WO1993021619A1

WO1993021619A1 - Surgical simulation model including process for performing training operations, checking results or the like

Info

Publication number: WO1993021619A1
Application number: PCT/DE1993/000338
Authority: WO
Inventors: Martin Neumann
Original assignee: Martin Neumann
Priority date: 1992-04-18
Filing date: 1993-04-18
Publication date: 1993-10-28
Also published as: DE4212908A1; AU3947393A

Abstract

A surgical simulation model for operative training purposes, especially laparoscopic, thoracoscopic and endoscopic techniques, is to be constructed in such a way that training and operations may be performed in an artificial, anatomically correct body cavity on the open abdomen or with minimal invasive methods. This is achieved in that the shape and surface of the inside of at least a human or animal body cavity corresponding to the respective layers are reproduced at least in part or in zones in a faithfull anatomic and topographic manner. The outside of the model corresponds at least in part or in zones to the anatomical shape or structure; objects, artificial organs or organic implants may be inserted and/or implanted in the body cavity or cavities; parts of the digestive tract, blood circulatory system, bronchial system and leads for electric power, fluids, gas, light, or the like have external access; and the body cavity or cavities can be hermetically closed after the insertion or implantation of objects and organs.

Description

Surgical simulation model, including procedures for

Practice of training operations, execution of

Success control or the like

The invention relates to a surgical simulation model, including methods for practicing training operations, carrying out success checks or the like, according to the preambles of claims 1 and 25. In the course of "minimally invasive surgery", general surgery is currently experiencing an incomparable "boom", since now with The endoscopic surgical technique in body cavities (abdominal cavity, chest cavity and small pelvis) directly affects the most common operations (gallbladder removal, appendectomy, inguinal cord surgery and operations on the colon) of general surgery.

Above all, there are the postoperative advantages (less pain, significantly shorter lying and recovery times, shorter periods of incapacity for work, smaller scars, less growth belly, fewer infections, less thrombosis, earlier intestinal activity) and the potential transition to outpatient treatment, which in all likelihood will further increase the proportion of this minimally invasive surgical technique in general surgical, conventional interventions. For the numerous minimally invasive operations in the future, sufficient surgeons must be trained in these training-intensive techniques and made available in good time. Deep rectal resection (removal of a section of the colon with a continent-preserving suture = anastomosis of the two free ends of the colon in the depth of the small pelvis) and rectal amputation (removal of the rectum with an artificial intestinal exit) appear to be particularly suitable for laparoscopic surgical techniques, for example, in the case of a tumor of the large intestine. Even with conventional surgery on the open stomach, the small pelvis is extremely inaccessible, so that must be operated with long instruments. In addition, when operating in the depth of the small pelvis, the viewing angle and illumination are severely restricted.

This conventional surgical technique makes it difficult to prepare the rectum in the small pelvis, which is particularly narrow in men and narrows downwards in a funnel shape, with important structures such as the bladder, ureter, vessels, nerves, prostate, and seminal vesicles , Vas deferens in men - uterus and ovaries in women - lie close together.

In exercise programs on the proposed simulation model, the individual steps of the conventional surgical technique should be trained laparoscopically and the technique should be optimized for laparoscopic use. The focus is on the further development of the surgical technique and the associated instruments.

Of course, the simulation model can also be used for training conventional rectal resection on the open stomach. However, other operations or special surgical techniques, as well as transplant surgery, can be trained in the same way. The result is a higher quality standard and greater safety in the corresponding operation on humans or animals. In addition, the simulation model provides the prerequisites for a clinical training, research, development and test center with regard to surgical operating techniques, especially the training-intensive laparoscopic, thoracoscopic and endoscopic operating techniques. The control, training task and quality assurance of the laparoscopic "boom" can thus be moved closer to the clinical area of responsibility.

The necessity for simulation models has already been shown in training and in training courses for laparoscopic gallbladder removal. The object of the present invention is to propose a simulation model for surgical training purposes, in particular laparoscopic, thoracoscopic and endoscopic (corresponds to minimally invasive surgery) surgical technique ¬ gene, by means of which in an artificial, anatomically correct Body cavity on the open stomach or minimally invasively trained and can be operated. The invention also relates to a method for practicing training operations on a simulation model according to the invention. These objects are achieved by the characterizing features of claims 1 and 25.

In the foreground are the resective and reconstructive operations on intestinal hollow organs. With the anatomically accurate replica of the transition from the abdominal cavity to the small pelvis, the small pelvis itself and the anal region, realistic training operations on the colon, sigmoid and rectum (parts of the large intestine), and especially the anastomosing technique in this area, are possible. The present invention advantageously enables the gradual adaptation to the reality demands desired for the training.

In the simplest case, in the empty body cavity of the simulation model, which can be repeatedly tightly sealed at the top with an exchangeable body cavity blanket, it is possible to do minimally invasive work on objects that were previously placed in the body cavity Techniques are practiced.

In addition, organs or parts of organs can be placed in the body cavity and training can be minimally invasive on them.

The next step is the topographical implantation of animal and / or artificial organs or parts of organs. The step becomes reality through an animal "full transplant" (heart, lung, abdominal cavity organs) or through a transplant from individual animal organs or organ ¬ achieved parts that are implanted in one or more body cavities (abdominal cavity, chest cavity, small pelvis) of the artificial model for the training operations. According to procedures from transplantation surgery, after the organ removal and the implantation in the simulation model, this is done using a

“Heart-lung machine” or only “heart machine” is supplied with the “donor blood”. The model thus prepared is for learning the minimally invasive surgical technique bleeding and complications caused can also be realistically simulated.

These steps can also be used to gain experience for transplantation surgery, and to train and improve conventional surgical techniques on the "open stomach". Important medical advances in the field of transplantation surgery, intensive care medicine, interdisciplinary surgery, laparoscopic surgery and drug use can thus be checked and researched. Another advantage is that it's not just operational

Standard situations, but also specifically caused critical situations can be trained. "

Also, without endangering a person's life, experiments and new surgical methods can be researched, including post-operative consequences, and functional tests can be carried out. The usability and reliability of the numerous new instruments, some of which have not yet been tried and tested, can be tested according to various test criteria and compared with other instruments. The training with the simulation model according to the invention is not tied to any particular locations.

Further advantageous embodiments of the invention are protected in the subclaims. In the following, exemplary embodiments of the surgical simulation model according to the invention with conceivable variants are described in more detail with reference to drawings. Show it:

Figure 1 is a semi-schematic view of the simulation model with an insight into the chest cavity, abdominal cavity and small pelvis; The abdominal wall and thoracic lid are removed

FIG. 2 shows a cross section through the abdominal cavity at the navel level with the abdominal wall relaxed,

2a shows a cross section through the abdominal cavity at navel height with the abdominal wall inflated, FIG. 2b shows an enlarged detail with the abdominal wall frame and the sealing area to the lower shell of the model, FIG. 3 shows a cross section through the diaphragm plate, which separates the abdominal cavity from the chest area. 3a shows a cross section through the upper sealing area of the diaphragm plate,

FIG. 4 shows a semi-schematic longitudinal section through a female model pool, FIG. 5 shows a semi-schematic longitudinal section through a male model pool,

6 shows a schematic view from above into a female model pool, FIG. 7 shows the anal canal with a screw-in coupling for the intestinal connection,

FIG. 8 the anal region with a needle ring and pressure ring for fixing the intestinal exit,

FIG. 9 shows schematic drawings of resective and reconstructive training operations on the colorectum. Figure 10 is a semi-schematic view of the upper body shell with the recesses of the intercostal spaces and the recess of the abdominal wall area, and the lower body shell.

FIG. 1 shows the anatomically correct model of a human body. Approach neck 1, arms 2 and legs 3 are formed. Anatomical structures, such as the clavicles 4, are indicated. An anatomically correct thoracic cover, which can be removed separately or together with the abdominal wall, has been removed. One looks directly into the chest cavity A, into the abdominal cavity B and partly into the small pelvis C. The ribs 8 and the elevation of the spine 5a are visible on the inner wall of the chest cavity A. The diaphragm plate 9, as a partition between the chest space A and the abdominal cavity B, can be inserted tightly from the ventral into a corresponding groove 20 and, with the ventral surface, complements the circumferential placement and sealing surface 10 for the tightly attachable thoracic lid 22 and the abdominal area which can also be placed tightly ceiling 14. Alternatively, a bracket can also be inserted for this purpose without the two caves A and B being separated. The elevation of the spine 5b in the abdominal cavity B is also designed as a continuation 5c in the small pelvis. The hollow system of the kidneys 6 and the ureters 7, which lie largely retroperitoneally under one layer, is shown in dashed lines. Connections 11, for example for arteries, veins and the bronchial system, are indicated in the neck area. FIG. 2 shows a cross section through the empty abdominal cavity B approximately at the level of the navel. On the lower shell 12 of the trunk with the elevation of the spine 5b there is an exchangeable, anatomically adapted frame 13 in which the layers of the abdominal wall 14 are edged. The abdominal wall 14 with the frame 13 can be exchanged for an undamaged cover if it has become unusable due to trocar punctures or cuts. After gas insufflation into the abdominal cavity B, the abdominal wall 14 expands to a desired degree, depending on the pressure (FIG. 2a). This is made possible by the circumferential placement and sealing surface 10 on the upper edge of the lower shell 12 of the fuselage, possibly with a continuation on the upper edge of the diaphragm plate - or the alternative bracket - if the thoracic lid and abdominal wall consist of two parts. On the underside of the frame 13, as well as on the underside of the thorax cover 22, a wedge-shaped web 15 protrudes all around, which fits into a corresponding, downwardly tapering groove 16 in the upper wall edge 10 or

Diaphragm or top edge of the temple can be pressed. The sides of the groove 16 are lined on both sides with an elastic, sealing material 17. Handles 18 on the frame 13 provide attachment points for lifting off or lifting off the abdominal wall 14. The same principle can be used to remove the thoracic lid 22 from the chest cavity A and to place it tightly again. In contrast to the abdominal wall, the thoracic lid 22 is not constructed from comparable elastic layers and is therefore not expandable to the extent that gas is pumped into the closed chest cavity A. It therefore seems sufficient to rigidly design the thoracic lid. Structures such as the continuation of the clavicles 4, the continuation of the ribs 8, the sternum or the nipples are favorable for orientation. However, it is also within the scope of the invention to reproduce the structure of the chest as a chest lid in the corresponding density and arrangement of the individual structures. FIG. 3 shows the top view of a part of the diaphragm plate 9, which is sealed by the seal 19 in the groove 20 on the Inner surface of the body wall is attached. Also shown is part of the upper wall edge 10 with the groove 16 for the thoracic lid 22 or the abdominal wall 14. Passage openings 21 for, for example, arteries, veins and esophagus are preferably provided in the central region of the diaphragm plate 9. FIG. 3a shows a cross section through the upper part of the diaphragm plate 9. The thoracic cover 22 and the frame 13 of the abdominal wall 14 are inserted with the respective wedge-shaped web 15 in a groove 16 on the upper edge of the diaphragm plate 9. FIGS. 4 and 5 show in FIG a sagittal section the anatomical conditions in the small pelvis C in a female model (Fig. 4) and a male model (Fig. 5). The elevation of the spine 5c bends dorsally in the area of the promontory 5d and ends in an arc shape as the tailbone 5e. Up to the anal canal 23 or anus 24, the small pelvis narrows downwards in a funnel shape and becomes forward in the man (Fig. 5) of the prostate 25, seminal vesicles 26, vas deferens 27 and the bladder 28, which is followed by the anterior abdominal wall 29, limited. The anterior border in the female model (FIG. 4) is formed by vagina 30, uterus 31 with adnexa 40, bladder 28 and anterior abdominal wall 29. The abdominal cavity B with continuation into the small pelvis C and the organs in the small pelvis are at least partially covered by a translucent layer 32 comparable to the peritoneum. In the preferred exemplary embodiment, the presacral cavity D is also covered by individual layers (comparable to the Waldeyer "see fascia 33 and the Denonvillier ^{^} see fascia 34). In the corresponding layer are the replicas of the two urethers (left urether 35 in FIG. 5 with crossing of the vas deferens 27, right urether approach 36) and their crossing or undercutting points with the vas deferens and the vasa iliaca communis or vasa iliaca externa and the larger vessels as closed, refillable hollow systems, part of the model Orientation is advisable if the pubic bone 37 and pelvic crests are indicated.

FIG. 6 shows a view from above into the small pelvis C of a female model and illustrates how it narrows in a funnel shape towards the anal canal 23. For illustrative purposes shown part of an implanted rectum 38, which is held away by a hook 39 so that the uterus 31 and the adnexa 40 (part of the model) are visible. If the graft cannot be implanted with the anal canal and anus, the intestinal lumen of the graft can be seen through the

If the model has to continue to the outside without the abdominal cavity leaking in this area, the anal canal and anus must alternatively become part of the model. FIG. 7 shows the artificial anus 24 and the tubular anal canal 23, which is equipped with an internal thread 25 at its inner end. The animal rectum 38 is pulled onto a short piece of pipe 41 and tightened with a tobacco pouch suture 43 pierced into the intestinal wall. A bead-shaped edge 42 at the end of the pipe section 41 additionally prevents the casing 38 from sliding off the pipe section 41. With the casing 38 fixed in this way, the pipe section 41 equipped with a thread is screwed into the artificial anal canal 23. When screwing in, a flange 45 presses a sealing ring 46 against the anal canal tube 23 and seals the connection. If the animal intestinal implant is implanted with an anal canal and a skin rosette, it is pulled outward through the artificial anal canal 23 - see FIG. 8. The skin rosette 47 is spread over the surface and placed on the needles 48, which extend outwards in a ring shape around the anus 24. For fixation, a corresponding perforated plate 49 is finally pressed onto the needles 48 and thus the rosette 47 is pressed sealingly against a seal 50 on the needle base. FIG. 9 schematically shows several examples of resective and reconstructive operations on the intestine. In the figures arranged in pairs, the initial finding with the section of the intestine to be resected (hatched), which contains the tumor, is always shown on the left and the condition after the operation with anastomosis or artificial outcome is shown on the right. The four bottom images show bypass operations of the intestinal passage. FIG. 10 shows the upper body shell 51, which can be placed in a sealing manner on the lower body shell 52. The legs, arms and neck are cut 53a, 54a, or indicated 53, 54, 61. In the upper body shell 51 is the area the abdominal wall 55 is recessed, as well as the intercostal spaces 56 in the area which corresponds to the areas between the sternum 57, collarbone 58, shoulder blade 59, or the ventral edge of the latissimus dorsi 60 and diaphragm 61 (indicated by dashed lines). The webs 62 between the intermediate rib spaces 56 remain as a rib replica. The circumferential edge 63 around the recess in the area of the abdominal wall 55 is indicated. With the pressure plates 64 (indicated by dashed lines on one side of the chest) in a corresponding shape and size, on which the intercostal spaces are also left out, flat inserts, preferably made of neoprene, can be screwed against the upper body shell 51 'from below, so that the intercostal spaces 56 are complete with the imitation skin, or neoprene are sealable. Through this imitation skin, or neoprene on the upper body shell 51, insertion sleeves for instruments and / or optics, instruments themselves, or drains can then be inserted into the chest cavity.

If the use of animal organs or organ parts is desired, it is expedient to integrate "cooling coils" in the body cavity or in the preferred example in the body wall, which can be connected to a cooling machine, so that one in the body cavity Desired cooling or freezing temperature can be achieved. By lowering the "operating temperature" during training operations on biologically active animal transplants, the metabolic processes are slowed down. This reduces the need for "nutrients" and oxygen. If you only practice on organs that have already died, cooling serves as a preservation during insertion into the simulation model or storage in the same.

The natural outcome of the intestine implanted in the simulation model is also required in a test procedure with an anastomosis tester. This consists of an air pump, a manometer and an adapter with a valve that is adapted to the outer shape of the anal region. It is expedient if this adapter piece can be separated from the pump system and / or supply system with the valve and can be pressed onto the anus in isolation with the valve and possibly the pressure gauge or Can be kept tight on the anus on the anal region via a holding device for the period of the measurement or measurement series. In order to be able to build up pressure retrograde in the intestinal lumen with the anastomosis tester, the intestine must be temporarily disconnected proximal to the anastomosis at a suitable height, ie for the duration of the measurement period.

With the proposed bio-simulation model, an arrangement is to be presented with which diagnostic and therapeutic interventions for exercise and testing purposes can be carried out as realistically as possible. This is suitable for conventional operations or individual surgical maneuvers, but in particular also for intraluminal and / or intracavitary endoscopic interventions as part of the so-called "minimally invasive therapy" (e.g. laparoscopic, thoracoscopic, gastroscopic, bronchoscopic, rectoscopic and coloscopic interventions). Furthermore, interventions with catheters can be carried out by means of the connectable circuit sections or vascular sections, and duct or cavity systems can be represented with the aid of contrast media and X-ray devices (e.g. ERCP = endoscopic iretrograde otiolangiography / ancreatography and / or intraoperative cholangiography). It is particularly expedient for the diaphragm to have holding devices on which the animal liver or organ replicas, possibly in combination with further holding devices, can be implanted and fixed approximately in an anatomically correct position. An opening on the diaphragm plate is conceivable for this purpose, through which portions of the animal diaphragm, which in places is firmly grown together with the associated liver, can be passed through the diaphragm plate from below. The part of the diaphragm carried out from below can then be fixed to the surface of the diaphragm plate either in a clamping device, or with a bracket or a pressure plate on the top of the diaphragm plate. The animal liver is against the diaphragm plate from below

stretchable and holds in anatomically correct position. The combination of an artificial body / body parts with animal organs / organ parts not only offers the prerequisite for realistic standardized operations, but also - especially with the connection of individual organs to a circulatory circulatory system - the simulation of bleeding and other complications, their Mastery can thus become part of training programs with the proposed bio-simulation model. After appropriate preparation, complete operations such as cholecystectomy (possibly with cholangiography techniques), appendectomy, hernia operations, resective and reconstructive operations on hollow intestinal organs, operations on the lungs, as well as individual operations, such as applying a pneumoperitoneum with verresne needles, can be carried out after appropriate preparation Trocar punctures, ligature, knot and clip techniques, preparation and hemostasis techniques with high-frequency current, laser and ultrasound dissector, use of irrigation and suction systems, insertion of drainage. In the neck area of the model, starting points for a model head with a shape of the natural openings and caves and cavity separation systems are conceivable, so that the lumen of the esophagus, trachea and vessels can be extended into the tightly attachable model head, and endoscopes, catheters or other insertion devices via the shaped Openings in the head area can be pushed into the body area of the simulation model. It is also clear that the features and methods described above, in particular the perfusion system, can be used as a preservation system for human transplantation purposes in order to temporarily implant individual human organs or organ systems into a simplified simulation model and temporarily with an adjustable temperature and / or connectable perfusion system keep biologically active.

Claims

Expectations

1. Surgical simulation model for surgical training purposes - in particular laparoscopic, thoracoscopic and endoscopic surgical technique, characterized in that the shape and area of the inside of at least one human or animal body cavity - preferably the abdominal cavity with continuation into the small pelvis - In accordance with the respective layers, at least partially or partially anatomically and topographically appropriately, it is simulated that the outside of the model at least partially or partially corresponds to the anatomical shape or structure, that objects, artificial organs can be found in the body cavity or body cavities It is possible to insert and / or implant implants or organic implants that parts of the digestive tract (eg esophagus, large intestine), parts of the bloodstream (eg arteries, veins), parts of the bronchial system and lines for electrical current, liquids, gas and Light or optics have access to the outside, and that the body cavity or body cavities can be locked gas or liquid-tight after the introduction or implantation of objects or organs.

2. Simulation model according to claim 1, characterized in that in addition to the abdominal cavity with continuation in the small pelvis also enclose the thoracic cavity and this is delimited against the abdominal cavity, either with an elastic membrane as a diaphragm simulation, or with a correspondingly shaped plate-shaped Element that can be inserted from above into a corresponding groove, possibly with an elastic, sealing lining, the diaphragm reproduction being provided with recesses for conduction pathways (for example, aorta, vena cava, esophagus).

3. Simulation model according to claim 1 or 2, characterized gekenn¬ characterized in that ribs, collarbones and sternum are retracted in the thoracic wall and the outer surface of the thorax is anatomically shaped for orientation for trocar punctures and provided with reproductions of the nipple, and that at least in the areas the wall between the ribs is designed to be comparable to the natural thoracic wall.

4. Simulation model according to claim 3, characterized in that the thorax consists entirely or partially of homogeneous material, in which characteristic structures (ribs, clavicles, sternum, nipples) are modeled.

5. Simulation model according to one of claims 1 to 4, characterized in that the abdominal wall is stretched in an anatomically adapted frame, which can be placed tightly on the corresponding attachment point on the lower shell half of the model and removed again, and thus also after the example laparoscopic training surgery against an intact abdominal wall (without the holes of the trocars) is interchangeable.

6. Simulation model according to claim 5, characterized in that the abdominal wall is modeled in elasticity, tear strength, strength, layer structure or the like. The natural abdominal wall, so that, for example, the piercing of the trocars, the layer-by-layer closing of an abdominal wound can be trained, or the inflation of the abdominal wall by means of a gas insufflation, which is required for the laparoscopic intervention, can be simulated as naturally as possible, and that the navel is modeled (at an anatomically correct location) for orientation.

7. Simulation model according to one of claims 1 to 6, characterized in that the upper part of the thorax is removable as a cover from the underside of the body and can be placed back on tightly.

8. Simulation model according to claim 7, characterized in that a removable bracket which can be inserted transversely to the body longitudinal axis on both inner sides of the model in corresponding formations at diaphragm height, the circumferential attachment and sealing surface for the separately removable thorax cover and the separately removable abdominal wall.

9. Simulation model according to claim 7, characterized in that the abdominal wall and the thoracic lid are removable as a part and can be put back on tightly.

10. Simulation model according to claim 7, characterized in that the removable abdominal wall and / or the thorax cover all around with a wedge-shaped projection in the corresponding recess on the underside of the model, which is lined laterally with elastic, sealing material, is tightly pressed, and that attachment points are provided on the cover for removing the same, and also sealing devices so that the pressed-in cover cannot lift off the inflated body.

11. Simulation model according to one of claims 1 to 10, da¬ characterized in that the material for the inner surface of the body cavities is selected so that a surgical thread needle can be inserted and removed and the pulled thread holds sufficiently, or that at least at anatomically important points for the fixation of objects, organs, ligaments and / or fascia (especially for the fixation of the enteral root, the large intestine, the liver and the diaphragm) a material is incorporated in which holding a thread or on which a thread can be knotted.

12. Simulation model according to one of claims 1 to 11, characterized in that on the one hand two kidneys, two ureters and a bladder, on the other hand prostate, seminal vesicles, vas deferens in the "male model" - in the "female model" uterus and adnexa - , and vessel sections are each designed as individual hollow systems which can be filled with liquid.

13. Simulation model according to one of claims 1 to 12, characterized in that nerves are reproduced which consist of a material which conducts the electrical current and which are part of a circuit with an optical and / or acoustic warning function.

14. Simulation model according to one of claims 1 to 13, characterized by the fact that individual anatomical layers in the abdominal area and individual layers and fascia leaves in the small pelvis are imitated (eg peritoneum, peritoneal envelope fold, Gerota's fascia, Waldayer cal Fascia, fascia pelvis visceralis, fascia pelvis parietalis, Denonvillier's fascia, urogenital diaphragm, levator ani muscle, paraproctia), and that in the pelvic region at least approximate structures of the pelvic ring (eg pelvic crests, pubis) and the spine are simulated .

15. Simulation model according to claim 14, characterized in that in the area of the small basin a funnel-shaped insert consisting of a plurality of cutable and preparable layers is interchangeably insertable, which lines the inner wall of the model in this area.

16. Simulation model according to one of claims 1 to 15, characterized in that the region around the anus is different

Material consists and is designed as an exchangeable, sewable and cutable material insert into which the implanted artificial or organic skin rosette of the anus can be sewn in, firmly clamped or clamped.

17. Simulation model according to claim 16, characterized in that for fixing the skin rosette of the anus to be implanted, needles are attached in a ring around the anus, onto which the skin rosette and a corresponding pressure plate can be inserted.

18. Simulation model according to one of claims 1 to 17, characterized in that the anus or anal canal is artificially simulated and has a thread, preferably an internal thread, at its inner end region, into which a short

Pipe piece with a corresponding mating thread, on the other end of which an intestinal end is drawn and fixed, can be screwed in, so that the intestinal lumen continues outwards.

19. Simulation model according to one of claims 1 to 18, characterized in that comparable connections (for e.g. esophagus, vessels, bronchial system) are provided in the neck area of the model as passage openings.

20. Simulation model according to one of claims 1 to 19, da¬ characterized in that an anastomosis tester can be placed on the anus, consisting of an air pump, a pressure gauge, a supply hose and a connector that can be disconnected from the hose and with a valve is provided.

21. Simulation model according to one of claims 1 to 20, characterized in that cooling units, cooling coils with corresponding connections for a cooling machine or for radiators are installed in the model or in the model wall.

22. Simulation model according to. Claim 21, characterized in that a thermostat or a thermal sensor with associated line is installed in the model to the outside.

23. Simulation model according to one of claims 1 to 22, characterized in that the material used largely corresponds to the natural conditions in the mechanical properties and / or in the color.

24. Simulation model according to one of claims 1 to 23, characterized in that the extremities and the neck are at least partially formed on the model.

25. Simulation model according to one of claims 1 to 24, da¬ characterized in that areas of the body shell or body shells for one or more accesses from the outside to the body cavity or body cavities are either themselves pierceable or cut through, or made of plastics with these Properties, or can be replaced from animal skin with one or more skin layers.

26. Simulation model according to one of claims 1 to 25, characterized in that the plate-shaped element correspondingly shaped as a diaphragm replica has a sealing surface on the upper edge so that both the body cavities (breast cavity A, and / or abdominal cavity B, and / or the small pelvis C) can be closed in a sealing manner, and the abdominal cavity B can also be sealed in a sealing manner against the chest cavity A.

27. Simulation model according to one of claims 1 to 26, characterized in that the plate-shaped diaphragm replica has at least one holding device to which animal organs or organ replicas can be attached and fixed under (caudal) the diaphragm replica.

28. Simulation model according to one of claims 1 to 27, characterized in that the longitudinal elevation of the spinal replica (5a, 5b, 5c) is designed as a conduit, in the longitudinal course of which at one or more suitable points, conduits (11) of can be guided outside into the body cavities (A and / or B and / or C), and that in the longitudinal course of the spine (5a, 5b, 5c) one or more transverse passages for retaining straps - preferably retaining straps known as "cable ties" - are trainable.

29. Simulation model according to one of claims 1 to 28, characterized in that in the upper body shell, intermediate rib spaces are left out - preferably in the area which corresponds to the boundary of the shoulder blade, clavicle, sternum and diaphragm - which have a flat shape interchangeable insert made of an animal skin or several animal skin layers or a plastic which simulates human skin in this area can be closed.

30. Simulation model according to claim 29, characterized in that a correspondingly shaped pressure plate, which also - in accordance with recessed on the thoracic intercostal spaces - has intercostal recesses, presses the sheet-like insert sealingly against the thoracic lid and can be fixed in this position, preferably with screws and wing nuts.

31. Simulation model according to one of claims 1 to 30, characterized by the fact that the upper body shell is divided into two and part areas of the chest, the second part areas of the abdominal wall, and that the parts of the upper body shell with each other and with the lower Body shell can be connected in a sealing manner.

32. Simulation model according to one of claims 1 to 31, characterized in that the upper body shell in the region of the abdominal wall has a flat recess, on the circumferential edge of which a frame corresponding in shape with the interposition of an animal skin or an artificial imitation skin seals the flat recess edge of the upper body shell part can be pressed on and fixed in this position, or that parts of the flat recess edge of the upper body shell part can be sealed against a corresponding surface on the underside of the model and / or on the surface with the interposition of an animal skin or an artificial imitation skin Diaphragm and / or can be pressed onto the chest lid and fixed in this position.

33. Simulation model according to one of claims 1 to 32, characterized in that one or more layers of an animal and / or artificial body are and can be used and fixed on the inside of the fuselage of the model.

34. Simulation model according to one of claims 1 to 33, characterized in that a ring, preferably as a fixation option for the implantable animal or artificial intestine, is attached to the outside of the model around the opening of the artificial anal canal formed in the model a cork ring into which individual needles or an annular pressure plate with needles can be inserted with the intestinal wall interposed, or that an annular pressure surface is formed on the outside of the model around the anal canal, to which a corresponding pressure plate is attached with screws can be screwed with the interposition of the intestine, so that the intestinal section can be tightly fixed in this area and the lumen of the intestine continues outwards.

35. Simulation model according to one of claims 1 to 34, characterized by the fact that around the simulation model an arrangement with cover brackets, drapes, lighting conditions, acoustic pulse frequency transmitter, connectable rinsing / suction systems, connectable hemostasis systems (eg electrical coagulation) , Instrument table, device tower (monitor, optical system, gas insufflation system, video system) and personnel setup can be adjusted, which largely corresponds to the real operating conditions. Method for practicing training operations on a simulation model according to one or more of claims 1 to 24, characterized in that objects or organs are implanted anatomically and topographically accordingly in a simulation model and on one or more circulating liquid or gas circuits with one or more external ones Routes can be connected.

36. Method for practicing training operations on a simulation model according to one or more of claims 1 to 35, characterized in that objects or organs are implanted anatomically and topographically accordingly in a simulation model and on one or more circulating liquid or gas circuits with one or several external lines can be connected.

37. The method according to claim 36, characterized in that for extensive simulation of the human intestinal length two or more parts of one or more animal intestines are anastomosed and implanted with or without the associated supplying tissue, or that the intestine corresponds ¬ accordingly shortened, and that beehive-like adhesions are released from an animal intestine intended for implantation, in particular pig intestine.

38. A method for practicing and monitoring the success of surgical techniques and operations according to claim 36, characterized in that surgical techniques and Operations performed, these recorded on video tape and compared with the corresponding standard operations.

39. Method for anastomosing parts of the digestive tract in the case of resective and / or reconstructive training operations on a simulation model according to one or more of claims 1 to 35, characterized in that a section of the digestive tract is removed with a resectate and the free ends with a seam or with a stapling device while maintaining the lumen, or that the free ends are bluntly closed, or that one or more stepped ends, closed or open, are passed out through the abdominal wall, or that parts are used as a bypass operation of the digestive tract are connected with a suture or with a stapling device in such a way that a connection of the lumen continues.

40. A method for testing the tightness of anastomosed sections of the digestive tract according to claim 39, characterized in that an anastomosis testing device according to claim 20 is placed tightly on an opening of the digestive tract (eg anus, anus praeter, esophagus), that the distal section of the digestive tract is clamped off and that a certain excess pressure is built up in the area of the digestive tract with the anastomosis to be tested, the maintenance or sinking of which is documented over time.

41. The method according to claim 36, characterized in that cuts or insertion sleeves (trocars) are introduced or introduced for training operations on the simulation model.