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WO2010088634A2 - Procédé et appareil chirurgical - Google Patents

Procédé et appareil chirurgical Download PDF

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Publication number
WO2010088634A2
WO2010088634A2 PCT/US2010/022782 US2010022782W WO2010088634A2 WO 2010088634 A2 WO2010088634 A2 WO 2010088634A2 US 2010022782 W US2010022782 W US 2010022782W WO 2010088634 A2 WO2010088634 A2 WO 2010088634A2
Authority
WO
WIPO (PCT)
Prior art keywords
vagina
elongated
surgical instrument
uterus
elongated body
Prior art date
Legal status (The legal status 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 status listed.)
Ceased
Application number
PCT/US2010/022782
Other languages
English (en)
Inventor
Tamer A. Seckin
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
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 Individual filed Critical Individual
Publication of WO2010088634A2 publication Critical patent/WO2010088634A2/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00278—Transorgan operations, e.g. transgastric
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00287—Bags for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B2017/3445—Cannulas used as instrument channel for multiple instruments

Definitions

  • the present invention relates to a surgical method and apparatus for use in connection with examinations and surgical interventions through a hollow organ forming a natural orifice of a human or animal body, preferably through the vagina of a female patient.
  • the present disclosure relates to subject-matter contained in US Provisional Application 61/148,949 filed on 31/01/2009 which is expressly incorporated herein by reference in its entirety.
  • Endoscopy is a minimally invasive diagnostic medical procedure that is used to assess the interior surfaces of an organ by inserting a tube into the body.
  • Endoscopic surgery methods are widely used for treatment of a variety of disorders that were formally treated by conventional surgical techniques.
  • Laparoscopic surgery is an endoscopic surgical technique in which operations in the abdomen or pelvic cavity are performed through small incisions as compared to larger incisions needed in traditional surgical procedures.
  • Natural orifice transluminal endoscopic surgery is performed with an instrument passed through a natural orifice (mouth, urethra, anus, etc.) then through an internal incision in the stomach, vagina, bladder or colon.
  • the instrument for natural orifice transluminal endoscopic surgery can consist of a rigid or flexible tube, a light delivery system to illuminate the organ or object under inspection, the light source is normally outside the body and the light is typically directed via an optical fiber system, a lens system transmitting the image to the viewer from the fiberscope, an additional channel to allow entry of medical instruments or manipulators.
  • US 5,279,548 discloses a surgical method and apparatus for use in pelvic surgery wherein a trocar sleeve is positioned in the vagina of a female patient such that the sleeve traverses the vaginal wall behind the cervix of the patient.
  • Some laparoscopic surgery procedures known in the prior art performed through the vagina and the rectouterine pouch are removal of the gallbladder at the end of endoscopical cholecystectomy, appendicectomies following vaginal hysterectomy, various gynaecological procedures, such as myomectomy and abdominal operations, such as cholecystectomies, colectomies and splenectomies.
  • Natural orifice transluminal endoscopic surgery performed through the rectouterine pouch or any other natural orifice can be applied in combination with open incision surgery or laparoscopic surgery.
  • the rectouterine pouch is the extension of the peritoneal cavity between the rectum and back wall of the uterus in the female human body. In women it is the deepest point of the peritoneal cavity, behind the uterus and in front of rectum. It is near the posterior fornix of the vagina.
  • the rectouterine pouch is a common site for the spread of pathology such as ascites, tumour, endometriosis, pus, etc. It is also known by the names Douglas pouch, Douglas space, Douglas cul-de-sac.
  • the Rectouterine Pouch can be reached through the posterior fornix of the vagina.
  • the present invention provides a surgical method and apparatus for performing examinations and surgical interventions through a natural orifice of a human or animal body, preferably through the vagina and the rectouterine pouch of a female patient.
  • an apparatus comprises an elongated body having an attachment means.
  • the body may be adapted to be received in the vagina of a female patient.
  • the body may be a tube, a trocar sleeve, a barrel, a solid body or a hollow body.
  • the body may be made of metal or plastic or rubber material.
  • the attachment means may be arranged on an inner surface or on an outer surface of the elongated body.
  • the attachment means may be a guiding means, a rail, a groove, a hole or a protrusion.
  • a distal end portion of the elongated body may be oblique and/or rounded, convex, hemispherical or quarter-spherical.
  • the elongated body may comprise an open end and a closed end.
  • the closed end may comprise at least one hole.
  • the closed end may make an angle with the surface of the elongated member which is lower or higher than 90 degrees.
  • the closed end may be formed oblique, hemispherical or quarter-spherical.
  • the elongated body may have channels there trough.
  • the attachment means may be arranged such that a rotatable part is attachable to the attachment means.
  • the rotatable part may be articulated on the elongated body.
  • the rotatable part may be rotated by an operator arm.
  • the rotatable part may have tooth at its end near the articulation point.
  • the operator arm at its distal end may attach to the rotatable part via hinge means or tooth means such that when the operator arm is pulled or pushed with respect to the rotatable part, the rotatable part is rotated about its articulation point.
  • the rotatable part may be the rotatable portion of a uterus manipulator.
  • the attachment means may be arranged such that a uterus manipulator is attachable to the attachment means.
  • the attachment means and the uterus manipulator may be arranged such that a movement of the elongated body with respect to the uterus manipulator causes a rotation of the rotatable part of the uterus manipulator.
  • a uterus manipulator may be positioned in a groove or channel of the apparatus.
  • the apparatus is adapted to be positioned in the vagina of a female patient so that the apparatus is able to traverse a portion of a vaginal wall located behind the cervix of the patient and so that distal end portion of the apparatus is able to penetrate or to be introduced to the rectouterine pouch of a female body.
  • a surgical instrument comprising an elongated part, the elongated part having a rotatable end portion.
  • the rotatable end portion may include an articulation or a hinge about which the rotatable portion is rotatable, preferably a flexible articulation.
  • the surgical instrument may be a uterus manipulator.
  • the surgical instrument may have an attachment means thereon.
  • the attachment means may be a rail or a protrusion or a hollow element.
  • the elongated rod may be adapted to be received into the elongated body or in a groove or in a channel of the elongated body.
  • the elongated body of the apparatus and the elongated part of the surgical instrument are arranged parallel to each other such that they are able to move in the longitudinal direction with respect to each other.
  • the rotatable portion of the surgical instrument is rotated to a vertical position at about 90 degrees with respect to the elongated body and/or elongated part before the apparatus traverses a portion of a vaginal wall located behind the cervix of the female patient and penetrates to the rectouterine pouch.
  • a sheet member adapted to be placed in a space in the human body.
  • the sheet may be a membrane.
  • the sheet may be a plastic, polymer or nylon sheet.
  • the sheet may be formed as a bag.
  • the sheet or the bag may comprise two separated zones or may comprise at least two separate compartments.
  • the sheet may comprise an opening.
  • An elongated port may be arranged at the opening .
  • the elongated port may comprise at least an open end.
  • the elongated port may be adapted to be received through the vagina of a female patient such that the open end is arranged outside the human body.
  • the sheet may comprise at least an attachment means for fixing the sheet to the inner parts of the human body.
  • the sheet may be under positive or negative gas or liquid pressure with respect to its ambient.
  • the sheet or the bag is inserted in a closed configuration through the vagina and the rectouterine pouch into a peritoneal cavity of the patient.
  • the sheet or the bag may be inserted through one of the guides or channels of the apparatus.
  • the sheet or the bag is then opened in a space in the human body.
  • the sheet or bag may be attached and fixed to the inner parts of the human body using the attachment means or pressurized liquid medium.
  • the liquid medium may be introduced through the vagina into the body cavity.
  • the pressure above and/or inside the apparatus is set higher than the pressure below and/or outside the apparatus so that the apparatus is placed and fixed inside the human body with the help of the pressure difference.
  • the pressure above and/or inside and/or below and/or outside the sheet is adjusted by a liquid or gaseous medium which is transferred to inside of the human body.
  • the liquid or gaseous medium may be transferred through one of the channels or guides of the apparatus.
  • a surgical method for performing examinations and surgical interventions through the vagina and the rectouterine pouch of a female patient comprises the steps of providing a tube adapted to receive one or more surgical instruments there through and having a distal end with an oblique profile such that the distal end of the tube is inclined making an oblique angle with the longitudinal axis of the tube forming a nose at the distal end of the tube, positioning the tube in the vagina of the patient such that the tube traverses a portion of a vaginal wall located behind the cervix of the patient so that the distal end of the tube penetrates to the rectouterine pouch.
  • the method further comprises the step of positioning the tube in the vagina such that the shortest longitudinal side of the tube faces the uterus of the patient and such that the nose at the distal end of the tube clears the penetration way of the tube.
  • the method further comprises the steps of providing an elongated housing, positioning the tube in the housing in a telescopically movable manner, preferably before positioning the tube in the vagina.
  • a method comprises the steps of providing a uterus manipulator having a rotatable distal end, positioning the uterus manipulator longitudinally parallel to and movable with respect to a tube in the vagina of the patient, placing the distal end of the uterus manipulator in the uterus and repositioning the uterus using the rotatable distal end of the uterus manipulator to an appropriate position before the tube traverses the vaginal wall such that the penetration way of the tube is cleared from obstacles and the posterior fornix of the vagina is visible through the vagina and an incision can be made in the posterior fornix of the vagina.
  • the method further comprises the step of positioning the uterus manipulator in the housing in a telescopically movable manner, preferably before positioning the tube and the uterus manipulator in the vagina.
  • the method further comprises the step of locking the tube and/or the uterus manipulator in the housing such that the tube and/or uterus manipulator can not be moved telescopically in the housing.
  • the method further comprises the steps of repositioning the uterus by tilting the rotatable distal end of the uterus manipulator to a position where the distal end of the uterus manipulator makes an angle 0 to 140 degree with the longitudinal axis of the tube, the angle being preferably about 90 degree and locking the rotatable end of the uterus manipulator at the position.
  • a surgical method for performing examinations and surgical interventions through the vagina and the rectouterine pouch of a female patient comprising the steps of providing a tube adapted to receive one or more surgical instruments therethrough and having a distal end and a uterus manipulator positioned longitudinally parallel to and movable with respect to the tube, the uterus manipulator having a rotatable distal end, positioning the tube and the uterus manipulator in the vagina of the patient, placing the distal end of the uterus manipulator in the uterus and repositioning the uterus using the rotatable distal end of the uterus manipulator to a position such that the penetration way of the tube is cleared from obstacles, preferably to a position where the longitudinal axis of the uterus body makes an angle with the longitudinal axis of the vagina, the angle being between 0 to 140 degrees, preferably the angle being 90 degrees, performing an incision in the vaginal wall, preferably at the posterior for
  • the method further comprises the steps of providing an elongated housing, positioning the tube and the uterus manipulator in the housing in a telescopically movable manner, preferably before positioning the tube and the uterus manipulator in the vagina.
  • the method further comprises the steps of repositioning the uterus by tilting the rotatable distal end of the uterus manipulator to a position making an angle 0 to 140 or 0 to 90 degree or 80 to 100 degree with the longitudinal axis of the tube, the angle being preferably 90 degree and locking the rotatable end of the uterus manipulator at the position.
  • the method further comprises the step of locking the tube and/or the uterus manipulator in the housing such that the tube and/or uterus manipulator can not be moved telescopically in the housing.
  • a surgical apparatus for performing examinations and surgical interventions through the vagina and the rectouterine pouch of a female patient comprises a tube adapted to receive one or more surgical instruments there through and having a distal end with an oblique profile such that the distal end of the tube is inclined making an oblique angle with the longitudinal axis of the tube forming a nose at the distal end of the tube.
  • the distal end of the tube is covered by a cap portion having one or more holes adapted to receive the one or more surgical instruments there through, the cap portion having preferably a convex shape.
  • the apparatus further comprises an elongated housing with a distal end such that the tube is telescopically movably arranged in the housing, the distal end of the housing preferably having an oblique profile such that the distal end of the housing is inclined making an oblique angle with the longitudinal axis of the housing, the housing preferably comprising a longitudinal slit.
  • the tube comprises one or more slits and/or grooves and/or rails and/or electrically conductive regions and/or magnetic regions on its outer surface.
  • the apparatus further comprises a uterus manipulator having a handle, a shaft extending from the handle and a rotatably distal end, the uterus manipulator preferably arranged longitudinally parallel to and movable with respect to the tube, preferably at the shortest longitudinal side of the tube and at the opposite side of the nose, the uterus manipulator preferably arranged in the housing in a telescopically movable manner.
  • the uterus manipulator comprises protrusions and/or one or more rail members and the uterus manipulator is slidably guided in one of the grooves.
  • an endobag or funnel shaped membrane is guided in one of the grooves and/or slits, the endobag or funnel shaped membrane preferably having guiding means, the guiding means preferably having one or more protrusions or a rail attached to the inner or outer surface of the endobag or funnel shaped membrane.
  • a surgical apparatus for performing examinations and surgical interventions through the vagina and the rectouterine pouch of a female patient comprises a tube adapted to receive one or more surgical instruments there through and a uterus manipulator having a handle, a shaft extending from the handle and a rotatably distal end, the uterus manipulator arranged longitudinally parallel to the tube.
  • the uterus manipulator is introduced into the uterus through the vagina and serves to tilt the uterus in various directions.
  • the hollow tube is able to receive one or more surgical instruments like graspers, scissors, clip applier, trocar, knife, vacuum, teneculum, light, visual apparatus, endobag, electrical apparatus, morcellator etc.
  • the uterus manipulator is arranged longitudinally movable with respect to the tube.
  • the tube comprises one or more slits and/or grooves and/or rails and/or electrically conductive regions and/or magnetic regions on its outer surface.
  • the uterus manipulator comprises protrusions and/or one or more rail members and the uterus manipulator is slidably mounted in one of the grooves.
  • the distal end of the tube is covered by a cap portion having one or more holes adapted to receive the one or more surgical instruments there through, the cap portion having preferably a convex shape.
  • the apparatus further comprises an elongated housing, the tube is telescopically movably arranged in the housing, the housing preferably comprising a longitudinal slit, the uterus manipulator and/or the tube preferably arranged in the housing in a telescopically movable manner.
  • an endobag or funnel shaped membrane is guided in one of the grooves and/or slits, the endobag or funnel shaped membrane preferably having guiding means, the guiding means preferably having one or more protrusions or a rail attached to the inner or outer surface of the endobag or funnel shaped membrane.
  • an endobag for transporting body tissue through transvaginal-transdouglas route having guiding means is provided.
  • the guiding means preferably consists of one or more protrusions or a rail or a rod or a channel or a pipe attached to the inner or outer surface of the endobag.
  • the endobag may be a funnel shaped membrane.
  • the present invention provides such a method and apparatus for a secure incision in the vaginal wall, preferably in the posterior fornix of the vagina, wherein uterine vessels and cardinal/uterosacral ligaments are accurately secured without causing any complication and prolongation of the operation.
  • the present invention provides such a method and apparatus for protecting the operation environment in the human body.
  • the present invention provides such a method and apparatus for protecting the rectum from being injured during the operation.
  • the present invention provides such a method and apparatus which may be used in laparoscopic surgery, preferably in natural orifice transluminal endoscopic surgery.
  • the present invention provides such a method and apparatus which substantially minimizes trauma to the patient and reduces healing time.
  • FIG. 1 is a partial cross-sectional view of a female body
  • FIG. 2 is a view of an embodiment of the present invention in the female body
  • FIG. 3A is a cross-sectional side view of the apparatus according to the invention.
  • FIG. 3B is a cross-sectional frontal view of the apparatus according to the invention.
  • FIG. 3C is a perspective view of the apparatus according to the invention comprising an elongated body and a uterus manipulator
  • FIG. 4A is a side view of an alternative embodiment of the apparatus of the present invention comprising an elongated body and a uterus manipulator
  • FIG. 4B is a side view of the uterus manipulator according to the invention.
  • FIG. 5A is a side view of a sheet or bag according to the invention.
  • FIG. 5B is a side view of another sheet or bag according to the invention.
  • FIG. 6A is a partial view of a sheet or bag according to the invention.
  • FIG. 6B is a cross-sectional view of the apparatus of FIG. 6A;
  • FIG. 7A is a partial cross-sectional view of a female body illustrating the positioned in the vaginal canal
  • FIG. 7B is a partial cross-sectional view of a female body illustrating the apparatus positioned in the vaginal canal;
  • FIG. 8 is a partial cross-sectional view of a female body illustrating the endobag apparatus according to the invention.
  • FIG. 9 is a partial cross-sectional view of a female body illustrating the apparatus positioned in the vaginal canal
  • FIG. 1OA, 10B and 10C illustrate the apparatus in side, frontal and perspective views.
  • the present invention is contemplated to be used in surgical procedures where manipulation of body structures is required to provide access to the particular body structure or adjacent body structures. While the apparatus of the present invention is particularly useful for manipulation of the uterus, it will also be useful for treating other body organs and structures during other laparoscopic and non-laparoscopic surgical procedures.
  • FIG. 1 there is illustrated in cross-sectional view of a partial female body showing the transvaginal-transdouglas route.
  • FIG. 2, 9, 10A, 10B and 10C show one embodiment of the apparatus constructed according to the present invention.
  • the apparatus comhses a tube.
  • the tube has a proximal and a distal end that penetrates into the rectouterine pouch.
  • the distal end is cut obliquely forming a nose.
  • This shape enables a smooth introduction of the apparatus into the transvaginal-transdouglas route.
  • a lip is formed at the tip of the distal end which is rotatably mounted at the nose.
  • the distal end is covered by a cap having multiple holes with different diameter. Different surgical instruments can be introduced through these holes.
  • FIG. 3A, 3B and 3C show another embodiment of the apparatus constructed according to the present invention.
  • the apparatus differs from the apparatus in FIG. 2A, 2B and 2C in that the distal end is covered by a convex cap having multiple holes with different diameter.
  • FIG. 4A, 4B show an alternative embodiment of the apparatus constructed according to the present invention.
  • the apparatus consists of a tube and a uterus manipulator.
  • the tube has a distal end that penetrates into the rectouterine pouch.
  • the distal end is covered by a cap having multiple holes with different diameter. Different surgical instruments can be introduced through these holes.
  • the uterus manipulator is guided in the upper groove which faces the uterus when the apparatus is positioned in the vagina.
  • An endobag is guided in the lower groove.
  • the uterus manipulator and the endobag have guiding means which are slided in the respective grooves.
  • the uterus manipulator has a distal end which is rotatable by moving or rotating a handle which will not be described here.
  • FIG. 5A, 5B and 8 show endobags with guiding means.
  • the guiding means can be guided through the grooves formed on the tube.
  • the endobag has an distal open end which is placed through the rectouterine pouch and a proximal open end. Body tissues can be transported through the endobag.
  • the distal open end of the endobag has a funnel shape.
  • FIG. 6A, 6B show another embodiment of the apparatus constructed according to the present invention.
  • the apparatus comprises a housing with channels in which the uterus manipulator and the tube are placed.
  • the housing has a slit through which an endobag is guided along the transvaginal-transdouglas route.
  • FIG. 7A, 7B show the apparatus constructed according to the present invention positioned in the vagina.
  • the distal end of the uterus manipulator is introduced into the uterus, the distal end is tilted 90 degree with respect to the tube and the tube is slided with respect to the uterus manipulator through the vagina.
  • the distal end of the tube is penetrated through the rectouterine pouch.
  • the surgical instruments are placed through the holes in the cap of the tube.
  • At least an elongated end portion of a surgical instrument is provided in the cavity of the uterus through the vagina of a female patient such that the uterus can be repositioned by manipulating said surgical instrument and an incision is performed on the vaginal wall for accessing to the rectouterine pouch.
  • An apparatus according to claims 1 to 8 or a surgical kit according to claims 9 to 10 is placed in the vagina before an elongated end portion of a surgical instrument is provided in the cavity of the uterus through the vagina.
  • the uterus is repositioned or rotated with respect to the vagina before performing said incision, preferably such that the longitudinal axis of said elongated end portion of said surgical instrument and/or said uterus make an angle of about 90 degrees with respect to the longitudinal axis of the vagina and/or said elongated body of said apparatus.
  • the surgical instrument is a uterus manipulator and/or said elongated body is a trocar sleeve or a cannula wherein the incision is performed by a second surgical instrument inserted through one of said channels of said elongated body, the second surgical instrument being preferably a trocar.
  • At least an elongated end portion of a surgical instrument is provided in the cavity of the uterus through the vagina of a female patient such that the uterus can be repositioned by manipulating said surgical instrument and a flexible element is provided in pelvis wherein said flexible element is looped around the uterus such that said flexible element encircles the uterus.
  • the flexible element is tightened such that the uterus is pressurized between said flexible element and said elongated end portion of said surgical instrument, preferably by drawing said flexible element.
  • the flexible element is an elastic ring or a tourniquet or a string comprising two end portions.
  • An incision is performed in the vaginal wall, preferably in the posterior fornix of the vagina to the rectouterine pouch and at least an end of said tourniquet or said string is introduced in to the pelvis through said incision in the vagina, said string is looped around the neck of the uterus and the loop is tightened by drawing said end portions of said string.
  • An apparatus according to claims 1 to 8 or a surgical kit according to claims 9 to 10 is placed in the vagina before an elongated end portion of a surgical instrument is provided in the cavity of the uterus through the vagina.
  • the uterus is repositioned or rotated with respect to the vagina before performing said incision, preferably such that the longitudinal axis of said elongated end portion of said surgical instrument and/or said uterus make an angle of about 90 degrees with respect to the longitudinal axis of the vagina and/or said elongated body of said apparatus.
  • the surgical instrument is a uterus manipulator and/or said elongated body is a trocar sleeve or a cannula wherein the incision is performed by a second surgical instrument inserted through one of said channels of said elongated body, the second surgical instrument being preferably a trocar and said elongated element is introduced through one of said channels of said elongated body.
  • An apparatus according to 22 to 25 is provided through the vagina and the rectouterine pouch such that said end opening and/or said bag shaped compartment is opened in the pelvis by applying liquid pressure into the pelvic cavity.
  • the pressure is applied by introducing pressurized liquid medium into the pelvis, preferably through the vagina, preferably through said elongated port of said apparatus.
  • the apparatus is introduced through the vagina and the rectouterine pouch by a method according to claims 11 to 14, preferably through said elongated body of said apparatus according to claims 1 to 8.
  • Transvaginal collecting bag system that deploys in pelvic cavity to baloon into the upper peritoneal cavity, for the purpose better visual operative space, to protect bowel and other intraperitoneal organs from infection, cancer that may be spilling from the specimen or other sources; bag (in a secondary compartment) that contains the spillage or irrigation fluid system to drain contiously to an external collection bagsystem.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Medical Informatics (AREA)
  • Reproductive Health (AREA)
  • Pregnancy & Childbirth (AREA)
  • Engineering & Computer Science (AREA)
  • Gynecology & Obstetrics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un appareil utilisable en endochirurgie, comportant un corps allongé conçu pour être placé au moins partiellement dans le vagin d'une patiente et passant partiellement à travers la paroi du vagin, de sorte qu'une partie terminale dudit élément allongé est introduite dans la poche recto-utérine ; le corps allongé comporte au moins un moyen de fixation pour loger au moins une partie d'au moins un instrument chirurgical comprenant une partie terminale conçue pour être reçue à l'intérieur du vagin, l'instrument chirurgical et l'appareil pouvant se déplacer l'un par rapport à l'autre. Un sac cœlioscopique ayant un orifice allongé est introduit dans le pelvis par le vagin. L'invention concerne un procédé pouvant être utilisé en chirurgie pelvienne ou péritonéale, le procédé consistant à introduire au moins une partie terminale allongée d'un instrument chirurgical dans la cavité d'un utérus en passant par le vagin d'une patiente de manière à repositionner l'utérus à l'aide de l'instrument chirurgical, et à pratiquer une incision sur la paroi vaginale pour accéder à la poche recto-utérine, un élément flexible étant introduit dans le pelvis et enroulé autour de l'utérus pour encercler l'utérus.
PCT/US2010/022782 2009-01-31 2010-02-01 Procédé et appareil chirurgical Ceased WO2010088634A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US14894909P 2009-01-31 2009-01-31
US61/148,949 2009-01-31

Publications (1)

Publication Number Publication Date
WO2010088634A2 true WO2010088634A2 (fr) 2010-08-05

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PCT/US2010/022782 Ceased WO2010088634A2 (fr) 2009-01-31 2010-02-01 Procédé et appareil chirurgical

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WO (1) WO2010088634A2 (fr)

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