The present invention relates to the field of surgical training, and more particularly, this invention relates to a porcine leaf fat membrane that may be incorporated into a tissue model for surgical training and related methods.
Surgical procedures may be performed using open or general surgery, laparoscopic surgery, and/or robotically assisted surgery. To become qualified to perform surgical procedures, surgeons participate in comprehensive training to become proficient in the variety of tasks required to perform the procedures. Such tasks include inserting and directing surgical tools to anatomical features of interest such as tissue or organs, manipulating tissue, grasping, clamping, cutting, sealing, suturing, and stapling tissue, as well as other tasks. To gain proficiency, it is beneficial to allow surgeons to repeatedly practice these tasks for multiple different procedures. In addition, it can be beneficial to quantify training and performance of such tasks by surgeons, thereby enabling them to track progress and improve performance.
Various surgical training systems have been developed to provide surgical training. For example, training may be conducted on human cadavers. However, cadavers may be expensive and provide limited opportunities to train. In addition, a single cadaver may not allow the surgeon to repeatedly practice the same procedure. Surgical tissue models have also been utilized for surgical training. However, these tissue models may not be suitable for training minimally invasive procedures using laparoscopic or robotically assisted tools. In minimally invasive procedures, the surgical tools are inserted into the body via natural orifices or small surgical incisions and then positioned near the anatomical features of interest.
Harvested porcine tissue has been used to develop surgical training models for use in thoracic and cardiac surgery because the anatomy of the porcine organs and tissue types, such as the heart and lungs, are similar in anatomy to human organs and may mirror the anatomy of the human body. One tissue type that has been challenging to simulate with a surgical training model is the tissue simulation of the human peritoneum membrane such that the cautery, adhesions and physical properties of the simulated peritoneum mirrors that of the peritoneum of human patients.
This summary is provided to introduce a selection of concepts that are further described below in the Detailed Description. This summary is not intended to identify key or essential features of the claimed subject matter, nor is it intended to be used as an aid in limiting the scope of the claimed subject matter.
A method for making a porcine leaf fat membrane may comprise exposing a porcine leaf fat tissue sample to a detergent solution, the porcine leaf fat tissue sample comprising a porcine leaf fat membrane and porcine leaf fat connected thereto. The method may include mechanically stripping the porcine leaf fat from the porcine leaf fat membrane after exposing the porcine leaf fat tissue sample to the detergent solution.
The detergent solution may be at a temperature in a range of 35° C. to 40° C. and the exposing may be carried out for a time in a range of 3 to 5 minutes. The mechanically stripping may comprise mechanically stripping to form a base porcine leaf fat membrane layer and a plurality of porcine leaf fat membrane projections extending therefrom. The plurality of leaf fat membrane projections may comprise at least 2 projections per square inch and having a length of at least 0.5 inches.
The mechanically stripping may comprise mechanically scraping with an edged tool, and in an example, mechanically scraping with a reciprocal motion. The mechanically scraping may also comprise mechanically scraping with a fluid assist. The porcine leaf fat membrane may be sealed in a resealable bag. A portion of the detergent solution may be added to the bag. The detergent solution may comprise at least one of an anionic and cationic surfactant in an aqueous solution.
A method for making a tissue model for surgical training may comprise exposing a porcine leaf fat tissue sample to a detergent solution, the porcine leaf fat tissue sample comprising a porcine leaf fat membrane and porcine leaf fat connected thereto. The method further includes mechanically stripping the porcine leaf fat from the porcine leaf fat membrane after exposing the porcine leaf fat tissue sample to the detergent solution and incorporating the porcine leaf fat membrane in the tissue model. The method may include incorporating the porcine leaf fat membrane as a substitute for peritoneum in the tissue model.
In an example, a porcine leaf fat membrane may comprise a base porcine leaf fat membrane layer and a plurality of porcine leaf fat membrane projections extending therefrom. The plurality of leaf fat membrane projections may comprise at least 2 projections per square inch and having a length of at least 0.5 inches. The porcine leaf fat membrane may have an elasticity in the range of 4.6 MPa to 20 MPa. A colorant may be added to the leaf fat membrane.
Other objects, features and advantages of the present invention will become apparent from the Detailed Description of the invention which follows, when considered in light of the accompanying drawings in which:
Different embodiments will now be described more fully hereinafter with reference to the accompanying drawings, in which preferred embodiments are shown. Many different forms can be set forth and described embodiments should not be construed as limited to the embodiments set forth herein. Rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope to those skilled in the art.
Referring now to the images of
As explained with reference to
The porcine leaf fat tissue sample 22 that includes the porcine leaf fat membrane 20 and porcine leaf fat 36 connected thereto is harvested from that area of the pig where it forms the soft visceral fat layer that surrounds the kidney of the pig and is often used for different cooking applications. Porcine leaf fat tissue 22 sits posterior to the kidneys and anterior to the pig's spinal column, and protects and insulates the pig's kidneys. Some of those skilled in the art within the porcine food community refer to the porcine leaf fat tissue 22 as the “backfat.”
The porcine leaf fat tissue sample 22 shown in the images of
In an example, the detergent solution 28 is at least one of an anionic and cationic surfactant in an aqueous solution and used in combination with heat to help loosen the porcine leaf fat 36 from the porcine leaf fat membrane 20. The detergent solution 28 may be heated to a temperature range of about 35° C. to about 40° C., corresponding to a range of human body temperatures. However, this range may vary and depending on the type of detergent solution, the lower temperature may be below 35° C. and the upper temperature may be above 40° C. for the specified range. In the example of the basin 24 shown in
An example detergent solution 28 that may be employed is a Tide® Free and Gentle Liquid Laundry Detergent in an aqueous solution that includes not only anionic and cationic surfactants when dissolved in the aqueous solution, but also includes other components to help saponify the porcine leaf fat 36 due to the amphiphilic nature of the detergent solution and the enzyme activity of other added components. The detergent solution 28 helps make the porcine leaf fat tissue sample 22 more malleable and loosens the porcine leaf fat membrane 20 from the porcine leaf fat 36. The long hydrocarbon chains making up the lipophilic portion of the detergent solution 28 contact the fatty components in the porcine leaf fat 36 and help form micelles and separate the porcine leaf fat membrane 20 from the porcine leaf fat.
The different detergent solutions 28 that may be used in a variety of forms, including anionic, cationic and non-ionic. For example, anionic detergents may have negatively-charged sulfate groups as the hydrophilic head, while cationic detergents contain a positively-charged ammonium group. The combination of the different molecules forming the detergent solution 28 may constitute active ingredients in a household detergent, such as the example Tide® Free and Gentle Liquid Laundry Detergent. The detergent solution 28 preferably does not include any harsh chemicals that may destroy the porcine leaf fat membrane 20 during exposure to the detergent solution and the subsequent mechanical stripping process.
Different detergent solutions 28 may be employed having different surfactants, such as more commonly used linear or branched anionic sodium alkylbenzene sulfonates. These and other classes of anionic surfactants may be employed that include a hydrophilic sulfonate head-group and hydrophobic alkylbenzene tail group. Other anionic surfactants, such as sodium laureth sulfate and similar branched alkylbenzene sulfonates, may be employed as non-limiting examples. This type of anionic surfactant may be combined with different cationic surfactants, including sodium salts that have a sodium cation and a conjugate base anion such as inorganic or organic acids that form the salt. An example includes sodium salts of C12-C18 fatty acids.
Other components added into the detergent solution 28 in conjunction with a primary surfactant may include sodium citrate as a sodium salt of citric acid, sodium formate as a sodium salt of formic acid, and sodium borate as a salt of sodium with an anion that includes boron and oxygen and possibly hydrogen or any hydrate thereof. The detergent solution 28 may also include different types of hydrotropes that solubilize hydrophobic compounds by a mechanism other than micellar solubilization, and may include hydrophilic and hydrophobic components similar to common surfactants, with the hydrophobic component usually being too small to create spontaneous self-aggregation as compared to typical surfactants.
The detergent solution 28 may include linear or branched polyethylenimine (PEI) having an amine group and aliphatic spacers. Different amine oxides may be incorporated that include a functional nitrogen-oxygen coordinate covalent bond with different hydrogen and/or substituent group side chains. Different enzymes may be incorporated, such as an amylase enzyme that catalyzes the hydrolysis of starch into sugars, and thus, helps loosen the porcine leaf fat membrane 20 from the porcine leaf fat 36. Different mannosidases may be incorporated that help cleave either the alpha or beta form of mannose and aid in separating the porcine leaf fat membrane 20 from the porcine leaf fat 36. Different serine proteases may be used to initiate nucleophilic attacks on peptide bonds, which also help loosen the protein rich porcine leaf fat membrane 20 from the porcine leaf fat 36.
In an example, the detergent solution 28 as noted before may be in the range of about 35° C. to about 40° C. corresponding to a range of human body temperature, which in the example of the harvested porcine leaf fat tissue sample 22, provides the best temperature range for saponification coupled with any enzyme action from various components in the detergent solution 28. That range may vary above and below the stated values as noted before. The exposure of the porcine leaf fat tissue sample 22 to the detergent solution 28 may be carried out for a time necessary to help loosen and separate the porcine leaf fat membrane 20 from the porcine leaf fat 36 and depends on the type and strength of the detergent solution. In an example, a time range of about 3 to 5 minutes exposure using the example Tide® Free and Gentle Liquid Laundry Detergent has been found adequate. However, that range may vary and the time period may vary with a lower exposure time below 3 minutes and a greater exposure time above 5 minutes.
It is possible to place 10 porcine leaf fat tissue samples 22 into the basin 24 for initial exposure to the detergent solution 28, followed by removing individual porcine leaf fat tissue samples 22 from the basin such as shown by the porcine leaf fat tissue sample 22 held vertically in the image of
As shown in the image of
An example of an edged tool 40 is a scraper shown in
It is useful to mechanically strip the porcine leaf fat membrane 20 from the porcine leaf fat tissue sample 22 under an enclosed hood 60 (
Usually, a reciprocating, back-and-forth motion may be used when manually operating the edged tool 40 to strip the porcine leaf fat membrane 20 from the porcine leaf fat 36. Once the porcine leaf fat membrane 20 is stripped from the porcine leaf fat 36, it may be sealed in a resealable bag with a portion of the detergent solution 28 added to the bag for storage. If the porcine leaf fat membrane 20 is to be used immediately after it has been mechanically stripped from the porcine leaf fat 36, it may be cut to size using a template 64 as shown in the image of
The method for making the porcine leaf fat membrane 20 as described prepares a porcine leaf fat membrane that may be used in an advanced tissue model for surgical training as shown by the image's upper portion at 66 in
As shown in the images of
The plurality of leaf fat membrane projections 70 may be at least about two (2) projections per square inch and have a length of at least about 0.5 inches. These leaf fat membrane projections 70 form the stringy texture on the porcine leaf fat membrane layer 68 that aids in attaching or suspending different components of the tissue model 66. For example, when simulating the peritoneal membrane, the projections 70 may help hold and stabilize other harvested porcine components forming the tissue model 66. There may be a variation in the lengths and types of the leaf fat membrane projections 70 on the porcine fat membrane layer 68 and may have a variation in color intensity. This variation of color may be due to the structure of the leaf fat membrane projections 70 that are largely protein based and highly reactive to dyes used to color the different portions of the tissue model 66.
An example of a leaf fat membrane projection 70 is shown in the image of
The projections 70 may extend out from and/or be embedded within the base porcine leaf fat membrane layer 68 as part of the porcine leaf fat membrane 20. The porcine leaf fat membranes 20 produced according to the process described herein may include projections 70 that have been elongated and/or with increased distribution density. In some examples, some projections 70 may be preserved to substantially match their initial state before processing. Porcine leaf fat membranes 20 produced according to the process described herein may also have superior adhesive properties when compared to traditional methods, and such improvement may be attributed to the projections 70 within the membranes, which may be elongated, rearranged, or preserved.
In simulated surgery using the tissue model 66, the use of the porcine leaf fat membrane 20 helps provide surgeons with a realistic surgical experience to build their skills in a safe learning environment. The porcine leaf fat membrane projections 70 aid in this objective by accurately simulating adhesions of the human peritoneum membrane to underlining simulated organ structures formed with harvested porcine tissue. Because these adhesions formed by the leaf fat membrane projections 70 help simulate a realistic human peritoneum, surgeons under training can learn how to dissect membrane apart using a combination of blunt dissection, cautery, and manual cutting. An adhesive may applied to the porcine leaf fat membrane 20 to help adhere the leaf fat membrane and the projections 70 to other simulated organ structures.
The table of
The porcine leaf fat membrane 20 has draping properties that permit it to fold and exhibit a bending and shearing behavior while maintaining the ability to move freely and contour to the many different surfaces within a tissue model 66 and maintain fluidity when dissected using a surgical robot. This draping characteristic and fluidity may be imparted because the detergent solution 28 weakens the lipid structures of the porcine leaf fat tissue sample 22 and interferes with the ability of lipid hydrocarbon chains to stack on top of each other, such as may occur at colder temperatures that create a more rigid structure. The formation of micelles around different hydrocarbon tails may also take-up space and create a non-uniform membrane structure, allowing for more fluidity of the individual hydrocarbon chains of the lipid molecules than exist within the porcine leaf fat 36. It is also possible because of this fluidity to harvest the porcine leaf fat membrane 20 in one large sheet instead of numerous smaller pieces.
Because of the unique dimensions and spacing of the leaf fat membrane projections 70, it is possible to identify what type of mechanical stripping has been used to harvest the porcine leaf fat membrane 20 based on the fluidity, texture, moisture content, and nature of the leaf fat membrane projections 70. Different mechanical stripping techniques may be used besides using the edged tool 40 as described relative to
The porcine leaf fat membrane 20 may also be stored for future use. For example, ten pieces of the harvested porcine leaf fat membrane 20 may be placed in a resealable bag with about one-half cup of the detergent solution 28 used in the initial exposure and mechanical stripping, the air removed from the bag, and then sealed. The bag may be labeled as required and the porcine leaf fat membrane 20 stored long-term for later use in surgical training with different tissue models 66.
Referring now to
Referring now to
The real-tissue surgical training model 100 may be used, for example, with remotely operated, computer-assisted or teleoperated surgical systems, such as those described in, for example, U.S. Pat. No. 9,358,074 (filed May 31, 2013) to Schena et al., entitled “Multi-Port Surgical Robotic System Architecture”, U.S. Pat. No. 9,295,524 (filed May 31, 2013) to Schena et al., entitled “Redundant Axis and Degree of Freedom for Hardware-Constrained Remote Center Robotic Manipulator”, and U.S. Pat. No. 8,852,208 (filed Aug. 12, 2010) to Gomez et al., entitled “Surgical System Instrument Mounting”, each of which is hereby incorporated by reference in its entirety. Further, the real-tissue surgical training model 100 described herein may be used, for example, with a da Vinci® Surgical System, such as the da Vinci X® Surgical System or the da Vinci Xi® Surgical System, both with or without Single-Site® single orifice surgery technology, all commercialized by Intuitive Surgical, Inc., of Sunnyvale, California. Although various embodiments described herein are discussed in connection with a manipulating system of a teleoperated surgical system, the present disclosure is not limited to use with a teleoperated surgical system. Various embodiments described herein can optionally be used in conjunction with hand held instruments, such as laparoscopic tools for real-time surgical training with a harvested porcine tissue cassette.
As discussed above, in accordance with various embodiments, surgical tools or instruments of the present disclosure are configured for use in teleoperated, computer-assisted surgical systems employing robotic technology (sometimes referred to as robotic surgical systems). Referring now to
As shown in the embodiment of
Instrument mount portion 1222 may include a drive assembly 1223 and a cannula mount 1224, with a transmission mechanism 1234 of the instrument 1230 connecting with the drive assembly 1223, according to an embodiment. Cannula mount 1224 is configured to hold a cannula 1236 through which a shaft 1232 of instrument 1230 may extend to a surgery site during a surgical procedure. Drive assembly 1223 contains a variety of drive and other mechanisms that are controlled to respond to input commands at the surgeon console and transmit forces to the transmission mechanism 1234 to actuate the instrument 1230. Although the embodiment of
Other configurations of surgical systems, such as surgical systems configured for single-port surgery, are also contemplated. For example, with reference now to
In the embodiment of
Other configurations of manipulator systems that can be used in conjunction with the present disclosure can use several individual manipulator arms. In addition, individual manipulator arms may include a single instrument or a plurality of instruments. Further, as discussed above, an instrument may be a surgical instrument with an end effector or may be a camera instrument or other sensing instrument utilized during a surgical procedure to provide information, (e.g., visualization, electrophysiological activity, pressure, fluid flow, and/or other sensed data) of a remote surgical site.
Transmission mechanisms 2385, 2390 are disposed at a proximal end of each shaft 2320, 2330 and connect through a sterile adaptor 2400, 2410 with drive assemblies 2420, 2430, which contain a variety of internal mechanisms (not shown) that are controlled by a controller (e.g., at a control cart of a surgical system) to respond to input commands at a surgeon side console of a surgical system to transmit forces to the force transmission mechanisms 2385, 2390 to actuate surgical instruments 2300, 2310.
The embodiments described herein are not limited to the embodiments of
This description and the accompanying drawings that illustrate various embodiments should not be taken as limiting. Various mechanical, compositional, structural, electrical, and operational changes may be made without departing from the scope of this description and the invention as claimed, including equivalents. In some instances, well-known structures and techniques have not been shown or described in detail so as not to obscure the disclosure. Like numbers in two or more figures represent the same or similar elements. Furthermore, elements and their associated features that are described in detail with reference to one embodiment may, whenever practical, be included in other embodiments in which they are not specifically shown or described. For example, if an element is described in detail with reference to one embodiment and is not described with reference to another embodiment, the element may nevertheless be claimed as included in the other embodiment.
For the purposes of this specification and appended claims, unless otherwise indicated, all numbers expressing quantities, percentages, or proportions, and other numerical values used in the specification and claims, are to be understood as being modified in all instances by the term “about,” to the extent they are not already so modified. Accordingly, unless indicated to the contrary, the numerical parameters set forth in the following specification and attached claims are approximations that may vary depending upon the desired properties sought to be obtained. At the very least, and not as an attempt to limit the application of the doctrine of equivalents to the scope of the claims, each numerical parameter should at least be construed in light of the number of reported significant digits and by applying ordinary rounding techniques.
It is noted that, as used in this specification and the appended claims, the singular forms “a,” “an,” and “the,” and any singular use of any word, include plural referents unless expressly and unequivocally limited to one referent. As used herein, the term “include” and its grammatical variants are intended to be non-limiting, such that recitation of items in a list is not to the exclusion of other like items that can be substituted or added to the listed items.
Further, this description's terminology is not intended to limit the invention. For example, spatially relative terms, such as “beneath”, “below”, “lower”, “above”, “upper”, “proximal”, “distal”, and the like, may be used to describe one element's or feature's relationship to another element or feature as illustrated in the figures. These spatially relative terms are intended to encompass different positions (i.e., locations) and orientations (i.e., rotational placements) of a device in use or operation in addition to the position and orientation shown in the figures. For example, if a device in the figures is turned over, elements described as “below” or “beneath” other elements or features would then be “above” or “over” the other elements or features. Thus, the example term “below” can encompass both positions and orientations of above and below. A device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly.
Further modifications and alternative embodiments will be apparent to those of ordinary skill in the art in view of the disclosure herein. For example, the devices and methods may include additional components or steps that were omitted from the diagrams and description for clarity of operation. Accordingly, this description is to be construed as illustrative only and is for the purpose of teaching those skilled in the art the general manner of carrying out the present teachings. It is to be understood that the various embodiments shown and described herein are to be taken as examples. Elements and materials, and arrangements of those elements and materials, may be substituted for those illustrated and described herein, parts and processes may be reversed, and certain features of the present teachings may be utilized independently, all as would be apparent to one skilled in the art after having the benefit of the description herein. Changes may be made in the elements described herein without departing from the spirit and scope of the present teachings and following claims.
It is to be understood that the particular examples and embodiments set forth herein are non-limiting, and modifications to structure, dimensions, materials, and methodologies may be made without departing from the scope of the present teachings.
Many modifications and other embodiments of the invention will come to the mind of one skilled in the art having the benefit of the teachings presented in the foregoing descriptions and the associated drawings. Therefore, it is understood that the invention is not to be limited to the specific embodiments disclosed, and that modifications and embodiments are intended to be included within the scope of the appended claims.
This application is based upon provisional Application No. 63/487,270, filed Feb. 28, 2023, the disclosure which is hereby incorporated by reference in its entirety.
Number | Date | Country | |
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63487270 | Feb 2023 | US |