WO2003043510A1

WO2003043510A1 - A tool for use at laparoscopic surgery at uterus

Info

Publication number: WO2003043510A1
Application number: PCT/SE2002/002020
Authority: WO
Inventors: Mikael Engman
Original assignee: Endolink AB
Current assignee: Endolink AB
Priority date: 2001-11-19
Filing date: 2002-11-06
Publication date: 2003-05-30
Anticipated expiration: 2004-05-19
Also published as: SE518937C2; SE0103834L; SE0103834D0; AU2002347724A1

Abstract

The present invention relates to an instrument for use in connection with laparoscopic surgery on the uterus and comprises a tubular element whose forward end is intended for insertion into the vagina of a patient and received by the cervix. The front end of the tubular element (10) is cut obliquely. The inside of the foremost part of the front end of the tubular element includes a wall thickening that is delimited by a chord on the circular cross-section of said element. Located in the centre of the thickening (12) is a radial slot (15), which includes undercut portions (18) in the proximity of the wall (14) of said element. The transition portions (19) of the thickening between the chord and the slot (15) are rounded. The forward surface of the thickening widens generally a in a plane normal to the axis of the tubular element (10). The radial thickness of the thickening (15) decreases rapidly in a direction towards the rear end of the tubular element (10). The thickening and the slot provide a favourable presentation of the upper part of the vagina, as viewed from inside the abdomen, and the slot in said thickening provides a favourable location for the application of a surgical instrument through the top of the vagina from the inside of the abdomen. The slot undercut provides favourable guidance of the instrument upon rotation of the tubular element (10).

Description

A TOOL FOR USE AT LAPAROSCOPIC SURGERY AT UTERUS

The present invention relates to an instrument for use in laparoscopic surgery on the uterus, of the kind defined in the preamble of Claim 1.

Thus, the invention relates to an instrument of the kind apparent from WO 98/10707. An instrument of this nature includes a tubular element, which has a front and a rear end. The element is inserted into the vagina, so that its front end will receives the cervix of the uterus. The rear end of the element includes a releasable closure that has a sealing transit or lead-through for a rod-like tool whose front-end portion can be inserted into the uterus via the cervix passageway for manipulation of the uterus. A suture is fastened in the cervix and anchored to the rear end of said element. The edge of the front end of said element pitches a surface that defines an oblique angle of, e.g., 30 degrees with a plane that is normal to the element axis, such that the front part of said element will obtain a forwardly projecting basin-like lip.

The surgeon is able to insert optical equipment through the abdominal wall of the patient, for illuminating and viewing chosen areas of the abdominal cavity. The surgeon is able to pressurise the abdominal cavity with the aid of a gas, in a well-known manner, so as to facilitate access to chosen areas or regions of the abdominal cavity.

The surgeon is also able to insert a surgical instrument through a port in the abdominal wall, for example an electrosurgical instrument of the hook-diathermic type, and can use the edge of the front part of the tubular element as a reference, for instance when cutting through the upper part of the vagina or sheath. The tubular element is adapted to sealingly shield the vagina against said gas pressure, with the aid of the closure at the rear-end of the element and possibly also with the aid of outer seals.

Although this known instrument functions in the manner intended, it has been found desirable to improve still further presentation of the upper part of the vagina wall in respect of the abdominal cavity. It has also been found desirable to provide secure guidance of the electrosurgical instrument with reference to the tubular element, particularly when the upper part of the vagina shall be cut through around the cervix. Accordingly, one object of the invention is to provide an instrument, which affords improved presentation of the upper part of the vagina with respect to the abdominal cavity. Another object is to provide, in this regard, an instrument design, which provides secure guiding of the instrument when cutting through the upper part of the vagina around the cervix perimeter.

Still another object is to provide an instrument design, which facilitates the insertion of surgical instruments in co-action with said tubular element as the element rotates.

These objects are achieved by the invention, either in full or in part.

The invention is defined in the accompanying independent Claim 1.

Further embodiments of the invention will be apparent from the accompanying dependent Claims.

According to one important feature of the invention, the most forward portion of the front end of the tubular element is provided with a radial wall-thickening which widens around a limited part of the periphery of said element, wherewith the front surface of the thickened wall portion widens generally in a plane normal to the axis of said element. Because the thickening is situated at the foremost portion of the front end of the element, the wall of the vagina will be raised towards the abdominal cavity and, at the same time, be outwardly tensioned and widened radially by the thickened end-portion of the tubular element. When the tubular element is rotated manually, the upper part of the vagina moves dynamically in the longitudinal direction of the element and, at the same time, in a radial direction.

The surgeon thereby obtains amplification of the presentation of the upper part of the vagina as viewed through a laparoscope from the interior of the abdomen.

When the thickened wall-portion has an axially directed recess, which is preferably open towards the inside of the tubular element via a slot, the recess provides a discernible location at which the electrosurgical instrument can be safely applied. Moreover, the surgeon is able to study optimal culpotomy locations from the abdominal cavity. As a result of the shape of the thickening and the increase in thickness of the foremost portion of the element, surrounding blood vessels will be lifted and moved to one side by the foremost portion of said element as the tubular element is rotated around the cervix. The electrosurgical element can be inserted in the recess of the tubular element in its thickened portion, and can be inserted axially therein (inserted from above the short side) and removed axially therefrom via a slot. The recess is undercut relative to the slot opening from the inside of the tubular element. The surgeon is able to rotate the tubular element such that the diathermal instrument will be caught in the following undercut portion, and thereby perform a displacement/cutting movement controlled by rotation of the tubular element, wherewith the surgical instrument constantly has the greatest possible safety distance to sensitive structures, such as the bladder and the ureter.

The thickening on the foremost portion of the tubular element can be rotated around the fornix and show successively the rear part, the front part or the side parts of the fornix, so as to mark optimal surgical positions.

As the tubular element rotates, its thickened tip-portion will successively lift the vaginal wall, so that those parts of the slot and the recess bordering on the vaginal wall will constantly be situated at the greatest possible safety distance from the ureter and bladder.

The invention will now be described by way of example, with reference to the accompanying drawing, in which

Fig. 1 is an axial sectioned view of an inventive instrument in an operative position;

Fig. 2 is a side view of the main part of said instrument;

Fig. 3 is an end view of the instrument taken on the line III-III in Fig. 2; Fig. 4 is a sectional view taken on the line IN-IN in Fig. 3; and

Fig. 5 is an axial sectioned view of a sealing ring.

Fig. 1 illustrates a tubular element 10 inserted in a patient's vagina. The front end 11 of the tubular element is bevelled, as seen in the insertion direction of said element. This bevel can be approximated by a plane that defines an angle of about 30 degrees with the plane normal to the axis of the element 10. Alternatively, the bevel may have the form of a curved surface, such as a slightly outwardly concave surface. The generatris of the curved surface is a straight line that defines essentially a right angle with the axis of the element 10 and which is displaced parallel along a curved path. The curved surface has a radius of about 50 mm and the tubular element 10 has a diameter of about 36-42 mm.

The rear end of the tubular element includes a sealing cap 20 which includes a self-sealing transit or lead-through 21 for a rod-like tool 30, the tip 31 of which can be inserted into the cervix passageway 41 and the uterus 44 for manipulating purposes. The rear end of the tubular element includes slots which enable said end to be anchored by a suture 19 fastened in the cervix at 17. The suture 19 holds the front end of the element 10 in contact with the top of the vagina around the cervix 40. The gap between the outer surface of the element 10 and the wall of the vagina is sealed by a sealing ring 74.

In the case of laparoscopic surgery on the uterus, there is inserted through the abdominal wall an optical device 60 which includes a pair of light conductors 61, 62 that function to illuminate a surgical area within the abdominal cavity and to optically scan the illuminated area. Also inserted into the abdominal cavity through the abdominal wall is a tool 50 that includes a tip 31 that can cut through the upper part 71 of the vagina, for instance.

The abdominal cavity is normally filled with gas so as to outwardly tension the cavity and provide an enhanced field of view to the surgeon. The act of cutting through the upper part of the vagina 71 enables pressurised gas to flow into the tubular element 10, which, however, is sealed by the cap 20. The tool 50 may be an electrosurgical instrument of the hook-diathermic type.

The tubular element 10 forms a guard between the tool 50 and the vaginal wall 70 in those instances when said element constitutes a working channel for the insertion of a gripping instrument via colpotomy to a free abdominal cavity, with the intention of gripping and extracting tissue from the abdomen in the absence of gas leakage.

It will be seen from Figs. 2-4 that the tubular element has on the inside of its foremost portion 11 a thickening 12 which is generally delimited by a chord of the cross-section of the tubular element 10. Thus, the thickening 12 has peripherally a thickness, which increases successively from one end and then successively decreases. This thickened portion 12 has a front end surface 13 which lies generally in a plane normal to the axis of the tubular element 10. As the element 10 is rotated around the cervix 40, the surface 13 of the thickened portion 12 will successively stretch or "pitch" the upper part of the vagina 71 radially outwards, wherewith the tensioned part of the top wall will be lifted up towards the abdominal cavity, therewith enabling the surgeon to conveniently chose an optimal surgical location.

It will be seen from Fig. 4 that the radial extension of the thickening 12 decreases rapidly in a direction towards the rear end of the tubular element 10.

It will be seen from Fig. 3 that the thickening 12 has a central interruption 15, which forms a radially inward open slot between thickening portions 17. The slot 15 has undercut portions 18 in the vicinity of the wall 14 of the tubular element. This provides additional amplification of the presentation of the vaginal top as viewed through a laparoscope from the abdominal interior. The thickenings extend from the forward edge of the tubular element at a distance from the forward end 27 of said element and include rounded corner portions 29 that extend to the region of a plane passing through the forward end 27 of the tubular element, this plane being normal to the axis of said element 10. In the case of a tested embodiment, the corner portions 29 almost reach the plane through the forward end of the element 10. An optimal colpotomy location can be chosen in conjunction with scanning the upper part of the vagina on the thickening as the element 10 rotates around the cervix.

The tool 50 can be inserted through the wall 71 to the slot 15, via the abdominal cavity, said wall 71 having been opened primarily by colpotomy. The tool 50 can be caused to make a cut around the periphery as the tubular element is rotated, particularly in the undercut portions 18 of the slot 15. As a result of the bevel on the foremost part of the tubular element 10 and the thickening of the foremost peripheral part of said element on the inside thereof, the vaginal wall, the uterus blood vessels and the bladder will be lifted away from the cervix and moved to one side as the tubular element is rotated past an observed location, by virtue of the pointed configuration of the element 10 and the radial increase in said wall thickness.

The slot 15 enables the insertion of an electrosurgical cutting instrument, by rear colpotomy, which is limited peripherally by the peripheral limitations of the slot. During surgery, the instrument can be moved around the fornix by rotating the tubular element 10, wherewith said element provides the greatest possible safety distance to sensitive structures, such as the bladder and the ureter. The tubular element illustrated in Fig. 3 may have the following dimensions: u = 5 mm s = 6 mm t = 4 mm

R = 15-18 mm p = 1.5 mm m (Fig. 4) = 10 mm

These dimensions may, of course, vary within wide limits.

Fig. 5 illustrates more clearly the sealing ring 74 illustrated schematically in Fig. 1, said sealing ring preferably consisting entirely of an elastomeric material. The ring 74 includes a sealing sleeve which surrounds the tubular element 10 sealingly and stably and which can be moved to a chosen, stable axial position on the tubular element 10. The sealing ring includes a flange 76 which is connected flexibly to the sleeve 75 and which extends out from the sleeve at an angle to the radial plane of said sleeve in the range of 15-40°, for example 25°. The ring 74 is positioned so that the flange 76 extends towards the forward end of the tubular element 10. The flange 76 is conveniently comprised of an elastomeric material.

Claims

1. An instrument for use in laparoscopic surgery on the uterus, comprising a tubular element whose forward end surface defines an oblique angle with the axis of said element, wherein the forward part of the element 10 is adapted to receive the cervix, characterised in that the foremost part of the front-end portion (11) of the tubular element has a radial wall thickening (12) which widens around a limited part of the periphery of the tubular element (10); and in that the thickened wall portion (12) has a forward end surface that widens generally in a plane normal to the axis of the element (10).

2. An instrument according to Claim 1, characterised in that the radial thickness of the wall thickening decreases in a direction towards the rear end of the element (10).

3. An instrument according to Claim 1 or 2, characterised in that the wall thickening is provided on the inside of the generally circular tubular element (10); and in that the forward end of the thickening is delimited generally by a chord on the cross-section of said tubular element.

4. An instrument according to any one of Claims 1-3, characterised in that the wall thickening includes a generally axial recess which is open towards the centre of the tubular element via a radial slot.

5. An instrument according to Claim 4, characterised in that the slot is undercut radially.

6. An instrument according to Claim 4 or 5, characterised in that the corner portions (27) formed on the thickening (12) by said slot extend to the region of a plane through the foremost end of the tubular element.

7. An instrument according to any one of Claims 4-6, characterised in that the slot (15) has a free peripheral width of about 2 mm; and in that the peripheral width of the recess is about 4 mm.

8. An instrument according to any one of Claims 1-7, characterised by a ring-shaped element (74) which is displaceably mounted on the outside of the tubular element (10) in a sealing and stable fashion; and in that the ring-shaped element (74) has an outwardly directed flange (76) which can be lowered elastically in the axial plane of the ring-shaped element.

9. An instrument according to Claim 8, characterised in that in the absence of load said flange (76) defines an angle with the radial plane of the ring-shaped element (74); and in that the ring-shaped element is positioned with the flange (76) facing towards the forward end portion of the tubular element (10).