UTERINE MANIPULATOR

Abstract: The invention relates to a manipulator (1) comprising a first and a second branch element (2 resp. 4), which each are divided into a central section (6) and connected thereto at an angle ( alpha resp. beta ) first and second end sections (8 resp. 10), which are maneuverable with respect to each other via the central section (6). Both the first and second end section (8 resp. 10) of the respective branch element (2 resp. 4) comprise guiding surfaces (12), which on one hand are intended to form gripping means and on the other hand are intended to form handles.

Description: UTERINE MANITOLATOR The present invention relates to a manipulator comprising a first and second branch element which each are divided into a central section and a first and second end section connected thereto at an angle connected thereto, which end sections are maneuverable with respect to each other via the central section. One of the most common operations in gynaecology is the removal of the womb. The womb has often become enlarged and fills a large part of the lower pelvis. The woman has problems of a feeling of heaviness, pressure against the bladder and so on. The most common operational technique is so-called open abdominal surgery where a decimeter long transverse cut is made in the abdominal wall so that the whole of the lower pelvis can be exposed and the position of the womb can be easily changed by the surgeon's hand so that the optimal conditions ensue. Open abdominal surgery is increasingly being abandoned and instead so-called Iaparoscopic techniques are used which entail the abdominal cavity being expanded by gas and a small hole being made in the abdominal wall through which narrow rounded instruments including optics can be introduced. The surgical removal of the womb involves the blood vessels of the womb being knotted or burnt away. The operation is facilitated if the womb can be moved in various directions and, as necessary, rotated. In Iaparoscopic surgery the size of the hole does not allow this to be done with the hand. Instead different types of instruments are used which from the vagina are attached to the portio. The usual instrument consists of a forceps with a short intermediate rod at the tip. The forceps are fastened on the portio with the metal rod inserted in the cavity of the womb. By changing the position of the forceps the womb can be moved, however it cannot be rotated to any great degree. Another instrument, the Stortz rotator, is available where after two branch elements have been folded out. the instrument allows the position of the womb to be changed. This instrument permits changing of the position of the womb including rotation. The construction for folding out the branches is complicated. US-A-3 921 641 shows a forceps-like means intended to guide a womb during Iaparoscopic sterilization. The forceps have two branches which are rotatable in relation to each other by means of a joint. One end of the forceps has two end parts which are bent 90° in relation to a central part.The other end of the forceps has a handle which extends 20° in relation to the central part. The forceps comprise a spring which acts to separate the end parts which are bent 90° in relation to the central part. During Iaparoscopic surgery it is sometimes desirable to expand the region in the body where the operation is to be performed by means of a gas. A gas-tight state must then be created around the surgical instruments and the holes in the body where the instruments are introduced. Because of the anatomy of the body the size of the womb varies in different women. It is therefore desirable that one and the same manipulator can be used for different womb lengths. The object of the present invention is to provide a manipulator which is adapted for wombs of different size. A further object of the present invention is to provide a manipulator which allows a gas-tight state during Iaparoscopic surgery. This is achieved according to the invention through both the first and second end sections of the respective branch elements comprising control surfaces which on one hand are intended to perform gripping means and on the other hand are intended to form handles. The manipulator according to the present invention concerns an instrument which is introduced into the womb from the vagina and which permits changing the position of the womb including rotation. The manipulator has a simple construction and permits versatile use. The invention will be described in more detail below with reference to the appended drawings showing examples of embodiments, where Figure 1 shows a manipulator according to a first embodiment, Figure 2 shows a manipulator according to a second embodiment, Figure 3 shows a cross-sectional view along the line A-A in Fig. 1, Figure 4 shows how the branch elements are controlled according to a first embodiment, Fig. 5 shows how the branch elements are controlled according to a second embodiment, Fig. 6 shows a manipulator according to Fig. 1 and Fig. 4, introduced into a womb, Fig. 7 shows a mampulator according to Fig. 1 and Fig. 4, introduced into a womb, seen from the side, Fig. 8 shows a manipulator according to a third embodiment. Fig. 9 shows a manipulator according to a fourth embodiment, which is introduced into a womb, Fig. 10 shows a manipulator according to a fifth embodiment, and Fig. 11 shows the mampulator according to the fifth embodiment with a cup placed on the central section. Fig. 1 shows a manipulator 1 according to a first embodiment, which comprises a first and a second branch element 2 resp. 4, which each are divided into a central section 6 and, attached thereto at an angle a first and a second end section 8 resp.10, which are maneuverable with respect to each other via the central section 6. Both the first and second end sections 8 resp. 10 on respective branch elements 2 resp. 4 comprise control surfaces 12 which on one hand are intended to form gripping means and on the other hand are intended to form handles. The branch elements 2 resp. 4 are rotatably joined to each other along the central section 6 by means of a tube 14, which mcloses the central section 6 of the branch elements 2 resp. 4. According to the first embodiment, the first end section 8 is angled in the opposite direction in relation to the the central section 6 compared with the second end section 10. The angle α of the first end section 8 in relation to the central section 6 can be different from the angle β of the second end section 10 in relation to the central section 6 and the first end section 8 can have a length which is greater than the length of the second end section 10. In this way a mampulator is achieved which can be adapted to wombs of different size and shape. Fig. 2 shows a mampulator 1 according to a second embodiment which differs from the first embodiment through the first end section 8 being angled in the same direction in relation to the central section 6 as the second end section 10. The angles α resp. β of the end sections 8 resp. 10 in relation to the central section 8 means that the user of the manipulator 1, e.g. a surgeon, can use different handgrips compared to when a mampulator 1 according to the first embodiment is used. Fig. 3 shows a cross-section along the line A-A in Fig. 1. The branch elements 2 resp. 4 are placed side-by-side and are encircled at the central section 6 by a tube 14. According to the embodiment shown the tube 14 is flattened and therefore has an elliptical cross-section. The tube 14 can, however, have another cross- sectional shape, e.g. round. The tube 14 is preferably manufactured from metal, but also other materials such as rubber or plastic are conceivable. Fig. 4 shows how the branch elements 2 resp. 4 are controlled according to a first embodiment. The first and second end sections 8 resp. 10 of respective branch element are, according to this embodiment, not in one and the same plane. This means that when the first branch elements 2 resp. 4 of the first end section 8 are moved together so that they are adjacent to each other, then the branch elements of the second end section 10 will be moved apart, and vice versa. The moved-apart branch elements 2 resp. 4 essentially form a V-shape. Fig. 5 shows how the branch elements 2 resp. 4 are controlled according to a second embodiment. The first and second end sections 8 resp. 10 of respective branch ele¬ ment 2 resp. 4 are in the one and same plane in this embodiment. This means that when the branch elements 2 resp. 4 of the first end section 8 are moved apart, then the branch elements 2 resp. 4 of the second end section 10 will also be moved apart, and vice versa. The moved-apart branch elements 2 resp. 4 essentially form a V- shape. Fig. 6 shows a manipulator 1 according to Fig. 1 and Fig. 4 introduced into a womb 16. In order to fix the first end section 8 of the manipulator 1 in a womb 16, first the branch elements 2 resp. 4 of the first end section 8 are moved together through the branch elements of the second end section 10 being moved apart. Then the first end section 8 of the manipulator 1 is introduced through the vagina 18 and through the cervical canal 20 and further into the cavity 22 of the womb. Thereafter the branch elements 2 resp. 4 of the second end section 10 are moved together so that the branch elements 2 resp. 4 of the first end section 8 are moved apart inside the womb cavity 22. The guiding surfaces 12 on the branch elements 2 resp. 4 of the first end section 8 will, in this fixed position for the mampulator 1, come into contact with the inner wall 24 of the womb cavity 22 so that the body of the womb 16 is held in a firm grip by the guiding surfaces 12 of me branch elements 2 resp. 4. The branch elements 2 resp. 4 ofthe second end section 10 in the folded together position can be locked to each other by means of a tube part 26 or a rubber band which is threaded onto the end ofthe second end section 10. A handle (not shown) can be threaded onto the second end section 10 to give better ergonomics for the surgeon who is to use the mampulator 1 during e.g. an operation. With the help of the manipulator 1, the surgeon can as necessary rotate, lift or lower the body of the womb 16 in order to, for example, during an operation reach the body of the womb 16 or organs connected thereto, from different directions. The ends of the branch elements (2 resp. 4) are preferably made rounded in order to protect the womb wall 38. Fig. 7 shows a mampulator 1 according to Fig. 1 and Fig. 4 introduced into a womb 16, seen from the side, where the first end section 8 ofthe manipulator 1 is fastened in the womb cavity 22. Depending on the size and shape ofthe womb 16, a manipulator 1 is used of which the end sections 8 resp. 10 have a length and angle in relation to the central section 6, which are adapted to the womb 16 which is to be treated. As the branch elements 2 resp. 4 of the second section 10 have a length and a shape which is different from the elements 2 resp. 4 of the first end section 8, the shape of the second end section 10 can be better suited to be fastened inside of the womb cavity 22 than the first end section 8. Fig. 8 shows a manipulator 1 according to a third embodiment where the branch elements 2 resp. 4 ofthe central section 6 are rotatably connected by means of a first and a second tube element 28 resp. 30, which are arranged at the ends of the central section 6. The inner diameter of the tube elements 28 resp. 30 can be less than the inner diameter ofthe tube 14 according to the first and second embodi¬ ments. This means that the clearance between the tube elements 28 resp. 30 and the branch elements 2 resp. 4 will be less. It is also conceivable that respective tube elements 28 resp. 30 are connected, for example by means of a welded joint, to one of the branch elements 2 resp. 4. Fig. 9 shows a manipulator 1 according to a fourth embodiment introduced into a womb 16. According to this embodiment a third tubular element 32 surrounds the first and second branch elements 2 resp. 4. The third tubular element 32 is arranged between the first and the second tubular element 28 resp. 30. A fillet 34 is provided at each end of the third tubular element 32. The fillet 34 can be attached by means of e.g. a weld. The fillet 34 can be provided with corrugated surfaces and with through-holes 36. The fillet 34 forms a fastening means for attaching the manipula¬ tor 1 to the cervix 37. This prevents the manipulator 1 from being displaced inward¬ ly into the womb cavity 22 with the risk that the branch elements 2 resp. 4 perforate the womb wall 38. The fillet 34 can be attached to the cervix 37 by a surgical instrument 40, such as a Bovin or Schroder forceps. The central section 6 of the branch elements 2 resp. 4 can be rotated inside the third tube 32, which means that the womb body 16 can be rotated relative to the cervix 37 by means of the mampulator 1. Fig. 10 shows a mampulator 1 according to a fifth embodiment, where the central section 6 of the second branch element 4 extends inside the central section 6 of the first branch element 2. This means that at least the central section 6 of the first branch element 2 is tubular and provided with openings 42 at each end of the central section 6 so that the end sections 8 resp. 10 of the second element 4 can extend out through these openings 42. The fit between the end sections 8 resp. 10 of the first and second elements 2 resp. 4 is so designed that it is gas-tight between the adjacent surfaces of the central sections 6. It is conceivable that a sealing means (not shown) can be introduced between the branch elements 2 resp. 4, to achieve a gas-tight fit. The branch elements 2 resp. 4 are consequently rotatably joined to each other along the central section 6 through the central section 6 of the first branch element 2 being tubular and the central section 6 of the second branch element 4 extending inside the central tubular section 6 of the first branch element 2. Fig. 11 shows the manipulator 1 according to titie fifth embodiment with a cup 44 attached to the central section 6. The cup 44 is intended to be placed around the portio 46 in order to form a seal so that the gas which is used to distend the abdomen during an operation shall not leak out and thereby fail to prevent the abdomen from falling together. The cup 44 makes it easier to identify the transi¬ tion between the vagina 18 and the portio 46 during an operation from inside the abdomen. The cup 44 is placed around the central section 6 of the manipulator 1 and a seal 48 arranged around the central section 6 prevents gas from flowing between the cup 44 and the central section 6 of the mampulator 1. The branch elements 2 resp. 4 can be manufactured of metal or plastic. The tube 14 and the tubular elements 28, 30, 32 can be manufactured of metal, plastic or rubber. The central section 6 of the manipulator 1 preferably has a length which is greater than the total length of the vagina 44 and the cervix 37. The angles α resp. β between the respective end sections 8 resp. 10 and the central section 6 can vary from substantially 90° to being substantially straight. The central section 6 and the end sections 8 resp. 10 can also be formed with an arcuate shape which has a bending radius. The manipulator 1 can be produced in different sizes and shapes but the manipulator 1 can also be made of such metal or plastic so that it can be bent to a suitable shape in the operating room. Each branch element can have a thickness of approximately 3-4 mm, and together with the surrounding tube or tubular element the largest total width of the mampulator 1 will be approximately 7-9 mm. This means that the cervical canal 20 must be widened to 8-10 mm so d at an instrument can be intro¬ duced through the cervical canal 20 into the womb 16. Such a widening or dilation can easily be done with the dilators found in every operating room. The manipulator 1 can also be used as a simple sample collector which can be introduced inside through a small hole in the abdominal wall and with a plastic bag attached to the branch elements. When the branch elements inside the abdomen with the attached plastic bag are rotated apart, the bag is opened and the specimen can be captured. The opening of the bag is then closed through the branch elements being moved together. The opening of the bag can then be drawn out dirough the small hole in the abdominal wall. The specimen can as necessary be broken up in the bag without any waste coming into the abdomen, and then removed through the small hole. If a plastic or rubber membrane is provided between the branches, the mani¬ pulator 1 can be used as an intestinal retractor, i.e. like a large spatula with which the intestines can be held out of the way.

Claims: Claims 1. Manipulator comprising a first and second branch element (2 resp. 4) which each are divided into a central section (6) and connected thereto at an angle (α resp. β) first and second end sections (8 resp. 10), which are maneuverable with respect to each other via the central section (6), characterized in that both the first and second end sections (8 resp. 10) on the respective branch elements (2 resp. 4) comprise guiding surfaces (12) which on one hand are intended to form gripping means and on the other hand are intended to form handles. 2. Manipulator according to Claim 1, characterized in that the branch elements (2 resp. 4) are rotatably joined with each other along the central section (6) by means of at least one tube ( 14), which encloses the central section (6) of the branch elements (2 resp. 4). 3. Manipulator according to Claim 1, characterized in that the branch elements (2 resp. 4) are rotatably joined with each other along the central section (6) through the central section (6) of the first branch element (2) being tubular and that the central section (6) of the second branch element (4) extending inside the central tubular section (6) ofthe first branch element (2). 4. Manipulator according to any of the previous claims, characterized in that the first end section (8) has a length which is greater than the length of the second end section (10). 5. Manipulator according to any ofthe previous claims, characterized in that the angle (α) of the first end section (8) in relation to the central section (6) is different from the angle (β) of the second end section (10) in relation to the central section (6).

Inventors: BERGSTROEM BO, BERGSTROEM, BO
Applicants: BERGSTROEM BO, BERGSTROEM, BO
Application year: 1997
Main classification: B25J1
IPC codes: A61B17