Uterine manipulator with cutting head
A uterine manipulator can include a shaft including a first end, a second end, and embodiments of a cutting head configured and arranged to receive a cervix. The cutting head can be configured and adapted to be used to cut the tissue joining the vaginal wall to the cervix and uterus to facilitate removal of the uterus in a minimally invasive manner.
1 . A uterine manipulator, comprising:
a shaft;
a handle coupled to a proximal end of the shaft;
a return path conductor extending along the shaft; and
a cutting head coupled to a distal end of the shaft, the cutting head including:
a cup coupled to the distal end of the shaft, wherein the cup is configured to be positioned at a juncture between a cervix and a vagina;
a conductive ring to which the return path conductor is electrically coupled;
a cutting wire conforming to and extending around at least a portion of the cup when in a stored position, wherein the cutting wire is configured to follow a substantially circular path when unwound about a longitudinal axis of the shaft, wherein the cutting wire has an extended position in which the distal portion of the cutting wire extends radially outwardly from the cup; and
wherein the cutting wire and the conductive ring define an annular gap sized to facilitate an arc discharge between the cutting wire and conductive ring when the cutting wire is energized.
2 . The uterine manipulator of claim 1 , wherein the cutting head further includes an annular trench in which the conductive ring is received.
3 . The uterine manipulator of claim 1 , wherein the uterine manipulator further comprising a push wire slidably disposed along the shaft, the push wire having a distal portion configured to engage the distal portion of the cutting wire so that the push wire is configured to pull the cutting wire outwardly from the cutting head to thereby move the cutting wire from the stored position to the extended position when the push wire is advanced distally.
4 . The uterine manipulator of claim 3 , wherein the cutting head includes an annular shaped groove formed within the cup, and the cutting wire, when in the stored position, is seated within and around the annular shaped groove, and when in the extended position, the wire is configured to be progressively pulled out of the annular shaped groove along a circumferential direction to follow the substantially circular path.
5 . The uterine manipulator of claim 4 , wherein the cutting head further includes an end cap that at least partially defines the annular shaped groove.
6 . The uterine manipulator of claim 5 , wherein the cutting head further includes a radially outwardly located lip that forms an annular trench and cooperates with a circumferential periphery of a distal cap to define the annular shaped groove.
7 . The uterine manipulator of claim 6 , wherein the distal cap and the radially outwardly located lip are composed of a dielectric material.
8 . The uterine manipulator of claim 6 , wherein the cutting head further includes a radially oriented opening formed through the end cap, such that the end cap has a radially outward solid portion adjacent the radially oriented opening, and wherein the distal portion of the cutting wire, when in the stored position, extends radially outwardly from the annular trench, wraps around the radially outward solid portion, and proximally through the radially oriented opening into engagement with the distal portion of the push wire, and wherein distal advancement of the push wire pulls the cutting wire distally and radially outward from the cup.
9 . The uterine manipulator of claim 3 , wherein a distal portion of the push wire includes a tissue-penetrating tip configured for piercing tissue near the cervix.
10 . The uterine manipulator of claim 9 , wherein the distal portion of the push wire has a pre-formed curvature configured to bend radially outwardly.
11 . The uterine manipulator of claim 3 , wherein the distal portion of the cutting wire comprises a cuff, and wherein the distal portion of the push wire is configured for being inserted into the cuff in order to pull the distal portion of the cutting wire outwardly from the cutting head.
12 . A system comprising:
the uterine manipulator of claim 1 ; and
an electrical power source electrically coupled to the cutting wire.
13 . A method of separating a uterus from a vagina of a patient, comprising:
providing the uterine manipulator of claim 1 ;
inserting a distal end portion of the uterine manipulator through a cervix of the patient; and
deploying the cutting wire through the tissue of the vagina and/or cervix outwardly into an abdominal cavity of the patient.
14 . The method of claim 13 , further comprising visualizing the cutting wire in the abdominal cavity through a laparoscopic procedure including insufflating the abdominal cavity of the patient, and visually locating a portion of the cutting wire extending into the abdominal cavity.
15 . The method of claim 14 , further comprising grasping the cutting wire using a second surgical instrument from within the abdominal cavity, and pulling the wire out of the uterine manipulator while unwinding the wire from about the cutting head along a circumferentially direction to sever the uterus or cervix from the vagina.
16 . The method of claim 15 , wherein the severing is accomplished without application of electrical current to the uterine manipulator.
17 . The method of claim 15 , wherein the severing is accomplished with application of electrical current to the uterine manipulator.