Vaginal wall incision instrument

A vaginal wall incision instrument includes a main body portion that is capable of being inserted into a vaginal canal; an incision portion that protrudes from a distal portion of the main body portion in a direction intersecting a center line of the vaginal canal and is formed by a conductive material; and an operating portion, wherein the main body portion includes an exterior portion and an interior portion, wherein the interior portion includes a contact portion, wherein a guide hole is configured on the interior portion, wherein the guide hole is capable of guiding the conductive member in a direction toward a boundary between the uterine cervix and the vaginal canal, and wherein the incision portion separates the vaginal canal along a circumference whose center is the center line of rotation by rotating the interior portion about the center line of rotation with respect to the exterior portion.

BACKGROUND OF THE INVENTION

Field of the Invention

The present invention relates to a vaginal wall incision instrument.

Description of Related Art

In recent years, as a procedure for incising a uterus, a total laparoscopic hysterectomy and a laparoscopic supracervical hysterectomy have been known. The total laparoscopic hysterectomy and the laparoscopic supracervical hysterectomy are procedures in which a laparoscope, a uterine manipulator, and a dissection instrument need to be used. That is, in the total laparoscopic hysterectomy and the laparoscopic supracervical hysterectomy, it is necessary to perform operations of checking an incision target part using the laparoscope, adjusting a separating line using the uterine manipulator, and performing incision using the dissection instrument along the separating line in a coordinated manner.

The laparoscope and the dissection instrument are inserted into an abdominal cavity through an abdominal wall using a trocar. In the total laparoscopic hysterectomy and the laparoscopic supracervical hysterectomy, when the dissection instrument is operated in the abdominal cavity, it is necessary to approach a separating line in a direction intersecting the separating line in a normal state in which the uterus is not tilted. For this reason, straight separation along the separating line is not easy without tilting the uterus using the uterine manipulator. When an operation of tilting the uterus is performed, a cooperative operation of the uterine manipulator, the dissection instrument and the laparoscope is necessary.

As an exemplary instrument for separating biological tissues in a body, a high-frequency incision instrument that can be combined with an endoscope is disclosed in Japanese Unexamined Patent Application, First Publication No. 1998-234743. In Japanese Unexamined Patent Application, First Publication No. 2010-178766, an endoscope for treatment that can be combined with a high-frequency snare configured to cut tissues when a high-frequency current is supplied is disclosed. The endoscope for treatment disclosed in Japanese Unexamined Patent Application, First Publication No. 2010-178766 has an engaging unit that can engage a loop part of the high-frequency snare at a distal end, and can totally resect a body wall using a wire-type part positioned more proximal than the loop part in the high-frequency snare as an incising electrode.

SUMMARY OF THE INVENTION

According to a first aspect of the present invention, a vaginal wall incision instrument includes a main body portion that is capable of being inserted into a vaginal canal; an incision portion that protrudes from a distal portion of the main body portion in a direction intersecting a center line of the vaginal canal and is able to penetrate through the vaginal canal while the main body portion is inserted into the vaginal canal, and is formed by a conductive material; and an operating portion that is disposed at a proximal part of the main body portion and is able to adjust an amount of protrusion of the incision portion, wherein the main body portion includes: an exterior portion that is contactable on an inner wall of the vaginal canal; and an interior portion that is inserted into the exterior portion and rotatable about a predetermined center line of rotation with respect to the exterior portion, and has a distal portion to which the incision portion is fixed, wherein the interior portion includes a contact portion having a surface that is contactable on an uterine cervix, wherein a guide hole configured on the interior portion to guide a distal end portion of the conductive member such that the distal end portion of the conductive member is capable of being advanced and retracted in a direction intersecting the center line of the vaginal canal, wherein the guide hole being capable of guiding the conductive member in a direction toward a boundary between the uterine cervix and the vaginal canal while the contact portion is in contact with the uterine cervix, and wherein the incision portion separates the vaginal canal along a circumference whose center is the center line of rotation by rotating the interior portion about the center line of rotation with respect to the exterior portion, in a state where the incision portion penetrates through the vaginal canal.

According to a second aspect of the present invention, in the vaginal wall incision instrument according to the first aspect, the exterior portion may include an outer tubular member having a tubular shape; and an airtight valve configured to airtightly close a gap between the outer tubular member and the interior portion.

According to a third aspect of the present invention, in the vaginal wall incision instrument according to the first aspect, the exterior portion may include a locking portion that protrudes from an outer circumferential surface of the exterior portion in a radially outward direction of the exterior portion and is lockable to the inner wall of the vaginal canal.

According to a fourth aspect of the present invention, in the vaginal wall incision instrument according to the third aspect, the locking portion may include a plurality of anchors that are lockable to the inner wall of the vaginal canal.

According to a fifth aspect of the present invention, in the vaginal wall incision instrument according to the second aspect, the operating portion may include a shaft body having a substantially bar shape; a serrated portion provided on an external surface of the shaft body; a slider attached to the shaft body; and a convex portion that is provided in the slider and engageable with a plurality of projections constituting the serrated portion.

According to a sixth aspect of the present invention, in the vaginal wall incision instrument according to the second aspect, the interior portion may include a cup-shaped member that is formed in a cup shape whose diameter gradually increases toward a distal side and whose inner surface is a surface that is contactable on the uterine cervix.

According to a seventh aspect of the present invention, in the vaginal wall incision instrument according to the second aspect, the interior portion may include a bar-shaped position-determining member that is formed to be coaxial with the center line of rotation of the interior portion and protrudes toward a distal side.

DETAILED DESCRIPTION OF THE INVENTION

A first embodiment of the present invention will be described.FIG. 1is a general view of a vaginal wall incision instrument1according to the present embodiment.FIG. 2is a partial cross-sectional view of the vaginal wall incision instrument1according to the present embodiment.FIG. 3is a cross-sectional view of an operating portion20in the vaginal wall incision instrument1according to the present embodiment.

The vaginal wall incision instrument1illustrated inFIG. 1is a medical instrument that can be used to separate a uterus from a vagina in a total laparoscopic hysterectomy and a laparoscopic supracervical hysterectomy.

As illustrated inFIG. 1, the vaginal wall incision instrument1has a substantially bar shape as a whole. The vaginal wall incision instrument1includes a main body portion2, an incision portion16, and the operating portion20.

As illustrated inFIGS. 1 and 2, the main body portion2has a substantially bar shape as a whole. The main body portion2can be inserted into a vaginal canal from a distal side. The main body portion2includes an exterior portion3and an interior portion8.

The exterior portion3forms an outermost layer of the main body portion2. The exterior portion3includes an outer tubular member4, a locking portion5, and an airtight valve7.

The outer tubular member4has a tubular shape having an external dimension insertable into the vaginal canal. The outer tubular member4is rigid or slightly elastic. In the present embodiment, the outer tubular member4is made of a resin or the like. Exemplary materials of the outer tubular member4include a fluorine resin (for example, a polytetrafluoroethylene), a nylon resin (for example, nylon), and an olefin resin (for example, a polyethylene and a polypropylene). An outer circumferential surface of the outer tubular member4includes a smoothly curved surface that does not damage mucous membranes.

The locking portion5includes an annular member6fixed to the outer circumferential surface of the outer tubular member4.

The annular member6is arranged in the vicinity of a distal end of the outer tubular member4. The annular member6extends in a circumferential direction of the outer tubular member4on the outer circumferential surface of the outer tubular member4. The annular member6and the outer tubular member4are fixed by, for example, bonding. The annular member6and the outer tubular member4may also be integrally formed.

The annular member6protrudes in a radially outward direction of the outer tubular member4from the outer circumferential surface of the outer tubular member4. An outer circumferential surface of the annular member6has a smoothly curved surface so as not to damage mucous membranes. In the annular member6, when the vaginal wall incision instrument1is used, a gap between the outer tubular member4and a vaginal wall is airtightly closed by the annular member6. When the vaginal wall is incised, the annular member6serves to hold the vaginal wall still with respect to the outer tubular member4.

The airtight valve7is a valve for airtightly closing the outer tubular member4and the interior portion8. The airtight valve7is fixed to an opening at a proximal end of the outer tubular member4. The airtight valve7has an annular shape including a hole7a. The interior portion8can be inserted into the hole7aformed in the airtight valve7. While a connecting member10of the interior portion8to be described below is inserted into the hole7a, the airtight valve7is slidably in close contact with the connecting member10in an airtight state. The airtight valve7has elasticity. In addition, a center line of an opening of the hole7aof the airtight valve7corresponds to a center line of the outer tubular member4. The airtight valve7supports the connecting member10such that the connecting member10is rotatable using the center line of the outer tubular member4as a center line of rotation. A material of the airtight valve7is not specifically limited as long as the material has elasticity. In the present embodiment, the airtight valve7is made of a silicone or urethane material.

The interior portion8is rotatable using the center line of the outer tubular member4as a center line of rotation inside the outer tubular member4. As illustrated inFIG. 2, the interior portion8includes an inner tubular member9, the connecting member10, and a contact portion11.

The inner tubular member9is a tubular member that is arranged inside the outer tubular member4. An outer diameter of the inner tubular member9is slightly smaller than an inner diameter of the outer tubular member4. A center line of the inner tubular member9has substantially the same axis as the center line of the outer tubular member4. The inner tubular member9has a rigidness of a degree at which a power for rotating the operating portion20using the center line of the outer tubular member4as a center line of rotation can be transmitted to the contact portion11.

The connecting member10connects a distal end of a shaft body22of a shaft portion21to be described below and a proximal end of the inner tubular member9in the operating portion20. The connecting member10has a substantially cylindrical shape including a hole10a. An outer circumferential surface of the connecting member10is in close contact with an inner surface of the hole7aof the airtight valve7. The distal end of the shaft body22of the operating portion20is inserted into the hole10aformed in the connecting member10. The connecting member10is fixed to the shaft body22by, for example, bonding.

The contact portion11is disposed at a distal portion of the interior portion8. When the vaginal wall incision instrument1is used, the contact portion11is contactable on a vaginal portion of the cervix. The contact portion11of the present embodiment includes a cup-shaped member12and a position-determining member15. The cup-shaped member12has a cup shape whose diameter gradually increases toward a distal side. The position-determining member15protrudes from an inner surface of the cup-shaped member12.

The cup-shaped member12is fixed to a distal end of the inner tubular member9. The cup-shaped member12includes a concave portion13and a guide hole14. The concave portion13is contactable on a uterine cervix. The guide hole14communicates with an inside of the inner tubular member9, and is formed to extend in a direction inclined with respect to the center line of the inner tubular member9.

A distal end of an insulating member18having a tubular shape to be described below in the incision portion16is fixed to the guide hole14of the cup-shaped member12. The guide hole14regulates an advancing and a retracting direction of a conductive member17that can protrude from the insulating member18of the incision portion16in a predetermined direction inclined with respect to the center line of the inner tubular member9.

The guide hole14guides an advancing and a retracting of the conductive member17such that, when the conductive member17is moved to a distal side of the inner tubular member9, a distal end of the conductive member17obliquely moves in a radially outward direction of the inner tubular member9. An angle of inclination of a center line of the guide hole14with respect to the center line of the inner tubular member9is set to an angle at which the distal end of the conductive member17is not in contact with the uterine cervix or a uterine corpus but is separated from the uterine cervix or the uterine corpus when the vaginal wall incision instrument1is used.

The position-determining member15is a bar-shaped member that protrudes toward a distal side from a bottom of the concave portion13of the cup-shaped member12. The position-determining member15extends coaxially with the center line of the inner tubular member9. A protrusion length from the concave portion13of the position-determining member15has a degree at which at least a distal end of the position-determining member15is inserted into an orifice of the uterus while the vaginal portion of the cervix is in contact with the concave portion13of the cup-shaped member12.

As illustrated inFIG. 4, the position-determining member15can connect the orifice of the uterus103and the contact portion11such that the contact portion11is rotatable using an orifice of the uterus103as a center line of rotation. While the position-determining member15is inserted into the orifice of the uterus103and the orifice of the uterus103and the contact portion11are connected, the conductive member17disposed in the guide hole14of the cup-shaped member12is rotatable using the orifice of the uterus103as a center line of rotation.

The incision portion16includes the conductive member17and the insulating member18. The conductive member17is made of a conductive material. The conductive member17is retractably inserted into the insulating member18in an advancing and retracting manner.

The conductive member17is a conductor such as a metal and has elasticity such that at least a distal portion has a linear shape when no external force is applied. In the present embodiment, the conductive member17is formed of an elastic wire having a restoring force that restores the conductive member17to a linear shape when no external force is applied.

The distal end of the conductive member17is supported by the guide hole14formed in the cup-shaped member12through the insulating member18. A proximal end of the conductive member17is fixed to a slider26of the operating portion20to be described below. The proximal end of the conductive member17is fixed to a connector29(to be described below) provided in the slider26. The conductive member17and the connector29are electrically continuous. An intermediate portion of the conductive member17is disposed inside the inner tubular member9.

The insulating member18has a cylindrical shape covering the conductive member17. A distal end of the insulating member18is fixed to an inner surface of the guide hole14of the cup-shaped member12. A proximal end of the insulating member18is fixed to the distal end of the shaft body22of the shaft portion21of the operating portion20.

The operating portion20illustrated inFIGS. 2 and 3is provided at a proximal part of the vaginal wall incision instrument1. The operating portion20is provided to perform an advancing and retracting operation of the conductive member17and a rotating operation in which the entire vaginal wall incision instrument1is rotated using the center line of the outer tubular member4as a center line of rotation. The operating portion20includes the shaft portion21and the slider26. The shaft portion21extends proximally from a proximal end of the connecting member10. The slider26is attached to the shaft portion21.

The shaft portion21has a substantially bar shape that an operator can grasp. The shaft portion21includes the shaft body22, a ring23, and a serrated portion24. The shaft body22has a substantially cylindrical shape. The ring23is formed at a proximal end of the shaft body22. The serrated portion24is disposed in a row in a longitudinal direction of the shaft body22on an external surface of the shaft body22.

The shaft body22has a substantially cylindrical shape into which a proximal part of the conductive member17is inserted. In the shaft body22, a through-hole22afor connecting the shaft body22and the slider26is provided to extend in the longitudinal direction of the shaft body22.

The distal end of the shaft body22is inserted into the hole10aof the connecting member10. The distal end of the shaft body22and the hole10aof the connecting member10are fixed by, for example, bonding. A center line of the shaft body22is set to be coaxial with the center line of the inner tubular member9. Accordingly, when the shaft body22is rotated using the center line of the shaft body22as a center line of rotation, the inner tubular member9and the contact portion11fixed to the inner tubular member9rotate using the center line of the inner tubular member9as a center line of rotation.

The ring23has a ring shape whose center line extends in a direction perpendicular to the center line of the shaft body22at the proximal end of the shaft body22. The ring23has an inner dimension of a degree at which the operator's finger can pass. An outer diameter of the ring23is greater than a diameter of the shaft body22. When an operation of rotating the shaft body22using the center line of the shaft body22as a center line of rotation is performed, the operator can hold the ring23with his or her finger.

The serrated portion24includes a plurality of projections25that protrude in a radially outward direction of the shaft body22on the external surface of the shaft body22. The serrated portion24is integrally formed with the shaft body22. In the present embodiment, the plurality of projections25constituting the serrated portion24are arranged inside the external surface of the shaft body22and along an open end of the through-hole22aformed in the shaft body22. In the present embodiment, the serrated portions24are arranged at two opposite sides with a central axis of the shaft body22interposed therebetween and protrude in opposite directions. The plurality of projections25constituting the serrated portion24are engaged with a convex portion28of the slider26to be described below. When the convex portion28is positioned between a set of adjacent projections25in the plurality of projections25of the serrated portion24, it is possible to keep a position of the slider26in the serrated portion24. When the operator applies an external force of a degree at which the convex portion28of the slider26passes over each of the projections25of the serrated portion24to the ring23, the slider26is movable with respect to the shaft body22in the longitudinal direction of the shaft body22at the serrated portion24.

The slider26is a member that can be advanced and retracted in the longitudinal direction of the shaft body22with respect to the shaft body22. The slider26is provided to advance and retract the conductive member17with respect to the insulating member18.

The slider26includes a cylindrical body27, the convex portion28, and the connector29. The shaft body22is inserted into the cylindrical body27. The convex portion28is provided on an inner surface of the cylindrical body27. The connector29is fixed to the cylindrical body27and fixed to the proximal end of the conductive member17.

As illustrated inFIG. 3, in the cylindrical body27, a through-hole27athat is slightly larger than an outer diameter of the shaft body22is formed. An inner diameter of the cylindrical body27is smaller than an outer diameter of the ring23illustrated inFIG. 2. The operator manually advances and retracts the cylindrical body27with respect to the shaft body22. An external surface of the cylindrical body27may have a configuration into which the operator can insert his or her finger.

The convex portion28protrudes from an inner surface of the through-hole27aformed in the slider26toward an inside of the cylindrical body27. The convex portion28is pressed against the serrated portion24by a resilient unit, for example, a spring.

As illustrated inFIGS. 2 and 3, the connector29is provided to attach a cord C to be connected to a high-frequency power supply device30. The connector29is fixed to a hole connecting the external surface of the cylindrical body27and the inner surface of the through-hole27aof the cylindrical body27and protrudes inward through the through-hole27aof the cylindrical body27. A part protruding inward through the through-hole27aof the cylindrical body27of the slider26in the connector29extends to a center line part of the shaft body22through the through-hole22aof the shaft body22and is fixed to the proximal end of the conductive member17. Accordingly, when the slider26is advanced and retracted with respect to the shaft body22in the longitudinal direction of the shaft body22, the slider26and the connector29are integrally advanced and retracted so that the conductive member17is advanced and retracted with respect to the shaft body22in the longitudinal direction of the shaft body22.

Next, an operation of the vaginal wall incision instrument1according to the present embodiment will be described.

Specifically, a total laparoscopic hysterectomy (TLH) using the vaginal wall incision instrument1according to the present embodiment will be exemplified.

In the total laparoscopic hysterectomy, treatment is performed on a plurality of ligaments, blood vessels, adhesive tissues, and adnexa supporting a uterus and then the uterus is extracted according to treatment of incising the vaginal canal.

In the present embodiment, the uterus is separated from a vaginal canal using a boundary part between an inguinal region and the vaginal canal of the uterus as a separating line. First, according to a known procedure, treatment is performed on the plurality of ligaments, blood vessels, adhesive tissues, and adnexa supporting the uterus. Such a procedure is performed under a laparoscope. In addition, as necessary, a uterine manipulator may be inserted into the uterus from the vaginal canal to adjust a position of the uterus.

The vaginal wall incision instrument1according to the present embodiment is prepared in a state (refer toFIG. 1) in which the high-frequency power supply device30is connected to the connector29. The slider26of the operating portion20is positioned at a proximal part in the shaft portion21. The distal end of the conductive member17is positioned more proximal than the distal end of the insulating member18. When the vaginal wall incision instrument1is used, first, the operator inserts the vaginal wall incision instrument1according to the present embodiment into a vaginal canal110. As illustrated inFIG. 4, the vaginal wall incision instrument1is inserted into the vaginal canal110from the contact portion11until the contact portion11is in contact with a part101(refer toFIG. 4, hereinafter referred to as a “first part101”) facing an inside of the vaginal canal110of a uterine cervix102.

As illustrated inFIG. 4, in the contact portion11, the concave portion13of the cup-shaped member12is in contact with the uterine cervix102to cover the first part101. The guide hole14formed in the cup-shaped member12supports the conductive member17through the insulating member18such that, in a direction substantially along an external surface of the uterine cervix102, the conductive member17can protrude in a direction inclined with respect to the center line of the inner tubular member9. In this case, a protrusion direction of a distal portion of the conductive member17is a linear direction intersecting a boundary part between the uterine cervix102and the vaginal canal110. The distal end of the position-determining member15is inserted into the orifice of the uterus103.

The operator checks that other tissues do not come in contact with the vicinity of the boundary part between the uterine cervix102and the vaginal canal110under a laparoscope. Then, the slider26(refer toFIG. 3) is moved toward a distal side of the shaft body22. As a result, as illustrated inFIG. 5, the conductive member17protrudes toward the boundary part between the uterine cervix102and the vaginal canal110. As necessary, the operator may move the slider26toward the distal side of the shaft body22while a high-frequency current is supplied to the conductive member17using the high-frequency power supply device30. The distal end of the conductive member17penetrates through a vaginal wall111in the boundary part between the uterine cervix102and the vaginal canal110and penetrates through the vaginal wall111to reach an inside of the abdominal cavity. A position of the distal end of the conductive member17can be recognized using the laparoscope. The operator stops an operation of the slider26at a position at which the conductive member17penetrates through the vaginal wall111. Since the convex portion28of the slider26and the projections25of the serrated portion24of the shaft body22are engaged, the slider26is held at a position at which the operator stopped the operation of the slider26. Accordingly, even when the operator releases his or her finger from the slider26, the conductive member17remains penetrated through the vaginal wall111.

After the conductive member17penetrates through the vaginal wall111, the operator rotates the shaft body22of the operating portion20using the center line of the shaft body22as a center line of rotation while a high-frequency current is supplied to the conductive member17. The shaft body22may be rotated in any direction. As a result, the shaft body22rotates the cup-shaped member12through the connecting member10and the inner tubular member9. The cup-shaped member12rotates using the orifice of the uterus103as a center line of rotation when the distal end of the position-determining member15is inserted into the orifice of the uterus103. The outer tubular member4does not rotate by a rotating operation of the shaft body22. For this reason, while the locking portion5provided in the outer tubular member4is locked on an inner surface of the vaginal wall111, the conductive member17incises the vaginal wall111while rotating in a circumferential direction of the vaginal wall111.

When the conductive member17rotates in the circumferential direction of the vaginal wall111one full time, the conductive member17returns to a penetration part of the vaginal wall111. That is, as illustrated inFIG. 6, the vaginal wall111is separated over the entire circumference using the boundary part between the uterine cervix102and the vaginal canal110as the separating line. Accordingly, a uterus100is separated from the vaginal canal110.

When the uterus100is separated from the vaginal canal110, the uterus100is extracted to the outside of the body through the vaginal canal110or through an incised part formed in an abdominal wall according to a known procedure.

In the vaginal wall incision instrument1according to the present embodiment, when the shaft body22of the operating portion20is rotated using the center line of the shaft body22as a center line of rotation, the conductive member17that has penetrated through the vaginal canal110can be rotated with the center line of the outer tubular member4and the inner tubular member9as a center line of rotation. An external surface of the outer tubular member4is in contact with an inner surface of the vaginal canal110, and the vaginal canal110has a tubular shape whose center is aligned with the center line of the outer tubular member4. Therefore, when the conductive member17rotates with the center line of the outer tubular member4and the inner tubular member9as a center line of rotation, the conductive member17can separate the vaginal canal110along a circular separating line that extends in a circumferential direction of the vaginal canal110in a plane perpendicular to a center line of the vaginal canal110, in the vaginal canal110having a tubular shape.

That is, the vaginal wall incision instrument1according to the present embodiment can separate the vaginal canal110along an ideal separating line in the boundary part between the uterine cervix102and the vaginal canal110. In addition, as an operation of separating the vaginal canal110, only an operation in which the shaft body22is rotated using the center line of the shaft body22as a center line of rotation is performed while a high-frequency current is supplied to the conductive member17, and a cooperative operation of a plurality of instruments is unnecessary. That is, when the vaginal canal110is held by the outer tubular member4, position determining for matching a position of the conductive member17with a separating line has already been performed. Therefore, the operator can separate the vaginal wall111along an ideal separating line when only the rotating operation of the shaft body22is performed.

In the vaginal wall incision instrument1according to the present embodiment, the conductive member17rotates such that separation starts from a part in which the conductive member17penetrates through the vaginal wall111, and when the separation ends, the conductive member17is returned to the penetration part. Therefore, a position of the conductive member17is easily adjusted during the separating operation and workability is excellent.

In the vaginal wall incision instrument1according to the present embodiment, the distal end portion of the conductive member17advances and retracts in a direction intersecting the center line of the vaginal canal110, and the conductive member17penetrates through the vaginal wall111in a radially outward direction of the vaginal canal110as it advances to the distal side. Therefore, compared to when the conductive member17protrudes in a direction perpendicular to the center line of the vaginal canal110, a separating operation using the vaginal wall incision instrument1according to the present embodiment can preserve the vaginal canal110with a small ablation amount of the vaginal canal110.

Further, when the operator causes the conductive member17to penetrate through the vaginal canal110or when the operator separates the vaginal canal110over the entire circumference using the conductive member17, the conductive member17is less likely to be in contact with the uterine cervix102. In addition, compared to when the conductive member17protrudes in a direction perpendicular to the center line of the vaginal canal110, it is possible to decrease a possibility of erroneous contact of the distal end of the conductive member17with other biological tissues inside the abdominal cavity.

In addition, while the concave portion13of the cup-shaped member12is in contact with the first part101, the cup-shaped member12is stable while covering the first part101. Therefore, when the operator only moves the slider26to the distal side while the concave portion13of the cup-shaped member12is pressed against the first part101, the conductive member17can easily penetrate through the boundary part between the uterine cervix102and the vaginal canal110.

While the concave portion13of the cup-shaped member12is in contact with the first part101, the cup-shaped member12is rotatable using the first part101as a center line of rotation. Therefore, when the operator only rotates the shaft body22while the concave portion13of the cup-shaped member12is pressed against the first part101, the conductive member17can be easily rotated along a separating line of the boundary part between the uterine cervix102and the vaginal canal110.

Since the guide hole14supporting the conductive member17through the insulating member18is formed in the cup-shaped member12, the distal end of the conductive member17is easily accessible at the boundary part between the uterine cervix102and the vaginal canal110.

In the vaginal wall incision instrument1according to the present embodiment, the cup-shaped member12is rotatable using the orifice of the uterus103as a center line of rotation by the position-determining member15. The position-determining member15suppresses a positional deviation of the uterus100with respect to the vaginal canal110and a positional deviation of the vaginal wall incision instrument1with respect to the uterus100. Therefore, it is possible to suppress a positional deviation from a separating line of the conductive member17during a separating procedure of the vaginal wall111using the conductive member17.

The locking portion5provided on the outer circumferential surface of the outer tubular member4holds the vaginal wall111such that positions of the outer tubular member4and the vaginal wall111are not deviated. Therefore, the vaginal canal110is less likely to be twisted during the separating operation, and the vaginal wall111is easily separated along an ideal separating line.

The airtight valve7for maintaining the outer tubular member4and the interior portion8in an airtight state is provided at the exterior portion3. Therefore, when a gas is input to the abdominal cavity in order to easily perform a procedure under a laparoscope, an amount of gas leaked from a gap between the outer tubular member4and the interior portion8is minimized, and the outer tubular member4and the interior portion8are rotatable using the center line of the outer tubular member4as a center line of rotation.

The locking portion5provided in the outer tubular member4can also suppress a gas filled in the abdominal cavity according to gas supply from leaking.

Next, a modification of the present embodiment will be described.FIG. 7is a side view of a configuration of a modification of the vaginal wall incision instrument according to the embodiment.

The present modification has a different configuration from the embodiment in that the locking portion5described in the embodiment includes a balloon31and an air feed conduit32instead of the annular member6, as illustrated inFIG. 7.

The balloon31has an annular shape whose center is aligned with the center line of the outer tubular member4on the outer circumferential surface of the outer tubular member4and is fixed to the outer circumferential surface of the outer tubular member4. The balloon31has an expandable membrane that inflates when a liquid or a gas is filled therein. When a liquid or a gas is filled inside the balloon31, the balloon31is inflated in a donut shape.

The air feed conduit32is a tubular member whose distal end communicates with an inside of the balloon31and whose proximal end is connected to a pump. The air feed conduit32is fixed to, for example, the external surface of the outer tubular member4.

In addition, the air feed conduit32may be drawn into the outer tubular member4through the outer tubular member4and extend to a proximal side of the main body portion2through a gap between the outer tubular member4and the interior portion8.

In the present modification, when an inflation diameter of the balloon31is adjusted, it is possible to adjust a pressing force of the balloon31against the vaginal wall111. Accordingly, in the present modification, it is possible to lock the outer tubular member4to the vaginal wall111with an appropriate locking force corresponding to individual differences of patients.

Next, a second embodiment of the present invention will be described. In embodiments to be described below, components having the same functions or structures as those in the vaginal wall incision instrument1according to the above-described first embodiment are denoted by the same reference numerals as in the first embodiment, and redundant descriptions thereof will be omitted.

FIG. 8is a perspective view of a part of a vaginal wall incision instrument1A according to the present embodiment.FIG. 9is a cross-sectional view of a distal portion of the vaginal wall incision instrument1A according to the present embodiment.

As illustrated inFIGS. 8 and 9, the vaginal wall incision instrument1A according to the present embodiment includes a main body portion2A whose configuration is different from the main body portion2described in the first embodiment.

As illustrated inFIG. 9, the main body portion2A includes an exterior portion3A and an interior portion8A. The exterior portion3A has a different configuration from the exterior portion3of the first embodiment in that a first stopper33is provided on an inner circumferential surface of the outer tubular member4. The interior portion8A has a different configuration from the interior portion8of the first embodiment in that a second stopper34is provided on an outer circumferential surface of the inner tubular member9and the guide hole14is provided in the inner tubular member9instead of the cup-shaped member12. The present embodiment includes the same incision portion16and operating portion20as those in the first embodiment.

The first stopper33provided at the outer tubular member4extends in the circumferential direction of the outer tubular member4and is provided over an entire circumference of the outer tubular member4on the inner circumferential surface of the outer tubular member4. The first stopper33protrudes from the inner circumferential surface of the outer tubular member4radially inward toward the outer tubular member4.

The second stopper34provided at the inner tubular member9extends in a circumferential direction of the inner tubular member9and is provided over an entire circumference of the inner tubular member9on the outer circumferential surface of the inner tubular member9. The second stopper34protrudes from the outer circumferential surface of the inner tubular member9in a radially outward direction of the inner tubular member9. There is a clearance between an outer circumferential surface of the second stopper34and the outer tubular member4. The clearance has a size of a degree at which the second stopper34is rotatable using the center line of the outer tubular member4as a center line of rotation with respect to the outer tubular member4. The second stopper34is positioned more distal than the first stopper33. An external surface of a proximal side in the second stopper34is contactable on an external surface of a distal side in the first stopper33.

Similarly to the first embodiment, the guide hole14formed in the inner tubular member9guides the conductive member17in a direction inclined with respect to the center line of the inner tubular member9. In addition, while the second stopper34is in contact with the first stopper33, a gap of a degree at which the conductive member17can protrude is open between the distal end of the outer tubular member4and the interior portion8A. Accordingly, in the present embodiment, the conductive member17protrudes from a gap between the distal end of the outer tubular member4and the interior portion8A.

Similarly to the first embodiment, the vaginal wall incision instrument1A according to the present embodiment can also separate the vaginal canal110along an ideal separating line set in a boundary between the uterine cervix102and the vaginal canal110.

Next, a third embodiment of the present invention will be described.FIG. 10is a perspective view of a main body portion of a vaginal wall incision instrument1B according to the present embodiment.FIG. 11is a perspective view of an outer tubular member4B of the vaginal wall incision instrument1B according to the present embodiment.FIG. 12is a perspective view of an intermediate tubular member36of the vaginal wall incision instrument1B according to the present embodiment.FIG. 13is a perspective view of an inner tubular member9B of the vaginal wall incision instrument1B according to the present embodiment.FIG. 14is a perspective view of an incision portion16B of the vaginal wall incision instrument1B according to the present embodiment.FIG. 15is a cross-sectional view of the inner tubular member9B of the vaginal wall incision instrument1B according to the present embodiment.FIG. 16is a diagram describing an operation of the vaginal wall incision instrument1B according to the present embodiment and is a cross-sectional view taken along line A-A ofFIG. 10.FIG. 17is a diagram describing an operation of the vaginal wall incision instrument1B according to the present embodiment and is a cross-sectional view taken along line A-A ofFIG. 10.

As illustrated inFIG. 10, the vaginal wall incision instrument1B according to the present embodiment includes a main body portion2B whose configuration is different from the main body portion2described in the first embodiment. The vaginal wall incision instrument1B according to the present embodiment includes the incision portion16B instead of the incision portion16described in the third embodiment.

The main body portion2B includes an exterior portion3B, a locking portion5B, and an interior portion8B. The exterior portion3B includes the outer tubular member4B whose shape is different from the outer tubular member4described in the first embodiment. The locking portion5B is disposed inside the exterior portion3B and has a different configuration from the locking portion5described in the first embodiment. The interior portion8B is disposed inside the locking portion5B and includes the inner tubular member9B whose configuration is different from the interior portion8described in the first embodiment.

As illustrated inFIG. 11, the outer tubular member4B of the exterior portion3B is a tubular member in which a plurality of through-holes35are formed on an outer circumferential surface. The plurality of through-holes35formed on an outer circumferential surface of the outer tubular member4B are arranged in a row or randomly at positions separated from each other in a circumferential direction of the outer tubular member4B. The plurality of through-holes35formed on the outer circumferential surface of the outer tubular member4B are arranged at positions separated from each other in a center line direction of the outer tubular member4B.

As illustrated inFIG. 12, the locking portion5B includes the intermediate tubular member36and a plurality of anchors37. The intermediate tubular member36is a tubular member disposed between the outer tubular member4B and the inner tubular member9B. The plurality of anchors37are fixed to an external surface of the intermediate tubular member36.

A distal end of the intermediate tubular member36is positioned at a position of a distal end of the outer tubular member4B or more proximal than the position of the distal end of the outer tubular member4B. A proximal end of the intermediate tubular member36is positioned more proximal than a proximal end of the outer tubular member4B. A proximal part of the intermediate tubular member36is a first grasping portion36athat the operator holds to rotate the intermediate tubular member36with his or her hand. The inner tubular member9B is inserted into the intermediate tubular member36.

A center line of the intermediate tubular member36is aligned to be substantially coaxial with both a center line of the outer tubular member4B and a center line of the inner tubular member9B. The intermediate tubular member36is rotatable with respect to the outer tubular member4B and the inner tubular member9B.

The anchor37includes a wire38and an end member39. The wire38is fixed to an outer circumferential surface of the intermediate tubular member36. The end member39is fixed to an end of the wire38.

The wire38of the anchor37has a restoring force that restores it to a substantially linear shape when no external force is applied. The wire38of the anchor37includes one end that is inserted into, for example, a sidewall of the intermediate tubular member36and is fixed to the intermediate tubular member36by, for example, bonding. In the present embodiment, each of the wires38of the anchor37is fixed perpendicularly to the outer circumferential surface of the intermediate tubular member36.

The end member39of the anchor37has a curved surface so as not to stimulate mucous membranes. In the present embodiment, the end member39of the anchor37is a spherical member into which an end of the wire38of the anchor37is inserted and fixed. An outer diameter of the end member39is greater than an inner diameter of the through-hole35formed on the outer circumferential surface of the outer tubular member4B.

As illustrated inFIG. 13, the interior portion8B includes the inner tubular member9B and the contact portion11B. The inner tubular member9B has a substantially tubular shape whose side is open at a distal portion and whose proximal end is open. The contact portion11B is provided at a distal end of the inner tubular member9B. In addition, a proximal part of the inner tubular member9B in the interior portion8B is a second grasping portion9athat the operator can grasp to rotate the inner tubular member9B about the center line of the inner tubular member9B.

A side opening at a distal portion of the inner tubular member9B is an opening through which a conductive member17B to be described below protrudes. That is, in the present embodiment, the conductive member17B is inserted into a distal side from a proximal end of the inner tubular member9B, and the conductive member17B protrudes from the side opening at the distal portion of the inner tubular member9B.

As illustrated inFIG. 15, the side opening at the distal portion of the inner tubular member9B has a curved surface or a flat surface inclined with respect to the center line of the inner tubular member9B inside the inner tubular member9B. Accordingly, the conductive member17B inserted from the proximal side to the distal side along the center line of the inner tubular member9B protrudes in a direction inclined with respect to the center line of the inner tubular member9B in the opening. In the present embodiment, similarly to the guide hole14described in the first embodiment, the side opening at the distal portion of the inner tubular member9B is a guide hole14B for guiding the distal end of the conductive member17B toward a boundary part between the uterine cervix and the vaginal canal.

The contact portion11B has a disc shape along a plane perpendicular to the center line of the inner tubular member9. Similarly to the first embodiment, the contact portion11B of the present embodiment may have a cup shape having a concave portion that is contactable on the uterine cervix. The vaginal portion of the cervix is contactable on an external surface of a distal side of the contact portion11B. Similarly to the concave portion13described in the first embodiment, a position of the conductive member17B can be determined such that the conductive member17B is directed toward the boundary part between the uterine cervix and the vaginal canal.

As illustrated inFIG. 14, as the incision portion16B, for example, a known high-frequency incision instrument having a needle-type electrode can be appropriately selected and used. As an example, the incision portion16B includes an insulating member18B (for example, an insulating sheath), the conductive member17B (for example, a needle-type electrode) and an operating portion20B. The insulating member18B corresponds to the insulating member18described in the first embodiment. The conductive member17B (for example, a needle-type electrode) corresponds to the conductive member17described in the first embodiment and is inserted into the insulating member18B. The operating portion20B is fixed to the proximal end of the insulating member18B. The operating portion20B is provided to advance and retract the conductive member17B.

Next, an operation of the vaginal wall incision instrument1B according to the present embodiment will be described.FIG. 18is a diagram describing a procedure using the vaginal wall incision instrument1B according to the present embodiment.FIG. 19is a diagram describing a procedure using the vaginal wall incision instrument1B according to the present embodiment and is a cross-sectional view taken along line B-B ofFIG. 18.FIG. 20is a diagram describing a procedure using the vaginal wall incision instrument1B according to the present embodiment.FIG. 21is a diagram describing a procedure using the vaginal wall incision instrument1B according to the present embodiment and is a cross-sectional view taken along line C-C ofFIG. 20.FIG. 22is a diagram describing a procedure using the vaginal wall incision instrument1B according to the present embodiment.FIG. 23is a diagram describing a procedure using the vaginal wall incision instrument1B according to the present embodiment and is a cross-sectional view taken along line D-D ofFIG. 22.FIG. 24is a diagram describing a procedure using the vaginal wall incision instrument1B according to the present embodiment.FIG. 25is a diagram describing a procedure using the vaginal wall incision instrument1B according to the present embodiment and is a cross-sectional view taken along line E-E ofFIG. 24.

In the present embodiment, when the operator rotates the intermediate tubular member36using the center line of the intermediate tubular member36as a center line of rotation with respect to the outer tubular member4B, the wire38of the anchor37can be inserted into or extracted from the through-hole35of the outer tubular member4B.

That is, as illustrated inFIGS. 18 and 19, when the operator inserts the main body portion2B into the vaginal canal110, the wire38of the anchor37is wound on the outer circumferential surface of the intermediate tubular member36(refer toFIG. 16). Next, while the main body portion2B is completely inserted into the vaginal canal110and the contact portion11B is in contact with the first part101, the operator rotates the intermediate tubular member36with respect to the outer tubular member4B and unwinds the wire38of the anchor37on the intermediate tubular member36. As a result, the wire38of the anchor37is pushed to the outside of the outer tubular member4B through each of the through-holes35on the outer circumferential surface of the outer tubular member4B while returning to a linear state (refer toFIG. 17). The restoring force that restores the wire38to the linear state is exerted on the wire38of the anchor37. Accordingly, the wire38may be pushed to the outside of the outer tubular member4B through each of the through-holes35of the outer tubular member4B only when a force with which the wire38is wound on the intermediate tubular member36is released according to a magnitude of the restoring force of the wire38.

As a result, as illustrated inFIGS. 20 and 21, the wire38of the anchor37presses the vaginal wall111in a radially outward direction thereof through the end member39. According to a frictional force between each of the end members39fixed to the wire38of the anchor37and the vaginal wall111, the outer tubular member4B is locked to the vaginal wall111, similarly to the locking portion5described in the first embodiment. When each of the wires38has the restoring force that pushes the wire38to the outside of the outer tubular member4B through each of the through-holes35of the outer tubular member4B only by releasing a force with which the wire38is wound on the intermediate tubular member36, rotation of the intermediate tubular member36stops at a position at which magnitudes of the restoring force of each of the wires38and a counterforce from the vaginal wall111become equal.

After the outer tubular member4B is locked to the vaginal wall111by the anchor37, as illustrated inFIGS. 22 and 23, the operator protrudes the conductive member17B from the guide hole14B, which is the side opening at the distal portion of the inner tubular member9. As a result, similarly to the first embodiment, the distal end of the conductive member17B penetrates through the vaginal wall111, and is in a state in which the conductive member17B penetrates through the vaginal wall111in the boundary part between the uterine cervix102and the vaginal canal110.

Next, while a high-frequency current is supplied to the conductive member17B, the operator rotates the second grasping portion9ausing the center line of the inner tubular member9B as a center line of rotation, as illustrated inFIGS. 24 and 25. As a result, with respect to the vaginal wall111locked to the outer tubular member4B by the locking portion5B, the conductive member17B is rotated using the center line of the vaginal canal110as a center line of rotation. Accordingly, similarly to the first embodiment, the conductive member17B separates the vaginal wall111over the entire circumference.

Similarly to the first embodiment, in the present embodiment, it is also possible to easily separate the vaginal wall111along an ideal separating line in the boundary between the uterine cervix102and the vaginal canal110.

In the present embodiment, an operation of appropriately adjusting a length of the wire38of the anchor37can be easily performed by adjusting an amount of rotation of the intermediate tubular member36with respect to the outer tubular member4B.

When each of the wires38has the restoring force that pushes the wire38to the outside of the outer tubular member4B through each of the through-holes35of the outer tubular member4B only by releasing a force with which the wire38is wound on the intermediate tubular member36, rotation of the intermediate tubular member36stops at the position at which magnitudes of the restoring force of each of the wires38and the counterforce from the vaginal wall111become equal. Therefore, regardless of individual differences of patients, it is possible to lock the outer tubular member4B to the vaginal wall111with a constant locking force.

Next, a fourth embodiment of the present invention will be described.FIG. 26is a general view of a vaginal wall incision instrument1C according to the present embodiment.FIG. 27is a perspective view of an outer tubular member4C of the vaginal wall incision instrument1C according to the present embodiment.FIG. 28is a perspective view of an intermediate tubular member36C of the vaginal wall incision instrument1C according to the present embodiment.FIG. 29is a perspective view of an inner tubular member9C of the vaginal wall incision instrument1C according to the present embodiment.FIG. 30is a cross-sectional view of the inner tubular member9C of the vaginal wall incision instrument1C according to the present embodiment.

As illustrated inFIG. 26, the vaginal wall incision instrument1C according to the present embodiment includes a main body portion2C whose configuration is different from the main body portion2described in the first embodiment. The vaginal wall incision instrument1C according to the present embodiment includes the incision portion16B described in the third embodiment instead of the incision portion16described in the first embodiment.

The main body portion2C includes an exterior portion3C, a locking portion5C, and an interior portion8C. The exterior portion3C includes the outer tubular member4C whose shape is different from the outer tubular member4described in the first embodiment. The locking portion5C is disposed inside the exterior portion3C and has a different configuration from the locking portion5described in the first embodiment. The interior portion8C is disposed inside the locking portion5C and includes the inner tubular member9C whose configuration is different from the interior portion8described in the first embodiment.

As illustrated inFIG. 27, the outer tubular member4C of the exterior portion3C is a tubular member in which a plurality of through-holes35C are formed on an outer circumferential surface. The plurality of through-holes35C of the outer tubular member4C are arranged in a row or randomly at positions separated from each other in a circumferential direction of the outer tubular member4C.

As illustrated inFIG. 28, the locking portion5C includes the intermediate tubular member36C and a plurality of anchors37C. The intermediate tubular member36C is a tubular member disposed between the outer tubular member4C and the inner tubular member9C. The plurality of anchors37C are fixed to an external surface of the intermediate tubular member36C.

A distal end of the intermediate tubular member36C is positioned at a position of a distal end of the outer tubular member4C or more proximal than the distal end of the outer tubular member4C. A proximal end of the intermediate tubular member36C is positioned more proximal than a proximal end of the outer tubular member4C. A proximal part of the intermediate tubular member36C is a first grasping portion36aC that the operator holds to advance and retract the intermediate tubular member36C with respect to the outer tubular member4C with his or her hand. The inner tubular member9C is inserted into the intermediate tubular member36C.

A center line of the intermediate tubular member36C36is aligned to be substantially coaxial with both a center line of the outer tubular member4C and a center line of the inner tubular member9C. The intermediate tubular member36C can advance and retract in a center line direction of the outer tubular member4C with respect to the outer tubular member4C. The intermediate tubular member36C is rotatable using the center line of the inner tubular member9C as a center line of rotation with respect to the inner tubular member9C.

The anchor37C includes a wire38C and an end member39C. The wire38C is fixed to an outer circumferential surface of the intermediate tubular member36C. The end member39C is fixed to an end of the wire38C.

The wire38C of the anchor37C has a restoring force with which the wire can be restored to a substantially linear shape when no external force is applied. One end of the wire38C of the anchor37C is fixed to the intermediate tubular member36C by, for example, bonding, to be inserted into, for example, a sidewall of the intermediate tubular member36C, or along the outer circumferential surface of the intermediate tubular member36C. The wire38C of the anchor37C is fixed to be inclined such that it is gradually separated from the outer circumferential surface of the intermediate tubular member36C from the distal end of the intermediate tubular member36C to a proximal side on an outer circumferential surface of the distal end of the intermediate tubular member36C.

The end member39C of the anchor37C has a curved surface so as not to stimulate mucous membranes. In the present embodiment, the end member39C of the anchor37C is the same spherical member as in the third embodiment. An outer diameter of the end member39C is greater than an inner diameter of the through-hole35C formed on an outer circumferential surface of the outer tubular member4C.

As illustrated inFIG. 29, the interior portion8C includes the inner tubular member9C having a cylindrical shape and the contact portion11C. The contact portion11C communicates with an inside of the inner tubular member9C provided at a distal end of the inner tubular member9C. In addition, a proximal part of the inner tubular member9C in the interior portion8C is a second grasping portion9aC that the operator can grasp to rotate the inner tubular member9C about the center line of the inner tubular member9B.

As illustrated inFIG. 30, a guide hole14C is formed in the contact portion11C. The guide hole14C is formed to protrude the conductive member17B inserted into a distal side from a proximal side of the inner tubular member9C in a radially outward direction of the inner tubular member9C.

Similarly to the guide hole14of the first embodiment, the guide hole14C supports the conductive member17B such that the distal end of the conductive member17B can penetrate through the boundary part between the uterine cervix and the vaginal canal. In the present embodiment, the insulating member18B of the incision portion16B is not fixed to an inner surface of the guide hole14C.

Similarly to the third embodiment, the contact portion11C has a disc shape along a plane perpendicular to the center line of the inner tubular member9. The first part101is contactable on an external surface of a distal side in the contact portion11B. Similarly to the concave portion13described in the first embodiment, a position of the conductive member17B can be determined such that the conductive member17B is directed toward the boundary part between the uterine cervix and the vaginal canal.

Next, an operation of the vaginal wall incision instrument1C according to the present embodiment will be described.FIG. 31is a diagram describing an operation of the vaginal wall incision instrument1C according to the present embodiment.FIG. 32is a diagram describing an operation of the vaginal wall incision instrument1C according to the present embodiment.FIGS. 33 to 36are diagrams describing a procedure using the vaginal wall incision instrument1C according to the present embodiment.

As illustrated inFIGS. 31 and 32, in the present embodiment, when the operator advances and retracts the intermediate tubular member36C with respect to the outer tubular member4C along the center line of the intermediate tubular member36C, the wire38C of the anchor37C can be inserted into or extracted from the through-hole35C of the outer tubular member4C.

That is, as illustrated inFIG. 33, when the main body portion2C is inserted into the vaginal canal110, the intermediate tubular member36C is pressed against a distal side of the outer tubular member4C such that the wire38C of the anchor37C is accommodated in a gap between the intermediate tubular member36C and the outer tubular member4C. Then, while the main body portion2C is completely inserted into the vaginal canal110and the contact portion11C is in contact with the first part101, the operator moves the intermediate tubular member36C to a proximal side of the outer tubular member4C as illustrated inFIG. 34. As a result, the wire38C of the anchor37C is pushed to the outside of the outer tubular member4C through the through-hole35C on the outer circumferential surface of the outer tubular member4C. The wire38C of the anchor37C is distorted in a radially outward direction of the outer tubular member4C by an inner surface of the through-hole35C of the outer tubular member4C. Therefore, at the outside of the outer tubular member4C, while the wire38C of the anchor37C is inclined to be gradually separated from the outer circumferential surface of the outer tubular member4C as it advances to the proximal side of the outer tubular member4C, the end member39C presses the vaginal wall111.

As a result, the wire38C of the anchor37C presses the vaginal wall111in a radially outward direction of the vaginal wall111through the end member39C. According to a frictional force between each of the end members39C fixed to the wire38C of the anchor37C and the vaginal wall111, the outer tubular member4C is locked to the vaginal wall111, similarly to the locking portion5described in the first embodiment.

The outer tubular member4C is locked to the vaginal wall111by the locking portion5C having the anchor37C, and then the operator protrudes the conductive member17B from the guide hole14C. As a result, similarly to the first embodiment, the distal end of the conductive member17B penetrates through the vaginal wall111, and the conductive member17B penetrates through the vaginal wall111in the boundary part between the uterine cervix102and the vaginal canal110(refer toFIG. 35).

Next, while a high-frequency current is supplied to the conductive member17B, the operator rotates the second grasping portion9aC using the center line of the inner tubular member9C as a center line of rotation, as illustrated inFIG. 36. As a result, with respect to the vaginal wall111locked to the outer tubular member4C by the locking portion5C, the conductive member17B is rotated using the center line of the vaginal canal110as a center line of rotation. Accordingly, similarly to the first embodiment, the conductive member17B separates the vaginal wall111over the entire circumference.

Similarly to the first embodiment, the vaginal wall incision instrument1C according to the present embodiment can also easily separate the vaginal wall111along an ideal separating line in the boundary between the uterine cervix102and the vaginal canal110.

In the present embodiment, an operation of appropriately adjusting a length of the wire38of the anchor37can be easily performed by adjusting an amount of a forward movement or an amount of a backward movement of the intermediate tubular member36with respect to the outer tubular member4C.

While the embodiments of the present invention have been described above with reference to the accompanying drawings, a detailed configuration is not limited to the embodiments and design modifications without departing from the scope of the present invention are also included.

For example, in the above-described embodiments, an exemplary conductor through which a high-frequency current is supplied was disclosed as the incision portions16and16B. However, in the vaginal wall incision instrument of the present invention, an incision portion that incises biological tissues using an ultrasound or laser may be provided instead of the incision portion made of a conductor.

According to another aspect of the present invention, a method of separating a vaginal wall is provided. In a boundary between the vaginal canal and the uterine cervix, an incision portion (knife) penetrates from an inside of the vaginal canal into the abdominal cavity. While the knife has penetrated through the vaginal canal, the knife is rotated using a center line of the vaginal canal as a center line of rotation, and thereby the vaginal canal is separated over the entire circumference.

According to the method, the uterus and the vaginal canal can be separated using the boundary part between the uterine cervix and the vaginal canal as a separating line.

In addition, in the method, the knife may penetrate through the vaginal canal in a direction intersecting a center line of the vaginal canal and at an angle away from the uterine cervix and the uterine corpus.

In addition, in the method, a contact portion that is contactable on the vaginal portion of the cervix may be inserted into the vaginal canal and the knife may be supported by the contact portion.

In addition, a position-determining member that can be inserted into the orifice of the uterus may be inserted into the orifice of the uterus, and the position-determining member may regulate a movement direction of the knife to a rotation direction in which the orifice of the uterus is used as a center line of rotation.