Inciseable Simulated Tissue

Abstract

To provide a simulated dissectible tissue model for surgical skills.SOLUTION: A simulated tissue comprises a simulated anatomical structure, such as a simulated rectum or one or more artificial vessels, embedded with a silicone gel layer between two silicone layers. The simulated dissectible tissue, with or without a simulated anatomical structure, is connected to one or more artificial organs via a fiberfill layer. The fiberfill layer includes a plurality of entangled fibers embedded in between two adjacent silicone layers. The fiberfill layer creates a dissection plane that permits the one or more artificial organs to be removed by spreading apart and selectively dissecting the chains of entangled fibers.SELECTED DRAWING: Figure 24

Description

[Technical field]

[0001] The present invention relates to surgical training tools, and in particular to simulated tissue structures and models for teaching and practicing surgical procedures.

[0002] Description of Related Applications This application claims priority to and the benefit of U.S. Provisional Patent Application No. 62 / 258,710, filed Nov. 23, 2015, which is incorporated herein by reference in its entirety. This application also claims priority to and the benefit of U.S. Provisional Patent Application No. 62 / 257,847, filed Nov. 20, 2015, which is incorporated herein by reference in its entirety. [Background technology]

[0003] Laparoscopic colectomy involves the resection of the intestine at various locations. Depending on where the intestine is located, the colectomy is called a right hemicolectomy, left hemicolectomy, sigmoidostomy, or total colectomy. A right hemicolectomy is the removal of the entire ascending colon, including a portion of the transverse colon, and is the most common of the colectomy procedures. The key step in the right hemicolectomy is to be able to identify important anatomical landmarks and vasculature to transect (cut laterally) the appropriate vessels and attachments to allow mobilization of the colon. The surgeon's first step in this procedure is to identify and transect the ileocolic vessels. With the patient in the Trendelenburg position with the right side facing upwards, the ileocolic vessels are retracted. This position helps to remove the omentum and small bowel. The ileocolic vessels are typically located adjacent to the duodenum, and are encapsulated within the mesentery, which is made up of two peritoneal layers. During this step, the surgeon uses the duodenum as a structural landmark in locating the ileocolic vessels. When transecting the ileocolic vessels, either a medial-lateral or a lateral-medial incision of the mesenteric layer may be performed. This incision is performed by blunt dissection using laparoscopic tools or energy compatible instruments that can cut and seal small vasculature or vasculature and lymph nodes encapsulated within the mesenteric layer. For a medial-lateral incision, an anterior movement of the duodenum and Gerota's fascia is made towards the mesenteric root, which is attached to the cecum and ileum. If the surgeon moves lateral-medial, the incision is made at the ileocecal junction and moved medially, again leaving the duodenum and Gerota's fascia anterior. Once the cecum and ileum have been mobilized, the surgeon elevates the White Line of Toldt to reach the right flexure of the colon. The White Line of Toldt is an avascular plane that is connected to the abdominal sidewall via lateral or external attachments. The surgeon typically uses energy compatible laparoscopic scissors or other laparoscopic instruments to dissect the attachments and the White Line of Toldt. During dissection of the White Line of Toldt, the attachments along the right flexure are removed in order to allow for external mobilization and transection of the bowel.Upon transection of the intestine, the surgeon performs an extracorporeal anastomosis, thereby reconnecting the remaining intestine.

[0004] Since there are several procedural steps for a right hemicolectomy, it is important to ensure that surgeons have a way to learn and practice this surgical procedure. The model needs to be anatomically accurate and includes the important landmarks and / or vasculature required for the right hemicolectomy procedure. The model should be compatible with any variations of procedural steps. As an example, it should allow either a medial-lateral or a lateral-medial incision to be performed on the model. Additionally, the model needs to simulate the feedback that the surgeon observes during the procedure. As an example, when an incision is made in the mesenteric layer, the difference in navigating the mesenteric layer to the larger blood vessels should be evident. The blood vessels should be able to be grasped, cut, and clipped. Although there are several procedural steps, the majority of the procedure involves mobilizing the intestines through various incision techniques, and therefore developing an accurate incision model is crucial to the simulation. The organs in the model should be simulated such that they can be moved and manipulated as they would be located in the body. In addition, the organs on the model should be attached to the model in a way that allows the organs on the model to be moved in the correct direction when the model is positioned in Trendelenburg or reverse Trendelenburg positioning. There is a need for an anatomical model that solves these problems.

[0005] Furthermore, surgical residents as well as practicing surgeons undergo extensive training before they are qualified to operate on human patients. The training teaches various aspects of surgery, which may include training to develop specific skills, practice specific surgical procedures, or practice with certain surgical instruments. There is a need for an integrated simulated model that facilitates training for surgeons. In particular, there is a need for simulated tissue that closely resembles the response of human tissue being dissected. The ability to make dissections between planes or to skeletonize the vasculature from the surrounding anatomical structures are skills found in surgical procedures. Particularly when laparoscopic procedures are performed, the manipulation of instruments to make the dissections is a skill that can be learned, which allows for an atraumatic procedure that minimizes trauma. The present invention relates to such simulated tissue. Summary of the Invention

[0006] According to one aspect of the present invention, there is provided a dissectable simulated tissue for surgical training. The dissectable simulated tissue has a first layer made of silicone and having an inner surface and an outer surface, a thickness defined between the inner surface and the outer surface. The dissectable simulated tissue has a second layer made of silicone and having an inner surface and an outer surface, a thickness defined between the inner surface and the outer surface. The dissectable simulated tissue has a third layer including a silicone gel disposed between the first layer and the second layer. The silicone gel is sealed by the first layer and the second layer. The first and second layers are dissectable and the third layer elastically adheres the first layer and the second layer to one another such that the first and second layers are separable by a blunt instrument.

[0007] According to another aspect of the present invention, a dissectable simulated tissue for surgical training is provided, the dissectable simulated tissue having an outer shell made of silicone and configured to define an internal cavity, a filler is disposed within the internal cavity and sealed, the encapsulated filler comprises silicone gel, and the outer shell is separable at the location of the filler to mimic surgical skeletonization.

[0008] According to another aspect of the present invention, there is provided a method for producing a dissectable simulated tissue for surgical training, the method comprising the steps of providing a first layer of silicone, curing the first layer, providing a mold with a central cavity, placing the first silicone layer on the mold such that the first layer covers the central cavity, preparing a silicone gel, applying the uncured silicone gel on the first layer, providing a second layer of silicone, placing the second layer on the silicone gel and the first layer, curing the silicone gel, and curing the second layer.

[0009] According to another aspect of the invention, there is provided a method of manufacturing a dissectable simulated tissue having one or more outer layers encapsulating an inner layer. The method includes the step of selecting a material for the outer layer. The step of selecting a material for the outer layer includes the step of selecting one of a silicone and a mixture of silicone and deadener. The method includes the step of selecting a material for the inner layer. The step of selecting a material for the inner layer includes the step of selecting one of a silicone gel and a mixture of silicone gel and deadener.

[0010] According to another aspect of the present invention, a dissectable simulated tissue structure for surgical training is provided. The dissectable simulated tissue structure includes a first cylinder of silicone having an outer surface and an inner surface defining a first lumen. The dissectable simulated tissue structure further includes a second cylinder of silicone having an outer surface and an inner surface defining a second lumen, and a third cylinder of silicone having an outer surface and an inner surface defining a third lumen. The dissectable simulated tissue structure further includes a fourth cylinder of polyfill disposed between the third cylinder and the second cylinder. A frame is provided defining an interior and an exterior. The first cylinder, the second cylinder, the third cylinder, and the fourth cylinder are suspended within an interior of the frame, the first cylinder disposed within the second cylinder, and the second cylinder disposed within the third cylinder.

[0011] According to another aspect of the present invention, there is provided a dissectable simulated tissue structure for surgical training. The dissectable simulated tissue structure has a top layer of silicone with upper and lower surfaces defining a top layer thickness, a bottom layer of silicone with upper and lower surfaces defining a bottom layer thickness, and an intermediate layer disposed between the top and bottom layers. At least one simulated blood vessel of silicone is disposed within the intermediate layer. The dissectable simulated tissue structure further has a second layer of silicone with upper and lower surfaces, defining a thickness between the top and lower surfaces. The dissectable simulated tissue structure further has a third layer of polyfill disposed between the second layer and the bottom layer.

[0012] According to another aspect of the present invention, there is provided a dissectable simulated tissue structure. The dissectable simulated tissue structure has a simulated organ made of silicone. One or more fasteners are coupled to the simulated organ. The dissectable simulated tissue structure has a tray made of a rigid material. The tray has a base and a support platform. The support platform is spaced apart from and above the base. The tray has one or more fastener placement locations. The simulated organ is coupled to the tray by coupling one or more fasteners to the one or more fastener placement locations. The one or more fasteners are releasably coupleable to the one or more fastener placement locations. [Brief description of the drawings]

[0013] [Figure 1] FIG. 1 is a top perspective view of a laparoscopic training device. [Diagram 2] FIG. 2 is a plan view of the right colon model of the present invention. [Diagram 3] FIG. 1 is a plan view of a right colon model with the omentum layer pulled back in accordance with the present invention. [Figure 4] FIG. 2 is a plan view of the large intestine of the right colon model of the present invention. [Diagram 5] FIG. 2 is a plan view of the aorta of the right colon model of the present invention. [Figure 6] FIG. 2 is a plan view of a simulated tissue structure of the present invention, for example, the mesenteric layer. [Figure 7A] 1 is a schematic diagram illustrating steps in the manufacturing process of a simulated tissue structure, eg, a mesentery layer, of the present invention. [Figure 7B] 1 is a schematic diagram illustrating steps in the manufacturing process of a simulated tissue structure, eg, a mesentery layer, of the present invention. [Figure 7C] 1 is a schematic diagram illustrating steps in the manufacturing process of a simulated tissue structure, eg, a mesentery layer, of the present invention. [Figure 7D] 1 is a schematic diagram illustrating steps in the manufacturing process of a simulated tissue structure, eg, a mesentery layer, of the present invention. [Figure 7E] 1 is a schematic diagram illustrating steps in the manufacturing process of a simulated tissue structure, eg, a mesentery layer, of the present invention. [Figure 8A] FIG. 1 shows a list of compositional variations in the outer layer of a simulated tissue structure of the present invention, for example the mesenteric layer. [Figure 8B] FIG. 1 shows a list of compositional variations in the middle or inner layer of a simulated tissue structure of the present invention, for example, the mesenteric layer. [Figure 9A] 1 is a flow diagram of compositional variations of simulated tissue structures, such as the mesenteric layer, of the present invention. [Figure 9B] 1 is a flow diagram of compositional variations of simulated tissue structures, such as the mesenteric layer, of the present invention. [Figure 10A] FIG. 2 is a plan view of a first layer of the dissectable simulated tissue of the present invention. [Figure 10B] FIG. 2 is a plan view of a mold and template for producing the dissectable simulated tissue of the present invention. [Figure 10C] FIG. 2 is a plan view of a first layer of dissectable simulated tissue on top of a mold and template of the present invention. [Figure 10D] FIG. 1 is a plan view of a simulated vasculature and a simulated tumor on top of the first layer, template and mold of the present invention. [Figure 10E] FIG. 1 is a top view of the simulated vasculature, simulated tumor, first layer, template, and second layer of gel on top of the mold of the present invention. [Figure 10F]FIG. 2 is a top view of a second layer of gel of the present invention, a simulated vasculature, a simulated tumor, a first layer, a template, and a third layer on top of a mold. [Figure 10G] FIG. 2 is a top perspective view of a dissectable simulated tissue model attached to a peg of the simulated tissue platform of the present invention. [Figure 10H] FIG. 2 is a plan view of a model of dissectable simulated tissue attached to a peg of the simulated tissue platform of the present invention. [Figure 11] FIG. 2 is a top plan view of a dissectable simulated tissue with an incision made in the outer layer exposing the inner gel layer in accordance with the present invention. [Figure 12] FIG. 2 is a cross-sectional perspective view of an organ model according to the present invention. [Figure 13] FIG. 2 is an exploded view of the organ model of the present invention. [Figure 14A] FIG. 2 is a plan view of an organ model with an incision made in accordance with the present invention. [Figure 14B] FIG. 2 is a plan view of an organ model with an incision retracted in accordance with the present invention. [Figure 15] FIG. 2 is a top perspective view of an organ model with the incision retracted in accordance with the present invention. [Figure 16] 1 is a partial schematic diagram of an organ model of the present invention. [Figure 17] FIG. 17 is a cross-sectional view of a portion of the organ model of the present invention taken along line A-A in FIG. 16. [Figure 18A] FIG. 1 is a plan view of two layers of silicone in the formation of the white line of a tort of the present invention. [Figure 18B] FIG. 1 is a plan view of two layers of silicone connected together by a white layer of silicone during the formation of a white line in a tort according to the present invention. [Figure 18C] FIG. 18C is a cross-sectional view of two layers of silicone of the present invention and the white line of the tort taken along line B-B of FIG. 18B. [Figure 19] FIG. 2 is a cross-sectional side view of a simulated mesenteric layer of the present invention. [Figure 20] FIG. 1 is a cross-sectional side view of a simulated mesenteric layer and fascia of a simulated tort of the present invention. [Figure 21] FIG. 1 is a cross-sectional side view of a simulated mesenteric layer and fascia of a simulated tort of the present invention. [Figure 22] FIG. 1 is a cross-sectional side view of a simulated mesenteric layer and fascia of a simulated tort of the present invention. [Figure 23] FIG. 1 is a top perspective view of a simulated aorta with a simulated nerve bundle according to the present invention. [Figure 24] FIG. 2 is a cross-sectional view taken along the midline of the pelvic region of the model of the present invention. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0014] An organ tray model of one or more simulated organs and tissues is ideal for training and practicing laparoscopic procedures and techniques when placed within a simulated laparoscopic training device, such as the SIMSEI Laparoscopic Training System manufactured by Applied Medical Resources Corporation of California. Laparoscopic training device 10 is shown in FIG. 1. Laparoscopic training device 10 is described in co-pending U.S. patent application Ser. No. 13 / 248,449, entitled "Portable laparoscopic trainer," filed Sep. 29, 2011 by Pravong et al., assigned to Applied Medical Resources Corporation, and published as U.S. Patent Application Publication No. 2012 / 0082970, which is incorporated by reference in its entirety. The laparoscopic training device 10 includes a top cover 12 connected to a base 14 by a pair of legs 16 that separate the top cover 12 from the base 14. The laparoscopic training device 10 is configured to simulate a patient's torso, e.g., abdominal region. The top cover 12 represents the anterior aspect of the patient, and the space defined between the top cover 12 and the base 14 represents the patient's interior or body cavity 18 in which the organs are located. The laparoscopic training device 10 is a useful tool for teaching, practicing, and demonstrating various surgical procedures and their associated instruments in a simulated patient environment. Surgical instruments are inserted into the cavity 18 through pre-drilled holes 20 in the top cover 12. These pre-drilled holes 20 may have seals simulating trocars or may have simulated tissue simulating the skin and abdominal wall portions of the patient. A variety of tools and methods can be used to penetrate the top cover 12, thereby allowing full-scale procedures to be performed on a model organ disposed between the top cover 12 and the base 14, such as the right colon model of the present invention.Once placed within the cavity 18 of the training device 10, the organ model is generally obscured from the user's view, and the user can then laparoscopically practice the surgical procedure by indirectly observing the surgical site via a video feed displayed on the video monitor 22.

[0015] A video display monitor 22 hinged to the top cover 12 is shown in an open orientation in FIG. 1. The video monitor 22 can be coupled to a variety of vision systems for transmitting images to the monitor 22. For example, a laparoscope inserted through a webcam provided in one of the pre-formed holes 20 or cavity and used to view the simulated procedure can be coupled to the video monitor 22 and / or a mobile computing device to provide images to the user. In another variation, the top cover 12 does not include a video display 22 but has a means for supporting a laptop computer, mobile digital device or tablet and connecting it to the training device 10 by wire or wirelessly.

[0016] When assembled, the top cover 12 is placed directly over the base 14 with the legs 16 disposed substantially at the periphery and interconnected between the top cover 12 and the base 14. The top cover 12 and the base 14 are of substantially the same shape and size and have substantially the same peripheral contours. The trainer 10 does not include side walls, but the legs 16 partially hide the interior cavity from view of the open ended trainer 10. The laparoscopic trainer 10 has the top cover 12 at an angle relative to the base 14. The legs 16 are configured to allow the angle of the top cover 12 relative to the base 14 to be adjusted. FIG. 1 shows the trainer 10 adjusted to an angle of about 30-45° relative to the base 14. The tilt of the trainer 10 advantageously simulates a patient in a Trendelenburg or reverse Trendelenburg position. In the Trendelenburg position, the patient's body is tilted so that the patient is lying flat on his back with the feet higher than the heart or vice versa. The Trendelenburg position allows good access to the pelvic organs when gravity is pulling the intestines away from the pelvis, thereby preventing the intestines from entering the pelvic surgical field and providing a large working space in the abdominal cavity where the surgeon can easily manipulate the organs. The selected angular position of the top cover 12 is locked by indicating thumb screws on the legs 16. The angle of the top cover 12 of the training device 10 relative to the base 14 or the angle of the top cover 12 relative to a horizontal plane, e.g., a table top, is particularly advantageous for training and practicing right hemicolectomy with the colon model of the present invention inserted into the cavity 18 of the training device 10.

[0017] 2, a right colon model 26 of the present invention is shown that is particularly suited for training and practicing procedures in a laparoscopic environment, particularly right hemicolectomy procedures, such as those described above with reference to FIG. 1, using the laparoscopic training device 10. The simulated organ is typically made of silicone or a thermoplastic elastomer (TPE) and is placed in a tray 28. The tray 28 is configured to accommodate the model organ contained within the tray 28. The tray 28 has a base and at least one side wall that is typically formed around the periphery of the base. Additional side walls are formed inside the periphery to define locations specific to anatomical structures, and are configured to accommodate simulated structures and tissues. These additional side walls provide lateral support in response to forces applied by the physician while the model 26 is contained within the cavity 18 and the physician manipulates the simulated organ with instruments inserted through the top cover 12 of the training device 10. FIG. 2 shows a simulated omentum layer 32 overlying a model liver 30 and other organs made of silicone disposed along the top of a tray 28, including their respective vasculature 34.

[0018] Referring to FIG. 3, the omentum layer 32 is shown pulled back to expose the underlying simulated organs, including at least a portion of the large intestine 36 (shown alone in FIG. 4) attachable to the appendix 42 and sigmoid colon, at least a portion of the small intestine 38, the liver 30 including the gallbladder assembly, the stomach, duodenum, kidneys, ureters, the aorta 40 (shown alone in FIG. 5), blood vessels 44 representing arteries and veins, and connective tissue layers including the peritoneum, Gerota's fascia, and mesenteric layer 46 (shown alone in FIG. 6). The organs are assembled to represent the correct anatomical positioning and location present in the human body for surgical training with various laparoscopic instruments. The right colon model 26, sometimes referred to as the right intestine model 26, is assembled using silicone simulated organs with modifications to highlight important landmarks and features for surgical training of right hemicolectomy.

[0019] A base tray 28 is provided. The base tray 28 is made of yellow or red foam and is sized and shaped so that it can be inserted into the cavity 18 of the trainer 10. Alternatively, the base tray 28 may have a liner made of yellow or red foam that fits directly into the base tray 28 and the base tray 28 can be inserted into the laparoscopic trainer 10 with the liner. An additional foam section may be added to the left side of the foam base to simulate the right side wall. Another model base is provided to allow for the simulation of various body positions during the simulated surgical procedure. For example, the right colon model base 28 or liner may be made of vacuum formed plastic with an inclined angle at one end of the model 26. This angle may simulate reverse Trendelenburg positioning of the patient during the surgical procedure. Additionally, the model 26 may be constructed on a vacuum-formed plastic base with a curved shape molded to mimic the shape of the pelvis, which extends proximally to form the curved shape of the abdominal sidewall.

[0020] A sheet made of silicone is attached to the top of the model's base 28 to aid in the mounting and assembly of the simulated organs. A list of silicone organ simulants and their colors appears below in Table 1. The colon 36, aorta 40 and mesentery 46 may remain substantially the size shown in Figures 2 and 3, or they may be shortened or shortened to better fit the base of the laparoscopic training device 10. These anatomical structures are attached to the top of the foam base tray 28 in a manner that closely represents their exact relative anatomical positioning. Table 1: Organs and their colors TIFF0007627722000001.tif103168

[0021] The mesenteric layer 46 encapsulates the artery and vein 44 and is adapted to be grasped and dissected using a laparoscopic dissector. Dissection between tissue layers has characteristics that cannot be simulated with silicone alone. Therefore, to solve this problem, several variations of dissectable simulated tissue suitable for simulating real anatomical structures, such as the mesentery 46, have been developed. The dissectable simulated tissue suitable for simulating the mesentery 46 is composed of three layers stacked on top of each other. The three layers include a top layer 48, a bottom layer 50 and a middle layer 54. The top layer 48 and the bottom layer 50 may represent the peritoneum layer, and the middle layer 54, which is made of gel, may represent the connective tissue surrounding the blood vessels 44, which is made of dissectable silicone.

[0022] 7A-7E, the construction of the dissectable simulated tissue of the present invention that can be used as an example mesenteric layer 46 will now be described. As noted, the dissectable simulated tissue 47 of the present invention is not limited to use as a mesenteric layer 46, and such dissectable simulated tissue can form at least a portion of any simulated tissue structure. The construction of the dissectable simulated tissue 47 includes the initial step of making two separate thin silicone sheets, one sheet for the top layer 48 and one sheet for the bottom layer 50, which are fully cured as shown in FIG. 7A. Once the sheets are fully cured, thin silicone gel layers 58a, 58b are spread using a spatula or similar tool onto the unpatterned sides of the silicone sheets 48, 50, respectively, as shown in FIG. 7B. The simulated vasculature 44, including silicone blood vessels, is placed onto one of the uncured gel layers 58a, 58b. FIG. 7C shows the simulated vasculature 44 placed on the uncured gel layer 58a on the sheet of top layer 48. The silicone sheets 48, 50 are then fully cured along with the gel layers 58a, 58b to attach the simulated vasculature 44 to the top layer 48. Once the gel lining layers 48, 50 are cured, a third or middle layer 54 of new silicone gel is prepared and poured onto one of the layers 48, 50. In one variation, new silicone gel is poured onto the silicone sheet 48 onto which the silicone vessels 44 are placed. The gel is spread to completely cover the simulated vessels of the vasculature 44. The second layer 50 is then placed on top of the first layer 48 over the middle layer 54 while the silicone is still an uncured gel and extrudes to the edges with air pockets creating a sandwich-like structure. As a result of this process, the three-layer dissectable simulated tissue 47 can be used to simulate a mesentery assembly 46, for example, as shown in FIG. 6, that is particularly suited and compatible for laparoscopic dissection and skeletonization of the encapsulated vasculature 44 located between the layers. The multiple layers provide an accurate and lifelike feel and function to the dissectable simulated tissue structure. Additionally, the dissectable simulated tissue 47 advantageously creates a variety of tissue planes through which a physician can hone their dissection skills.Not only does the model 26 provide the ability to dissect layers, but it also allows the physician to properly identify tissue planes or layers 44, 48, 50, 54, 58a, 58b, which is an important skill to learn for each individual procedure. In one variation, the dissectable simulated tissue 47 is constructed without the vasculature layer 44, and such dissectable simulated tissue can also be used to perform dissections.

[0023] During the process of making the dissectable simulated tissue 47, several additives are introduced that result in various desired properties and iterations of the dissectable simulated tissue 47. A list of various ingredients for the outer first and second layers 48, 50 and the inner or middle layer 54 of the dissectable mesenteric layer 46 is shown in Table 2, which is summarized in the flow chart of Figures 8A and 8B. A flow chart for determining the optimal dissectable sheet based on the desired properties of Figures 8A and 8B is shown in Figures 9A and 9B. In Figures 9A and 9B, the mesenteric layer is used as an example application of the dissectable simulated tissue of the present invention, and the flow chart of Figures 9A and 9B is not limited to the application for making only a simulated mesenteric layer, but includes use in any simulated tissue structure. Also, the vessels shown in Figures 9A and 9B are not limited to simulated vessels, but may include any simulated anatomical structure or tissue in the implanted state, including, but not limited to, tumors, pathological lesions, organs, ducts, cartilage, etc. The silicone outer layers 48, 50 are made of a conventional two part room temperature vulcanizing (RTV) silicone in a 1:1 ratio, or a 1:1 ratio of RTV silicone and deadener additive, or a 2:1 ratio of RTV silicone and deadener additive. RTV includes, but is not limited to, platinum cure room temperature vulcanizing silicone (PCRTVS). Silicone deadeners belong to a family of silicone fluid chemistries including, but not limited to, silicone oils, which are platinum cure silicone additives. One example of a deadener is called SLACKER, manufactured by Smooth-On, Inc. of Macungie, Pennsylvania. Deadening agents as additives soften silicone to resemble the feel of skin or human tissue, yet make it realistic. Silicone deadeners are silicone additives that can soften and modify the resulting "feel" as well as rebound properties of the cured silicone. They are in the chemical family of silicone fluids, which includes silicone oils.Silicone fluids and silicone oils have a range of uses that depend on the viscosity and chemical structure of the fluid. Silicone deadeners are a type of silicone oil that are miscible with platinum cure room temperature vulcanizing silicones.

[0024] The durometer of conventional silicones used to mold organs ranges from 00-10 Shore to 10A Shore. Thus, the addition of deadening agents results in different properties when added to silicones of different durometers. The addition of deadening agents to silicones that are soft in terms of durometer results in a gel-like composition upon full cure. However, the addition of deadening agents to silicones with high durometer results in the desired characteristics of a soft-feeling silicone, which easily reaches its deformation break point upon full cure. Thus, the combination of silicone and deadening agent can provide the tactile characteristics of the outer layers 48, 50 that make up the mesentery 46, e.g., the peritoneal layer.

[0025] Modifications of the intermediate layer include: (1) a gel containing a deadener or deadening agent; (2) a gel containing alcohol; (3) a gel containing alcohol and heat applied; or (4) a gel containing a deadener or deadening agent and alcohol and heat applied. Isopropyl alcohol is used. The addition of additives to the encapsulating gel layer 54 reduces the amount of pressure and force used to cut the layer and facilitates cutting the layer. The gel is a platinum cured silicone rubber gel that can be used as the intermediate layer 54 in the mesentery assembly 46. Another modification to facilitate cutting the intermediate layer 54 is to add alcohol to thin the gel, thus making it easier to penetrate the gel. Further degradation of the gel layer 54 can further increase the ease with which the intermediate layer 54 can be cut. The alcohol and gel mixture is heated to about 70° C. to speed up the setting time and create a porous intermediate layer 54 that occurs as a result of the evaporation of the alcohol. The porous intermediate layer 54, comprised of gel, alcohol and heat, reduces the inherent tackiness of the gel, making it easier to penetrate and dissect the mesenteric layer 48, 50, 54. In another variation, deadener is added to the silicone gel, resulting in a formulation that has low elastic properties but is more tacky when fully cured. To alleviate issues with the stickiness of the cured gel mixture, alcohol is added to the silicone gel and deadener mixture in the same ratio. The resulting properties, when fully cured, are less tacky compared to the gel mixture itself and the gel and deadener, but also exhibit the desired dissecting feel when using laparoscopic dissectors. Again, the addition of heat to the mixture creates a porous intermediate layer 54 with the characteristics listed above for the other dissecting layer variations. The intermediate dissecting layer 54 variation, comprised of gel and various additives, advantageously provides a feel for moving through tissue to dissect free blood vessels contained within the mesenteric layer 46 between the two outer layers 48, 50. Additionally, the formulated gel variations provided herein impart a realistic, wet appearance to layer 54 that provides a sheen or luster that is particularly advantageous in laparoscopic procedures where the cavity is enclosed and illuminated by a laparoscope. Table 2: Layers and materials TIFF0007627722000002.tif40161

[0026] The vasculature 44 present in the right colon model 26 is made from silicone or KRATON polymer tubing manufactured by Kraton Polymers of Houston, Texas. The blood vessels are contained within the simulated mesenteric layer 46 described above. The vasculature 44 is anatomically positioned and attached to the peritoneal layers 48, 50 by a gel intermediate layer 54. Additionally, although the dissectable tissue containing the vasculature 44 has been described with respect to a right hemicolectomy model, this method of manufacture can be utilized for any tissue simulated model by similar means or as a stand-alone model for a simulated tissue platform.

[0027] Another component of the right colon tray is the omentum 32. The omentum 32 is attached over the large intestine 36, which is hung on top of the model 26. Several variations of the omentum 32 have been developed. The first variation is a textured silicone cast omentum 32 that can be easily hung on top of the model 26. However, to simulate the weight and feel of the omentum 32, the omentum may also be cast using soft silicone foam. The foam omentum 32 is colored yellow, which appears to take up a large space in the abdominal cavity, but can be hung on top of the model 26. Vasculature 34 is present on both variations of the omentum 32 to simulate the appearance of the omentum 32 as it would appear in the body.

[0028] Referring back to FIG. 3, the presence of attachments 64 on the model connecting the ascending colon 60 to the abdominal wall 62 is an important feature for training the right hemicolectomy procedure. To address the abdominal wall 62, several identical models are made. The first model of the abdominal wall 62 is made by attaching a long thin piece of foam approximately 2 inches (5.08 cm) in height to the side of the base 28, which may also be made of foam. The abdominal side walls 62 may also be built into the base 28 through the curvature of the molded base and side walls described above. Finally, the abdominal sides 62 may be made of a curved, rigid, hard cast material that extends the length of the foam base 28 and is attached to the foam base 28. An outer attachment 64 may be attached to any of the abdominal walls 62 described above. The outer attachment 64 is made by using two textured silicone sheets that are attached to the top of any of the later abdominal walls 62 described above. Between the two sheets that are attached to the abdominal wall 62 is the linea alba of Tolt. There are several models for the linea alba of Tolt. The first phantom simulates the linea alba of Tolt with rope fiber. Strands of white cotton rope are used in the model 26 to mimic the appearance of the vasculature plane of the linea alba of Tolt. The linea alba of Tolt can also be simulated by creating white stripes or fringes in silicone to represent anatomical landmarks. The linea alba of Tolt is attached between two layers of silicone sheeting, which are then attached to each other along the edges and then to the ascending colon 60. The resulting structure is an external attachment that connects to the side wall 62 containing the intestine 36.

[0029] In another aspect of the present invention, the dissectable simulated tissue 47 is composed of at least two distinct layers. The first layer is composed of a silicone layer and the second layer is composed of a silicone gel. The dissectable simulated tissue 47 can be used to create synthetic tissue and organ models with anatomical similarity and can be used as a simulated training model for training in dissection and other surgical procedures. The dissectable simulated tissue 47 of the present invention is an assembly composed of at least one outer silicone layer and a gel layer encapsulated by one or more outer silicone layers, resulting in a structure that closely resembles an incision observed by a surgeon. The one or more silicone layers of the dissectable simulated tissue are made of a two-part RTV10A durometer silicone mixed with a silicone deadener that accounts for 33% of the total weight, resulting in a 2:1 ratio of total silicone to deadener used. Deadener is a silicone oil that softens the properties of the cured silicone to which it is added. As a result, a 10A durometer silicone to which deadener is added will cure to a durometer silicone less than 10A. The amount of deadener added is proportional to the change in durometer properties to which it is added. A silicone pigment is added to the silicone and deadener mixture, which causes the silicone to be cast to create a viscous mixture with the pigment corresponding to the anatomical structure it represents. The silicone mixture is cast onto a sheet of foam, optionally with texture, or onto a textured sheet made of a gypsum material. The cast silicone mixture is cured at room temperature for about 45 minutes if foam is used, or in an oven at a temperature of about 70°C for about 25 minutes if foam is not used. The sheet size may have a length and width that varies depending on the size of the plane or surface being incised.

[0030] Once the silicone sheet has cured, it is placed on a mold with a rectangular cavity, the cavity being smaller than the silicone size. The silicone sheet is placed on the mold such that the central region of the sheet is placed in the cavity and the outer periphery of the sheet is laid flat on the surface of the mold. Providing this set-up configuration facilitates the gel encapsulation process with minimal gel leakage. Within the central cavity, the silicone vasculature and pathological lesion, e.g., tumor, are attached using a silicone adhesive onto the portion of the sheet located within the cavity. The placement of the vasculature and pathological lesion resembles the anatomical tissue where incisions are typically performed. When the silicone adhesive cures and the vasculature and pathological lesion are intact, an intermediate gel layer is created. The present invention is not limited to the implantation of vasculature, but also includes other anatomical landmarks and structures, including but not limited to vasculature, tumor, pathological lesion, organ and tissue structures, and their construction materials include but are not limited to any polymeric material, silicone, KRATON, and the like.

[0031] In one variation, the encapsulating gel present in the dissectable simulated tissue is composed of silicone gel, deadener, and isopropyl alcohol. To make the gel, the two-part silicone gel is placed in a mixing cup in equal parts by weight and volume. Deadener is added in an amount equal to the total silicone addition volume. Isopropyl alcohol is added in an amount equal to the volume of deadener. The mixture is mixed until a homogenous solution is obtained. Silicone pigments can be added as needed to create a pigment that closely resembles the human tissue to be dissected. Once the solution is thoroughly mixed, it is cast on top of the outer silicone sheet that is placed in the cavity of the mold to create a gel layer. The gel is encapsulated and does not pass over the top of the cavity, as this would cause gel leakage, which would be detrimental to the overall tissue model. The silicone gel is a silicone elastomer. However, it is platinum-cured silicone rubber that is extremely soft. The durometer of silicone gels is below the Shore 00 hardness scale, which makes the gel soft, sticky, and has low tear resistance. One example of a gel used for dissectable tissue is ECOFLEX gel, manufactured by Smooth-On, Inc., which has a hardness of 000-35.

[0032] At this point of manufacture, there are two separate ways to complete the dissectable simulated tissue model. For example, the dissectable simulated tissue can be consumed as a component in an organ tray targeted to training surgical procedures as described with reference to Figures 1-6. In such a case, if the dissectable simulated tissue is consumed as a component in a tray, a second silicone sheet having the same size and silicone, deadener, and pigment reanimation as the first silicone sheet is used to encapsulate the gel layer. The second silicone sheet is placed on the first sheet containing the gel. The layer is pressed so that air pockets are pushed to the side of the sheet and released into the atmosphere. A silicone adhesive is used to line the perimeter of the cavity between the two silicone sheets, thereby creating a seal between the two silicone layers to prevent leakage of the gel. The gel is allowed to cure at room temperature between the two silicone sheets. Once cured, the dissectable simulated tissue can be removed from the casting mold. The perimeter of the silicone sheet can be used to attach the dissectable simulated tissue to various silicone organs in the organ tray. The dissectable simulated tissue 47 may be specifically constructed for a simulated organ training tray for training in a right hemicolectomy procedure as shown in FIGS.

[0033] In another example, the dissectable simulated tissue 46 can be utilized on a small platform to train only on dissection skills. In this case, once the gel layer is poured into the cavity, it is cured in an oven at about 60° C. for about 35 minutes. Once the gel is cured, a 10A durometer silicone mixture is prepared with the same pigment as the outer silicone sheet of the dissectable simulated tissue. To form a second silicone sheet layer, a silicone mixture is cast onto the gel and the outer silicone sheet layer, and then cured in an oven at about 60° C. for about 30 minutes. The resulting dissectable simulated tissue model is a stand-alone model that can be used to practice dissection skills. This model of the dissectable simulated tissue is a one-sided model, in this case only one of the outer layers is soft silicone with similar properties to human tissue. The outer layer, constructed of 10A durometer silicone, serves as a taut support for the model when placed within a suturing platform of the type described, for example, in U.S. patent application Ser. No. 14 / 037,005, filed Sep. 25, 2012, entitled "Surgical training model for laparoscopic procedures," which is incorporated by reference in its entirety.

[0034] The deadening agent as an additive added during the preparation of the outer silicone layer makes the silicone soft and realistic to the touch of skin or human tissue after curing. The addition of deadening agent results in different properties when added to silicones with different durometers. The addition of deadening agent to a durometer soft silicone results in a gel-like composition upon full curing. However, the addition of deadening agent to a durometer high silicone results in the desired characteristic of a soft-feeling silicone, which easily reaches its deformation breaking point upon full curing. Thus, the combination of silicone and deadening agent can provide the tactile characteristics of human tissues that make up the mesentery, such as the peritoneum layer.

[0035] The intermediate gel layer has a gel containing deadener, alcohol and heat added. The addition of each additive to the encapsulating gel layer reduces the amount of pressure and force used to make the incision, thereby facilitating the incision. The gel is a platinum cured silicone rubber gel that can be used as an intermediate dissectable layer in a dissectable simulated tissue. Alcohol is added to thin the gel, making the intermediate layer easier to incise and penetrate. Additionally, degradation of the gel layer can further enhance the dissectable properties of the intermediate layer. The alcohol and gel mixture is heated to speed up the curing time and evaporate the alcohol to create a porous intermediate layer. The porous intermediate layer composed of gel and alcohol reduces the inherent tackiness of the gel and makes it easier to penetrate and incise the encapsulating gel layer. In another variation, deadener is added to the silicone gel, resulting in a formulation with reduced elastic properties but increased tackiness when fully cured. To alleviate issues with tackiness of the cured gel mixture, alcohol is added to the silicone gel and deadener mixture in equal ratios. The resulting properties, when fully cured, are less tacky compared to the gel mixture itself and the gel plus deadner, but also exhibit the desired dissectable feel when used with laparoscopic dissectors. Again, application of heat to the mixture creates a porous intermediate layer having the characteristics listed above for the other variations of the dissectable layer. The construction of the intermediate dissectable layer, comprised of gel and various additives, provides the feel of moving through the tissue to dissect free blood vessels within the mesenteric layer or other tissue structure or organ. Additionally, the use of a gel sheen or glaze provides a realistic wet appearance similar to that of real tissue, which is particularly useful when viewed on a video monitor during training of laparoscopic skills.

[0036] Variations in making the outer silicone layer include changing the durometer of the silicone. RTV platinum cured silicones, which are useful for making simulated organ models, have 00-10 durometer and 10A durometer, and the silicone outer layer can be made with either silicone. In addition, deadeners can be added to the silicone to soften the cured form of the silicone. The change in softness and elasticity of the silicone is directly proportional to the amount of deadener added. Figure 8A shows a flow diagram of the outer silicone layer forming the dissectable simulated tissue.

[0037] The middle gel layer is made of a base silicone gel to which additives including deadener and alcohol are applied and heat is applied to cure. Each additive is eliminated separately to provide variations at each step and thus properties for each form. FIG. 8B shows variations of each gel layer composition with additives in specific ratios and properties exhibited by these additives. Throughout this specification for all embodiments, ratios for the outer layers can be either by volume or by weight since the densities of the silicone and deadener are approximately equal. The ratios of the gel layer, deadener, and alcohol are by volume.

[0038] A variation in the assembly of the dissectable simulated mesenteric layer may include the use of silicone gel to hold the vasculature together. The construction of this assembly involves the initial step of making two separate sheets of silicone with deadeners and allowing them to fully cure as shown in FIG. 7A. Once the sheets are fully cured, a spatula or similar tool is used to spread a thin layer of silicone gel 58a, 58b onto the plain side of each of the silicone sheets 48, 50 as shown in FIG. 7B. The vasculature 44 made of silicone vessels is placed onto the uncured gel layer 58a on one of the sheets as shown in FIG. 7C. The silicone sheets 48, 50 including the gel layers 58a, 58b are allowed to fully cure. Once the gel liner layer is cured, new silicone gel 54 is prepared and cast onto the silicone sheet 48 with the silicone vessels 44 in place. The gel 54 is spread so that it completely covers the vessels 44 as shown in FIG. 7D. A second silicone sheet 50 is then placed onto the uncured gel and any air pockets are pushed out to the edges. As a result of this process, the multi-layered mesentery may be compatible with laparoscopic dissection as shown in FIG. 7E.

[0039] The dissectable simulated tissue of the present invention has the mechanical properties of low tear resistance, elasticity, toughness, color, and texture of the representative tissue to be dissected. A laparoscopic tool, such as a Maryland dissecting container or laparoscopic scissors, can be used in the tissue to dissect or cut the tissue, respectively. The use of gel in the dissectable tissue imparts a unique sheen to the material, which allows the material to have a realistic wet appearance. The gel used to construct the dissectable tissue is silicone-based, so that the gel can be bonded to various other silicone models or other organs already manufactured, such as silicone blood vessels. Furthermore, the viscosity of the gel allows blood vessels made of other thermoplastic elastomers, such as KRATON polymers, to be attached to the outer silicone layer with silicone gel.

[0040] The dissectable simulated tissue of the present invention is dissectable and has several advantageous properties that closely resemble human tissue. The simulated tissue mimics the mechanical properties of human tissue, such as elasticity, toughness, color, and texture. The simulated tissue also has low tear resistance or tear strength, which advantageously allows for the propagation of tissue separation. The low tear resistance of the simulated tissue facilitates blunt dissection using laparoscopic Maryland dissectors or laparoscopic scissors with minimal force. The simulated tissue can also include anatomical landmarks or structures representative of anatomical structures that require dissection. These anatomical landmarks or structures include, but are not limited to, organs, vasculature embedded between mesenteric layers, or peritoneal sheets surrounding pathological lesions that need to be excised, such as tumors. The anatomical landmarks or structures can be grasped using atraumatic laparoscopic graspers or Maryland dissectors or cut using laparoscopic scissors. In addition, the dissectable simulated tissue of the present invention allows for manipulation and manipulation of anatomical structures upon completion of dissection. The movement of these structures closely resembles the movement of anatomical structures of human tissue upon completion of dissection. In addition, the dissectable simulated tissue can be consistently manufactured. The simulated tissue can be molded to assume the shape of a human organ or membrane. The dissectable simulated tissue can also be bonded with a variety of silicone and thermoplastic resins. In the present invention, any and all of the silicone layers can be translucent or transparent to allow for a slight visibility of the underlying implanted pathological lesion, tumor, vasculature, etc. through one or more of the layers. Working Example

[0041] With reference to Figures 10A-10H, an embodiment of manufacturing a simulated tissue model having a bias with a dissectable simulated tissue composition will now be described. A 10A durometer silicone is prepared that includes two parts, namely part A and part B. Approximately 5 grams of part A of the 10A durometer silicone is mixed with approximately 5 grams of part B of the 10A durometer silicone. Approximately 5 grams of silicone deadener is added. A yellow silicone pigment is added. The silicone, deadener and pigment are thoroughly mixed. The mixture is cast onto a textured mold and allowed to cure to form a first layer sheet 66 as shown in Figure 10A. A rectangular mold 68 is prepared with a central cavity 70 about 0.125 inches (3.175 mm) deep as shown in Figure 10B. The depth of the central cavity 70 can be varied depending on the desired dissectable thickness. A vasculature template 72 is placed within the central cavity of the rectangular mold as shown in Figure 10B. The template 72 shows lines 74 where the silicone blood vessels should be placed for the correct anatomy. The template 72 further includes an indication of anatomic location 76 where a particular pathological lesion should be placed. Although a vasculature template 72 is disclosed, the invention is not limited thereto and any anatomical feature template 72 can be used with the template 72 oriented to where a particular structure, pathological lesion, organ, tumor and other tissue and anatomical landmark should be placed. The first layer sheet 66 is then placed on the mold 68 such that it is aligned with the outer edge of the mold 68 as shown in FIG. 10C. The first layer sheet 66 is transparent so that the template 72 can be viewed through the first layer sheet 66. The simulated vasculature 78 and simulated tumor 80 are then attached to the first silicone sheet layer 66 using a silicone adhesive and placed in the location shown on the underlying template 72 as shown in FIG. 10D. The simulated vasculature 78 is placed on the lines 74 of the template 72. Lines 74 or other shapes on template 72 may be further colored to place correspondingly colored vessels and / or organs in their correct anatomical locations. Mix approximately 3.3 grams of Part A Silicone Gel with approximately 3.3 grams of Part B Silicone Gel.Approximately 6.67 millimeters of silicone deadener and 5.27 grams of isopropyl alcohol are added to the silicone gel and mixed together. By volume or volume measurement, this amounts to approximately 3.3 milliliters of Part A silicone gel, approximately 3.3 milliliters of Part B silicone gel, 6.67 milliliters of silicone deadener, and 6.67 milliliters of isopropyl alcohol. The yellow and white silicone contents are added and mixed. The mixture is poured into the central cavity to enclose the simulated vasculature 78 but not to leak beyond the cavity, thereby forming the middle gel layer 82 as shown in FIG. 10E. All of the components are cured in an oven at approximately 60° C. for approximately 35 minutes. The middle gel layer 82 is also clear when cured, thus allowing the simulated blood vessels 78 and the simulated tumor 80 to be visible through the middle gel layer 82. Approximately 35 grams of Part A and 35 grams of Part B of 10A durometer silicone are mixed together. Silicone is cast onto the cured gel and sides of the model to form a second outer layer 84. The model is then cured in an oven at about 60° C. for about 25 minutes. The second outer layer 84 is also transparent, allowing the embedded landmarks in the gel layer 82 and outer layer 84 combination, such as the simulated tumor 80 and the simulated blood vessels 78, to be visible through the layers 66, 82, 84. The excess perimeter of the silicone sheet sandwich is trimmed off to give the model dimensions of about 4 inches by 5 inches (10.16 cm by 12.7 cm) and the middle gel layer 82 is encapsulated by the two surrounding outer layers 66, 84. The perimeter of the model is made of the two outer layers 66, 84 attached together with no middle gel layer 82 between them to prevent leakage of the gel layer 82 from the model. The outer layers 66, 84 serve to seal and encapsulate the gel middle layer 82. Referring to Figures 10G and 10H, four holes 86 are drilled into the corners of the rectangular model and the model is placed on upright pegs 88 of a simulated tissue platform 90 so that it can float like a trampoline and allow dissection to be practiced.The simulated tissue model of Figures 10A-10H is a model of the vasculature in the vicinity of the gallbladder and may be considered a partial gallbladder model, which may or may not include a simulated gallbladder. In use, the model is suspended on a platform 90 or forms part of a larger organ model or organ tray, and placed in a surgical simulation and / or training device for a physician to train a surgical procedure on the model. The model may also be used outside of the simulation and / or training device. Still referring to Figure 11, the physician cuts into the second outer layer 84 to enter the middle gel layer 82. The physician spreads the second outer layer 84 away from the first outer layer 66, thereby accessing the implanted structures, the simulated blood vessel 78 and the simulated tumor 80. In doing so, the physician may need to separate or cut open the middle gel layer 82. The middle gel layer 82 is soft, shiny, and elastic. Upon lifting the second outer layer 84, the soft elastic gel of the intermediate layer 82 advantageously resembles a fibrous membrane as it stretches when the second outer layer 84 is moved away from the first outer layer 66. As the intermediate gel layer 82 stretches, it advantageously opens into a deep pocket with the strands of gel 92 remaining interconnected between the two layers where the surgeon practices cutting through the strands of gel. Blunt or sharp dissection of the soft silicone gel follows to open a space, thereby creating a dissection plane through the intermediate gel layer 82 and between the first outer layer 66 and the second outer layer 84. The anterior layers may also be cut and divided to provide further visibility of structures such as the simulated vasculature 78 embedded within the intermediate gel layer 82, thereby simulating skeletonization.

[0042] Next, an organ model 200 according to another embodiment of the present invention will be described with reference to Figures 12 to 15. The organ tray model 200 includes all of the features described with reference to Figures 2 to 6, which are associated with the right colon model 26, and further includes features of the left colon model including one or more of the following simulated anatomical structures: a simulated spleen, a simulated descending colon, a simulated sigmoid colon, a simulated intestine, a simulated transverse colon, a simulated rectum, a simulated left ventral wall, a simulated left linea alba of the tort, a simulated aorta, a simulated left kidney, a simulated pancreas, a simulated nerve, a simulated fascia / cavity of the tort between the mesentery and the retroperitoneal space, a simulated left ureter, a simulated gonadal vessel, a simulated prostate, a simulated seminal vesicle, a simulated urethra, a simulated bladder, a simulated mesentery, a simulated Danon-Villiers fascia, a simulated pelvis, a left internal mesenteric vein and vessel, and a plastic base. The simulated anatomical structure 202 is supported on an optional platform 204, which is disposed within a base 206 and covered with an outer simulated epidermal layer 208. The platform 204 has a number of holes 209 for receiving fasteners, such as rivets 226, which are associated with the simulated anatomical structure 202 and configured to snap into the holes 209 to releasably couple the simulated anatomical structure 202 to the platform 204. The addition of the epidermal layer 208 can simulate an open procedure. An incision 211 is placed in the epidermal layer 208 as shown in FIG. 14A, and then retracted to expose the simulated anatomical structure 202 as shown in FIG. 14B and FIG. 15. The model 200 allows a user to practice a total mesenteric excision (TME) using an open or laparoscopic surgical technique. For simulated laparoscopic surgery, the model 200 without the epidermal layer 208 is placed into the cavity 18 of the training device 10. To practice open procedures, the legs 16 of the training device 10 are removed and the top cover 12 is placed directly onto the base 14 to reduce the size and height of the cavity 18 with the model 200 located between the top cover 12 and the base 14. A silicone wall insert is placed into the large aperture 20 in the top cover 12.In another configuration for practicing the open procedure, the legs 16 of the trainer device 10 are modified to shorten the length, thereby reducing the height of the cavity 18 between the top cover 12 and the base 14. In yet another configuration for practicing the open procedure, the top cover 12 of the trainer device 10 is removed and a silicone sheet is placed over the model 200 disposed within the base 14. A silicone sheet 208 simulating an epidermis layer is also placed over the base 14 and the sidewalls of the base 14, for example as shown in FIG.

[0043] 16 and 17, a portion of a simulated intestine 210 including a simulated ascending colon 216, a simulated transverse colon 218, and a simulated descending colon 220 is shown along with a right simulated tort white line 212 and a left simulated tort white line 214. Although both the right simulated tort white line 212 and the left simulated tort white line 214 are shown in FIG. 16, the model 200 may include only both or only one of the right or left tort white lines. FIG. 17 is a cross-sectional view focused on the left tort white line 214. The right tort white line 212 is substantially identical for the right side of the model 200. The simulated peritoneal layer 222 overlies the intestine 210 and is joined to a simulated mesenteric layer 224 from the bottom of the intestine 210 to form a simulated left tort white line 214, which is then connected to the side walls by fasteners, e.g., 226, inserted through apertures 209 in the side walls of the platform 204. At least a portion of the simulated mesenteric layer 224 has a first layer 228 of silicone and a second layer 230 of silicone separated by a third layer 232 of polyfill fibrous material to create a sandwich layer as described in detail in U.S. Provisional Patent Application No. 62 / 193,143, filed July 16, 2015.

[0044] The polyfill layer is comprised of a plurality of one or more non-aligned randomly arranged non-woven fibers that may or may not be connected to one or more adjacent silicone layers at one or more locations along the length of the fibers. The fibers are connected to one or more of the first and second layers by being embedded in one or more of the first and second layers during a manufacturing process described in detail below. Each fiber may be in the form of a strand, filament, yarn, microfiber, or the like, each fiber having a length and at least a first end and a second end. An adhesive may or may not be used to connect the fibers. The fibers of the third layer are located in a randomly arranged manner within the gap between the first and second layers. For example, a strand of fiber may be connected to a first layer at one location and then connected again to the first or second layer at another location along the length of the fiber, with its free end either embedded or not embedded in the first or second layer. Several strands of fiber may not be connected to the first or second layer, but are freely disposed between the first and second layers. Several strands of fiber are loosely intertwined and twisted with other strands so that they can move relative to the other strands. The fiber may span a gap to be connected to the opposite or second layer at one or more locations along the length of the fiber. A single fiber strand can be used to construct the third layer instead of multiple fiber strands. A single fiber strand has a long length to fill and create gaps between layers compared to using a shorter strand to fill the same gap. Although the term polyfill is used throughout the specification, the composition is not limited to polyester.The fibers may be selected from any suitable material, such as polyester, polyamide, acrylic, acetate, polyolefin, cotton, fiberfill, wadding, polyethylene terephthalate, polyethylene naphthalate, nylon, polyfil, fiberfill, polymer, plastic, spandex or other suitable fibers, natural fibers, non-absorbent fibers, synthetic fibers or fibrous materials, but such fibers are still referred to as polyfill. Such materials may be woven, non-woven, or partially woven. Fiberfill / polyfill is typically made by garnetting, in which a garnetting machine receives the fibers and combs them into a batt. The garnetting machine then bends and cuts the fibers, thereby creating short, yet clumped strands. The fibers entangle, intertwine, and bundle together. The fibers advantageously provide the appearance of shiny tissue, especially when viewed on a video monitor with a laparoscopic image capture device, as light is reflected in many directions from the shiny fibers which mimics living tissue in a wet state.

[0045] 18A-18C, the white lines 212, 214 of the simulated tort are created by placing two thin layers 234a, 234b of flat silicone on top of each other as shown in FIG. 18A. The bottom layer 234b is a polyfill sandwich layer with a third layer 232 of polyfill placed between the first silicone layer 228 and the second silicone layer 230 to simulate the fascia of the tort. A narrow strip 236 is removed from both layers 234a, 234b by making two juxtaposed cuts as shown in FIG. 18A. A layer 238 of white silicone simulating the white lines of the tort is deposited across the gap created by the removal of the narrow strip 236 and allowed to harden as shown in FIG. 18B. As a result of this construction, four layers, two each of the first silicone layer 234a and the second silicone layer 234b, are attached to each other by the white layer of silicone 238, as shown in Fig. 18C. The first layer 234a and the second layer 234b of silicone on one side of the white line 238 of the simulated tort form the simulated peritoneum layer 222 and the simulated mesentery 224, respectively, and these layers 234a, 234b are connected to the colon by adhesive, and the first layer 234a and the second layer 234b of silicone on the other side of the white line 234 of the simulated tort are attached to the sidewall of the platform 204 by fasteners, e.g., plastic rivets 226, inserted into holes 209 in the platform 204. Layer 222 may also be attached to the sidewall on the other side near the right colon using silicone, fasteners, rivets, or cyanoacrylate adhesive.

[0046] In one form, the simulated mesentery 224 is comprised of a gel sandwich of three layers, a top layer 48 of silicone, a bottom layer 50 of silicone, and a middle layer 54 of gel, which encapsulates a simulated blood vessel 44 made of silicone or the like between the top and bottom layers as described herein and shown in FIG. 19. In another form, shown in FIG. 20, the simulated mesentery layer 224 has a first layer 228 of silicone and a second layer 230 of silicone with a third layer 232 of polyfill fabric located between the first and second layers. The first layer 228 of silicone is attached to the bottom layer 50 of silicone by an adhesive 240, which together with the top layer 48 of silicone sandwiches the middle layer 54 of gel. The middle layer 54 of gel may encapsulate a simulated blood vessel 44 made of silicone. In yet another embodiment shown in FIG. 21, a top layer 48 of silicone and a bottom layer 50 of silicone sandwich a middle layer 54 of gel, which may encapsulate a simulated blood vessel 44 made of silicone. The bottom layer 50 is joined to a second layer 230 of silicone to sandwich a third layer 232 of polyfill fabric therebetween. In yet another embodiment shown in FIG. 22, a first layer 228 of silicone is joined to a second layer 230 of silicone to sandwich a third layer 232 of polyfill therebetween. A top layer 48 of silicone is provided, with a simulated blood vessel 44 disposed between the top layer 48 and the first layer 228. The simulated blood vessel 44 is attached to the first layer 228 by an adhesive 240, but not to the top layer 48. The top layer 48 is also attached to the first layer 228 by adhesive 240 applied to selected areas between the simulated blood vessels 44, for example as shown in FIG. 22. In this configuration, there is no intermediate layer of gel. In another configuration, the first and second layers 228 and 230 of silicone have a third layer 232 of polyfill disposed therebetween. The top layer 48 of silicone has an intermediate layer 54 of polyfill between the top layer 48 and the first layer 228, with the silicone simulated blood vessel 44 disposed between the top layer 48 and the first layer 228.Also, a bottom layer 50 may be provided between the middle layer 54 of polyfill and the first layer 228 of silicone. The configurations shown in Figures 19-22 are configurations that simulate the tort's fascia / cavity between the mesentery and the retroperitoneal space. The cavity is defined by two silicone layers, with a third layer 232 of polyfill located between the two silicone layers. The configurations in Figures 20-22 show the configuration of the combination of the tort's fascia 242 and the mesentery 224. Within the fascia layers, a simulated ureter, a simulated genital vessel, a simulated duodenum, and a simulated nerve bundle may be located.

[0047] 23, there is shown a simulated aorta 40, preferably made of red dyed silicone. A simulated nerve bundle 244, made of yellow dyed silicone, is provided and attached to the simulated aorta 40 as shown. The simulated nerve bundle 244 has a number of openings 246. In one form, the simulated nerve bundle 244 fits over the aorta within the cavity of Tolt's fascia 242 in the polyfill area. In one form, the color of the simulated nerve bundle 244 is not yellow.

[0048] Referring now to FIG. 24, the model 200 has a lower pelvic portion. After practicing mobilization of the right or left colon, the user can practice incising into the pelvic region to remove the simulated mesorectum 262. FIG. 24 shows an approximate midline cross section of the pelvic region of the model 200. The model 200 has a plastic sheet 248 located anteriorly configured to simulate the pubic bone. The plastic sheet 248 reduces the working space the user must practice in. The anatomical structure above the simulated rectum 250 includes a simulated prostate system 252. The simulated prostate system 252 includes a simulated prostate 254, a simulated seminal vesicles 256, a simulated bladder 258, a simulated urethra, and a simulated vas deferens. The simulated urethra and the simulated vas deferens are made of silicone formed into solid or hollow tubes. The simulated seminal vesicles 256 are made of urethane foam or other foam or material overmolded onto the simulated vas deferens. The simulated prostate 254 is made of urethane foam or other foam or material coated onto the simulated urethra. The simulated prostate system 252 is connected to the plastic sheet 248 by fasteners, such as rivets 226, inserted through holes 209 in the plastic sheet 248. A plastic base 260 is provided at the rear of the model 200. The plastic base 260 creates a confined space for practicing surgical procedures. The simulated rectum 250 has a cylindrical shape of silicone surrounded by a simulated mesorectal layer 262. Another layer or tube 264 of silicone is provided, which includes an inner layer 266 of polyfill fiber. The surgeon practices cutting the polyfill fiber layer 266 to mobilize a portion of the simulated rectum 250. The simulated rectum 250 is connected to the base 260 by fasteners, such as rivets 226, inserted through holes 209 in the plastic base 260. The rivet 226 is attached to the second layer or tube 264 to provide the user with space to enter and cut open the polyfill layer 266 to remove the simulated rectum 250 and simulated mesorectum 262 .

[0049] The specification of International Application No. PCT / US2015 / 022774 (title: Simulated dissectible tissue), filed on March 26, 2015, is incorporated herein by reference in its entirety. The specification of International Application No. PCT / US / 2016 / 041852 (title: Simulated dissectible tissue), filed on July 12, 2016, is incorporated herein by reference in its entirety.

[0050] It will be appreciated that various modifications may be made to the embodiments of the dissectable simulated tissue disclosed herein. Thus, the above description should not be construed as limiting the invention, but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications that are within the scope and spirit of the invention.

Claims

1. 1. A dissectable simulated tissue structure for surgical training, comprising: a top layer of silicone having an upper surface and a lower surface, the top layer defining a thickness between said upper surface and said lower surface; a bottom layer of silicone having an upper surface and a lower surface, the bottom layer defining a thickness between said upper surface and said lower surface; a middle layer disposed between the top layer and the bottom layer; a first layer of silicone having an upper surface and a lower surface, the first layer defining a thickness between the upper surface and the lower surface; a third layer of polyfill disposed between the first layer and the bottom layer to form a multi-layer structure; a second layer of silicone having an upper surface and a lower surface; the second layer is bonded to the multi-layer structure to form a bond along the entire length of the white strip of silicone; A dissectable simulated tissue structure.

2. the contact area on one side of the outer side of the joint, the second layer, and the multi-layer structure are connected to a portion of a simulated intestine; The dissectable simulated tissue structure of claim 1 .

3. The portion of the simulated intestine comprises a simulated ascending colon and a simulated descending colon. The dissectable simulated tissue structure of claim 2.

4. the contact area on one side of the joint, the second layer, and the multi-layer structure are connected to a frame; The dissectable simulated tissue structure according to claim 2 or 3.

5. the frame includes one or more fastener locations; The dissectable simulated tissue structure of claim 4.

6. the second layer and the multi-layer structure are connected to the frame via a connection of one or more fasteners to the one or more fastener locations; The dissectable simulated tissue structure of claim 5.

7. the one or more fasteners are rivets and the one or more fastener locations are holes formed in the frame to receive the rivets. The dissectable simulated tissue structure of claim 6.

8. a third layer of polyfill coupled to at least one of the first layer and the bottom layer; The dissectable simulated tissue structure according to any one of claims 1 to 7.

9. the intermediate layer is configured to surround at least one simulated tube, the at least one simulated tube being made of silicone; The dissectable simulated tissue structure according to any one of claims 1 to 8.

10. The at least one simulated tract comprises one or more of a simulated ureter, a simulated reproductive tract blood vessel, a simulated duodenum, and a simulated nerve bundle. The dissectable simulated tissue structure of claim 9.

11. The intermediate layer is made of a gel or polyfill layer. The dissectable simulated tissue structure according to any one of claims 1 to 10.

12. the third layer of polyfill being in the form of a strand, filament, yarn, or microfiber having a length and first and second ends; A dissectable simulated tissue structure according to any one of claims 1 to 11.

13. some of the strands of fiber are embedded in the first and bottom layers at one or more locations along the length of the fiber, and their first and second free ends may or may not be embedded in the first or bottom layers; some of the other fibers are freely disposed between the first and second layers without being connected to the first or bottom layers; the other fibers are entangled and intertwined with the other fiber strands in a loose manner such that the other fiber strands can move freely; The dissectable simulated tissue structure of claim 12.

14. the strands of fiber are selected from the group consisting of polyester, polyamide, acrylic, acetate, polyolefin, cotton, fiberfill, wadding, polyethylene terephthalate, polyethylene naphthalate, nylon, polyfill, polymers, plastics, spandex, natural fibers, non-absorbent fibers, and synthetic fibers; The dissectable simulated tissue structure according to claim 12 or 13.

15. the white stripe of silicone, the second layer, and the multi-layer structure respectively represent a combination of a white tort, a simulated peritoneal layer, a simulated mesentery, and a simulated tort fascia; A dissectable simulated tissue structure according to any one of claims 1 to 14.

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