Note : Les descriptions sont présentées dans la langue officielle dans laquelle elles ont été soumises.
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"Connection Mech~ni~ms for Uterine Nobilizer"
Technical Field
The present invention relates to a gynecologic
instrument useful in gynecologic laparoscopy. More
particularly, the present invention is directed to a
uterine mobilizer or manipulator. Specifically the
present invention is directed to an improved uterine
mobilizer provided with improved connection mechanism
for connecting and disconnecting the head of the
instrument to the tube of the instrument.
Bac~4lo~"~ Art
In my U.S. Patent 4,022,208, the disclosure of which
in its entirety is incorporated by reference herein, I
disclose and claim a gynecologic instrument capable of
rotating the uterus to any of its natural positions
within the peritoneal cavity which instrument lessens the
danger of damage to vaginal and uterine tissue and which
instrument may be adopted for injection of dye into a
uterus while the uterus is maintained in any of its
natural positions.
Summary of the Invention
The present invention is directed to an improvement
to be embodied in gynelogic instruments that is
particularly useful when embodied in the ~ynecologic
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lnstrument disclosed and clA~ in U.S. Patent
No. 4,022,208.
In the apparatus of the present invention, the
improvements r~side in ~-n~ for connecting the tube to
the head wherein the tube is fitted or otherwise attached
to an end of a piston held in place in the head by a pin
which is capable of moving within a groove within the
' head in such a manner that does not permit removal of the
; piston from the head as long as the tube is not pivoted
about the piston beyond a predeter~i ne~ degree.
Brief Des~ri~tion of the Drawinqs
The invention will be clearly understood aftc=
reference to the following detailed specification read in
conjunction with the drawings.
In the drawings:
Fig. 1 is a 8ide view elevational of an apparatus in
accordance with the present invention.
Fig. 2 is a side view of an apparatus in accordance
with the present invention, and Fig. 2a is a partial
side view of the head end of the apparatus in accordance
with the present invention.
Fig. 3 i8 a top view of an apparatus in accordance
with the present invention.
Fig. 4 is a partial side view of an apparatus in
accordance with the present invention showing the head in
the fully extended position.
Figs. 5 and 5a are partial side views of an
apparatus in accordance with the present invention
showing the head in the fully flexed position.
Fig. 6 is a partial side view of the tail end of
the apparatus in accordance with the present invention.
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Fig. 7 is a cross-sectional view of the head of the
apparatus of the present invention.
Fig. 8 is a cross-sectional view of the tube holder
of the apparatus of the present invention.
S Fig. 9 is a cross-sectional view of the sleeve on
the tube for connection with the tube holder of the
apparatus of the present invention.
Fig. 10 is an illustration of removing the tube from
the tube holder of the apparatus in accordance with the
present invention.
Fig. 11 ~ 8 an illustration of removing the tube from
the head of the apparatus in accordance with the present
invention.
Figs. 12 and 13 are schematic illustrations of the
general r~nner of-use of the apparatus in accordance with
the present invention.
D~sclosure of the Invention
The instrument illustrated in the Figures has a
stem, tubing, or tube 1 and a block or head 2 pivotally
mounted on the tube by piston 3. The improvements of
the present invention are directed to an improved
assembly of elements of head 2, tube holder 23, tube
sleeve 27.
The head 2 of the apparatus of the present invention
is provided with a chAnnel 2a for receiving a journal 3
adapted to rotate or pivot about its axis in the channel
2a. The head is also provided with a groove 9a for
receiving a pin 9 attached to the journal 3 for engaging
the groove 9a to connect the head 2 to the tube. The
pin 9 attached to the journal 3 when inserted in the
groove 9a in the head 2 are adapted to prevent removal of
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the journal 3 from the channel 2a in the head 2 when the
pin 9 is positioned within the groove. The pin 9 and the
groove 9a are disengaged by rotating the tube 1 attached
~` to the journal 3 by a prescribed degree of rotation until
the pin becomes free of the groove to permit the journal
3 to which the tube 1 is attached to be pulled out of the
head 2.
As shown in the Figures, tube holder 23 is provided
~ at one end with a luer syringe connector 22 which in turn
is connected to a syringe 20. At the opposite end of the
tube connector 23 there is a cylindrical cavity 25 having
an entrance in which an "O" ring 25a is positioned for
receiving the distal end of tube 1. The tube holder 23 is
provided with a locking mechanism 24 pivotally attached
to the tube holder by a pin or other means 26 which
permits rotation of the loc~ing me~hAni~ thereabout. The
locking mechanism 24, at the end which points towards the
sleeve 27, has a tooth 28 which engages the first groove
28a of the sleeve and locks it in place. The locking
mechanism is adapted to pivot about axis 26 in a seesaw
or reciprocal manner. To this end, a spring or other
~n~ for biasing 29 is provided at one end of the
locking mech~ni-~ 24 which pushes the loc~ing mechanism
up and consequently pushes the tooth downward into the
groove at the opposite end of the tube holder.
As illustrated in Fig. 10, to remove the tube 1 from
the tube holder 23, one merely needs to push the end of
the locking mechanism 24 over the spring downwardly
compressing the spring and lifting the tooth 28 of the
locking mechanism up from the groove 28a of the sleeve
27. This releases the sleeve 27 and the tube 1 can be
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pulled out from the tube holder 23.
As long as the tube 1 is locked into the tube holder
23 during the manipulation of the head 2 from the
~` straight position to a rotation of 120- as shown in
Figs. 2, 4, 5, and 5A, the pin 9 is engaged in the groove
9a of the head 2 and the ~ournal or piston 3 can not be
~ removed.
; The tube 1 can be completely separated from the
tube holder 23 and the head 2 in the following way.
The tube 1 is removed from the tube holder 23 as
described above; then the tube 1 is rotated
countercloc~wise as shown in Fig. 11. At that point the
pin 9 becomes disengaged from groove 9a, journal piston 3
is in a position to be pulled out from the head 2. To re-
attach the tube simply follow the removal procedure in
reverse order.
In operation all of the elements of the instrument
from syringe 20 to hook 7 include passageways, chAn~els
~ or conduits (whether or not clearly shown) to permit the
passage of fluid from the syringe, out of the end of hook
7. Thus, fluid may be in~ected from the syringe 18 into
the chAnnel of the extension tube 23a of tube holder 23
and in turn through the chAnnel la in tube 1, piston 3a,
head 2a, and from there into the c~nnllla 7 which is
inserted in cavity 4 and loc~ed into the head.
Head 2 has a substantial flat cervix engaging
shoulder that is adapted to abut the vaginal part of the
uterus cervix. A recess or cavity 4 is provided in head
2 to receive an obturator, cannula or equivalent device
designated generally as hook 7 in U.S. Patent No.
4,022,208 and shown in Fig 1 ~s ~uch. The control l~nk
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5 has an extension or spacer bar 6 at its free end. The
spacer bar 6 has a through bore 6a so that it can move
~ relative to tube 1. A thumb screw or loc~ screw 8
`` ~ threadedly engages in spacer bar 6 and can be turned to
tighten against tube 1 to loc~ the link 5 with respect to
tube 1 and fix the angular position of head 2 and hook 7
with respect to tube 1. Thus, the hook 7 can be
manipulated to any desired angular position with respect
~ to the tube 1 and maintained in that position by the set
thumbscrew 8.
Head 2 includes a substantially part spherical
surface 12 opposite shoulder 13. This surface must be
smooth in order to ~in~ize the chances of injury to
sensitive vaginal tissue during rotation of head 2 about
journal or piston 3. A partial spherical surface is the
most desirable shape although other smooth contours may
; be employed. As the uterus is moved by the movement of
cannula 7, ligaments attached to the uterus may cause the
~ instrument to be pressed against the vaginal wall. Thus, 20 the smooth part spherical surface will distribute any
such pressure and support the instrument and uterus
throughout the full range of possible positions.
Shoulder 13 ensures that excess penetration of cannula 7
will not occur during movement of the uterus. A range of
sizes of cAnntlla obturator or similar devices 7, as shown
; in Fig 1, may be provided to accommodate any particular
patient or condition. A properly chosen size of the
cannula or equivalent device and the action of shoulder
i 13 will together eliminate the danger of perforating the
uterus during use of the instrument.
A control lin~ 5 pivotally connects the proximal end
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thereof with the h~ad 2 by pin 9 and extends from its
pivotal connection therewith to adjacent the free distal
end of the tube 1. Tube 1 may be provided with a grip
(not shown) at ~he distal end thereof. Preferably such a
grip can include a syringe 20. The free distal end of
tube 1 may also be provided with a grip, such as the one
identified as element 2 in the U.S. Patent No. 4,022,208.
In either case, a surgeon can, by moving the grips or the
distal ends of the spacer bar 5 and tube 1 away from or
10~ towards each other in the directions of the arrows 22,
rotate head about its pivotal connection with the tube.
Thus, a cannula or eguivalent device 7 can be caused to
move from one dotted line position shown in Figs. 12, and
13, though the solid line position to the other dotted
line position whereby to move the cannula to any desired
angular position with respect to the tube. While a
greater arc of rotation may be provided the instrument
~ will usefully serve its intended function if the head is
; pivoted so as to permit movement of the cannula through
an arc of at least approximately 135 . To achieve full
natural rotation of the uterus, link 5 must be capable of
pivoting the cannula from a position where the tube and
cannula are substantially parallel to a position where
the angle between the tube and the cannula is not greater
than about 45-. This is described in more detail in U.S.
Patent No. 4,022,208.
Figs. 12 and 13 are schematic illustrations of a
gynecologic laparoscopy showing the patient in
Trendelenburg position, as disclosed in U.S. Patent No.
4,022,208, and the laparoscope 36 in position to view the
uterus 38. The field of vision of the laparoscope is
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~ndicated by the numeral 40. The instrument may be used
~n association with a tenaculum ~n the conventional
manner. Coil spring 15 would on control link 5 and
; sliding fitting or tenaculum holder 16 for a tenaculum
facilitate such use.
The obturator, c~n~ a, or hook 7 of the instrument
is inserted into the uterus through the vaginal opening
until the cervix engaging shoulder 12 abuts against the
~ cervix of the uterus. Shoulder 12 thus limits the depth
of penetration of obturator 7 into the uterus and also
supports the uterus as it is moved to the desired
position. By manipulation of link 5 and tube 1, e.g. via
grips provided at their distal ends; towards or away
from each other a surgeon can support the uterus in any
position in a vertical or medium sagittal plane from the
one illustrated in Fig. 12 to the one illustrated in
Fig. 13. ~his range of vertical positioning gives
ex~ellent opportunity for laparoscope inspection. As
shown in Fig. 12, the uterus may be flexed to the natural
position closest to the abdominal wall. By tightening
thu,mb screw 8 one can fix the obturator 7 in any desired
angular position with respect to the tube 1. Thus, the
uterus may be maintained at any desired position in the
vertical or median sagittal plane. After the uterus has
been located in a desired position, the instrument may be
rotated about the longi~t~ln~l axis of tube 1 in the
direction of the arrow 42 shown in Fig. 12. Thus, the
uterus may be rotated either to the left or right while
close to the abdominal wall giving the surgeon an
excellent lateral view.
As disclosed above, the instrument facilitates
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injection of gases or liquid into the uterus when the
obturator 7 is tubular in nature and tube l is provided
at its distal end with a syringe 20 for providing a gas
or liquid through tube 1 which thus functions as a
conduit to the head of the obturator 7 as a gas or liquid
supply line as disclosed in U.S. Patent No. 4,022,208.
Related to this, as disclosed in U.S. Patent No.
4,022,208, a tubular hook 7a may be provided with
openings 24 for passage of fluid. The hook 7a may be
provided with a tubular extension 15 by means of which a
flexible conduit 16 may be fluidly connected to hook 7a.
The conduit adv~ntageously passes from the end of such a
tubular portion 15 of hook 7a through a fluid passageway
in piston 3 through head 2 and thence in a direction
parallel to tube 1. Fluid can then be passed through the
tube by means of a syringe 18 or other conventional
means. S~ch a modified instrument provides the
gynecologist with the ability to inject gases or liquids
including dyes while the uterus is maintained in any of
its natural positions.
The general method of performing a gynecologic
laparoscopy is well known and not referred to in detail.
It is well described in the book, "Laparoscopy,
Culdoscopy and Gynecography," by Melvin R. Cohen,
published 1970 by W.B. Saunders Co~r~y of Philadelphia,
Pa. London, Ontario and Toronto, Ontario.
It will be appreciated to those of ordinary skill in
the art that, while the present invention has been
described herein by referenCe to particular means,
methods, and materials, the ~cope of the present
invention is not limited there~y, and extends to any and
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all other means, methods, and materials suitable for
: practice of the present invention.
