WO1993012709A1

WO1993012709A1 - U-formed instrument for elevation of the uterus at laparoscopy

Info

Publication number: WO1993012709A1
Application number: PCT/DK1992/000375
Authority: WO
Inventors: Erik Gregersen
Original assignee: Erik Gregersen
Priority date: 1991-12-27
Filing date: 1992-12-14
Publication date: 1993-07-08
Also published as: DK206791A; DK206791D0; AU3157293A; DE4294496T1

Abstract

A U-formed tube (1) to elevate the uterus at laparoscopy consisting of a conical end (2) continuing in a spike (3) to be introduced into the uterus through the cervix via the vagina. The other end consists of a handle (4) to dirigate the instrument and the uterus, which because of the shape can be highly moved facilitating the survey of the female internal genitals. The surgeon can handle the instrument without bringing his hands outside the sterile operation area and inject fluid into the uterus with a syringe placed at the opening at the handle. Pressing the instrument against the cervix it will be tight. During the operation the patient can be placed at a normal position at her back with the advantages of this position. When not in use the instrument is kept in its place by the shape, the weight of the handle and the position of the legs.

Description

U-FORMED INSTRUMENTFOR ELEVATION OFTHE UTERUS ATLAPAROSCOPY

The invention consists of a u-formed tube - in the fol¬ lowing mentioned U-ELEVATOR - by means of which the uterus can be elevated giving a possibility of examina¬ tion and operation of the internal female genitals through a laparoscope ( a "telescope" for introduction into the abdominal cavity).

The U-ELEVATOR is in one end formed as a cone ending in a pointed elongation for insertion into the uterus o through the cervix via the vagina. The other end is provided with a cylindric handle allowing the surgeon to elevate the uterus during the laparoscopic operation in the abdominal cavity without to need to remove the hands from the sterile operation field, and the tube- 5 construction allows simultaneous instillation of dye (fluid) into the uterus and Fallopian tubes, by means of which the passage through these can be estimated.

Several known instruments are existing for the elevation o of the uterus at laparoscopic operations.

LUBKE uterine vacuum cannula consists of a straight tube with a little curve at the end for insertion into the uterus. The end continues in a little cone at which is mounted a vacuum-cup. At the other end is a handle 5 with an opening for instillation of fluid into the uterus and an opening for application of vacuum for the vacuum-cup. The use of the instrument demands the woman to be placed with spread legs allowing the surgeon to get the instrument and manage it. At this procedure he o however will move outside the operation field, unless he will let an assistant manage the instrument. Because of the straight shape of it and the direction of the vagina, the possibilities to elevate the uterus is limi¬ ted to a few degrees. COHEN uterine cannula is fixated to the cervix with a forceps in stead of a vacuum-cup.

In the QUINONES model the fixation forceps and the tube are built together into one instrument. The use of it

5 is as mentioned above.

WADIA elevator consists of a slightly curved tube ending in a spike continuing conically at the tube. The other end consists of a handle with an opening for instillation of fluid. Instillation is possible pressing the instru- o ment against the uterine cervix and at the same time elevating the uterus. There is no fixation of the instru¬ ment for which reason it must be managed by an assistant. The use of it is as described at the model of LUBKE.

5 The present invention is unique as the instrument can be managed from the sterile operation field by the sur¬ geon by means of the handle, which implies that also instillation of fluid (dye) into the uterus can be performed by the surgeon, who thus himself is able to o dose the press which is necessary to keep the conical tip thight to the uterine cervix.

Another advantage is that the woman does not need to be placed at a gynecological position at the often long lasting operations but can lie streched out at her back 5 at the operation table, which has got some hemodynamic advantages and facilitate the preparations for the operation as the risk of contamination is reduced. The fixation is obtained according to the invention of an instrument said in the introduction and characterized o to be u-shaped as this form combined with the weight of the handle cause the instrument to stay after being inserted into the uterus, which is located in the ab¬ dominal cavity behind the pubic os. The instrument is forming a semi-circle with a radius of 6,5 cm with the handle and the conical tip as straight elongations at which a slight open u-shape appears. The result is that the instrument is fit for all women who - regardless of size have nearly the same distance between the pubic os and the uterine cervix. The tip of the conical part and the handle are because of the anatomy of the woman placed at a reciprocal distance of 14 cm. o The back position with the legs close together support the fixation of the instrument.

The uterus can , because of the curve of the U-ELEVATOR, be elevated very strongly upward and forward at which the view at the laparoscopi is improved as the uterus 5 can be dislocated at both sides by which means both the view and the operations are further facilitated.

The figure (Fig.l) is describing the invention in 2 planes The U-ELEVATOR consists of a tube (1) ending in a cone (2) o continuing in a spike (3) ( to be placed into the uterus). The other end is transformed to a handle (4), which can be placed at the sterile operation field. In the opening of the handle (5) a syringe can be placed for instillation of dye into the uterus. 5 Unused the U-ELEVATOR is fixed by its shape supplied with the weight of the handle and the legs placed close together .

The insertion usually is performed in general anestesia o with the woman placed with bent spread knees at the operation table. The vagina is washed with a desinfec- tion medium using a Collins speculum,. after which the UTELEVATOR is inserted by means of a tenaculum placed at the uterine cervix. The handle is placed at a sterile drape covering the pubic area. After removal of the tenaculum and the speculum, the legs are placed close together and a usual desinfection procedure is performed.

The utility will be all kinds of laparoscopic examination and operations of the internal female genitals. Typically at sterilisation procedures and operations for infertilit and pelvic pains.

In the preferred form the U-ELEVATOR consists of metal for repeated use, but it can be produced in plastic as disposable, as it can be produced in a massive version in stead of the tube-form.

Claims

PATENT-CLAIMS

Instrument to elevate the uterus at examination and operation of the internal female organs through the laparoscope and composed of a conical end (2) with a spike (3) for insertion into the uterus and in the other end a handle (4) for the manipulation of the instrument. The instrument is formed as a tube for instillation of fluid through an opening in the handle (5) and c h a r a t e r i z e d to be u-formed (1). The u-form is slightly open and the distance between the conical spike and the handle match with the distance between the female pubic os and the uterus. Pressing the conical end to the cervix, there will be a tight connection allowing fluid (dye) to be instilla- ted into the uterine cavity.