Abstract:
A surgical simulation system for demonstrating a laparoscopic surgical instrument includes a frame defining an internal cavity for supporting an object simulative of human tissue. A wall is coupled to the frame and obstructs a view of the cavity from a surgical vantage point. The wall is constructed of three adjacent layers including an outer layer simulative of skin tissue coupled to the frame by a first fastener, an intermediate layer, and an inner layer simulative of abdominal tissue. The inner layer is coupled to the intermediate layer by a second fastener such that the inner layer is removable from the intermediate layer independently of the outer layer. At least one aperture is defined through the wall to provide entry of the endoscopic surgical instrument into the cavity. A camera captures images from within the cavity transmits the images to a monitor visible from the surgical vantage point.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This application claims the benefit of and priority to U.S. Provisional Application No. 61/325,597, filed on Apr. 19, 2010, the entire content of which is incorporated herein by reference. 
    
    
     BACKGROUND 
     1. Technical Field 
     The present disclosure relates generally to an apparatus for demonstrating the use of a laparoscopic, endoscopic or other minimally invasive surgical instrument. In particular, the disclosure relates to an apparatus for simulating visual and tactile operating conditions under which the instrument may be used for minimally invasive surgery. 
     2. Background of Related Art 
     Laparoscopic surgery, sometimes referred to as minimally invasive surgery (MIS), is a procedure in which a small incision or puncture is made in the abdominal wall of a patient&#39;s body. A cannula is then inserted into a body cavity through the incision, which provides a passageway for inserting various surgical devices such as scissors, dissectors, retractors, or similar instruments. To facilitate operability through the cannula, instruments adapted for laparoscopic or endoscopic surgery typically include a relatively narrow, elongated shaft extending distally from a housing, and supporting an end effector at a distal end thereof. Arranging the shaft of such an instrument through the cannula allows a surgeon to manipulate actuators on the housing from outside the body to induce the end effector to carry out a surgical procedure at a remote internal surgical site. To view the end effector of a laparoscopic instrument within an internal body cavity, a viewing scope may be inserted through an additional puncture in the abdomen. The viewing scope may transmit images to an external monitor that may be viewed by the surgeon. This type of minimally invasive procedure has proven beneficial over traditional open surgery due to reduced trauma, improved healing and other attendant advantages. 
     Devices and techniques have been developed for the use of an artificial human abdomen in which a laparoscopic surgical procedure may be simulated for demonstration, training or other purposes. These devices typically include a simulated abdominal wall, which obstructs a view of a simulated operative site, and a mechanism for remotely viewing the simulated operative site. A simulator may be constructed to represent the conditions expected for a particular procedure on a particular type of patient. Since each surgical procedure is unique, various techniques may be practiced more readily on a simulator that is adjustable to accommodate a unique expected operating environment. 
     SUMMARY 
     The present disclosure describes a surgical simulation system for demonstrating the operation of a laparoscopic surgical instrument. The system includes a frame defining an internal cavity therein, a mount configured to support an object simulative of human tissue within the cavity, and at least one wall coupled to the frame and obstructing a view of the cavity from a surgical vantage point. The at least one wall is constructed of three adjacent layers including an outer layer simulative of skin tissue that is coupled to the frame by a first fastener, an intermediate support layer intimately coupled to the frame, and an inner layer simulative of abdominal tissue that is coupled to the intermediate support layer by a second fastener such that the inner layer is selectively removable from the intermediate support layer independently of the outer layer. At least one aperture is defined through the three adjacent layers to provide entry of the endoscopic surgical instrument into the cavity. A camera is mounted to receive light from within the cavity, and a monitor is mounted in a position visible from the surgical vantage point. The monitor is coupled to the camera such that the monitor displays images of the cavity. 
     The second fastener may include a hook-and-loop fastener, and the outer layer may be constructed of a sheet of silicone rubber. The inner layer may be constructed of a closed cell polyethylene foam, and the polyethylene foam may exhibit a density in the range of about 1.8 pcf to about 2.2 pcf. 
     The at least one wall may be generally curved around the cavity, and the frame may define first and second open sides with the at least one wall defined therebetween. The frame may define a first height when the frame is supported along the first open side and a second height when the frame is supported along the second open side, the second height being substantially greater than the first height. 
     The at least one aperture defined through the three adjacent layers may include at least one surgical port, such as those ports sold under the trademark SILS™ (Single Incision Laparoscopic Surgery™) by Covidien AG, the surgical port opening having a diameter of at least about 1.1 inches. The at least one aperture defined through the three adjacent layers may include a self closing opening defined through the outer layer to obstruct a view through the opening, the self closing opening formed by intersecting slits defined through the outer layer. The at least one aperture defined through the three adjacent layers may include a plurality of openings spaced from one another by about by about 1.95 inches in a first direction and by about 2.8 inches in a second direction. An illumination source may be defined within the internal cavity. 
     According to another aspect of the disclosure, an apparatus for simulating a surgical environment includes a mount configured to support an object simulative of human tissue. A shroud for obstructs a view of object simulative of human tissue from a surgical vantage point, and includes first and second open sides with at least one wall defined therebetween. The shroud defines a first height when the shroud is supported along the first open side and a second height when the shroud is supported along the second open side. The second height is substantially greater than the first height. A camera is mounted within the shroud to capture a view of the object simulative of human tissue. 
     The first height may be about 8.7 inches for simulation of typical laparoscopic procedures and the second height may be about 12.1 inches for simulation of bariatric procedures. The camera may be configured to receive and transmit audio signals to a storage device. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the present disclosure and, together with the detailed description of the embodiments given below, serve to explain the principles of the disclosure. 
         FIG. 1  is a perspective view of an apparatus for simulating a surgical environment in accordance with the present disclosure including a sample tray, a frame, a curve-like simulated abdominal wall, and a visualization system; 
         FIG. 2A  is a side view of the apparatus of  FIG. 1  in a first configuration for simulating a first type of surgical procedure; 
         FIG. 2B  is a side view of the apparatus of  FIG. 1  in a second configuration for simulating a second type of surgical procedure; 
         FIG. 3  is a schematic view of a system incorporating the apparatus of  FIG. 1 ; 
         FIG. 4  is an exploded, perspective view of the simulated abdominal wall of  FIG. 1 ; and 
         FIG. 5  is a perspective view of the apparatus of  FIG. 1  including instrumentation inserted through the simulated abdominal wall. 
     
    
    
     DETAILED DESCRIPTION 
     Referring initially to  FIG. 1 , an apparatus  10  for simulating a surgical environment includes a sample tray  14  for supporting tissue or other material to be manipulated in a surgical simulation. The apparatus  10  may be supported on a table or workbench (not shown) so that the sample tray is positioned at a height approximating the height of a patient&#39;s abdomen during surgery. In use, a direct view of the sample tray  14  is generally obstructed from the vantage point of a user by a shroud  16 . The shroud  16  generally includes a frame  20 , a pair of sidewalls  22  and a simulated abdominal wall  28 . The simulated abdominal wall  28  is generally curved, and thus permits a user to position the shroud  16  such that the simulated abdominal wall  28  obstructs both a direct front view and a direct overhead view of the sample tray  14 . To provide a remote view of the of the sample tray  14 , a visualization system  30 , including a camera  32  and illumination strips  34  is provided on an interior of the shroud  16 . 
     The sample tray  14  includes a flat bottom  42  and rim  44  projecting from a perimeter of the flat bottom  42 . The flat bottom  42  of the tray  14  may support a tissue sample (not shown) or other specimen to be dissected or manipulated in a surgical simulation. The rim  44  permits the tray  14  to contain liquids associated with the sample, or errant portions of the tissue sample generated by the simulation. The tray  14  may be constructed of metal or plastic such that the tray  14  may be easily cleaned once the simulation is complete. 
     The frame  20  of the shroud  16  includes an arrangement of extruded aluminum bars  48   a ,  48   b  and  48   c . In the configuration depicted in  FIG. 1 , the bars  48   a  define a height “h” operating environment behind the shroud  16 , while the bars  48   b  define a width “w” and the bars  48   c  define a depth of the shroud  16 . Extrusions such as those commercially available from 80/20, Inc. of Columbia City, Ind. may be used as the bars  48   a ,  48   b  and  48   c . Various brackets, e.g.,  50   a ,  50   b  that connect the bars  48   a ,  48   b  and  48   c  to one another and to the sidewalls  22  may also be commercially available from 80/20 Inc. The frame  20  also includes adjustable leveling mounts  52  coupled to the extruded bars  48   b . The leveling mounts  52  may each include a threaded stud (not shown), which may be threaded into the bars  48   b  to an appropriate depth to maintain the frame  20  in a level and stable configuration. 
     The sidewalls  22  facilitate obstructing the view of the sample tray  22  and are curved along one edge to facilitate the maintenance of curvature in the simulated abdominal wall  28 . Various materials may be employed for the construction of the sidewalls  22  including aluminum, ABS plastic or an acrylic. Aesthetic considerations may be incorporated into the sidewalls  22  such as various designs or colors. 
     The simulated abdominal wall  28  is constructed to exhibit a curvature approximating the shape of an insufflated abdomen in a laparoscopic procedure. As described with greater detail below with reference to  FIG. 4 , the simulated abdominal wall  28  is constructed of various layers to respond to manipulation by a user in a manner similar to the layers of tissue forming an abdominal wall of a patient. 
     The visualization system  30  includes camera  32  positioned to receive light and sound from within the shroud  16  and mounted to the frame  20  by a mounting arm  56 . The mounting arm  56  is configured to position the camera  32  appropriately to ensure that a tissue sample supported in the sample tray  14  is captured in the field of view of the camera  32 . The angle of the camera  32  with respect to the sample tray  14  may be adjusted by a hinged connection between the camera  32  and the mounting arm  56 . Various commercially available cameras, such as the Logitech® Pro 9000 webcam, may be employed as the camera  32 , and the camera  32  may be equipped with pan, tilt, and zoom capabilities. 
     The visualization system  30  is supported by a pair of lighting strips  34  fastened to one or both of the extruded aluminum bars  48   b  comprising the frame  20 . The lighting strips  34  may comprise adhesive strips of LED lighting elements commercially available from Elemental LED of Emeryville, Calif. These Elemental LED adhesive lighting strips  34  may be cut to an appropriate length, and may be powered by a 12V DC adapter plugged into a standard electrical outlet. In some embodiments, lighting strips  34  may be configured for connection to a USB port of a computer  72  (see  FIG. 3 ), and may be configured to receive power therefrom. The lighting strips  34  may be positioned to direct light downward from bar  48   b  toward the sample tray  14 , and back toward the simulated abdominal wall  28 . 
     Referring now to  FIGS. 2A and 2B , the apparatus  10  is depicted in first and second configurations simulating two different types of surgical environments. The first configuration of the apparatus  10  is depicted in  FIG. 2A  and may simulate a typical laparoscopic surgical environment. The shroud  16  is supported along a first open side, e.g., with the bars  48   c  of the frame  20  extending horizontally and forming a base for the shroud  16 . The first configuration is suitable for use with a first surgical instrument  60 , which includes a handle assembly  60   a  and an elongated shaft  60   b . The elongated shaft  60   b  of the instrument  60  is sized such that the shaft  60   b  may be positioned through the simulated abdominal wall  28  to provide access to the sample tray  14 . 
     The second configuration of the apparatus  10  is depicted in  FIG. 2B  wherein the shroud  16  is supported along a second open side, e.g., with the bars  48   a  of the frame  20  extending horizontally and forming a base for the shroud  16 . In the second configuration, the simulated abdominal  28  wall extends to a greater elevation over the sample tray  14  defining an increased height “H” (compare with the height “h” of  FIG. 2A ). Thus, the second configuration may simulate bariatric laparoscopic procedures wherein a greater thickness of tissue typically separates the body cavity being manipulated from the outside environment. A second surgical instrument  62  for use with the apparatus  10  in the second configuration includes a handle assembly  62   a  and an elongated shaft  62   b , which is generally longer than the shaft  60   a.    
     The two separate configurations of the apparatus  10  permit a user to practice or demonstrate each type of surgical procedure with little or no adjustment to the shroud  16 . The shroud may simply be rolled from one side to another. The leveling mounts  52 , and the camera  32  may be duplicated to accommodate each configuration of the apparatus, or alternatively, the leveling mounts  52  and camera  32  may be repositioned. The two configurations permit demonstration or training of various techniques that require varying angles of attack and alternate instrumentation. 
     Referring now to  FIG. 3 , a system includes the apparatus  10  for simulating a surgical environment and a laptop computer  72  for visualizing the obstructed view of the surgical instrument  60  within the simulated surgical environment. The laptop computer  72  is positioned to be visible from a surgical vantage point and is coupled to the camera  32 . The laptop computer  72  is configured to control the camera  32  and to receive and display images on a monitor representative of the views and perspectives available in an actual surgical procedure. 
     The laptop computer  72  includes a processor (not shown) and may be loaded with software to provide a user interface for the camera  32 . The user interface may incorporate a plurality of software programs that work together to streamline the operation of the camera. For example, upon booting up the laptop computer  72 , the user may be prompted to simultaneously launch multiple software applications by selecting a single button (not shown) with the use of a macro or batch file. The individual software applications may include webcam software such as the Logitech® Webcam Software available with the camera  32 . The webcam software provides control over every variable function of the camera  32  and displays a window  76  on the computer  72  that allows the user to control pan, tilt, zoom and focus features of the camera  32 . A webcam companion software such as those available from ArcSoft, Inc. may also be launched. The webcam companion software may specialize in capturing feed from an external camera and providing an optimal refresh rate and may provide a full-screen view  78  of the simulated operating environment. 
     The laptop computer  72  may also be configured to record and archive both audio and video signals transmitted from the camera  32 . Audio signals often represent commentary of the user that may be useful to review in evaluating the surgical simulation at a later time. 
     Referring now to  FIG. 4 , the simulated abdominal wall  28  includes three distinct layers to simulate the responsiveness of human tissue to surgical manipulation. An outer layer  82  is configured for attachment to the frame  20  ( FIG. 1 ) to define an outer or user-facing surface on an exterior of the shroud  16 . The outer layer  82  includes bolt holes  84  to permit the outer layer  82  to be coupled to the frame in a readily removable manner. Various entry points  86  for trocars or narrow instruments, e.g., instrument  60  (see  FIG. 3 ), are distributed over the outer layer  82 . The entry points  86  are constructed as a pair of intersecting slits that self close when not in use. The closure of the entry points  86  permits the outer layer  82  to effectively obstruct the view of simulated surgical environment. The entry points  86  are spaced generally by about 1.95 inches in a first direction along the width “w” of the apparatus  10  ( FIG. 1 ) and by about 2.8 inches in a second direction along the depth “d” of the apparatus  10 . This spacing may be representative of typical spacing between incisions in actual surgical procedures. 
     A larger opening  88  is centrally disposed on the outer layer  82  and is configured to receive a surgical port, such as a port sold under the trademark term and referred to as a SILS™ (Single Incision Laparoscopic Surgery™) Port. The outer layer  82  may be constructed of a relatively flexible sheet of silicone rubber to simulate skin tissue. A sheet of silicone rubber having a thickness of about ⅛ inch may be suitable. 
     An intermediate layer  90  is constructed of a relatively stiff sheet of polystyrene plastic, which may exhibit a thickness of about 0.15 inches, and provides support to the outer layer  82 . The intermediate layer  90  includes bolt holes  94  corresponding the bolt holes  84  of the outer layer  82 , and thus, the intermediate layer  90  may be affixed to the frame  20  ( FIG. 1 ) along with the outer layer  82 . Clearance holes  96  and  98  correspond to the locations of the entry points  86  and surgical port opening  88 , respectively. The clearance holes,  96  and  98  are sized to permit free passage of instrumentation therethrough. 
     An interior layer  102  is constructed of closed cell polyethylene foam to simulate fat or muscle tissue. A foam having a density in the range of about 1.8 pcf to about 2.2 pcf may be suitable. The interior layer  102  is provided with strips of hook-and-loop fasteners  104  securely applied thereto by an adhesive or similar mechanism. The hook-and-loop fasteners  104  permit attachment of the interior layer  102  to corresponding strips of hook-and-loop fasteners (not shown) disposed on an underside of the intermediate layer  90 . Since the interior layer  102  is provided with the hook-and-loop fasteners  104 , the interior layer  102  may be removable from the shroud  16  ( FIG. 1 ) independently of the outer and intermediate layers  82 ,  90 . Thus, various thicknesses of foam, or foams with alternate material properties may be substituted for the interior layer  102 . The simulated abdominal wall  28  is modular to permit simulation of alternate surgical procedures. 
     Referring now to  FIG. 5 , the apparatus  10  is depicted with instrumentation inserted through the simulated abdominal wall  28 . Trocars  110  are inserted through entry points  86 , and a surgical port  112 , as described herein and otherwise known in the art, is inserted through the surgical port opening  88 . An insufflation portal  114  associated with the surgical port  112  is also inserted through an entry point  86 . Even with the instrumentation inserted, a view of the simulated operating environment behind the shroud  16  is obstructed. 
     A first set of leveling mounts is provided on the first side of the shroud  16  for supporting the shroud  16  in the first configuration (see  FIG. 2A ). A second set of leveling e pair of leveling mounts  52  is provided on the second side of the shroud to support the shroud  16  in the second configuration (see  FIG. 2B ). 
     Although the foregoing disclosure has been described in some detail by way of illustration and example, for purposes of clarity or understanding, it will be obvious that certain changes and modifications may be practiced within the scope of the appended claims.