Design a realistic anatomical model for training in laparoscopic bile duct exploration

Design a realistic anatomical model for training in laparoscopic bile duct exploration

Driessen, P.

Goossens, R.H.M. (mentor)
Jakimowicz, J.J. (mentor)
Nassar, A.H.M. (mentor)

Industrial Design Engineering

Design Engineering

Master of Science Integrated Product Design

2011-02-22

The presence of gall stones in the gallbladder is a well-known phenomenon. Many people know or have experience with the disease. Less known is the presence of bile duct stones in the biliary tract. Gallstones in the biliary tract can cause obstruction, which hinders the flow of bile towards the duodenum. This causes pain, jaundice and a distortion in food digestion. There are several procedures for removing gallstones in the biliary tract. One of these procedures is the laparoscopic bile duct exploration. In such a procedure the biliary tract is explored via laparoscopic surgery (minimally invasive surgery). Gallstones can be detected and extracted via the minimal incisions. When all the stones are removed, the bile duct and incisions are closed. Laparoscopy is a relative young specialism within general surgery. The replacement of one single (large) incision, by several minimal ones, has several benefits for patients. For the surgeon however, laparoscopic surgery requires some advanced skills, when compared to normal open surgery. The laparoscopic bile duct exploration is an advanced laparoscopic surgery procedure. It requires some advanced skills in laparoscopy. A special artificial model has been developed for training the procedure and the required skills. This model can be applied in training of young and/or inexperienced surgeons, in box trainers and augmented reality surgery simulators. Finally training on this model increases the safeness in the operating room. The artificial model is based on anatomical human data. For the representation of the real procedure, the visual and tactile characteristics of the model are ultimately important. The model is built of a landscape which represents the human abdominal area. It consists of a base platform, liver, esophagus, stomach, duodenum, biliary tract, gallbladder, artery, portal vein and some fattish tissue. Some structures will be manipulated and damaged; and are therefore designed as disposables. After every procedure these disposables need to be replaced. The artificial models are developed in elastic materials such as latex and silicone rubber. A study showed that these materials are most applicable for the mimicking of human tissue. Via an iterative process and in cooperation with surgeons, the best composition and thickness of the structures was tested and specified. During the development the visual and tactile characteristics were qualifying. Finally the first prototypes have been tested with 27 experienced surgeons who participated in a training course in advanced gastrointestinal laparoscopy in Cairo (Egypt). Overall the surgeons were extremely positive towards the training model. Questionnaires showed that most of the surgeons assess the model ‘usable’ for the training of (resident) surgeons. We developed a test protocol and let the surgeons perform some procedural tasks of the CBD exploration. All tasks have been independently rated as ‘fairly realistic’. The transparency of the biliary tract showed to be valuable; since surgeons are able to observe (via the laparoscope) the behavior of the choledochoscope, while they control it by hand (eye-hand coordination). Based on the test results, a second series of more advanced model is in development. Additional tests with experienced laparoscopic surgeons will be required in order to validate the concept idea.

laparoscopy
bile duct exploration
training model

http://resolver.tudelft.nl/uuid:140b1868-b57c-48e3-84ec-8366a1a9ba34

2011-02-22

Campus only

Student theses

master thesis

(c) 2011 Driessen, P.