Transvaginal tube as an aid to laparoscopic surgery

Abstract

It will be understood that the invention disclosed and defined herein extends to all alternative combinations of two or more of the individual features mentioned or evident from the text or drawings. All of these different combinations constitute various alternative aspects of the invention. Various changes and modifications may be made to the embodiments described and illustrated without departing from the present invention.

1 . (canceled)  
   
   
       2 . (canceled)  
   
   
       3 . (canceled)  
   
   
       4 . (canceled)  
   
   
       5 . A transvaginal tube adapted for insertion into the vaginal tract of a patient for use during performance of a laparoscopic hysterectomy or other laparoscopic surgery on the patient utilising electro-coagulation diathermy, the tube being of substantially stiff but flexible plastics material, having a diameter greater than the patient's cervix opening and having a distal end and a proximal end, the proximal end being cut in a plane non-normal to its tubular axis so that said proximal end is angled and dimensioned to define the patient's cervico-vaginal junction to facilitate separation of the vagina by electro-coagulation diathermy, the tube further comprising a sealing means capable of forming a seal at the distal end of the tube during said surgery, said tube being capable of maintaining the pneumoperitoneum when inserted into the vaginal tract of a patient with said seal formed at the distal end of the tube.  
   
   
       6 . A tube according to  claim 5  wherein the tube and its longitudinal axis are slightly curved between said proximal and distal ends so that the shorter longitudinal dimension defined by said non-normal plane is on the inside of the curve.  
   
   
       7 . A tube according to  claim 6  wherein said sealing means comprises a cap with at least one integral portal structure adapted to engage and seal about a surgical tool or other device.  
   
   
       8 . A tube according to  claim 5  wherein said sealing means comprises a cap with at least one integral portal structure adapted to engage and seal about a surgical tool or other device.  
   
   
       9 . A tube according to  claim 8  where said integral portal structure forms valve means.  
   
   
       10 . A tube according to  claim 9  wherein said cap is hingedly linked to a ring by which it is retained on the tube.  
   
   
       11 . A tube according to  claim 8 , including a tube body and a headpiece engageable with the tube body, said cap being releasably sealingly engageable with the headpiece.  
   
   
       12 . A tube according to  claim 11 , further including a handle integral with said headpiece for rotational alignment of the tube in situ.  
   
   
       13 . A tube according to  claim 5 , including a tube body and a headpiece engageable with the tube body.  
   
   
       14 . A tube according to  claim 13 , further including a handle integral with said headpiece adapted to facilitate rotational alignment of the tube in situ.  
   
   
       15 . A transvaginal tube as claimed in  claim 5  wherein the annular edge and sealing means are positioned at respective proximal and distal ends of the tube.  
   
   
       16 . A transvaginal tube as claimed in  claim 5  wherein the length of the tube is greater than approximately 25 cm.  
   
   
       17 . A transvaginal tube as claimed in  claim 5  wherein the annular edge defines the patient's cervico-vaginal junction as viewed from the patient's abdomen.  
   
   
       18 . A transvaginal tube as claimed in  claim 5  wherein the annular edge defines vaginal fornices.  
   
   
       19 . A tube according to  claim 5  wherein said seal is selectively releasable.  
   
   
       20 . A tube according to  claim 5  wherein the proximal end of the tube is bevelled.  
   
   
       21 . A tube according to  claim 5  wherein the proximal end has a smooth edge.  
   
   
       22 . A tube according to  claim 5  wherein the tube is substantially transparent.  
   
   
       23 . A tube according to  claim 5  wherein the sealing means comprises a plug or cap.  
   
   
       24 . A tube according to  claim 23  wherein the plug or cap is arranged to form a seal at the distal end of the tube effective for a pressure of approximately 5 to 30 cm of water.  
   
   
       25 . A tube according to  claim 23  wherein the plug or cap is arranged to form a seal at the distal end of the tube effective for a pressure of approximately 15 cm of water.  
   
   
       26 . A tube according to  claim 5  wherein the sealing means comprises a valve means.  
   
   
       27 . A tube according to  claim 26  wherein the valve means is in releasable engagement with the distal end of the tube.  
   
   
       28 . A tube according to  claim 26  wherein the valve means is arranged to form a seal at the distal end of the tube effective for a pressure of approximately 5 to 30 cm of water.  
   
   
       29 . A tube according to  claim 26  wherein the valve means is arranged to form a seal at the distal end of the tube effective for a pressure of approximately 15 cm of water.  
   
   
       30 . A tube according to  claim 5  further comprising bore tube receiving means for receipt of a bore tube to facilitate washing of body fluids and tissue specimens from the proximal end of the interior of the tube.  
   
   
       31 . A tube according to  claim 30  wherein the bore tube is arranged to provide suction within the tube.  
   
   
       32 . A tube according to  claim 5  further comprising surgical manipulator receiving means for receipt of surgical manipulator.  
   
   
       33 . A tube according to  claim 5  further comprising a fluid tight channel supported in concentric arrangement within the tube, said channel being sealed at its proximal end and open at its distal end and wherein the circumferential rim of the distal end of the channel is in sealing engagement with a portal formed in the distal end of the tube thus providing a means of communication between the interior of the channel and the exterior of the tube.  
   
   
       34 . A tube according to  claim 33  wherein the sealing engagement between the channel and the tube is effective for a pressure of approximately 5 to 30 cm of water.  
   
   
       35 . A tube according to  claim 33  further comprising further valve means releasably engaged to the longitudinal wall of the tube.  
   
   
       36 . A tube according to  claim 5  wherein said tube includes an externally roughened region for enhanced gripping of the vagina to aid presentation of the vagina for suture closure.  
   
   
       37 . A tube according to  claim 5  including means for applying suction to the tube interior for sucking surgical specimens into the tube.  
   
   
       38 . A tube according to  claim 5  wherein the tube has a diameter greater than 30 mm.  
   
   
       39 . A tube according to  claim 16  wherein the tube has a diameter greater than 30 mm.  
   
   
       40 . A transvaginal tube, adapted for laparoscopic hysterectomy surgery or other laparoscopic surgery involving insertion of the tube into the vaginal tract of a patient, said tube having a diameter greater than 30 mm and thereby greater than the patient's cervix whereby vaginal walls of the patient envelop at least a longitudinal portion of an external cylindrical surface of the tube to substantially seal thereagainst, the tube comprising an annular edge which lies substantially in a plane non-normal to its tubular axis to define the patient's cervico-vaginal junction, and sealing means for sealing the tube during said surgery to maintain the pneumoperitoneum; and wherein the tube and its tubular axis are slightly curved between said proximal and distal ends so that the shorter longitudinal dimension defined by said non-normal plane is on the inside of the curve.  
   
   
       41 . A tube according to  claim 40 , wherein said tube includes a segment in which the wall thickness is tapered longitudinally of the tube.  
   
   
       42 . A tube according to  claim 40  wherein the tube and its longitudinal axis are slightly curved between said proximal and distal ends so that the shorter longitudinal dimension defined by said non-normal plane is on the inside of the curve.  
   
   
       43 . A tube according to  claim 42  wherein said sealing means comprises a cap with at least one integral portal structure adapted to engage and seal about a surgical tool or other device.  
   
   
       44 . A tube according to  claim 40  wherein said sealing means comprises a cap with at least one integral portal structure adapted to engage and seal about a surgical tool or other device.  
   
   
       45 . A tube according to  claim 44  where said integral portal structure forms valve means.  
   
   
       46 . A tube according to  claim 45  wherein said cap is hingedly linked to a ring by which it is retained on the tube.  
   
   
       47 . A tube according to  claim 44 , including a tube body and a headpiece engageable with the tube body, said cap being releasably sealingly engageable with the headpiece.  
   
   
       48 . A tube according to  claim 47 , further including a handle integral with said headpiece for rotational alignment of the tube in situ.  
   
   
       49 . A tube according to  claim 40 , including a tube body and a headpiece engageable with the tube body.  
   
   
       50 . A tube according to  claim 49 , further including a handle integral with said headpiece adapted to facilitate rotational alignment of the tube in situ.  
   
   
       51 . A transvaginal tube as claimed in  claim 40  wherein the annular edge and sealing means are positioned at respective proximal and distal ends of the tube.  
   
   
       52 . A transvaginal tube as claimed in  claim 40  wherein the length of the tube is greater than approximately 25 cm.  
   
   
       53 . A transvaginal tube as claimed in  claim 40  wherein the annular edge defines the patient's cervico-vaginal junction as viewed from the patient's abdomen.  
   
   
       54 . A transvaginal tube as claimed in  claim 40  wherein the annular edge defines vaginal fornices.  
   
   
       55 . A tube according to  claim 40  wherein said seal is selectively releasable.  
   
   
       56 . A tube according to  claim 40  wherein the proximal end of the tube is bevelled.  
   
   
       57 . A tube according to  claim 40  wherein the proximal end has a smooth edge.  
   
   
       58 . A tube according to  claim 40  wherein the tube is substantially transparent.  
   
   
       59 . A tube according to  claim 40  wherein the sealing means comprises a plug or cap.  
   
   
       60 . A tube according to  claim 59  wherein the plug or cap is arranged to form a seal at the distal end of the tube effective for a pressure of approximately 5 to 30 cm of water.  
   
   
       61 . A tube according to  claim 59  wherein the plug or cap is arranged to form a seal at the distal end of the tube effective for a pressure of approximately 15 cm of water.  
   
   
       62 . A tube according to  claim 40  wherein the sealing means comprises a valve means.  
   
   
       63 . A tube according to  claim 62  wherein the valve means is in releasable engagement with the distal end of the tube.  
   
   
       64 . A tube according to  claim 62  wherein the valve means is arranged to form a seal at the distal end of the tube effective for a pressure of approximately 5 to 30 cm of water.  
   
   
       65 . A tube according to  claim 62  wherein the valve means is arranged to form a seal at the distal end of the tube effective for a pressure of approximately 15 cm of water.  
   
   
       66 . A tube according to  claim 40  further comprising bore tube receiving means for receipt of a bore tube to facilitate washing of body fluids and tissue specimens from the proximal end of the interior of the tube.  
   
   
       67 . A tube according to  claim 66  wherein the bore tube is arranged to provide suction within the tube.  
   
   
       68 . A tube according to  claim 40  further comprising surgical manipulator receiving means for receipt of surgical manipulator.  
   
   
       69 . A tube according to  claim 40  further comprising a fluid tight channel supported in concentric arrangement within the tube, said channel being sealed at its proximal end and open at its distal end and wherein the circumferential rim of the distal end of the channel is in sealing engagement with a portal formed in the distal end of the tube thus providing a means of communication between the interior of the channel and the exterior of the tube.  
   
   
       70 . A tube according to  claim 69  wherein the sealing engagement between the channel and the tube is effective for a pressure of approximately 5 to 30 cm of water.  
   
   
       71 . A tube according to  claim 69  further comprising further valve means releasably engaged to the longitudinal wall of the tube.  
   
   
       72 . A tube according to  claim 40  wherein said tube includes an externally roughened region for enhanced gripping of the vagina to aid presentation of the vagina for suture closure.  
   
   
       73 . A tube according to  claim 40  including means for applying suction to the tube interior for sucking surgical specimens into the tube.  
   
   
       74 . A tube according to  claim 40  wherein the tube has a diameter greater than 30 mm.  
   
   
       75 . A tube according to  claim 52  wherein the tube has a diameter greater than 30 mm.  
   
   
       76 . A method of performing a laparoscopic hysterectomy treatment or other laparoscopic treatment on a patient, utilising a transvaginal surgical device that comprises a tube having a diameter greater than the patient's cervix, and an annular edge which lies substantially in a plane non-normal to its tubular axis, and a sealing means capable of sealing the tube during surgery to maintain the pneumoperitoneum, said method comprising: 
 (i) introducing said device into a patient's vaginal so that the annular edge defines a cervico-vaginal junction; and    (ii) separating the cervix from the vagina at said defined cervico-vaginal junction.    
   
   
       77 . A method according to  claim 76  wherein said separating of the cervix from the vagina is effected intra-abdominally and laparoscopically.  
   
   
       78 . A method according to  claim 77  further comprising laparoscopically suturing the vault of the vagina following said separating step, with the tube in position in the vagina to support the vaginal edges.  
   
   
       79 . A method according to  claim 78  wherein the needle for said suturing is introduced through the tube and returned to the tube after completion of the suturing.  
   
   
       80 . A method according to  claim 77 , further comprising: 
 (iii) mobilising a surgical specimen resulting from said separating step into an end of the tube which is adjacent said annular edge; and    
   
   
       81 . A method according to  claim 80  further comprising, after said mobilising step: 
 (iv) withdrawing the tube, with said surgical specimen contained therein, from the vagina.    
   
   
       82 . A method according to  claim 81  further comprising, after step (iv); 
 (v) reintroducing the tube into the vagina and laparoscopically suturing the vault of the vagina, with the tube in position in the vagina to support the vaginal edges.    
   
   
       83 . A method according to  claim 82  wherein the needle for said suturing is introduced through the tube and returned to the tube after completion of the suturing.  
   
   
       84 . A method according to  claim 80  wherein said mobilising of the surgical specimen is effected by laparoscopically grasping the specimen and feeding it into the tube.  
   
   
       85 . A method according to  claim 80  wherein said mobilising of the surgical specimen is effected at least in part by applying suction via the tube.  
   
   
       86 . A method according to  claim 77  wherein said laparoscopic separation of the cervix from the vagina is effected by electro-coagulation diathermy.  
   
   
       87 . A method according to  claim 86  wherein said electro-coagulation diathermy is effected by: 
 exposing and holding the cervix with a laparoscopic grasping manipulators, inserting a knife or diathermy knife to the proximal end of the tube, and rotating the tube so that the annular edge non-normal to the tubular axis stretches the vagina and locally reduces blood flow, and at the same time cutting the cervico-vaginal junction as the tube is rotated.    
   
   
       88 . A method according to  claim 80  wherein said laparoscopic separation of the cervix from the vagina is effected by electro-coagulation diathermy.  
   
   
       89 . A method according to  claim 88  wherein said electro-coagulation diathermy is effected by: 
 exposing and holding the cervix with a laparoscopic grasping manipulators,    inserting a knife or diathermy knife to the proximal end of the tube, and    rotating the tube so that the annular edge non-normal to the tubular axis stretches the vagina and locally reduces blood flow, and at the same time cutting the cervico-vaginal junction as the tube is rotated.    
   
   
       90 . A method according to  claim 88  further comprising, after step (iv); 
 (v) reintroducing the tube into the vagina and laparoscopically suturing the vault of the vagina, with the tube in position in the vagina to support the vaginal edges.    
   
   
       91 . A method according to  claim 90  wherein the needle for said suturing is introduced through the tube and returned to the tube after completion of the suturing.  
   
   
       92 . A method according to  claim 88  wherein said mobilising of the surgical specimen is effected by laparoscopically grasping the specimen and feeding it into the tube.  
   
   
       93 . A method according to  claim 76 , further comprising: 
 (iii) mobilising a surgical specimen resulting from said separating step into an end of the tube which is adjacent said annular edge; and    
   
   
       94 . A method according to  claim 93  further comprising, after said mobilising step: 
 (iv) withdrawing the tube, with said surgical specimen contained therein, from the vagina.    
   
   
       95 . A method of performing a laparoscopic hysterectomy treatment or other laparoscopic treatment on a patient, utilising a transvaginal surgical device that comprises a tube having a diameter greater than the patient's cervix, and a sealing means capable of sealing the tube during surgery to maintain the pneumoperitoneum, said method comprising: 
 (i) introducing said device into a patient's vagina;    (ii) separating the cervix from the vagina; and    (iii) mobilising a surgical specimen resulting from said separating step into an end of the tube which is adjacent said annular edge.    
   
   
       96 . A method according to  claim 95 , further comprising: 
 (iv) withdrawing the tube, with said surgical specimen contained therein, from the vagina.    
   
   
       97 . A method according to  claim 96  wherein said separation of the cervix from the vagina is effected intra-abdominally laparoscopically at a cervico-vaginal junction defined by an annular edge at an end of said tube.  
   
   
       98 . A method according to  claim 97  wherein said laparoscopic separation of the cervix from the vagina is effected by electro-coagulation diathermy.  
   
   
       99 . A method according to  claim 98  wherein said electro-coagulation diathermy is effected by: 
 exposing and holding the cervix with a laparoscopic grasping manipulators,    inserting a knife or diathermy knife to the proximal end of the tube, and    rotating the tube so that the annular edge stretches the vagina and locally reduced blood flow, and at the same time cutting the cervico-vaginal junction as the tube is rotated.    
   
   
       100 . A method according to  claim 96  further comprising, after step (iv); 
 (v) reintroducing the tube into the vagina and laparoscopically suturing the vault of the vagina, with the tube in position in the vagina to support the vaginal edges.    
   
   
       101 . A method according to  claim 100  wherein the needle for said suturing is introduced through the tube and returned to the tube after completion of the suturing.  
   
   
       102 . A method according to  claim 95  wherein said mobilising of the surgical specimen is effected by laparoscopically grasping the specimen and feeding it into the tube.  
   
   
       103 . A method according to  claim 96  wherein said mobilising of the surgical specimen is effected at least in part by applying suction via the tube.  
   
   
       104 . A method according to  claim 98  wherein said mobilising of the surgical specimen is effected by laparoscopically grasping the specimen and feeding it into the tube.