Apparatus for assisting the performance of pelvic endoscopic procedures

United States Patent [19]

Hasson

[54] APPARATUS FOR ASSISTING THE

PERFORMANCE OF PELVIC ENDOSCOPIC
PROCEDURES

[76] Inventor: Harrith M. Hasson, 2043 N.

Sedgwick, Chicago, HI. 60614

[21] Appl. No.: 406,796

[22] Filed: Mar. 20,1995

Related U.S. Application Data

[63] Continuation of Ser. No. 816,667, Jan. 3, 1992, abandoned.

[51] Int. CI.6 A61B 17/42; A61B 17/46

[52] U.S. CI 606/119

[58] Field of Search 128/762, 778;

600/6; 604/1; 606/1, 119, 108, 190, 191, 193, 205-209

[56] References Cited

U.S. PATENT DOCUMENTS

2,977,958 4/1961 Seiger 606/205

3,877,464 4/1975 Vermes 604/1

4,000,743 1/1977 Weaver 606/119

4,175,560 11/1979 Knoll 604/1

4,393,872 7/1983 Reznik et al 606/206

4,432,352 2/1984 Wineland 606/208

4,585,438 4/1986 Makler 604/106

4,997,419 3/1991 Lakatosetal 606/190

5,037,430 8/1991 Masson 606/119

5,059,198 10/1991 Gimpelson 606/119

5,104,377 4/1992 Levine 606/193

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US005562680A

[ii] Patent Number: 5,562,680 [45] Date of Patent: Oct. 8,1996

FOREIGN PATENT DOCUMENTS

0369334 1/1907 France 604/11

Primary Examiner—Michael H. Thaler

Assistant Examiner—Glenn Dawson

Attorney, Agent, or Firm—Wood, Phillips, VanSanten, Clark

& Mortimer

[57] ABSTRACT

An apparatus for assisting the performance of laparoscopic pelvic procedures. The apparatus has a first structure for engaging a uterus to effect stabilization thereof and a second structure for holding a spacing material such as a resilient moisture absorbent material into the vaginal fornix. The first and second structures are cooperatively engaged to allow the resilient moisture absorbent material held by the second structure to be selectively movably positioned relative to a uterus which is engaged by the first structure. The invention further contemplates a method of assisting the performance of laparoscopic pelvic procedures, which method consists of the steps of: providing a structure to grasp the uterine cervix; grasping the uterus with the structure to stabilize the position thereof; providing an elongate rod with a proximal end and a distal end; connecting the elongate rod to the cervix grasping structure for movement relative thereto; attaching the resilient material at the distal end of the elongate rod; and manipulating the proximal end of the elongate rod to change the position of the elongate rod relative to the uterine grasping structure and position the resilient material at the distal end of the elongate rod where desired in the vicinity of the uterine cervix.

16 Claims, 2 Drawing Sheets

2><o

1

APPARATUS FOR ASSISTING THE
PERFORMANCE OF PELVIC ENDOSCOPIC
PROCEDURES

This application is a continuation of application Sen No. 5 07/816,667, filed Jan. 3, 1992, now abandoned.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates to pelvic endoscopic surgical procedures and, more particularly, to an apparatus that can be used to simultaneously support the uterus and distend the vagina through the placement of resilient moisture absorbent material around the cervix. This facilitates identification of 15 the vaginal apex and prevents vaginal collapse around the cervix, to thereby minimize escape of gas used to distend the abdominal cavity, as during the performance of a laparoscopic hysterectomy.

2. Background Art 20 It is estimated that in the last year approximately 600,000

hysterectomies were performed. Hysterectomies are conventionally performed either through the abdomen or the vagina.

The abdominal hysterectomy is performed by making an 25 incision in the abdomen which is large enough to access, sever and remove the uterus with or without the fallopian tubes and ovaries. The procedure is completed by stitching closed the vaginal opening which is penetrated by the cuff of the cervix. The abdominal hysterectomy is desirable in that 30 it can be performed on virtually all patients. The principal drawbacks associated with this type of procedure are that the patient experiences pain from the incision and healing may require relatively lengthy hospitalization.

3*5

The vaginal hysterectomy is performed through the vaginal opening by progressively cutting out and removing the uterus, fallopian tubes and ovaries. Performance of the hysterectomy by the vaginal technique is preferred over the abdominal technique principally because the patient remains unscarred and may require only a short hospital stay. 40

The vaginal technique has several limitations however. First of all, performance of the vaginal hysterectomy requires a relaxed vaginal opening, to permit access to the cervix and beyond. Therefore, not all women are candidates 45 for laparoscopic hysterectomies, particularly those who have not already borne children.

Recently, a laparoscopic technique has been described through which the uterus is removed through the vagina. This technique utilizes a telescope, video camera and moni- 50 tor and various other special instruments introduced into the abdomen through small incisions.

The principal drawback with vaginal hysterectomies is the inherent dangers associated with this type of operation due to a) loss of depth perception from a video screen as well as 55 the loss of palpatory information otherwise available with an open abdomen and b) the limited points of access through which instruments can be directed and utilized. The region of the uterus which is severed during a hysterectomy is in close proximity to the rectum, bladder and other vital organs 60 which, if inadvertently cut or severed, could cause severe internal injury or even death. The operation itself is a very delicate one requiring the disconnection of the ovaries, the ligaments supporting the uterus, etc. in a very precise fashion. Accordingly, during the laparoscopic procedure, it 65 is necessary that all internal organs be positively identifiable at all times during the surgery.

2

To provide the necessary visibility during the performance of the laparoscopic hysterectomy, it is important to distend the abdominal cavity by the introduction of a gas to enlarge the working area. However, once a vaginal incision is made, the system is no longer closed and the gas escapes. This results in a confined working area. Blood accumulation therein virtually destroys what little visibility remains. To continue the surgery under these circumstances, special tools are required to open the vaginal cuff. To effectively do this, it is important that the uterus be supported in a proper orientation, which may require even additional instruments.

To overcome these problems, it is known to provide rods with sponges on the ends thereof to block the escape of gas after an incision is made into the vaginal apex during laparoscopic hysterectomy. Commonly, one or a plurality or the rods are directed through the vagina into the vicinity of the cervical cuff. The principal difficulty with this conventional technique is that the surgeon is required to blindly direct the sponge into position. A misdirected rod could itself cause a rupture or difficulty in identifying the vaginal apex with possible subsequent entry into the bladder or rectum.

Additionally, it is difficult and may be virtually impossible for the surgeon to control the positioning of all of the separate instruments that are directed through the vaginal opening to distend the vaginal apex and elevate the uterus at the same time during the hysterectomy. Not only is there the potential for interference between the many instruments, but there is also increased likelihood that the surgeon may confuse the identity of the instruments with again potentially dire consequences.

SUMMARY OF THE INVENTION

The present invention is specifically directed to overcoming the above-enumerated problems in a novel and simple manner.

More particularly, the invention comprehends an apparatus for assisting the performance of pelvic laparoscopic procedures, for example, a laparoscopic hysterectomy. The apparatus has a first structure for engaging a uterus/cervix to effect stabilization thereof and a second structure for holding a resilient moisture absorbent material. The first and second structures are cooperatively engaged to allow the resilient moisture absorbent material held by the second structure to be selectively movably positioned relative to a cervix which is engaged by the first structure.

Because the first structure uses the uterus/cervix as a foundation, the second structure can be positively guided relative to the cervix and first structure thereon to consistently position and hold a resilient moisture absorbent material, such as a sponge, where desired, particularly in the vaginal cuff surrounding the cervix.

In one form, the first and second structures are connected together for pivoting movement relative to each other about a first axis.

To provide a further degree of freedom for the second structure, the second structure can be movable in a translatory path relative to the first structure along a line that is transverse to the first axis.

In another form of the invention, there is a third structure for holding a resilient moisture absorbent material that cooperates with at least one of the first and second structures to allow the moisture absorbent material thereon to be controllably directed to a position wherein it blocks escape of gas from an abdomen during the performance of a laparoscopic hysterectomy. The third structure is, in a pre