Developing a Realistic Model for the Training of the Laparoscopic Nissen Fundoplication

Abstract

A realistic human anatomy simulation model developed for training to perform laparoscopic Nissen fundoplication (antireflux surgery) could reduce the need and use of animal tissue models. This article elaborates the designing process of this model and the development process used to create the abdominal organs with realistic haptic feedback. Before developing the artificial organs, first the mechanical characteristics of human tissue were examined. Next, separate animal organs that resembled these characteristics the closest was used to create the model. The haptic feedback of the intra-abdominal organs variables studied included tissue, geometry, and context. The stress-strain curves of the different tissues were calculated and compared with the properties of industrial materials to find the best material for the production of the organs. The aspects that influenced haptic feedback as determined above and used to select the most promising material groups were: E-modulus, density, coefficient of friction, sensitivity to tearing, wall thickness, and shelf life. Based on these criteria, silicone and latex materials mimiked human tissue best. Changeable velvet rope was used for connections of the organs to the surface and other simulated tissue. A reusable modular model of the upper abdomen anatomy with haptic properties was created for training of upper gastrointestinal surgery laparoscopic procedures, such as the Nissen fundoplication.