Entwicklung und Validierung eines neuartigen Simulators für die kranio-maxillofaziale Chirurgie

Marianne Hollensteiner

Entwicklung und Validierung eines neuartigen Simulators für die kranio-maxillofaziale Chirurgie

Marianne Hollensteiner

Publikation: Typen von Abschlussarbeiten › Dissertation

Abstract

Die maschinelle Bearbeitung von Knochen ist ein Standardverfahren in der Chirurgie. Um Patientenschäden zu vermeiden, müssen vom Chirurgen entsprechende Kräfte und Geschwindigkeiten bei der Handhabung von chirurgischen Instrumenten eingesetzt werden. Traditionell findet die chirurgische Ausbildung im Operationssaal statt, in welchem eine Operation beobachtet, assistiert und dann erste praktische Erfahrungen unter der Aufsicht eines erfahrenen Chirurgen gemacht werden können. Das Risiko für den Patienten während dieser ”learning by doing”-Chirurgie ist sehr hoch. Modell-basierte Simulatoren mit realistischer Anatomie und Haptik bieten eine sichere Trainingsumgebung für chirurgische Novizen. Die Entnahme von Transplantaten aus der Schädelkalotte ist eine anerkannte Standard-Praxis und beliebt in der Schädel-Gesichtschirurgie. Schnell drehende Instrumente werden typischerweise verwendet, um Kalvarialtransplantate zu heben. Um einen hohen Realitätsgrad eines künstlichen Schädelmodells zu erreichen, wurden künstliche Knochen entwickelt und biomechanisch validiert. Die biomechanischen Messungen erfolgten mit realen Instrumenten und wurden an autoklavierten parietalen Knochenproben durchgeführt. Bei den Messungen wurden alle Schädelschichten senkrecht durchdrungen und dabei die Insertionskräfte verschiedener Instrumente aufgezeichnet. Basierend auf diesen Ergebnissen wurden schrittweise geeignete Materialien für künstliche Schädelknochen entwickelt. Zuerst wurden zweischichtige Blöcke entwickelt und getestet. In weiterer Folge wurde ein Herstellungsverfahren bestimmt und damit dreischichtige künstliche Schädelkappen entwickelt. Mikro-Computertomographie-Bilder aller Präparate wurden aufgenommen, um die Schichtdicken der Knochen zu bestimmen. Die Ergebnisse wurden zur Einstellung der Knochenschichtdicken der künstlichen Schädelkalotten während des Herstellungsverfahrens herangezogen. Ein mechanisch validiertes Schädelkappen- Modell wurde mit einer künstlichen Kopfhaut bedeckt und in einer Pilotstudie wurde dieser neue, modell-basierte Simulator von erfahrenen Chirurgen getestet. Abgesehen vom Fräsvorgang bietet der künstliche Knochen ein realistisches taktiles Feedback während eines maschinellen Eingriffs. Erfahrene Chirurgen bestätigen, dass alle Verfahrensschritte mit dem Simulator realistisch durchgeführt werden konnten und der Prototyp somit als Ausbildungsinstrument für chirurgische Novizen geeignet ist. Zusammenfassend wurde ein künstlicher Schädelknochen entwickelt, welcher die Eigenschaften des menschlichen Parietalknochens widerspiegelt und sich somit für ein Training zum Heben eines Tabulaexterna- Transplantats eignet. Der Simulator kann in Zukunft einen wichtigen Beitrag zur Ausbildung von Chirurgen leisten.

Originalsprache	Englisch
Publikationsstatus	Veröffentlicht - 2017

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title = "Entwicklung und Validierung eines neuartigen Simulators f{\"u}r die kranio-maxillofaziale Chirurgie",

abstract = "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.",

author = "Marianne Hollensteiner",

year = "2017",

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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 -

Entwicklung und Validierung eines neuartigen Simulators für die kranio-maxillofaziale Chirurgie

Abstract

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