Uterus raising deviceThe cross reference of related application
Rights and interests for the U.S. Provisional Patent Application the 62/334,074th submitted this application claims on May 10th, 2016 and preferentialPower, the entire disclosure are incorporated herein by reference.
Technical field
This disclosure relates to a kind of uterus raising device and its application method.More specifically, this disclosure relates to such a uterus raising device andIts application method：The uterus raising device is configured in uterus raising device by providing improved visualization during vagina and cervix so as to justSuitably placed intrauterine in the distal portion of uterus raising device.
Background technology
Uterus raising device generally during laparoscopically hysterectomy using to transfer and position vagina and cervix, consequently facilitatingTheir separation simultaneously allows to remove uterus after colpotomy has been carried out.Generally, uterus raising device include handle, from handle distadThe axle of extension, the expandable bladder being supported on the end opposite with handle of axle, and it is supported on axle in the nearside of expandable bladderOn uterine neck cup.In use, expandable bladder is pushed through vagina and cervix with contraction state and is positioned at uterusIt is interior.Once being positioned at intrauterine, expandable bladder is just expanded so that uterus raising device is fixed on into intrauterine.Uterus raising device, as its name suggests, thenIt is used to manipulate uterus in separating uterus and vagina and from during vagina removal uterus.
Between known uterus raising device is placed into uterus mid-term, vagina, cervix and the visualization in uterus may be blurred,So that the appropriate placement of uterine neck cup and expandable bladder is more difficult.Constant demand one kind is by uterus raising device in the artContribute to vaginal canal and the improved visual uterus raising device of cervix during being placed in intrauterine.
The content of the invention
One scheme of the disclosure is intended to a kind of uterus raising device, and it includes the elongated hollow axle with proximal end and distal end portion.The quill shaft defines passage and has printing opacity distal end.Handle is located in the proximal portion of the axle, and can be fromThe expandable bladder that contraction state is transformed into swelling state is supported on the distal portion of the axle.Uterine neck cup is along the axleMovably position.The passage of the axle is sized to receive endoscope in order to which body cavity passes through the described of the axleLight distal end visualizes.
In embodiment, the uterine neck cup along the axle from the distal position very close to the expandable bladder toExpandable bladder proximal position spaced apart movably positions.
In certain embodiments, the uterine neck cup includes edge, and the edge is oriented to when the capsule is in expansionState and the expandable bladder is engaged when the uterine neck cup is in the distal position.
In certain embodiments, the multiple lamps of the edge supports.
In embodiment, the multiple lamp is positioned around the edge with annular array.
In embodiment, the expandable bladder is lubrication.
In embodiment, the uterus raising device further comprises the locking component on the handle, the locking componentIt can operate so that the uterine neck cup to be locked relative to the axle.
Another program of the disclosure is intended to a kind of method for performing operation technique, and methods described includes：By the remote of uterus raising deviceSidepiece is inserted into the introitus of patient, and the uterus raising device includes quill shaft, and the quill shaft defines passage and with branchSupport the distal portion of expandable bladder and printing opacity distal end；Pass through by the first endoscope being positioned in the quill shaft describedLight distal end visualizes vaginal canal during insertion；The cervix that the expandable bladder is advanced through to patient enters sonGong Zhong；And make the intrauterine capsule expansion that the uterus to be fixed to the distal portion of the uterus raising device.
In certain embodiments, methods described further comprises the distal portion of the uterus raising device being inserted into patientIntroitus before the expandable bladder is positioned very close to the uterine neck cup.
In certain embodiments, methods described further comprises making the uterine neck cup be positioned to the uterus relative to patientNeck abuts.
In embodiment, methods described further comprises lighting the lamp in the distal side edge of the uterine neck cup.
In certain embodiments, methods described further comprises the second endoscope being inserted through the belly of patient to visiblePositioned at the position of the lamp at the edge of the uterine neck cup of posterior fornix of vagina to confirm the edge relative to cervix suitablyPlace.
In certain embodiments, methods described further comprise by cutter device be inserted through second endoscope andTissue is directly cut in the top of the lamp so that the uterus of patient to be separated with cervix.
Another program of the disclosure is intended to a kind of uterus raising device, and it includes：Slender axles, it has proximal end and distal end portion；WithAnd Handleset, it is located in the proximal portion of the axle.Distally position is removable to proximal position along the axle for uterine neck cupPosition dynamicly.The uterine neck cup includes the main body with the edge for supporting multiple lamps.
In embodiment, the multiple lamp is positioned around the edge with annular array.
In certain embodiments, expandable bladder is supported on the axle in the distal side of the uterine neck cup.It is described can be swollenSwollen capsule can be transformed into swelling state from contraction state.
In certain embodiments, the slender axles define passage and have printing opacity distal end.The passage is determinedThe printing opacity distal end that size passes through the slender axles into reception endoscope in order to body cavity visualizes.
In embodiment, the uterine neck cup defines chamber and positions around the axle and prolong towards the HandlesetThe tubular protrusions stretched.The edge of the uterine neck cup can be positioned so that when the capsule is in swelling state and describedUterine neck cup engages the expandable bladder when being in the distal position.
In certain embodiments, the first handgrip is supported in the proximal portion of the slender axles and second-hand graspsPortion is supported in the proximal portion of the tubular protrusions.First handgrip can be relative to second handgripMovement is so that the main body of the uterine neck cup axially moves relative to the expandable bladder.
Brief description of the drawings
Describe the various embodiments of the uterus raising device of the disclosure with reference to the accompanying drawings herein below, wherein：
Fig. 1 is the side isometric view of the exemplary embodiment of the uterus raising device of the disclosure, and wherein expandable bladder is in contraction-likeState and uterine neck cup is in its farthest side position on the axle of uterus raising device；
Figure 1A is the side isometric view of the distal portion of the uterus raising device shown in Fig. 1, and wherein expandable bladder is in contraction state；
Fig. 2 is to be in expansion shape along the side perspective sectional view of Figure 1A hatching 2-2 interceptions, wherein expandable bladderState；
Fig. 3 is to be inserted through under uterus raising device is in swelling state in expandable bladder when introitus enters vagina in Fig. 2The side view partial sectional view of the distal portion of shown uterus raising device；
Fig. 4 is the side view partial sectional view of the distal portion of the uterus raising device shown in Fig. 1, and wherein expandable bladder is with contraction stateIt is positioned at intrauterine and uterine neck cup is positioned to abut cervix；
Fig. 5 is the side view partial sectional view of the distal portion of the uterus raising device shown in Fig. 2, and wherein expandable bladder is with swelling stateIt is positioned at intrauterine and uterine neck cup is positioned to abut cervix；
Fig. 6 is the side view partial sectional view of the distal portion of the uterus raising device shown in Fig. 2, and wherein expandable bladder is with swelling stateIt is positioned at intrauterine, uterine neck cup is positioned to abut cervix and endoscope is positioned adjacent to the position of cervix through bellyIn order to which uterine neck cup is in the visualization of the opening position of rear arched roof；And
Fig. 7 is the side view partial sectional view of the distal portion of the uterus raising device shown in Fig. 2, and wherein expandable bladder is with swelling stateBe positioned at intrauterine, uterine neck cup is positioned to abut cervix and belly endoscope positions adjacent to cervix, consequently facilitatingPosition of the uterine neck cup at posterior fornix when making the cervix be separated with uterus using the operation tool positioned by belly endoscopeVisualization.
Embodiment
The uterus raising device of the disclosure is described in detail referring now to accompanying drawing, wherein identical is attached in each of some viewsIcon note represents identical or corresponding element.In this manual, term " nearside " generally to refer to device closer to clinicThe part of doctor, and term " distal side " is generally referring to the part further away from clinician of device.In addition, term " endoscope "Generally to refer to endoscope, laparoscope, arthroscope and by small otch or intubation inserted into the patient carry out it is any itsIts operation technique.Finally, term clinician is generally referring to the medical worker including doctor, nurse and support staff.
The uterus raising device of the disclosure be provided to convenient uterus raising device be inserted through vagina and cervix and enter uterus when withAnd the visualization in the inner chamber of body is improved during uterus separates with cervix.In embodiment, the uterus raising device bag of the disclosureInclude flexible hollow axle, the Handleset in the proximal portion of flexible shaft, may expand on the distal portion end of flexible shaftCapsule, and can be along the uterine neck cup that flexible shaft moves between inflatable air bag and handle.The distal end portion of flexible shaft is by transparentThe end covering of printing opacity.Flexible shaft is dimensioned and is configured to receive endoscope or hysteroscope, when uterus raising device is pushed away towards uterusWhen entering, the endoscope or hysteroscope allow the visualization of vagina and cervix by the end.Uterine neck cup includes surroundingThe ring edge of axle positioning, and it is configured to abut cervix.Ring edge supports multiple lamps, such as light emitting diode(LED).From the position outside cervix by cervix it can be seen that lamp, in order to before cervix separates with uterus by palaceNeck cup is properly positioned relative to cervix, and determines cutting position for clinician.
Referring to figs. 1 to Fig. 2, being shown generally as the uterus raising device of 10 disclosure includes Handleset 12 (Figure 1A), elongatedFlexible shaft 14, expandable bladder 16 and uterine neck cup 18.Flexible shaft 14 is hollow and receives endoscope or hysteroscope 20, such as5mm endoscope.The distal end portion of flexible shaft 14 defines the opening 15 for receiving transparent or printing opacity end 22.Or transparent endEnd 22 can be integrally formed with flexible shaft 14.In embodiment, end 22 can have taper configurations in order to by vagina" V " and cervix " C " simultaneously enter uterus " U " (Fig. 3).End 22 should have construction that is smooth, not causing damage, with minimumChange the latent lesion to internal.
Expandable bladder 16 is supported on the distal portion of adjacent end 22 of axle 14.By injecting such as physiological saline, waterOr the port 26 on the fluid of air to the proximal portion positioned at uterus raising device 10, capsule 16 can be swollen from the contraction state shown in Figure 1AThe swollen swelling state to shown in Fig. 2.Injecting fluid can be by syringe or any other known injection dress into port 26Put to provide.In embodiment, capsule 16 can be formed by a variety of materials known in the art, including polytetrafluoroethylene (PTFE)(PTFE).In certain embodiments, capsule 16 can impregnate or lift palace coated with lubriation material as known in the artThe distal portion of device 10 is non-invasively inserted through body cavity (such as vaginal canal).See, for example, U.S. Patent No. 7,951,413, its is completePortion's content is incorporated herein by reference.
Around the positioning of the outer surface of axle 14 and including main body 30, main body 30 defines cavity 32 and had uterine neck cup 18Edge 34 annular, towards distal side.Main body has the tubular protrusions 38 extended towards handle 12 to nearside.As it is following enter oneWhat step was discussed in detail, tubular protrusions 38 slide around axle 14 from farthest side position (Fig. 3) to nearest side position (Fig. 4), so as toIn uterine neck cup 18 is repositioned relative to expandable bladder 16.In its farthest side position (Fig. 3), when capsule 16 is in swelling stateWhen (Fig. 2), edge 34 positions very close to the proximal face of capsule 16.In its nearest side position along axle 14, uterine neck cup 18The edge 34 for being enough to allow capsule to be positioned at intrauterine while uterine neck cup 18 is separated with capsule 16 and cervix " C " is in syntopleA distance.Although main body 30 is shown as substantial cylindrical, but it is contemplated that main body 30, which can use, includes frustum of a coneOther constructions of shape, ellipse etc..
Handleset 12 includes the handgrip 12a of the proximal portion fixed to axle 14 and the tubulose fixed to uterine neck cup 18The handgrip 14a of the proximal portion of extension 38.Handgrip 12a and 14a can be moved relative to each other so that uterine neck cup18 reposition relative to expandable bladder 16.Locking device 21 is supported on tubular protrusions 38, and be it is exercisable withThe main body 30 of uterine neck cup 18 is fixed relative to the position of capsule 16.
In embodiment, locking device 21 includes being threadedly coupled to the positioning screw 23 of tubular protrusions 38.Positioning screw23 can rotate to and be contacted with axle 14, axle 14 be fixed relative to tubular protrusions 38 and by the phase of main body 30 of uterine neck cup 18Fixed for expandable bladder 16.It is contemplated that other locking devices can be provided by uterine neck cup 18 relative to expandable bladder16 fix.
The edge 34 of the main body 30 of uterine neck cup 18 supports the lamp 36 that multiple annular spaces are opened.In embodiment, lamp 36 canWith the lamp of any other known type used including light emitting diode (LED) or suitable for inside.Lamp 36 towards distal direction simultaneouslyAnd it is spaced apart in the whole length at edge 34 along edge 34.Although being not shown, lamp 36 can pass through one or more conductors(for example, electric wire) is connected to the power supply in Handleset 12.For example, electric wire can be arranged in the main body 30 of uterine neck cup 18 simultaneouslyAnd tubular protrusions 38 are extended through to Handleset 12, or Handleset 12 is extended in tubular protrusions 38, orHandleset 12 is extended in axle 14.Handleset 12 can support battery pack or including being suitable for connection to inserting for electric energySeat.For example, handgrip 12a can define the jack 25 for being configured to receive battery 25a.Detachable cover 27 can be supported onTo close jack 25 on handgrip 12a.
With reference to figure 3, in use, the distal portion of uterus raising device 10 is inserted into introitus 50 by distad impeller-hub 14In.In this respect, axle 14 should be by allowing axle to be pushed through vaginal canal 52 without collapsing with enough rigidity(collapsing) flexible material is made.In order that uterine neck cup 18 is non-invasively translated across vaginal canal 52, by uterus raising device10 distal portion is inserted through before introitus 50, and expandable bladder 16 is transformed into swelling state.In embodiment, capsule 16 is swollen at itsThere is the external diameter slightly larger than uterine neck cup 18, so that the distal portion of uterus raising device 10 is being inserted between the mid-term of vaginal canal 52 under swollen stateAvoid the substantial exposure of wall of the uterine neck cup 18 with limiting vaginal canal 52.When the distal portion of uterus raising device 10 is inserted into vaginal canal 52When middle, the visualization of vaginal canal 52 is provided by the transparent ends 22 of axle 14 via endoscope 20.
With reference to figure 4, the distal portion of uterus raising device 10 is pushed into vaginal canal 52, until capsule is close to cervix " C ".When capsule 16During close to cervix " C ", as seen by the end 22 of endoscope 20 and axle 14, capsule 16 is transformed into its contraction state, withIt is easy to the distal portion of uterus raising device 10 to enter in uterus " U ".After the contraction of capsule 16, axle 14 is promoted by distad end, by endEnd 22 is positioned in uterus " U " and is positioned to the edge 34 of uterine neck cup 18 to be in syntople with cervix " C ".Work as edge34 adjoining cervix " C " when, by make locking device 21 depart from the contact with axle 14, the tubular protrusions 38 of uterine neck cup 18 andAxle 14 departs from.When locking device 21 departs from the engagement with axle 14, axle 14 is pushed into independently of uterine neck cup 18, can be swollenSwollen capsule 16 is positioned in uterus " U ".The main body 30 of uterine neck cup 18 is also positioned to abut cervix " C ".When capsule 16 suitablyBe positioned at uterus " U " it is interior when, the tubular protrusions 38 of uterine neck cup 18 can be again fixed to axle 14 using locking device 21.
With reference to figure 5, when capsule 16 be appropriately positioned in uterus " U " it is interior when, capsule 16 is transformed into swelling state with by uterus raising device 10Distal portion be fixed to uterus " U ".Capsule 16 expansion after, can manipulate uterus raising device 10 with by uterine neck cup 18 relative to uterusNeck " C " is properly located.
With reference also to Fig. 6, endoscope 60 is inserted into the edge 34 of visible uterine neck cup 18 from belly in posterior fornix of vaginaThe position of 62 placement.As described above, the edge 34 of uterine neck cup 18 includes the multiple lamps 36 positioned around edge 34.Lamp 36 canTo be seen by cervix " C " by the belly endoscope 60 close to fornix vagina 62, so as to confirm uterine neck cup for clinician18 appropriate placement and determine appropriate cutting position.If uterine neck cup 18 is not properly positioned, can determine againPosition uterus raising device 10 is so that the edge 34 of uterine neck cup 18 is repositioned relative to cervix " C ".
With reference to figure 7, after the main body 30 of uterine neck cup 18 suitably positions relative to cervix " C ", the quilt of cutting device 64Belly endoscope 60 is inserted through, and clinician can directly cut tissue above lamp 36 and be cut to carry out vagina exactlyOpen art and separate uterus " U " and cervix " C ".In embodiment, operating theater instruments 64 can be such as ultrasonic cut apparatus orThe electric operation device of RF cutting devices.Every kind of in the apparatus of these types can be cut and be condensed simultaneously.
It will be understood by those skilled in the art that the apparatus and method for specifically describing and being shown in the drawings herein are non-limitingExemplary embodiment.It is contemplated that without departing from the scope of the disclosure, shown with reference to an exemplary embodiment orThe element and feature of description can be with the elements and combinations of features of another embodiment.Equally, those skilled in the art will be based onAbove-described embodiment expects the further features and advantages of the disclosure.Therefore, in addition to the content pointed by appended claims,The disclosure is not limited by the content having been particularly shown and described.