Surgical Method and Apparatus

Abstract

An apparatus for use in connection with an endoscopic surgery includes an elongated body adapted to be placed at least partially in the vagina of a female patient partially passing through the wall of the vagina such that an end portion of said elongated element is introduced into rectouterine pouch. The elongated body includes at least an attachment means for accommodating at least a part of at least a surgical instrument comprising an end portion adapted to be received inside the vagina, the surgical instrument and the apparatus are movable to each other. An endobag having an elongated port is provided through the vagina into the pelvis.

Claims

1. A method of pelvic or peritoneal surgery comprising the steps of: introducing at least an elongated end portion of a surgical instrument into the cavity of the uterus through the vagina of a female patient, manipulating said surgical instrument such that the uterus can be repositioned, and performing an incision on the vaginal wall for accessing the rectouterine pouch.

2. The method of claim 1 wherein an apparatus selected from the group consisting of: (i) an elongated body adapted to be placed at least partially in the vagina of a female patient for passing one or more surgical instruments through the vagina, said elongated body comprising attachment means on its outer side for slidable attachment to a surgical instrument which is adapted to be placed at least partially in the vagina; (ii) an elongated body adapted to be placed at least partially in a cavity of a hollow organ forming a natural orifice of a human or animal body, wherein said elongated body is configured to partially pass through a wall forming part of said hollow organ such that an end portion of said elongated element is introduced into said human or animal body; said elongated body comprising at least an attachment means for accommodating at least a part of at least a surgical instrument comprising an end portion adapted to be received inside said cavity, wherein said attachment means is configured such that said end portion of said surgical instrument is positioned inside said cavity when said end portion of said elongated body is placed inside said cavity and when said end portion of said elongated body is introduced into said human or animal body; and (iii) an elongated body adapted to be placed at least partially in the vagina of a female patient, wherein said elongated body is configured to partially pass through the wall of the vagina such that an end portion of said elongated element is introduced into rectouterine pouch; said elongated body comprising at least an attachment means for accommodating at least a part of at least a surgical instrument comprising an end portion adapted to be received inside the vagina, wherein said attachment means is configured such that said end portion of said surgical instrument is positioned inside the vagina when said end portion of said elongated body is placed inside the vagina and when said end portion of said elongated body is introduced into rectouterine pouch is placed in the vagina before an elongated end portion of a surgical instrument is introduced into the cavity of the uterus through the vagina.

3. The method according to claim 1 wherein the uterus is repositioned or rotated with respect to the vagina before performing said incision, such that the longitudinal axis of said elongated end portion of said surgical instrument or said uterus, or both surgical instrument and said uterus, make an angle of about 90 degrees with respect to one or more of the longitudinal axis of the vagina, or said elongated body of said apparatus.

4. The method of claim 1 wherein said surgical instrument is a uterus manipulator. and/or wherein said elongated body is a trocar sleeve or a cannula wherein the incision is performed by a second surgical instrument inserted through one of said channels of said elongated body, the second surgical instrument being preferably a trocar.

5. A method of pelvic or peritoneal surgery comprising the steps of: introducing an apparatus comprising at least an elongated end portion of a surgical instrument into the cavity of the uterus through the vagina of a female patient such that the uterus can be repositioned by manipulating said surgical instrument, and introducing a flexible element into the pelvis wherein said flexible element is looped around the uterus such that said flexible element encircles the uterus.

6. The method of claim 5 wherein said flexible element is tightened such that the uterus is pressurized between said flexible element and said elongated end portion of said surgical instrument by drawing said flexible element.

7. The method of claim 5 wherein said flexible element is an elastic ring, a tourniquet or a string comprising two end portions.

8. The method of claim 5 further comprising the steps of: (i) performing an incision in the vaginal wall from the posterior formix of the vagina to the rectouterine pouch and (ii) introducing at least an end of said tourniquet or said string into the pelvis through said incision in the vagina, said string being looped around the neck of the uterus and the loop being tightened by drawing said end portions of said string.

9. The method of claim 5 wherein an apparatus selected from the group consisting of: (i) an elongated body adapted to be placed at least partially in the vagina of a female patient for passing one or more surgical instruments through the vagina, said elongated body comprising attachment means on its outer side for slidable attachment to a surgical instrument which is adapted to be placed at least partially in the vagina; (ii) an elongated body adapted to be placed at least partially in a cavity of a hollow organ forming a natural orifice of a human or animal body, wherein said elongated body is configured to partially pass through a wall forming part of said hollow organ such that an end portion of said elongated element is introduced into said human or animal body; said elongated body comprising at least an attachment means for accommodating at least a part of at least a surgical instrument comprising an end portion adapted to be received inside said cavity, wherein said attachment means is configured such that said end portion of said surgical instrument is positioned inside said cavity when said end portion of said elongated body is placed inside said cavity and when said end portion of said elongated body is introduced into said human or animal body; and (iii) an elongated body adapted to be placed at least partially in the vagina of a female patient, wherein said elongated body is configured to partially pass through the wall of the vagina such that an end portion of said elongated element is introduced into the rectouterine pouch; said elongated body comprising at least an attachment means for accommodating at least a part of at least a surgical instrument comprising an end portion adapted to be received inside the vagina, wherein said attachment means is configured such that said end portion of said surgical instrument is positioned inside the vagina when said end portion of said elongated body is placed inside the vagina and when said end portion of said elongated body is introduced into the rectouterine pouch is placed in the vagina before an elongated end portion of a surgical instrument is provided in the cavity of the uterus through the vagina.

10. The method of claim 8 wherein the uterus is repositioned or rotated with respect to the vagina before performing said incision, preferably such that the longitudinal axis of said elongated end portion of said surgical instrument and/or said uterus make an angle of about 90 degrees with respect to the longitudinal axis of the vagina and/or said elongated body of said apparatus.

11. The method of claim 5 wherein said surgical instrument is a uterus manipulator; wherein said elongated body is a trocar sleeve, or a cannula; wherein the incision is performed by a second surgical instrument inserted through one of said channels of said elongated body, the second surgical instrument being a trocar; and wherein said elongated element is introduced through one of said channels of said elongated body.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0055] The accompanying drawings, referred to herein and constituting a part hereof, illustrate preferred embodiments of the present invention and together with the description, serve to explain the principles of the present invention, wherein:

[0056] FIG. 1 is a partial cross-sectional view of a female body;

[0057] FIG. 2 is a view of an embodiment of the present invention placed in the female body;

[0058] FIG. 3A is a cross-sectional side view of an embodiment of the present invention;

[0059] FIG. 3B is a cross-sectional frontal view of an embodiment of the present invention;

[0060] FIG. 3C is a perspective view of an embodiment of the present invention;

[0061] FIG. 4A is a cross-sectional side view of an alternative embodiment of the present invention;

[0062] FIG. 4B is a side view of a surgical instrument according to the invention;

[0063] FIGS. 5A and 5B show alternative surgical bag embodiments according to the invention;

[0064] FIG. 6A is a partial view of an alternative surgical bag embodiment and an alternative embodiment of the apparatus according to the invention;

[0065] FIG. 6B is a frontal view of the apparatus of FIG. 6A;

[0066] FIG. 7A is a partial cross-sectional view of a female body with an embodiment of the present invention positioned in the vaginal canal in a first position;

[0067] FIG. 7B is a partial cross-sectional view of a female body with an embodiment of the present invention positioned in the vaginal canal in a second position;

[0068] FIG. 8 is a partial cross-sectional view of a female body illustrating an embodiment of an endobag apparatus according to the invention;

[0069] FIG. 9 is a partial cross-sectional view of a female body illustrating an embodiment of an apparatus according to the invention positioned in the vaginal canal;

[0070] FIG. 10A, 10B,10C show the apparatus of FIG. 9 in side, frontal and perspective views.

DESCRIPTION OF THE EMBODIMENTS

[0071] The present invention is contemplated to be used in surgical procedures where manipulation of body structures is required to provide access to the particular body structure or adjacent body structures. While the apparatus of the present invention is particularly useful for manipulation of the uterus, it will also be useful for treating other body organs and structures during other laparoscopic and non-laparoscopic surgical procedures.

[0072] Referring to FIG. 1, there is illustrated in cross-sectional view of a partial female body showing the transvaginal-transdouglas route.

[0073] FIGS. 2, 9, 10A, 10B and 10C show an embodiment of the apparatus constructed according to the present invention. The apparatus comprises an elongated body 8, 23, 27. The elongated body 8, 23, 27 has a proximal end and a distal end 9 that penetrates into the rectouterine pouch 7. The distal end 9 may be shaped oblique forming a nose. This shape may enable a smooth introduction of the apparatus into the transvaginal-transdouglas route. The elongated body has one or more channels 10. Different surgical instruments can be introduced through the channels 10. There is provided one or more longitudinal grooves 19 on the outer surface of the elongated body 8. A uterus manipulator 12 is guided in the upper groove 19 which faces the uterus when the apparatus is positioned in the vagina. The uterus manipulator 12 has a distal end 32 which is rotatable by moving or rotating a handle 33, 34 which will not be described here.

[0074] FIGS. 3A, 3B and 3C show an embodiment of the apparatus constructed according to the present invention.

[0075] FIG. 4A, 4B show an alternative embodiment of the apparatus constructed according to the present invention. The apparatus comprises a tube 8 and a uterus manipulator 12 is slidably attached to the apparatus. The tube 8 has a distal end 9 that penetrates into the rectouterine pouch. Different surgical instruments can be introduced through the tube 8.

[0076] FIGS. 5A, 5B and 8 show an endobag 30 constructed according to the present invention. The endobag has an distal open end 14 which is placed through the rectouterine pouch 7 and a proximal open end 17. Body tissues can be transported through the endobag 30. The distal open end 14 of the endobag 30 may have a funnel shape.

[0077] FIG. 6A, 6B show another embodiment of the endobag apparatus constructed according to the present invention. The endobag is guided in a lower groove 26 of an elongated body 23. The endobag may have guiding means 31 which can slide in the lower groove 26.

[0078] FIG. 7A, 7B show an embodiment of the apparatus constructed according to the present invention positioned in the vagina 4. The distal end 32 of the uterus manipulator 12 is introduced into the uterus 2, is tilted 90 degree with respect to the elongated body 8 and the elongated body 8 is slided with respect to the uterus manipulator 12 through the vagina 4. The distal end 9 of the elongated body 8 is penetrated through the rectouterine pouch 7. One or more surgical instruments 11 are placed through the holes in the distal end 9 of the elongated body 8.

[0079] At least an elongated end portion 32 of a surgical instrument 12 is provided in the cavity 3 of the uterus 2 through the vagina 4 of a female patient such that the uterus 2 can be repositioned by manipulating the surgical instrument and an incision is performed on the vaginal wall for accessing to the rectouterine pouch. An apparatus according to claims 1 to 8 or a surgical kit according to claims 9 to 10 is placed in the vagina 4 before an elongated end portion 32 of a surgical instrument 12 is provided in the cavity 3 of the uterus 2 through the vagina 4. The uterus 2 is repositioned or rotated with respect to the vagina 4 before performing the incision, preferably such that the longitudinal axis of the elongated end portion 32 of the surgical instrument 12 or the uterus 2 make an angle of about 90 degrees with respect to the longitudinal axis of the vagina 4 or the elongated body 8 of the apparatus. The surgical instrument 12 may be a uterus manipulator 12 and the elongated body may be a trocar sleeve or a cannula wherein the incision is performed by a second surgical instrument 11 inserted through one of the channels 10 of the elongated body 8, the second surgical instrument 11 being preferably a trocar. At least an elongated end portion 32 of a surgical instrument 12 is provided in the cavity 3 of the uterus 2 through the vagina 4 of a female patient such that the uterus 2 can be repositioned by manipulating the surgical instrument 12 and a flexible element 13 is provided in pelvis wherein the flexible element 13 is looped around the uterus 2 such that the flexible element 13 encircles the uterus 2. The flexible element 13 is tightened such that the uterus 2 is pressed between the flexible element 13 and the elongated end portion 32 of the surgical instrument 12, preferably by drawing the flexible element 13. The flexible element 13 may be an elastic ring or a tourniquet or a string comprising two end portions. An incision is performed in the vaginal wall 21, preferably in the posterior formix 6 of the vagina 4 to the rectouterine pouch 7 and at least an end of flexible element 13 is introduced in to the pelvis through the incision in the vagina 4, flexible element 13 is looped around the neck of the uterus 2 and the loop is tightened by drawing the end portions of flexible element 13. An apparatus according to claims 1 to 8 or a surgical kit according to claims 9 to 10 is placed in the vagina 4 before an elongated end portion 32 of a surgical instrument 12 is provided in the cavity 3 of the uterus 2 through the vagina 4. The uterus 2 is repositioned or rotated with respect to the vagina 4 before performing the incision, preferably such that the longitudinal axis of the elongated end portion 32 of the surgical instrument 12 or the uterus 2 make an angle of about 90 degrees with respect to the longitudinal axis of the vagina 4 or the elongated body 8 of the apparatus. The surgical instrument 12 may be a uterus manipulator 12 and the elongated body 8 may be a trocar sleeve or a cannula wherein the incision is performed by a second surgical instrument 11 inserted through one of the channels 10 of the elongated body 8, the second surgical instrument 11 being preferably a trocar and the elongated element 13 is introduced through one of the channels 10 of the elongated body 8. An apparatus according to 22 to 25 is provided through the vagina 4 and the rectouterine pouch 7 such that an end opening or a bag shaped compartment 14, 15, 33, 34 is opened in the pelvis by applying pressure P into the pelvic cavity. The pressure P may be applied by introducing pressurized liquid or gaseous medium into the pelvis, preferably through the vagina 4, preferably through an elongated port 16 of the apparatus. The apparatus is introduced through the vagina 4 and the rectrouterine pouch 7 by a method according to claims 11 to 14, preferably through the elongated body 8 of the apparatus according to claims 1 to 8.

[0080] While the above description contains many specifics, these specifics should not be construed as limitations on the scope of the invention, but merely as exemplifications of preferred embodiments thereof. Those skilled in the art will envision many other possible variations that are within the scope and spirit of the invention as defined by the claims appended hereto.

[0081] List of key features of the invention: [0082] Uterine Arteries sutured after Corpus Uteri amputation [0083] Steps Part 1

[0084] Insuflation

[0085] One Skin Incision Umbilical

[0086] One Port multichannel (3 mm.times.2 or 5 mm+3 mm)

[0087] Two 3 mm.times.2 or 5 mm+3 mm [0088] Step O

[0089] Notes Uterine Manipulator Crania-Caudal

[0090] Rotation Lateral-Medial, 0 to 90 degree Antireflection

[0091] Multi-channel Round/Elliptical barrel 8 with a groove 19 that accommodates Slides 12 in the Rounded Shaft of Pelosi/Valchev Uterine Manipulator Concept [0092] Properties of the Barrel 8 [0093] Future [0094] Single Site Surgery [0095] Notes

[0096] Barrel 8

[0097] Solid and Flexible (durable rubber) that accommodates different size operative instruments 11 namely to function as uterine artery suture 13 and occlusion system

[0098] Introduction Flexible Tip Camera

[0099] Introduction and execution of Cervico-Corporal Amputation System 13 (Lina Loop, Lap Loop, and similar Storz kind)

[0100] Accommodate or Introduction of Irrigation and Suction, Anti adhesive and Anti Bacterial

[0101] Barrier Gel and Spray system

[0102] Accommodate or Introduction of Multiple Vaginal Ports and Tracers both solid and flexible

[0103] To access and operate in peritoneal and retroperitoneal space and organs kidney, bowel, liver, appendix, spleen, artery, vein, pancreas transvaginally.

[0104] Accommodate or Introduction Morcellator (Straight Knife and Circular Motorized)

[0105] Accommodate or Introduction Morcellator Laparachute Bag system 30 [0106] Laparachute

[0107] Transvaginal collecting bag system 30 that deploys in pelvic cavity to baloon into the upper peritoneal cavity, for the purpose better visual operative space, to protect bowel and other intraperitoneal organs from infection, cancer that may be spilling from the specimen or other sources; bag (in a secondary compartment) that contains the spillage or irrigation fluid system to drain continuously to an external collection bagsystem. [0108] Steps Part 2

[0109] Uterine Arteries Transcervical (Single Choking Loop Suture)

[0110] Amputation-Corpus Uteri Detachment (Vaginal)

[0111] Lap Loop

[0112] Lina Loop

[0113] Morcellation Vaginal

[0114] Bags Vaginal [0115] Uterine Artery Single Choking Loop Suture 13

[0116] Posterior endocervical insertion of a suture 13 into peritoneal cavity, the path following through avascular broad ligament leafs, circumventing the anerious cervix 2 anagain piercing through the contralateral brad ligament leaf then being grabbed transcervically, pulled out tied into the cervical canal, where the knots get buried.