WO1993018713A1 - Uterine retractor - Google Patents

Uterine retractor Download PDF

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Publication number
WO1993018713A1
WO1993018713A1 PCT/US1992/002081 US9202081W WO9318713A1 WO 1993018713 A1 WO1993018713 A1 WO 1993018713A1 US 9202081 W US9202081 W US 9202081W WO 9318713 A1 WO9318713 A1 WO 9318713A1
Authority
WO
WIPO (PCT)
Prior art keywords
retractor
finger
pivot
uterus
uterine
Prior art date
Application number
PCT/US1992/002081
Other languages
French (fr)
Inventor
James F. Hodgson
Original Assignee
Hodgson James F
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Hodgson James F filed Critical Hodgson James F
Priority to PCT/US1992/002081 priority Critical patent/WO1993018713A1/en
Priority to AU22242/92A priority patent/AU2224292A/en
Publication of WO1993018713A1 publication Critical patent/WO1993018713A1/en

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0218Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/42Gynaecological or obstetrical instruments or methods
    • A61B17/4241Instruments for manoeuvring or retracting the uterus, e.g. during laparoscopic surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00535Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • A61B2017/00557Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated inflatable

Definitions

  • the present invention relates in general to medical devices.
  • the present invention relates to an improved device for positioning and controlling the uterus within the abdominal cavity to aid in medical procedures.
  • the uterus of the human female lies within the pelvic region in the abdominal cavity.
  • the uterus essentially consists of a muscular sack opening onto the innermost end of the vaginal cavity.
  • the connection to the fallopian tubes near the upper end of the uterus, and a narrow band of fascia connecting the lower lateral portions of the uterus to the pelvic wall there are no strong connections holding the uterus in place.
  • An object of the present invention is the provision of a medical device which will allow movement of the uterus to a desired position, in more than two dimensions, and maintain the uterus in this position.
  • Another object of the present invention is to provide such a device which may firmly and saf ly maintain the uterus in the desired position.
  • Yet another object of the present invention is to provide such a device which may allow for hydrotubation.
  • a uterine retractor having an elongated actuator grip which provides relative sliding movement between a support bar and a slide bar.
  • One end of the actuator grip includes a handle grip with a trigger for initiating relative movement between the support bar and slide bar.
  • the other end of the actuator handle mounts a retractor housing.
  • the retractor housing is fixed to the support bar and supports a retractor pivot for movement about an axis substantially perpendicular to the support bar.
  • the retractor pivot is pivotally connected to the slide bar such that relative sliding movement between the slide bar and support bar will cause relative rotational movement between the retractor housing and retractor pivot.
  • retractor finger Extending outwardly from the retractor pivot is a retractor finger which may be inserted within the uterus, upon the insertion of the retractor housing within the vaginal tract of the patient, with the handle grip and trigger remaining outside of the patient. Movement of the retractor finger, due to actuation of the trigger, will thus impart movement to the uterus, allowing placement for medical procedures.
  • Fig. 1 is a perspective view of the device according to the present invention
  • Fig. 2 is a detail perspective view of a portion of the device of Fig. 1;
  • Fig. 3 is an exploded side view of the retractor assembly of Fig. l;
  • Fig. 4 is a partial side view in cross-section of the device of Fig. 1. ;
  • Figs. 5-8 show embodiments of retractor fingers according to the present invention.
  • Fig. 9 shows a second embodiment of the device according to the present invention.
  • Figs. 10 and 11 are cross-sectional side views showing operation of the device.
  • the device according to the present invention is generally designated by reference numeral 10.
  • the device 10 generally consists of an actuator grip 12, a retractor housing 14 and a retractor finger 16.
  • the actuator grip 12 is preferably of a form commonly employed for various medical devices, such as surgical scissors, clamps, etc.
  • the grip 12 includes an elongated support rod 18 which includes an integral handle grip 20 at a first end thereof.
  • the handle grip 20 may include various protrusions 22 to improve control of the handle grip when it is manually grasped.
  • Extending rearwardly from a lower end of the handle grip 20 is a catch member 24.
  • the catch member 24 extends in an arc about a pivot axis 26 adjacent the intersection of the handle grip 20 and support rod 18.
  • the catch member 24 includes a plurality of pawls along at least one side thereof.
  • the pawls 26 are adapted to engage a lower end of a trigger 28 which pivoted to the axis 26 adjacent an upper end of the trigger.
  • the pawls 28 will engage with the trigger 30 to prevent movement of the trigger relative to the catch member in at least one direction.
  • the trigger 30 may include an extending through hole 32 adapted to receive the user's thumb therethrough and act as a thumb grip to allow the trigger 30 to be drawn rearwardly away from the handle grip 20.
  • a spring could be provided for biasing the trigger rearwardly of the handle grip. This could be affected by use of a coil spring extending between these two members, preferably formed as a coil spring extending about the axis 26 and engaged between the members 20 and 30.
  • trigger 30 extends beyond axis 26 and is pivoted to a slide rod 34 slidably mounted upon support rod 18.
  • the support rod 18 have a roughly circular exterior configuration (in cross-section) and include a slide cavity 36 extending longitudinally through the length of the support rod 18. This slide cavity receives the slide rod 34.
  • these elements have appropriate mating configurations, such as a trapezoidal configuration shown in Fig. 2.
  • pivotal movement of the trigger 30 about axis 26 will result in sliding movement of the slide rod 34 with respect to support rod 18. It is this relative sliding movement which is employed in the present device to effect movement of the retractor finger 16 with respect to the retractor housing 14.
  • the retractor housing 14 is mounted upon a second end of the support rod 18 and is fixed with respect thereto.
  • the mounting of the retractor housing to the support rod may be permanent, in which case various portions of the retractor housing may be made monolithic with the support rod, or the retractor housing may be removably mounted upon the support rod 18.
  • the second end of the support rod may include a circumferential catch groove 38 extending about a portion of the outer periphery of the support rod which will receive a mating ridge of the retractor housing.
  • Other arrangements allowing removal of the housing could of course be employed, such as exterior threads on the support rod which engage with a threaded collar on the housing, etc.
  • the retractor housing extends forwardly of the second end of the support rod 18 to a pair of lateral pivot blocks 40.
  • the pivot blocks 40 are spaced from each other and provide a pivotal mount for a retractor pivot 42 which is mounted between the pivot blocks.
  • the retractor pivot is mounted for rotation about an axis substantially perpendicular to the longitudinal axis of the support rod 18.
  • a portion of the periphery of the retractor pivot 42 is substantially circular such that it may freely pivot with respect to housing 14.
  • a laterally central portion of protractor pivot 42 is removed along a chord spaced from the pivot axis of pivot 42 to define a channel 44.
  • a first end of a swing arm 46 is pivoted to the retractor pivot about an axis substantially perpendicular to the longitudinal axis of the support rod 18, at a point spaced from the pivot axis of pivot 42.
  • the swing arm 46 extends rearwardly from this connection to the retractor pivot 42 and is connected at its second end to the slide rod 34.
  • the coupling 48 is pivoted to the second end of swing arm 46 about an axis substantially perpendicular to the longitudinal axis of support rod 18.
  • the other end of coupling 48 will include means for connecting with the slide rod 34. This may be by means of a coupling cavity 50 which is sized to receive the second end of slide rod 34.
  • the coupling 48 must be removably mounted to slide rod 34.
  • the second end of slide rod 34 may be provided with a peripheral groove 52, similar to catch groove 38 on the support rod, and the interior of the coupling cavity 50 include a mating ridge which will be removably received within groove 52.
  • an appropriate slit (not shown) extending perpendicular to the ridge may be provided.
  • the pivot housing is provided integral with the support rod 18 the swing arm 46 need not be removable from the slide rod 34. In such situations the second end of swing arm 46 may be pivoted directly to slide rod 34, as is shown in Figs. 10 and 11.
  • the outer periphery of retractor pivot 42 includes a finger mounting hole 54.
  • Mounting hole 54 extends radially inward of the retractor pivot and includes appropriate means, such as internal threads, to removably mount the retractor finger 16.
  • the retractor finger 16 is an essentially elongated member preferably having a rounded free end 56 and means at the other end, such as a threaded bolt 55, for engagement with the mounting hole 54.
  • the retractor housing 14 is formed as a main housing 58 having a cavity 60 adapted to receive the support rod 18.
  • the main housing 58 also includes a swing arm channel 62 extending froi? the cavity 60 outwardly to a mounting face 64. As shc-ild be apparent, the swing arm channel will house the swing arm 46 and allow its communication between the retractor pivot 42 and slide rod 34.
  • the mounting face 64 includes a pair of chamfer blocks 66 extending outwardly therefrom. As is shown in Fig. 3, the chamfer blocks taper inwardly t wards the mounting face 64 when viewed from the side.
  • the chamfer blocks each serve to mount an associated pivot support 68.
  • Each pivot support may be a substantially cylindrical member having an outer diameter substantially equal to that of the retractor pivot 62, such that these elements form a substantially continuous cylindrical surface. In such a case the outer peripheral edges of each pivot support are preferably provided with smooth transitions 76 to reduce sharp edges and thus the possibility of damage to the vaginal tract.
  • Each pivot support 68 includes a trapezoidal channel 70 at a position on the periphery thereof, and opening onto the interior planar face, which will mate with the associated chamfer block 66.
  • the chamfer block 66 and channels 70 may be provided with appropriate grooves and ridges, as with grooves 38 or 52, such that the pivot supports will be securely retained in place during use of the device.
  • Each of the pivot supports 68 also includes a substantially centrally located pivot hole 72 adapted to receive a pivot rod 74 extending outwardly from the planar faces of the retractor pivot 42.
  • the retractor pivot will be held in place by the pivot rods 74 received within the pivot holes 72 while the pivot supports are maintained in position upon the chamfer blocks 66.
  • the retractor housing 14 may be at least partially disassembled for cleaning.
  • the pivot rods could of course be formed on the pivot supports, with the retractor pivot 42 having pivot holes 72, or the pivot rods could be formed by a single long rod extending through the pivot supports and retractor pivot.
  • pivot supports it is also possible to avoid the use of pivot supports entirely.
  • an arrangement similar to a standard hinge could be employed for pivoting the retractor pivot to the main housing.
  • the both the retractor pivot and main housing could have one or more integrally formed through holes, each offset in their longitudinal direction such that they combine to define a single through hole. A hinge pin would then be inserted through this hole and be releasably retained therein.
  • various means of forming the pivotal connection could be employed.
  • the elements of the retractor housing 14 may be formed of any material suitable for the purpose. For example, rugged plastics or metals may be employed. With the increase in the use of surgical lasers, it is preferred that the exterior of the retractor housing 14 include a matte finish, possibly black. This will avoid reflection of the laser and aid in determining when an incision has been made completely through the vaginal walls, during procedures which require such incisions.
  • the retractor finger 16 may similarly be formed of a variety of materials, including plastics and metals. As with the housing 14, it may be preferable to provide the exterior of finger 16 with a matte finish.
  • the retractor finger 16 may consist essentially of an elongated solid member, having an exterior diameter of approximately 3 mm. While the finger 16 of Fig. 5 has been shown as extending in a substantially straight line, it is possible to form the finger 16 with curvatures such that it does not extend directly radially outward from the retractor pivot 42.
  • the retractor finger may be provided with a guard flange 17 near the lower end thereof, as shown in Fig. 6.
  • This flange will prevent the finger from fully entering the uterus, due to abutment between the flange and the patient's cervix. Use of such a flange will ensure a known insertion depth for the finger, so that it does not perforate or injure the fundus, or other portions, of the uterus.
  • the maximum width of flange 17 may be on the order of 20 mm, with the finger remaining approximately 3mm in diameter. It is preferred that the finger and flange be formed as a monolithic unit.
  • the retractor finger 16 With means to expand and contract the finger adjacent the free end thereof. This expansion should be sufficient such that the finger contacts the interior of the uterus, reducing or eliminating movement of the uterus with respect to the finger.
  • the finger 16 includes a longitudinally extending groove 78 along at least a portion of the length thereof.
  • a sheath 80 formed of a resilient material.
  • the sheath 80 includes a circumferentially extending pocket 82 which is connected to the exterior by a catheter 84 (not shown in cross section for clarity) which extends within the groove 78.
  • the sheath 80 In its initial configuration, the sheath 80 will conform closely to the exterior of finger 16 and as such provide little increase in its outer dimensions, allowing easy insertion of the finger. As the catheter 84 is located within groove 78, there is no longitudinal protuberance along the side of the finger where the catheter runs. Once the finger 16 has been inserted through the cervix and is located within the uterine cavity, a saline solution, air, inert gas or other material may be pumped through the catheter 84 and into the pocket 82. Due to the resilient nature of sheath 80, this will result in expansion of the pocket, increasing the sheath (and therefore the finger) diameter at this point. Once withdrawal of the finger 16 from the uterine cavity is desired, the fluid, air or other material within pocket 82 may be removed therefrom, causing the resilient sheath 80 to collapse to a diameter substantially corresponding to that of finger 16.
  • the use of the flange 17 in conjunction with the expandable finger provides excellent advantages. These elements work together to maintain the uterus in position upon the finger. This in turn allows the finger to be moved such that the uterus is placed in the proper position and reliably maintained in this position.
  • finger 16 is additionally provided with means to effect hydrotubation.
  • the finger 16 is provided with a second groove 86 extending longitudinally thereof to a point above or below the anticipated position of pocket 82.
  • the sheath 80 will include an opening 88 which is connected to a second catheter (also not shown in cross section for clarity) which is run along the second groove 86 to the exterior of the patient, similar to catheter 84.
  • a second catheter also not shown in cross section for clarity
  • saline solution, a dye in saline solution, or other material may be passed through second catheter 90 to be expelled from the opening 88.
  • various openings could be provided within sheath 80 with appropriate communication via catheters or subcatheters running within associated grooves in the finger 16.
  • the finger 16 may be reusable, but it is preferred that it be a one-time or disposable member. Where the finger is provided with the sheath 80 (having pocket 82, opening 88 or both), they may be provided as a single unit for one-time use, or the finger may be reused with a new sheath.
  • the flange prevents excessive insertion of the finger which may damage the uterus. Since there is variation in the size of the uterus from individual to individual, it is preferred that the finger be provided in a number of lengths, such as four. For assurance of the proper size, the different sizes may each be assigned a particular color.
  • This arrangement may be further enhanced by a modification of a standard prior art tool used for uterine sounding, the procedure employed for determining the size of the uterus.
  • This prior art tool consists of an elongated thin rod which is inserted through the cervix into the uterus, until the end of the rod touches the fundus of the uterus, mounted on the rod is a collar which may slide with difficulty along the rod, and which has a exterior diameter greater than the cervix.
  • This collar will abut against the cervix as the rod is inserted , and slid along the rod.
  • the position of the collar on the rod provides an indication of the size of the uterus.
  • this rod may be modified to include several color bands at longitudinal positions, corresponding to the different colored sizes of finger 16. The physician therefore need only match the color of the finger to the color on the rod at the position of the collar.
  • Figs. 10 and 11 The operation of the present device is best illustrated with reference to Figs. 10 and 11.
  • the device 10 has been inserted within the vaginal tract 92 of the patient and the retractor finger 16 inserted through the cervix 94 to be located within the cavity of uterus 96.
  • the finger 16 has been provided with a sheath 80, with the pocket 82 thereof having been inflated to maintain the device in proper position.
  • the trigger 30 has been pivoted towards the handle grip 20, causing the slid rod 34 to move rearwardly with respect to support rod 18. This rearward movement is transmitted to the swing arm 46, causing it to move rearward also, thus causing the retractor pivot 42 to be moved clockwise (in Fig. 10) .
  • the retractor finger 16 is fixed to the retractor pivot 42, the finger 16 is also rotated clockwise, bringing the device into the most anteverted position and moving the uterus towards the symphysis pubis or pelvic bone, and upward out of the abdominal cavity.
  • the device 10 may be rotated about the longitudinal axis of support rod 18 to thus move the uterus laterally to the left or right of the midline plane when in the position shown in Fig. 10. This rotation is easily accomplished by manual movement of the handle grip, which is exterior of the patient. In addition to allowing greater visualization, this will extend the fascia and blood vessels which extend between the sides of the uterus and the pelvic wall. This greatly facilitates procedures on this area, and is an important aspect of the present invention.
  • the trigger 30 has been moved rearwardly away from the handle grip 20, thus causing the slide rod to move forward with respect to the support rod 18.
  • this motion will be transmitted to the swing arm 46 causing the retractor pivot 42 to be moved counter ⁇ clockwise from the position of Fig. 10.
  • This will in turn cause the retractor finger 16 to be moved counter-clockwise, causing the uterus to move downward within the abdominal cavity towards the rectum and into its most retroflexed position.
  • the device 10 may be rotated about the longitudinal axis to provide left or right movement of the tip of the uterus.
  • the amount of angular movement of the retractor pivot 42, and thus the finger and uterus, is dependent upon the geometry of the device, i.e. the placement of the pivot points, length of the swing arm, etc. It is preferred, however, that the device be capable of approximately 115° of movement between the most anteverted position and the most retroflexed position.
  • An important aspect of the present invention is the provision of the pawls 28 which engage with the trigger 30, allowing the retractor pivot to be located securely at numerous angular positions between these extremes.
  • Various other arrangements could be employed for maintaining the trigger in place, such as a screw arrangement.
  • the support rod 18 may be provided with appropriate markings or indicia 92 (Fig. 2) which cooperate with a hash mark 94 upon the slide rod 34.
  • the position of the hash mark 92 with respect to the indicia 93 may thus indicate the position of the finger.
  • elements 92 and 94 have been indicated as adjacent the second end of the slide and support rods in Fig. 2, it is to be understood that the elements 92 and 94 must be placed sufficiently close to the handle assembly 20 such that they will not be obscured by placement within the vaginal tract when the device is in use.
  • the retractor housing 14 may take various shapes other than the substantially cylindrical configuration shown.
  • the retractor may take a shape as shown in Fig. 9, where the lateral sides of the housing and the retractor pivot 42 are formed such that the forwardmost end is a portion of a sphere, with a transition into a generally circular configuration in a plane perpendicular to the longitudinal axis of the support rod. This arrangement may provide a more natural shape for entry into the vaginal tract and provide less damage thereto.
  • the device or portions of the device may be formed of ceramics rather than plastics or metals, and the rotation of the retractor pivot 42 may be affected by other means, such as an electric motor, pressurized saline solution, etc.

Abstract

A uterine retractor (10) having an elongated actuator grip (12) which includes a handle grip (20) with a trigger (30) for initiating relative movement between a support bar (18) and a slide bar (34). The other end of the support bar (18) mounts a retractor housing (14) which supports a retractor pivot (42) for movement about an axis perpendicular to the support bar (18). The retractor pivot (42) is pivotally connected to the slide bar (34) by a swing arm (46) such that movement between the slide bar (34) and support bar (18) will cause rotational movement between the retractor housing (14) and retractor pivot (42). Extending outwardly from the retractor pivot (42) is a retractor finger (16) which may be inserted within the uterus, upon the insertion of the retractor housing (14) within the vaginal tract, with the handle grip (20) and trigger (30) remaining outside of the patient. Movement of the retractor finger (16), due to actuation of trigger (30), will impart movement to the uterus, allowing placement for medical procedures.

Description

UTERINE RETRACTOR
TECHNICAL FIELD
The present invention relates in general to medical devices. In particular, the present invention relates to an improved device for positioning and controlling the uterus within the abdominal cavity to aid in medical procedures.
BACKGROUND ART
The uterus of the human female lies within the pelvic region in the abdominal cavity. The uterus essentially consists of a muscular sack opening onto the innermost end of the vaginal cavity. With the exception of this connection to the vagina, the connection to the fallopian tubes near the upper end of the uterus, and a narrow band of fascia connecting the lower lateral portions of the uterus to the pelvic wall, there are no strong connections holding the uterus in place.
Various surgical procedures are performed upon and near the uterus, such as hysterectomy and tubal ligation. During many of these surgical procedures the uterus needs to be moved to various positions to assist in the procedure. The lack of a strong connection between the uterus and other internal organs allows such movement, but effecting such movement has been a source of continuing difficulty.
DISCLOSURE OF INVENTION
An object of the present invention is the provision of a medical device which will allow movement of the uterus to a desired position, in more than two dimensions, and maintain the uterus in this position.
Another object of the present invention is to provide such a device which may firmly and saf ly maintain the uterus in the desired position.
Yet another object of the present invention is to provide such a device which may allow for hydrotubation.
These and other objects are achieved by a uterine retractor having an elongated actuator grip which provides relative sliding movement between a support bar and a slide bar. One end of the actuator grip includes a handle grip with a trigger for initiating relative movement between the support bar and slide bar. The other end of the actuator handle mounts a retractor housing. The retractor housing is fixed to the support bar and supports a retractor pivot for movement about an axis substantially perpendicular to the support bar. The retractor pivot is pivotally connected to the slide bar such that relative sliding movement between the slide bar and support bar will cause relative rotational movement between the retractor housing and retractor pivot. Extending outwardly from the retractor pivot is a retractor finger which may be inserted within the uterus, upon the insertion of the retractor housing within the vaginal tract of the patient, with the handle grip and trigger remaining outside of the patient. Movement of the retractor finger, due to actuation of the trigger, will thus impart movement to the uterus, allowing placement for medical procedures.
BRIEF DESCRIPTION OF THE DRAWINGS
The objects and features of the invention noted above are explained in more detail with reference to the drawings in which like reference numerals denote like elements, and in which:
Fig. 1 is a perspective view of the device according to the present invention; Fig. 2 is a detail perspective view of a portion of the device of Fig. 1;
Fig. 3 is an exploded side view of the retractor assembly of Fig. l; Fig. 4 is a partial side view in cross-section of the device of Fig. 1. ;
Figs. 5-8 show embodiments of retractor fingers according to the present invention;
Fig. 9 shows a second embodiment of the device according to the present invention; and
Figs. 10 and 11 are cross-sectional side views showing operation of the device.
BEST MODE OF CARRYING OUT THE INVENTION With reference to Fig. 1, the device according to the present invention is generally designated by reference numeral 10. The device 10 generally consists of an actuator grip 12, a retractor housing 14 and a retractor finger 16.
The actuator grip 12 is preferably of a form commonly employed for various medical devices, such as surgical scissors, clamps, etc. The grip 12 includes an elongated support rod 18 which includes an integral handle grip 20 at a first end thereof. The handle grip 20 may include various protrusions 22 to improve control of the handle grip when it is manually grasped. Extending rearwardly from a lower end of the handle grip 20 is a catch member 24. The catch member 24 extends in an arc about a pivot axis 26 adjacent the intersection of the handle grip 20 and support rod 18. The catch member 24 includes a plurality of pawls along at least one side thereof.
The pawls 26 are adapted to engage a lower end of a trigger 28 which pivoted to the axis 26 adjacent an upper end of the trigger. The pawls 28 will engage with the trigger 30 to prevent movement of the trigger relative to the catch member in at least one direction. The trigger 30 may include an extending through hole 32 adapted to receive the user's thumb therethrough and act as a thumb grip to allow the trigger 30 to be drawn rearwardly away from the handle grip 20. Alternatively, or additionally, a spring could be provided for biasing the trigger rearwardly of the handle grip. This could be affected by use of a coil spring extending between these two members, preferably formed as a coil spring extending about the axis 26 and engaged between the members 20 and 30.
The upper end of trigger 30 extends beyond axis 26 and is pivoted to a slide rod 34 slidably mounted upon support rod 18. As is best shown in Fig. 2, it is preferred that the support rod 18 have a roughly circular exterior configuration (in cross-section) and include a slide cavity 36 extending longitudinally through the length of the support rod 18. This slide cavity receives the slide rod 34. To ensure that the slide rod is maintained within the slide cavity 36, it is preferred that these elements have appropriate mating configurations, such as a trapezoidal configuration shown in Fig. 2.
As may be readily seen, pivotal movement of the trigger 30 about axis 26 will result in sliding movement of the slide rod 34 with respect to support rod 18. It is this relative sliding movement which is employed in the present device to effect movement of the retractor finger 16 with respect to the retractor housing 14.
The retractor housing 14 is mounted upon a second end of the support rod 18 and is fixed with respect thereto. The mounting of the retractor housing to the support rod may be permanent, in which case various portions of the retractor housing may be made monolithic with the support rod, or the retractor housing may be removably mounted upon the support rod 18. For such a removable mounting the second end of the support rod may include a circumferential catch groove 38 extending about a portion of the outer periphery of the support rod which will receive a mating ridge of the retractor housing. Other arrangements allowing removal of the housing could of course be employed, such as exterior threads on the support rod which engage with a threaded collar on the housing, etc.
The retractor housing extends forwardly of the second end of the support rod 18 to a pair of lateral pivot blocks 40. The pivot blocks 40 are spaced from each other and provide a pivotal mount for a retractor pivot 42 which is mounted between the pivot blocks. The retractor pivot is mounted for rotation about an axis substantially perpendicular to the longitudinal axis of the support rod 18.
With particular reference to Fig. 4, it will be seen that at least a portion of the periphery of the retractor pivot 42 is substantially circular such that it may freely pivot with respect to housing 14. A laterally central portion of protractor pivot 42 is removed along a chord spaced from the pivot axis of pivot 42 to define a channel 44. Within channel 44 a first end of a swing arm 46 is pivoted to the retractor pivot about an axis substantially perpendicular to the longitudinal axis of the support rod 18, at a point spaced from the pivot axis of pivot 42. The swing arm 46 extends rearwardly from this connection to the retractor pivot 42 and is connected at its second end to the slide rod 34.
As may be readily envisioned from Fig. 4, relative movement of the slide rod 34 will cause movement of swing arm 46, thus causing rotation of retractor pivot 42. Since the swing arm 46 is pivoted to the retractor pivot 42 at a position spaced from the pivot axis of member 42, vertical motion will be imparted to the first end of the swing arm. If such vertical movement were imparted to the slide rod 34, this could cause binding within the slide cavity 36, restricting movement of the slide rod. To overcome this difficulty, it may be necessary to provide the second end of swing arm 46 with a pivotal connection to the slide rod. This may be effected by various means, for example by use of a coupling 48.
The coupling 48 is pivoted to the second end of swing arm 46 about an axis substantially perpendicular to the longitudinal axis of support rod 18. The other end of coupling 48 will include means for connecting with the slide rod 34. This may be by means of a coupling cavity 50 which is sized to receive the second end of slide rod 34. Where the retractor housing 14 is removably mounted upon the support rod 18, the coupling 48 must be removably mounted to slide rod 34. To affect this, the second end of slide rod 34 may be provided with a peripheral groove 52, similar to catch groove 38 on the support rod, and the interior of the coupling cavity 50 include a mating ridge which will be removably received within groove 52. To allow the ridge of the coupling to fit over the end of the slide rod 34, an appropriate slit (not shown) extending perpendicular to the ridge may be provided. Of course, where the pivot housing is provided integral with the support rod 18 the swing arm 46 need not be removable from the slide rod 34. In such situations the second end of swing arm 46 may be pivoted directly to slide rod 34, as is shown in Figs. 10 and 11.
The outer periphery of retractor pivot 42 includes a finger mounting hole 54. Mounting hole 54 extends radially inward of the retractor pivot and includes appropriate means, such as internal threads, to removably mount the retractor finger 16. The retractor finger 16 is an essentially elongated member preferably having a rounded free end 56 and means at the other end, such as a threaded bolt 55, for engagement with the mounting hole 54.
Regardless of whether the retractor housing 14 is removable from the support rod 18, it is preferable that the device be capable of partial disassembly for cleaning after use. One such arrangement to effect cleaning is shown in Fig. 3. As is shown in this figure, the retractor housing 14 is formed as a main housing 58 having a cavity 60 adapted to receive the support rod 18. The main housing 58 also includes a swing arm channel 62 extending froi? the cavity 60 outwardly to a mounting face 64. As shc-ild be apparent, the swing arm channel will house the swing arm 46 and allow its communication between the retractor pivot 42 and slide rod 34.
The mounting face 64 includes a pair of chamfer blocks 66 extending outwardly therefrom. As is shown in Fig. 3, the chamfer blocks taper inwardly t wards the mounting face 64 when viewed from the side. The chamfer blocks each serve to mount an associated pivot support 68. Each pivot support may be a substantially cylindrical member having an outer diameter substantially equal to that of the retractor pivot 62, such that these elements form a substantially continuous cylindrical surface. In such a case the outer peripheral edges of each pivot support are preferably provided with smooth transitions 76 to reduce sharp edges and thus the possibility of damage to the vaginal tract.
Each pivot support 68 includes a trapezoidal channel 70 at a position on the periphery thereof, and opening onto the interior planar face, which will mate with the associated chamfer block 66. The chamfer block 66 and channels 70 may be provided with appropriate grooves and ridges, as with grooves 38 or 52, such that the pivot supports will be securely retained in place during use of the device.
It should of course be apparent that various other means of attaching the pivot supports to the main housing could be employed, such as a threaded hole in the pivot support which receives a bolt extending through the main housing. The particular manner of attaching the pivot supports is not critical, and is determined by ease of manufacturing, security of attachment and ability to disassemble for cleaning. Each of the pivot supports 68 also includes a substantially centrally located pivot hole 72 adapted to receive a pivot rod 74 extending outwardly from the planar faces of the retractor pivot 42. As may be readily envisioned, the retractor pivot will be held in place by the pivot rods 74 received within the pivot holes 72 while the pivot supports are maintained in position upon the chamfer blocks 66. As such, the retractor housing 14 may be at least partially disassembled for cleaning. The pivot rods could of course be formed on the pivot supports, with the retractor pivot 42 having pivot holes 72, or the pivot rods could be formed by a single long rod extending through the pivot supports and retractor pivot.
It is also possible to avoid the use of pivot supports entirely. For example an arrangement similar to a standard hinge could be employed for pivoting the retractor pivot to the main housing. In such an arrangement the both the retractor pivot and main housing could have one or more integrally formed through holes, each offset in their longitudinal direction such that they combine to define a single through hole. A hinge pin would then be inserted through this hole and be releasably retained therein. As such, it should be apparent that various means of forming the pivotal connection could be employed.
The elements of the retractor housing 14 may be formed of any material suitable for the purpose. For example, rugged plastics or metals may be employed. With the increase in the use of surgical lasers, it is preferred that the exterior of the retractor housing 14 include a matte finish, possibly black. This will avoid reflection of the laser and aid in determining when an incision has been made completely through the vaginal walls, during procedures which require such incisions.
The retractor finger 16 may similarly be formed of a variety of materials, including plastics and metals. As with the housing 14, it may be preferable to provide the exterior of finger 16 with a matte finish.
As shown in Fig. 5, the retractor finger 16 may consist essentially of an elongated solid member, having an exterior diameter of approximately 3 mm. While the finger 16 of Fig. 5 has been shown as extending in a substantially straight line, it is possible to form the finger 16 with curvatures such that it does not extend directly radially outward from the retractor pivot 42.
The retractor finger may be provided with a guard flange 17 near the lower end thereof, as shown in Fig. 6. This flange will prevent the finger from fully entering the uterus, due to abutment between the flange and the patient's cervix. Use of such a flange will ensure a known insertion depth for the finger, so that it does not perforate or injure the fundus, or other portions, of the uterus. The maximum width of flange 17 may be on the order of 20 mm, with the finger remaining approximately 3mm in diameter. It is preferred that the finger and flange be formed as a monolithic unit.
To ensure that the uterus is maintained in the desired position, it is an important aspect of the present invention to provide the retractor finger 16 with means to expand and contract the finger adjacent the free end thereof. This expansion should be sufficient such that the finger contacts the interior of the uterus, reducing or eliminating movement of the uterus with respect to the finger.
One means for effecting this is shown in the embodiment of Fig. 7. In this embodiment, the finger 16 includes a longitudinally extending groove 78 along at least a portion of the length thereof. Mounted over the finger 16 is a sheath 80 formed of a resilient material. The sheath 80 includes a circumferentially extending pocket 82 which is connected to the exterior by a catheter 84 (not shown in cross section for clarity) which extends within the groove 78.
In its initial configuration, the sheath 80 will conform closely to the exterior of finger 16 and as such provide little increase in its outer dimensions, allowing easy insertion of the finger. As the catheter 84 is located within groove 78, there is no longitudinal protuberance along the side of the finger where the catheter runs. Once the finger 16 has been inserted through the cervix and is located within the uterine cavity, a saline solution, air, inert gas or other material may be pumped through the catheter 84 and into the pocket 82. Due to the resilient nature of sheath 80, this will result in expansion of the pocket, increasing the sheath (and therefore the finger) diameter at this point. Once withdrawal of the finger 16 from the uterine cavity is desired, the fluid, air or other material within pocket 82 may be removed therefrom, causing the resilient sheath 80 to collapse to a diameter substantially corresponding to that of finger 16.
The use of the flange 17 in conjunction with the expandable finger provides excellent advantages. These elements work together to maintain the uterus in position upon the finger. This in turn allows the finger to be moved such that the uterus is placed in the proper position and reliably maintained in this position.
In yet another embodiment shown in Fig. 8, the features of the embodiment of Fig. 7 are retained, but finger 16 is additionally provided with means to effect hydrotubation. In this arrangement the finger 16 is provided with a second groove 86 extending longitudinally thereof to a point above or below the anticipated position of pocket 82. The sheath 80 will include an opening 88 which is connected to a second catheter (also not shown in cross section for clarity) which is run along the second groove 86 to the exterior of the patient, similar to catheter 84. When hydrotubation is desired, saline solution, a dye in saline solution, or other material may be passed through second catheter 90 to be expelled from the opening 88. As should be apparent to those skilled in the art, various openings could be provided within sheath 80 with appropriate communication via catheters or subcatheters running within associated grooves in the finger 16.
The finger 16 may be reusable, but it is preferred that it be a one-time or disposable member. Where the finger is provided with the sheath 80 (having pocket 82, opening 88 or both), they may be provided as a single unit for one-time use, or the finger may be reused with a new sheath.
As noted above, the flange prevents excessive insertion of the finger which may damage the uterus. Since there is variation in the size of the uterus from individual to individual, it is preferred that the finger be provided in a number of lengths, such as four. For assurance of the proper size, the different sizes may each be assigned a particular color.
This arrangement may be further enhanced by a modification of a standard prior art tool used for uterine sounding, the procedure employed for determining the size of the uterus. This prior art tool consists of an elongated thin rod which is inserted through the cervix into the uterus, until the end of the rod touches the fundus of the uterus, mounted on the rod is a collar which may slide with difficulty along the rod, and which has a exterior diameter greater than the cervix.
This collar will abut against the cervix as the rod is inserted , and slid along the rod. Upon withdrawal of the rod from the patient, the position of the collar on the rod provides an indication of the size of the uterus. To aid in choosing the proper size of finger 16, this rod may be modified to include several color bands at longitudinal positions, corresponding to the different colored sizes of finger 16. The physician therefore need only match the color of the finger to the color on the rod at the position of the collar.
The operation of the present device is best illustrated with reference to Figs. 10 and 11. In each of these figures the device 10 has been inserted within the vaginal tract 92 of the patient and the retractor finger 16 inserted through the cervix 94 to be located within the cavity of uterus 96. In each of these figures, the finger 16 has been provided with a sheath 80, with the pocket 82 thereof having been inflated to maintain the device in proper position.
In the position of Fig. 10, the trigger 30 has been pivoted towards the handle grip 20, causing the slid rod 34 to move rearwardly with respect to support rod 18. This rearward movement is transmitted to the swing arm 46, causing it to move rearward also, thus causing the retractor pivot 42 to be moved clockwise (in Fig. 10) . As the retractor finger 16 is fixed to the retractor pivot 42, the finger 16 is also rotated clockwise, bringing the device into the most anteverted position and moving the uterus towards the symphysis pubis or pelvic bone, and upward out of the abdominal cavity.
It should be apparent that in this position the surgeon will have excellent visualization of, and access for operation upon, the uterus, the fallopian tubes and other organs during surgical procedures. The uterus in this position lies well away from the other abdominal organs, such as the bowel, reducing the possibility of injury to these other organs during procedures. This position has been found to greatly facilitate surgery in this area, especially using laproscopic techniques.
It should also be noted that the device 10 may be rotated about the longitudinal axis of support rod 18 to thus move the uterus laterally to the left or right of the midline plane when in the position shown in Fig. 10. This rotation is easily accomplished by manual movement of the handle grip, which is exterior of the patient. In addition to allowing greater visualization, this will extend the fascia and blood vessels which extend between the sides of the uterus and the pelvic wall. This greatly facilitates procedures on this area, and is an important aspect of the present invention.
In the position shown in Fig. 11, the trigger 30 has been moved rearwardly away from the handle grip 20, thus causing the slide rod to move forward with respect to the support rod 18. As above, this motion will be transmitted to the swing arm 46 causing the retractor pivot 42 to be moved counter¬ clockwise from the position of Fig. 10. This will in turn cause the retractor finger 16 to be moved counter-clockwise, causing the uterus to move downward within the abdominal cavity towards the rectum and into its most retroflexed position. As before, the device 10 may be rotated about the longitudinal axis to provide left or right movement of the tip of the uterus.
The amount of angular movement of the retractor pivot 42, and thus the finger and uterus, is dependent upon the geometry of the device, i.e. the placement of the pivot points, length of the swing arm, etc. It is preferred, however, that the device be capable of approximately 115° of movement between the most anteverted position and the most retroflexed position.
An important aspect of the present invention is the provision of the pawls 28 which engage with the trigger 30, allowing the retractor pivot to be located securely at numerous angular positions between these extremes. Various other arrangements could be employed for maintaining the trigger in place, such as a screw arrangement.
For an accurate indication of the angular position of the finger with respect to the support rod, the support rod 18 may be provided with appropriate markings or indicia 92 (Fig. 2) which cooperate with a hash mark 94 upon the slide rod 34. The position of the hash mark 92 with respect to the indicia 93 may thus indicate the position of the finger. (While elements 92 and 94 have been indicated as adjacent the second end of the slide and support rods in Fig. 2, it is to be understood that the elements 92 and 94 must be placed sufficiently close to the handle assembly 20 such that they will not be obscured by placement within the vaginal tract when the device is in use.)
While the above invention has been described with reference to a particular embodiment, it should be apparent to those skilled in the art that various modifications may be made. For example, the retractor housing 14 may take various shapes other than the substantially cylindrical configuration shown. For example, the retractor may take a shape as shown in Fig. 9, where the lateral sides of the housing and the retractor pivot 42 are formed such that the forwardmost end is a portion of a sphere, with a transition into a generally circular configuration in a plane perpendicular to the longitudinal axis of the support rod. This arrangement may provide a more natural shape for entry into the vaginal tract and provide less damage thereto. Various other modifications could of course be made. For example, the device or portions of the device may be formed of ceramics rather than plastics or metals, and the rotation of the retractor pivot 42 may be affected by other means, such as an electric motor, pressurized saline solution, etc.
From the foregoing it will be seen that this invention is one well adapted to attain all ends and objects hereinabove set forth together with the other advantages which are obvious and which are inherent to the structure.
It will be understood that certain features and subcombinations are of utility and may be employed without reference to other features and subcombinations. This is contemplated by and is within the scope of the claims.
Since many possible embodiments may be made of the invention without departing from the scope thereof, it is to be understood that all matter herein set forth or shown in the accompanying drawings is to be interpreted as illustrative, and not in a limiting sense.

Claims

CLAIMS :
1. A uterine retractor, characterized by: a retractor housing adapted to be inserted within the vaginal tract of a patient; a retractor finger rotatably mounted to, and extending outwardly from, said retractor housing and adapted to be inserted through the cervix and into the uterus of the patient; and means for causing relative pivotal movement of said retractor finger with respect to said retractor housing, thereby causing movement of said retractor finger and the uterus with respect to the vaginal tract.
2. A uterine retractor as in Claim 1, wherein said retractor finger includes means permitting ejection of fluids therefrom.
3. A uterine retractor as in Claim 1, wherein said retractor finger includes a first free end and a second end adjacent said retractor housing, said second end including an enlarged outwardly directed flange adapted to abut against the cervix of the patient.
4. A uterine retractor as in Claim 1, wherein said retractor finger includes a first free end and a second end adjacent said retractor housing, and further includes a selectively expandable portion adjacent said first end, said expandable portion adapted to prevent unintentional removal of said finger from the uterus of the patient, and further including means permitting expansion and contraction of said expandable portion.
5. A uterine retractor as in Claim 4, wherein said retractor finger includes a first free end and a second end adjacent said retractor housing, said second end including an enlarged outwardly directed flange adapted to abut against the cervix of the patient.
6. A uterine retractor as in Claim 4, wherein said retractor finger includes means permitting ejection of fluids therefrom.
7. A uterine retractor as in Claim 6, wherein said retractor finger includes a first free end and a second end adjacent said retractor housing, said second end including an enlarged outwardly directed flange adapted to abut against the cervix of the patient.
8. A uterine retractor, characterized by: an actuator grip having an elongated support rod, a slide rod slidably mounted to, and substantially contained by, said support rod, a handle grip mounted on a first end of said support rod, and a trigger pivotally mounted to said first end of each said support and slide rod at spaced locations such that movement of said trigger with respect to said handle grip causes relative sliding movement between said support rod and said slide rod; a retractor housing mounted to a forward second end of said support rod and adapted to be inserted within the vaginal tract of a patient, said housing including at least one pivot support; a retractor pivot mounted to said pivot support for pivotal movement about an axis; a swing arm having a first end pivotally mounted to a second end of said slide rod and a second end pivotally mounted to said retractor pivot at a point spaced from said axis, whereby relative sliding movement between said slide rod and said support rod causes relative pivotal movement between said pivot support and said retractor pivot; and a retractor finger mounted to, and extending outwardly from, said retractor pivot and adapted to be inserted through the cervix and into the uterus of the patient whereby movement pivotal movement of said retractor pivot causes pivotal movement of said retractor finger and the uterus with respect to the vaginal tract.
9. A uterine retractor as in Claim 8, wherein said retractor pivot, and thus said finger, may pivot about said axis through an arc having end angles, the longitudinal axis of said support rod being between said end angles, and is capable of being releasably fixed at at least three locations between and including said end angles.
10. A uterine retractor as in Claim 8, wherein said pivot support is removable from said main housing, and said retractor pivot is removable from said pivot support, whereby cleaning is facilitated.
11. In method of performing surgical procedures upon a female human in the area of the uterus, the improvement being characterized by: inserting a retractor finger within the uterus; moving said retractor finger, and thus the uterus, to one of a plurality of positions between antroverted and retroflexed extremes; and fixing said finger, and thus said uterus, at said one of said positions.
12. A uterine retractor finger, characterized by: an elongated body having a first end adapted to be inserted through the cervix and located within the uterus and a second end having connector means for allowing releasable connection to a medical device.
13. A uterine retractor finger as in Claim 12, further including a radially outwardly extending flange adjacent said second end, said flange adapted to abut against the cervix.
14. A uterine retractor finger as in Claim 13, further including a selectively expansible and contractible portion adjacent said first end, said portion adapted to contact the interior of the uterus.
15. A uterine retractor finger as in Claim 14, further including an opening at said first end and a conduit connected to said opening and extending toward said second end, said conduit allowing fluid or gas to pass out of said opening, and thus said finger, into the uterus.
PCT/US1992/002081 1992-03-14 1992-03-14 Uterine retractor WO1993018713A1 (en)

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PCT/US1992/002081 WO1993018713A1 (en) 1992-03-14 1992-03-14 Uterine retractor
AU22242/92A AU2224292A (en) 1992-03-14 1992-03-14 Uterine retractor

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Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2003015643A2 (en) * 2001-08-17 2003-02-27 Francois Jacques Lubbe Uterus manipulation device for hysterectomy and colpotomy
EP2308401A1 (en) * 2009-10-12 2011-04-13 Karl Storz GmbH & Co. KG Uterus manipulator
US7988699B2 (en) 2004-10-19 2011-08-02 Warsaw Orthopedic, Inc. Adjustable instrumentation for spinal implant insertion

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US3747603A (en) * 1971-11-03 1973-07-24 B Adler Cervical dilators
US3796211A (en) * 1972-08-07 1974-03-12 Medics Res & Dev Inc Biopsy sampling method and device for the female genital tract
US3877433A (en) * 1973-11-05 1975-04-15 Raymond Lee Organization Inc Uterine elevator and manipulator
US4000743A (en) * 1975-07-09 1977-01-04 Kenneth Weaver Uterine anteverter
US4323057A (en) * 1980-05-27 1982-04-06 Jamieson David J Self retaining uterine elevator
US4430076A (en) * 1982-02-04 1984-02-07 Harris James H Combined uterine injector and manipulative device
US4585438A (en) * 1983-04-14 1986-04-29 Amnon Makler Device for injecting material directly into uterine cavity
US4664114A (en) * 1985-08-12 1987-05-12 Kamran Ghodsian Dilator for cervical canal

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US424178A (en) * 1890-03-25 Murdoch chisholm
US3060924A (en) * 1960-06-01 1962-10-30 Joseph C Rush Apparatus for application of radioactive substance to pelvic cancer
US3747603A (en) * 1971-11-03 1973-07-24 B Adler Cervical dilators
US3796211A (en) * 1972-08-07 1974-03-12 Medics Res & Dev Inc Biopsy sampling method and device for the female genital tract
US3877433A (en) * 1973-11-05 1975-04-15 Raymond Lee Organization Inc Uterine elevator and manipulator
US4000743A (en) * 1975-07-09 1977-01-04 Kenneth Weaver Uterine anteverter
US4323057A (en) * 1980-05-27 1982-04-06 Jamieson David J Self retaining uterine elevator
US4430076A (en) * 1982-02-04 1984-02-07 Harris James H Combined uterine injector and manipulative device
US4585438A (en) * 1983-04-14 1986-04-29 Amnon Makler Device for injecting material directly into uterine cavity
US4664114A (en) * 1985-08-12 1987-05-12 Kamran Ghodsian Dilator for cervical canal

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2003015643A2 (en) * 2001-08-17 2003-02-27 Francois Jacques Lubbe Uterus manipulation device for hysterectomy and colpotomy
WO2003015643A3 (en) * 2001-08-17 2003-10-16 Francois Jacques Lubbe Uterus manipulation device for hysterectomy and colpotomy
US7988699B2 (en) 2004-10-19 2011-08-02 Warsaw Orthopedic, Inc. Adjustable instrumentation for spinal implant insertion
EP2308401A1 (en) * 2009-10-12 2011-04-13 Karl Storz GmbH & Co. KG Uterus manipulator

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