TY - BOOK
T1 - Entwicklung und Validierung eines neuartigen Simulators für die kranio-maxillofaziale Chirurgie
AU - Hollensteiner, Marianne
PY - 2017
Y1 - 2017
N2 - To avoid injuries of the patient during standard bone machining procedures a surgeon has
to apply appropriate forces and speeds with the surgical instruments. Extensive training
would be necessary to maintain a high quality health care system. Traditionally the education
happens by watching a surgical procedure and gaining first hands-on experience
under supervision of an experienced surgeon or during training on human and animal
specimens, live animals and simulators. The risk for the patient during “first hands on”
surgeries led to the development of new training tools. Model-based simulators with a
sufficient degree of realism, either haptical and anatomical provide a safe training environment
for surgical trainees. Taking grafts from the skull vault is an accepted standard
practice and popular in facial-skeletal surgery to treat traumatic, reconstructive and even
cosmetic deformities. Machining instruments are typically used to harvest these calvarial
grafts. To reach a high degree of accuracy of an artificial skull model artificial bones
were biomechanically validated. Measurements with real machining tools, penetrating all
bony layers, were performed on autoclaved human parietal bone specimens. The skull
layers were penetrated perpendicularly while forces were recorded. Based on these results
appropriate materials for artificial skull bones were developed. First, two-layered
blocks were created and tested. Second, a manufacturing process was determined and
three-layered skulls were manufactured and tested to exclude material property changes
due to the manufacturing process. Micro-computed tomography was used to determine
the cortical and cancellous bone layer thickness of human and artificial bones. These
measurements were also used as a reference to adjust the bone layer thickness in the
manufacturing process. A suitable skull-cap model was covered with an artificial scalp.
Within a pilot study, this model-based simulator was tested by experienced surgeons. Appropriate
material mixtures for artificial parietal bones were identified based on penetration
measurements on autoclaved human specimens. The artificial skull caps which were
made of these materials were able to mimic human bone layers. Apart from the milling
the artificial bone provided a realistic tactile feedback during surgical machinal instrumentation
in comparison to the human reference. All procedural steps could be performed
realistically with the simulator as reported by the surgeons. Both surgeons confirmed the
suitability of the prototype as a valid educational tool for surgical residents. In conclusion,
an artificial bone has been created which reflected the properties of human parietal bone
and thus is suitable for tabula externa graft lift training. The grafting simulator presented
in this study can contribute to the education of surgeons performing grafting procedures
on the human parietal bone.
AB - To avoid injuries of the patient during standard bone machining procedures a surgeon has
to apply appropriate forces and speeds with the surgical instruments. Extensive training
would be necessary to maintain a high quality health care system. Traditionally the education
happens by watching a surgical procedure and gaining first hands-on experience
under supervision of an experienced surgeon or during training on human and animal
specimens, live animals and simulators. The risk for the patient during “first hands on”
surgeries led to the development of new training tools. Model-based simulators with a
sufficient degree of realism, either haptical and anatomical provide a safe training environment
for surgical trainees. Taking grafts from the skull vault is an accepted standard
practice and popular in facial-skeletal surgery to treat traumatic, reconstructive and even
cosmetic deformities. Machining instruments are typically used to harvest these calvarial
grafts. To reach a high degree of accuracy of an artificial skull model artificial bones
were biomechanically validated. Measurements with real machining tools, penetrating all
bony layers, were performed on autoclaved human parietal bone specimens. The skull
layers were penetrated perpendicularly while forces were recorded. Based on these results
appropriate materials for artificial skull bones were developed. First, two-layered
blocks were created and tested. Second, a manufacturing process was determined and
three-layered skulls were manufactured and tested to exclude material property changes
due to the manufacturing process. Micro-computed tomography was used to determine
the cortical and cancellous bone layer thickness of human and artificial bones. These
measurements were also used as a reference to adjust the bone layer thickness in the
manufacturing process. A suitable skull-cap model was covered with an artificial scalp.
Within a pilot study, this model-based simulator was tested by experienced surgeons. Appropriate
material mixtures for artificial parietal bones were identified based on penetration
measurements on autoclaved human specimens. The artificial skull caps which were
made of these materials were able to mimic human bone layers. Apart from the milling
the artificial bone provided a realistic tactile feedback during surgical machinal instrumentation
in comparison to the human reference. All procedural steps could be performed
realistically with the simulator as reported by the surgeons. Both surgeons confirmed the
suitability of the prototype as a valid educational tool for surgical residents. In conclusion,
an artificial bone has been created which reflected the properties of human parietal bone
and thus is suitable for tabula externa graft lift training. The grafting simulator presented
in this study can contribute to the education of surgeons performing grafting procedures
on the human parietal bone.
M3 - Doctoral Thesis
ER -
