WO2015033094A1

WO2015033094A1 - Medical applicator

Info

Publication number: WO2015033094A1
Application number: PCT/GB2014/000353
Authority: WO
Inventors: John Sanders Everingham; Gilbert Marcus Filshie
Original assignee: Oi Medical Limited
Priority date: 2013-09-06
Filing date: 2014-09-05
Publication date: 2015-03-12
Also published as: GB2517962B8; GB2517962A8; GB2517962A; GB2517962B; GB201315887D0

Abstract

A medical applicator for use in female sterilization of a fallopian tube using an occlusive plug comprises: an elongate probe for insertion into the womb of said female; means for delivery of fluid to a distil end of said probe; means for illuminating a region in front of said distil end of said probe; and viewing means for viewing in front of said distil end of said probe. The probe has a small outside dimension in the range 7mm or less, and a camera on integrated circuit chip at the distal end of the probe.

Description

MEDICAL APPLICATOR

_ Field of the Invention

[0001] The invention relates to a medical applicator for female sterilisation.

~

Background of the Invention

[0002] For female sterilization the known Filshie procedure using the known Filshie clip system is recognised as the leading surgical procedure worldwide, accounting for over 80% of female sterilisations in England and Canada, and having a low failure rate of around 0.27%. The Filshie clip system involves making an incision in the patient's abdomen and fitting a removable clip around each of the patient's fallopian tubes and therefore requires post operative care and a hospital stay. [0003] As an alternative to the Filshie clip, the plugging of fallopian tubes as a medical procedure has been known both in principle and in practice for some years as a means of sterilisation. These procedures avoid abdominal surgery and involve the use of a medical applicator inserted in to the patient's womb via the vagina, and are therefore less traumatic than abdominal surgery. Examples of the techniques are known in WO 97/12569, and WO2007/072004.

[0004] WO97/12569 discloses a hysteroscope used for insertion of a self tapping screw occlusive plug into the fallopian tubes, and using a flexible tube applicator having an octagonal head connector for attaching to an occlusive plug.

[0005] However, the fitting of a plug into a fallopian tube is not without its difficulties despite the availability of hysteroscopic vision to aid the medical practitioner. [0006] One difficulty is that the dimensions of known medical applicators cause discomfort to the patient, and require local anaesthetic. If the dimensions of the part of the applicator which enters the human body can be reduced, then there is the possibility of a achieving a surgical technique which avoids the need for local anaesthetic. This could potentially improve the sterilization technique significantly, and could lead to more widespread use of occlusive plugs for reversible female sterilization. [0007] Further, it is an ongoing objective to reduce the cost of medical applicators to such an extent thattbey can become economically viable to make them disposable for use in a single female sterilization operation.

[0008] It is a further object to reduce component cost for a re-useable medical applicator which can be sterilized using an autoclave, thereby increasing the potential number of patients which can benefit from female sterilization using the occlusive plug technique. This may make a single use option become commercially viable. [0009] An object of the present invention is the provision of an improved applicator for use in the fitting of an occlusive plug of the screw-in kind to a fallopian tube.

Summary of the Invention

[0010] According to one aspect there is provided a medical applicator for use in female sterilization of a fallopian tube, said applicator comprising: an elongate probe for insertion into the womb of said female; characterized in that a maximum outer dimension of said probe in a direction transverse to a main length direction of said probe is less than 7mm. [0011] According to a second aspect there is provided a medical applicator for use in female sterilization of a fallopian tube, said applicator comprising: an elongate probe for insertion into the womb of said female; characterized by a camera being located at a distal end of said probe, said camera arranged to capture a view-inside said womb- in a forward direction in front of said distal end of said probe.

[0012]. According to a third aspect here is provided a medical applicator for use in female sterilization of a fallopian tube, said applicator comprising; an elongate probe for insertion into the womb of said female; means for delivery of fluid to a distil end of said probe; means for illuminating a region in front of said distil end of said probe; and viewing means for viewing in front of said distil end of said probe.

[0013] According to a fourth aspect there is provided a medical applicator for use in female sterilization of a fallopian tube, said applicator comprising; an elongate probe; a connector for connecting to an occlusive plug, said connector located at a distal end of said elongate probe; and a housing located at said distal end of said probe; wherein said connector is retractable in to said housing, to draw at least part of a length of said occlusive plug into said housing. [0014] According to a fifth aspect there is provided a method of fitment of an occlusive plug to a fallopian tube using an applicator having an elongate probe comprising a connector and a housing into which said connector is retractable into and extendible out of, said method comprising: connecting an occlusive plug to said connector at a distal end of said probe; navigating said probe to locate said distal end of said probe opposite a fallopian tube to be occluded; inserting an end of said plug into said fallopian tube; extending said plug out of said housing by extending said connector to a position outside said housing; rotating said plug to drive said plug into said fallopian tube; and disconnecting said connector from said occlusive plug.

[0015] According to a sixth aspect there is provided a method of removing an occlusive plug from a fallopian tube, using a medical applicator having an elongate probe comprising a connector and a housing into which said connector is retractable into and extendible from, said method comprising: inserting said probe member into a womb; manipulating said probe member such that a distal end of said probe is positioned opposite an occlusive plug; engaging said connector of said probe with a portion of said occlusive plug to attach said plug to said probe; rotating said plug to remove said plug from said fallopian tube; retracting said connector so as to draw said plug at least partially, into said housing; and withdrawing said probe from said womb, with said occlusive plug at least partially contained within said housing.

[0016] The invention includes an applicator for use in the fitting of an occlusive plug of the screw-in kind to a fallopian tube comprising :-

(i) an elongate body member;

(ii) a hollow probe carried by, and projecting from, the other end of the body member;

(iii) a nose piece movably mounted with respect to one end of a carrier tube which is located internally of the probe, and adapted to releasably receive a rear, drive end of an occlusive plug;

(iv) a mechanical connection extending between the body member and the nose-piece whereby the practitioner may, within limits, vary the angle of the nose-piece with respect to its carrier tube;

(v) a rotational drive means extending between the body member and the nose-piece to apply torque & hence rotational movement to an occlusive plug temporarily held by the nose-piece;

(vi) a camera mounted at the end of the probe to allow the surgeon a view of the occlusive plug and a view in front of the probe; and

(vii) an illumination means for illuminating inside the womb cavity.

[0017] Specific embodiment applicators disclosed herein may provide a single instrument with which a practitioner may, aided by hysteroscopic vision, accurately locate a leading end of a screw type occlusive plug in the lumen of a fallopian tube, by firstly applying any angular adjustment of the plug that may be necessary to locate the nose of a plug at an ostium, and when so located, by rotating the plug to screw it further into the fallopian tube, for example by a distance of up to 20mm, so that the plug effects a self-retaining engagement of the lumen.

[0018] Other aspects are as set out in the claims herein. Brief Description of the Drawings

[0019] For a better understanding of the invention and to show how the same may be carried into effect, there will now be described by way of example^" onjy, specific embodiments, methods and processes according to the present invention with reference to the, accompanying drawings in which:

Figure 1 herein illustrates schematically one example of an applicator for fitting and removing an occlusive plug, in accordance with a specific embodiment of the present invention;

Figure 2 herein illustrates schematically in perspective view from the rear;

Figure 3 herein illustrates schematically in cut away view the applicator of figure 1 herein;

Figure 4 herein, shows the applicator in view from above;

Figure 5 herein shows the applicator in view from one side;

Figure 6 herein shows the applicator in view from the front end;

Figure 7 herein shows a close up view of the distal part of one embodiment of a probe of the applicator, in a first configuration showing a connector for attaching to an occlusive plug, and having a sheath portion retracted from the end of the probe;

Figure 8 herein shows a close up view of the distal part of the probe of the applicator in a second configuration carrying an occlusive plug, and having the cover sheath retracted, to expose the occlusive plug;

Figure 9 herein shows the distal end of the probe in view from one side, in the second configuration, in which the sheath is retracted to expose a nose portion of the probe which carries an occlusive plug; Figure 10 herein shows the probe in a second configuration, in cut away view in a third configuration, in which the distal end of^~the probe carries an- occlusive plug, and the cover sheath is extended over the plug, so that the plug is protected by the cover sheath;

Figure 11 herein shows the distal end of the probe in perspective view in the second configuration, carrying an occlusive plug with the cover sheath retracted; Figure 12 herein shows schematically the distal end of the probe inside a female body, with an occlusive plug inserted into a fallopian tube, and the applicator engaged with one end of the plug;

Figure 13 herein shows schematically the distal end of the probe inside a womb, with an occlusive plug fitted in a fallopian tube, with the applicator disengaged from the occlusive plug;

Figure 14 herein shows schematically a view as seen through a camera of the applicator, showing an occlusive plug attached to the end of the applicator whilst the applicator is positioned within the womb of a female patient;

Figure 15 herein shows in perspective view, the distal end of a second embodiment probe of the medical applicator; Figure 16 shows a further perspective view of the second embodiment probe;

Figure 17 shows another perspective of the distal end of the second embodiment probe;

Figure 18 illustrates schematically, the distal end of the probe, partially shrouding an occlusive plug; Figure 19 shows the distal end of the second embodiment probe with an end connector and occlusive plug projecting;

Figure 20 herein - illustrates schematically the end of the second embodiment probe detached from the occlusive plug;

Figure 21 illustrates schematically the end of the second embodiment probe holding an occlusive plug for occluding a fallopian tube; Figure 22 illustrates schematically the second embodiment probe inserting an occlusive plug into a fallopian tube; and

Figure 23 herein illustrates schematically the detachment of the distal end of the second embodiment probe from an occlusive plug in situ in a fallopian tube

Detailed Description of the Embodiments

[0020] There will now be described by way of example a specific mode contemplated by the inventors. In the following description numerous specific details are set forth in order to provide a thorough understanding. It will be apparent however, to one skilled in the art, that the present invention may be practiced without limitation to these specific details. In other instances, well known methods and structures have not been described in detail so as not to unnecessarily obscure the description. [0021] In this specification, the term "camera" is intended to include but is not limited to image sensors on integrated circuits, including for example charge coupled delay (CCD) devices, or other equivalent small size image sensors capable of generating a video image. Typically such image sensors may have dimensions of the order of 1.5mm x 1.5mm or smaller. Overview

[0022] Referring to Figure 1 herein, there is shown in perspective external view an applicator for fitting an occlusive plug of the screw in type into a fallopian tube of a female for the purpose of reversible female sterilization.

" .

[0023] Referring to Figure 2 herein, there_is-shown in cut away view the applicator for fitting an occlusive plug of the screw in kind, to a fallopian tube.

[0024] Referring to Figures 3 and 4 herein, there is shown the applicator in views from above and one side respectively.

[0025] Referring to Figure 5 herein there is shown the applicator in view from the front. [0026] As shown in Figures 1 to 3, the applicator 100 comprises an elongate body member 101 having a molded plastics outer casing 102; viewing screen or monitor 103 at a rear end of the body; an elongate hollow probe 104 at a front end of the body; an optional battery pack positioned towards the rear of the body, the battery pack optionally having a light source; a universal connector 106 for accepting the battery pack and light source; a bendable nose assembly 107 positioned at a forward end of the probe 104, for inserting a plug into a fallopian tube; a small scale camera located at the distal end of the probe for viewing the occlusive plug and its immediate surrounds within a patient's womb; an electrical communications lead extending from the casing to the distal end of the probe which both powers the camera and carries the video signal from the camera to the body portion, where it can be accessed thought a communications port, for example a USB 3.0, Firewire® or similar communications port; optionally, a light conducting fibre optic cable for transmitting light from the light source to the end of the probe for illuminating an area around the end of the probe; and a fluid tube for carrying fluid along the probe and emitting fluid in the region around the end of the probe; an electric stepper motor 108 for rotating a plug relative to the probe; optionally, a gearbox driven by the stepper motor; a flexible drive shaft 109 extending along the probe and between the gearbox and a distal end of the probe, and driven in a reverse or forwards direction by the stepper motor, optionally via the gearbox or in a preferred embodiment directly; a forwards/reverse switch 110 for operation of the stepper motor to turn the drive shaft in a forwards or reverse direction; an angular adjustment mechanism 111 for manually adjusting an angle of the nose relative to the probe 104; a power inlet 112 for connection to_an external electrical power supply for powering the stepper motor; and a fluid inlet 113 for introducing fluid to flush around the nose of the device inside a patient's womb so as to distend the uterine cavity. The probe comprises a hollow tube 119 and a slidable outer sheath 120 which is manually slidable in a direction along a length of the probe between and extended position in which it covers the distal end of the tube 104, and a retracted position, in which it exposes the end of the tube 104, and plug connector. Casing

[0027] The casing 101 is formed of two approximately mirror image shell halves 114, 115 which surround the front end of the eyepiece, and other internal components such as the switch 110, stepper motor 108, a stepper motor printed circuit board, and part of the fluid tubes and optional fibre optic cable. At the rear of the casing is provided a cover portion 116 for covering the optics at the front of the eyepiece, which is removable separate from the casing shell halves 114, 115 for inspection. The casing shell halves 114, 115 may be provided with slots or apertures 117, to allow air to flow through the casing for cooling of the stepper motor 108.

[0028] A front portion 118 of the outer casing 100 may provide a curved rough shaped recess or trough 117 which allows inspection of the near or proximal end of the probe, and in particular to allow viewing of the flexible drive shaft 109, and an elongate spring which extends along the length of the probe for bending the nose end of the probe 107. The flexible drive shaft 109 protrudes through an aperture in the trough portion of the casing, before entering an open end of the tubular probe 104. This allows the operator to visually check that the drive shaft is rotating, without the need to remove the probe from the patient's body.

[0029] In other embodiments, the trough 117 at the front end of the casing may be covered with a transparent see through plastics cover.

[0030] In a preferred embodiment, the casing has a length, excluding eye piece and excluding the probe member in the range 200mm to 280mm, and preferably of the order of 267mm; a maximum width in the range 40mm to 60mm, and preferably of the order of 50mm; and a maximum height in the range 58mm to 78mm, and preferably of the order of 68mm.

[0031] Preferably the two shell halves of the casing are connected together by a plurality of screws. Similarly, the rear cover 116 is retained to the casing shell halves by a pair of small screws.

Drive Means

[0032] The probe 104 comprises an elongate rigid tubular member 119, having a rotatable drive rod 109 passing there through, which can rotate relative to the rigid tube 119. A distal end of the drive member is fitted with a bayonet fitting type socket connector comprising a substantially cylindrical hollow tubular member having a pair of diametrically opposed slots, for engaging with a substantially cylindrical end of the plug, where the end of the plug has a pair of radially extending bayonet type protrusions, which engage with the slots in the hollow cylindrical end of the bayonet connector of the probe. In use, the plug can be inserted into a fallopian tube on the end of the probe, rotated in a first direction to drive the plug along the fallopian tube, for example by distance of up to 20mm, and then the rotational direction of the drive means is reversed, to disengage the bayonet socket from the end of the plug, thereby leaving the plug in situ within the fallopian tube. Subsequently, the probe member can be removed from the patient's body. [0033] In the second embodiment, the drive means also includes means for extending and retracting the drive shaft in an axial direction along a length of the elongate probe, so that an occlusive plug connected at the end of the drive shaft can be extended or retracted relative to the end of the probe.

Illumination System

[0034] In one embodiment, the region around the distafend of the probe is illuminated by the battery pack 105, and a light source within the battery pack, which is focused onto the end of a fibre optic cable and carried to the end of the probe, where the fibre optic cable illuminates the regions at the end of the probe. The illumination system comprises a universal connector or socket and a focusing lens or mirror. The connector can accept either a detachable battery pack 105, which is provided at one end with a light emitting diode or incandescent light filament light source, or a known dedicated surgical theatre light source.

[0035] The light source may be coupled to one or more independent optical fibres the specific function of which is to transmit light from the light source, along the probe member and to illuminate the end of the probe at the. nose. In the best mode, one or more light conducting optical fibres, and a viewing optical fibre are incorporated into a single multi-function cable which extends to a position immediately rear of the end of the drive shaft at the end of the nose of the probe 104.

[0036] In an alternative and best mode embodiment, the distal end of the probe is fitted with one or more electrically powered light sources, such as a light emitting diode and electrical power is carried to the light emitting diode via a positive and negative conductor which extend from the body portion to the end of the probe. The light emitting diode can emit light in the visible region, for use with a camera on chip device which view in the visible light range, or in a variation, the camera can be an infra-red camera device, and the light emitting diode can be an infra-red emitting diode. The choice of camera and diode is dictated by availability of components, and selecting the type of camera which gives the best view. [0037] Other small light emitting devices, e.g. semiconductor light emitters of the non-diode type can also be used.

Probe

[0038] As shown in figure 7, a first embodiment probe comprises a rigid tubular member 104, which carries internally the drive shaft 109, for driving bayonet type connector 701 rotationally, for engaging the plug, disengaging the plug and driving the plug rotationally; an end housing 702 which is of external dimensions in the plane perpendicular to the main length of the tube 104, similar to the maximum outer dimensions of the tube 104; a hood or shroud portion 703 which extends from a distal end of the housing; a spring member 704 which connects the housing to the end of the tube 104 and allows the housing to deflect relative to a main length axis of the tube 104; a camera device 705 located at the distal end of the housing and shielded by the shroud or hood 703; a cable 706 which contains one or more electrical leads to the camera device 705; light source 707, which can either be one or more fibre optic cables receiving light from a light source 105 at the body end of the applicator, or which can be one or more light emitting diodes which receive electrical power via a pair of electrical conductors running along the inside of the tube 104; a fluid delivery tube 708 which runs along the length of the tube 104 and has an open end at the distal end of the probe, for delivery of fluid to the region around the end of the probe.

[0039] In the best mode, the electrical connection to the camera chip, the fluid delivery tube and the fibre optic cable for transmission of light to the end of the probe are all separate discrete components within the probe, so that each component can be sourced separately as off the shelf components.

[0040] However, in other embodiments, the electrical leads to the camera, the fluid delivery tube and/or the fibre optic cable can be combined into a single moulded component or be placed within a single flexible cylindrical outer tube, to keep these components neatly together and to minimize the overall width dimensions of these combined components. [0041] Individual ones of the electrical leads to the camera integrated circuit, the fibre optic light cable, and the fluid delivery tube may be bundled together, in a manner optimized for reducing the overall width dimensions of these components, to reduce the overall cross sectional profile of the probe in a direction perpendicular to a main length of the probe.

[0042] The fibre optic illumination cable may be replaced by a small light emitting diode located at the end of the probe adjacent to the camera. The choice between using a fibre optic cable and a light emitting diode is made on grounds of the minimum size dimensions in cross sectional view along the length of the probe. For the light emitting diode, a diode of a power rating which emits sufficient light to illuminate the end region of the probe and the cavity in the womb is needed, but the diode is selected to have a heat output low enough so as not to cause discomfort through heat, or to cause damage to any tissues within the womb though excess heat dissipation from the light emitting diode.

[0043] One or more light emitting diodes can be used instead of or as well as the fibre optic cable. [0044] By using separate fibre optic cable, electrical leads and fluid pipe, this gives more options on placement of these three separate components within the probe, to optimize space saving and reducing the overall width and height dimensions of the probe. [0045] Early embodiments of the device had a probe with maximum outer dimensions in a direction perpendicular to the main length of the probe of 9.5mm height and 7.5mm width.

[0046] Ideally the maximum outside dimension of the probe herein, that is a maximum width of the probe in a direction perpendicular to its main length, is no greater than 7mm, including the outer sheath. This corresponds to a maximum cross sectional area of the probe of around 39mm² or less. By reducing the width dimension of the part of the applicator which enters the womb, the procedure for strerilisation can be made less traumatic to the point where no anaesthetic may be needed. Ideally the maximum width dimension is reduced to around 4mm, which means thaUhe drive shaft, tube 104, light source, and fluid delivery tube all need to be contained within a cross sectional area of maximum dimension 4mm, or maximum cross sectional area 13mm² or less. It is expected that a maximum width dimension in the range 5mm to 6mm can be achieved by use of an electronic camera forthe viewing means and a light emitting diode for the light source, so that the components which extend along the length of the tube include the tube104, the outer sheath, the drive shaft 109, the fluid delivery tube, and one or more electrical conductors to provide power to the light emitting diode and camera and to return the camera video signal along the probe.

[0047] The lower limit for the external dimensions of the probe are determined by the diameter of the occlusive plug. The outside diameter of the occlusive plug is dependent upon which market at which the plug is aimed at. For example Chinese women tend to have smaller fallopian tubes than European or African women, and therefore a plug having an outside diameter of 3mm may be appropriate for Asia. For other regions or races, a plug having a maximum outside diameter of 4mm may be appropriate. By using the image sensor as disclosed herein at the end of the probe, it may be possible to reduce the overall maximum width or height dimension of the probe to between 5mm to 7 mm, with the smaller dimension probes being more suitable for use with the smaller dimension occlusive plugs. Outer Sheath

[0048] Referring to Figure 7 herein, there is shown in perspective view the distal end of the probe, covered by an outer sheath 120. The outer sheath is slidable over the nose of the probe so as to protect the probe and attached plug when entering or being withdrawn from the uterine cavity. The end of the sheath has a chamfered or angled end to assist in insertion into and removal from the uterine cavity. [0049] The tubular wall 104 of the probe is substantially oval in cross section, having rounded corners. At the distal end of the tube comprising the nose portion of the probe, there is a gap of around-15mm to 35mm between the end of the tube 104 and the housing 702. The housing provides a loop, through which the drive shaft 109 and electrical leads, and optional fibre optic cable extend, to the housing. The function of the gap is to allow the housing to move in a direction off axis to the tube, that is, to allow the housing to point in a direction at an angle to the main length axis of the tube 104, whilst the flexible drive shaft 109 can still rotate the bayonet connector 601 to rotate the plug. Since the camera and light source are located at the distal end of the housing, viewing in a direction in front of the housing, as the housing deflects relative to the length of the probe, the camera view corresponds with the location of the bayonet connector and shows the view immediately in front of the connector. [0050] Secured to the end of the housing nearest the tube 104, is the spring strip 704, being preferably a leaf spring which is flexible enough to bend to allow the nose of the probe to bend, and the housing to deflect at an angle of up to 60°, relative to the main length of the probe, but rigid enough to be able to push or pull the housing 702 on the end of the probe so that the housing can be deflected, either side of a straight ahead or axial direction of the main probe tubular body.

[0051] The housing 702 comprises a loop portion 608 which is substantially oval in cross section, the loop portion having extending from a rear end, a rear hood portion 709 which extends into the gap between the housing and the end of the tube 104, and a the front or distal end of the housing, the shroud portion 703 which extends in front of the loop, and shields the camera and partially shields the occlusive plug when fitted. The rear hood portion is substantially part cylindrical in shape, and has an outer surface continuous with the outer surface of the loop portion. The front shroud also has a substantially part cylindrical or dish shape, and is deflected inwardly slightly towards a main central axis of the housing. [0052] Internally of the distal end of the tube 104 is positioned a locating piece 711 through which the flexible rotatable drive shaft 109 and the cables for the light source and camera-pass, and through which the fluid pipe-passes. The drive shaft passes through a first cylindrical bore in the locating piece, and the cables and fluid tube pass through a second bore in the locating piece. The locating piece located the rotating drive shaft at a fixed axial position within the tube, near the distal end of the tube 104.

[0053] The cables or electrical leads, and the flexible drive rod pass through the hollow tube 104 and protrude from the distal end of the tube. As shown in Figure 7, the flexible drive rod 109 preferably comprises a normally cylindrical elongate helically wound spring tube, which allows the distal end of the drive shaft to be self supporting, but also allows enough flexibility for the drive shaft to bend whilst under rotation either clockwise or anti-clockwise, whilst being retained within the tube and within the tubular loop 710 of the housing at the end of the tube.

[0054] Referring to Figure 8 herein, there is shown the end of the first embodiment probe, having an occlusive plug fitted.

[0055] Referring to Figure 9 herein, there is shown the end of the probe 104 in a configuration, whereby the outer sheath 120 is retracted, thereby exposing the window portion of the tube and exposing the occlusive plug and connector 701.

[0056] The probe comprises a hollow tube 104, manufactured from a resilient bendable material, for example medical grade polycarbonate, or a metal alloy. A housing portion is attached at the end of the tube, attached by a resilient bendable strip, for example a leaf spring, and a further bendable portion, so that the leaf spring and the attachment portion act as a push - pull arrangement to pull or push the housing out of line with the main length direction of the tube by as much as 60 degrees, so that the end of the probe can deflect within the womb cavity, to align with the ostium of a female. The camera, being attached to the housing, points its field of view in the same direction as the direction of the housing end of the probe. Similarly, the illumination means also shines light in the direction-in which the housing is pointing and-in which the connector 701 points, illuminating the region immediately in front of the probe.

[0057] The material connecting the housing to the end of the tube 1Ό4 will flex enough to bend over an angle of up to 60° with respect to the inline position, without the material of the tube fracturing. [0058] Referring to Figure 10, there is shown the end of the probe having an occlusive plug connected, and the sheath retracted, in a further perspective view.

[0059] Referring to Figure 11 herein, there is illustrated in cut away view, the end of the probe, having an occlusive plug fitted to the bayonet fixing 701 at the end of the drive shaft 109 and with the outer sheath or sleeve 120 extended over the plug.. In this configuration, the sheath protects the occlusive plug and the drive shaft, multi-function cable 707 and loop 704 from catching or snagging on the sides of the vagina or womb during insertion and thereby prevents the occlusive plug from detaching from the end connector 708. In a preferred embodiment, the end connector 708 comprises a hollow cylindrical tube having a pair of bayonet fixing slots, to cooperate and engage with a pair of protruding lugs on the end of a cylindrical end of an occlusive plug. However, in other embodiments, the connector 708 may comprise a cylindrical socket having an elongate hexagonal or square recess to cooperate with a hexagonal or square end of an occlusive plug.

Slideable Sheath

[0060] Along the probe, and surrounding the probe is provided a slidable protective sheath 120 comprising a hollow tube surrounding the outside of the inner tube 104. The function of the tubular sheath is to aid insertion of the probe into the patient's womb, whilst at the same time providing a covering for the nose portion of the probe which holds the occlusive plug. Since the occlusive plug is relatively small and held in place by a connector, the sheath protects the plug against detachment from the end of the probe during the initial insertion of the probe through the cervix-and through towards the ostium of the patient. The distal end of the tubular sheath has a chamfered end to aid insertion and removal, and so as to provide a relatively blunt end to the probe during initial insertion of the applicator.

[0061] The sheath can be slid back to expose the nose of the probe when the probe is in situ in the womb, and sliding the sheath back then allows deflection of the nose portion relative to the main elongate axis direction of the probe.

[0062] The end of the sheath nearest or proximal to the body 102 of the applicator is provided with a plate 121 which allows the medical practitioner to grasp the end of the sheath and either withdraw or extend the sheath relative to the end of the probe, that is , to slide the sheath backwards or forward along the probe.

[0063] The plate 121 also allows the medical practitioner to judge the depth of the probe within the patiert's body, and to judge the position of the probe relative to the length of the probe.

[0064] On withdrawal of the probe from the patient's body, once the nose end of the probe is straightened, the sheath can be slid back over the probe end, whilst the end of the probe is still in the uterine cavity, and this protects the end of the probe against snagging on removal, and if a plug is attached, prevents the plug detaching from the probe end and becoming loose in the uterine cavity.

Drive Mechanism

[0065] The drive mechanism for rotating the bayonet socket and rotating the plug comprises the electric stepper motor 108, operated by a forward-off- reverse switch 110 located on the underside of the body; the electric motor 108 being connected via a gearbox to the flexible torsional drive rod 109 which passes through the rigid tubular member 104, and at a distal end of which is fitted the bayonet socket 701. The electric motor can be driven in a forward or a reverse direction by- operation of the forwards/backwards switch 110, and its speed may be reduced by gearing in the optional gearbox. Preferably a gear ratio of 1 :6 is provided to reduce the motor speed.

[0066] The drive electronics to the stepper motor incorporates a means to induce step wise rotation of the drive shaft so as to induce vibration at the nose assembly, so as to vibrate the bayonet fixing end of the plug from the bayonet socket end of the drive mechanism, when in situ in the fallopian tube. Hence, the medical practitioner, by using the touch switch 110 can effect various modes of operation of the drive shaft as follows:

> Smooth clockwise rotation of the drive shaft, with continuously variable speed over a predetermined range. This is used for insertion of the plug into a fallopian tube. The number of revolutions per activation can be predetermined, so that activation of the switch in a forward direction makes for example seven clockwise revolutions. The number of revolutions may be preset to the type of plug used, and the pitch of thread on the plug. It is estimated that the optimum number of revolutions is between seven and a half, and fourteen complete revolutions of the occlusive plug. The precise number of revolutions required to anchor the plug in the fallopian tube depends upon the maximum outside diameter of the plug, and the dimensions of the fallopian tube.

> Smooth counterclockwise rotation of the drive shaft with controllable continuously variable speed. This is used for movement of the occlusive plug into the fallopian tube, and possible for rotating the end of the bayonet connector to align with the ends of the plug for engagement with the plug end. > Stepwise clockwise angular rotations of the drive shaft at a stop - start frequency in the range 5 to 20 Hz. This is useful for fine adjustment of the plug position within the fallopian tube. _ > Stepwise- counterclockwise angular rotations of the drive shaft at a stop - start frequency in the range 5 to 20 Hz. This is useful for disengaging the bayonet end connector of the drive shaft from the end of the plug when in situ in the ostium. > Alternating clockwise/counterclockwise rotations of the drive shaft at a direction reversal frequency in the range 5Hz to 20 Hz. This may be useful if the plug encounters difficulty in removal from the bayonet connector and operates to rotationally "shake" the plug off the end of the drive shaft. Variations on the alternating clockwise/anticlockwise rotation, such as two anti clockwise step rotations followed by one clockwise step rotation, or in the general case a number X anticlockwise angular movements followed by a number Y clockwise angular movements. With X and Y being variable and controlled by predetermined program.

[0067] In the general case, the electric drive to the stepper motor may be programmable by the practitioner to achieve a set of drive speeds and angular rotational movement profiles to best suit the medical conditions of patients, and optimized for accuracy and controllability of the plug rotation and manipulation within the body.

Viewing Means

[0068] In the best mode, the surgeon will be able to align the applicator using a monitor screen.

[0069] The viewing means may comprise a small video screen with associated integrated circuit, located within the casing. The image sensor comprises an integrated circuit mounted at the end of the probe. This sends a video signal back along an electrical conductor to a video processing integrated circuit, within the casing of the applicator. The video circuit sends a video signal to the monitor screen at the end of the applicator so that the surgeon can view the end of the probe by looking directly at the screen. Additionally or alternatively, a video signal can be sent via a video port, for example a USB connector, or a wireless link to a separate monitoring device such as a mobile phone, laptop, palmtop or tablet device, allowing the surgeon to manipulate the applicator in a more comfortable and economically optimized manner.

Fluid Delivery

[0070] The applicator can be connected to an external fluid source via the luer type fluid connector 113 which comprises part of the housing of the optics assembly. In the best mode, where a multi-function cable is used, the cable comprises a hollow tubular passage through which a fluid, for example de-ionized water, or other clear transparent medical grade fluid can be injected. Pressurized fluid flows through the connector 113, into the tubular fluid passage of the multifunction cable and is delivered of the nose or the probe. When the probe is inside the body, enough fluid can be delivered to expand the womb cavity, so that the walls of the womb in the region of the ostium are expanded, thereby allowing greater freedom of movement of the end of the probe 6 within the womb cavity. Fluid may be delivered under pressure, for example using an electric pump, or under gravity pressure, for example from a drip feed bag. Angular Adjustment of the Probe

[0071] The nose assembly can be moved angularly with respect to a main length of the probe, so as to deflect the nose assembly within the patient's body by an angle in the range 0° to 60° with respect to an inline position along the main length direction of the probe.

[0072] A mechanism for adjusting the angle of the nose comprises an actuation wire, preferably in the form of a nylon filament, which is attached to the nose piece and which extends along the tube 104, and can be pulled by means of a hand operated adjustment wheel 113. Operation of the wheel in a first rotational direction causes tension on the cable and pulls the cable so as to deflect the end of the probe from its normal straight ahead bias-position, when under no tension from the cable. Rotation of the wheel in an opposite direction causes the cable to pay out and move back along the probe, so the end of the probe can move back towards its normal unbiased straight ahead position. Tha position of the wheel can be locked using a friction pad, latch or ratchet, to allow the nose to be kept ant any angular deflection of the nose relative to the main probe length, within its maximum range of deflection, so once set, the operator can leave the probe at a selected angle of deflection. Typically there may be markings on the wheel to indicate angles of deflection of the probe end of 0°, 30°, 40°, 50° and 60°.

[0073] In other embodiments, the angular adjustment wheel may be replaced by a cam or pulley attached to a filament, wire or cable.

[0074] In other embodiments there may be is provided a rack located internally of the body member which is adapted to be displaced manually to and fro along the body member to allow for angular displacement of the end of the nose relative to the inline or co-axial direction of the probe.

[0075] The leaf spring 706 biases the bayonet socket to remain in an inline or co-axial position, unless the angle is deflected via the manually operated nose adjuster wheel.

[0076] As shown in Figure 10 herein, when the end of the probe is in a straight ahead position, the strip or leaf spring 706 when in a neutral position as set by the adjustment wheel 111 , adopts a straight ahead inline position with the rest of the tube 104. In this configuration, neither the leaf spring 706 nor the connecting portion connecting the end of the tube to the housing are under tension, and the tube adopts its normal as manufactured straight ahead position. [0077] As shown in Figure 12, when the leaf spring 706 is pulled under tension by the adjustment wheel 111 so as to be drawn back into the tube slightly, the leaf spring pulls the loop end 702-of the tube thereby deflecting the end of the tube from its normal rested straight ahead position. One side of the loop is pulled by the leaf spring, so as to bend over the end, about the flexible tube side wall which bends correspondingly. The flexible drive shaft 109 also bends, as does the fluid delivery tube and electrical connections to the camera. In this position, the drive shaft 109 is still rotatable either clockwise or anticlockwise. The flexible drive shaft 109 can rotate the plug clockwise or anticlockwise whilst the nose is in a deflected position.

[0078] Also shown in Figure 12 for illustrative purposes, in cut away view is an ostium 1200 and fallopian tube 1201 of the female body, showing fitment of the occlusive plug in situ in the patient's body, as the occlusive plug has been driven into the fallopian tube via the ostium, moving itself forward using the self- tapping screw of the occlusive plug. The thread of the plug lodges into the endosalpinx and cuts into the endosalpinx which slightly traumatizes the tissue.

[0079] Referring to Figure 13 herein, there is shown the occlusive plug in situ in the fallopian tube and detached from the nose of the applicator. Using the stepper motor control, the drive shaft 109 and end connector 701 can be rotated or vibrated in an anti-clockwise or clockwise direction to aid detachment of the end of the occlusive plug from the end connector or the applicator once the occlusive plug is in position.

Operation of the Applicator

[0080] The applicator is deployed as follows. The applicator is prepared for use by inserting new batteries into the battery pack, checking operation of the probe adjuster 111 by turning the thumb wheel, connecting power to the power socket 112, and connecting a fluid supply to the fluid connector 113. The practitioner also checks sliding of the sheath backwards and forwards along the probe, and fits an occlusive plug into the connector at the end of the probe. The sheath is slid over the nose of probe_: protecting the occlusive plug. The wireless connection or cable connection to the monitor is checked to ensure that a video signal and view of the end of the probe are available.

[0081] The practitioner inserts the probe into the female patient's vagina, and at the same time may view the end of the probe using the monitor 103, under illumination from the light source. Ihe_end of the probe is inserted through the neck of the womb, which needs to be dilated. The sheath of sleeve 120 protects plug on the end of the probe. The practitioner may inject fluid via the fluid connector, which flows out of the end of the fluid pipe in the region around the nose. The fluid distends the uterine cavity so that the operator can see inside the cavity and identify for example the left ostium.

[0082] Preferably, the signal from the camera chip is output via a port, for example a Universal serial bus (USB, Firewire® or other hardwired port, or may be transmitted via a wireless port transmitter in the casing, to be received by a television camera, or other monitor such as a laptop, desktop, tablet or mobile phone having video facility, using a known video format, allowing the practitioner to see the view through the end of the probe on a screen, which is ergonomically efficient for the surgeon, allowing the surgeon to stand upright whilst manipulating the applicator.

[0083] The operator may draw back the sheath, exposing the end of the nose whilst the end of the probe is inside the patient's womb, and may deflect the end of the probe using the deflection control thumb wheel 111 , (or in other embodiments, a motor driven preset deflection). Rotation of the thumb wheel in one direction causes deflection of the nose from its straight ahead position, and rotation of the thumb wheel in an opposite direction causes the end of the probe to move towards its normal un-deflected straight ahead position. [0084] The operative identifies the ostium through the viewing system and can manipulate the whole body of the applicator, and deflect the end of the probe to align the occlusive plug with the ostium. The geometry of the probe is designed such that the end of the probe lines up correctly in a direction pointing at the ostium, after insertion through the neck of the womb. The tip of the plug can be manipulated into the ostium and the medical practitioner can drive the plug in a clockwise direction so that the tip of the plug, which has- a self-tapping thread, drives into the end of the fallopian tube whilst being rotated by the rotatable drive shaft^" 109. Depending on the type of plug used, a predetermined numbenof rotations mayJ)e_applied by a single activation of the motor control switch.

[0085] Typically, insertion of the plug requires between seven and fourteen rotations. The exact number of rotations depends upon the size of the plug, since smaller plugs may have fewer number of screw thread turns. For plugs having a maximum amount outside diameter of around 4mm, for example seven turns to insert the plug, plus some extra turns to tighten and anchor the plug within the fallopian tube may be required. The drive electronics to the motor can be programmed for a specific number of turns to suit the individual plug type and size.

[0086] In other variants, the speed of rotation may be continuously variable, and the practitioner may drive the plug either in the forward or reverse direction as appropriate under fine speed control of the motor control switch 110.

[0087] Once fully inserted, the operative must then detach the plug from the connector 701. However first the practitioner may slightly over-tighten the plug within the fallopian tube, so that the tissue around the ostium compresses at the collar at the end of the plug, and then slightly relax the rotation of the plug before removing the connector. This helps stop any trivial bleeding which may have occurred during insertion of the plug.

[0088] Removal of the connector from the end of the plug should be by straight forward withdrawal or pulling of the end of the applicator away from the plug, the plug being retained in the fallopian tube. The dimensions of the connector relative to the dimensions of the end of the plug are selected so that the plug normally stays in place in the connector 701 , when being driven clockwise or anti-clockwise, but can easily be slid out of the connector, when the connector is withdrawn in a direction along a main central axis of the plug. However, if there is any sticking of the plug, the operator can apply either clockwise or anti-clockwise rotation-of the drive shaft, or in a further mode of operation, the stepper motor is driven to make a series of small angle rotations on a stop-start cycle, with a stop-start duty cycle in the range 5Hz to 20Hz, which has the effect of vibrating or shaking the plug free of the end connector 701. A variety of preset rotational or shake cycles are as described herein above.

[0089] In the best mode, a single operation of the switch 111 in the forwards direction may be preprogrammed to make between 6 and 9 and preferably 7.5 clockwise revolutions of the drive shaft, followed by one anticlockwise revolution, followed by a shake function to detach the connector from the rear of the plug, (alternate back/ forwards step rotations). [0090] Figure 14 herein illustrates schematically a view taken by the camera at the end of the probe, which may be displayed on a monitor screen, e.g. a TV monitor or computer screen. There is shown an occlusive plug connected to the end of the connector 701. Individual turns of the screw thread of the plug can be seen, and the position of the end of the plug can be judged by the operator.

[0091] The applicator can also be used to reverse a sterilized patient who has a pair of occlusive plugs fitted. Reversal of the sterilization operation is achieved by inserting the applicator into the uterine cavity of the womb, as herein above described, but without any plug attached to the applicator, sliding back the protective sheath once the probe end is in the uterine cavity, deflecting the end of the probe to align with the ostium, identifying the end of the plug protruding from the ostium and attaching the connector 701 of the applicator to the protruding plug end by sliding the connector on to the plug end.

[0092] The motor control 111 is operated to rotate the drive shaft 109 in an anticlockwise direction so that the rotational movement of the plug within the fallopian tube urges the plug in a direction out of the tube into the lumen. There will be a certain amount of trauma to the cornu where the plug was fitted at the end of the fallopian tube, however this part of the womb has good regenerative capacity, and-will heal up, resulting in a patent lumen capable of conducting sperm and fertilized egg, so a return to fertility can be expected.

[0093] The probe end is then withdrawn-slightly, and straightened whilst still in the uterine cavity, and the previously retracted protective sheath is slid over the distal end of the probe to cover the occlusive plug on the end of the probe and prevents the plug becoming detached and loose in the uterine cavity. The plug, attached to the end of the drive shaft and the connector 701 can then be removed by withdrawal of the probe through the neck of the womb. The fallopian tube on the other side of the womb is treated similarly.

[0094] Referring to Figure 15 herein, there is shown in perspective view from one side, the end of a second embodiment probe for use with a medical applicator as described herein before.

[0095] The second embodiment probe comprises an elongate-rigid tube 1501 ; an outer sheath 1502 which is slideable along a length of the inner tube 1501 ; a distal housing 1503 connected to an end of the rigid tube 1501 by a resiliency deformable member 1504, which may be for example a leaf spring; a flexible drive shaft 1505 in the form of a helical spring; a bayonet type substantially cylindrical connector 1506, adapted for receiving a male end of an occlusive plug 1507; a flexible wire or line 1508, operable by a user by rotating a thumb control of the applicator, for drawing a rear end of the housing 1503 towards the end of the tube 1501 in order to deflect or bend the end of the probe; an image sensor device 1509 located at the front of the housing with a view in the same direction as that in which the occlusive plug 1507 points; a fluid delivery tube 1510, having its outlet at a front face of the housing 1503; an illumination means 1511 ; a cable or lead 1512 for carrying electrical signals between the image sensor 1509 and a set of control electronics within the housing of the applicator; and a further electrical conductor 1513 for carrying electrical power to the illumination means. [0096] As with the previous embodiment the illumination means can either be a fibre optic cable 1530, or an electrical conductor 1513_supplying a light emitting diode 1511.

[0097] As shown in^~Figures 15 to 23, in the second embodiment probe, the substantially cylindricarfemale connector 1506 is retractable into a cylindrical passage within the housing, so that a substantial portion of the occlusive plug is withdrawn into the passage in the housing, for insertion of the probe and plug into the womb, or for removal of the probe and plug out of the womb, with the plug attached.

[0098] As shown in Figures 15 and 16 herein, approximately 50% to 60% of the length of the occlusive plug can be withdrawn into the housing by pulling back the drive shaft 1505 relative to the inner tube 1501 and end housing 1503.

[0099] As shown in Figure 17 herein, the occlusive plug 1507 can be extended out of the housing of 1503 to enable_connection of the male rear part of the plug to the female hollow cylindrical bayonet connector 1506. The connector 1506 and flexible drive shaft 1505 are movable in a length wise direction of the main length of the probe. Further, as the housing is deflected relative to the main length direction of the probe, the bayonet connector 1506 and occlusive plug are movable in an axial direction of the housing 1503, which itself can be deflected at an angle to the main length direction of the probe as shown in figures 21 to 23 herein.

[0100] A rear portion of the housing 1514 partially shields the flexible drive shaft 1505, and also provides an anchor point for the tension wire or line 1508. [0101] Referring to figure 18 herein, there is shown in view from one side, the housing of the second embodiment probe, having an occlusive plug partially retracted therein. [0102] Referring to Figure 19 herein, there is illustrated the housing of the second embodiment probe, having the bayonet connector 1506 extended out of the end of the housing, to -allow connection to the rear part of ^"the plug. [0103] Referring to Figure 20 herein, there is illustrated schematically in view-from one side, the housing of the second probe embodiment having the connector 1506 extended out of the front end of the housing, with the plug detached from the bayonet connector, showing the alignment of the rear portion of the plug with the hollow cylindrical bayonet connector 1506, in an orientation in which the bayonet connector 1506 can be slid on to the end of the plug and attached or detached from the plug.

[0104] Use of a medical applicator having the second embodiment probe is substantially as described herein above with reference to the first embodiment probe, but modified to allow retraction and extension of the occlusive plug out of and into the housing 1503. Rotation of the plug, attachment of the plug, insertion and extraction of the probe from the womb, and navigation of the end of the probe within the womb_are all substantially as described herein before, but with the improvement that during insertion and extraction of the probe through the womb with the occlusive plug attached to the end of the probe, the probe is partially enclosed by the housing, so that the plug is less prone to being knocked and disconnected from the bayonet connector, and therefore there being less risk of the plug becoming loose in the womb cavity. [0105] Referring to Figure 21 herein, there is illustrated schematically a first stage of insertion of an occlusive plug into a fallopian tube 2100 of a patient. The applicator has been manipulated, and the end of the probe has been bent by tensioning the tension wire or cable 1508. The womb region immediately adjacent at the end of the probe has been expanded by injection of fluid via the fluid tube 1510, which outlets from the end of the housing. The operative has manipulated the medical applicator so that the front end of occlusive plug enters the ostium. At this stage, the occlusive plug is still retracted into the housing 1503 of the end of the probe. The surgeon can view the region in front of the probe using the monitor at the end of the probe, or via other monitoring means such as a computer screen, via a hard cable or wireless connection to the applicator as described herein previously. [0106] Referring to Figure 22 herein, there is shown a further stage of fitment of the occlusive plug into a fallopian tube. The bayonet connector -1.506 has been extended^" out of the end of the housing 1503 of the probe, and at the same time the flexible drive shaft 1505 is rotated a predetermined number of turns, so that the occlusive plug enters the fallopian tube. Initial entry of the fallopian tube may be by pushing the whole medical applicator towards the ostium, or by leaving the end of the probe in a fixed position, and extending the bayonet coupling out of the end of the housing. Once enough length of the occlusive plug is entered into the end of the fallopian tube, rotation of the plug causes the plug to draw itself into the fallopian tube. As described herein before, the plug is rotated a predetermined number of times which, depending upon the type of plug can be between seven and fourteen rotations, which includes enough rotations to draw the plug into the tube, and to tighten the plug, once in situ. [0107] Referring to Figure 23 herein, similarly as previously described, the bayonet connector is detached from the end of the plug by a combination of rotation and vibration of the connector, which shakes loose the end of the plug from the bayonet connector. Once the plug is in situ, the male connector part of the plug protrudes from the end of the fallopian tube, so that the occlusion of the fallopian tube can be reversed by reconnecting the bayonet connector to the end of the plug and removing the plug substantially as herein before described.

[0108] For an operation to remove an occlusive plug from a fallopian tube, and thereby to reverse a sterilization process, removal of the plug is substantially a reversal of the process for fitting the plug. The applicator is inserted into in the womb, and navigated so that the front of the housing faces directly in front of the ostium and the protruding plug end. The flexible drive shaft 1505 is extended relative to the tubular probe, so as to push the bayonet connector out of the end of the housing, to a position as shown in Figure 23. The bayonet connector is then connected to the end of the plug as shown in Figure 22, and the drive shaft is rotated in an opposite direction, so-as- to unscrew the occlusive plug from-the fallopian tube. The plug is then retracted into the housing 1503 prior to straightening of the end of the probe, and retraction of the probe from the womb, with the plug carried within the housing and protected. irom being knocked off the end of the probe by its partial shrouding within the housing 1503.

[0109] Other specific embodiments and/ or variations of the best mode embodiment may comprise any one or more of the following optional features.

[0110] The synthetic plastic is cf medical grade polycarbonate.

[0111] A leaf spring arrangement biases the nose-piece to an in-line, co- axial location.

[0112] An actuation wire is attached to the nose-piece via a bayonet screw, and extends along the carrier to a spool having an integral spur wheel in engagement with a rack located internally of the body member, which rack is adapted to be displaced manually to and fro along the body member by the practitioner e.g. using a thumb to deflect the spring and hence to rotate the plug to a different angular position from in-line, if such deflection is required to assist in locating the leading end of the plug, as a pilot nose, in the fallopian tube. [0113] The rack is provided with an integral thumb piece 111 located externally of the body member.

[0114] From its in-line position, the leaf spring may be deflected by the practitioner, such that the plug is at 30°, 40°, 50° or 60° with respect to the in-line position.

[0115] For a plug having an hexagonal trailing end e.g. as disclosed in WO/2007/072004, the nose-piece includes an hexagonal drive socket connected by a flexible drive cable housed in a carrier tube extending along the probe to the manually operable drive system for translating linear or arcuate movement of a trigger, into rotational movement via a step-up gearing. [0116] As an alternative to a bayonet type fixing, a hexagonal trailing end and complementary drive socketmay be provided to connect the releasable plug- to-the-nose piece.

[0117] Irrespective of the drive connection to the plug at the nosepiece, the applicator also incorporates means, operable by the practitioner, to induce a vibration at the drive connection, to aid disconnection after the plug has been successfully inserted.

[0118] In an alternative embodiment, the vibration means may comprise a rotatable, out-of-balance body, which could be drivable by a drive shaft or by electric induction. In the best mode, vibration is achieved by drive of the stepper motor.

[0119] In one embodiment, a manually operable drive system comprises a gearbox housing at least two spur gearwheels, with a bevel friction drive to a drive head in which an end of a flexible drive cable is secured.

[0120] Preferably, the gearwheels provide a 1 :6 ratio, whereby translational movement of the trigger from a start position to a stop position produces six revolutions of the flexible drive cable and hence six revolutions of the plug which, if the plug is as described in PCT/GB2009/002450, would advance the plug by some 20mm along the lumen of the fallopian tube.

[0121] The optional gearbox preferably comprises a casing e.g. of medical grade polycarbonate, with integral pivot pins for receiving the gearwheels e.g. of Nylon (delrin), with a closure cover e.g. of medical grade polycarbonate, secured to the casing by two stainless steel screws. [0122] Preferably, the trigger comprises a 'C'-shaped loop able to receive a finger of the practitioner, and an integral lever operable to rotate the gearing to rotate the drive cable.

[0123] The mechanical connection between the body membe and the nose piece-may be power operable.

[0124] Embodiments of the applicator may be designed to be single use disposable, or engineered to be sterilisable for repeated use in an autoclave.

Claims

1. A medical applicator for use in female sterilization of a fallopian tube, said -applicator comprising: an elongate probe for insertion into the womb^"of said female; characterized in that a maximum outer dimension of said probe in a direction transverse to a main length direction of said probe is less than 7mm.

2. The medical applicator as claimed in claim 1 wherein a maximum outer dimension of said probe in a direction transverse to a main length of said probe is in the range 4mm to 6mm.

3. The medical applicator as claimed in claim 1 or 2, wherein said probe comprises: an elongate inner tube; an elongate outer sheath slidable along said inner tube; a flexible rotatable drive shaft extending through said inner tube; a fluid delivery tube extending atong a length of said inner tube; a camera located at a distal end of said probe, said distal end for insertion into a womb of said female; and an illumination means for illuminating a region at said distal end of said probe.

4. The medical applicator as claimed in any of preceding claims, wherein said illumination means comprises a fibre optic cable arranged to transmit-light along a length of said probe, to illuminate a region- in front of said^" distil end of said probe.

5. The medical applicator as claimed in any of the preceding claims, wherein said fluid delivery means comprises a flexible tube extending along a length of said probe, a flexible tube having an open distil end, through which fluid can be injected under pressure, to output from said open end.

6. A medical applicator for use in female sterilization of a fallopian tube, said applicator comprising: an elongate probe for insertion into the womb of said female; characterized by a camera being located at a distal end of said probe, said camera arranged to capture a view inside said womb in a forward direction in front of said distal end of said probe.

7. The medical applicator as claimed in claim 6, wherein said camera comprises an integrated circuit camera of maximum dimension less than 1.5mm.

8. The medical applicator as claimed in claim 6 or 7, wherein said integrated circuit camera, in use, is completely enclosed within a womb of said female.

9. The medical applicato^r as claimed in any one of claims 6 to 8, further comprising an electrical conductor extending along a length of said probe between said camera and proximal end of said probe, for carrying electrical power to said camera.

10. The medical applicator as claimed in any one of claims 6 to 9, further comprising: an electrical conductor extending along a length of said probe between said camera and proximal end of said probe; and _ ^"

a signal output terminal at a proximal end of said probe; wherein said camera sends a video signal to said signal output terminal for access at said a proximal end of said probe.

11. The medical applicator as claimed in claim 10, wherein said signal output terminal comprises a wireless transmitter.

12. The medical applicator as claimed in any one of claims 6 to 11, wherein said camera provides a video signal in a signal format suitable for display on a computer device.

13. A medical applicator for use in female sterilization of a fallopian tube, said applicator comprising; an elongate probe for insertion into the womb of said female; means for delivery of fluid to a distil end of said probe; means for illuminating a region in front of said distil end of said

probe; and viewing means for viewing in front of said distil end of said probe.

14. The medical applicator as claimed in claim 13, wherein said viewing means comprises a semiconductor camera mounted at a distil end of said probe.

15. The medical applicator as claimed in claim 13 or 14, wherein said illumination means comprises a fibre optic cable arranged to transmit light along a length of said probe, to illuminate a region in front of a distil end of said probe.

16. The medical applicator as claimed in any one of claims 13 to 14, wherein said illumination means comprises one or more light emitting diodes.

17. The medical applicator as claimed in any one of claims 13 to 16 wherein said viewing means and said illumination means operate in the visible light range.

18. The medial applicator as claimed in any one of claims 13 to 17, wherein said camera and said illumination means operate in the infra-red region.

19. The medical applicator as claimed in any of the claims 13 to 18, wherein said fluid delivery means comprises a flexible hollow tube extending along a length of said probe, said flexible tube having a first open end which in use is outside the body of said female, and a second end which in use is located within a womb of said patient, such that fluid can be injected into said womb via said fluid delivery tube.

20. A medical applicator for use in female sterilization of a fallopian tube, said applicator comprising; an elongate probe; a connector for connecting to an occlusive plug, said connector located at a distal end of said elongate probe; and a housing located at said distal end of said probe; wherein said connector is retractable in to said housing, to draw at least part of a length of said occlusive plug into said housing.

21. The medical applicator as claimed in claim 20, wherein said connector is retractable into and extendable out of said housing along a main length direction of said housing.

22. The medical applicator as claimed in claim 20 or 21 , wherein said connector is rotatable about an axis of rotation; and said connector is movable in an axial direction along said axis of rotation.

23. A method of fitment of an occlusive plug to a fallopian tube using an applicator having an elongate probe comprising a connector and a housing into which said connector is retractable into and extendible out of, said method comprising: connecting an occlusive plug to said connector at a distal end of said probe; navigating said probe to locate said distal end of said probe opposite a fallopian tube to be occluded; inserting an end of said plug into said fallopian tube; extending said plug out of said housing by extending said connector to a position outside said housing; rotating said plug to drive said plug into said fallopian tube; and disconnecting said connector from said occlusive plug.

24. A method of removing an occlusive plug from a fallopian tube, using a medical applicator having an elongate probe comprising a connector and a housing into which said connector is retractable into and extendible from, said method comprising: inserting said probe member into a womb; manipulating said probe-member such that a distal end of said probe is positioned opposite an occlusive plug; engaging said connector of said probe with, a portion of said occlusive plug to attach said plug to said probe; rotating said plug to remove said plug from said fallopian tube; retracting said connector so as o draw said plug at least partially, into said housing; and withdrawing said probe from said womb, with said occlusive plug at least partially contained within said housing.