GYNAECOLOGICAL SPATULA

Abstract: A gynaecological spatula which is adapted to take smears from the cerival canal simultaneously with smears from the cervical external os, comprising (a) a spatula elongate body portion having two oppositely disposed scraper elements at one end thereof for presentation to a cervix, and (b) a spatula extension member having oppositely disposed scraping edges and which is axially slidably mounted in said body portion at the said one end thereof and moveable between extended and retracted positions so that when in its extended position it is adapted to enter the cervical canal of a cervix.

Description: GYNAECOLOGICAL SPATULA This invention relates to a gynaecological spatula which may be used for the taking of cervical smears, and which in particular may be used for taking smears from the external os and the cervical canal, and which further may be provided for taking vaginal smears. The objective of a cervical screening programme is to detect epithelial abnormalities of the cervix at a preinvasive stage. These abnormalities almost always arise at the squamo-columnar junction, extend up into the endocervical canal and down to the ectocervix and vaginal wall. Invasion may occur at any time during this process. The rate of progression varies greatly and the exact relationship between intrepithelial and invasive-neoplasis of the cervix is still not fully understood. The squamo-columnar junction may move up or down in the cervical canal, sometimes being found inside the external os and sometimes exposed in the vaginal tract of the cervix. The cervix is not always well exposed under vaginal dilatation. It is easy to miss the external Os and scrape around the vaginal portion of the cervix, or even the vaginal vault. If there are malignant cells on the vaginal cervical surface, they may be collected even with a vaginal smear test because usually they fall into the vaginal lumen. If a lesion is in the cervical canal, the cells may fall into the inside portion of the internal os and the smear may thus give a negative result. Cervical smears have hitherto been taken with an Ayre's spatula, which is normally made of wood, and is formed in one piece one end having a single wing-like protuberance and at the other end a portion of enhanced width for the taking of vaginal smears. Because of the fixed shape of the instrument, it has been necessary to ensure that the wing portion has a sufficiently large size to effectively scrape round the cervical external 05. Because of its size this operation can produce trauma and frequent bleeding. As both hands are required to effect a rotation of 3600, the spatula may become dislodged and frequently scrapes the wrong tissues. In practice a full 3600 rotation is often not effected. An Ayre's spatula fails to produce adequate smears in terms of endocervical content in approximately half of the smears collected. False negative rates of 13% are not uncommon and about 10% of these are thought to be failures of smear taking technique. Any pathological situation for example adhesions, tumours or lumps, which can change the normal position of the uterus and cervix makes the examination more difficult. Any anatomical change of the introitus in the vaginal shape will have an adverse effect on the normal procedure of taking a smear. Thus physiological changes include post-menopausal vaginal atrophy, and pathological changes include post radiation vaginal atrophy, adhesions, stenoaji and prolapse0 With inoreasingly more oonservat#ve mtnagemont of intraepithelial lesions or the oerrsxt d4agnon4 at an early stage becomes even more essential. Once a carcinoma in situ has extended into the endocervical canal, conservative treatment at colposcopy is no longer feasible and cone biopsy is indicated, Long-standing lesions may not be completely removed by cone biopsy or even total hysterectomy. Clearly for an early diagnosis to be made, thesquamo-columnar junctions must be scraped in its entirety. The reasons for these failures are easy to understand because spatulas hitherto used have a fixed shape designed for applying to a cervix of average shape. Various factors can change the shape of a woman's cervix including pregnancy, previous pregnancies, labour and previous operations on the cervix, either for diagnostic or curative reasons, and good smears are not obtainable. For these reasons a number of cases of early cervical carcinoma and epithelial abnormalities are missed when using a conventional Ayre's spatula. The spatula according to the invention is provided at one -end portion with two oppositely-disposed scraper elements whereby a smear may be extracted from the external os with a 1800 rotation of the spatula, and also has a longitudinal axially-slidable extension member having oppositely disposed scraping edges whereby when in the extended position smears may be simultaneously taken from the walls of the cervical canal and from the canal adjacent to the external os, during rotation of the spatula. The other end of the spatula according to the invention may if desired be provided with a scraper element for removal of vaginal smears. The extension may be of round or oval cross-section and provided with scraping ribs, but is preferably of flat configuration. A particularly effective spatula according to the invention is one in which the said scraper elements have a concave edge for presentment to the mouth of the cervix following the contours of the mouth of the cervix. The spatula according to the invention may readily and cheaply be manufactured from suitable plastics material, ie. plastics material which may readily be moulded and which is tough. An example of such plastics material is provided by the so-called ABS plastics (acrylonitrile/ butadiene/styrene plastics). Other plastics material may be used, e.g. polyolefins such as polyethylene and polypropylene. One embodiment of the invention is hereinafter described and illustrated in Figures 1 and 2 of the accompanying drawings. Referring to Figures 1 and 2, Figure 1 is a plan view of the spatula and Figure 2 is a side elevation thereof along the lines A-A'. The spatula is provided with a longitudinally ribbed central portion 1 having at one end thereof cervical blade scrapers in the form of oppositely-disposed wing portions 2 and 3 having a leading edge of concave arcuate form. Such wing portions are of generally similar configuration. A further scraper portion 4 is provided forming a longitudinal extension of the spatula portion 1 and which is longitudinally slidably mounted therein. The rear portion of the said slidably mounted extension portion is provided with a button 3 exposed in a slot 6 whereby the extension portion may be moved longitudinally in the body portion. To carry out tests on the vaginal wall the spatula of the invention may be provided#at its other end with a fizzed scraper element 7. After inserting the said other end into the distended vagina for the purpose of obtaining a vaginal 'smear, 'a vaginal smear is taken by application of the scraper 7 to the vaginal wall and the spatula removed. Operation-vAof the spatula according to the invention is illustrated in Figure 3 of the accompanying drawings. A cervix is generally represented at 8, and vaginal dilatation is effected by a conventional speculum diagrammatically shown at 9. The spatula is presented to the cervix with the axial extension member 3 in the retracted position. The two oppositely-disposed scraper elements contact the cervix, which then follows the concave arcuate profile of the scraper elements as shown at 11. The button at the rear end of the axial extension member is then moved forward so that the front end 3 of the axial extension enters the cervical canal 10 to a position 3a shown in broken outline. Rotation of the spatula through 1800 then secures smears through 3600 simultaneously from the cervix and the cervical canal. Further and important improvements in the spatula according to the invention are hereinafter described and illustrated in Figures 4, Figures 5 to 7 and Figures 8 and 9 of the accompanying dra#drigs. The taking of smears from the cervical canal is greatly expedited if the longitudinal axially-slidable extension member is provided with acutely-angled scraping edges, Examples of such configurations are shown in crosssection in Figures 3, 6 and 7. In Figure 3 the scraping edge on the same side of the extension member 32, rotation in one direction producing a build-up of smear 13 on one edge, and subsequent rotation in the opposite direction producing a further smear on the same side Of the member but on the opposite edge. In Figure 6 the scraping edges are on opposite sides of the member 42, the smears 13 being produced on opposite sides of the member during a single rotation. In Figure 7, the scraping edges are produced on all four corners of the member 22 by the provision of a V-cut in each of the opposite edges of the member, thus producing four smears during rotation thereof followed by opposite rotation within a cervical canal. As represented in Figure 4, if the V-cuts shown in Figure 7 are continued along the length of the extension member 22 which is axially slidably mounted within the main body 21 of the spatula member on corresponding profiles along the main body member, the interface 12 providing means of holding the slidable member within the main body, and thus greatly simplifies the overall construction of the spatula. In an alternative and useful form of the spatula according to the invention the spatula extension member has scraping edges having a U-shaped profile extending along each edge surface of a flat extension member and engaging a corresponding profile along the main body member. Such cofiguration is found in practice to provide ease of movement with unusually effective scraping action. A further improvement is shown in Figures 8 and 9, wherein the extension member 50 is provided with sides of generally tapering configuration. Such tapering sides facilitate entry into a cervical canal 53 which usually has a progressive#ly diminishing diameter. To prevent entry of unwanted matter between the space between the main body 51 of the spatula and the tapering extension a seal is provided between the edges of the tapering edges of the extension member and the main body portion, said seal being provided by tongue portions 52 bearing on the edges of the tapering extension member 50, and preserving the seal as the extension member 50 moves out from the main body, as shown in Figure 9, by elastic forces of the material from which the main body is made. An alternative procedure of presentment of the spatula to a cervix is to ensure that the extension member of the spatula is in a fully extended position as the spatula is brought up to the cervix. The fully-extended extension member then enters the cervical canal and slides to some extent back into the main body of the member depending on the degree of resistance offered by the walls of the cervical canal. In a manually-operated spatula as illustrated in the accompanying drawings, the degree of retraction may be controlled manually through the button on the rear portion of the spatula.

Claims: CLAIMS 1. A gynaecological spatula having at one end thereof a scraper element for a cervix, characterized in that the spatula comprises (a) a spatula elongate body portion (l) having two oppositely-disposed scraper elements (2, 3) at one end thereof for presentation to a cervix, and (b) a spatula extension in..member (4) having oppositely-disposed scraping edges and which is axially slidably mounted in said body portion at the said one end thereof and moveable between extended and retracted positions so that when in its extended position it is adapted to enter the cervical canal of a cervix. 2. A spatula according to Claim 1, wherein the said scraper elements (2, 3) are each provided with a concave scraping edge. 3. A spatula according to Claim 1 or Claim 2, wherein the said spatula extension member is mounted axially within the said body member and is provided at its rear end with a button 5 whereby the extension member may manually be moved along the said body member. 4. A spatula according to any of Claims 1 to 3, wherein the said extension member is provided with acutely-angled scraping edges. 5, A spatula according to any of Claims 1 to 3 wherein the said extension member is provided with scraping edges each having a V-shaped profile extending along each edge surface of a flat extension member engaging a corres pondingprofile in the spatula body member. 6. A spatula according to any of Claims 1 to 3, wherein the said extension member is provided with scraping edges each having a U-shaped profile extending along each edge surface of a flat extension member and engaging a corres ponding profile in the spatula body member, 7. A spatula according to any of Claims 1 to 6, wherein the said extension member is provided at its leading end with a tapering configuration. 8. A spatula according to Claim 7, wherein a seal is provided to provide sealing of the space between the said tapered extension member and the said body portion. 9. A spatula according to Claim 8, wherein the said seal is provided by tongue elements of the said body portion bearing on the external surface of the tapered portion of said extension member.

Inventors: PISTOFIDIS, GEORGE
Applicants: PISTOFIDIS, GEORGE
Application year: 1983
Main classification: A61B10
IPC codes: A61B10