WO1994010926A1 - Organ presenting and holding apparatus for celioscopic hysterectomy - Google Patents

Organ presenting and holding apparatus for celioscopic hysterectomy Download PDF

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Publication number
WO1994010926A1
WO1994010926A1 PCT/FR1993/001137 FR9301137W WO9410926A1 WO 1994010926 A1 WO1994010926 A1 WO 1994010926A1 FR 9301137 W FR9301137 W FR 9301137W WO 9410926 A1 WO9410926 A1 WO 9410926A1
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WIPO (PCT)
Prior art keywords
proximal
rod
distal
hysterectomy
distal part
Prior art date
Application number
PCT/FR1993/001137
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French (fr)
Inventor
Jacques Alain Hourcabie
Original Assignee
Jacques Alain Hourcabie
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 Jacques Alain Hourcabie filed Critical Jacques Alain Hourcabie
Priority to AU55658/94A priority Critical patent/AU5565894A/en
Publication of WO1994010926A1 publication Critical patent/WO1994010926A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/42—Gynaecological or obstetrical instruments or methods
    • A61B17/4241—Instruments for manoeuvring or retracting the uterus, e.g. during laparoscopic surgery

Definitions

  • the present invention relates to an apparatus intended for per laparoscopic hysterectomy and making it possible in particular to present the anterior and posterior vaginal cul de sac while maintaining the uterine position in the desired situation.
  • the object of the invention is to propose a device of simple design, easy to set up and to use and able to facilitate in particular the operations of dissection and hemostasis under the conditions specific to hysterectomy per laparoscopic and in particular taking into account the need to ensure the consistency of the peritoneum tire.
  • the subject of the invention is an apparatus for presenting and holding organs for per laparoscopic hysterectomy, characterized in that it consists of: an elongated body and of substantially cylindrical section, comprising a distal part capable of to be introduced into the vagina and provided with two cheeks in the extension of the wall of said body, arranged substantially diametrically opposite and of shape and dimensions so as to marry, one, the anterior vaginal pouch and, the other, the posterior vaginal pouch, and a proximal part,
  • proximal part of the body - means for gripping said proximal part of the body, - a so-called sealing sleeve, of suitable shape, capable of sliding freely over said body between the proximal and distal parts,
  • a uterine manipulation rod capable of sliding freely, tightly and axially, in said body.
  • Such a device is easy to put into place in the vagina, by marrying by said cheeks each anterior and posterior cul de sac, while leaving the lateral cul de sac free.
  • the sealing sleeve by an adequate displacement along the body of the device, between it and the internal wall of the vagina, allows in a simple way to ensure the constancy of the tire o-peritoneum from the opening of the vagina .
  • the uterine manipulation rod keeps its mobility with respect to the rest of the device at all times, thus making it possible to maintain the uterus during various interventions and to remove it by the vaginal route at the end of the operation. .
  • the body and the sealing sleeve are preferably made of a material, for example silicone, which does not conduct electricity and heat and tolerates the possible application of an electric scalpel without alteration.
  • FIG. 1 is a side elevational view of an apparatus body according to the invention.
  • Figure 2 is a right end view of the body of Figure 1;
  • FIG. 3 is a top view of the body of Figure 1; - Figure 4 is a sectional view along the line
  • Figure 5 is a side elevational view of a uterine manipulation rod
  • Figure 6 is an axial sectional view of a button for controlling the uterine manipulation rod
  • Figure 7 is a side elevational view of a handle for handling the body of the apparatus
  • FIG. 8 is an elevational view with axial half-section of a said sealing sleeve
  • FIG. 9 is a diagram illustrating the apparatus of the invention in situ, during a laparoscopic hysterectomy
  • FIG. 10 illustrates the apparatus of FIG. 9 in the pushed-back position towards the inside of the abdomen of the vaginal cul de sac
  • Figure 11 illustrates the device in the withdrawn position with its sealing sleeve in place.
  • the device shown in Figures 1 to 8 comprises a body 1 of elongated shape and of substantially cylindrical section ( Figures 1 to 4), gripping means 2
  • the body 1 comprises a distal part of the tubular which can be introduced into the vagina and provided with two cheeks, respectively 5 and 6, in the extension of the external wall of said part 1a.
  • the cheeks 5 and 6 are arranged substantially diametrically opposite and of shape and dimensions so as to marry, one (5), the anterior vaginal pouch and, the other (6), the vaginal pouch posterior.
  • the cheeks 5 and 6 are arcuate and of constant and equal thickness and delimit between them, in the tubular wall of the part la, two opposite lateral notches 7.
  • the part thus forms a sort of tulip with two petals (cheeks 5,6) opposite, of unequal length, the posterior cheek 6 being longer than the anterior cheek 5.
  • the bottom of the part 1c is a solid disc 8 pierced in its center with a hole 9 in the axis of the body 1.
  • the distal part 1c is connected to a proximal part 1b, also of tubular shape with a bottom 10 in the form of a disc pierced in its center with a hole 11 identical to the hole 9 and in the axis of the body 1.
  • the distal and the proximal parts 1b are connected to each other by two parallel link arms 12 whose external sides are in the extension of the cylindrical external walls of the parts la, lb.
  • the gripping means 2 of the body 1 are constituted
  • the sealing sleeve 3 is a cylindrical tube whose internal diameter is very slightly greater than the external diameter of the parts 1a, 1b and 12 of the body 1, so that it can be slid onto the latter and slide therein .
  • the sleeve 3 has two parts, one called distal 3a, of reduced thickness and slightly tapered end (16), and the other called proximal 3b, of greater thickness, the two parts 3a, 3b being connected by a frustoconical part 3c.
  • Parts 1 and 3 are preferably made of a material which does not conduct electricity and heat, for example silicone.
  • the uterine manipulation rod 4 (FIG. 5) comprises a cylindrical rod 4a, for example metallic, removably attached at its proximal end to a manipulation button 4b.
  • the rod 4a is provided with a conical thread 17 whose diameter is reduced towards the distal end of the rod 4a.
  • the thread 17 is for example constituted by a spring wire fixed to the rod 4a.
  • the diameter of the rod 4a is very slightly less than that of the holes 9 and 11 in order to be able to engage the rod in the body 1.
  • Figure 9 there is shown the device of the invention in place during a hysterectomy ie per laparoscopic.
  • the distal part 1a of the body 1 is introduced into the vagina 18, the rod 4a having previously been introduced into the holes 9 and 11, the screw 17 being in the space between the cheeks 5,6 and the button 4b being screwed sure the proximal end of the rod 4a after its introduction.
  • the body 1 is held and directed by the handle 13, the sealing sleeve 3 (not shown in FIG. 9) having previously been threaded onto the body 1.
  • the rod 4a is held in the position of maximum withdrawal, the screw 17 being against the bottom 8 of the part la.
  • FIG. 10 represents the part la of the body 1 pushed further into the vagina 18, with the rod 4a held relative to the body 1 to push the uterus 20 into the abdomen, so as to clear the areas 21, 22 where will be made sectioning and dissection operations, while leaving the side sacks free, thanks to the notches 7 between the cheeks 5 and 6.
  • FIG. 11 the section of the peritoneum is shown at 23 and that of the vagina 18 at 24.
  • the distal part 1a is shown in partial withdrawal in the vagina, after dissection, and the sleeve 3 is in the position inserted into the vagina, thus illustrating the position of the device of the invention in the final phase d 'intervention.
  • the part 1a is partially withdrawn, the rod 4a holding the uterus 20 pushed into the abdomen, in order to carry out the haemostasis of the main arteriovenous pedicles of the uterus.
  • the sleeve 3 is of course also in place in the vagina during the dissection and provides the necessary seal for the laparoscopic o-peritoneum tire regardless of the position of the distal part 1a and for the entire time necessary.
  • the rod 4a acts as an intrauterine tutor and allows the uterus 20 to be drawn out by the vaginal route by a simple pulling outwards after possible fragmentation of the uterus.
  • the handle 13 makes it possible to easily introduce and orient the body 1 and to present the cheeks 5 and 6 at will at the bottom of the vaginal cul de sac.
  • anterior cheek 5 makes dissection of the bladder easier because it has a hard underlying plane which no longer leaks under the forceps but resists.
  • the presence of a hard intravaginal mass makes it possible to know exactly where to incise the vagina in a cautious way and thus to make the progressive hemostasis of all the veins and arteries of the anterior cul de sac. It is the same for the posterior cheek 6.
  • the length of the part of the rod 4a penetrating into the uterus 20 is of the order of 6 to 10 cm.
  • the screw 17 can be replaced by a smooth cone making it possible to avoid traumatizing the cervix under certain operating circumstances, this cone allowing a length of rod 4a of 6 to 12 cm to penetrate inside the uterus .
  • the device of the invention can also be used for other functions such as the preparation of the anterior vesicovaginal dissection or the presentation of the uterus when it is necessary to extract bulky abdominal masses by the way of the ass posterior vaginal sac.
  • the invention is obviously not limited to the embodiment shown and described above, but on the contrary covers all the variants thereof, in particular as regards the shape, dimensions and arrangement of the anterior cheeks 5 and posterior 6, and the means for gripping and orienting the body i.

Abstract

An organ presenting and holding apparatus for celioscopic hysterectomy, consisting of an elongated body with a substantially cylindrical cross-section, including a distal portion (1a) for insertion into the vagina, provided with two substantially diametrically opposite flanges (5, 6) extending from the end of said body and being shaped and sized in such a way that one (5) fits the anterior fornix while the other (6) fits the posterior fornix; as well as a proximal portion (1b), a member (13) for gripping said proximal portion (1b) of the body, a suitably shaped sealing sleeve freely slidable over said body between the proximal (1b) and distal (1a) portions thereof, and a uterine manipulation rod (4a) freely, sealably and axially slidable within said body. The apparatus may be used for celioscopic hysterectomy.

Description

APPAREIL DE PRESENTATION ET MAINTIEN DES ORGANES POUR HYSTERECTOMIE PER COELIOSCOPIQUE APPARATUS FOR PRESENTING AND HOLDING ORGANS FOR COELIOSCOPIC HYSTERECTOMY
La présente invention a trait à un appareil destiné à l'hystérectomie per coelioscopique et permettant de réaliser notamment la présentation des culs de sac vaginaux antérieur et postérieur tout en maintenant la position utérine dans la situation désirée.The present invention relates to an apparatus intended for per laparoscopic hysterectomy and making it possible in particular to present the anterior and posterior vaginal cul de sac while maintaining the uterine position in the desired situation.
Le but de l'invention est de proposer un appareil de conception simple, facile de mise en place et d'usage et apte à faciliter en particulier les opérations de dissection et d'hémostase dans les conditions propres à l'hystérectomie per coelioscopique et notamment en tenant compte de la nécessité d'assurer la constance du pneu o- péritoine.The object of the invention is to propose a device of simple design, easy to set up and to use and able to facilitate in particular the operations of dissection and hemostasis under the conditions specific to hysterectomy per laparoscopic and in particular taking into account the need to ensure the consistency of the peritoneum tire.
A cet effet, l'invention a pour objet un appareil de présentation et maintien des organes pour hystérectomie per coelioscopique, caractérisé en ce qu'il est constitué : d'un corps de forme allongée et de section sensiblement cylindrique, comprenant une partie distale susceptible d'être introduite dans le vagin et munie de deux joues dans le prolongement de la paroi dudit corps, disposées de façon sensiblement diamétralement opposée et de forme et dimensions en sorte d'épouser, l'une, le cul de sac vaginal antérieur et, l'autre, le cul de sac vaginal postérieur, et une partie proximale,To this end, the subject of the invention is an apparatus for presenting and holding organs for per laparoscopic hysterectomy, characterized in that it consists of: an elongated body and of substantially cylindrical section, comprising a distal part capable of to be introduced into the vagina and provided with two cheeks in the extension of the wall of said body, arranged substantially diametrically opposite and of shape and dimensions so as to marry, one, the anterior vaginal pouch and, the other, the posterior vaginal pouch, and a proximal part,
- de moyens de préhension de ladite partie proximale du corps, - d'un manchon dit d'étanchéité, de forme appropriée, susceptible de coulisser librement par dessus ledit corps entre les parties proximale et distale,- means for gripping said proximal part of the body, - a so-called sealing sleeve, of suitable shape, capable of sliding freely over said body between the proximal and distal parts,
- et d'une tige de manipulation utérine susceptible de coulisser librement, de manière étanche et axialement, dans ledit corps.- And a uterine manipulation rod capable of sliding freely, tightly and axially, in said body.
Un tel appareil est facile à mettre en place dans le vagin, en épousant par lesdites joues chaque cul de sac antérieur et postérieur, tout en laissant libre les culs de sac latéraux. Le manchon d'étanchéité, par un déplacement adéquat le long du corps de l'appareil, entre celui-ci et la paroi interne du vagin, permet de manière simple d'assurer la constance du pneu o-péritoine dès l'ouverture du vagin. Enfin, la tige de manipulation utérine garde à tout moment sa mobilité par rapport au reste de l'appareil, permettant ainsi de maintenir l'utérus au cours des diverses interventions et d'extirper celui-ci par la voie vaginale en fin d'opération.Such a device is easy to put into place in the vagina, by marrying by said cheeks each anterior and posterior cul de sac, while leaving the lateral cul de sac free. The sealing sleeve, by an adequate displacement along the body of the device, between it and the internal wall of the vagina, allows in a simple way to ensure the constancy of the tire o-peritoneum from the opening of the vagina . Finally, the uterine manipulation rod keeps its mobility with respect to the rest of the device at all times, thus making it possible to maintain the uterus during various interventions and to remove it by the vaginal route at the end of the operation. .
Le corps et le manchon d'étanchéité sont de préférence réalisés en un matériau, par exemple du silicone, non conducteur de l'électricité et de la chaleur et tolérant l'application éventuelle d'un bistouri électrique sans altération.The body and the sealing sleeve are preferably made of a material, for example silicone, which does not conduct electricity and heat and tolerates the possible application of an electric scalpel without alteration.
D'autres caractéristiques et avantages ressortiront de la description qui va suivre d'un mode de réalisation d'un appareil selon l'invention, description donnée à titre d'exemple uniquement et en regard des dessins annexés sur lesquels :Other characteristics and advantages will emerge from the following description of an embodiment of an apparatus according to the invention, description given by way of example only and with reference to the appended drawings in which:
- Figure 1 est une vue en élévation latérale d'un corps d'appareil conforme à l'invention ;- Figure 1 is a side elevational view of an apparatus body according to the invention;
Figure 2 est une vue en bout de droite du corps de la figure 1 ;Figure 2 is a right end view of the body of Figure 1;
- Figure 3 est une vue de dessus du corps de la figure 1 ; - Figure 4 est une vue en coupe suivant la ligne- Figure 3 is a top view of the body of Figure 1; - Figure 4 is a sectional view along the line
IV-IV- du corps de la figure 3 ;IV-IV- of the body of Figure 3;
Figure 5 est une vue en élévation latérale d'une tige de manipulation utérine ;Figure 5 is a side elevational view of a uterine manipulation rod;
Figure 6 est une vue en coupe axiale d'un bouton de commande de la tige de manipulation utérine ; Figure 7 est une vue en élévation latérale d'une poignée de manipulation du corps de l'appareil ;Figure 6 is an axial sectional view of a button for controlling the uterine manipulation rod; Figure 7 is a side elevational view of a handle for handling the body of the apparatus;
- Figure 8 est une vue en élévation avec demi-coupe axiale d'un manchon dit d'étanchéité ; - Figure 9 est un schéma illustrant l'appareil de l'invention in situ, au cours d'une hystérectomie par coelioscopique ;- Figure 8 is an elevational view with axial half-section of a said sealing sleeve; - Figure 9 is a diagram illustrating the apparatus of the invention in situ, during a laparoscopic hysterectomy;
Figure 10 illustre l'appareil de la figure 9 en position repoussée vers l'intérieur de l'abdomen des culs de sac vaginaux, etFIG. 10 illustrates the apparatus of FIG. 9 in the pushed-back position towards the inside of the abdomen of the vaginal cul de sac, and
Figure 11 illustre l'appareil en position de retrait avec son manchon d'étanchéité en place.Figure 11 illustrates the device in the withdrawn position with its sealing sleeve in place.
L'appareil représenté sur les figures 1 à 8 comprend un corps 1 de forme allongée et de section sensiblement cylindrique (figures 1 à 4) , des moyens de préhension 2The device shown in Figures 1 to 8 comprises a body 1 of elongated shape and of substantially cylindrical section (Figures 1 to 4), gripping means 2
(figure 7) , un manchon d'étanchéité 3 (figure 8) et une tige de manipulation utérine 4 (figures 5 et 6) .(Figure 7), a sealing sleeve 3 (Figure 8) and a uterine manipulation rod 4 (Figures 5 and 6).
Le corps 1 comprend une partie distale la tubulaire susceptible d'être introduite dans le vagin et munie de deux joues, respectivement 5 et 6, dans le prolongement de la paroi externe de ladite partie la. Les joues 5 et 6 sont disposées de façon sensiblement diamétralement opposée et de forme et dimensions en sorte d'épouser, l'une (5) , le cul de sac vaginal antérieur et, l'autre (6) , le cul de sac vaginal postérieur.The body 1 comprises a distal part of the tubular which can be introduced into the vagina and provided with two cheeks, respectively 5 and 6, in the extension of the external wall of said part 1a. The cheeks 5 and 6 are arranged substantially diametrically opposite and of shape and dimensions so as to marry, one (5), the anterior vaginal pouch and, the other (6), the vaginal pouch posterior.
Les joues 5 et 6 sont arquées et d'épaisseur constante et égale et délimitent entre elles, dans la paroi tubulaire de la partie la, deux échancrures latérales opposées 7.The cheeks 5 and 6 are arcuate and of constant and equal thickness and delimit between them, in the tubular wall of the part la, two opposite lateral notches 7.
La partie le forme ainsi une sorte de tulipe avec deux pétales (joues 5,6) opposés, de longueur inégale, la joue postérieure 6 étant plus longue que la joue antérieure 5.The part thus forms a sort of tulip with two petals (cheeks 5,6) opposite, of unequal length, the posterior cheek 6 being longer than the anterior cheek 5.
Le fond de la partie le est un disque plein 8 percé en son centre d'un trou 9 dans l'axe du corps 1.The bottom of the part 1c is a solid disc 8 pierced in its center with a hole 9 in the axis of the body 1.
La partie distale le est reliée à une partie proximale lb, également de forme tubulaire avec une fond 10 en forme de disque percé en son centre d'un trou 11 identique au trou 9 et dans l'axe du corps 1.The distal part 1c is connected to a proximal part 1b, also of tubular shape with a bottom 10 in the form of a disc pierced in its center with a hole 11 identical to the hole 9 and in the axis of the body 1.
Les parties distale la et proximale lb sont reliées entre elles par deux bras de liaison parallèles 12 dont les flancs externes sont dans le prolongement des parois externes cylindriques des parties la, lb.The distal and the proximal parts 1b are connected to each other by two parallel link arms 12 whose external sides are in the extension of the cylindrical external walls of the parts la, lb.
Les moyens de préhension 2 du corps 1 sont constituésThe gripping means 2 of the body 1 are constituted
(figure 7) d'une poignée 13 reliée à un collier de fixation 14, déporté latéralement par rapport à la poignée 13, et muni d'un trou taraudé 15 pour l'engagement d'une vis de blocage. Le collier 14 est susceptible de s'engager par dessus la partie proximale lb sur laquelle il est verrouillé grâce à ladite vis de blocage. Le manchon d'étanchéité 3 (figure 8) est un tube cylindrique dont le diamètre interne est très légèrement supérieur au diamètre externe des parties la, lb et 12 du corps 1, en sorte de pouvoir être enfilé sur ce dernier et d'y coulisser. Le manchon 3 comporte deux parties, l'une dite distale 3a, d'épaisseur réduite et d'extrémité légèrement effilée (16) , et l'autre dite proximale 3b, d'épaisseur plus importante, les deux parties 3a,3b étant reliées par une partie tronconique 3c. Les pièces 1 et 3 sont de préférence réalisée en un matériau non conducteur de l'électricité et de la chaleur, par exemple en silicone.(Figure 7) of a handle 13 connected to a fixing collar 14, offset laterally relative to the handle 13, and provided with a threaded hole 15 for the engagement of a locking screw. The collar 14 is capable of engaging over the proximal part 1b on which it is locked by virtue of said locking screw. The sealing sleeve 3 (FIG. 8) is a cylindrical tube whose internal diameter is very slightly greater than the external diameter of the parts 1a, 1b and 12 of the body 1, so that it can be slid onto the latter and slide therein . The sleeve 3 has two parts, one called distal 3a, of reduced thickness and slightly tapered end (16), and the other called proximal 3b, of greater thickness, the two parts 3a, 3b being connected by a frustoconical part 3c. Parts 1 and 3 are preferably made of a material which does not conduct electricity and heat, for example silicone.
La tige 4 de manipulation utérine (figure 5) comprend une tige cylindrique 4a, par exemple métallique, fixée de manière amovible à son extrémité proximale à un bouton 4b de manipulation. En outre, à quelque distance de son extrémité distale, la tige 4a est munie d'un filet conique 17 dont le diamètre va en se réduisant vers l'extrémité distale de la tige 4a. Le filet 17 est par exemple constitué par un fil à ressort fixé à la tige 4a. Le diamètre de la tige 4a est très légèrement inférieur à celui des trous 9 et 11 afin de pouvoir engager la tige dans le corps 1.The uterine manipulation rod 4 (FIG. 5) comprises a cylindrical rod 4a, for example metallic, removably attached at its proximal end to a manipulation button 4b. In addition, at some distance from its distal end, the rod 4a is provided with a conical thread 17 whose diameter is reduced towards the distal end of the rod 4a. The thread 17 is for example constituted by a spring wire fixed to the rod 4a. The diameter of the rod 4a is very slightly less than that of the holes 9 and 11 in order to be able to engage the rod in the body 1.
Sur la figure 9 on a représenté le dispositif de l'invention en place lors d'une hystérecto ie per coelioscopique.In Figure 9 there is shown the device of the invention in place during a hysterectomy ie per laparoscopic.
La partie distale la du corps 1 est introduite dans le vagin 18, la tige 4a ayant au préalable été introduite dans les trous 9 et 11, la vis 17 se trouvant dans l'espace entre les joues 5,6 et le bouton 4b étant vissé sur l'extrémité proximale de la tige 4a après son introduction.The distal part 1a of the body 1 is introduced into the vagina 18, the rod 4a having previously been introduced into the holes 9 and 11, the screw 17 being in the space between the cheeks 5,6 and the button 4b being screwed sure the proximal end of the rod 4a after its introduction.
Le corps 1 est tenu et dirigé grâce à la poignée 13, le manchon d'étanchéité 3 (non représenté sur la figure 9) ayant au préalable été enfilé sur le corps 1. Au moment de l'introduction de la partie la dans le vagin, la tige 4a est maintenue en position de retrait maximale, la vis 17 étant contre le fond 8 de la partie la.The body 1 is held and directed by the handle 13, the sealing sleeve 3 (not shown in FIG. 9) having previously been threaded onto the body 1. When the part 1a was introduced into the vagina , the rod 4a is held in the position of maximum withdrawal, the screw 17 being against the bottom 8 of the part la.
Dans la position représentée sur la figure 9, les joues 5 et 6 sont presque arrivées au fond respectivement du cul de sac vaginal antérieur, sous la vessie 19 et du cul de sac vaginal postérieur, entre les ligaments utéro-sacrés et la tige 4a est enfoncée jusqu'à ce que la vis 17 soit complètement engagée dans le col de l'utérus 20.In the position shown in FIG. 9, the cheeks 5 and 6 have almost arrived at the bottom respectively of the anterior vaginal sac, under the bladder 19 and of the posterior vaginal cul, between the uterosacral ligaments and the rod 4a is pushed in until screw 17 is fully engaged in the cervix 20.
La figure 10 représente la partie la du corps 1 enfoncée davantage dans le vagin 18, avec la tige 4a maintenue par rapport au corps 1 pour repousser l'utérus 20 dans l'abdomen, en sorte de dégager les zones 21,22 où se feront les opérations de section et dissection, tout en laissant libre les culs de sacs latéraux, grâce aux échancrures 7 entre les joues 5 et 6.FIG. 10 represents the part la of the body 1 pushed further into the vagina 18, with the rod 4a held relative to the body 1 to push the uterus 20 into the abdomen, so as to clear the areas 21, 22 where will be made sectioning and dissection operations, while leaving the side sacks free, thanks to the notches 7 between the cheeks 5 and 6.
Sur la figure 11 on a représenté en 23 la section du péritoine et en 24 celle du vagin 18.In FIG. 11, the section of the peritoneum is shown at 23 and that of the vagina 18 at 24.
En outre, sur cette figure 11, la partie distale la est représentée en retrait partiel dans le vagin, après dissection, et le manchon 3 est en position introduite dans le vagin, illustrant ainsi la position du dispositif de l'invention en phase finale d'intervention.In addition, in this FIG. 11, the distal part 1a is shown in partial withdrawal in the vagina, after dissection, and the sleeve 3 is in the position inserted into the vagina, thus illustrating the position of the device of the invention in the final phase d 'intervention.
Dans cette phase finale, la partie la est partiellement retirée, la tige 4a maintenant l'utérus 20 poussé dans l'abdomen, afin de procéder à l'hémostase des pédicules artério-veineux principaux de l'utérus.In this final phase, the part 1a is partially withdrawn, the rod 4a holding the uterus 20 pushed into the abdomen, in order to carry out the haemostasis of the main arteriovenous pedicles of the uterus.
Le manchon 3 est bien entendu également en place dans le vagin au cours de la dissection et assure l'étanchéité nécessaire au pneu o-péritoine coelioscopique indépendamment de la position de la partie distale la et durant tout le temps nécessaire.The sleeve 3 is of course also in place in the vagina during the dissection and provides the necessary seal for the laparoscopic o-peritoneum tire regardless of the position of the distal part 1a and for the entire time necessary.
En l'absence d'un tel manchon 3, en effet, le gaz carbonique introduit dans la cavité abdominale s'échapperait par la voie vaginale dès l'ouverture des culs de sac antérieur et postérieur. La tige 4a fait office de tuteur intra-utérin et permet d'extirper l'utérus 20 par la voie vaginale par une simple traction vers l'extérieur après fragmentation éventuelle de l'utérus. La poignée 13 permet d'introduire et orienter facilement le corps 1 et de présenter à volonté les joues 5 et 6 au fond des culs de sac vaginaux.In the absence of such a sleeve 3, in fact, the carbon dioxide introduced into the abdominal cavity would escape via the vaginal route as soon as the anterior and posterior cults are opened. The rod 4a acts as an intrauterine tutor and allows the uterus 20 to be drawn out by the vaginal route by a simple pulling outwards after possible fragmentation of the uterus. The handle 13 makes it possible to easily introduce and orient the body 1 and to present the cheeks 5 and 6 at will at the bottom of the vaginal cul de sac.
La présence de la joue antérieure 5 rend plus aisée la dissection de la vessie car elle présente un plan sous- jacent dur qui ne fuit plus sous les pinces mais résiste. De plus, la présence d'une masse dure intra-vaginale permet de savoir exactement où inciser le vagin de façon précautionneuse et ainsi de faire l'hémostase progressive de toutes les veines et artères du cul de sac antérieur. II en est de même pour la joue postérieure 6.The presence of the anterior cheek 5 makes dissection of the bladder easier because it has a hard underlying plane which no longer leaks under the forceps but resists. In addition, the presence of a hard intravaginal mass makes it possible to know exactly where to incise the vagina in a cautious way and thus to make the progressive hemostasis of all the veins and arteries of the anterior cul de sac. It is the same for the posterior cheek 6.
La longueur de la partie de la tige 4a pénétrant dans l'utérus 20 est de l'ordre de 6 à 10 cm.The length of the part of the rod 4a penetrating into the uterus 20 is of the order of 6 to 10 cm.
La vis 17 peut être remplacée par un cône lisse permettant d'éviter de traumatiser le col de l'utérus dans certaines circonstances opératoires, ce cône laissant pénétrer à l'intérieur de l'utérus une longueur de tige 4a de 6 à 12 cm environ.The screw 17 can be replaced by a smooth cone making it possible to avoid traumatizing the cervix under certain operating circumstances, this cone allowing a length of rod 4a of 6 to 12 cm to penetrate inside the uterus .
Le dispositif de l'invention peut être utilisé également pour d'autres fonctions telles que la préparation de la dissection vésico-vaginale antérieure ou la présentation de l'utérus lorsqu'on a besoin d'extraire des masses abdominales volumineuses par la voie du cul de sac vaginal postérieur.The device of the invention can also be used for other functions such as the preparation of the anterior vesicovaginal dissection or the presentation of the uterus when it is necessary to extract bulky abdominal masses by the way of the ass posterior vaginal sac.
Enfin, l'invention n'est évidemment pas limitée au mode de réalisation représenté et décrit ci-dessus, mais en couvre au contraire toutes les variantes, notamment en ce qui concerne les forme, dimensions et disposition des joues antérieure 5 et postérieure 6, et les moyens de préhension- orientation du corps i. Finally, the invention is obviously not limited to the embodiment shown and described above, but on the contrary covers all the variants thereof, in particular as regards the shape, dimensions and arrangement of the anterior cheeks 5 and posterior 6, and the means for gripping and orienting the body i.

Claims

R E V E N D I C A T I O N S
1. Appareil de présentation et maintien des organes pour hystérectomie per coelioscopique, caractérisé en ce qu'il est constitué :1. Apparatus for presenting and holding organs for per laparoscopic hysterectomy, characterized in that it consists of:
- d'un corps (1) de forme allongée et de section sensiblement cylindrique, comprenant une partie distale (la) susceptible d'être introduite dans le vagin et munie de deux joues (5,6) dans le prolongement de la paroi dudit corps, disposées de façon sensiblement diamétralement opposée et de forme et dimensions en sorte d'épouser, l'une (5), le cul de • sac vaginal antérieur et, l'autre (6) , le cul de sac vaginal postérieur, et une partie proximale (lb) , de moyens (2) de préhension de ladite partie proximale (lb) du corps, - d'un manchon (3) dit d'étanchéité, de forme appropriée, susceptible de coulisser librement par dessus ledit corps (1) entre les parties proximale (lb) et distale (la) ,- a body (1) of elongated shape and of substantially cylindrical section, comprising a distal part (la) capable of being introduced into the vagina and provided with two cheeks (5,6) in the extension of the wall of said body , arranged in a substantially diametrically opposite manner and in shape and dimensions so as to match, one (5), the anterior vaginal pouch and, the other (6), the posterior vaginal pouch, and a proximal part (1b), means (2) for gripping said proximal part (1b) of the body, - a sleeve (3) said sealing, of suitable shape, capable of sliding freely over said body (1 ) between the proximal (lb) and distal (la) parts,
- et d'une tige (4) de manipulation utérine susceptible de coulisser librement, de manière étanche et axialement, dans ledit corps (1) .- And a rod (4) uterine manipulation capable of sliding freely, tightly and axially, in said body (1).
2. Appareil suivant la revendication 1, caractérisé en ce que ladite partie distale (la) est tubulaire et sa paroi est prolongée par deux joues opposées (5,6) de longueur inégale, définissant entre elles des échancrures latérales (7) dans ladite paroi.2. Apparatus according to claim 1, characterized in that said distal part (la) is tubular and its wall is extended by two opposite cheeks (5,6) of unequal length, defining between them lateral notches (7) in said wall .
3. Appareil suivant la revendication 1 ou 2, caractérisé en ce que lesdits moyens de préhension sont constitués par une poignée (13) susceptible d'être rapportée de manière amovible sur ledit corps (1) latéralement en sorte de dégager l'extrémité proximale (lb) du corps.3. Apparatus according to claim 1 or 2, characterized in that said gripping means consist of a handle (13) capable of being removably attached to said body (1) laterally so as to release the proximal end ( lb) of the body.
4. Appareil suivant l'une des revendications 1 à 3, caractérisé en ce que ledit manchon d'étanchéité (3) comporte deux parties (3a, 3b) d'épaisseur inégale, la partie distale (3a) étant d'épaisseur réduite et, de préférence, effilée (16) à son extrémité. 4. Apparatus according to one of claims 1 to 3, characterized in that said sealing sleeve (3) comprises two parts (3a, 3b) of uneven thickness, the distal part (3a) being of reduced thickness and preferably tapered (16) at its end.
5. Appareil suivant l'une des revendications 1 à 4, caractérisé en ce que ladite tige de manipulation utérine (4) comporte une tige cylindrique (4a) dont l'extrémité proximale est reliée de façon amovible à un bouton de commande (4b) et dont la partie distale est munie, à quelque distance de l'extrémité, d'un élément susceptible de s'engager dans le col de l'utérus.5. Apparatus according to one of claims 1 to 4, characterized in that said uterine manipulation rod (4) comprises a cylindrical rod (4a) whose proximal end is removably connected to a control button (4b) and the distal part of which is provided, at some distance from the end, with an element capable of engaging in the cervix.
6. Appareil suivant la revendication 5, caractérisé en ce que ledit élément est une vis d'extraction (17) , de forme conique.6. Apparatus according to claim 5, characterized in that said element is an extraction screw (17), of conical shape.
7. Appareil suivant la revendication 5, caractérisé en ce que ledit élément est un cône lisse.7. Apparatus according to claim 5, characterized in that said element is a smooth cone.
8. Appareil suivant l'une des revendications 1 à 7, caractérisé en ce que ledit corps (1) et ledit manchon d'étanchéité (3) sont en un matériau non conducteur de l'électricité et de la chaleur, de préférence du silicone. 8. Apparatus according to one of claims 1 to 7, characterized in that said body (1) and said sealing sleeve (3) are made of a material which does not conduct electricity and heat, preferably silicone .
PCT/FR1993/001137 1992-11-19 1993-11-18 Organ presenting and holding apparatus for celioscopic hysterectomy WO1994010926A1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU55658/94A AU5565894A (en) 1992-11-19 1993-11-18 Organ presenting and holding apparatus for celioscopic hysterectomy

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR92/14126 1992-11-19
FR9214126A FR2697989B1 (en) 1992-11-19 1992-11-19 Organ presentation and support device for per laparoscopic hysterectomy.

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WO1994010926A1 true WO1994010926A1 (en) 1994-05-26

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WO (1) WO1994010926A1 (en)

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WO1998010707A1 (en) * 1996-09-16 1998-03-19 Endolink Ab A tool for use at laparoscopic surgery at uterus
US5746750A (en) * 1996-02-05 1998-05-05 Richard Wolf Gmbh Medical instrument for manipulation of the uterus
WO2003043510A1 (en) * 2001-11-19 2003-05-30 Endolink Ab A tool for use at laparoscopic surgery at uterus
US6572631B1 (en) 1993-10-22 2003-06-03 Gynetech Pty Ltd. Transvaginal tube as an aid to laparoscopic surgery
DE102011102618A1 (en) * 2011-05-27 2012-11-29 BRENNER MEDICAL GmbH Device for visualizing, identifying and positioning tissue structure for removing e.g. organic body, from fibroids of human, has retaining element provided with distal opening that is formed in form of spherical portion
US8323278B2 (en) 2010-12-06 2012-12-04 Soulor Surgical, Inc. Apparatus for treating a portion of a reproductive system and related methods of use

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CN1150855C (en) * 1993-10-22 2004-05-26 吉奈技术私人有限公司 Transvaginal tube as an aid to laparoscopic surgery
CA2224640A1 (en) * 1995-06-14 1997-01-03 Incont, Inc. Surgical kit and method for performing laparoscopic urethropexy, and apparatus employed in same
US5997554A (en) * 1995-06-14 1999-12-07 Medworks Corporation Surgical template and surgical method employing same
US6042583A (en) * 1995-06-14 2000-03-28 Medworks Corporation Bone anchor-insertion tool and surgical method employing same
FR2745171B1 (en) * 1996-02-26 1998-05-22 Hourcabie Jacques Alain SURGICAL INSTRUMENT FOR PERELELOSCOPIC HYSTERECTOMY
EP1420706A2 (en) * 2001-08-17 2004-05-26 François Jacques Lubbe Uterus manipulation device for hysterectomy and colpotomy

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US3636940A (en) * 1967-12-07 1972-01-25 Leland C Gravlee Method for collecting cellular material by circulating a fluid within a body cavity
US4085756A (en) * 1975-07-09 1978-04-25 Kenneth Weaver Method and apparatus for performing an electrosurgical procedure
US5108408A (en) * 1990-04-20 1992-04-28 Lally James J Uterine-ring hysterectomy clamp
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Cited By (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6572631B1 (en) 1993-10-22 2003-06-03 Gynetech Pty Ltd. Transvaginal tube as an aid to laparoscopic surgery
US8082925B2 (en) 1993-10-22 2011-12-27 Gynetech Pty Ltd. Transvaginal tube as an aid to laparoscopic surgery
US5746750A (en) * 1996-02-05 1998-05-05 Richard Wolf Gmbh Medical instrument for manipulation of the uterus
DE19603981C2 (en) * 1996-02-05 1998-11-05 Wolf Gmbh Richard Medical instrument for uterine manipulation
WO1998010707A1 (en) * 1996-09-16 1998-03-19 Endolink Ab A tool for use at laparoscopic surgery at uterus
US6174317B1 (en) 1996-09-16 2001-01-16 Endolink Ab Tool for use at laparoscopic surgery at uterus
WO2003043510A1 (en) * 2001-11-19 2003-05-30 Endolink Ab A tool for use at laparoscopic surgery at uterus
US8323278B2 (en) 2010-12-06 2012-12-04 Soulor Surgical, Inc. Apparatus for treating a portion of a reproductive system and related methods of use
US8608738B2 (en) 2010-12-06 2013-12-17 Soulor Surgical, Inc. Apparatus for treating a portion of a reproductive system and related methods of use
US10034687B2 (en) 2010-12-06 2018-07-31 Surgigyn, Inc. Apparatus for treating a portion of a reproductive system and related methods of use
DE102011102618A1 (en) * 2011-05-27 2012-11-29 BRENNER MEDICAL GmbH Device for visualizing, identifying and positioning tissue structure for removing e.g. organic body, from fibroids of human, has retaining element provided with distal opening that is formed in form of spherical portion

Also Published As

Publication number Publication date
FR2697989B1 (en) 1995-02-10
FR2697989A1 (en) 1994-05-20
AU5565894A (en) 1994-06-08

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