JPH02500416A - hysterectomy device - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

[Detailed description of the invention] hysterectomy device The present invention relates to the field of surgical procedures, particularly in the human body, and relates to hysterectomy methods and The present invention relates to an apparatus for carrying out this method.

The uterus has two parts: the cervix connected to the vagina and the uterine body in the abdominal cavity. Part 0, which reminds us that hysterectomy is the removal of the uterus from a medical perspective. Targeted or complete excision, ie, the neck can be left in place or removed. The theory below The description will first be made with reference to the accompanying drawings.

In particular, partial hysterectomies performed in the past are faster because the blood vessels in the uterus are not severed. It has the advantage of being fast and causing very little bleeding. Additionally, it usually damages the ureter. The ureters are passageways that connect each kidney to the bladder, so do not damage them. No. This technique has become obsolete because the preserved neck continues to become the site of cancer. Ta.

Hysterectomy, referred to as complete removal, therefore replaces partial removal of the uterus. , two techniques for complete removal were proposed. That is, Fibrous Toho hysterectomy, i.e. hysterectomy through both sides and outside of the neck, and Fibers eastward hysterectomy, i.e. transmitting vegetative and sensory innervation of the pelvic organs, sacrum-rectum-genital-pubic bone closely attached to the cervical region to preserve the integrity of the bundle wAlli I went through a hysterectomy. However, this technique involves bleeding and electrical Cervical piercing using a willow blade is difficult.

In addition, cervical cancer occurs at the junction between the endocervical lining of the uterus and the outside of the cervix inside the vagina. Therefore, the basic idea of the present invention is to remove the cervical lining and eliminate the risk of cancer. That's true. This endocervical avulsion removes the entire cervical endometrium during partial hysterectomy. A fibrous eastward hysterectomy performed by one author recommended that electrocoagulation be Same as variant.

Therefore, the hysterectomy method according to the present invention is performed by cylindrical resection or coring. , involves resection of the inside of the cervix after partial removal of the uterus, and thus the present invention The method is referred to as a ``endocervical'' complete hysterectomy, and coring is preferably done by electrical excision. Achieved by coagulation.

The above method can be carried out reliably with very little blood loss by means of the device according to the invention. and quickly implemented, the device consists of cooperating cylindrical brakes. The blade rotates in translation along a cylindrical surface and around itself. directional guiding means, anchored in a counterplace manner and deflected relative to the axis of the cervical canal; means for aligning the trajectory of the blade in either the rotational or translational direction; or act as a means of driving both and a handle to remove the device from outside the uterus. It includes means to enable it to be held in the hand.

Said anchoring and alignment element consists of a spherical cap-type cup centered on the rod. Advantageously, it can be provided with hooks around its periphery.

According to a special and simple embodiment of the device according to the invention, the blade comprises the collar and its a cylindrical sleeve formed at a first end thereof at a second end thereof by a neck of the sleeve; , said means for driving the blades being provided at diametrically opposite ends of the collar neck; The entire assembly consists of a blade, sleeve, collar, neck and and lugs forming a single piece. The lugs are removed by the surgeon, who rotates the sleeve with his fingers. The lugs allow you to rotate and drive it at the same time, in which case the lugs It constitutes means for driving in the translational direction. be used as a handle in such devices. The means used are movably mounted on the rod, but are not resistant to rotation about its axis. It is made from horizontal rods that are fixed.

According to a preferred embodiment of the invention, which is slightly more complex, said rod has at least one length. A portion of the neck is also threaded, while a corresponding hole in the neck is also threaded.

According to a particularly advantageous arrangement, the sleeve is in the form of a cylindrical blade or a single piece as described above. The whole thing is connected to a voltage source and produces electrocoagulation as an ablation method, like an electric willow blade. connected to a voltage source so that

In general, as described above, more complex and motorized embodiments of the device If so, the means for driving the blade is a hollow cylinder integral with and coaxial with the collar. , and a wheel supported by a drive shaft, said wheel being a hollow cylinder. The drive shaft is housed in the cylinder between the rod and the inner wall of the cylinder, and the drive shaft is Is it powered by a battery-powered electric motor built into the grip or a remote power source? The advantage of mechanically driven solutions is that Frees the surgeon from the attention that would otherwise be paid to manual drive, and frees up one hand. , and to make the driving speed more uniform.

According to one variant, the sleeve is a piece attached to the collar, and the collar is an intermediate piece. It can be attached to the neck with a screw. This last variant has different diameter blocks. It allows you to choose your route. The sleeve is made from plastic material The edges are sharpened by the insertion of a metal blade. The sleeve is made into a single end and can be made disposable due to the low cost of the sleeve. This arrangement can be applied to both manual and motorized equipment.

Details of the invention include an intracervical hysterectomy method and implementation of this method with reference to the accompanying drawings. This will be better understood from the description of the device that makes this possible. Among them, Figure 1 is a diagrammatic illustration of the method referred to as partial hysterectomy; Figure 2 is an explanatory diagram of a similar method referred to as Fiber Toho complete hysterectomy; Figure 3 is a similar illustration of a similar method referred to as a complete hysterectomy; These methods are known in obstetric surgery and FIG. 4 is a detailed illustration of the present invention referred to as a complete endocervical hysterectomy; FIG. 5 is a partially sectional front view through the axial plane of the device for "manual" operation of the method of the invention; , Figures 5a, 5b and 6 are detailed views of said drawings from different viewing angles; Figures 7 and 7a show a method according to the invention including an intermediate piece allowing selection of the blade diameter. a partial cross-sectional diagrammatic illustration of the “mechanical” drive of the device; FIG. 8 is a diagrammatic sectional view of another embodiment of the device according to the invention, on a smaller scale than the above; FIG. 9 is an explanatory diagram of a sleeve that can be applied to any of the above embodiments; FIG. 10 is a partially cut away side view of a second device for manual operation of the method of the invention, FIG. 10a; is an explanatory diagram of the internal structure of the rod in the device shown in FIG. 10, and FIG. A similar illustration of the improved cup in series, Figure 10c, shows the diametrical plane of the cup. 11 is an end view of the piece assembly of FIG. 10, and FIG. 12 is a cutaway view. FIG.

Figures 1 to 3 illustrate the prior art hysterectomy method as described above, and illustrate the conventional hysterectomy method as described above. These diagrammatic illustrations do not require further elaboration to be understood by other people. And in the simplified anatomical part, the thick dash-dotted line is removed by peeling. It is restricted to the uterus.

In FIG. 4, the method of the present invention includes, in the first step, a similar operation or surgery as in FIG. However, according to the present invention, it involves partial removal of the uterus ( Dot-dash line 2) Completed by internal 1 coring.

In FIGS. 5 and 6, the device for manual operation, according to the invention, is provided with a collar at the end. The neck part 6 of the collar part comprises a cylindrical blade 3 forming an extension of the end of the part 5. A pair of lugs 7, a rod 8, a cup 9 attached to one end of the rod and the other end The handle 10 may be attached to the handle 10.

A counter plate that anchors and aligns one end of the blade to the cervix (dotted line in Figure 4). The cup 9 forming the base element has the overall shape of a spherical cap and the rod 8 is rotated and rotated by a radially projecting stud 11 at its end. It is fixed in the translational direction, however, it is necessary to align the stabilizer with the transverse groove 12 of the cup. One can be moved away from the other by driving the rod and rotating it 90″. I can do it. The cup end 13 is provided with a number of small hooks as at 14 Preferably, the inner wall of the cup is provided with a circular groove 21 located in the extension of the blade 3. is advantageous.

The above cup-shaped, anchoring and counterplace elements shown for illustration purposes are satisfactory. However, different types of anchoring devices such as disc, spherical or It is recognized that anchoring devices with elliptical or extensible walls may be used. I can't stand it.

Figures 5 and 5b particularly show that the rod 8 is over most of its length as 15. be studded, and the neck 6 of the top of the collar 5 is itself internally studded; This shows that the effect of this corresponding outer and inner thread is on the blade around the rod. rotation of the blades causes a displacement along their common axis 16; is the insertion of the surgeon's finger into the diametrical lug 7 (Fig. 5b) supported on the upper end of the neck 6. Achieved by continuous pressurization. Rotating the screw is not strictly necessary but useful; Also, the holes in the rod and neck 6 can be smooth.

The rod 8 has a handle 1o which engages the flat end 17 of the rod passing through a rectangular groove 18. so that it remains stable throughout the surgery, and the flat end 17 hangs over the pin 19 that intersects the groove 18. The handle 1o is in this particular case a simple cylindrical rod. be. The installation of the rod at the end of this rod is against one of these pieces, and against the other. allow some degree of rotation of the but fixed against rotation about their axis 16 are doing.

In FIG. 7, the mechanized device is shown at the rear end of the handle 31, the shape of which is not specified. a threaded rod 30 engaged and retained in the rod, the other end of the rod being shown in FIG. You can receive the cup exactly like the one you bought. However, the illustrated In the embodiment, the sleeve 33, one tip 32 of which forms a blade, is 35, for example, also called collar and similar to collar 5 in FIG. It is fixed on the acting intermediate piece 36, which itself has the function of the neck 6. Threaded piece 3, which can be screwed onto a piece with a threaded hole 37 (FIG. 5) 7 extends toward the rear of the hollow cylinder 38 shape, and its inner surface 39 is grooved. Yes, the hollow cylinder houses the end of the handle 31, and the handle 31 is connected to the rod 30. If surface 39 is grooved, it is grooved by drive shaft 41 parallel to The wheel 40 is supported. The wheel 40 rotates to drive the blade. In place of the doctor's finger, the rotation-induced axial displacement is grooved and This is also possible due to the cylindrical shape of the inner surface 39.

In FIG. 7a, the intermediate collar 36' is a blade of smaller diameter than the sleeve 33. It is possible to connect the sleeve 33' to the threaded part 37. However A set of blades of varying diameters are conveniently available to the surgeon. Such attire The arrangement is applicable to both manual and motorized devices as shown in FIG.

Furthermore, Fig. 8 shows a simpler modification of the device shown in Fig. 7, which controls the rotation of the blade. holding part of a mechanized device having a grip 42 with a pushbutton 43 for controlling It shows.

In FIG. 9, the sleeve 45 is similar to the sleeves 4, 33 and 33' of the previous figures. similar in its function, however it has a hole 46 in the wall , is made of plastic material and has a metal blade 47 at its inner end. The metal etching 48 is different in that it is cut into the sleeve. The blade is connected to a screw 49 to ensure contact with the collar.

In Figures 10 to 12, the device corresponds to the one in Figure 5 but has a more precise structure. The second device or surgical instrument comprises several improvements compared to said instrument. There is.

First of all, the device of FIG. 10 is asymmetrical and curved and almost identical to that of FIG. A handle 51 is provided which is incomparable to the handle 42 of the device, and the handle 51 is It is integrated with a threaded rod 52 which is a hollow rod containing a smooth rod 53. The smooth rod 53 has a transverse recess 54 near one of its ends; Allowing the passage of a rod 55 with a transverse lever 56 that can be slid within the handle 51, the rod 55 is for fixing the smooth rod 53 to the threaded rod 53 and the handle 51. Acting as a lock, the other end of the smooth rod 53 connects to the end of the smooth rod as described above. The stud 5 protruding in the radial direction allows the cutout 60 to be fixed. It has 7. The shoulder 63 near the end of the rod 53 is such that the rod reaches the tip of this shoulder. Prevent it from passing through the cup.

The main purpose of having separate rods, one with a threaded rod and the other with a smooth rod. The aim is to enable the following operations included in the method of the invention, in which the cervix is incised. When removed or cored, the belly loop of the threaded rod with handle The sleeve is then withdrawn along with the uterine core it houses. (The inner lining of the sleeve separates from the thread of the rod at the end of the neck resection stage).

The handle can then be used to pull the cervical stump upwards through the cup. As such, it is once again secured to the rod, which allows a direct hemostatic suture to be applied to the cut end. can be reached.

At the end of the surgical procedure, the handle is released from the rod again and the rod is moved through the abdomen. secondly, pushing the cap through the shoulder 63 to open the vaginal loop. be pulled out with it by the root, or else first by the vaginal root. For withdrawal, the cup and rod are separated one from the other.

60, the cup 7 is a part of the end of FIGS. 5 and 6. 61 is higher than the other diametrically opposite portion 62 with respect to the cup bottom. It is non-contrastive and its purpose is to This creates a slight tilt, which is favorable for surgical operations. equipment The angular position of the high end of the cup about the axis corresponds to the position of the handle 51 This correspondence is also determined by the angular position of the recess 54 and stud 57. determined by the position of the housing relative to the so-called blocking 64 made in the top. determined. Hand (at the beginning of the nete, a rough outline of the cup introduced through the vaginal route) The position is detected by contact with the protruding portion 67 on the outside of its bottom surface. Each of the above figures In the surface device, the transverse groove 65 allows the passage of the rod and the stud 57. (This action of securing the cup to the rod is illustrated by arrow 66 in FIG. ), in this example the ends 61,62 of the cup are smooth.

Another difference lies in the structure of the sleeve that makes up the cylindrical blade, as shown in Figure 10. In the case of a sleeve, the circular end 68 forming the blade has a diameter smaller than the inner diameter of the sleeve. As a result, the resected part of the muscle that enters the sleeve is slightly expanded, which causes At the same time, it facilitates operation and increases accuracy. Another preferred arrangement is for the rod 52 to on the inner wall of the sleeve with threads 69 of a pitch greater than that of the same pitch; The muscular part held in the sleeve stretches slightly during rotation of the sleeve, and its Get away from the wall.

Section 10c shows a special recess at the bottom of the cup, which indicates that the cup is located at the cervix. It allows it to fit into the concave shape within the vagina. Finally, the sleeve is shown in Figure 5. or the type shown in Figures 7 and 8 or the 9th cabinet, or the type shown in Figure 1. Even with the type shown in Figure 0, it is possible to remove cores with a length of 3 to 50 mm. In this respect it is used today for carrying out circular resections of the skin or blood vessels, for example. It is different from the cylindrical blades that were introduced in surgery until now.

Finally, the essential feature of Figures 10 to 12, namely the separation of the rads, is Applicable to any location.

Although special embodiments of the present invention have been described above, the scope of the present invention is not limited to these types. implementation of the method limited above and/or described above. It can be extended to any device containing the general features described above.

Tabetsu Sansho Beef kMenw++s++aIAm&”-”@, PCT/FR8210○327 International Investigation report

Claims (1)

[Claims] 1. Partial removal of the uterus, followed by a cylindrical resection or coreectomy A method of hysterectomy that involves removing the inside of the cervix by surgical removal. 2. To work together, the cylindrical blades are arranged along a substantially cylindrical surface. means for guiding rotationally and around itself, in a counterbraced manner means for anchoring and aligning the trajectory of the blade with respect to the axis; and as a means for driving in either or both of the translational and translational directions, and as a handle. any type of device or surgical instrument that includes means for activating and allowing manual retention of the device in which the anchoring and alignment element has a concave bottom and a rod (8, 30, 5 3) said device consisting of a cup (9, 60) of the type of a spherical cap aligned thereon; (Figures 5, 6, 10). 3. Said means for guiding the blade include rods (8, 30, 5) and axial bores. Consisting of a circular collar (5, 36) extended by a perforated neck, the axis of the neck 3. The device of claim 2, wherein the directional hole is adapted for passage of the rod. 4. The blade (3) is secured to its second position by means of said collar (5) and its neck (6). Consisting of a first end of a cylindrical sleeve (4) closed at the end, the blade is driven The means for controlling the collar include a pair of lugs (7) provided at diametrically opposite ends of the neck of the collar. ), a sleeve (4), a collar (5), a neck (6) and a lug forming a single piece. (7) The device according to claim 2 (FIG. 5). 5. Said means acting as a handle are movable and only on its axis (16). A transverse bar (10) attached to a rod (8) fixed against rotation An apparatus according to claim 4 (FIG. 5) comprising: 6. The rod (8, 30) is threaded on at least part of its length, and the neck (6 , 37) are correspondingly threaded. 7. At least the blade is connected to a voltage source and produces electrocoagulation as an ablation operation. 3. The device according to claim 2. 8. The metallic blade (47) has a sleeve (45) made of plastic material. and said sleeve made of plastic material is attached to said collar. Applicable device according to claim 2 (FIG. 9). 9. Said means for driving the blades are further integral with the collar (36, 37) and are associated therewith. A wheel supported by a coaxial hollow cylinder (38) and a drive shaft (50) A rod (30) and a rod (30) are provided in the hollow cylinder. The device according to claim 6 (FIG. 7) accommodated between the inner wall (39) of the ). 10. Said threaded rod (52) is a hollow rod housing a smooth rod (53). The threaded rod (52) is integral with the handle (51), and the smooth rod (52) is integral with the handle (51). The rod is separable from the threaded rod, and said cup (60) is attached to one end thereof. that the portion is higher than the other diametrically opposite portion (62) with respect to the bottom of the cup. 7. The device of claim 6, wherein the device is asymmetrical.