Vaginal cuff closure tool and method

Abstract

An apparatus includes a hollow sleeve member with an open interior section and a sleeve proximal and a sleeve distal end. Two or more probes are disposed within the open interior section and extending beyond the sleeve distal end when in a deployed position. Distal ends of the probes have a lateral space between each other. One or more tissue manipulators are disposed at the distal end of each of the at least two probes. The hollow sleeve member and the two or more probes move axially relative to each other to reduce the lateral space. A method of closing a vaginal cuff of a vaginal canal is also provided.

What is claimed is: 
     
         1 . An apparatus comprising:
 a hollow sleeve member with an open interior section and a sleeve proximal and a sleeve distal end;   two or more probes disposed within the open interior section and extending beyond the sleeve distal end when in a deployed position and wherein probe distal ends of the probes have a lateral space between each other; and   one or more tissue manipulators disposed at the probe distal end of each of the at least two probes;   
       wherein the hollow sleeve member and the two or more probes move axially relative to each other to reduce the lateral space. 
     
     
         2 . The apparatus of  claim 1 , wherein the hollow sleeve member is configured to be advanced into a patient's anatomy to reduce the lateral space between the probe distal ends. 
     
     
         3 . The apparatus of  claim 2 , wherein the at least two probes are flexible. 
     
     
         4 . The apparatus of  claim 3 , wherein each of the at least two probes has a distal end portion disposed at the probe distal end, the distal end portion being preformed into a preformed arcuate shape. 
     
     
         5 . The apparatus of  claim 4 , wherein the hollow sleeve member defines a longitudinal axis extending along the length of the hollow sleeve member through the open interior section, wherein the probe distal end of each probe is disposed a distance apart from the longitudinal axis when the probe distal end of each probe extends beyond the sleeve distal end in the deployed position. 
     
     
         6 . The apparatus of  claim 5 , wherein the probe distal end of each probe extends at an angle of at least 30 degrees from the longitudinal axis when the probe distal end of each probe extends beyond the sleeve distal end in the deployed position. 
     
     
         7 . The apparatus of  claim 5 , wherein each tissue manipulator includes a grasper having first and second parts that are hinged together at proximal ends of the first and second parts. 
     
     
         8 . The apparatus of  claim 7 , wherein each first part has a first toothed side and each second part has a second toothed side, the first and second toothed sides configured to mate together. 
     
     
         9 . The apparatus of  claim 5 , wherein each probe of the at least two probes is configured to move axially with respect to one another. 
     
     
         10 . The apparatus of  claim 5 , wherein the at least two probes have an individually movable state and a fixed together state, wherein each probe of the at least two probes is configured to move axially with respect to one another in the individually moveable state, and wherein the at least two probes are attached together in the fixed together state. 
     
     
         11 . The apparatus of  claim 5 , further comprising an outer cannula, the hollow sleeve member being axially moveable along the longitudinal axis with respect to the outer cannula. 
     
     
         12 . A method of closing a vaginal cuff of a vaginal canal, the vaginal cuff being formed at a distal end of the vaginal canal and the vaginal canal forming a vaginal opening at a proximal end of the vaginal canal, the method comprising:
 advancing a hollow sleeve member with an open interior section and a sleeve proximal and a sleeve distal end into a patient's anatomy;   advancing a first probe and a second probe through the open interior section of the hollow sleeve member and into the patient's anatomy through the sleeve distal end, the first probe having a first tissue manipulator disposed at a probe distal end of the first probe and the second probe having a second tissue manipulator disposed at a probe distal end of the second probe;   grasping a first tissue portion of the vaginal cuff with the first tissue manipulator and grasping a second tissue portion of the vaginal cuff with the second tissue manipulator, the first and second tissue portions being spaced apart from each other by a lateral space;   moving at least one of the hollow sleeve member and the first and second probes relative to each other to reduce or eliminate the lateral space.   
     
     
         13 . The method of  claim 12 , wherein the step of moving the at least one of the hollow sleeve member and the first and second probes relative to each other comprises advancing the hollow sleeve member over the first and second probes, thereby bringing together the distal ends of the first and second probes and the first and second tissue portions to reduce or eliminate the lateral space. 
     
     
         14 . The method of  claim 13 , wherein the step of moving at least one of the hollow sleeve member and the first and second probes relative to each other comprises advancing the hollow sleeve toward the vaginal cuff over the first and second probes. 
     
     
         15 . The method of  claim 14 , further comprising inserting an outer cannula into the patient's anatomy, the step of advancing the hollow sleeve member including advancing the hollow sleeve member through the outer cannula, wherein advancing the hollow sleeve member toward the vaginal cuff over the first and second probes includes moving the hollow sleeve member axially with respect to the outer cannula. 
     
     
         16 . The method of  claim 15 , wherein the vaginal cuff defines a vaginal cuff plane, the first and second tissue portions being disposed generally within the vaginal cuff plane, the method further comprising holding the first and second probes with respect to the outer cannula after grasping the first and second tissues portions and keeping the first and second tissue manipulators generally within the vaginal cuff plane when the hollow sleeve member is advanced over the first and second probes. 
     
     
         17 . The method of  claim 16 , further comprising suturing the first and second tissue portions together while holding the first and second tissue portions together with the first and second tissue manipulators. 
     
     
         18 . The method of  claim 17 , wherein the step of suturing includes beginning the suturing by fixing a first suture through a first central portion of the first tissue portion and a second central portion of the second tissue portion, thereby connecting the first and second central portions together, the first and second central portions being disposed on opposite sides of the vaginal cuff. 
     
     
         19 . The method of  claim 18 , wherein the first and second probes are provided having a flexible material that is preformed into an arcuate shape. 
     
     
         20 . The method of  claim 12 , wherein the step of advancing the hollow sleeve member into the patient's anatomy includes advancing the hollow sleeve member into the vaginal canal through the vaginal opening.