Surgical training model for laparoscopic procedures

A surgical training device includes a model comprising a simulated tissue portion mounted in selectable tension onto a plurality of posts connected to a base. Each post includes at least one notch configured for retaining the simulated tissue portion. Mounting the simulated tissue portion that is in the form of a sheet in notches of different heights creates an angled installation of simulated tissue upon which surgical techniques such as cutting and suturing can be practiced in a simulated laparoscopic environment. More than one sheet can be mounted and each sheet can be mounted with selectable tension by pulling the sheet more or less as desired onto the posts. One variation includes a simulated tumor disposed between sheets, angled or wobbly posts and textured and imprinted simulated tissue surfaces to provide various levels of dynamism and difficulty for surgical skills training in a laparoscopic environment.

FIELD OF THE INVENTION

This application is generally related to surgical training tools, and in particular, to simulated tissue structures and models for teaching and practicing various surgical techniques and procedures related but not limited to laparoscopic, endoscopic and minimally invasive surgery.

BACKGROUND OF THE INVENTION

Medical students as well as experienced doctors learning new surgical techniques must undergo extensive training before they are qualified to perform surgery on human patients. The training must teach proper techniques employing various medical devices for cutting, penetrating, clamping, grasping, stapling, cauterizing and suturing a variety of tissue types. The range of possibilities that a trainee may encounter is great. For example, different organs and patient anatomies and diseases are presented. The thickness and consistency of the various tissue layers will also vary from one part of the body to the next and from one patient to another. Different procedures demand different skills. Furthermore, the trainee must practice techniques in various anatomical environs that are influenced by factors such as the size and condition of the patient, the adjacent anatomical landscape and the types of targeted tissues and whether they are readily accessible or relatively inaccessible.

Numerous teaching aids, trainers, simulators and model organs are available for one or more aspects of surgical training. However, there is a need for model organs or simulated tissue elements that are likely to be encountered and that can be used in practicing endoscopic and laparoscopic, minimally invasive surgical procedures. In laparoscopic or minimally invasive surgery, a small incision, as small as 5-10 mm is made through which a trocar or cannula is inserted to access a body cavity and to create a channel for the insertion of a camera, such as a laparoscope. The camera provides a live video feed capturing images that are then displayed to the surgeon on one or more monitors. At least one additional small incision is made through which another trocar/cannula is inserted to create a pathway through which surgical instruments can be passed for performing procedures observed on the monitor. The targeted tissue location such as the abdomen is typically enlarged by delivering carbon dioxide gas to insufflate the body cavity and create a working space large enough to safely accommodate the scope and instruments used by the surgeon. The insufflation pressure in the tissue cavity is maintained by using specialized trocars. Laparoscopic surgery offers a number of advantages when compared with an open procedure. These advantages include reduced pain, reduced blood and shorter recovery times due to smaller incisions.

Laparoscopic or endoscopic minimally invasive surgery requires an increased level of skill compared to open surgery because the target tissue is not directly observed by the clinician. The target tissue is observed on monitors displaying a portion of the surgical site that is accessed through a small opening. Therefore, clinicians need to practice visually determining tissue planes, three-dimensional depth perception on a two-dimensional viewing screen, hand-to-hand transfer of instruments, suturing, precision cutting and tissue and instrument manipulation. Typically, models simulating a particular anatomy or procedure are placed in a simulated pelvic trainer where the anatomical model is obscured from direct visualization by the practitioner. Simulated pelvic trainers provide a functional, inexpensive and practical means to train surgeons and residents the basic skills and typical techniques used in laparoscopic surgery such as grasping, manipulating, cutting, knot tying, suturing, stapling, cauterizing as well as how to perform specific surgical procedures that utilize these basic skills. Simulated pelvic trainers are also effective sales tools for demonstrating medical devices required to perform these laparoscopic procedures.

One of the techniques mentioned above that requires practice in laparoscopic or minimally invasive surgery is cutting and suturing. Therefore, it is desirable to present a model for practicing cutting and suturing. It is also desirable to have a model that not only simulates the particular anatomy but also presents the anatomy at a particular step or stage of the procedure or isolates a particular step of a procedure for the trainee to practice in a simulated laparoscopic environment. The model is then disposed inside a simulated laparoscopic environment such as a laparoscopic trainer in which it is at least partially obscured from direct visualization. A camera and monitor provide visualization to the practitioner as in real surgery. After a technique is practiced, it is furthermore desirable that such a model permits repeatable practice with ease, speed and cost savings. In view of the above, it is an object of this invention to provide a surgical training device that realistically simulates an anatomy, isolates such anatomy and presents such an anatomy at a particular stage or step of a procedure that also enables repeatable practice. It has been demonstrated that the use of simulation trainers greatly enhances the skill levels of new laparoscopists and are a great tool to train future surgeons in a non-surgical setting. There is a need for such improved, realistic and effective surgical training models.

SUMMARY OF THE INVENTION

According to one aspect of the invention, a surgical training device is provided. The device includes a top cover connected to and spaced apart from a base to define an internal cavity between the top cover and the base. At least one aperture or a penetrable region for accessing the internal cavity is provided. A laparoscopic camera extends into the internal cavity and a video display is connected to the laparoscopic camera and configured to display to a user images captured by the laparoscopic camera. A removable model is disposed inside the internal cavity. The model includes at least one simulated tissue portion connected to a plurality of mounting posts that are connected in spaced apart fashion to a base. Each mounting post includes at least one notch formed in its outer surface and along the longitudinal axis and configured to hold the simulated tissue portion in the location of the at least one notch such that the simulated tissue portion is suspended by a distance from the base.

According to another aspect of the invention, a surgical training device is provided. The device includes a base having an upper surface and a plurality of mounting posts connected to the base and extending upwardly from the upper surface of the base. Each mounting post has a proximal end connected to the base and a tapered distal end. At least one substantially planar simulated tissue portion having an upper surface and a lower surface is provided. Apertures in the simulated tissue portion are connected to the mounting posts such that the simulated tissue portion is suspended by the posts extending through the apertures. The simulated tissue portion is made of flexible and stretchable material such that it is mounted in tension between the plurality of mounting posts. The simulated tissue portion is penetrable with surgical instruments including a suture needle and scalpel. Also, the material is configured to hold sutures without propagating the point of penetration while the simulated tissue portion is held in tension on the posts. Each mounting post includes at least one notch equally spaced from one end of the post such that all the mounting posts have notches at the same height.

According to another aspect of the invention, a method for surgical training is provided. The method includes the step of providing a surgical training model comprising a base having an upper surface. The model includes a plurality of mounting posts connected to the base and extending upwardly from the upper surface of the base. Each mounting post has a proximal end connected to the base and a tapered distal end with the proximal end connected to the base. The method further includes the step of providing at least one substantially planar simulated tissue structure having an upper surface and a lower surface. The simulated tissue structure is flexible and stretchable. The method includes the step of mounting the at least one simulated tissue structure onto the mounting posts. The method includes the step of piercing the simulated tissue structure with the tapered distal ends of the mounting posts to connect the simulated tissue structure to the mounting posts with selectable tension such that the simulated tissue portion is suspended by the posts extending through apertures. The method includes stretching the simulated tissue between mounting posts. The method includes the step of providing apertures in the simulated tissue structure. The method includes the step of providing apertures in the simulated tissue structure prior to mounting the simulated tissue portion to the mounting posts. The method includes the step of providing apertures in the simulated tissue portion wherein the apertures are formed by piercing the simulated tissue structure with the mounting posts in selected locations along the simulated tissue structure. The method includes mounting the at least one planar simulated tissue portion at an angle with respect to the base. The method includes providing a plurality of notches in the mounting posts and locating the simulated tissue structure such that the simulated tissue structure is retained within the notches. The method further includes providing a second planar simulated tissue structure. The method further includes the step of mounting the second simulated tissue structure on the mounting posts. Wherein the step of mounting the at least one simulated tissue structure includes the step of selectively piercing the at least one simulated tissue structure with the distal ends of the mounting posts. Wherein the step of mounting the second simulated tissue structure and the at least one other simulated tissue structure, further includes the step of selectively piercing the at least one simulated tissue structure with the distal ends of the mounting posts. The method includes the step of mounting the second simulated tissue structure above the first simulated tissue structure. The method further includes the step of providing a laparoscopic trainer. The laparoscopic trainer includes a trainer base and a trainer top cover connected to and spaced apart from the base to define an internal trainer cavity between the top cover and the base. The laparoscopic trainer includes at least one aperture or a penetrable region for accessing the internal trainer cavity and a laparoscopic camera extending into and for viewing the internal trainer cavity. A video display connected to the laparoscopic camera and configured to display to a user images captured by the laparoscopic camera is further provided. The method further includes placing the surgical training model into the cavity of the laparoscopic trainer such that it is substantially obscured from view of the user. The method further includes providing a predetermined pathway on an upper surface of the at least one simulated tissue structure and cutting the simulated tissue structure along the predetermined pathway. The method includes cutting the at least one simulated tissue structure with a laparoscopic instrument to create an opening. The method includes laparoscopically suturing the opening closed. The method includes the step of providing a simulated tumor located between the second simulated tissue structure and the at least one other simulated tissue structure. The method includes the step of penetrating the second simulated tissue structure to access the tumor. The method includes the step of observing the surgical training model and procedure with the laparoscope. The method includes laparoscopically excising the tumor from the surgical training model. The method includes the step of suturing the at least one simulated tissue structure and the second simulated tissue structure. The method includes the step of mounting a second simulated tissue structure onto the mounting posts such that it is angled with respect to the at least one other simulated tissue structure. The method includes the step of stretching the at least one simulated tissue structure. Mounting posts that wobble, angulate or rotate polyaxially are provided. The method includes angulating at least one of the mounting posts upon contact with the at least one simulated tissue portion with a surgical instrument.

DETAILED DESCRIPTION OF THE INVENTION

A surgical training device10that is configured to mimic the torso of a patient such as the abdominal region is shown inFIG. 1. The surgical training device10provides a body cavity12substantially obscured from the user and configured for receiving simulated or live tissue or model organs or training model of the like described in this invention. The body cavity12is accessed via a tissue simulation region14that is penetrated by the user employing devices to practice surgical techniques on the tissue or organ model found located in the body cavity12. Although the body cavity12is shown to be accessible through a tissue simulation region, a hand-assisted access device or single-site port device may be alternatively employed to access the body cavity12. An exemplary surgical training device is described in U.S. patent application Ser. No. 13/248,449 entitled “Portable Laparoscopic Trainer” filed on Sep. 29, 2011 and incorporated herein by reference in its entirety. The surgical training device10is particularly well suited for practicing laparoscopic or other minimally invasive surgical procedures.

Still referencingFIG. 1, the surgical training device10includes a top cover16connected to and spaced apart from a base18by at least one leg20.FIG. 1shows a plurality of legs20. The surgical training device10is configured to mimic the torso of a patient such as the abdominal region. The top cover16is representative of the anterior surface of the patient and the space between the top cover16and the base18is representative of an interior of the patient or body cavity where organs reside. The surgical trainer10is a useful tool for teaching, practicing and demonstrating various surgical procedures and their related instruments in simulation of a patient undergoing a surgical procedure. Surgical instruments are inserted into the cavity12through the tissue simulation region14as well as through pre-established apertures22in the top cover16. Various tools and techniques may be used to penetrate the top cover16to perform mock procedures on model organs placed between the top cover16and the base18. The base18includes a model-receiving area24or tray for staging or holding a simulated tissue model or live tissue. The model-receiving area24of the base18includes frame-like elements for holding the model (not shown) in place. To help retain simulated tissue model or live organs on the base18, a clip attached to a retractable wire is provided at locations26. The wire is extended and then clipped to hold the tissue model in position substantially beneath the tissue simulation region14. Other means for retaining the tissue model include a patch of hook-and-loop type fastening material (VELCRO®) affixed to the base18in the model-receiving area24such that it is removably connectable to a complementary piece of hook-and-loop type fastening material (VELCRO®) affixed to the model.

A video display monitor28that is hinged to the top cover16is shown in a closed orientation inFIG. 1. The video monitor28is connectable to a variety of visual systems for delivering an image to the monitor. For example, a laparoscope inserted through one of the pre-established apertures22or a webcam located in the cavity and used to observe the simulated procedure can be connected to the video monitor28and/or a mobile computing device to provide an image to the user. Also, audio recording or delivery means may also be provided and integrated with the trainer10to provide audio and visual capabilities. Means for connecting a portable memory storage device such as a flash drive, smart phone, digital audio or video player, or other digital mobile device is also provided, to record training procedures and/or play back pre-recorded videos on the monitor for demonstration purposes. Of course, connection means for providing an audio visual output to a larger screen other than the monitor is provided. In another variation, the top cover10does not include a video display but includes means for supporting a laptop computer, a mobile digital device or tablet such as an IPAD® and connecting it by wire or wirelessly to the trainer.

When assembled, the top cover16is positioned directly above the base18with the legs20located substantially around the periphery and interconnected between the top cover16and base18. The top cover16and base18are substantially the same shape and size and have substantially the same peripheral outline. The internal cavity is partially or entirely obscured from view. In the variation shown inFIG. 1, the legs include openings to allow ambient light to illuminate the internal cavity as much as possible and also to advantageously provide as much weight reduction as possible for convenient portability. The top cover16is removable from the legs20which in turn are removable or collapsible via hinges or the like with respect to the base18. Therefore, the unassembled trainer10has a reduced height that makes for easier portability. In essence, the surgical trainer10provides a simulated body cavity12that is obscured from the user. The body cavity12is configured to receive at least one surgical model accessible via at least one tissue simulation region14and/or apertures22in the top cover16or sides through which the user may access the models to practice laparoscopic or endoscopic minimally invasive surgical techniques.

A surgical training model30according to the present invention is shown inFIG. 2. The model30is configured to be placed inside the surgical training device10described above or other surgical trainer similar to the one described above. The model30may also be used by itself without a laparoscopic trainer to train or practice certain procedures and surgical techniques. The model30includes a base32, a plurality of posts34, and at least one simulated tissue portion36.

The base32of the model30is a platform that serves as a bottom support for the rest of the model30and it is sized and configured such that the model30does not tip over. The platform is made of any material such as metal or plastic. The base32is of sufficient heft to maintain the stability of the model30in the upright position while being manipulated by a user. The base32may include holes for receiving posts34. Alternatively, the posts34may be integrally form with the base32as a unitary body. The model30is sized and configured to be placed into the body cavity12of the surgical trainer10in the location of the model receiving area24. The underside of the base32is provided with means to affix the model30inside the surgical trainer10. Such means to affix the model30inside the trainer10include but are not limited to adhesive, suction cup, snap-fit, magnet, and a hook-and-loop type fastener material attached to the bottom surface of the base32and configured to connect with a complementary hook-and-loop type fastener material or adhesive attached to the base18of the surgical trainer30.

Still referencingFIG. 2, four posts34are connected to the base32of the model30or, alternatively, the posts34are integrally formed with the base32. Each post34is elongate and cylindrical in shape having a proximal end connected to the base32and a distal end that extends upwardly from the base32. In one variation, the distal end includes a tapered section38that terminates at a blunt tip surface40so as to not injure a user but is sharp enough to puncture holes in simulated tissue. In one variation, as shown inFIG. 2, the distal end is conical or tapered and has smoothly curved, rounded or flat tip. Each post34includes at least one circumferential notch42or cut that extends radially inwardly from the outer surface and into the post34. In the variation shown inFIG. 2, each post34includes three notches42a,42b,42cspaced apart along the length of the post34although any number of notches may be included in the post34. The notches34are perpendicular to the longitudinal axis of the each post34. In one variation, all of the posts34have the same number of notches34in the same locations or distances along the longitudinal axis. The posts34are spaced apart and located in substantially the four corners of the base32. The posts34may be oriented perpendicular to the base32or angled outwardly as shown inFIG. 2to help retain a tensioned simulated tissue portion36or to allow for varied tension in the simulated tissue portion36. In one variation, the posts are movable with respect to the base32such that their angle with respect to the base32can be selected by the user in order to vary the tension on the simulated tissue portion26. In another variation, the angle of the posts34are not fixed but vary within constrained parameters upon manipulation of the connected simulated tissue portion36thereby increasing the difficulty for the clinician in performing the surgical technique. At least one of the posts34angulates, shifts, tilts, wobbles or is movable with respect to base32in response to forces applied to the simulated tissue portion36by the practitioner. The proximal end of at least one post34is connected to the base32and configured such that the post angulates polyaxially or rotates polyaxially with respect to the base. In another variation at least one of the posts34is a flexible gooseneck which can be adjusted with the position being maintained by the gooseneck post34following the adjustment. The gooseneck post34is advantageous in adjusting the tension in the simulated tissue portion36. The posts34are configured to support the simulated tissue portion36and to selectively locate and position the simulated tissue portion36in the notches34. If the simulated tissue portion36is in the form of a sheet as shown inFIG. 2, then the thickness of the notches42is at least as thick as the thickness of the sheet forming the simulated tissue portion36such that the simulated tissue portion36is supported within and by the notches42and retained in the notches42along the posts34and thereby prevented from slipping or moving along the length of the post34as a clinician manipulates the simulated tissue portion36. In one variation, the simulated tissue sheet36is approximately 0.05 inches thick and the notches are approximately 0.1 inches thick and the notches42are spaced apart by approximately 0.25 inches. In another variation, the notches42are thinner than the sheet36to slightly compress the sheet in position within the notch42. For example, the notch42is approximately 0.08 inches and the sheet is approximately 0.1 inches. One variation includes mounting posts that have notches that are formed at the same height. For example, a post34is approximately 4.0 inches long and includes first, second, third and fourth notches located at approximately 1.0 inch, 1.8 inches, 2.7 inches, and 3.7 inches, respectively. The outer diameter of the posts34are approximately 0.3 inches and the inner diameter of the posts34in the location of the notches is approximately 0.23 inches.

In one variation, the posts34are removable from the base32. The base32includes four apertures and the posts34are passed into the apertures from underneath the base32. Each post34is provided with a flange and each aperture is keyed for allowing the flanged post34to pass into the aperture. Once inserted into the aperture of the base32, the post34is twisted relative to the base32to lock the post34in position relative to the base32. To remove the post34, the post34is twisted in the opposite direction and pushed down through the aperture. The underside of the base32includes an alcove provided with detents into which the posts34may be snapped into for flat storage of the model. Of course, rigid posts34may be interchangeable with flexible/movable ones.

Still referencingFIG. 2, the simulated tissue portion36includes a sheet of simulated tissue material. In another variation, the simulated tissue portion can take the form and shape of a particular organ. The simulated tissue portion36is connected to the posts34and in essence suspended from the upper surface of the base by a distance defined by the distance of the notch42to which the simulated tissue portion is attached. The simulated tissue portion36is free on all sides except at the points of support at the posts34. The simulated tissue portion36is mounted in tension being slightly stretched between and connected to the posts34. The tension of the sheet may be adjusted by angulating the posts34or by stretching and piercing the simulated tissue portion36in locations closer together along the simulated tissue portion. In one variation, the simulated tissue portion36is a sheet of silicone. In another variation the simulated tissue portion is a sheet of fabric or mesh coated with silicone on at least one side. The fabric or mesh is a 2-way or 4-way stretch material such as stretch nylon or spandex or a stretch nylon/spandex blend mesh or fabric. The fabric or mesh material is stretchable and porous and weighs approximately 79 grams per square yard. The material of the sheet can be any polymeric material that is flexible and can stretch and may include a mesh or other reinforcement material or fiber. The silicone coating on the mesh provides a realistic tissue feel and may include a textured surface to provide the user with tactile feedback and to allow the user to grab onto the surface with graspers. The mesh, fabric, fiber or other filler material provides reinforcement to the silicone such that the sheet can hold a suture without tearing or be stretched without tearing when being manipulated or connected to the posts34. The simulated tissue portion36may also be made of KRATON® or other thermoplastic elastomer.

In one variation, the simulated tissue portion36includes a marking or a predetermined pathway drawn on the upper surface of the at least one simulated tissue portion36with ink for example for the user to cut along. A shape may also be drawn which the user can practice cutting out. A pre-marked simulated tissue portion36provides a starting point for the user. Also, a blank simulated tissue portion36allows the user to draw their own line, path or shape on the simulated tissue portion36that then the user can cut along employing laparoscopic scissors and dissectors to practice precision cutting and then practice suturing the cut or opening closed. Furthermore, in one variation, the simulated tissue portion36includes pre-formed apertures44located along the perimeter at the four corners as shown inFIG. 2. These apertures are approximately 0.125 inches in diameter and are set back from the edges by approximately 0.413 inches. The apertures44are located in the four corners of the sheet36and are used for mounting the simulated tissue portion36onto the four posts34as shown. The simulated tissue portion36in the form of a sheet is approximately 1 to 10 mm thick for example. In another variation, the simulated tissue portion36that is formed in a sheet includes a textured upper surface and a smooth lower surface. The texturing can include protrusions or other realistic organ details. If desired, the user may flip the sheet such that the smooth surface is facing upwardly on the posts. The smooth surface may increase the difficulty in grasping and manipulating the simulated tissue portion with instruments. In another variation, the sheet of simulated tissue36includes several pre-cut paths and/or holes which forces the user to maintain tension on the simulated tissue portion drawing opposite sides of the hole or pre-cut path close together for suturing.

In use, a user will mount at least one simulated tissue portion36onto the posts34. If the simulated tissue portion36includes preformed apertures44then mounting the simulated tissue portion36includes placing the apertures44over each post34and sliding the simulated tissue portion36to rest within one of the at least one notches42formed in the post34. The simulated tissue portion36is mounted on all four posts34. Fewer posts may be employed to suspend the simulated tissue portion36. The notches42advantageously permit the entire sheet36to be mounted at an angle such that one side or at least one corner of the simulated tissue portion36is mounted on a higher or lower notch relative to the other corners and posts. For example, one side of the simulated tissue portion36is connected to two posts34by positioning the simulated tissue portion36along that first side to rest in notches42aand the other side of the simulated tissue portion36is connected to two posts34by positioning the simulated tissue portion36along that second side to rest in notches42cwhich are lower than notches42athereby angulating the simulated tissue portion36. If the simulated tissue portion36is not provided with preformed apertures44, the tapered distal ends38of the posts34can be used to puncture apertures44anywhere into the sheet36. Hence, the tension in the simulated tissue portion36can be selected by the user when the user mounts the simulated tissue portion36onto the posts34. For example, when the simulated tissue portion36is mounted by piercing an aperture44into the simulated tissue portion36, it can then be selectively stretched making the simulated tissue portion36as tense or loose as the user wishes before piercing at least a second aperture44to mount the simulated tissue portion on another post34and so forth. The fabric reinforced silicone material prevents the aperture44from propagating. Multiple preformed apertures44can be included in the sheet36to provide different degrees of tension when the sheet is mounted using a specific set of preformed apertures44. As the simulated tissue portion36in the form of a sheet is stretched over a post, it then snaps into place inside one of the notches42. The posts34may include barbs, a shoulder or flange (not shown) extending outwardly from the outer surface to help retain the simulated tissue portion36in position together with or without notches42. The posts34allow the user to set the sheet to different tensions to allow for different levels of difficulty as well as different angles to represent different structures or locations within the body.

FIG. 3shows a variation of the model30that includes more than four posts34. In particular, there is a first or outer set of posts34and a second inner set of posts46. There are four outer posts34and four inner posts46for a total of eight posts. The inner posts46are shorter relative to the outer posts34. Both sets of posts are generally positioned in the four corners of the base32and adjacent to each other. Having two sets of posts allows greater variation or selectability in the tension or angles for mounting the simulated tissue portion36. The second set of posts46, like the first set of posts34, includes notches42for positioning the simulated tissue portion36. Although one notch42is shown in all of the posts34,46, the invention is not so limited and any number of notches at varying heights can be formed in the posts34,42.FIG. 3does not illustrate the simulated tissue portion36.

Turning now toFIG. 4, there is shown a model30according to the present invention having two simulated tissue portions36a,36bmounted on the posts34. As shown the simulated tissue portions36a,36bare formed as sheets but are not so limited and may include shapes that simulate organs and other tissue structures. A first simulated tissue portion36ais mounted onto the posts34and placed into notches42cand a second simulated tissue portion is shown mounted onto posts34and placed into notches42a. Of course, the second sheet36bcan be placed into the same notches as the first sheet36aor angled in any manner with respect to the first sheet36awhich may also be angled and placed in different notches. Placing the sheets36a,36bin the same notches creates a layered tissue that can be used to mimic muscle tissue as found in the abdominal region. The sheets of simulated tissue36can be any color and include markings and vascular structures drawn on the simulated tissue structure36to mimic real tissue structures. The multiple sheets may all be connected together and retained with adhesive selectively applied in selected areas between the sheets. Although, two sheets36a,36bare shown, the invention is not limited to the number of sheets that can be mounted on the posts34. The posts34can be accordingly constructed to be longer and include more notches42to accommodate more sheets and a wider selection of angulations.FIG. 4illustrates a simulated tumor48located between the two sheets36a,36b. The tumor48can be attached to one or both of the layers36a,36bor not be attached. The clinician can practice making an incision in the second layer36bto uncover the tumor48, then practice excising the tumor48and then practice suturing the defect left behind in the first layer36aif the tumor48was attached to the first layer36aand then practice suturing the second layer36bclosed as well.

The model30is also suitable for use as a blunt dissection model. The simulated tissue sheet36for blunt dissection is made of silicone with no fabric reinforcement which allows the dissectors or trocars to puncture and separate the material. Multiple sheets may be layered together and attached together by means of silicone adhesive or thinner layers of silicone to allow for tissue dissections and separations of tissue planes.

The model30provides a realistic platform for presenting simulated tissue structures for training in a laparoscopic environment. As the clinician practices certain techniques such as cutting and suturing, the clinician will use certain instruments such as graspers, cutters, suture needles, sutures, laparoscopes, endoscopes, trocars and the like. When the simulated tissue structure that is supported on the posts in the model of the present invention is contacted with such instruments, the simulated tissue structure will give and flex under the force, deflecting a certain degree depending upon the tension with which it is mounted. This dynamism of the simulated tissue structure advantageously mimics real live tissue that gives way, moves and flexes upon manipulation in real life. Also, cutting and suturing feels differently when performed on simulated tissue structure that is suspended, that is in tension and that allows for a certain amount of deflection. These simulation advantages are provided by the model30of the present invention and are particularly useful when practicing laparoscopic surgical techniques that allow the user to fine tune depth perception and tissue manipulation skills while suturing, cutting and puncturing in a simulated laparoscopic environment.