Gynecologic instrument

Jan. 24, 1967

H. S. RUBENS

3,299,883

GYNECOLOGIC INSTRUMENT

FIG. I

Filed Nov. 8, 1963 2 Sheets-Sheet 1

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HARRY S. RUBENS

ATTORNEY

AGENT

Jan. 24, 1967

3,299,883

H. S. RUBENS

GYNECOLOGIC INSTRUMENT

<img file="US3299883A_D0002.tif" />

United States Patent Office

3,299,883

Patented Jan. 24, 1967

299 883

GYNECOLOGIC’INSTRUMENT

Harry S. Rubens, Massapequa, N.Y., assignor to Engelhard Hanovia, Inc., Newark, N.J., a corporation of New Jersey

Filed Nov. 8,1963, Ser. No. 322,414 5 Claims. (CI. 128—4)

The present invention deals with a gynecologic instrument and more particularly with an endoscopic type instrument for use in the practice of culdoscopy.

In the practice of culdoscopy, the distal end of the endoscopic instrument or culdoscope, is introduced into the peritoneal cavity through a small puncture made in the posterior fornix. Where clinical or surgical operative procedures was indicated, e.g. the lysis of adhesions, biopsys, aspiration of ovarian follicular content for cypological and ova studies, etc., a surgical instrument was inserted through the tubular culdoscope structure and manipulated in the vicinity of the objective lens for performing the surgery, etc. The operative procedure, with instruments nearly coaxial with the optical system of the culdoscope presented orientation and operative disadvantages because of the limited movement of the operating instrument relative to the objective lens and the area which it observes, whereby proper visualization and manipulation were difficult.

The invention concerns a gynecologic instrument adapted to obviate the aforementioned difficulty by permitting greater flexibility of manipulation and providing improved visualization.

It is an object of the invention to provide an improved gynecologic instrument.

It is another object of the invention to provide a unitary culdoscopic combination having manipulator components cooperatively associated with an endoscopic cannula.

It is a further object of the invention to provide a unitary culdoscopic combination instrument of improved manipular flexibility and improved visibility.

Other objects and advantages of the invention will be- ⁴⁰come apparent from the description hereinafter following and the drawings forming a part hereof, in which:

FIGURE 1 is an elevational side view of a gynecologic compound cannular manipulator assembly according to the invention,45

FIGURE 2 is an end view along lines 2—2 of FIGURE 1,

FIGURE 3 is a top view of FIGURE 2 and including a compound obturator means positioned in the compound cannular assembly,50

FIGURE 4 is an isometric view of the compound obturator means, and

FIGURE 5 is an isometric view of the cannular assembly including operative instruments cooperatively associated therewith.65

Regarding FIGURES 1, 2 and 3 the gynecologic compound cannular manipulator assembly comprises a main cannular 1 having an open end thereof mounted in bore 2 through a vertical plate 3 extending upwardly of one side of a block 4. The block 4 carries mounted thereon a U-shaped rail member 5 having parallel arcuate legs 6 and 7 extending upwardly of the block with the ends of the legs mounted in laterally spaced vertical bores 8 and 9 and secured by means of set screws 1» and 11 passing into the sides of the block and in contact with the ⁶⁵mounted legs. The rail legs are spaced rearwardly of the main cannula 1 and are spaced of each other a lateral distance exceeding the diameter of the main cannula to permit the passage of an endoscope therebetween and into the main cannula. The arcuate legs 6 and 7 are ⁷⁰curved upwardly in the direction of the free end of the cannula 1. The plate 3 is provided with a. boss 12 on its rearward face extending from the upper portion of the block 4 upwardly beyond the bore 2 and terminated laterally along the vertical diameter of bore 2. The boss 12 is provided with a cylindrical surfaced C-shaped groove or notch co-axial with the bore 2 and thereby forming one-half of a clamp means. A rectangular slot 13 is provided in one side of the block 4 intermediate the plate 3 and legs 6 and 7 for a distance substantially onehalf the width of the block in the direction of the boss 12. A second L-shaped clamp element 14 comprising a body portion 15 and upwardly extending leg 16 is inserted into the slot 13 with its body portion 15 movable in the slot 13. The leg 16 has a cylindrical surfaced C-shaped notch in one side facing the boss 12, co-axial with bore 2 and mating with the notch in the base 12 to form a clamp means for a cylindrical member inserted therebetween. A screw member 17 having a knurled head 18 passes through the body portion 15 and is threadedly engaged into the wall in the block terminating the slot 13, whereby turning the screw 17 provides clamping movement.

Each rail leg 6 and 7 is provided with a rider means 19 and 20,. respectively, selectively slidably adjustable along the rail legs. The rider means comprise sleeves 21 and 21' each having a shaft 22 and 22' passing therethrough and each having a bore 23 and 23' formed diametrically through an end portion thereof, the leg 6 passing through bore 23 and the leg 7 passing through bore 23' in slidably movable relationship. The shafts 22 and 22' are each threaded partly along the length thereof and are threadedly engaged with the inner surface of the knurled nuts 26 and 26' as at 24, whereby turning the knurled nuts 26 and 26' permits a selective fixation of the riders on the rail legs.

Each sleeve is provided with a collar 27 and 27' intermediate their ends, the collars each having ears 28 and 28' depending therefrom. The ears are each provided with bores 29 and 29' formed therethrough and having axes normal to the sleeves 21 and 21'. The sleeves 21, 21', the ears 28, 28' and the bores 29, 29' are positioned laterally outwardly of the legs 6 and 7 on which they are mounted so that they are on opposite sides of the rail means 5. The end portions of a pair of manipulator cannulae 30 and 31 are each preferably fixedly mounted in one of the bores 29 and. 29', respectively, with the opposite ends of the cannulae extending toward the free end of main cannula 1. A manipular fulcrum means 32 is fixed to main cannula 1 and extends laterally outwardly thereof in opposite directions. The fulcrum 32 is positioned on the cannula 1 a short distance from the free end of the cannula. For example, the fulcrum may be in the form of a substantially elliptical ring passed over the cannula 1 and fixed thereto at its minor axis leaving open ring passages on the opposite sides of the main cannula. The passages are spaced laterally of each other a distance less than the lateral spacing of the bores 29 and 29' relative of each other. The manipulator cannulae 30 and 31 are one each positioned through the passages with a short end of each of the cannulae extending in the direction of the free end of the main cannula and substantially coextensive with the free end of the main cannula. With the cannulae 30 and 31 each fixedly mounted through one of the bores 29 and 29' and through the open passages of the fulcrum ring 32, the cannulae are effectively pivoted at the fulcrum and converge in the direction of the free end of the main cannula. When the riders 19 and 20 are manipulated to move along the arcuate rail legs 6 and 7, the free ends of the cannulae 30 and 31 forward of the fulcrum 32 are caused to move along an arc and relative to the free end portion of the cannula 1.

3,299,883 ³

Obviously, arcuate movement of the riders on the rail means 5 produces a lesser oppositely directed arcuate movement of the fore ends of the manipulator cannulae, but the function is advantageous since as such there is provided a more precise movement control. Since the 6 cannulae 30 and 31 are movable independent of each other, the free ends are adapted for substantially great freedom of movement relative to each other and to the main cannula.

In the initial application of the compound cannular 10 manipulator, the cannulae are advantageously obturated by a composite obturator 33 designed to obturate all cannulae with a common single insertion movement and, likewise, the component obturators of the composite obturator are simultaneously removed. The composite ob- 15 turator is shown in applied position by FIGURE 3 and is more particularly illustrated by FIGURE 4 and comprises an elongated cross-bar 34 having a handle means 35 extending outwardly centrally of the bar in a direction normal to the bar longitudinal axis, and three obturator 20 shafts 36, 37 and 38 are laterally spaced from each other and extend from the bar in a direction opposite that of the handle means. The shafts are each provided with obturator heads 39, 40 and 41, respectively, at their free ends. Preferably, the shafts are so mounted on the 25 cross-bar that one shaft 37 extends from the center of the bar intermediate its ends and the other two shafts 36 and 38, which are flexible, are rotatably mounted at the ends of the cross-bar by pivot means 42 and 43. The pivoted mounting of the two outer shafts 36 and 38 is to ³⁰provide easy entry and exit from the converging cannulae 30 and 31 without subjecting the shafts to excessive bending strains and possible deformation. The two outer shafts 36 and 38 are provided with plug means 44, 45 and 46 respectively, for seating within the proximal ³⁵ends of the cannula.

FIGURE 5 illustrates the culdoscopic manipulator assembly with the composite obturator removed and with an endoscope or culdoscope together with operating instruments substituted. The culdoscope 47 is shown in mounted position in main cannula 1 with the fenestrum or objective 48 extending outwardly of the distal end of the cannula. Forceps 49 and cautery 50 are shown mounted in the manipulator cannulae 30 and 31 the cauterizing end 51 of the cautery and the forceps clamp member 52 in working position below and in view of the fenestrum or objective 48. By moving the riders 19 and 20 along rails 6 and 7 the cannulae are manipulated for the operative procedure.

Various modifications are contemplated within the scope of the appended claims. For example, while a pair of manipulator cannulae 30 and 31 are illustrated, there are instances where only one of the manipulator cannulae is employed and, consequently, the instrument may be provided with one of the cannulae and its cooperating rail omitted.