Computer Simulation of the Transanal Endoscopic Microsurgery for the Improvement of Optimal Operation Range

Ⅰ. 서 론

, ,

(Natural Orifice Transluminal Endoscopic Surgery, NOTES)

, , . [1,2]

NOTES

(Transanal Endoscopic Microsurgery, TEM) , (Rectoscope Tube)

,

( 1) ,

.[3,4] Wolf , Storz TEM ,

(40 mm) ,

,

. , TEM

김형태 ¹ , 김광기 ¹ , 남경원 ¹ , 김현호 ¹ , 손대경 ²

1

2

Computer Simulation of the Transanal Endoscopic Microsurgery for the Improvement of Optimal Operation Range

Hyung Tae Kim ¹ , Kwang Gi Kim ¹ , Dae Kyung Sohn ² , Hyun Ho Kim ¹ , Kyoung Won Nam ¹

1 Biomedical Engineering Branch, National Cancer Center

2 Center for Colorectal Cancer, National Cancer Center (Received June 17, 2009. Accepted November 23, 2009)

Conventional devices for transanal endoscopic microsurgery that are currently used clinically for intestine or rectal cancer patients have 40 mm external diameter of rectoscope tube - induces anal damage and long-term postoperative pain for small-sized patients. In this paper, we designed rectum and rectoscope models and calculated the changing trends of operation area of the surgical tools in accordance with the step-by-step variation of design parameters of the rectoscope tube - external diameter, axial length, and distal angle. Using the results of computer simulation, we suggested an optimal set of design parameters that minimizes external diameter of the rectoscope tube and at the same time, maintains similar operation area of the surgical tools compared with commercialized devices ( 4274.7mm ² ). The results of the simulation showed that the optimal design parameters were 35 mm external diameter, 100 mm axial length, and 45˚ distal angle of the rectoscope tube. This result can be applied to the development of endoscopic microsurgery device that can minimize side effects to the intestine or rectal cancer patients.

Transanal Endoscopic Microsurgery, Rectoscope Tube, Computer Simulation

Corresponding Author :

(410-769)

111

Tel : +82-31-920-2241 / Fax : +82-31-920-2242 E-mail : kimkg@ncc.re.kr

본 연구는

2009

(

: 0810122, 0910520)

(KRF-2009-0074628)

.

이 논문은

2009

(

)

(KRF-2009-0074628).

이 논문은 국립암센터 기관고유지원사업의 지원을 받아 수행된 연구임

(0810122).

, TEM

. , ,

. ,

,

. TEM

TEM

,

.

,

.

Ⅱ. 재료 및 방법

TEM 2

(Rectoscope Tube) ,

CO 2 (suction port) (Housing),

(endoscope port) (instrument

port) (Working Insert) [5].

TEM

이산화탄소 포트 및 흡입구 (CO

, suction port)

직장경 (Rectoscope tube)

틀 (Housing)

핸들 (Handle)

기구 삽입부 (Working insert)

내시경 삽입구 (Endoscope port)

기구 삽입구 (Instrument port)

그림 2. 현재 임상에 사용 중인 TEM 시술 장비의 각부 명칭 (Wolf 社 ) Fig. 2. Structure of the clinically applied TEM surgical device

CO

삽입구

광원

내시경

흡입기구 수술기구 직장경

기구 고정 링크

그림 1. 경항문 내시경 미세수술법 (Transanal Endoscopic Microsurgery, TEM) (http://blog.naver.com/dohjt?Redirect=Log&logNo=20056643308)

Fig. 1. Concept of the Transanal Endoscopic Microsurgery(TEM)

, , , . ,

,

,

, TEM

,

10 mm ( 3(a)). ,

CO 2

60 mm

, 1 mm

. , TEM

5 mm, 405 mm . ,

, (zoom)

,

.

,

(A), (B),

(C) ( 3(b)),

3

. TEM

, .

TEM

, (A) 30 ~ 40 mm

1 mm , (B) 100 ~ 140

mm 5 mm , (C) 0° ~

45° 5° ( 1).

TEM (rectum)

, 50

mm, 130 ~ 150 mm [6].

,

. ,

150 mm ,

50 mm . , TEM

, TEM

(a) (b)

그림 3. 시뮬레이션에 사용된 설계 인자 설정 (a) 기구 삽입구 위치 설정 , (b) ^{가변 인자 설정} Fig. 3. Setting of design parameters used in simulation (a) Position of instrument ports, (b) Setting of adjustable design parameters

Storz 社 Wolf 社 제안된 모델

외경(mm) 40 40 30~40

축방향 길이(mm) 150 120-200 100~140

말단부 각(°) 30 45 0~45

표 1. 기존 제품들과 시뮬레이션 모델의 직장경 설계 치수 비교

Table 1. Comparison of design parameters between clinically applied devices and proposed model

80 mm

( 4).

TEM

CATIATM V5 (Dassault Systemes HQ, Velizy-Villacoublay,

France) TEM 3

,

( 5). 5

. TEM

,

. ,

. , TEM

4274.7 mm ² ,

[7]

.

Ⅲ. 결 과

6

. 6(a)

100 mm, 45˚

,

6(b) 40 mm, 45˚

. . 6(c)

괄약근

TEM 장치

그림 4. 시술 가능 영역 계산을 위한 직장 및 TEM 장비 모델 설정 Fig. 4. Rectum and TEM device models for operation area calculation

직장

TEM 장치

수술 도구

수술 도구의 활동 영역 시술 가능 영역

그림 5. CATIA ^TM V5 를 이용한 시술 가능 영역 추출

Fig. 5. Extraction of the operation area of surgical tools using CATIA ^TM V5

.

0˚ 45˚ 5˚ ,

.

,

. ,

40 mm, 100 mm, 45°

,

8169.3 mm ² .

(45°) ,

2 . ,

(a) (b)

(c)

그림 6. 가변 인자 수치 변경에 따른 시술 가능 영역 면적 변화 양상

Fig. 6. Changing trend of the operation area in accordance with the parameter adjustment

축방향 길이 (mm)

100 105 110 115 120 125 130 135 140

외경 (mm)

30 1516.2 1276.7 1053.8 848.29 660.66 491.36 341.38 212.2 106.51

31 2070 1808.6 1564 1333.9 1119.2 920.14 736.77 569.72 419.14

32 2684.5 2405.8 2141.5 1892.4 1656.2 1433.8 1225.2 1030.5 849.38

33 3357.7 3064.8 2785 2519.5 2265.7 2024.4 1795.4 1579 1374.5

34 4053.8 3767.3 3486.7 3211.3 2944.3 2687.5 2442.1 2208.1 1984.8

35 4740.7 4464 4192.8 3927.3 3666.4 3411.7 3160.6 2913.9 2675.4

36 5423.8 5156.6 4894.7 4638 4386.4 4139.1 3897.9 3659.3 3425

37 6109 5850.6 5597.6 5349.4 5105.9 4867.4 4634.7 4404.2 4177.8

38 6803.2 6552.5 6307.4 6067.1 5831.6 5601.1 5374.8 5153.7 4934.9 39 7502.7 7267.2 7031.7 6798.5 6570.1 6346.5 6127.1 5912.3 5702.5

40 8169.3 7957.6 7745.4 7533.9 7322.7 7111.2 6900 6691.1 6488.3

표 2. 직장경의 말단부 각이 최대인 경우 외경과 길이 변화에 따른 시술 가능 영역 면적

Table 2. Operation area of surgical tools in accordance with the adjustment of external diameter and axial length of the rectoscope tube when distal angle of the

tube is maximal value

A=35 mm, B=100 mm, C=45°

.

Ⅳ. 토 의

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[8]

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V. 결 론

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참고문헌

[1] M.H. Sodergren, J. Clark, T. Athanasiou, J. Teare, G.Z. Yang, and A. Darzi, “Natural orifice translumenal endoscopic surgery:

critical appraisal of applications in slinical practice,” Surg Endosc, vol. 23, no. 4, pp. 680-687, 2009.

[2] S.V. Delius, S. Gillen, E. Doundoulakis, A. Schneider, D.

Wilhelm, A. Fiolka, S. Wagenpfeil, R.M. Schmid, H. Feussner, and A. Meining, “Comparison of transgastric access techniques for natural orifice transluminal endoscopic surgery,” GASTRO- INTESTINAL ENDOSCOPY, vol. 68, no. 5, pp. 940-947, 2008.

[3] Y. Yamashita, T. Sakai, T. Maekawa, T. Shirakusa, “Clinical use of a front lifting hood rectoscope tube for transanal endoscopic microsurgery,” Surg Endosc, vol. 12, no. 2, pp. 151-153, 1998.

[4] S.G. de la Fuente, E.J. Demaria, J.D. Reynolds, D.D Portenier, and A.D. Pryor, “New Developments in Surgery:Natural Orifice Transluminal Endoscopic Surgery(NOTES),” Arch Surg, vol.

142, no. 3, pp. 295-297, 2007.

[5] M. Boebel, D. Metsch, J.M. Ramirez Rodriguez, G.F. Buess, “ Medical instrument, in particular a rectoscope,” US patent US6,458,077, 2002.

[6] http://info.ncc.re.kr/cancer/cancer_is/01/1190422_2853.html [7] Richard Wolf GmbH. Instructions for TEM combination system,

2003.

[8] S. Can, A. Fiolka, D. Wilhelm, M. Burian, S.V. Delius, A.

Meining, A. Schneider, and H. Feussner, “Set of instruments for

innovative, safe and sterile sigmoid access for natural-orifice

transluminal endoscopic surgery,” Biomed Tech, vol. 53, no. 4,

pp. 185-189, 2008.