Surgery – Instruments – Obstetric or gynecological instruments
Reexamination Certificate
1999-03-15
2001-01-16
Hirsch, Paul J. (Department: 3732)
Surgery
Instruments
Obstetric or gynecological instruments
Reexamination Certificate
active
06174317
ABSTRACT:
BACKGROUND
1. Field of the Invention
The present invention relates to an instrument for laparoscopic uterine surgery of the kind having a tubular element which is adapted for insertion into the vagina with the front end-part of the instrument, as seen in the insertion direction, receiving the cervix, the edge of the front part of the tubular element being shaped to support against the top wall of the vagina, and the instrument including a sealing ring which embraces the tubular element and functions to provide a seal between the element and the vaginal wall.
2. Description of the Related Art
It is known in the performance of an hysterectomy to use a tubular element which is inserted into the vagina such as to bear against the cervix, wherewith the front part of the tubular element supports against the top wall of the vagina so as to raise and support the same, e.g. in the manner of a “pitched tent”; cf WO 94/10926 for instance. A probe is passed through the tubular element, through the neck of the uterus and into the body of the uterus. The probe has an external thread by means of which it can be screwed firmly to the neck of the uterus, or cervix.
One drawback with this known instrument is that the probe blocks the cervical canal.
Another drawback with this known instrument is that it fails to adequately protect the vaginal wall in the case of certain types of surgery.
SUMMARY OF THE INVENTION
One object of the present invention is to provide an instrument which will eliminate these drawbacks either completely or partially.
This object is achieved with an instrument for use in uterine laparoscopic surgery including a tubular element for insertion into the vagina with the front end-part of the instrument, as seen in the insertion direction, receiving the cervix, wherewith the edge of the front part of said tubular element is shaped to support against the top wall of the vagina, and wherewith the instrument includes a sealing ring which embraces the tubular element and functions to provide a seal between the element and the vaginal wall, the edge portion of the front part (
2
) of the tubular element having a curvature by which the top wall of the vagina is supported around the full periphery of said edge portion when the tubular element is positioned in the vagina, the instrument including end closure means detachably fastened to the tubular element, the rear end-part of the tubular element having anchorage means for a suture which is anchored through the cervix, and the rear end of the tubular element, as seen in the insertion direction, carrying the end closure means which functions to pressure-seal the passageway passing through the tubular element.
Further developments of the instrument include an instrument in which the rear end-part of the tubular element includes a wedge-shaped slit in which a suture can be anchored. The edge portion of the tubular element is defined by a section between the tubular element and a single-curved surface whose concave side lies distal from the tubular element, wherein the generatrix of the single-curved surface is perpendicular to the axis of the tubular element, and wherein a plane which approximates the single-curved surface and which extends parallel with said generatrix defines an angle of roughly 30° with a plane extending normal to the axis of the tubular element. The end closure means may further comprise a central, self-sealing lead-through which is adapted to enable a rod-shaped element to be inserted sealingly into the interior of the tubular element. The end closure means may further include a tubular flange which embraces the rear end-part of the tubular element, and a clamping sleeve which includes a manipulator grip may be firmly clamped on the rear end-part of the tubular element, preferably on the tubular flange of the end closure means. The clamping sleeve can include a rod which can be connected to an external attachment point. The instrument may be further characterized in that the self-sealing lead-through in the end closure means is provided at the bottom of a recess that extends towards the interior of the tubular element, the recess having an undercut part such that a plug can be inserted into the recess and an enlarged peripheral part of the plug snaps into the undercut part, the plug having a through-passing passageway which is aligned with the self-sealing lead-through, therewith enabling a rod-shaped element to be gripped in the passageway in the plug and fixated axially in the plug when the plug is pressed into the recess. The plug may further include a lateral opening for enabling a rod-shaped element to be inserted laterally into and removed laterally from the passageway in the plug when the plug is located outside the recess. The plug and/or the wall of the recess may be comprised of a rubber elastic material, and an insertion end of the plug may be conical, the bottom part of the recess also being conical and having a slightly larger cone angle than the plug insertion end, wherein the cone-apex part of the plug is being compressed more pronouncedly circumferentially around a rod-shaped element in said plug passageway in coaction with the bottom part of the recess wall. Such a plug is adapted to prevent axial leakage of fluid between the rod-shaped element and the recess wall, in coaction with the wall of the recess.
The inventive instrument also enables novel surgical techniques to be carried out, as made evident below.
One important feature of the inventive instrument is that it enables a suture to be fastened in the cervix, and that the tubular element is provided with suture anchoring means, for instance a wedging slot, in the rear, outer end of the element. The instrument thus provides two important functions. Firstly, the forward, inner end of the tubular element can be readily given a chosen “pitching” effect irrespective of the length of the cervix, simply by pulling on the suture until the end of the tube is brought into firm engagement with the upper wall of the vagina with a suitable force, and secondly the cervical canal will not be blocked by an anchoring device. This latter function makes possible an antegrade excision of the cervical canal. It will be understood that by “pitching function” as used in this document is meant a raising and supporting function in a manner similar to that of “pitching” a tent.
A further important feature of the invention is that the front edge of the tubular element is shaped to lie stably against the upper vagina wall around the whole of the cervix. This enables the top of the vagina to be twisted, angled and displaced with the aid of the tubular element.
Because the wall of the tubular element also protects the vagina wall from its top and around its periphery, an antegrade excision can be performed without risk of the excision instrument, for instance a tubular knife, damaging the vagina wall. The instrument is intended primarily for laparoscopic surgery (keyhole surgery).
The inventive contouring of the front end-part of the tubular element enables the top of the vagina to be held raised effectively in the abdominal cavity of the patient, so that it will be distanced far from the bladder and ureters and therewith reduce the risk of damage to these organs.
The inventive contouring of the front, distal end of the tubular element enables the lateral fornices to be lifted high in the uterine canal. This increases the distance to the ureters in relation to the uterine vessel. Good orientation is obtained relative to the forward edge of the tubular element around the full circumference and to the sides. Coagulation and ligature of uterine vessels can be made while using the edge of the tubular element as a reference. At the same time, an indication is given that the instrument is distanced as far as possible from the ureters.
The inventive tubular element includes a passageway that extends along the full length of the element, and the rear end of said element includes a pressure-tight lead-through or transit for the insertion of a rod-like instrument. The ability of
Endolink AB
Hirsch Paul J.
Jacobson Price Holman & Stern PLLC
Priddy Michael B.
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