The present disclosure relates to laparoscopic hysterectomy procedures and, more particularly, to uterine manipulators for performing a colpotomy procedure.
Colpotomy, one of the final steps in a laparoscopic hysterectomy, requires making a circular incision in vaginal tissue to separate the uterus from the vagina. This incision is typically performed with the aid of a uterine manipulator.
Uterine manipulators are conventionally used during laparoscopic hysterectomy procedures to mobilize and position the vagina and the cervix to facilitate separation and to enable removal of the uterus or other tissue specimens subsequent to performance of a colpotomy. Typically, uterine manipulators include a handle, a shaft extending distally from the handle, an inflatable balloon supported on the end of the shaft opposite the handle, and a cervical or colpotomy cup supported on the shaft proximally of the inflatable balloon. In use, the inflatable balloon is advanced through the vagina and cervix and is positioned within the uterus in a deflated position. Once positioned within the uterus, the inflatable balloon is inflated to secure the uterine manipulator within the uterus and the colpotomy cup is positioned about the cervix for effectuating the colpotomy.
In accordance with an aspect of the present disclosure, a uterine manipulator is provided. The uterine manipulator includes a handle and a central shaft that extends distally from the handle. The uterine manipulator further includes a balloon supported on a distal end portion of the central shaft, a cervical cup supported on the central shaft, an occluder shaft slidably supported on the central shaft, and a non-inflatable plug secured to the occluder shaft and configured to move with the occluder shaft as the occluder shaft slides along the central shaft.
In some embodiments, the cervical cup may be selectively detachable from the central shaft.
In certain embodiments, the cervical cup may include one or more light emitting diodes.
In some embodiments, the uterine manipulator may include a shuttle slidably supported on the central shaft and selectively coupled to the cervical cup. The shuttle may include one or more tabs that are depressible to selectively couple the shuttle to the cervical cup. The cervical cup may include a ledge. The one or more tabs may be positioned to engage the ledge of the cervical cup to selectively secure the shuttle and cervical cup together. The cervical cup may include a raised ring that extends from the ledge and may be positioned to surround the one or more tabs.
In some embodiments, the central shaft may include a collar adjacent to the balloon. The collar may be positioned to engage the shuttle to prevent the cervical cup from sliding off the central shaft while the cervical cup is coupled to the shuttle.
In certain embodiments, the uterine manipulator may include a locking mechanism having a spring supported about the central shaft and positioned to selectively lock the occluder shaft to the central shaft to prevent the occluder shaft from sliding along the central shaft.
In some embodiments, the non-inflatable plug has a tapered configuration that is configured to be received within a vagina to occlude the vagina.
According to yet another aspect, a uterine manipulator includes a central shaft, a cervical cup, a shuttle selectively secured to the cervical cup and supported for slidable movement with the cervical cup along the central shaft, and a plug supported for slidable movement along the central shaft.
In certain embodiments, the plug may be positioned to slide along the central shaft independent of the shuttle.
In some embodiments, the cervical cup may be separable from the shuttle to enable the cervical cup to separate from the central shaft.
In certain embodiments, the plug may include a foam material.
In some embodiments, the plug may have a tapered configuration that is positioned to be received within a vagina to occlude the vagina.
In certain embodiments, the plug may have a frustoconical configuration.
In some embodiments, the cervical cup may include one or more light emitting diodes.
In some embodiments, the plug may be supported on an occluder shaft that is slidably mounted on the central shaft.
In certain embodiments, the occluder shaft may support a locking mechanism. The locking mechanism may support a torsion spring that selectively prevents the occluder shaft from sliding along the central shaft. The locking mechanism may include an actuator coupled to the torsion spring. The actuator may be positioned for actuation to tension the torsion spring and enable the occluder shaft to slide along the central shaft.
Other aspects, features, and advantages will be apparent from the description, the drawings, and the claims that follow.
The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the disclosure and, together with a general description of the disclosure given above, and the detailed description given below, serve to explain the principles of the disclosure, wherein:
Embodiments of the present uterine manipulators are described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views. As used herein, the term “distal” refers to that portion of structure farther from the user, while the term “proximal” refers to that portion of structure, closer to the user. As used herein, the term “clinician” refers to a doctor, nurse, or other care provider and may include support personnel.
In the following description, well-known functions or constructions are not described in detail to avoid obscuring the present disclosure in unnecessary detail.
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Distal end portion 40a of central shaft 40 further includes a stop collar 44 that extends radially outward from central shaft 40. Stop collar 44 may be in the form of a flange. Each end portion of distal and proximal end portions 40a, 40b of central shaft 40 can include one or more indicia (or series of indicia) such as depth markers (e.g., sequential numbers to indicate depth of insertion—not shown).
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Locking mechanism 64 of occluder shaft 60 includes an actuator 64a and a spring 64b (e.g., a torsion spring) that are coupled together to selectively lock occluder shaft 60 to central shaft 40. Actuator 64a of locking mechanism 64 is pivotally coupled to gripping arm 62 at a pivot 64c to enable locking mechanism 64 to pivot between unactuated (
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Tubular body 72 of shuttle 70 has a proximal end portion 72a that tapers proximally and surrounds a proximal opening 72b defined therein and in fluid communication with, and part of, central passage 70a of shuttle 70. Proximal end portion 72a of tubular body 72 is configured to be removably received within distal bore 62g of occluder shaft 60 (e.g., friction fit, interference fit, slidable fit, etc.). Tubular body 72 of shuttle 70 extends to a distal end portion 72c having one or more flexible tabs 72d (e.g., four) including flexible arms 72f having a distal portion with heads 72g supported thereon. Flexible tabs 72d are circumferentially spaced apart from one another (e.g., angularly displaced 90 degrees apart) around distal end portion 72c and extend distally from annular flange 74 to a distal face 72e. Tabs 72d of tubular body 72 are radially deflectable, as indicated by arrows “C,” to releasably attach (e.g., snap-fit) heads 72g of tabs 72d to cervical cup 80. Distal faces 72e of tabs 72d of tubular body 72 function as a backstop that abuts against stop collar 44 of central shaft 40 of uterine manipulator 10 to prevent shuttle 70 of uterine manipulator 10 from sliding off and/or separating from central shaft 40. Inner surface 72i of tubular body 72 includes a proximal inner lip 76a and a distal inner lip 76b that define a bearing recess 76c for supporting a bearing 75 (
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With cervical cup 80 of uterine manipulator 10 properly sized, the clinician dilates the patient's cervix with standard reusable GYN dilators (not shown) until central shaft 40 of uterine manipulator 10 can be inserted into the patient's cervix. Tip 46 of central shaft 40 is then inserted into the cervix until tip 46 is sufficiently deep into the uterus. A clinician can note the depth of tip 46 past the cervix by a depth marking (not shown) supported on the distal end portion 40a of central shaft 40 that is visible on central shaft 40 at the cervical opening (e.g., a tip depth measurement).
With inflation source 50 (e.g., a syringe) coupled to fluid conduit 30 via port 30a, inflatable balloon 42 is then inflated inside the uterus (e.g., via fluid injection) to secure uterine manipulator 10 in place. Once inflatable balloon 42 is inflated, fluid clamp 32 is actuated to clamp fluid conduit 30 and prevent the fluid from leaking back out (proximally) of fluid conduit 30 once inflation source 50 is detached.
Cervical cup 80 and shuttle 70 of uterine manipulator 10 is then advanced distally along central shaft 40 of uterine manipulator 10 up to the cervix. The independent motion from occluder shaft 60 enables the clinician to visualize the position of cervical cup 80 on the cervix and also provides access to enable the clinician to suture cervical cup 80 to the cervix if desired for ensured positioning.
The clinician then depresses actuator 64a of locking mechanism 64 to release spring 64b of locking mechanism 64 and distally advance occluder shaft 60 along central shaft 40 until distal bore 62g of occluder shaft 60 mates with proximal end portion 72a of shuttle 70.
As detailed above, central shaft 40 may include one or more depth markers (not shown) adjacent proximal end portion 40b of central shaft 40. In particular, a second series of depth markers (e.g., numbers) may be visible on central shaft 40 proximal to occluder shaft 60. A maker that is visible at the proximal end portion of occluder shaft 60 can indicate a depth measurement that may be configured to correspond to, and/or be consistent with, the tip depth measurement at the cervical opening previously determined to ensure that, during manipulation, tip 46 of central shaft 40 will not be advanced too far, for example, to prevent perforation of the fundus. Actuator 64a of locking mechanism 64 is then released to lock occluder shaft 60 in position on central shaft 40 of uterine manipulator 10.
Plug 66 of occluder shaft 60 of uterine manipulator 10, which may include a compressible foam material, can be compressed during insertion into the vagina such that it expands to its final or resting position behind cervical cup 80 of uterine manipulator 10 to occlude the vaginal canal and prevent loss of pneumoperintoneum once the clinician creates a colpotomy incision.
Handle 20 of uterine manipulator 10 can then be used to manipulate the uterus (antevert, retrovert, lateral motion) while the clinician prepares the uterus laparoscopically (cutting down the blood supply, bladder flap dissection, removing structural ligaments, etc.). The large curvature of central shaft 40 of uterine manipulator 10 provides for a wide range of motion.
The clinician then effectuates a colpotomy incision (e.g., dissects the uterus from the vagina) by using an RF or harmonic scalpel or other cutting device (not shown) positioned up against rim 88 of cervical cup 80 in a circumferential motion. The clinician then removes the uterus (still attached to the uterine manipulator) from the abdomen through the vagina, and the vaginal cuff can be closed via suturing.
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In some embodiments, an actuatable switch (e.g., a button—not shown) can be provided to selectively complete the circuit to enable battery 104 to selectively illuminate diodes 102 upon actuation of actuatable switch. In certain embodiments, battery 104 may not be built in cervical cup 100, but may be supported, for example, in handle 20 of uterine manipulator 10, (or in any other component of uterine manipulator 10) such that wires 108 are routed through a uterine manipulator (e.g., uterine manipulator 10) to a power source (not shown) supported by, or coupled to, uterine manipulator 10 (e.g. an internally supported battery). In some embodiments, the power source can be an external energy source (e.g., a generator, outlet, and/or external battery).
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In embodiments, the presently disclosed central shafts 40, 114 may include metallic and/or polymeric materials. In some embodiments, the presently disclosed central shafts 40, 114 may include a coating to facilitate gripping of springs 64b, 118b of the presently disclosed locking mechanisms 64, 118. The coating may include polymeric materials, shrink wrap, rubber, etc. In certain embodiments, the presently disclosed central shafts 40, 114 may include surface texturing such as knurling, ridges, or the like.
Securement of any of the components of the presently disclosed devices may be effectuated using known securement techniques such welding, crimping, gluing, fastening, etc.
The various embodiments disclosed herein may also be configured to work with robotic surgical systems and what is commonly referred to as “Telesurgery.” Such systems employ various robotic elements to assist the clinician and allow remote operation (or partial remote operation) of surgical instrumentation. Various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and may be designed with a robotic surgical system to assist the clinician during the course of an operation or treatment. Such robotic systems may include remotely steerable systems, automatically flexible surgical systems, remotely flexible surgical systems, remotely articulating surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc.
The robotic surgical systems may be employed with one or more consoles that are next to the operating theater or located in a remote location. In this instance, one team of clinicians may prep the patient for surgery and configure the robotic surgical system with one or more of the instruments disclosed herein while another clinician (or group of clinicians) remotely controls the instruments via the robotic surgical system. As can be appreciated, a highly skilled clinician may perform multiple operations in multiple locations without leaving his/her remote console which can be both economically advantageous and a benefit to the patient or a series of patients.
For a detailed description of exemplary medical work stations and/or components thereof, reference may be made to U.S. Patent Application Publication No. 2012/0116416, and PCT Application Publication No. WO2016/025132, the entire contents of each of which are incorporated by reference herein.
Persons skilled in the art will understand that the structures and methods specifically described herein and shown in the accompanying figures are non-limiting exemplary embodiments, and that the description, disclosure, and figures should be construed merely as exemplary of particular embodiments. It is to be understood, therefore, that the present disclosure is not limited to the precise embodiments described, and that various other changes and modifications may be effected by one skilled in the art without departing from the scope or spirit of the disclosure. Additionally, the elements and features shown or described in connection with certain embodiments may be combined with the elements and features of certain other embodiments without departing from the scope of the present disclosure, and that such modifications and variations are also included within the scope of the present disclosure. Accordingly, the subject matter of the present disclosure is not limited by what has been particularly shown and described.
This application is a continuation of U.S. patent application Ser. No. 15/593,594, filed May 12, 2017, the entire contents of which are incorporated herein by reference.
Number | Date | Country | |
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Parent | 15593594 | May 2017 | US |
Child | 17553927 | US |