GENERAL UTERINE MANIPULATOR AND SYSTEM
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.
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.
FIELD OF THE INVENTIONThe present invention relates to a general uterine manipulator and system which may be used in general surgery, gynaecological or non-surgical procedures.
BACKGROUND OF THE INVENTIONThe 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.
SUMMARY OF THE INVENTIONAccording 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.
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
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.
One form of the first fitting 22 is shown in greater detail in
Threaded portion 28 is slightly flared outwardly so as it is screwed into screw thread T1 at end 16, the clamp shells 36 move toward each other. When 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. Thus 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.
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 T1 at end 16. In the event that for example the manipulator 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 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. In this regard in the event that manipulator rod 26 is in use, a clearance exists between second fitting 24 and an outer surface of rod 26 to allow the flow of dye or other fluid. Further, the close fitting between the rod 26 and second length 46 of axial 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 the second length 46 to further minimize back leakage of dye or other liquid injected through the hydrotubation 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 the manipulator 10, 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. Thus 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
However, alternate forms of second fittings may be incorporated in the manipulator 10.
It is envisaged that the fitting 24a 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.
With reference to
Plug 92 sits on the outside of funnel 90 and when used in gynaecological procedures forms a plug in the vagina. With reference to
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, the forceps holder 70, cervical funnel 90 and the plug 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 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.
The cervical funnel 90b is provided with a wave like outer surface profile on its tube 94 as depicted most clearly in
In the embodiment in
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 90d 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.
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 the first fitting 22. However in an alternate embodiment, a hydrotubation port may be formed on the tube 12 at a location near first end 16 but beyond the screw thread T1. In one embodiment, 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.
Claims
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: 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;
- 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
- 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.
Type: Application
Filed: Sep 24, 2012
Publication Date: Mar 14, 2013
Inventors: Jai Singh (Woodvale), Jiwan Steven Singh (Woodvale)
Application Number: 13/625,255
International Classification: A61B 17/42 (20060101);