WO2007101994A1 - Intrauterine manipulator - Google Patents

Intrauterine manipulator Download PDF

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Publication number
WO2007101994A1
WO2007101994A1 PCT/GB2007/000780 GB2007000780W WO2007101994A1 WO 2007101994 A1 WO2007101994 A1 WO 2007101994A1 GB 2007000780 W GB2007000780 W GB 2007000780W WO 2007101994 A1 WO2007101994 A1 WO 2007101994A1
Authority
WO
WIPO (PCT)
Prior art keywords
intrauterine
support
implement
curvature
clamping
Prior art date
Application number
PCT/GB2007/000780
Other languages
French (fr)
Inventor
Christropher B-Lynch
Carlton Willis
Original Assignee
Milton Keynes General Nhs Trust
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Milton Keynes General Nhs Trust filed Critical Milton Keynes General Nhs Trust
Publication of WO2007101994A1 publication Critical patent/WO2007101994A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/10—Balloon catheters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/42—Gynaecological or obstetrical instruments or methods
    • A61B17/4241—Instruments for manoeuvring or retracting the uterus, e.g. during laparoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters

Definitions

  • This invention relates to an intrauterine implement which is passed into the uterus of a patient.
  • the invention is particularly concerned with an intrauterine manipulator.
  • a manipulator may be of the type that is used to position a uterus in order to facilitate viewing through a viewing scope which may, for example, be passed through the abdominal wall of a patient.
  • the invention is applicable to other intrauterine implements which need to be manipulated into position in the uterus of a patient. Such implements could be used not only to position a uterus, but also to carry out procedures, make measurements, and so forth.
  • US-A-4 775 362 discloses an intrauterine manipulator comprising a curved catheter tube portion to be inserted into the uterus, provided with a balloon adjacent its end, which is inflated once positioned correctly within the uterus.
  • the catheter is supported in sliding fashion by a correspondingly curved sheath which forms a channel in which the catheter tube is mounted.
  • the sheath is provided with a clamp at the end remote from the patient, which holds the catheter in place with respect to the sheath.
  • the clamp is released by squeezing opposable tabs between the finger and thumb of an operator.
  • the manipulator is inserted into the vagina until the catheter extends into the uterus.
  • the balloon is then inflated, by injecting air through a valve, and then the manipulator is withdrawn until the balloon engages the wall of the uterus around the internal opening from the cervical canal.
  • the operator releases the clamp and slides the sheath relative to the catheter, until it engages the cervix, at which point the clamp is then allowed to grip the catheter.
  • the operator may then move the manipulator in order to alter the position of the uterus.
  • a problem with this known manipulator is that operators use one hand to hold the tabs of the clamp to support the manipulator, and the other to slide the catheter relative to the sheath when the clamp is released. This results in a number of problems. Firstly, it is difficult to get a good grip on the manipulator. Secondly, when moving the manipulator the clamp may be released inadvertently, thus allowing the catheter to slip relative to the sheath. Thirdly, when adjusting the position of the catheter relative to the sheath, the sheath may be moved relative to the patient. In practice, it has been found that difficulties in positioning the manipulator can result in perforation of the uterus during keyhole surgery.
  • an intrauterine implement comprising an elongate, curved support having a distal end for insertion into the vagina of a patient, and a proximal end for projecting out of the vagina of the patient; an elongate intrauterine member for extending into the uterus of the patient, the intrauterine member being supported by the support for relative sliding movement and having a curvature generally matching the curvature of the support; and means for clamping the intrauterine member with respect to the support; characterised in that the support is provided with a laterally projecting handle which is positioned at the proximal end of the support, and the means for clamping the intrauterine member is longitudinally spaced along the support from the handle.
  • the functions of holding the implement during manipulation, and clamping and releasing the intrauterine member are separated. This reduces the risk of unwanted sliding of the intrauterine member during manipulation of the implement.
  • the expression "laterally" with respect to the handle does not imply any particular orientation, i.e. up, down, left or right. However preferably the handle projects in the plane of curvature of the support, and more preferably it projects in a direction that will be generally downwards in use. It will be appreciated that the orientation of the handle and the intrauterine implement relative to a patient may vary during use.
  • one hand will be used to grip the handle, leaving the other hand to release the clamping means and slide the intrauterine member relative to the support. It would be possible to achieve this by releasing a clamping mechanism, sliding the intrauterine member relative to the support, and then clamping the intrauterine member again, in a sequence of operations in which the hand of the operator move between a clamping mechanism and the intrauterine member, although that would be an inconvenient way of working.
  • the sliding movement to be effected by the hand, whilst a finger or thumb simultaneously controls a clamping mechanism. Again, that would be an inconvenient way of working.
  • the arrangement is such that release of clamping between the support and the intrauterine member can be effected by deflecting the intrauterine member laterally with respect to clamping means provided on the support.
  • the intrauterine member deflecting it so as to release the clamping effect, sliding the intrauterine member with respect to the support and then allowing the intrauterine member to move so that the clamping effect is restored, adjustment can be carried out without having to modify the position of the hand on the intrauterine member.
  • the intrauterine member is resilient and is held normally in locking engagement with a locking element on the support, the intrauterine member being capable of deflection laterally, against its resilience, out of engagement with the locking element to permit longitudinal sliding movement of the of the intrauterine member with respect to the support.
  • the lateral direction of deflection is in the plane of curvature of the intrauterine member.
  • the intrauterine member is essentially rigid or semi-rigid, and has a natural curvature.
  • the intrauterine member is deflected out of its natural curvature by engagement with a locking element such as a sharp edge, pin or the like which grips the surface of the intrauterine member.
  • the resilience of the intrauterine member tending to return to its natural curvature, biases the intrauterine member against the locking element, to resist sliding movement.
  • the surface of the member is disengaged from the locking element and the intrauterine member can then be slid relative to the support.
  • the intrauterine member is released and is then urged back into engagement with the locking element, so as to be locked in position relative to the support.
  • the intrauterine member follows generally the curvature of the support from the distal end of the support to adjacent the proximal end of the support, where there is first constraining means provided with a locking element, constraining the intrauterine member to follow a curvature which is tighter than that of the natural curvature, i.e. deflecting the intrauterine member by an amount "x" from its natural curvature.
  • first constraining means provided with a locking element
  • second constraining means Spaced from the first constraining means a short distance along the support towards its distal end, is second constraining means which also constrains the intrauterine member to follow a curvature which is tighter than that of the natural curvature, but in this case deflecting the intrauterine member by an amount "y" that is less than "x”.
  • Deflection of the intrauterine member to release it from the locking element takes place between the locking element and the second constraining means.
  • the intrauterine member is then free to slide through the second constraining means, as the deflection at that point is not so great as to create friction which significantly impedes such movement.
  • the intrauterine member is attached to the support only be being constrained by the first constraining means, the second constraining means and third constraining means adjacent the distal end of the support. This avoids the need for the support to be formed with a channel.
  • the invention provides an intrauterine implement, comprising an elongate, curved support having a distal end for insertion into the vagina of a patient, and a proximal end for proj ecting out of the vagina of the patient; an elongate intrauterine member having a distal end for extending into the uterus of the patient, the intrauterine member being supported by the support for relative sliding movement and having a curvature generally matching the curvature of the support; and means for clamping the intrauterine member with respect to the support; characterised in that the arrangement is such that release of clamping between the support and the intrauterine member can be effected by deflecting the intrauterine member laterally with respect to clamping means provided on the support.
  • the intrauterine implement is an intrauterine manipulator, in which the elongate intrauterine member is a hollow tube, provided adjacent its distal end with a balloon, and adjacent its proximal end with means for inflating the balloon, in a manner similar to that disclosed in US-A-4 775 362.
  • the invention provides a method of positioning within a patient an intrauterine implement of a type in accordance with one or more of the preceding aspects of the invention.
  • the invention provides a method of positioning an intrauterine implement within a patient, the method comprising the steps of:
  • the support carrying an elongate intrauterine member having a distal portion which extends into the uterus of the patient, the intrauterine member having a curvature generally matching the curvature of the support and being clamped releasably to the support ; holding the support in one hand by means of a laterally projecting handle which is positioned at the proximal end of the support, and manipulating the support;
  • a support for use in constructing an intrauterine implement comprising an elongate, curved support member having a distal end for insertion into the vagina of a patient, and a proximal end for projecting out of the vagina of the patient; a handle projecting laterally from the support member adjacent the proximal end; means for supporting an elongate curved intrauterine member for relative sliding movement with respect to the support member, the supporting means comprising proximal constraining means for the intrauterine member adjacent the proximal end of the support member, displaced towards the distal end from the handle, and distal constraining means adjacent the distal end of the support member, the constraining means constraining the intrauterine member to adopt a rest configuration; and means for locking the intrauterine member with respect to the support member, the locking means comprising means for engaging the surface of the
  • the support in an implement in accordance with the invention may be re-usable, for example being of a material such as stainless steel that can be sterilised, or may be disposable and made e.g. of plastics.
  • the intrauterine member, such as a tube, is preferably disposable and of plastics.
  • the manipulator of the invention may be used in one or more of the following procedures:
  • Figure 1 is a side view of an intrauterine manipulator body in accordance with the invention.
  • Figure 2 is a side view of a catheter tube for use with the manipulator body of Figure 1;
  • Figure 3 is an end view of first constraining means on the support, incorporating locking means
  • Figure 4 is an end view of second constraining means
  • Figure 5 is a view from one end of third constraining means, the view from the other end corresponding;
  • Figure 6 is a side view of the third constraining means
  • Figure 7 is a view of the third constraining means from above and the other side.
  • Figure 8 is a view showing the complete intrauterine manipulator, comprising the body of Figure 1 with the handle shown in Figure 1 and the catheter tube of Figure 2.
  • Figure 1 shows a stainless steel support component 1 of an intrauterine manipulator, comprising an elongate curved portion provided with a handle 3 at its proximal end , extending laterally and in the plane of curvature of portion 2.
  • Constraining member 4 is positioned adjacent the proximal end of portion 2, spaced from the handle.
  • a second constraining member 5 is spaced somewhat further along portion 2, and a third constraining member 6 is positioned at the distal end of the portion 2.
  • the constraining members 4, 5 and 6 are used to support a somewhat rigid, plastics intrauterine tube 7, shown in Figure 2.
  • the tube 7 is curved so as to match the curvature of portion 2 of the support 1, but is sufficiently resilient to permit deflection out of its natural curvature..
  • gradations 8 are provided for use when positioning the tube.
  • tube 7 is provided with an end portion 9 having an inflatable balloon 10.
  • a connector 11 Adjacent the proximal end of the tube 7, a connector 11 is provided. This can be connected to e.g. a syringe so that air can be injected through the tube 7 to inflate the balloon 10, in the manner described in US-A-4775 362.
  • the first constraining means 4 comprises a plate 12 attached to the portion 2 of the support. This is provided with a cut out portion 13 to receive the tube 7, and the plate is also profiled at 13 to facilitate insertion of the tube into the portion 13.
  • a locking element in the form of a point, ridge or the like which grips against the surface of the tube 7 when the tube is constrained by the constraining means 4, 5 and 6.
  • the tube In the rest position as shown in Figure 3, the tube has been deflected from its natural curvature, and bears against locking element 15 under its own natural resilience. However the tube 17 can be released from locking element 15, and then allowed back into engagement with it, by movement in the direction of the arrows shown on Figure 3.
  • the second constraining means 5 is shown in Figure 4. It comprises a plate 16 attached to support portion 2, with a cut out 17 to receive the tube 7. It constrains the tube 7 to follow a path slightly deflected from its natural curvature. When the tube 7 is lifted from locking element 15 on constraining means 4, deflection of the tube 7 takes place between plate 4 and plate 5.
  • Third constraining means 6 is shown in Figures 5, 6 and 7. It comprises a pair of plates 18 and 12, connected to support portion 2, joined by a connecting portion 20.
  • Plate 18 has a cut out 19 to receive tube 7, open in one direction, and plate 21 has a corresponding cut out to receive tube 7, pointing in the other direction.
  • the tube 7 can be manipulated into the cut outs so that it is constrained against movement in all lateral directions, but can slide relative to the support.
  • the tube is then deflected somewhat and inserted into the cut out 17 of the second constraining means, and finally deflected to that it enters the cut out 13 of the first constraining means and is engaged resiliency against locking element 15.
  • the handle 3 will be held in one hand, and the tube held in the other. Simply by using that other hand, the tube can be released, slid into position, and locked in place.
  • the intrauterine manipulator would normally be used in an orientation inverted to that shown in
  • an intrauterine manipulator which comprises an elongate, curved support (1) carrying a curved tube (7) for extending into the uterus of the patient which can be slid relative to the support and locked in position by locking means (4, 15).
  • the tube is engaged by virtue of its own resilience against a locking element (15) and the arrangement is such that release of locking between the support (1) and tube (7) can be effected by deflecting the intrauterine member away from the locking element (15).
  • the support (1) is provided at its proximal end with a laterally projecting handle (3) to be gripped by the other hand, the locking means (4, 15) being longitudinally spaced along the support (1) from the handle (3).

Abstract

An intrauterine manipulator comprises an elongate, curved support (1) carrying a curved tube (7) for extending into the uterus of the patient which can be slid relative to the support and locked in position by locking means (4, 15). The tube is engaged by virtue of its own resilience against a locking element (15) and the arrangement is such that release of locking between the support (1) and tube (7) can be effected by deflecting the intrauterine member away from the locking element (15). Thus unlocking and sliding can be accomplished with one hand. The support (1) is provided at its proximal end with a laterally projecting handle (3) to be gripped by the other hand, the locking means (4, 15) being longitudinally spaced along the support (1) from the handle (3). Supports for the implement and methods of positioning intrauterine implements are also provided.

Description

Intrauterine Manipulator
This invention relates to an intrauterine implement which is passed into the uterus of a patient. The invention is particularly concerned with an intrauterine manipulator. Such a manipulator may be of the type that is used to position a uterus in order to facilitate viewing through a viewing scope which may, for example, be passed through the abdominal wall of a patient. However, the invention is applicable to other intrauterine implements which need to be manipulated into position in the uterus of a patient. Such implements could be used not only to position a uterus, but also to carry out procedures, make measurements, and so forth.
US-A-4 775 362 discloses an intrauterine manipulator comprising a curved catheter tube portion to be inserted into the uterus, provided with a balloon adjacent its end, which is inflated once positioned correctly within the uterus. The catheter is supported in sliding fashion by a correspondingly curved sheath which forms a channel in which the catheter tube is mounted. The sheath is provided with a clamp at the end remote from the patient, which holds the catheter in place with respect to the sheath. The clamp is released by squeezing opposable tabs between the finger and thumb of an operator. In use, the manipulator is inserted into the vagina until the catheter extends into the uterus. The balloon is then inflated, by injecting air through a valve, and then the manipulator is withdrawn until the balloon engages the wall of the uterus around the internal opening from the cervical canal. To maintain this relationship, the operator releases the clamp and slides the sheath relative to the catheter, until it engages the cervix, at which point the clamp is then allowed to grip the catheter. The operator may then move the manipulator in order to alter the position of the uterus.
Individual operators may alter the precise order of installing the manipulator, further adjustments may be made and so forth. A problem with this known manipulator is that operators use one hand to hold the tabs of the clamp to support the manipulator, and the other to slide the catheter relative to the sheath when the clamp is released. This results in a number of problems. Firstly, it is difficult to get a good grip on the manipulator. Secondly, when moving the manipulator the clamp may be released inadvertently, thus allowing the catheter to slip relative to the sheath. Thirdly, when adjusting the position of the catheter relative to the sheath, the sheath may be moved relative to the patient. In practice, it has been found that difficulties in positioning the manipulator can result in perforation of the uterus during keyhole surgery.
It is therefore an object of the present invention to provide an intrauterine implement which reduces or eliminates problems of this type.
Viewed from one aspect the present invention provides an intrauterine implement, comprising an elongate, curved support having a distal end for insertion into the vagina of a patient, and a proximal end for projecting out of the vagina of the patient; an elongate intrauterine member for extending into the uterus of the patient, the intrauterine member being supported by the support for relative sliding movement and having a curvature generally matching the curvature of the support; and means for clamping the intrauterine member with respect to the support; characterised in that the support is provided with a laterally projecting handle which is positioned at the proximal end of the support, and the means for clamping the intrauterine member is longitudinally spaced along the support from the handle.
In this manner the functions of holding the implement during manipulation, and clamping and releasing the intrauterine member, are separated. This reduces the risk of unwanted sliding of the intrauterine member during manipulation of the implement. It will be appreciated that the expression "laterally" with respect to the handle does not imply any particular orientation, i.e. up, down, left or right. However preferably the handle projects in the plane of curvature of the support, and more preferably it projects in a direction that will be generally downwards in use. It will be appreciated that the orientation of the handle and the intrauterine implement relative to a patient may vary during use.
With such an arrangement, in use one hand will be used to grip the handle, leaving the other hand to release the clamping means and slide the intrauterine member relative to the support. It would be possible to achieve this by releasing a clamping mechanism, sliding the intrauterine member relative to the support, and then clamping the intrauterine member again, in a sequence of operations in which the hand of the operator move between a clamping mechanism and the intrauterine member, although that would be an inconvenient way of working. Alternatively, it would be possible for the sliding movement to be effected by the hand, whilst a finger or thumb simultaneously controls a clamping mechanism. Again, that would be an inconvenient way of working.
Preferably, therefore, the arrangement is such that release of clamping between the support and the intrauterine member can be effected by deflecting the intrauterine member laterally with respect to clamping means provided on the support. Thus, by holding the intrauterine member, deflecting it so as to release the clamping effect, sliding the intrauterine member with respect to the support and then allowing the intrauterine member to move so that the clamping effect is restored, adjustment can be carried out without having to modify the position of the hand on the intrauterine member. Thus, preferably the intrauterine member is resilient and is held normally in locking engagement with a locking element on the support, the intrauterine member being capable of deflection laterally, against its resilience, out of engagement with the locking element to permit longitudinal sliding movement of the of the intrauterine member with respect to the support.
Preferably the lateral direction of deflection is in the plane of curvature of the intrauterine member. In one preferred embodiment, the intrauterine member is essentially rigid or semi-rigid, and has a natural curvature. As mounted on the support, the intrauterine member is deflected out of its natural curvature by engagement with a locking element such as a sharp edge, pin or the like which grips the surface of the intrauterine member. The resilience of the intrauterine member, tending to return to its natural curvature, biases the intrauterine member against the locking element, to resist sliding movement. By further deflecting the intrauterine member in the same direction out of its natural curvature, the surface of the member is disengaged from the locking element and the intrauterine member can then be slid relative to the support. When the desired position has been reached, the intrauterine member is released and is then urged back into engagement with the locking element, so as to be locked in position relative to the support.
In a preferred arrangement, the intrauterine member follows generally the curvature of the support from the distal end of the support to adjacent the proximal end of the support, where there is first constraining means provided with a locking element, constraining the intrauterine member to follow a curvature which is tighter than that of the natural curvature, i.e. deflecting the intrauterine member by an amount "x" from its natural curvature. Spaced from the first constraining means a short distance along the support towards its distal end, is second constraining means which also constrains the intrauterine member to follow a curvature which is tighter than that of the natural curvature, but in this case deflecting the intrauterine member by an amount "y" that is less than "x". Deflection of the intrauterine member to release it from the locking element, takes place between the locking element and the second constraining means. The intrauterine member is then free to slide through the second constraining means, as the deflection at that point is not so great as to create friction which significantly impedes such movement.
In a preferred embodiment, the intrauterine member is attached to the support only be being constrained by the first constraining means, the second constraining means and third constraining means adjacent the distal end of the support. This avoids the need for the support to be formed with a channel.
The method of clamping the intrauterine member is inventive irrespective of the manner in which the implement is held. Thus, viewed from another aspect the invention provides an intrauterine implement, comprising an elongate, curved support having a distal end for insertion into the vagina of a patient, and a proximal end for proj ecting out of the vagina of the patient; an elongate intrauterine member having a distal end for extending into the uterus of the patient, the intrauterine member being supported by the support for relative sliding movement and having a curvature generally matching the curvature of the support; and means for clamping the intrauterine member with respect to the support; characterised in that the arrangement is such that release of clamping between the support and the intrauterine member can be effected by deflecting the intrauterine member laterally with respect to clamping means provided on the support.
In preferred embodiments of the invention, the intrauterine implement is an intrauterine manipulator, in which the elongate intrauterine member is a hollow tube, provided adjacent its distal end with a balloon, and adjacent its proximal end with means for inflating the balloon, in a manner similar to that disclosed in US-A-4 775 362.
Viewed from other aspects the invention provides a method of positioning within a patient an intrauterine implement of a type in accordance with one or more of the preceding aspects of the invention.
Thus, for example, viewed from another aspect, the invention provides a method of positioning an intrauterine implement within a patient, the method comprising the steps of:
inserting the distal end of an elongate, curved support into the vagina of me patient, the support carrying an elongate intrauterine member having a distal portion which extends into the uterus of the patient, the intrauterine member having a curvature generally matching the curvature of the support and being clamped releasably to the support ; holding the support in one hand by means of a laterally projecting handle which is positioned at the proximal end of the support, and manipulating the support;
holding the a proximal portion of the intrauterine member in the other hand;
releasing clamping between the support and the intrauterine member by deflecting the intrauterine member laterally with respect to clamping means provided on the support, using said other hand;
sliding the intrauterine member longitudinally into a desired position with respect to the support, using said other hand, whilst maintaining deflection of the intrauterine member so that clamping between the intrauterine member and the clamping means continues to be released; and
ceasing deflection of the intrauterine member so that clamping is re-established between the clamping member and the support so as to maintain the desired position of the intrauterine member with respect to the support.
The invention also extends to a support for use in an implement in accordance with the above aspects of the invention. Thus, for example, in accordance with another aspect of the invention there is provided a support for use in constructing an intrauterine implement, the support comprising an elongate, curved support member having a distal end for insertion into the vagina of a patient, and a proximal end for projecting out of the vagina of the patient; a handle projecting laterally from the support member adjacent the proximal end; means for supporting an elongate curved intrauterine member for relative sliding movement with respect to the support member, the supporting means comprising proximal constraining means for the intrauterine member adjacent the proximal end of the support member, displaced towards the distal end from the handle, and distal constraining means adjacent the distal end of the support member, the constraining means constraining the intrauterine member to adopt a rest configuration; and means for locking the intrauterine member with respect to the support member, the locking means comprising means for engaging the surface of the intrauterine member when constrained by the constraining means so as to adopt the rest configuration, so that deflection of the intrauterine member away from the rest configuration releases the intrauterine member from locking engagement with the locking means.
The support in an implement in accordance with the invention may be re-usable, for example being of a material such as stainless steel that can be sterilised, or may be disposable and made e.g. of plastics. The intrauterine member, such as a tube, is preferably disposable and of plastics.
The manipulator of the invention may be used in one or more of the following procedures:
diagnostic laparoscopy, laparoscopic assisted vaginal hysterectomy, laparoscopic hysterectomy, laparoscopic myomectomy, laparoscopic B S O, laparoscopic salpingectomy, laparoscopic adhesiolysis, laparoscopic sterilisation, laparoscopic CO2 laser ablation, laparoscopic lunauterosacral nerve ablation, laparoscopic ventrosuspension, laparotomy, myomectomy, abdominal hysterectomy, colposuspension, moscowitz, hysterosalpingogram, tubalsalpingostomy, and/or marsupialisation of ovaries. An embodiment of the invention will now be described by way of example and with reference to the accompanying drawings, in which: -
Figure 1 is a side view of an intrauterine manipulator body in accordance with the invention;
Figure 2 is a side view of a catheter tube for use with the manipulator body of Figure 1;
Figure 3 is an end view of first constraining means on the support, incorporating locking means;
Figure 4 is an end view of second constraining means;
Figure 5 is a view from one end of third constraining means, the view from the other end corresponding;
Figure 6 is a side view of the third constraining means
Figure 7 is a view of the third constraining means from above and the other side; and
Figure 8 is a view showing the complete intrauterine manipulator, comprising the body of Figure 1 with the handle shown in Figure 1 and the catheter tube of Figure 2.
Turning now to the drawings in more detail, Figure 1 shows a stainless steel support component 1 of an intrauterine manipulator, comprising an elongate curved portion provided with a handle 3 at its proximal end , extending laterally and in the plane of curvature of portion 2. Constraining member 4 is positioned adjacent the proximal end of portion 2, spaced from the handle. A second constraining member 5 is spaced somewhat further along portion 2, and a third constraining member 6 is positioned at the distal end of the portion 2. The constraining members 4, 5 and 6 are used to support a somewhat rigid, plastics intrauterine tube 7, shown in Figure 2. The tube 7 is curved so as to match the curvature of portion 2 of the support 1, but is sufficiently resilient to permit deflection out of its natural curvature.. At the proximal end of the tube 1, gradations 8 are provided for use when positioning the tube. At its distal end tube 7 is provided with an end portion 9 having an inflatable balloon 10. Adjacent the proximal end of the tube 7, a connector 11 is provided. This can be connected to e.g. a syringe so that air can be injected through the tube 7 to inflate the balloon 10, in the manner described in US-A-4775 362.
As shown in Figure 3, the first constraining means 4 comprises a plate 12 attached to the portion 2 of the support. This is provided with a cut out portion 13 to receive the tube 7, and the plate is also profiled at 13 to facilitate insertion of the tube into the portion 13. At the base of portion 13 is a locking element in the form of a point, ridge or the like which grips against the surface of the tube 7 when the tube is constrained by the constraining means 4, 5 and 6. In the rest position as shown in Figure 3, the tube has been deflected from its natural curvature, and bears against locking element 15 under its own natural resilience. However the tube 17 can be released from locking element 15, and then allowed back into engagement with it, by movement in the direction of the arrows shown on Figure 3.
The second constraining means 5 is shown in Figure 4. It comprises a plate 16 attached to support portion 2, with a cut out 17 to receive the tube 7. It constrains the tube 7 to follow a path slightly deflected from its natural curvature. When the tube 7 is lifted from locking element 15 on constraining means 4, deflection of the tube 7 takes place between plate 4 and plate 5.
Third constraining means 6 is shown in Figures 5, 6 and 7. It comprises a pair of plates 18 and 12, connected to support portion 2, joined by a connecting portion 20. Plate 18 has a cut out 19 to receive tube 7, open in one direction, and plate 21 has a corresponding cut out to receive tube 7, pointing in the other direction. In use, the tube 7 can be manipulated into the cut outs so that it is constrained against movement in all lateral directions, but can slide relative to the support. The tube is then deflected somewhat and inserted into the cut out 17 of the second constraining means, and finally deflected to that it enters the cut out 13 of the first constraining means and is engaged resiliency against locking element 15.
The complete intrauterine manipulator is then as shown in Figure 8. By deflecting the tube 7 in the direction of the arrow A, tube 7 is released from locking element 15 and can be slid forwards or backwards in the direction of arrow B. By releasing the tube 7, it re-engages the locking element 15 and is locked in its chosen position relative to support 1.
In use, the handle 3 will be held in one hand, and the tube held in the other. Simply by using that other hand, the tube can be released, slid into position, and locked in place. In use, the intrauterine manipulator would normally be used in an orientation inverted to that shown in |Figure 8.
There is thus provided an intrauterine manipulator which comprises an elongate, curved support (1) carrying a curved tube (7) for extending into the uterus of the patient which can be slid relative to the support and locked in position by locking means (4, 15). The tube is engaged by virtue of its own resilience against a locking element (15) and the arrangement is such that release of locking between the support (1) and tube (7) can be effected by deflecting the intrauterine member away from the locking element (15). Thus unlocking and sliding can be accomplished with one hand. The support (1) is provided at its proximal end with a laterally projecting handle (3) to be gripped by the other hand, the locking means (4, 15) being longitudinally spaced along the support (1) from the handle (3).

Claims

1. An intrauterine implement, comprising an elongate, curved support having a distal end for insertion into the vagina of a patient, and a proximal end for projecting out of the vagina of the patient; an elongate intrauterine member for extending into the uterus of the patient, the intrauterine member being supported by the support for relative sliding movement and having a curvature generally matching the curvature of the support; and means for clamping the intrauterine member with respect to the support; characterised in that the support is provided with a laterally projecting handle which is positioned at the proximal end of the support, and the means for clamping the intrauterine member is longitudinally spaced along the support from the handle.
2. An implement as claimed in claim 1 , wherein the arrangement is such that release of clamping between the support and the intrauterine member can be effected by deflecting the intrauterine member laterally with respect to clamping means provided on the support.
3. An implement as claimed in claim 2, wherein the intrauterine member is resilient and is held normally in locking engagement with a locking element on the support, the intrauterine member being capable of deflection laterally, against its resilience, out of engagement with the locking element to permit longitudinal sliding movement of the of the intrauterine member with respect to the support.
4. An implement as claimed in claim 2 or 3, wherein the lateral direction of deflection is in the plane of curvature of the intrauterine member.
5. An implement as claimed in claim 4, wherein the intrauterine member has a natural curvature and, as mounted on the support, is deflected out of its natural curvature by engagement with a locking element which grips the surface of the intrauterine member.
6. Aa implement as claimed in claim 5, wherein the intrauterine member follows generally the curvature of the support from the distal end of the support to adjacent the proximal end of the support, where there is first constraining means provided with the locking element, constraining the intrauterine member to follow a curvature which is tighter than that of the natural curvature.
7. An implement as claimed in claim 6, wherein spaced from the first constraining means along the support towards its distal end, is second constraining means which also constrains the intrauterine member to follow a curvature.
8. An implement as claimed in claim 7, wherein the second constraining means constrains the intrauterine member to follow a curvature which is tighter than that of the natural curvature, but deflects the intrauterine member by less than the first constraining means.
9. An implement as claimed in claim 7 or 8, wherein the intrauterine member is attached to the support by being constrained by the first constraining means, the second constraining means and third constraining means adjacent the distal end of the support.
10. An intrauterine implement, comprising an elongate, curved support having a distal end for insertion into the vagina of a patient, and a proximal end for projecting out of the vagina of the patient; an elongate intrauterine member having a distal end for extending into the uterus of the patient, the intrauterine member being supported by the support for relative sliding movement and having a curvature generally matching the curvature of the support; and means for clamping the intrauterine member with respect to the support; characterised in that the arrangement is such that release of clamping between the support and the intrauterine member can be effected by deflecting the intrauterine member laterally with respect to clamping means provided on the support.
11. An implement as claimed in claim 10, wherein the intrauterine member is resilient and is held normally in locking engagement with a locking element on the support, the intrauterine member being capable of deflection laterally, against its resilience, out of engagement with the locking element to permit longitudinal sliding movement of the of the intrauterine member with respect to the support.
12. An implement as claimed in claim 10 or 11, wherein the lateral direction of deflection is in the plane of curvature of the intrauterine member.
13. An implement as claimed in claim 12, wherein the intrauterine member has a natural curvature and, as mounted on the support, is deflected out of its natural curvature by engagement with a locking element which grips the surface of the intrauterine member.
14. An implement as claimed in claim 13, wherein the intrauterine member follows generally the curvature of the support from the distal end of the support to adjacent the proximal end of the support, where there is first constraining means provided with the locking element, constraining the intrauterine member to follow a curvature which is tighter than that of the natural curvature.
15. An implement as claimed in claim 14, wherein spaced from the first constraining means along the support towards its distal end, is second constraining means which also constrains the intrauterine member to follow a curvature.
16. An implement as claimed in claim 15, wherein the second constraining means constrains the intrauterine member to follow a curvature which is tighter than that of the natural curvature, but deflects the intrauterine member by less than the first constraining means.
17. An implement as claimed in claim 15 or 16, wherein the intrauterine member is attached to the support by being constrained by the first constraining means, the second constraining means and third constraining means adjacent the distal end of the support.
18. An implement as claimed in any preceding claim, in the form of an intrauterine manipulator, in which the elongate intrauterine member is a hollow tube.
19. An implement as claimed in claim 18, wherein the tube is provided adjacent its distal end with a balloon, and adjacent its proximal end with means for inflating the balloon.
20. An implement as claimed in any of claims 10 to 18, wherein the support is provided with a laterally projecting handle which is positioned at the proximal end of the support, and the means for clamping the intrauterine member is longitudinally spaced along the support from the handle.
21. A support for an implement as claimed in claim 20, the support comprising an elongate, curved support member having a distal end for insertion into the vagina of a patient, and a proximal end for projecting out of the vagina of the patient; a handle projecting laterally from the support member adjacent the proximal end; means for supporting an elongate curved intrauterine member for relative sliding movement with respect to the support member, the supporting means comprising proximal constraining means for the intrauterine member adjacent the proximal end of the support member, displaced towards the distal end from the handle, and distal constraining means adjacent the distal end of the support member, the constraining means constraining the intrauterine member to adopt a rest configuration; and means for locking the intrauterine member with respect to the support member, the locking means comprising means for engaging the surface of the intrauterine member when constrained by the constraining means so as to adopt the rest configuration, so that deflection of the intrauterine member away from the rest configuration releases the intrauterine member from locking engagement with the locking means.
22. A method of positioning an intrauterine implement within a patient, the method comprising the use of an implement as claimed in any of claims 1 to 20.
23. A method of positioning an intrauterine implement within a patient, the method comprising the steps of:
inserting the distal end of an elongate, curved support into the vagina of the patient, the support carrying an elongate intrauterine member having a distal portion which extends into the uterus of the patient, the intrauterine member having a curvature generally matching the curvature of the support and being clamped releasably to the support ;
holding the support in one hand by means of a laterally projecting handle which is positioned at the proximal end of the support, and manipulating the support;
holding the a proximal portion of the intrauterine member in the other hand;
releasing clamping between the support and the intrauterine member by deflecting the intrauterine member laterally with respect to clamping means provided on the support, using said other hand;
sliding the intrauterine member longitudinally into a desired position with respect to the support, using said other hand, whilst maintaining deflection of the intrauterine member so that clamping between the intrauterine member and the clamping means continues to be released; and
ceasing deflection of the intrauterine member so that clamping is re-established between the clamping member and the support so as to maintain the desired position of the intrauterine member with respect to the support.
24. A method as claimed in claim 23, wherein the implement is in the form of an intrauterine manipulator, in which the elongate intrauterine member is a hollow tube provided adjacent its distal end with a balloon, and adjacent its proximal end with means for inflating the balloon.
25. A method of performing one or more of the following procedures:
diagnostic laparoscopy, laparoscopic assisted vaginal hysterectomy, laparoscopic hysterectomy, laparoscopic myomectomy, laparoscopic B S O3 laparoscopic salpingectomy, laparoscopic adhesiolysis, laparoscopic sterilisation, laparoscopic CO2 laser ablation, laparoscopic lunauterosacral nerve ablation, laparoscopic ventrosuspension, laparotomy, myomectomy, abdominal hysterectomy, colposuspension, moscowitz, hysterosalpingogram, tubalsalpingostomy, and/or marsupialisation of ovaries
comprising the use of an implement or support according to any one of claims 1 to 21 and/or a method according to claim 22 to 24.
26. An intrauterine implement, substantially as hereinbefore described with reference to the accompanying drawings.
27. A support for an intrauterine implement, substantially as herein before described with reference to the accompanying drawings.
28. A method of positioning an intrauterine implement within a patient, substantially as herein before described with reference to the accompanying drawings.
PCT/GB2007/000780 2006-03-06 2007-03-06 Intrauterine manipulator WO2007101994A1 (en)

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GB0604511A GB0604511D0 (en) 2006-03-06 2006-03-06 Intrauterine manipulator
GB0604511.6 2006-03-06

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Cited By (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN101862215A (en) * 2010-03-18 2010-10-20 王万玲 Maternity assisting device
US20170215798A1 (en) * 2016-01-28 2017-08-03 Healoe Llc Device and Method to Control and Manipulate a Catheter
US9895140B1 (en) 2007-07-17 2018-02-20 Histologics, LLC Frictional trans-epithelial tissue disruption collection apparatus and method of inducing an immune response
US10149666B2 (en) 2010-03-26 2018-12-11 Histologics Llc Frictional tissue sampling and collection method and device
US10201332B1 (en) 2012-12-03 2019-02-12 Healoe Llc Device and method of orienting a biopsy device on epithelial tissue
US10258780B2 (en) 2007-07-17 2019-04-16 Histologics, LLC Frictional trans-epithelial tissue disruption collection apparatus and method of inducing an immune response
WO2020033625A1 (en) * 2018-08-08 2020-02-13 Innomed One, Llc Artificial insemination system

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3042030A (en) * 1958-11-25 1962-07-03 Read Thane Spherical type insert plug for body passageway and tool therefor
DE2544262A1 (en) * 1975-10-03 1977-04-14 Max Bernhard Ulrich Catheter for intra:uterine use - has puncturing point and protective and removable hose in longitudinal central channel
GB2222951A (en) * 1988-09-21 1990-03-28 Richard Fredrick Kronner Uterine manipulator with externally securable clamp
US5549563A (en) * 1994-10-11 1996-08-27 Kronner; Richard F. Reinforcing insert for uterine manipulator

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3042030A (en) * 1958-11-25 1962-07-03 Read Thane Spherical type insert plug for body passageway and tool therefor
DE2544262A1 (en) * 1975-10-03 1977-04-14 Max Bernhard Ulrich Catheter for intra:uterine use - has puncturing point and protective and removable hose in longitudinal central channel
GB2222951A (en) * 1988-09-21 1990-03-28 Richard Fredrick Kronner Uterine manipulator with externally securable clamp
US5549563A (en) * 1994-10-11 1996-08-27 Kronner; Richard F. Reinforcing insert for uterine manipulator

Cited By (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9895140B1 (en) 2007-07-17 2018-02-20 Histologics, LLC Frictional trans-epithelial tissue disruption collection apparatus and method of inducing an immune response
US10258780B2 (en) 2007-07-17 2019-04-16 Histologics, LLC Frictional trans-epithelial tissue disruption collection apparatus and method of inducing an immune response
US11213664B2 (en) 2007-07-17 2022-01-04 Histologics, LLC Frictional trans-epithelial tissue disruption collection apparatus and method of inducing an immune response
CN101862215A (en) * 2010-03-18 2010-10-20 王万玲 Maternity assisting device
US10149666B2 (en) 2010-03-26 2018-12-11 Histologics Llc Frictional tissue sampling and collection method and device
US10201332B1 (en) 2012-12-03 2019-02-12 Healoe Llc Device and method of orienting a biopsy device on epithelial tissue
US11571188B1 (en) 2012-12-03 2023-02-07 Healoe Llc Device and method for locating and retaining biopsy sampling device on epithelial tissue
US20170215798A1 (en) * 2016-01-28 2017-08-03 Healoe Llc Device and Method to Control and Manipulate a Catheter
WO2017132051A1 (en) * 2016-01-28 2017-08-03 Healoe Llc Device and method to control and manipulate placement of a catheter
US11013466B2 (en) 2016-01-28 2021-05-25 Healoe, Llc Device and method to control and manipulate a catheter
WO2020033625A1 (en) * 2018-08-08 2020-02-13 Innomed One, Llc Artificial insemination system

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