DE102015012657A1 - Medical tool for uterine manipulation and tool for it - Google Patents

Abstract

The present invention provides a medical instrument for uterine manipulation, for example, in endoscopic hysterectomy and a tool therefor. According to the invention, the tool (10) for the medical instrument for uterus manipulation comprises a rod-shaped body (7) having one end a distal end portion (10 a) with a balloon (6), and other ends a proximal end portion (10 b) with a cylindrical cup (5), wherein a cup edge (5a) for receiving the cervix uteri to the distal end portion (10a) of the tool (10) is aligned.

Description

The invention relates to a medical instrument for uterus manipulation and a tool therefor.

Uterus manipulators are known in the art which are designed to be inserted into a uterus through the cervical canal and are designed to perform inter alia a laparoscopically assisted vaginal hysterectomy. For example, describes the DE 20 2004 019 868 U1 a uterine manipulator having a shaft, at the distal end of a tool and at the proximal end of a handle are provided. The tool can be moved by an actuator on the handle. A clamping element serves as a locking element to bring the tool from a first position to a second, from the first angled position and to hold in the second position.

EP 2 329 776 A1 describes a manipulator, wherein a suction cup for receiving the Portio uteri is provided. The suction cup is connected to a suction channel, whereby a negative pressure is generated and the suction cup can be stuck to the Portio. A proximally directed sealing cup seals off vaginally.

Further shows EP 2 060 236 A2 a manipulator having a rod-shaped body that can be inserted into the uterus. On the rod-shaped body, a bell-shaped element is arranged, which moves along the body and can be locked in two positions. The bell-shaped element is intended to be able to record and hold the Portio.

Out DE 10 2009 049 169 A1 For example, a medical instrument is known that has a first balloon at a distal portion insertable into the uterus. By means of a joint, the distal portion can be angled. The balloon can be deployed within the uterus. A second balloon is used for sealing to the outside.

In the aforementioned devices, there is the difficulty that at the eventual removal of the uterus it is traumatically held only at certain points of attachment with a clamp, forceps or hook and can not be removed from the body, thus dislodging diseased tissue from the uterus and within the abdomen can remain. A further disadvantage is that the devices are very complex and the operation of the functions by means of the respective handle is cumbersome, since usually a further instrument, such as a ball clamp, ball tongs o. Ä., Is necessary for the removal of the uterus.

Based on this prior art, it is an object of the present invention to provide an improved tool for a medical instrument for uterus manipulation, which is simple in construction and provides secure support and guidance upon removal of the uterus.

This object is achieved by a tool having the features of claim 1.

The further object of providing a medical instrument for uterine manipulation that operates reliably and is easy to use is solved by the instrument having the features of independent claim 7.

Further developments or preferred embodiments of the medical instrument and the tool are set forth in the subclaims.

A first embodiment relates to a tool for a uterine manipulation medical instrument having a rod-shaped body. In accordance with the invention, the rod-shaped body has an end having a balloon with a distal end portion and a proximal end portion having a cup with other ends aligned with a cup rim for receiving the portion toward the distal end portion of the tool.

As the rod-shaped body forms a main component of the tool in its configuration, the distal end portion and the proximal end portion of the rod-shaped body also correspond to a distal end portion and a proximal end portion of the tool. The name can be used synonymously.

The said tool can be used, for example, in an endoscopic hysterectomy. The tool has the particular advantage of keeping the uterus particularly simple and secure. The cup takes up the portio and can enclose it; the balloon protrudes through the cervical canal into the uterus and, in an expanded state, can fill the uterus and stabilize it atraumatically during an operation. In addition, the cup rim can serve as an abutment for the cutting process.

The invention may provide that the tool has an elbow connecting the distal end portion to the proximal end portion, the elbow having a cylindrical portion and a conical portion, a longitudinal axis of the conical portion being at an angle with respect to a longitudinal axis of the cylindrical portion is arranged in a range of 0 ° to 90 °, preferably at an angle of 45 °. The elbow thus forms the Angled form of the tool, which can be easily reached during surgery, the Portio and the tool can be set such that the balloon can be safely inserted into the cervix and the cup can safely enclose the Portio.

The invention may provide that the cup has a cylindrical or conical basic shape, wherein in the latter embodiment, the cup tapers towards the proximal end portion of the tool. This can be used depending on the anatomical conditions, a matching cup.

Also, the invention may provide that the cup, in particular embedded in the cup rim, one or more high-frequency electrode (s) has. The electrode may be both an active and a passive RF electrode. Even if the electrode is designed as a passive electrode, no separate passive electrode, which is attached to any part of the body outside the body, is more necessary.

If, in another embodiment, the active electrode is let into the cup rim, a separate active electrode device can be dispensed with and an activation of this electrode in the operation can be used as a so-called semi-automatic cut.

Furthermore, the tool may have a pin-shaped connection attachment, which is arranged on the proximal end portion of the tool and can be brought into engagement with a shaft of a medical instrument. The tool can thus be a disposable item as separable, separate component.

The invention may provide that the pin-shaped connection attachment is connected to the rod-shaped body via the elbow. In this case, the rod-shaped body at the transition between the rod-shaped body and the elbow on a conically widening to the elbow extending sealing portion which can seal the cervical canal from the inside and serves for guidance and stabilization. The sealing portion extends through the cup, wherein the cup may be integrally formed with the rod-shaped body, or with its sealing portion. In an alternative embodiment, the cup may also be formed as a separate part and have a corresponding opening for receiving the sealing portion.

The sealing portion may preferably be in or on a same portion of the rod-shaped body as the cup rim and thus extend on both sides at the level of the cup rim. Depending on the embodiment, d. H. Cup height and diameter, the sealing portion may vary in width and length. The cup may preferably have an outer diameter in a range of 25 mm to 45 mm. By way of example, be mentioned in about 35 mm. The diameter of cup rim, cup bottom and a cup length can be provided largely variably adjusted, since there are different uterine sizes. The tool can thus be advantageously provided patient-related.

In a further embodiment it can be provided that the cup on its shell side, in particular at a distance from the cup rim or adjacent to a bottom of the cup, d. H. whose bottom has a recess through which a hose can be passed. The hose is thus arranged to save space and not squeezed by the cup. It also prevents the hose from hitting the cut. The balloon can be used properly.

In a preferred embodiment, the cup is simply cylindrical. In this case, the lateral surface of the cup, except the Schlauchausnehmung, no further recesses or openings, but is designed consistently. Advantageously, the wound edges can thus be supported after a cut. Otherwise, without the existing lateral surface, the wound edges would simply collapse, whereby an exact cut would no longer be possible.

A cup rim of the cup may be arranged orthogonal or perpendicular to the longitudinal axis of the rod-shaped body. This makes it easy to create a straight seam. Alternatively, the cup edge may also be inclined at an angle to the longitudinal axis of the bar-shaped body. This optimizes the cut.

In order to be able to fill the balloon with an expansion medium, the balloon can be connected to a hose which has a connecting piece at its end facing away from the balloon. The connector may be connected to a reservoir for the expansion medium for the balloon. In particular, saline solution may be provided as the expansion medium. Other equivalent expansion media for the balloon may be used. Saline solution has the advantage here that an exact inference of injected volume can be drawn on the diameter of the balloon.

In one embodiment of the invention, the tool of a skin and body friendly plastic, in particular polyamide (PA) or a be constructed similar plastic. It is also possible to construct essential or simple parts of the tool from a stainless steel or from another sterilizable material. Thus, the tool can also be reused.

The invention further relates to a medical instrument for uterine manipulation. The instrument has a shaft having a distal end portion and a proximal end portion. In this case, a handle is arranged on the proximal end section of the shaft and a tool on the distal end section of the shaft. The tool is a previously described inventive tool.

Particularly advantageously, the tool can be releasably connected to the shaft, so that the tool itself can be removed. The stem of the instrument can be reused, requiring sterilization.

As a result, the handling is very simple and the instrument cost. In addition, waste is avoided by not the whole instrument, but only the tool alone must be disposed of.

Furthermore, the invention can provide that the shaft is a hollow tube and has at its distal end portion a pair of pliers which can be partially or completely retracted into the interior of the shaft. The forceps can be operated by means of a pull lever, which is arranged on the handle of the medical instrument. The tool can be easily plugged into the shaft and simply released by pressing the pull lever again. It can be operated with one hand, which saves time and generally simplifies operation.

In order for the tool to be fixedly connected to the shaft and securely held, a further development of the invention may provide that one end of the pin-shaped connection cap has a connecting pin and one end of the forceps engaged with the end of the pin-shaped connecting cap, two or more jaws having. The connecting pin and the jaws are designed as engagement partners. The preferred embodiment of the pin-shaped connection attachment and the jaws of the forceps as mutually corresponding parts serve to produce a positive connection between the shank and the tool, when said components are in engagement with each other.

It can be provided that the instrument has a further so-called sealing device. This may in particular be conical or annular and be arranged in a portion of the shaft which adjoins the distal end portion of the shaft. In one embodiment, the sealing device may be a balloon. Alternatively, it may also be a wedge or cone shaped structure of a soft, resilient plastic that tapers toward the distal end of the tool. Depending on the embodiment, the device can be displaceably arranged on the shaft or fixedly connected to the shaft. Also, a preferred arrangement of the device may be disposed in the distal end portion of the shaft or further in the direction of the handle. This device allows a vaginal seal, so that as little as possible air escapes from the inside of the abdomen during the separation and removal of the uterus. Advantageously, the pressure in the abdomen, which is created by inflating the same with CO ₂ , can be maintained constant.

So that the sealing device can be filled with an expansion medium, this is connected to a hose. In this case, the hose can be connected via a connecting piece with a reservoir for the expansion medium for the device, in particular saline. In this case, the same reservoir as for the first balloon of the tool or a separate reservoir can be provided.

The invention provides an adaptable to the particular patient instrument, wherein a user finds a simple and inexpensive use.

The medical instrument may be used by an operator in the following manner:
In a first step, the pull handle is actuated in the proximal direction, now the tool can be placed on the shaft, wherein the connecting pin of the tool engages the jaws within the shaft and is held by these immediately. By releasing the pull handle it slides in the distal direction, whereby the tool is fixed. The distal end of the instrument can now be inserted vaginally, with the rod-shaped body of the tool being passed through the cervical canal. The instrument is advanced so far that the edge of the cup encloses the portio. The balloon comes to rest inside the uterus and the cup picks up the cervix. Saline or other adequate expansion medium is used to inflate the balloon so that it substantially or completely fills the uterus. The uterus is held atraumatic, fixed and stabilized by means of the instrument

Depending on the surgical technique, the uterus can be removed totally, radically or supracervically and becomes appropriate during the operation separated. The separation can take place by means of an HF electrode, wherein the HF electrode can be guided separately, or can also be provided in the cup rim or inside the cup. After the uterus has been separated, this vaginal is removed by means of the instrument according to the invention. The cervix is held by the rod-shaped body and the balloon provides additional security and holds the body Uteri in position in shape. There are no further instruments necessary, whereby the uterus is not unnecessarily injured when pulling out. The tissue remains intact and the risk of diseased tissue remaining in the body can be greatly reduced.

Other embodiments as well as some of the advantages associated with these and other embodiments will become apparent and better understood by the following detailed description with reference to the accompanying drawings. Items or parts thereof that are substantially the same or similar may be provided with the same reference numerals. The figures are merely a schematic representation of an embodiment of the invention.

Showing:

1 a side view of an embodiment of the invention of the medical instrument,

2 a detailed view of the tool according to the invention with cups,

3 a detailed view of the tool with partial section through the cup,

4 a sectional view of the medical instrument,

5 a detailed view of the detachable connection between the tool and medical instrument, and

6 a perspective view of another embodiment of the invention of the medical instrument.

The device according to the invention relates to a medical instrument 1 for uterine manipulation.

In the 1 . 4 and 6 is a medical instrument 1 essentially from a shaft 2 and a tool 10 built up. The shaft 2 has a distal end portion 2a and a proximal end portion 2 B on. At the proximal end portion 2 B of the shaft 2 is a handle 3 and a pull lever 4 arranged. The tool 10 is at the distal end portion 2a of the shaft 2 arranged and fastened via a designed as a quick release connector releasably secured thereto. By means of the pull lever 4 can the tool 10 from the shaft 2 be connected or disconnected. The tool 10 can be made as a disposable article of a biocompatible plastic; the shaft 2 On the other hand, it can be made of stainless steel and sterilized and reused together with the handle.

The tool 10 is in detail in 2 and 3 described. The tool 10 has a distal end portion 10a and a proximal end portion 10b on, with the tool 10 essentially of a rod-shaped body 7 is constructed. At the proximal end portion 10b is the tool 10 to the distal end portion 2a of the shaft 2 releasably connectable. This is at the proximal end portion 10b a connection attachment 9 provided, which is designed as a plug-in, so that the two parts of the instrument can be easily and quickly connected or disconnected.

Further, at the distal end portion 10a of the rod-shaped body 7 a balloon 6 arranged, which is shown in the figures in already expanded or partially expanded form. This balloon 6 is substantially annular or conical, so that when inflated it is perpendicular or orthogonal normal to the longitudinal direction of the tool 10 expands. There may also be other forms, such as. B. cylindrical shapes may be provided. To the distal end portion 10a and to the proximal end 10b indicative are holders 11 for the balloon 6 arranged the balloon 6 hold on both sides. The brackets 11 are made of a more rigid material than the balloon 6 which is made of silicone or a similar biocompatible and stretchable or non-stretchable plastic. The balloon 6 so it can be kept in shape as it expands.

The balloon 6 is with a hose 13 connected along the rod-shaped body 7 and a sealing section 7a is guided. It can by a partially planar in lateral top view recess 12 of the mug 5 extending over the mantle and part of the cup bottom 5b extends, be guided, and so safely guided without being pinched. The hose 13 has at its free end a connector 14 with which the balloon 6 can be connected to a reservoir in which an expansion medium for the balloon 6 , For example, saline may be present.

Along the rod-shaped body 7 is to the proximal end portion 10b towards the cone-shaped sealing section 7a intended. He expands into an elbow 8th conical and can serve to seal the cervical canal. There are also conceivable sealing sections whose expansion is not linear.

To the sealing section 7a closes an elbow 8th on, which is a cylindrical section 8a which, through a further cone-shaped portion 8b is completed, at an angle of 0 ° to 90 °, so for example. In about 45 ° from a longitudinal axis of the tool 10 parallel to the pen-shaped body 7 runs, emerges. At the end of the elbow 8th closes the connection tower 9 along with the angled, cone-shaped section 8b the proximal end portion 10b forms. The connection attachment 9 indicates the connection with the shaft 2 of the instrument 1 a connecting pin 16 with molded wings 17 on.

Around the cylindrical section 8a of the elbow 8th around is to the rod-shaped body 7 the cup is directed 5 arranged, with a cup edge 5a to the distal end portion 10a directed the tool points. The cup 5 is simply cylindrical and has a circular disc-shaped bottom or cup bottom 5b and the cup 5 closes at the bottom. A cup rim 5a is circular and to the bottom 5b away. The cup 5 is except for the partial shell-shaped recess 12 consistently formed and thus has a nearly closed lateral surface. He has no other openings or recesses. In this way, a particularly secure attitude of the wound edges can be achieved after the cut. The cup 5 is integral with the cylindrical section 8a of the elbow 8th connected and encloses the elbow in this area 8th full.

In the cup rim 5a an electrode can be arranged or inserted, and serve as an active or passive RF electrode. However, the electrode may also be on the outside of the shell side of the cup 5 be arranged. The electrode can thus come into contact with the body, so that in the case of a passive electrode, the previously required separate passive electrode, which is to be attached to a body part on the outside of the human body, is no longer necessary. The cup 5 opens out from the proximal end portion 10b to the distal end portion 10a and thus can absorb the cervix uteri.

The 5 (Enlargement circle off 4 ) shows an enlargement of the distal end section to illustrate the quick release 2a of the shaft 2 , The shaft 2 itself is tubular and houses a rod guide 20 that with the pull lever 4 operatively linked. The handle 3 has a blind hole in which a spring 21 an upper end of the rod guide 20 surrounds. The feather 21 is one end in the bottom of the blind hole of the handle 3 stored and lies at the other end to a counter bearing 22 at.

At the distal end of the shaft 2 is at the corresponding end of the rod guide 20 a pincer 15 attached. The forceps 15 is about a thread 19 in a corresponding hole 19a in one end of the rod guide 20 screwed. At her the tool 10 facing end points the pliers 15 jaws 18 on that a connection essay 9 of the tool 10 are designed accordingly as an intervention partner. For this purpose, the connection attachment 9 a connecting pin 16 on, the wings trained on its sides 17 Has. The sides of the wings 17 lie on an inner side of the shaft 2 at. The pliers jaws 18 grab this in the view of 5 rotated by 90 ° on the connector 16 and take the wings 17 on what the jaws 18 corresponding recesses 18a exhibit. The connection attachment 9 is with his the tool 10 facing end into a hole 8a of the elbow 8th used and held there, either screwed or glued.

As a triggering mechanism, a simple pulling mechanism in the handle 3 be provided, via the pull lever 4 can be served.

The 6 shows a further embodiment of the medical instrument according to the invention 1 , Here is another device as a so-called sealing device 23 on the shaft 2 arranged. In this case, the sealing device 23 such on the shaft 2 arranged to attach to the distal end portion 2 of the shaft 2 borders. It is cone-shaped or annular, so that through an annular opening 23a the device 23 not just the shaft 2 but also to the balloon 6 leading hose 13 is feasible. The device 23 This forms a further seal to the outside to maintain the pressure in the abdomen. She is with a hose 24 connected, at its free end a connector 25 having, whereby the sealing device 23 can be connected to a reservoir for an expansion medium, such as saline. The hose 24 is loose around the shaft 2 placed, or may be adhered to this adjacent or otherwise secured so that it is not damaged.

LIST OF REFERENCE NUMBERS

1

Medical instrument

2

shaft

2a

distal end

2 B

proximal end

3

handle

4

pull lever

5

cups

5a

cup edge

5b

bottom

6

balloon

7

body

7a

sealing section

8th

elbow

8a

cylindrical section

8b

cone-shaped section

9

connection essay

10

Tool

10a

Distal end section

10b

Proximal end section

11

Bracket balloon

12

Recess cup

13

Hose balloon

14

Connector balloon

15

tongs

16

connecting pin

17

wing

18

jaws

18a

Recess pliers jaws

19

thread

19a

drilling

20

baton

21

feather

22

upper end rod guide

23

sealing device

23a

ring opening

24

Hose sealing device

25

Connector sealing device

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• DE 202004019868 U1 [0002]
• EP 2329776 A1 [0003]
• EP 2060236 A2 [0004]
• DE 102009049169 A1 [0005]

Claims (12)

Tool ( 10 ) for a medical instrument for uterine manipulation comprising a rod-shaped body ( 7 ), which - one end has a distal end portion ( 10a ) with a balloon ( 6 ), and - at the other end a proximal end portion ( 10b ) with a cup ( 5 ), wherein a cup rim ( 5a ) for receiving the portio to the distal end portion ( 10a ) of the tool ( 10 ) is aligned. Tool ( 10 ) according to claim 1, characterized in that the tool ( 10 ) an elbow ( 8th ) having the distal end portion ( 10a ) with the proximal end portion ( 10b ) and a cylindrical section ( 8a ) and a cone-shaped section ( 8b ), wherein a longitudinal axis of the cone-shaped portion ( 8b ) with respect to a longitudinal axis of the cylindrical portion ( 8a ) is arranged at an angle in a range of 0 ° to 90 °, preferably at an angle of 45 °. Tool ( 10 ) according to claim 1 or 2, characterized in that the tool ( 10 ) a pin-shaped connection attachment ( 9 ), which at the proximal end portion ( 10b ) of the tool ( 10 ) is arranged and with a shaft ( 2 ) of a medical instrument ( 1 ) is engageable. Tool ( 10 ) according to claim 3, characterized in that the pin-shaped connection attachment ( 9 ) with the rod-shaped body ( 7 ) over the elbow ( 8th ), the rod-shaped body ( 7 ) at the transition between the rod-shaped body ( 7 ) and the angle piece ( 8th ) a cone-shaped to the elbow ( 8th ) expanding sealing section ( 7a ) having. Tool ( 10 ) according to at least one of claims 1 to 4, characterized in that the cup ( 5 ), in particular in the cup edge ( 5a ), at least one high-frequency electrode, wherein the electrode is an active or passive RF electrode, and / or the cup ( 5 ) is cylindrically or conically shaped, the cup being tapered towards the proximal end portion of the tool. Tool ( 10 ) according to at least one of claims 1 to 5, characterized in that the balloon ( 6 ) with a hose ( 13 ) connected to his balloon ( 6 ) end facing away from a connector ( 14 ) provided with a reservoir for a balloon expansion medium ( 6 ), in particular saline solution, is connectable. Tool ( 10 ) according to at least one of claims 1 to 6, characterized in that the cup ( 5 ) at a side facing away from the cup rim or facing the proximal end side of a recess ( 12 ) which extends over a defined portion of the shell and / or bottom surface of the cup and through which the tube ( 13 ) can be passed. Medical Instrument ( 1 ) for uterine manipulation, with a shaft ( 2 ), which has a distal end ( 2a ) and a proximal end ( 2 B ), wherein at the proximal end ( 2 B ) of the shaft ( 2 ) a handle ( 3 ) and the distal end ( 2a ) of the shaft ( 2 ) a tool is arranged, characterized in that the tool is a tool ( 10 ) according to at least one of claims 1 to 7. Medical Instrument ( 1 ) according to claim 8, characterized in that the shaft ( 2 ) is a hollow tube and at its distal end ( 2a ) partially or completely into the interior of the shaft ( 2 ) retractable pliers ( 15 ), which by means of a pull lever ( 4 ) attached to the handle ( 3 ) is arranged, is operable. Medical Instrument ( 1 ) according to claim 9, characterized in that one end of the pin-shaped connection attachment ( 9 ) of the tool ( 10 ) a connecting pin ( 19 ) and one end of the pliers ( 15 ) Jaws ( 18 ), which engages with the end of the pin-shaped connection cap, wherein the connecting pin ( 19 ) and the jaws ( 18 ) are designed as engagement partners. Medical Instrument ( 1 ) according to at least one of claims 8 to 10, characterized in that the instrument ( 1 ) a sealing device ( 23 ), which is in particular conical and which in a portion of the shaft ( 2 ) which is attached to the distal end ( 2a ) of the shaft ( 2 ) adjoins. Medical Instrument ( 1 ) according to claim 11, characterized in that the sealing device ( 23 ) with a hose ( 24 ) and an associated connector ( 25 ) connected to a reservoir for a balloon expansion medium ( 6 ), in particular saline solution, is connectable.

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