Atraumatic uterine director

Abstract

A medical instrument particularly designed for manipulating and positioning the human uterus during a laparoscoptomy. The device is generally similar to the conventional Simms cervical tenaculum and includes a generally cup-shaped member whose end wall is connected to a source of vacuum through a tube or the like. Within the member is a conical element to which a plurality of different size tips may be releasably connected. The instrument is inserted through the vaginal passage and the cone placed against the cervical os, and the vacuum in the cup member causes the uterus to adhere to the cone. The tip, which is now in the uterus, and which is connected to the rigid tube, may be manipulated by corresponding movement of the tube.

Description

BACKGROUND OF THE INVENTION

In performing laparoscope tubal fulguration, irrespective of the particular procedure used, a laparoscope is inserted through an abdominal incision, and the physician uses such instrument to view the uterus and the tubes which are to be cut, cauterized or otherwise blocked. Whether the cutting or cauterizing tool is associated with the laparoscope or whether it is inserted through a separate lower incision, it is imperative that the surgeon can clearly view the tubal area on both sides of the uterus in order to perform the tubal sterilization operation. The multigravidas patient as well as patients undergoing second trimester abortions concommitantly with the tubal fulgurations, has a larger uterine size, the uterus is generally flaccid and further difficulty is encountered in properly directing or manipulating the uterus for proper viewing of the tubes through the laparoscope.

In accordance with the teachings of the present invention, an instrument is provided which may safely, conveniently and readily manipulate, move and direct the uterus so as to provide the surgeon with both proper viewing and surgical accessibility to the tubes so that tubal fulguration may be performed.

The instrument is designed to utilize a range of tip sizes whereby the end of the tip may approach the fundus or top of the uterus to provide for maximum uterine mobility.

THE DRAWING

FIG. 1 is a side elevational view of the uterine director of the present invention.

FIG. 2 is a front view of a portion of the device, taken in the plane indicated by line 2--2 of FIG. 1.

FIG. 3 is an end view of the device.

FIG. 4 is a cross-sectional view taken in the plane indicated by line 4--4 of FIG. 3.

FIG. 5 is a side view of a typical tip.

DESCRIPTION OF THE PREFERRED EMBODIMENT

The device of the present invention, as illustrated in the drawing, includes a rigid tube 10, preferably having a straight portion 12 and an angularly related portion 14. The distal end of the latter has an enlarged portion 16 for releasable attachment to a hose 18 or the like, which may be connected to a suitable pump or other source of vacuum, not shown. Tube 10 may be formed of stainless steel and has an axial passage 20 through which a vacuum may be induced. Extending laterally outwardly from a portion of the tube portion 12, adjacent its juncture with tube portion 14, is a generally rectangular plate 22, whose function will be later described.

Secured in any suitable manner to the other end of the tube portion 12 is a member 24 which includes a central block-like conical element 26 which emerges from the transaxial base plate 28 of member 24 and which is co-axial with tube 12. Element 26 terminates in a flat transaxial wall 30 having a central threaded opening 32.

Also extending from plate 28 is a wall 34 which diverges outwardly and which terminates in a smooth lip 36 lying substantially in the same plane as the cone wall 30.

An annular space 38 is defined between the cone 26 and wall 34, and such space is in flow communication with the tube passage 20 by means of a passage 40 interconnecting the same.

The threaded opening 32 is adapted to receive the threaded end portion 42 of a tip 44, the latter having a slight arcuate configuration. The shoulder 46 between the end 42 and the tip is adapted to seat against the wall 30 when the tip is threadedly engaged with the opening 32. It is also significant and important to note that when such seating occurs the curve of the tip 44 is always oriented in a particular manner relative to the plate 22. This function will also be later described. The tip 44 is removable from member 24 so as to permit the use of different length or sizes of tips.

The manner of using the device in connection with performing a laparoscopic tubal fulguration (following an abortion) will now be briefly described.

First, after determining the uterus location and dilating the cervic in any acceptable conventional manner, an abortion may be performed. Then, whether an abortion has been performed or not, the physician, having already sounded the uterus to determine its size, location, etc., will select a tip 44 of a length which will generally approximate the distance from the cervical os to the fundus.

The instrument is then inserted (tip first) through the vagina, the tip passing through the cervix and entering the uterus, until the cone wall 38 engages the cervical os. At this time, a vacuum is induced through hose 14, tube 10, passage 40 and the space or chamber 38. This causes the uterine wall surrounding the cervical os to be pulled against the lip 36 whereby the device is now held in position.

The normal abdominal incision may then be made and carbon dioxide pumped into the abdominal cavity. The laparoscope is inserted through such incision, and the physician, in looking into the laparoscope, may manually engage the portion of tube 10 which extends outwardly from the vaginal passage and effect rotation or other motion to the instrument so as to direct or orient the uterus accordingly. The plate 22, as above mentioned, is specifically oriented relative to the curve of the tip 44 so that the physician can immediately determine by merely grasping the plate, in which direction the tip is curved, and thus more readily direct or manipulate the uterus.

Because of the vacuum the uterus will be retained in position against the instrument until deliberately reoriented by turning of the device.

The total fulguration may then be performed in any suitable manner.

While the device has been described in connection with a particular type of surgical procedure, it should be understood that the instrument may be used in other situations where deliberate directing and movement of the uterus is required.

Claims

What is claimed is:

1. A device of the character described comprising a member having an end wall, a continuous side wall extending axially outwardly from the periphery of said end wall, an element extending axially from a central portion of said end wall and spaced radially inwardly from said side wall to define a continuous space therebetween, a tip extending axially from said element, a rigid tube connected to said end wall and extending in a contra direction to said side wall, and means defining a passage placing said tube and said continuous space in flow communication.

2. A device as set forth in claim 1, in which said tip is releasably connected to said element whereby tips of different sizes may be used.

3. A device as set forth in claim 1, in which said tip is curved along the axial extent thereof.

4. A device as set forth in claim 1 in which said element has a distal end wall disposed in a transaxial direction and generally coterminous with the distal end of said side wall.

5. A device as set forth in claim 4 in which said element is of generally frusto-conical configuration with its maximum dimension adjacent said end wall.

6. A device as set forth in claim 1 in which said passage extends through said element.

7. A device as set forth in claim 4 in which said element has a tapped hole extending to the end wall thereof, and said tip is provided with a threaded end portion releasably engageable with said tapped hole.

8. A device as set forth in claim 1 in which said tube is provided with a manually engageable orienting plate axially spaced from said end wall.

9. A device as set forth in claim 8 in which said tip is curved along its axial extent, and releasably connected to said element, and in which said plate is disposed in a predetermined angular orientation with respect to the curvature of said tip.