Functional uterine manipulator
A uterine manipulator operable to detach the uterus and cervix from the vagina. The uterine manipulator includes an umbrella-like tip that creates a secure connection between the uterine manipulator and the uterus and cervix. The uterine manipulator also includes a pneumooccluder that enables rotation of the manipulator shaft while maintaining pneumoperitoneum. The uterine manipulator further includes a cutter that travels in a circle at the junction of the cervix and the vagina, permitting detachment of the uterus and cervix from the top of the vagina.
1. A uterine manipulator adapted for insertion into a uterus, the uterine manipulator comprising:
a shaft including a first end and a second end;
a handle coupled to the first end;
a tip assembly coupled to the second end and adapted for insertion into the uterus, the tip assembly including:
a tip housing;
a tip shaft retractable within the tip housing;
an expansion tip retractable within the tip housing and including a substantially rounded tip covering a distal end of the tip shaft; and
expansion elements positioned over the tip shaft and abutting an edge of the tip housing, the expansion elements extending from the distal end of the tip shaft to the edge of the tip housing, the tip assembly capable of being situated into an expanded position where the tip shaft is retracted into the tip housing, causing the expansion elements to expand outward in their circumferential direction, and a retracted position where the tip shaft is retracted out from the tip housing, causing the expansion elements to retract inward in their circumferential direction.
2. The uterine manipulator of claim 1 wherein the tip assembly is capable of being inserted into the uterus when situated in the retracted position and is capable of being stabilized within the uterus when situated in the expanded position.
3. The uterine manipulator of claim 1 further comprising an expansion actuator positioned on the handle and expansion connectors coupled between the expansion actuator and the expansion tip, wherein pulling the expansion actuator causes the tip assembly to be moved into the expanded position.
4. The uterine manipulator of claim 3 wherein the expansion elements are spring-like elements that are in tension when the tip assembly is situated in the retracted state and in compression when the tip assembly is situated in the expanded state, and wherein the expansion elements are in tension when at rest to allow the tip assembly to revert back to the retracted state when the expansion actuator is pressed back into the handle.
5. The uterine manipulator of claim 3 wherein the expansion connectors are routed from the expansion actuator, through the shaft, to the expansion tip.
6. The uterine manipulator of claim 1 further comprising connectors that couple the handle to the tip assembly.
7. The uterine manipulator of claim 1 wherein the handle is coupled to the first end in a pivotable manner and the tip assembly is coupled to the second end in a pivotable manner.
8. The uterine manipulator of claim 1 wherein the shaft is constructed of a non-rigid, flexible material.
9. The uterine manipulator of claim 1 and further comprising a cutter assembly coupled around the shaft and adapted to receive the cervix when the tip assembly is inserted into the uterus, the cutter assembly including a tube with a first tube end and a second tube end; a backstop coupled to the first tube end and including a cup portion and a cutter; and a cutting handle coupled to the second tube end.
10. The uterine manipulator of claim 1 further comprising a pneumooccluder coupled around the shaft and capable of being positioned within a vaginal cavity when the tip assembly is inserted into the uterus, the pneumooccluder including a bearing positioned around the shaft; a balloon positioned around the bearing; and an occluder tube coupled to the balloon; wherein the bearing is configured to allow the shaft to be rotated independently from the balloon.
11. The uterine manipulator of claim 1 , wherein the handle is pivotable relative to the first end about a first axis; and the tip assembly is pivotable relative to the second end along a second axis parallel to the first axis.
12. The uterine manipulator of claim 11 , wherein the tip assembly pivots in a first direction along a plane in response to the handle pivoting in a second, opposite direction along the plane.
13. The uterine manipulator of claim 11 , wherein the tip assembly pivots above the second end and below the second end; and the handle pivots above the first end and below the first end.
14. The uterine manipulator of claim 11 , wherein the tip assembly is pivotable about the first axis in a range of degrees to enable both raising and lowering the uterus.
15. The uterine manipulator of claim 14 , wherein the handle includes a curved track, and a hinge pin slidable within the track for the range of degrees.