US20130066328A1 - General uterine manipulator and system - Google Patents
General uterine manipulator and system Download PDFInfo
- Publication number
- US20130066328A1 US20130066328A1 US13/625,255 US201213625255A US2013066328A1 US 20130066328 A1 US20130066328 A1 US 20130066328A1 US 201213625255 A US201213625255 A US 201213625255A US 2013066328 A1 US2013066328 A1 US 2013066328A1
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- Prior art keywords
- fitting
- uterine manipulator
- general uterine
- screw thread
- hole
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/42—Gynaecological or obstetrical instruments or methods
- A61B17/4241—Instruments for manoeuvring or retracting the uterus, e.g. during laparoscopic surgery
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/42—Gynaecological or obstetrical instruments or methods
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
- A61B10/02—Instruments for taking cell samples or for biopsy
- A61B10/0291—Instruments for taking cell samples or for biopsy for uterus
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
- A61B2017/00464—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable for use with different instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
- A61B2017/00473—Distal part, e.g. tip or head
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/42—Gynaecological or obstetrical instruments or methods
- A61B2017/4216—Operations on uterus, e.g. endometrium
Definitions
- the present invention relates to a general uterine manipulator and system which may be used in general surgery, gynaecological or non-surgical procedures.
- the present inventor has invented numerous medical instruments which are currently in use in surgical and non-surgical procedures.
- One such instrument is described in International publication no. WO 2008/074054 which is used in various procedures including total laparoscopic hysterectomy.
- the instrument described in this publication comprises a tube provided with an integral funnel at one end and through which a uterine cannula can be inserted. Both the tube and the cannula are provided with longitudinal slots or cut outs that aid in visualising the rotational position of a distal end of the instrument when inserted into the vagina and also aid in gripping of the instrument.
- a general uterine manipulator comprising:
- an elongated hollow tube defining an internal passage and having opposite first and second ends;
- first screw thread being formed at the first end and the second screw thread being formed at the second end.
- the general uterine manipulator may comprise a first fitting having a screw thread arranged to engage the first screw thread, the first fitting also having an axial through hole and configured to receive an inner manipulator shaft.
- the first fitting is configured to apply increasing clamping force on a received inner manipulator when the first fitting a screw further into the first end.
- the general uterine manipulator may comprise a hydrotubation port in fluid communication with the internal passage wherein a fluid injected into or through the hydrotubation port is able to flow into the internal passage.
- the hydrotubation port is formed in the elongated hollow tube at a location near the first end and beyond the first screw thread.
- the hydrotubation port is formed in the first fitting and is in fluid communication with the axial through hole.
- the axial through hole may comprise a first length which opens onto an end of the first fitting distant the screw thread of the first fitting, and a second contiguous length wherein the first length has a first internal diameter and the second length has a second internal diameter which is greater than the first internal diameter; and wherein the hydrotubation port opens onto the second length of the axial through hole.
- the general uterine manipulator may comprise a second fitting having a threaded portion provided with a screw thread configured to engage the second internal thread on the elongated hollow tube and a body portion extending co-linearly from the threaded portion.
- the body portion comprises a tubular member which is open at one end distal the threaded portion and is closed at an end near to the threaded portion to form a cavity.
- the tubular member comprises a circumferential wall and at least one internal passage formed in the circumferential wall, the or each internal passage opening onto axially opposite ends of the circumferential wall.
- the body portion comprises a conically shaped portion with decreasing outer diameter in a taper direction being away from the threaded portion and wherein the conically shaped portion is provided with an external coarse screw thread.
- the second fitting is provided with an axial through hole.
- the general uterine manipulator may comprise an inner manipulator shaft, the shaft capable of being received in the axial through hole of the first fitting and the axial through hole of the second fitting and extending through the internal passage.
- a crest of the coarse screw thread is provided with a flattened surface wherein a line on the flattened surface is inclined relative to a central axis of the coarse screw thread in the taper direction.
- the coarse screw thread is a ball screw thread.
- the general uterine manipulator comprising a forceps holder supported on the elongated hollow tube and configured to be releasably lockable in a plurality of positions along the elongated hollow tube.
- the forceps holder comprises a first component seated on the elongated hollow tube and provided with a detent for gripping a finger hole of the forceps.
- the forceps holder comprises a locking nut engagable with the first component and arranged to releasably lock the first component in a fixed position along the elongated hollow tube when rotated in a first direction, and to release the second component to allow sliding motion along the elongated hollow tube when rotated in an opposite direction.
- general uterine manipulator comprising:
- an elongated hollow tube defining an internal passage and having opposite first and second ends;
- first screw thread being formed at the first end and the second screw thread being formed at the second end;
- first fitting having a screw thread arranged to engage the first screw thread, the first fitting also having an axial through hole;
- a second fitting having a threaded portion provided with a screw thread configured to engage the second internal thread on the elongated hollow tube and a body portion extending co-linearly from the threaded portion; and, an inner manipulator shaft arranged to extend through the axial through hole, the internal passage and the second fitting, the inner manipulator shaft having one end which is bent and protrudes from the second fitting.
- the general uterine manipulator comprises a resistance mechanism enabling the axial and rotational position of the inner manipulator shaft to substantially held in the absence of adjustment by a user of the manipulator.
- the resistance mechanism comprises clamp shells incorporated in the first fitting.
- the resistance mechanism comprises a bend in a portion of the inner manipulator shaft within the internal passage the bend being to an extent that the inner manipulator shaft bears against an inside surface of the tube.
- the general uterine manipulator comprises a hydrotubation port formed in the first fitting and in fluid communication with the axial through hole wherein a fluid injected into or through the hydrotubation port is able to flow into the internal passage.
- the axial through hole comprises a first length which opens onto an end of the first fitting distant the screw thread of the first fitting, and a second contiguous length wherein the first length has a first internal diameter and the second length has a second internal diameter which is greater than the first internal diameter; and the hydrotubation port opens onto the second length of the axial through hole.
- the second fitting comprises a threaded portion provided with a screw thread configured to engage the second internal thread on the elongated hollow tube and a body portion extending co-linearly from the threaded portion, the body portion having a frusto-conical shape with decreasing outer diameter in a direction away from the threaded portion and on which is provided an external coarse screw thread.
- the general uterine manipulator comprises a forceps holder supported on the elongated hollow tube and configured to be releasably lockable in a plurality of positions along the elongated hollow tube.
- the forceps holder comprises a first component seated on the elongated hollow tube and provided with a detent for gripping a handle of the forceps.
- the forceps holder comprises a locking nut engagable with the first component and arranged to releasably lock the first component in a fixed position along the elongated hollow tube when rotated in a first direction, and to release the second component to allow sliding motion along the elongated hollow tube when rotated in an opposite direction.
- the general uterine manipulator comprises a cervical funnel mounted on the tube.
- a general uterine manipulator system comprising:
- an elongated hollow tube defining an internal passage and having opposite first and second ends;
- first screw thread being formed at the first end and the second screw thread being formed at the second end;
- At least one first fitting the or each first fitting having a screw thread arranged to engage the first screw thread, the first fitting also having an axial through hole;
- each second fitting having a threaded portion provided with a screw thread configured to engage the second internal thread on the elongated hollow tube and a body portion extending co-linearly from the threaded portion;
- the at least one first fitting comprises one or both of: (a) a clamping first fitting configured to apply increasing clamping force on a received inner manipulator when the first fitting a screw further into the first end; and (b) a hydrotubation first fitting which has a hydrotubation port in fluid communication with the internal passage wherein a fluid injected into or through the hydrotubation port is able to flow into the internal passage; and wherein
- the at least one second fitting comprises one or both of: (c) a cervical second fitting in which its body portion is of a frusto-conical shape with decreasing outer diameter in a direction away from the threaded portion and is provided with an external coarse screw thread; and (d) a tubular second fitting in which its body portion comprises a tubular member which is open at one end distal the threaded portion of the second fitting and is closed at an end near to the threaded portion of the second fitting to form a cavity.
- tubular member of the tubular second fitting comprises a circumferential wall and at least one internal passage formed in the circumferential wall, the or each internal passage opening onto axially opposite ends of the circumferential wall.
- the general uterine manipulator system comprises an inner manipulator shaft arranged to extend through the axial through hole, the internal passage and the second fitting when the second fitting is the cervical second fitting, the inner manipulator shaft having one end which is bent and protrudes from the cervical.
- the general uterine manipulator system a resistance mechanism enabling the axial and rotational position of the inner manipulator shaft to substantially held in the absence of adjustment by a user.
- the general uterine manipulator system a forceps holder supported on the elongated hollow tube and configured to be releasably lockable in a plurality of positions along the elongated hollow tube.
- a medical instrument configured to facilitate a gynaecological procedure comprising:
- first and second end portions a body provided with opposite first and second end portions, the first end portion having a first opening and the second end portion having a second opening;
- a throughway extending between the first and second openings, the throughway arranged to enable the body to be supported on a shaft to facilitate insertion of one of the first and second end portions into a body cavity.
- first and second end portions are different in one or more of their shape, size and configuration.
- the first end portion is of a tubular configuration and has a first outer diameter.
- the second end portion is of a tubular configuration and has a second outer diameter that is different to the first outer diameter.
- the second end portion is of a frusto conical configuration.
- the first end portion is of a frusto conical configuration and has a first outer diameter.
- the second end portion is of a frusto conical configuration and has a second outer diameter that is different to the first outer diameter.
- each end portion of frusto conical configuration is provided with a lip that extends radially outward from an outer surface of the second end portion and for an arc of less than 360°.
- one or both of the first and second end portions is provided with an illumination device arranged to enable the emission of light from the respective end portion.
- the device comprises an illumination device arranged to enable the emission of light from the lip.
- the general uterine manipulator system comprises an illumination device arranged to enable the emission of light from an end of the tubular portion.
- the general uterine manipulator system comprises an illumination device arranged to enable the emission of light from an end of the cervical funnel.
- the general uterine manipulator system comprises an illumination device arranged to enable the emission of light from an end of the tubular second fitting.
- the general uterine manipulator system comprises a motor arranged to engage and rotate the cervical funnel.
- the general uterine manipulator system comprises a foot operated switch associated with the motor and switchable between a first position wherein the motor rotates in a clockwise direction and a second position wherein the motor rotates in an anti-clockwise direction.
- the cervical funnel has conical portion and a through hole formed in or near a large diameter end the conical portion.
- the large diameter end of the conical portion has an outwardly flared lip that extend for a part of the circumference of the conical portion and wherein the hole is formed in the lip.
- the general uterine manipulator system comprises an illumination device arranged to illuminate the through hole.
- a cervical funnel comprising a conical portion and a through hole formed in or near a large diameter end the conical portion.
- the funnel comprises the large diameter end of the conical portion has an outwardly flared lip that extend for a part of the circumference of the conical portion and wherein the hole is formed in the lip.
- the funnel comprises an illumination device arranged to illuminate the through hole.
- the illumination device comprises an annular light guide surrounding the through hole.
- a cervical funnel comprising a conical portion and a tube extending coaxially form a small diameter end of the conical portion, wherein an outer surface of the tube is profiled to mechanically engage a motor to facilitate rotation of the cervical funnel.
- the outer surface of the tube is provided with gear teeth arranged to enable mechanical engagement with the motor.
- the funnel comprises a through hole formed in or near a large diameter end the conical portion.
- the large diameter end of the conical portion has an outwardly flared lip that extend for a part of the circumference of the conical portion and wherein the hole is formed in the lip.
- FIG. 1 a is a representation of one embodiment of a general uterine manipulator in accordance with the present invention
- FIG. 1 b is a disassembled view of the general uterine manipulator depicted in FIG. 1 a;
- FIG. 2 is a longitudinal section view of the tube incorporated in the general uterine manipulator shown in FIGS. 1 a and 1 b;
- FIG. 3 is an isometric view of a tail screw incorporated in the general uterine manipulator shown in FIGS. 1 a and 1 b;
- FIG. 4 is a side view of the tail screw shown in FIG. 3 ;
- FIG. 5 is an end view of the tail screw shown in FIG. 3 ;
- FIG. 6 is an isometric view of a second form of tail screw that may be incorporated in the general uterine manipulator shown in FIGS. 1 a and 1 b;
- FIG. 7 is a side view of the tail screw shown in FIG. 6 ;
- FIG. 8 is an end view of the tail screw shown in FIG. 6 ;
- FIG. 9 a is a side view of a second fitting incorporated in the general uterine manipulator shown in FIGS. 1 a and 1 b;
- FIG. 9 b is a longitudinal section view of the second fitting shown in FIG. 9 a;
- FIG. 9 c is an isometric representation of the second fitting
- FIG. 10 a is a side view of a second form of setting fitting that may be incorporated in the general uterine manipulator depicted in FIGS. 1 a and 1 b;
- FIG. 10 b is an end view of the second fitting shown in FIG. 9 a;
- FIG. 10 c is an isometric view from one end of the second fitting
- FIG. 10 d is a isometric view from an opposite angle of the second fitting
- FIG. 11 is an isometric view of a forceps holder incorporated in the uterine manipulator
- FIG. 12 is an isometric view of an embodiment of the general uterine manipulator and associated system with additional fittings to enable performance of a total laparoscopic hysterectomy.
- FIG. 13 a is a side view of a cervical funnel incorporated in an embodiment of the general uterine manipulator shown in FIGS. 1 a and 1 b;
- FIG. 13 b is a longitudinal section view of the cervical funnel
- FIG. 13 c is an end view of the cervical funnel shown in FIGS. 13 a and 13 b,
- FIG. 14 a is an isometric representation of a vaginal plug incorporated in an embodiment of the general uterine manipulator shown in FIGS. 1 a and 1 b;
- FIG. 14 b is a section view of the vaginal plug shown in FIG. 14 a;
- FIG. 15 is a side view of a manipulator handle which may be incorporated in an embodiment of the general uterine manipulator;
- FIG. 16 a is a side view of a further from of second fitting that may be incorporated in the general uterine manipulator depicted in FIGS. 1 a and 1 b;
- FIG. 16 b is an end view of the second fitting shown in FIG. 16 a;
- FIG. 16 c is an isometric view from a first angle of the second fitting shown in FIG. 16 a;
- FIG. 16 d is a isometric view from a second angle of the second fitting shown in FIG. 16 a;
- FIG. 16 is a schematic representation of an illumination device incorporated in the second fitting shown in FIG. 16 a;
- FIG. 17 is a side view of a cervical funnel with an illumination device incorporated in a further embodiment of the general uterine manipulator;
- FIG. 17 b is a longitudinal section view of the cervical funnel shown in FIG. 17 a;
- FIG. 17 c is an end view of the cervical funnel shown in FIGS. 17 a and 17 b;
- FIG. 17 d is a schematic representation of the illumination device incorporated in the cervical funnel shown in FIGS. 17 a and 17 b;
- FIG. 18 is an isometric view of the general uterine manipulator shown in FIG. 12 but modified with the inclusion of a drive to enable powered rotation of an associated cervical funnel;
- FIG. 19 is view of cross section A-A of the manipulator shown in FIG. 18 ;
- FIG. 20 is a schematic representation of a medical instrument that can be incorporated in or used with an embodiment of the general uterine manipulator
- FIG. 21 is a schematic representation of an alternate medical instrument that can be incorporated in or used with an embodiment of the general uterine manipulator
- FIG. 22 is a schematic representation of a further form of medical instrument that can be incorporated in or used with an embodiment of the general uterine manipulator;
- FIG. 23 a is a side view of a further embodiment cervical funnel with an illumination device that may be used with the general uterine manipulator;
- FIG. 23 b is a longitudinal section view of the cervical funnel shown in FIG. 23 a;
- FIG. 23 c is an end view of the cervical funnel shown in FIGS. 23 a and 23 b ;
- FIG. 23 d is a schematic representation of a lip portion of the cervical funnel shown in FIGS. 23 a and 23 b.
- each embodiment of the general uterine manipulator 10 (hereinafter referred to in general as “manipulator 10 ”) is based on or incorporates an elongated hollow tube 12 defining an internal passage 14 .
- Tube 12 has opposite first and second ends 16 and 18 and a smooth continuous outer surface 20 of constant outer diameter.
- a first internal screw thread T 1 is formed at the first end 16 and a second internal screw thread T 2 is formed at the second end 18 .
- FIGS. 1 a and 1 b illustrate a first fitting in the form of tail screw 22 and a second fitting in the form of a cervical screw 24 .
- An inner manipulator rod 26 is also illustrated in FIGS. 1 a and 1 b which extends through the first fitting 22 , tube 12 , and second fitting 24 .
- the first fitting 22 comprises a threaded portion 28 ; an integral body portion 30 ; and, an internal axial hole 32 .
- Threaded portion 28 is configured to engage screw thread T 1 and is provided with a transverse slot 34 terminating prior to the body portion 30 .
- Slot 34 in effect divides the threaded portion 28 into opposed clamp shells 36 a and 36 b (hereinafter referred to in general as “clamp shells 36 ”).
- Body portion 30 is in the general form of a cylinder with two flats 38 a and 38 b on opposed sides that assist in gripping of the fitting 22 .
- Axial hole 32 is of constant diameter for the length of the fitting 22 except for a counter sink 40 at a distal end of fitting 22 .
- Threaded portion 28 is slightly flared outwardly so as it is screwed into screw thread T 1 at end 16 , the clamp shells 36 move toward each other.
- an inner manipulator rod 26 is used in the manipulator 10 this results in a clamping action on the rod providing resistance to movement of the rod 26 so as to hold it at a desired rotational and translational position. Unscrewing of the portion 28 releases or reduces this resistance to enable adjustment of the position and orientation of the rod 26 .
- the first fitting can be considered in this embodiment as incorporating or comprising a resistance mechanism which substantially maintains the position of the rod 26 until moved or adjusted by a surgeon or other user.
- FIGS. 6 to 8 depict an alternate form of the first fitting denoted as 22 ′.
- Fitting 22 ′ comprises a threaded portion 28 ′, body 30 ′, an inner axial hole 32 ′ with counter sink 40 ′ at a distal end, and opposed flats 38 ′ a and 38 ′ b formed on body portion 30 ′.
- Fitting 22 ′ differs from fitting 22 by the omission of slot 34 , the inclusion of a hydrotubation port 42 , and a re-configuring of the axial hole 32 ′.
- the axial hole 32 ′ has a first length 44 and a contiguous second length 46 .
- the first length 44 extends from the threaded portion 28 ′ for a majority of the axial length of fitting 22 ′.
- the second length 46 extends between and joins the counter sink 40 ′ to the first length 44 .
- the inner diameter of the first length 44 is greater than the inner diameter of second length 46 ′.
- the inner diameter of second length 46 is dimensioned to be slightly greater than an outer diameter of the inner manipulator rod 26 forming a close fit but enabling the rod 26 to pass through the axial hole 32 ′.
- Hydrotubation port 42 is formed in the body 30 ′ at a location where it communicates with the first length 44 .
- the thread on threaded portion 28 ′ is arranged to engage with the thread T 1 at end 16 .
- the dye may be injected through the hydrotubation port 42 .
- the dye then flows through the internal passage 14 and from an opposite end of second fitting 24 attached to end 18 .
- a clearance exists between second fitting 24 and an outer surface of rod 26 to allow the flow of dye or other fluid.
- the close fitting between the rod 26 and second length 46 of axial hole 32 ′ substantially prevents any back leakage of the dye.
- a rubber grommet seal (not shown) may be provided in the second length 46 to further minimize back leakage of dye or other liquid injected through the hydrotubation port 42 .
- the inner manipulator rod 26 can be bent to varying degrees intermediate of its length so that the rod 26 bears against an inside surface of tube 12 to provide resistance to both axial and rotational motion when fitting 22 ′ is used. This still allows the rod 26 to substantially maintain its position until moved or adjusted manipulated by a surgeon or other user.
- the intermediate bend in the rod 26 can be equated with or considered to be another or alternate form of resistance mechanism which substantially maintains the position of the rod 26 until moved or adjusted by a surgeon or other user.
- the second fitting 24 of FIGS. 1 a and 1 b is shown in greater detail in FIGS. 9 a , 9 b and 9 c .
- the fitting 24 comprises a threaded portion 48 configured to engage thread T 2 , and an integral body portion 50 .
- Body portion 50 is of a frusto-conical shape with a decreasing outer diameter in a taper direction D being away from threaded portion 48 .
- a coarse screw thread 52 is formed about the conically shaped body portion 50 .
- the crest of thread 52 has a flattened surface orientated so that a line 53 on the surface of the crest is inclined parallel with a central axis 55 of second portion 24 .
- An axial through hole 57 is also formed through second portion 24 .
- second fitting 24 is a cervical screw which is configured to screw into the cervix forming an attachment point as well as a seal.
- FIGS. 10 a - 10 d illustrate an alternate second fitting 24 a .
- Fitting 24 a is in the form of a hollow probe having a threaded portion 48 a and a body portion 50 a .
- Threaded portion 48 a has a thread configured to engage with thread T 2 .
- Body portion 50 a is in the form of a tubular member which is open at its distal end 56 and is closed at an end 58 near threaded portion 48 a to define or otherwise form a cavity 60 .
- Distal end 56 is formed with a chamfer or bevel 62 to assist in insertion of the fitting 24 a into a body cavity such as a vagina or rectum.
- Fitting 24 a may be used for example during a hysterectomy to maintain pneumoperitoneum after removal of the uterus.
- the cavity 60 also allows for collection of pelvic tissue and specimens from the abdominal and pelvic cavities.
- a lumen (i.e. through hole) 64 may be formed axially through a circumferential wall 66 of the body 50 a .
- the lumen 64 may have an internal diameter of approximately 6 mm to enable the receipt of a 4 mm telescope to enable illumination and visualization of tissue in cavities. For example this may be used in pelvic floor operations where the vagina and rectum septum need to be dissected out. This reduces the possibility of a recto-vaginal fistula occurring.
- fitting 24 a may be made in a variety of different sizes and in particular different diameters. For example 40 mm outer diameter, 30 mm outer diameter, and 20 mm outer diameter.
- FIG. 11 illustrates one form of a forceps holder 70 that may be incorporated in an embodiment of manipulator 10 .
- the forceps holder 70 is configured to seat on the elongated hollow tube 12 and releasably lock at a desired location along the tube 12 .
- Forceps holder 70 comprises a first component 72 that is able to slide over and along tube 12 and is provided with detents 74 for gripping a handle of the forceps.
- Two detents 74 are shown on opposite sides of a central boss 76 . However in other configurations alternate numbers of detent 74 may be provided.
- the boss 76 is provided with a screw thread 78 extending from a cross piece 80 which contains the detent 74 .
- the forceps holder 70 Extending axially from the thread portion 78 is a split collar 82 .
- the forceps holder 70 also includes a locking nut 84 that is able to screw onto the threaded portion 78 over the split collar 82 and act to clamp the collar 82 onto an outer surface of the tube 12 thereby releasably locking the holder 70 at an outside location along the tube 12 .
- the forceps holder 70 may be used to hold valsellum forceps which in turn holds the manipulator 10 to the cervix making the manipulator self retaining.
- the manipulator 10 may also support a cervical funnel 90 and a plug 92 .
- the cervical funnel 90 is formed as a unitary device comprising a tube 94 of constant inner and outer diameter and an integral conical portion 96 which increases in outer diameter in a direction away from first end 16 of tube 12 .
- the conical portion is provided with a lip 98 that extends about a part of the circumference of conical portion 96 and is flared in a radial outward direction.
- Plug 92 sits on the outside of funnel 90 and when used in gynaecological procedures forms a plug in the vagina.
- the forceps holder 70 may also act as a positioning device for the funnel 90 .
- FIGS. 13 a and 13 b depict in greater detail the cervical funnel 90 incorporated in the manipulator 10 shown in FIG. 12 .
- the lip 98 is flared outwardly by an angle ⁇ of approximately 130°. In this embodiment the outermost edge of the lip 98 extends for an arc a of approximately 115° about the conical portion 96 .
- An inside diameter of the tube 94 is arranged to be slightly greater than the outer diameter of the tube 12 to enable the cervical funnel 90 to be rotatably and linearly moveable with respect to the tube 12 .
- FIGS. 14 a and 14 b depict in greater detail the vaginal plug 92 shown previously in FIG. 12 .
- the plug 92 has a main body 100 formed of a constant outer diameter and a contiguous distal end portion 102 of progressively reducing outer diameter tapering to the distal end 104 of the plug 92 .
- An interior surface 106 of the plug 92 has a first portion 108 of constant inner diameter, and a contiguous second portion 110 of progressively increasing outer diameter. More particularly, the surface of the portion 110 is arranged to seat an exterior surface of the conical portion 96 of cervical funnel 90 .
- the increase in inner diameter of the surface of portion 110 is substantially the same as the angle of increasing diameter of the outer surface of conical portion 96 .
- FIG. 15 depicts an optional handle 120 incorporated in embodiments of the manipulator 10 .
- the handle 120 comprises a grip 122 and a contiguous extension 124 .
- the extension 124 is provided with a through hole 126 and a screw thread 128 .
- the screw thread 128 extends from approximately the location of the hole 126 to an end 130 of the handle 120 .
- the through hole 126 is dimensioned to enable the tube 12 to pass there through either with a slight interference fit or a small clearance.
- the screw thread 130 is configured to enable coupling with a nut such as a second locking nut 84 .
- the locking nut when tightened on screw thread 128 can then act to clamp the handle 120 to the tube 12 .
- the handle 120 can be applied to any portion of the tube 12 between the end fittings 22 and 24 which is not otherwise covered by other components such as the cervical funnel 90 .
- the manipulator may take many different forms owing the interchangability of first and second fittings and the ability to use additional components such as the rod 26 , the forceps holder 70 , cervical funnel 90 and the plug 92 .
- a general uterine manipulator system or kit may be provided to surgeons and doctors composed of all or at least a selection of the first and second fitting; together with other components such as the rod 26 , forceps holder 70 , cervical funnel 90 and the plug 92 . In this way the surgeon or doctor will always have at hand various components to enable the performance of many different procedures.
- FIGS. 16 a - 16 d illustrate a further form of a second fitting 24 b which primarily differs from the second fitting 24 a by the inclusion of an illumination device 140 .
- the illumination device 140 is in the form of a ring 142 fitted to or otherwise supported at the distal end 56 of fitting 24 b .
- the illumination device 140 enables light to be emitted from the distal end 56 .
- the ring 140 is a ring of material embedded with one or more light emitting diodes (LEDs) 124 .
- ring 142 may be made from a transparent acrylic resin.
- Power to the LEDs 144 is provided via a cable 146 that extends through the lumen 64 .
- the lumen 64 may nevertheless be configured to also receive a telescope to enable visualization of the body cavity into which the fitting 24 b is inserted.
- the ring 142 itself comprises a light guide that receives light from an optical fiber that passes through the lumen 64 . Light transmitted through the optical fiber enters and travels about the ring 142 thus enabling the emission of light from the distal end 56 .
- FIGS. 17 a - 17 c depict a cervical funnel 90 a which differs from the cervical funnel 90 by the provision of a light emitting device 140 a enabling the emission of light form distal end 99 and more particularly from the 98 of the funnel 90 a .
- the funnel 90 a has essentially the same physical structure as a funnel 90 and accordingly includes a first conical portion 96 and integrally formed tube 94 .
- the lip 98 extends partly about an opening 101 formed at the distal end 99 .
- the illumination device 140 a comprises an arcuate transparent body 142 a which may for example be made from of a transparent acrylic resin. Coupled to the body 142 a is an optical fiber 146 which is arranged to transmit light from a source to the body 142 a .
- the body 142 a has a configuration enabling it to be attached to the lip 98 in a manner so as to form a substantially continuous surface of the lip 98 .
- the optical fiber 146 extends can through a channel or hole 148 formed in the funnel 90 a .
- a channel or groove can be cut in the exterior surface of the body 90 a in which the optical fibre 146 is laid. Thereafter the groove can be filled with a resinous material and smoothed, effectively encapsulating the fiber 146 in the funnel 90 a .
- a coupling 148 at the end of the optical fiber 146 enables coupling with a light source or another optical fiber which carries light from the light source.
- the body 142 a may have embedded therein one or more LEDs which when provided with electric current either: emit light directly from the body 142 a ; or alternatively transmit light into the body 122 a from which it is emitted.
- the optical fiber 126 is replaced with a wire or cable to provide electrical power to the LEDs.
- FIG. 18 illustrates a manipulator 10 similar to that shown in FIG. 12 but with a modified cervical funnel 90 b and a motor 150 arranged to rotate the cervical funnel 90 b on, and relative to, the tube 12 .
- the motor 150 is held within a housing 152 which is supported on a bracket 154 .
- the bracket 154 is a squared U shaped configuration with opposed arms.
- the motor 150 is attached to one of the arms and a clamp 155 attached to the other arm.
- the clamp 155 can be operated to selectively grip and release the tube 12 . When the clamp 155 is tightened it grips the tube 12 preventing axial or rotational motion of the tube 12 .
- the cervical funnel 90 b is provided with a wave like outer surface profile on its tube 94 as depicted most clearly in FIG. 19 .
- Successive troughs 156 and peaks 158 of the wave like profile act as rounded gear teeth about the periphery of tube 94 b .
- These engage with a complementary shaped annular gear 160 driven by the motor 150 .
- the motor 150 When the motor 150 is energized it rotates the gear wheel 160 and, due to its engagement with the outer surface of the tube 94 b , causes the funnel 90 b to rotate about and on the tube 12 . Due to the manner of engagement of the motor 150 with the outer surface of the tube 94 , the funnel 90 b can be slid linearly along the tube 12 while maintaining engagement with the motor 150 .
- the bracket 154 is attached to an arm 162 that in turn can be clamped on to a stable support such as an operating table.
- a foot controlled switch 164 communicates with the motor 150 via a cord 166 .
- a surgeon is able to operate the motor 150 by the foot operated switch 164 .
- the motor may be in the forms of a bi-directional stepper motor and the switch arranged to control the direction of rotation.
- the illuminating device 120 a depicted in FIGS. 17 a - 17 c may also be incorporated with the funnel 90 b.
- FIGS. 20 a - 20 c illustrate variations of a medical instrument that may be used with the manipulator 10 .
- the medical instrument 170 comprises in effect the second fitting 24 a or 24 b formed back to back and integrally with the cervical funnel 90 or 90 a .
- the second fittings 24 a , 24 b differs slightly from those previously described in that they does not comprise a thread portion 48 but rather have a through hole at their proximal end 172 that communicates with the tube 94 .
- Instrument 170 may be considered as comprising a body 174 provided with opposite first and second end portions 176 and 178 .
- First end portion 176 has a first opening 180 and the second end portion 178 has a second opening 182 .
- a throughway 184 constitute by the tube 94 extends between the first and second openings 180 and 182 and is arranged to enable the body 174 to be supported on a shaft such as the tube 12 .
- the instrument 170 can be supported on the tube 12 with either of the first and second end portions 176 , 178 at the leading end of the manipulator 10 . Whichever of the end portions 176 or 178 is at the leading end will be inserted into the body cavity during a medical procedure.
- end portions 176 and 178 differ in one or more of their shape, size and configuration.
- the end portions 176 and 178 differ in at least their shape and configuration.
- End portion 176 has an outer diameter D 1 measured in a plane of the opening 180 while the end portion 178 has an outer diameter D 2 measured in a plane containing opening 162 .
- D 1 may equal D 2 or alternatively D 1 and D 2 may be different.
- FIG. 21 illustrates an alternate form of medical instrument denoted as 170 a comprising an opposite first and second end portions 176 a and 178 a respectively joined by an integral tube 94 .
- Each of the portions 176 a and 178 a is of the general configuration of the portion 178 described in FIG. 20 but with different outer diameters D 1 and D 2 .
- D 1 is less than D 2 .
- Instrument 170 a would be used in substantially the same manner as the second fitting 24 a or 24 b .
- having the two end portions of different diameters D 1 and D 2 allows a medical specialist to simply use the end of instrument 170 a which is dimensioned for the best suit the body cavity into which it is to be inserted.
- FIG. 22 illustrates a form of the medical instrument 170 b in which the first and second end portions 176 b and 178 b are both of the same general frusto conical configuration as the first end portion 176 in FIG. 20 .
- the difference between the end portion 176 b and 178 b being their respective outer diameters D 1 and D 2 .
- D 1 is greater than D 2 .
- FIGS. 23 a - 23 d illustrate a further variations to the cervical funnel 90 c .
- the funnel 90 c is of the same general shape and configuration and works in the same way as funnel 90 , but differs by the provision of a through hole 190 in the lip 98 .
- the through hole 190 is provided mid way along the arc of the lip 98 .
- the funnel 98 may also comprise an illumination device 192 .
- the illumination device 192 is in the form of an annular light guide coupled to an optical fiber.
- the annular light guide 192 surrounds the through hole 190 .
- the optical fiber 194 When the optical fiber is coupled to a light source the light is guided by the fiber 194 to the annular light guide and illuminates the annular light guide 192 providing a ring of light about the hole 190 .
- the annular light guide 192 can be in the form a transparent acrylic resin ring.
- the optical fiber 194 can be embedded/encapsulated in a groove formed along the cervical funnel 90 d.
- the hole 190 is dimensioned to receive the tip of an electrical cautery probe. During say a hysterectomy the probe is inserted into the hole 190 . It is believed that the hole 190 will ordinarily be easily visible or locatable by a surgeon. However the provision of the illumination device 192 will assist in visually locating the hole 190 .
- the electrical cautery probe is inserted through the vagina wall (which is being lifted by the lip 98 ) and into the hole 190 . By applying electric current and rotating the funnel 90 d a very clean and precise circumcision can be made of the vaginal wall to separate it from the cervix.
- the through hole 190 may also of course be incorporated in every other form of cervical funnel described hereinbefore. As can the annular light guide 192 .
- the hydrotubation port 42 is illustrated and described as being formed on the first fitting 22 .
- a hydrotubation port may be formed on the tube 12 at a location near first end 16 but beyond the screw thread T 1 .
- the first and second fittings 22 , 24 may be formed from a plastics material so as to be disposable after a single use while the elongated hollow tube 12 may be made from surgical grade stainless steel so as to be reusable. All such modifications and variations together with others that would be obvious to persons of ordinary skill in the art are deemed to be within the scope of the present invention the nature of which is to be determined from the above description and the appended claims.
Abstract
A general uterine manipulator 10 incorporates an elongated hollow tube 12 defining an internal passage 14. Tube 12 has opposite first and second ends 16 and 18, formed with internal threads T1 and T2; and a smooth continuous outer surface 20 of constant outer diameter. A first fitting comprising a tail screw 22 is screwed into thread T1 and a second fitting cervical screw 24 is screwed in thread T2. An inner manipulator rod 26 extends through the first fitting 22, tube 12, and second fitting 24. A range of alternate first and second fitting is provided. A forceps holder 70 is attachable to the tube 12 between ends 16 and 18. The manipulator 10 may also support a cervical funnel 90 and a plug 92.
Description
- This application is a continuation-in-part of International Patent Application Serial No. PCT/AU2012/000332, filed on Mar. 30, 2012, which is a non-provisional of U.S. Provisional Application No. 61/472,705 filed on Apr. 7, 2011, the contents of which applications are herein incorporated by reference in their entirety.
- The present invention relates to a general uterine manipulator and system which may be used in general surgery, gynaecological or non-surgical procedures.
- The present inventor has invented numerous medical instruments which are currently in use in surgical and non-surgical procedures. One such instrument is described in International publication no. WO 2008/074054 which is used in various procedures including total laparoscopic hysterectomy. The instrument described in this publication comprises a tube provided with an integral funnel at one end and through which a uterine cannula can be inserted. Both the tube and the cannula are provided with longitudinal slots or cut outs that aid in visualising the rotational position of a distal end of the instrument when inserted into the vagina and also aid in gripping of the instrument.
- The success and efficacy of the above described and other instruments developed by the present inventor together with the need for improved and more versatile instruments have lead to the present invention.
- According to one aspect of the present invention there is provided a general uterine manipulator comprising:
- an elongated hollow tube defining an internal passage and having opposite first and second ends;
- a smooth continuous outer surface of constant outer diameter extending between the first and second ends; and,
- internal first and second screw threads formed in the elongated hollow tube, the first screw thread being formed at the first end and the second screw thread being formed at the second end.
- The general uterine manipulator may comprise a first fitting having a screw thread arranged to engage the first screw thread, the first fitting also having an axial through hole and configured to receive an inner manipulator shaft.
- In some embodiments the first fitting is configured to apply increasing clamping force on a received inner manipulator when the first fitting a screw further into the first end.
- The general uterine manipulator may comprise a hydrotubation port in fluid communication with the internal passage wherein a fluid injected into or through the hydrotubation port is able to flow into the internal passage.
- In some embodiments the hydrotubation port is formed in the elongated hollow tube at a location near the first end and beyond the first screw thread.
- In some embodiments the hydrotubation port is formed in the first fitting and is in fluid communication with the axial through hole.
- The axial through hole may comprise a first length which opens onto an end of the first fitting distant the screw thread of the first fitting, and a second contiguous length wherein the first length has a first internal diameter and the second length has a second internal diameter which is greater than the first internal diameter; and wherein the hydrotubation port opens onto the second length of the axial through hole.
- The general uterine manipulator may comprise a second fitting having a threaded portion provided with a screw thread configured to engage the second internal thread on the elongated hollow tube and a body portion extending co-linearly from the threaded portion.
- In some embodiments the body portion comprises a tubular member which is open at one end distal the threaded portion and is closed at an end near to the threaded portion to form a cavity.
- In some embodiments the tubular member comprises a circumferential wall and at least one internal passage formed in the circumferential wall, the or each internal passage opening onto axially opposite ends of the circumferential wall.
- In some embodiments the body portion comprises a conically shaped portion with decreasing outer diameter in a taper direction being away from the threaded portion and wherein the conically shaped portion is provided with an external coarse screw thread. In some embodiments the second fitting is provided with an axial through hole.
- The general uterine manipulator may comprise an inner manipulator shaft, the shaft capable of being received in the axial through hole of the first fitting and the axial through hole of the second fitting and extending through the internal passage.
- In some embodiments a crest of the coarse screw thread is provided with a flattened surface wherein a line on the flattened surface is inclined relative to a central axis of the coarse screw thread in the taper direction.
- In some embodiments the coarse screw thread is a ball screw thread.
- In some embodiments the general uterine manipulator comprising a forceps holder supported on the elongated hollow tube and configured to be releasably lockable in a plurality of positions along the elongated hollow tube.
- In some embodiments the forceps holder comprises a first component seated on the elongated hollow tube and provided with a detent for gripping a finger hole of the forceps.
- In some embodiments the forceps holder comprises a locking nut engagable with the first component and arranged to releasably lock the first component in a fixed position along the elongated hollow tube when rotated in a first direction, and to release the second component to allow sliding motion along the elongated hollow tube when rotated in an opposite direction.
- In a second aspect there is provided general uterine manipulator comprising:
- an elongated hollow tube defining an internal passage and having opposite first and second ends;
- a smooth continuous outer surface of constant outer diameter extending between the first and second ends;
- internal first and second screw threads formed in the elongated hollow tube, the first screw thread being formed at the first end and the second screw thread being formed at the second end;
- a first fitting having a screw thread arranged to engage the first screw thread, the first fitting also having an axial through hole;
- a second fitting having a threaded portion provided with a screw thread configured to engage the second internal thread on the elongated hollow tube and a body portion extending co-linearly from the threaded portion; and,
an inner manipulator shaft arranged to extend through the axial through hole, the internal passage and the second fitting, the inner manipulator shaft having one end which is bent and protrudes from the second fitting. - In one embodiment the general uterine manipulator comprises a resistance mechanism enabling the axial and rotational position of the inner manipulator shaft to substantially held in the absence of adjustment by a user of the manipulator.
- In one embodiment the resistance mechanism comprises clamp shells incorporated in the first fitting.
- In one embodiment the resistance mechanism comprises a bend in a portion of the inner manipulator shaft within the internal passage the bend being to an extent that the inner manipulator shaft bears against an inside surface of the tube.
- In one embodiment the general uterine manipulator comprises a hydrotubation port formed in the first fitting and in fluid communication with the axial through hole wherein a fluid injected into or through the hydrotubation port is able to flow into the internal passage. In this embodiment the axial through hole comprises a first length which opens onto an end of the first fitting distant the screw thread of the first fitting, and a second contiguous length wherein the first length has a first internal diameter and the second length has a second internal diameter which is greater than the first internal diameter; and the hydrotubation port opens onto the second length of the axial through hole.
- In one embodiment the second fitting comprises a threaded portion provided with a screw thread configured to engage the second internal thread on the elongated hollow tube and a body portion extending co-linearly from the threaded portion, the body portion having a frusto-conical shape with decreasing outer diameter in a direction away from the threaded portion and on which is provided an external coarse screw thread.
- In one embodiment the general uterine manipulator comprises a forceps holder supported on the elongated hollow tube and configured to be releasably lockable in a plurality of positions along the elongated hollow tube.
- In one embodiment the forceps holder comprises a first component seated on the elongated hollow tube and provided with a detent for gripping a handle of the forceps.
- In one embodiment the forceps holder comprises a locking nut engagable with the first component and arranged to releasably lock the first component in a fixed position along the elongated hollow tube when rotated in a first direction, and to release the second component to allow sliding motion along the elongated hollow tube when rotated in an opposite direction.
- In one embodiment the general uterine manipulator comprises a cervical funnel mounted on the tube.
- In a third aspect there is provided a general uterine manipulator system comprising:
- an elongated hollow tube defining an internal passage and having opposite first and second ends;
- a smooth continuous outer surface of constant outer diameter extending between the first and second ends;
- internal first and second screw threads formed in the elongated hollow tube, the first screw thread being formed at the first end and the second screw thread being formed at the second end;
- at least one first fitting the or each first fitting having a screw thread arranged to engage the first screw thread, the first fitting also having an axial through hole;
- at least one second fitting the or each second fitting having a threaded portion provided with a screw thread configured to engage the second internal thread on the elongated hollow tube and a body portion extending co-linearly from the threaded portion;
- wherein the at least one first fitting comprises one or both of: (a) a clamping first fitting configured to apply increasing clamping force on a received inner manipulator when the first fitting a screw further into the first end; and (b) a hydrotubation first fitting which has a hydrotubation port in fluid communication with the internal passage wherein a fluid injected into or through the hydrotubation port is able to flow into the internal passage; and wherein
- the at least one second fitting comprises one or both of: (c) a cervical second fitting in which its body portion is of a frusto-conical shape with decreasing outer diameter in a direction away from the threaded portion and is provided with an external coarse screw thread; and (d) a tubular second fitting in which its body portion comprises a tubular member which is open at one end distal the threaded portion of the second fitting and is closed at an end near to the threaded portion of the second fitting to form a cavity.
- In one embodiment the tubular member of the tubular second fitting comprises a circumferential wall and at least one internal passage formed in the circumferential wall, the or each internal passage opening onto axially opposite ends of the circumferential wall.
- In one embodiment the general uterine manipulator system comprises an inner manipulator shaft arranged to extend through the axial through hole, the internal passage and the second fitting when the second fitting is the cervical second fitting, the inner manipulator shaft having one end which is bent and protrudes from the cervical.
- In one embodiment the general uterine manipulator system a resistance mechanism enabling the axial and rotational position of the inner manipulator shaft to substantially held in the absence of adjustment by a user.
- In one embodiment the general uterine manipulator system a forceps holder supported on the elongated hollow tube and configured to be releasably lockable in a plurality of positions along the elongated hollow tube.
- In a fourth aspect there is provided a medical instrument configured to facilitate a gynaecological procedure comprising:
- a body provided with opposite first and second end portions, the first end portion having a first opening and the second end portion having a second opening;
- a throughway extending between the first and second openings, the throughway arranged to enable the body to be supported on a shaft to facilitate insertion of one of the first and second end portions into a body cavity.
- In one embodiment the first and second end portions are different in one or more of their shape, size and configuration.
- In one embodiment the first end portion is of a tubular configuration and has a first outer diameter.
- In one embodiment the second end portion is of a tubular configuration and has a second outer diameter that is different to the first outer diameter.
- In one embodiment the second end portion is of a frusto conical configuration.
- In one embodiment the first end portion is of a frusto conical configuration and has a first outer diameter.
- In one embodiment the second end portion is of a frusto conical configuration and has a second outer diameter that is different to the first outer diameter.
- In one embodiment the or each end portion of frusto conical configuration is provided with a lip that extends radially outward from an outer surface of the second end portion and for an arc of less than 360°.
- In one embodiment one or both of the first and second end portions is provided with an illumination device arranged to enable the emission of light from the respective end portion.
- In one embodiment the device comprises an illumination device arranged to enable the emission of light from the lip.
- In one embodiment the general uterine manipulator system comprises an illumination device arranged to enable the emission of light from an end of the tubular portion.
- In one embodiment the general uterine manipulator system comprises an illumination device arranged to enable the emission of light from an end of the cervical funnel.
- In one embodiment the general uterine manipulator system comprises an illumination device arranged to enable the emission of light from an end of the tubular second fitting.
- In one embodiment the general uterine manipulator system comprises a motor arranged to engage and rotate the cervical funnel.
- In one embodiment the general uterine manipulator system comprises a foot operated switch associated with the motor and switchable between a first position wherein the motor rotates in a clockwise direction and a second position wherein the motor rotates in an anti-clockwise direction.
- In one embodiment the cervical funnel has conical portion and a through hole formed in or near a large diameter end the conical portion.
- In one embodiment the large diameter end of the conical portion has an outwardly flared lip that extend for a part of the circumference of the conical portion and wherein the hole is formed in the lip.
- In one embodiment the general uterine manipulator system comprises an illumination device arranged to illuminate the through hole.
- In a fifth aspect there is provided a cervical funnel comprising a conical portion and a through hole formed in or near a large diameter end the conical portion.
- In one embodiment the funnel comprises the large diameter end of the conical portion has an outwardly flared lip that extend for a part of the circumference of the conical portion and wherein the hole is formed in the lip.
- In one embodiment the funnel comprises an illumination device arranged to illuminate the through hole.
- In one embodiment the illumination device comprises an annular light guide surrounding the through hole.
- In a sixth aspect there is provided a cervical funnel comprising a conical portion and a tube extending coaxially form a small diameter end of the conical portion, wherein an outer surface of the tube is profiled to mechanically engage a motor to facilitate rotation of the cervical funnel.
- In one embodiment the outer surface of the tube is provided with gear teeth arranged to enable mechanical engagement with the motor.
- In one embodiment the funnel comprises a through hole formed in or near a large diameter end the conical portion.
- In one embodiment the large diameter end of the conical portion has an outwardly flared lip that extend for a part of the circumference of the conical portion and wherein the hole is formed in the lip.
-
FIG. 1 a is a representation of one embodiment of a general uterine manipulator in accordance with the present invention; -
FIG. 1 b is a disassembled view of the general uterine manipulator depicted inFIG. 1 a; -
FIG. 2 is a longitudinal section view of the tube incorporated in the general uterine manipulator shown inFIGS. 1 a and 1 b; -
FIG. 3 is an isometric view of a tail screw incorporated in the general uterine manipulator shown inFIGS. 1 a and 1 b; -
FIG. 4 is a side view of the tail screw shown inFIG. 3 ; -
FIG. 5 is an end view of the tail screw shown inFIG. 3 ; -
FIG. 6 is an isometric view of a second form of tail screw that may be incorporated in the general uterine manipulator shown inFIGS. 1 a and 1 b; -
FIG. 7 is a side view of the tail screw shown inFIG. 6 ; -
FIG. 8 is an end view of the tail screw shown inFIG. 6 ; -
FIG. 9 a is a side view of a second fitting incorporated in the general uterine manipulator shown inFIGS. 1 a and 1 b; -
FIG. 9 b is a longitudinal section view of the second fitting shown inFIG. 9 a; -
FIG. 9 c is an isometric representation of the second fitting; -
FIG. 10 a is a side view of a second form of setting fitting that may be incorporated in the general uterine manipulator depicted inFIGS. 1 a and 1 b; -
FIG. 10 b is an end view of the second fitting shown inFIG. 9 a; -
FIG. 10 c is an isometric view from one end of the second fitting; -
FIG. 10 d is a isometric view from an opposite angle of the second fitting; -
FIG. 11 is an isometric view of a forceps holder incorporated in the uterine manipulator; -
FIG. 12 is an isometric view of an embodiment of the general uterine manipulator and associated system with additional fittings to enable performance of a total laparoscopic hysterectomy; and, -
FIG. 13 a is a side view of a cervical funnel incorporated in an embodiment of the general uterine manipulator shown inFIGS. 1 a and 1 b; -
FIG. 13 b is a longitudinal section view of the cervical funnel; -
FIG. 13 c is an end view of the cervical funnel shown inFIGS. 13 a and 13 b, -
FIG. 14 a is an isometric representation of a vaginal plug incorporated in an embodiment of the general uterine manipulator shown inFIGS. 1 a and 1 b; -
FIG. 14 b is a section view of the vaginal plug shown inFIG. 14 a; -
FIG. 15 is a side view of a manipulator handle which may be incorporated in an embodiment of the general uterine manipulator; -
FIG. 16 a is a side view of a further from of second fitting that may be incorporated in the general uterine manipulator depicted inFIGS. 1 a and 1 b; -
FIG. 16 b is an end view of the second fitting shown inFIG. 16 a; -
FIG. 16 c is an isometric view from a first angle of the second fitting shown inFIG. 16 a; -
FIG. 16 d is a isometric view from a second angle of the second fitting shown inFIG. 16 a; -
FIG. 16 is a schematic representation of an illumination device incorporated in the second fitting shown inFIG. 16 a; -
FIG. 17 is a side view of a cervical funnel with an illumination device incorporated in a further embodiment of the general uterine manipulator; -
FIG. 17 b is a longitudinal section view of the cervical funnel shown inFIG. 17 a; -
FIG. 17 c is an end view of the cervical funnel shown inFIGS. 17 a and 17 b; -
FIG. 17 d is a schematic representation of the illumination device incorporated in the cervical funnel shown inFIGS. 17 a and 17 b; -
FIG. 18 is an isometric view of the general uterine manipulator shown inFIG. 12 but modified with the inclusion of a drive to enable powered rotation of an associated cervical funnel; -
FIG. 19 is view of cross section A-A of the manipulator shown inFIG. 18 ; -
FIG. 20 is a schematic representation of a medical instrument that can be incorporated in or used with an embodiment of the general uterine manipulator; -
FIG. 21 is a schematic representation of an alternate medical instrument that can be incorporated in or used with an embodiment of the general uterine manipulator; -
FIG. 22 is a schematic representation of a further form of medical instrument that can be incorporated in or used with an embodiment of the general uterine manipulator; -
FIG. 23 a is a side view of a further embodiment cervical funnel with an illumination device that may be used with the general uterine manipulator; -
FIG. 23 b is a longitudinal section view of the cervical funnel shown inFIG. 23 a; -
FIG. 23 c is an end view of the cervical funnel shown inFIGS. 23 a and 23 b; and -
FIG. 23 d is a schematic representation of a lip portion of the cervical funnel shown inFIGS. 23 a and 23 b. - Embodiments of the general uterine manipulator and associated system provide a multipurpose manipulator that may be used for a variety of procedures by interchanging particular fittings of the manipulator. With particular reference to
FIGS. 1 a to 2, each embodiment of the general uterine manipulator 10 (hereinafter referred to in general as “manipulator 10”) is based on or incorporates an elongatedhollow tube 12 defining aninternal passage 14.Tube 12 has opposite first and second ends 16 and 18 and a smooth continuousouter surface 20 of constant outer diameter. A first internal screw thread T1 is formed at thefirst end 16 and a second internal screw thread T2 is formed at thesecond end 18. - The versatility of the
manipulator 10 and associated system arises from the ability to connect with a number of different fittings depending on the specific application at hand.FIGS. 1 a and 1 b illustrate a first fitting in the form oftail screw 22 and a second fitting in the form of acervical screw 24. Aninner manipulator rod 26 is also illustrated inFIGS. 1 a and 1 b which extends through thefirst fitting 22,tube 12, andsecond fitting 24. - One form of the
first fitting 22 is shown in greater detail inFIGS. 3 to 5 . In this embodiment thefirst fitting 22 comprises a threadedportion 28; anintegral body portion 30; and, an internalaxial hole 32. Threadedportion 28 is configured to engage screw thread T1 and is provided with atransverse slot 34 terminating prior to thebody portion 30.Slot 34 in effect divides the threadedportion 28 into opposedclamp shells Body portion 30 is in the general form of a cylinder with twoflats Axial hole 32 is of constant diameter for the length of the fitting 22 except for acounter sink 40 at a distal end of fitting 22. - Threaded
portion 28 is slightly flared outwardly so as it is screwed into screw thread T1 atend 16, the clamp shells 36 move toward each other. When aninner manipulator rod 26 is used in themanipulator 10 this results in a clamping action on the rod providing resistance to movement of therod 26 so as to hold it at a desired rotational and translational position. Unscrewing of theportion 28 releases or reduces this resistance to enable adjustment of the position and orientation of therod 26. Thus the first fitting can be considered in this embodiment as incorporating or comprising a resistance mechanism which substantially maintains the position of therod 26 until moved or adjusted by a surgeon or other user. -
FIGS. 6 to 8 depict an alternate form of the first fitting denoted as 22′. Features of the fitting 22′ which are of the same or similar configuration or function as those of fitting 22 are denoted with the same reference numbers but with the addition of the prime (′) symbol. Fitting 22′ comprises a threadedportion 28′,body 30′, an inneraxial hole 32′ with counter sink 40′ at a distal end, and opposed flats 38′a and 38′b formed onbody portion 30′. Fitting 22′ differs from fitting 22 by the omission ofslot 34, the inclusion of ahydrotubation port 42, and a re-configuring of theaxial hole 32′. With particular reference toFIG. 7 it can be seen that theaxial hole 32′ has afirst length 44 and a contiguoussecond length 46. Thefirst length 44 extends from the threadedportion 28′ for a majority of the axial length of fitting 22′. Thesecond length 46 extends between and joins thecounter sink 40′ to thefirst length 44. The inner diameter of thefirst length 44 is greater than the inner diameter ofsecond length 46′. Further, the inner diameter ofsecond length 46 is dimensioned to be slightly greater than an outer diameter of theinner manipulator rod 26 forming a close fit but enabling therod 26 to pass through theaxial hole 32′. -
Hydrotubation port 42 is formed in thebody 30′ at a location where it communicates with thefirst length 44. The thread on threadedportion 28′ is arranged to engage with the thread T1 atend 16. In the event that for example themanipulator 10 is being used in a gynaecological application and it is desired to inject a liquid such as a dye to assist in the visualisation of tissue the dye may be injected through thehydrotubation port 42. The dye then flows through theinternal passage 14 and from an opposite end ofsecond fitting 24 attached to end 18. In this regard in the event thatmanipulator rod 26 is in use, a clearance exists between second fitting 24 and an outer surface ofrod 26 to allow the flow of dye or other fluid. Further, the close fitting between therod 26 andsecond length 46 ofaxial hole 32′ substantially prevents any back leakage of the dye. Alternately and/or in addition if desired, a rubber grommet seal (not shown) may be provided in thesecond length 46 to further minimize back leakage of dye or other liquid injected through thehydrotubation port 42. - As the fitting 22′ does not have the clamping shells 36 of fitting 22 it is unable to clamp
inner manipulation rod 26. However in embodiments of themanipulator 10, theinner manipulator rod 26 can be bent to varying degrees intermediate of its length so that therod 26 bears against an inside surface oftube 12 to provide resistance to both axial and rotational motion when fitting 22′ is used. This still allows therod 26 to substantially maintain its position until moved or adjusted manipulated by a surgeon or other user. Thus the intermediate bend in therod 26 can be equated with or considered to be another or alternate form of resistance mechanism which substantially maintains the position of therod 26 until moved or adjusted by a surgeon or other user. - The
second fitting 24 ofFIGS. 1 a and 1 b is shown in greater detail inFIGS. 9 a, 9 b and 9 c. The fitting 24 comprises a threadedportion 48 configured to engage thread T2, and anintegral body portion 50.Body portion 50 is of a frusto-conical shape with a decreasing outer diameter in a taper direction D being away from threadedportion 48. Acoarse screw thread 52 is formed about the conically shapedbody portion 50. The crest ofthread 52 has a flattened surface orientated so that aline 53 on the surface of the crest is inclined parallel with acentral axis 55 ofsecond portion 24. An axial throughhole 57 is also formed throughsecond portion 24. This allows for the passage of theinner manipulator rod 26 and/or other instruments as well as fluids including saline, dye, and air. In this embodiment of themanipulator 10,second fitting 24 is a cervical screw which is configured to screw into the cervix forming an attachment point as well as a seal. - However, alternate forms of second fittings may be incorporated in the
manipulator 10.FIGS. 10 a-10 d illustrate an alternate second fitting 24 a. Fitting 24 a is in the form of a hollow probe having a threadedportion 48 a and abody portion 50 a. Threadedportion 48 a has a thread configured to engage with thread T2.Body portion 50 a is in the form of a tubular member which is open at itsdistal end 56 and is closed at anend 58 near threadedportion 48 a to define or otherwise form acavity 60.Distal end 56 is formed with a chamfer or bevel 62 to assist in insertion of the fitting 24 a into a body cavity such as a vagina or rectum. Fitting 24 a may be used for example during a hysterectomy to maintain pneumoperitoneum after removal of the uterus. Thecavity 60 also allows for collection of pelvic tissue and specimens from the abdominal and pelvic cavities. A lumen (i.e. through hole) 64 may be formed axially through acircumferential wall 66 of thebody 50 a. In one embodiment thelumen 64 may have an internal diameter of approximately 6 mm to enable the receipt of a 4 mm telescope to enable illumination and visualization of tissue in cavities. For example this may be used in pelvic floor operations where the vagina and rectum septum need to be dissected out. This reduces the possibility of a recto-vaginal fistula occurring. - It is envisaged that the fitting 24 a may be made in a variety of different sizes and in particular different diameters. For example 40 mm outer diameter, 30 mm outer diameter, and 20 mm outer diameter.
-
FIG. 11 illustrates one form of aforceps holder 70 that may be incorporated in an embodiment ofmanipulator 10. Theforceps holder 70 is configured to seat on the elongatedhollow tube 12 and releasably lock at a desired location along thetube 12.Forceps holder 70 comprises afirst component 72 that is able to slide over and alongtube 12 and is provided withdetents 74 for gripping a handle of the forceps. Twodetents 74 are shown on opposite sides of acentral boss 76. However in other configurations alternate numbers ofdetent 74 may be provided. Theboss 76 is provided with ascrew thread 78 extending from across piece 80 which contains thedetent 74. Extending axially from thethread portion 78 is asplit collar 82. Theforceps holder 70 also includes a lockingnut 84 that is able to screw onto the threadedportion 78 over thesplit collar 82 and act to clamp thecollar 82 onto an outer surface of thetube 12 thereby releasably locking theholder 70 at an outside location along thetube 12. In one example, theforceps holder 70 may be used to hold valsellum forceps which in turn holds themanipulator 10 to the cervix making the manipulator self retaining. - With reference to
FIGS. 12-14 b, themanipulator 10 may also support acervical funnel 90 and aplug 92. Thecervical funnel 90 is formed as a unitary device comprising atube 94 of constant inner and outer diameter and an integralconical portion 96 which increases in outer diameter in a direction away fromfirst end 16 oftube 12. The conical portion is provided with alip 98 that extends about a part of the circumference ofconical portion 96 and is flared in a radial outward direction. -
Plug 92 sits on the outside offunnel 90 and when used in gynaecological procedures forms a plug in the vagina. With reference toFIG. 12 , it can be seen that theforceps holder 70 may also act as a positioning device for thefunnel 90. -
FIGS. 13 a and 13 b depict in greater detail thecervical funnel 90 incorporated in themanipulator 10 shown inFIG. 12 . Thelip 98 is flared outwardly by an angle θ of approximately 130°. In this embodiment the outermost edge of thelip 98 extends for an arc a of approximately 115° about theconical portion 96. An inside diameter of thetube 94 is arranged to be slightly greater than the outer diameter of thetube 12 to enable thecervical funnel 90 to be rotatably and linearly moveable with respect to thetube 12. -
FIGS. 14 a and 14 b depict in greater detail thevaginal plug 92 shown previously inFIG. 12 . Theplug 92 has amain body 100 formed of a constant outer diameter and a contiguousdistal end portion 102 of progressively reducing outer diameter tapering to thedistal end 104 of theplug 92. When theplug 92 is used with themanipulator 10, it is orientated so that thedistal end portion 102 is directed toward thesecond fitting 24. Aninterior surface 106 of theplug 92 has a first portion 108 of constant inner diameter, and a contiguoussecond portion 110 of progressively increasing outer diameter. More particularly, the surface of theportion 110 is arranged to seat an exterior surface of theconical portion 96 ofcervical funnel 90. Thus the increase in inner diameter of the surface ofportion 110 is substantially the same as the angle of increasing diameter of the outer surface ofconical portion 96. -
FIG. 15 depicts anoptional handle 120 incorporated in embodiments of themanipulator 10. Thehandle 120 comprises agrip 122 and acontiguous extension 124. Theextension 124 is provided with a throughhole 126 and ascrew thread 128. Thescrew thread 128 extends from approximately the location of thehole 126 to anend 130 of thehandle 120. The throughhole 126 is dimensioned to enable thetube 12 to pass there through either with a slight interference fit or a small clearance. Thus thehandle 120 extends perpendicular to thetube 12. Thescrew thread 130 is configured to enable coupling with a nut such as asecond locking nut 84. The locking nut when tightened onscrew thread 128 can then act to clamp thehandle 120 to thetube 12. Thehandle 120 can be applied to any portion of thetube 12 between theend fittings cervical funnel 90. - From the above description it will be recognised that dependant on the application at hand the manipulator may take many different forms owing the interchangability of first and second fittings and the ability to use additional components such as the
rod 26, theforceps holder 70,cervical funnel 90 and theplug 92. It is envisaged that a general uterine manipulator system or kit may be provided to surgeons and doctors composed of all or at least a selection of the first and second fitting; together with other components such as therod 26,forceps holder 70,cervical funnel 90 and theplug 92. In this way the surgeon or doctor will always have at hand various components to enable the performance of many different procedures. -
FIGS. 16 a-16 d illustrate a further form of asecond fitting 24 b which primarily differs from the second fitting 24 a by the inclusion of an illumination device 140. Features of the fitting 24 b that have the same structure or function as the fitting 24 a are designated with the same reference numbers. In this embodiment the illumination device 140 is in the form of a ring 142 fitted to or otherwise supported at thedistal end 56 of fitting 24 b. The illumination device 140 enables light to be emitted from thedistal end 56. In one form the ring 140 is a ring of material embedded with one or more light emitting diodes (LEDs) 124. In this embodiment ring 142 may be made from a transparent acrylic resin. Power to the LEDs 144 is provided via a cable 146 that extends through thelumen 64. In the embodiment thelumen 64 may nevertheless be configured to also receive a telescope to enable visualization of the body cavity into which the fitting 24 b is inserted. In a variation of the illumination device 140, the ring 142 itself comprises a light guide that receives light from an optical fiber that passes through thelumen 64. Light transmitted through the optical fiber enters and travels about the ring 142 thus enabling the emission of light from thedistal end 56. -
FIGS. 17 a-17 c depict a cervical funnel 90 a which differs from thecervical funnel 90 by the provision of a light emitting device 140 a enabling the emission of light formdistal end 99 and more particularly from the 98 of the funnel 90 a. The funnel 90 a has essentially the same physical structure as afunnel 90 and accordingly includes a firstconical portion 96 and integrally formedtube 94. Thelip 98 extends partly about anopening 101 formed at thedistal end 99. The illumination device 140 a comprises an arcuate transparent body 142 a which may for example be made from of a transparent acrylic resin. Coupled to the body 142 a is an optical fiber 146 which is arranged to transmit light from a source to the body 142 a. The body 142 a has a configuration enabling it to be attached to thelip 98 in a manner so as to form a substantially continuous surface of thelip 98. The optical fiber 146 extends can through a channel or hole 148 formed in the funnel 90 a. In one embodiment, a channel or groove can be cut in the exterior surface of the body 90 a in which the optical fibre 146 is laid. Thereafter the groove can be filled with a resinous material and smoothed, effectively encapsulating the fiber 146 in the funnel 90 a. A coupling 148 at the end of the optical fiber 146 enables coupling with a light source or another optical fiber which carries light from the light source. In a variation to the illumination device 140 a, the body 142 a may have embedded therein one or more LEDs which when provided with electric current either: emit light directly from the body 142 a; or alternatively transmit light into thebody 122 a from which it is emitted. In the event that thebody 122 a carries one or more LEDs, then theoptical fiber 126 is replaced with a wire or cable to provide electrical power to the LEDs. -
FIG. 18 illustrates amanipulator 10 similar to that shown inFIG. 12 but with a modifiedcervical funnel 90 b and amotor 150 arranged to rotate thecervical funnel 90 b on, and relative to, thetube 12. Themotor 150 is held within ahousing 152 which is supported on abracket 154. Thebracket 154 is a squared U shaped configuration with opposed arms. Themotor 150 is attached to one of the arms and aclamp 155 attached to the other arm. Theclamp 155 can be operated to selectively grip and release thetube 12. When theclamp 155 is tightened it grips thetube 12 preventing axial or rotational motion of thetube 12. - The
cervical funnel 90 b is provided with a wave like outer surface profile on itstube 94 as depicted most clearly inFIG. 19 .Successive troughs 156 andpeaks 158 of the wave like profile act as rounded gear teeth about the periphery of tube 94 b. These engage with a complementary shapedannular gear 160 driven by themotor 150. When themotor 150 is energized it rotates thegear wheel 160 and, due to its engagement with the outer surface of the tube 94 b, causes thefunnel 90 b to rotate about and on thetube 12. Due to the manner of engagement of themotor 150 with the outer surface of thetube 94, thefunnel 90 b can be slid linearly along thetube 12 while maintaining engagement with themotor 150. Thebracket 154 is attached to anarm 162 that in turn can be clamped on to a stable support such as an operating table. A foot controlledswitch 164 communicates with themotor 150 via acord 166. A surgeon is able to operate themotor 150 by the foot operatedswitch 164. The motor may be in the forms of a bi-directional stepper motor and the switch arranged to control the direction of rotation. The illuminatingdevice 120 a depicted inFIGS. 17 a-17 c may also be incorporated with thefunnel 90 b. -
FIGS. 20 a-20 c illustrate variations of a medical instrument that may be used with themanipulator 10. InFIG. 20 themedical instrument 170 comprises in effect the second fitting 24 a or 24 b formed back to back and integrally with thecervical funnel 90 or 90 a. Thesecond fittings thread portion 48 but rather have a through hole at theirproximal end 172 that communicates with thetube 94.Instrument 170 may be considered as comprising abody 174 provided with opposite first andsecond end portions First end portion 176 has afirst opening 180 and thesecond end portion 178 has asecond opening 182. Athroughway 184, constitute by thetube 94 extends between the first andsecond openings body 174 to be supported on a shaft such as thetube 12. With reference toFIG. 1 a, if the end of themanipulator 10 provided with thecervical screw 24 is taken is the leading end, then theinstrument 170 can be supported on thetube 12 with either of the first andsecond end portions manipulator 10. Whichever of theend portions - In the embodiment in
FIG. 20 , it can be readily seen that theend portions FIG. 20 , theend portions End portion 176 has an outer diameter D1 measured in a plane of theopening 180 while theend portion 178 has an outer diameter D2 measured in aplane containing opening 162. In this embodiment D1 may equal D2 or alternatively D1 and D2 may be different. -
FIG. 21 illustrates an alternate form of medical instrument denoted as 170 a comprising an opposite first andsecond end portions integral tube 94. Each of theportions portion 178 described inFIG. 20 but with different outer diameters D1 and D2. In particular in this embodiment D1 is less than D2.Instrument 170 a would be used in substantially the same manner as the second fitting 24 a or 24 b. However having the two end portions of different diameters D1 and D2 allows a medical specialist to simply use the end ofinstrument 170 a which is dimensioned for the best suit the body cavity into which it is to be inserted. -
FIG. 22 illustrates a form of the medical instrument 170 b in which the first andsecond end portions first end portion 176 inFIG. 20 . The difference between theend portion end portion -
FIGS. 23 a-23 d illustrate a further variations to thecervical funnel 90 c. Thefunnel 90 c is of the same general shape and configuration and works in the same way asfunnel 90, but differs by the provision of a throughhole 190 in thelip 98. The throughhole 190 is provided mid way along the arc of thelip 98. Optionally thefunnel 98 may also comprise anillumination device 192. In this embodiment theillumination device 192 is in the form of an annular light guide coupled to an optical fiber. The annularlight guide 192 surrounds the throughhole 190. When the optical fiber is coupled to a light source the light is guided by thefiber 194 to the annular light guide and illuminates the annularlight guide 192 providing a ring of light about thehole 190. The annularlight guide 192 can be in the form a transparent acrylic resin ring. Theoptical fiber 194 can be embedded/encapsulated in a groove formed along the cervical funnel 90 d. - The
hole 190 is dimensioned to receive the tip of an electrical cautery probe. During say a hysterectomy the probe is inserted into thehole 190. It is believed that thehole 190 will ordinarily be easily visible or locatable by a surgeon. However the provision of theillumination device 192 will assist in visually locating thehole 190. The electrical cautery probe is inserted through the vagina wall (which is being lifted by the lip 98) and into thehole 190. By applying electric current and rotating the funnel 90 d a very clean and precise circumcision can be made of the vaginal wall to separate it from the cervix. - The through
hole 190 may also of course be incorporated in every other form of cervical funnel described hereinbefore. As can the annularlight guide 192. - Now that an embodiment of the invention has been described in detail it will be apparent to those skilled in the relevant arts that numerous modifications and variations may be made without departing from the basic inventive concepts. For example, in one embodiment, the
hydrotubation port 42 is illustrated and described as being formed on thefirst fitting 22. However in an alternate embodiment, a hydrotubation port may be formed on thetube 12 at a location nearfirst end 16 but beyond the screw thread T1. In one embodiment, the first andsecond fittings hollow tube 12 may be made from surgical grade stainless steel so as to be reusable. All such modifications and variations together with others that would be obvious to persons of ordinary skill in the art are deemed to be within the scope of the present invention the nature of which is to be determined from the above description and the appended claims.
Claims (28)
1. A general uterine manipulator comprising:
an elongated hollow tube defining an internal passage and having opposite first and second ends, a smooth continuous outer surface of constant outer diameter extending between the first and second end, and internal first and second screw threads formed in the elongated hollow tube, the first screw thread being formed at the first end and the second screw thread being formed at the second end; and
a first fitting having a screw thread arranged to engage the first screw thread, the first fitting also having an axial through hole and configured to receive an inner manipulator shaft.
2. The general uterine manipulator according to claim 1 comprising a hydrotubation port in fluid communication with the internal passage wherein a fluid injected into or through the hydrotubation port is able to flow into the internal passage.
3. The general uterine manipulator according to claim 1 comprising a hydrotubation port formed in the first fitting and in fluid communication with the axial through hole wherein a fluid injected into or through the hydrotubation port is able to flow into the internal passage.
4. The general uterine manipulator according to claim 3 wherein the axial through hole comprises a first length which opens onto an end of the first fitting distant the screw thread of the first fitting, and a second contiguous length wherein the first length has a first internal diameter and the second length has a second internal diameter which is greater than the first internal diameter; and wherein the hydrotubation port opens onto the second length of the axial through hole.
5. The general uterine manipulator according to claim 1 comprising a second fitting having a threaded portion provided with a screw thread configured to engage the second internal thread on the elongated hollow tube and a body portion extending co-linearly from the threaded portion.
6. The general uterine manipulator according to claim 5 wherein the body portion comprises a tubular member which is open at one end distal the threaded portion and is closed at an end near to the threaded portion to form a cavity.
7. The general uterine manipulator according to claim 5 wherein the body portion is of a frusto-conical shape with decreasing outer diameter in a direction away from the threaded portion and is provided with an external coarse screw thread.
8. The general uterine manipulator according to claim 7 wherein the second fitting is provided with an axial through hole.
9. The general uterine manipulator according to claim 8 comprising an inner manipulator shaft, the shaft capable of being received in the axial through hole of the first fitting and the axial through hole of the second fitting and extending through the internal passage.
10. The general uterine manipulator according to claim 1 comprising a forceps holder supported on the elongated hollow tube and configured to be releasably lockable in a plurality of positions along the elongated hollow tube.
11. The general uterine manipulator according to claim 1 comprising a cervical funnel mounted on the tube.
12. A general uterine manipulator system comprising:
an elongated hollow tube defining an internal passage and having opposite first and second ends, a smooth continuous outer surface of constant outer diameter extending between the first and second ends, and internal first and second screw threads formed in the elongated hollow tube, the first screw thread being formed at the first end and the second screw thread being formed at the second end;
at least one first fitting the or each first fitting having a screw thread arranged to engage the first screw thread, the first fitting also having an axial through hole; and
at least one second fitting the or each second fitting having a threaded portion provided with a screw thread configured to engage the second internal thread on the elongated hollow tube and a body portion extending co-linearly from the threaded portion;
wherein the at least one first fitting comprises one or both of: (a) a clamping first fitting configured to apply increasing clamping force on a received inner manipulator when the first fitting is screwed further into the first end; and (b) a hydrotubation first fitting which has a hydrotubation port in fluid communication with the internal passage wherein a fluid injected into or through the hydrotubation port is able to flow into the internal passage; and wherein
the at least one second fitting comprises one or both of: (c) a cervical second fitting wherein its body portion is of a frusto-conical shape with decreasing outer diameter in a direction away from the threaded portion and is provided with an external coarse screw thread; and (d) a tubular second fitting wherein its body portion comprises a tubular member which is open at one end distal the threaded portion of the second fitting and is closed at an end near to the threaded portion of the second fitting to form a cavity.
13. The general uterine manipulator system according to claim 12 comprising an inner manipulator shaft arranged to extend through the axial through hole, the internal passage and the second fitting when the second fitting is the cervical second fitting, the inner manipulator shaft having one end which is bent and protrudes from the cervical second fitting.
14. The general uterine manipulator system according to claim 13 comprising a resistance mechanism enabling an axial and rotational position of the inner manipulator shaft to substantially held in the absence of adjustment by a user.
15. The general uterine manipulator system according claim 12 comprising a cervical funnel configured to mount on the tube.
16. The general uterine manipulator system according to claim 1 comprising a capable of being mounted on the hollow tube, the tube medical instrument comprising:
a body provided with opposite first and second end portions, the first end portion having a first opening and the second end portion having a second opening;
a throughway extending between the first and second openings, the throughway arranged to enable the body to be supported on a shaft to facilitate insertion of one of the first and second end portions into a body cavity, the first and second end portions being different in one or more of their shape, size and configuration.
17. The general uterine manipulator system according to claim 16 wherein the first end portion is of a tubular configuration and has a first outer diameter.
18. The general uterine manipulator system according to claim 17 wherein the second end portion is of a tubular configuration and has a second outer diameter that is different to the first outer diameter.
19. The general uterine manipulator system according to claim 17 wherein the second end portion is of a frusto conical configuration.
20. The general uterine manipulator system according to claim 16 wherein the first end portion is of a frusto conical configuration and has a first outer diameter, and the second end portion is of a frusto conical configuration and has a second outer diameter that is different to the first outer diameter.
21. The general uterine manipulator system according to claim 6 comprising an illumination device arranged to enable the emission of light from an end of the tubular portion.
22. The general uterine manipulator system according to claim 11 comprising an illumination device arranged to enable the emission of light from an end of the cervical funnel.
23. The general uterine manipulator system according to claim 22 wherein cervical funnel has a frusto conical portion and a large diameter end of the conical portion has an outwardly flared lip that extends for a part of the circumference of the conical portion.
24. The general uterine manipulator system according to claim 23 wherein a through hole is formed in the lip.
25. The general uterine manipulator system according to claim 24 wherein the illumination device is arranged to illuminate the through hole.
26. The general uterine manipulator system according to claim 25 wherein the illumination device comprised an annular light guide surrounding the through hole.
27. The general uterine manipulator system according to claim 11 wherein the cervical funnel comprises a tubular shaft extending coaxially form a small diameter end of the conical portion, wherein an outer surface of the tubular shaft is profiled to mechanically engage a motor to facilitate rotation of the cervical funnel.
28. The general uterine manipulator system according to claim 27 wherein the outer surface of the tube is provided with gear teeth to arranged to enable mechanical engagement with the motor.
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US13/720,086 US20130197536A1 (en) | 2011-04-07 | 2012-12-19 | General uterine manipulator and system |
KR1020147034277A KR101726666B1 (en) | 2012-09-24 | 2013-09-23 | General uterine manipulator and system |
PCT/US2013/061180 WO2014047554A1 (en) | 2012-09-24 | 2013-09-23 | General uterine manipulator and system |
CN201710697321.5A CN107518934B (en) | 2012-09-24 | 2013-09-23 | Universal uterine manipulator and system |
JP2015526774A JP6133423B2 (en) | 2012-09-24 | 2013-09-23 | General uterine manipulator and system |
EP13839679.1A EP2861166B1 (en) | 2012-09-24 | 2013-09-23 | General uterine manipulator and system |
CN201380043089.3A CN104768483B (en) | 2012-09-24 | 2013-09-23 | General uterus raising device and system |
AU2013317826A AU2013317826B2 (en) | 2012-09-24 | 2013-09-23 | General uterine manipulator and system |
US14/498,166 US9101390B2 (en) | 2011-04-07 | 2014-09-26 | General uterine manipulator and system |
US14/722,025 US9987042B2 (en) | 2011-04-07 | 2015-05-26 | General uterine manipulator and system |
HK15109590.8A HK1208792A1 (en) | 2012-09-24 | 2015-09-30 | General uterine manipulator and system |
AU2017203026A AU2017203026B2 (en) | 2012-09-24 | 2017-05-05 | General uterine manipulator and system |
US15/970,686 US10792072B2 (en) | 2011-04-07 | 2018-05-03 | General uterine manipulator and system |
AU2018241220A AU2018241220B2 (en) | 2012-09-24 | 2018-10-08 | General uterine manipulator and system |
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Also Published As
Publication number | Publication date |
---|---|
WO2012135893A1 (en) | 2012-10-11 |
EP2693961A4 (en) | 2015-09-23 |
EP2693961B1 (en) | 2017-05-31 |
US20170135727A1 (en) | 2017-05-18 |
CN203647441U (en) | 2014-06-18 |
US9451985B2 (en) | 2016-09-27 |
US9974567B2 (en) | 2018-05-22 |
EP2693961A1 (en) | 2014-02-12 |
US20140052144A1 (en) | 2014-02-20 |
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