannequin to simulate the retroperitoneal background, c) a porcine ureter and/or one or more blood vessels selected from the group consisting of the abdominal aorta, the main celiac trunk or its major branches, gastroepiploic vessels and mesenteric vessels, d) a means for pulsatile perfusion of real and/or fake blood through the one or more blood vessels or porcine ureter, e) a silicone drape placed inside the mannequin to simulate the retroperitoneal background and improve fidelity during use of the model, f) a native porcine aorta, and g) a length of en bloc porcine esophagus comprising one or more vagus nerve segments.
17. The cassette of claim 16 , wherein the surgeon training apparatus comprises one or more vagus nerve segments, and the one or more vagus nerve segments allow for simulations that include the performance of anastomosis of the distal esophagus to the stomach or small bowel.