Surgical Method and Apparatus

Abstract

An apparatus for use in connection with an endoscopic surgery includes an elongated body adapted to be placed at least partially in the vagina of a female patient partially passing through the wall of the vagina such that an end portion of said elongated element is introduced into rectouterine pouch. The elongated body includes at least an attachment means for accommodating at least a part of at least a surgical instrument comprising an end portion adapted to be received inside the vagina, the surgical instrument and the apparatus are movable to each other. An endobag having an elongated port is provided through the vagina into the pelvis.

1 . A method of pelvic or peritoneal surgery comprising the steps of: introducing at least an elongated end portion of a surgical instrument into the cavity of the uterus through the vagina of a female patient, manipulating said surgical instrument such that the uterus can be repositioned, and performing an incision on the vaginal wall for accessing the rectouterine pouch. 
     
     
         2 . The method of  claim 1  wherein an apparatus selected from the group consisting of: (i) an elongated body adapted to be placed at least partially in the vagina of a female patient for passing one or more surgical instruments through the vagina, said elongated body comprising attachment means on its outer side for slidable attachment to a surgical instrument which is adapted to be placed at least partially in the vagina; (ii) an elongated body adapted to be placed at least partially in a cavity of a hollow organ forming a natural orifice of a human or animal body, wherein said elongated body is configured to partially pass through a wall forming part of said hollow organ such that an end portion of said elongated element is introduced into said human or animal body; said elongated body comprising at least an attachment means for accommodating at least a part of at least a surgical instrument comprising an end portion adapted to be received inside said cavity, wherein said attachment means is configured such that said end portion of said surgical instrument is positioned inside said cavity when said end portion of said elongated body is placed inside said cavity and when said end portion of said elongated body is introduced into said human or animal body; and (iii) an elongated body adapted to be placed at least partially in the vagina of a female patient, wherein said elongated body is configured to partially pass through the wall of the vagina such that an end portion of said elongated element is introduced into rectouterine pouch; said elongated body comprising at least an attachment means for accommodating at least a part of at least a surgical instrument comprising an end portion adapted to be received inside the vagina, wherein said attachment means is configured such that said end portion of said surgical instrument is positioned inside the vagina when said end portion of said elongated body is placed inside the vagina and when said end portion of said elongated body is introduced into rectouterine pouch is placed in the vagina before an elongated end portion of a surgical instrument is introduced into the cavity of the uterus through the vagina. 
     
     
         3 . The method according to  claim 1  wherein the uterus is repositioned or rotated with respect to the vagina before performing said incision, such that the longitudinal axis of said elongated end portion of said surgical instrument or said uterus, or both surgical instrument and said uterus, make an angle of about 90 degrees with respect to one or more of the longitudinal axis of the vagina, or said elongated body of said apparatus. 
     
     
         4 . The method of  claim 1  wherein said surgical instrument is a uterus manipulator. and/or wherein said elongated body is a trocar sleeve or a cannula wherein the incision is performed by a second surgical instrument inserted through one of said channels of said elongated body, the second surgical instrument being preferably a trocar. 
     
     
         5 . A method of pelvic or peritoneal surgery comprising the steps of: introducing an apparatus comprising at least an elongated end portion of a surgical instrument into the cavity of the uterus through the vagina of a female patient such that the uterus can be repositioned by manipulating said surgical instrument, and introducing a flexible element into the pelvis wherein said flexible element is looped around the uterus such that said flexible element encircles the uterus. 
     
     
         6 . The method of  claim 5  wherein said flexible element is tightened such that the uterus is pressurized between said flexible element and said elongated end portion of said surgical instrument by drawing said flexible element. 
     
     
         7 . The method of  claim 5  wherein said flexible element is an elastic ring, a tourniquet or a string comprising two end portions. 
     
     
         8 . The method of  claim 5  further comprising the steps of: (i) performing an incision in the vaginal wall from the posterior formix of the vagina to the rectouterine pouch and (ii) introducing at least an end of said tourniquet or said string into the pelvis through said incision in the vagina, said string being looped around the neck of the uterus and the loop being tightened by drawing said end portions of said string. 
     
     
         9 . The method of  claim 5  wherein an apparatus selected from the group consisting of: (i) an elongated body adapted to be placed at least partially in the vagina of a female patient for passing one or more surgical instruments through the vagina, said elongated body comprising attachment means on its outer side for slidable attachment to a surgical instrument which is adapted to be placed at least partially in the vagina; (ii) an elongated body adapted to be placed at least partially in a cavity of a hollow organ forming a natural orifice of a human or animal body, wherein said elongated body is configured to partially pass through a wall forming part of said hollow organ such that an end portion of said elongated element is introduced into said human or animal body; said elongated body comprising at least an attachment means for accommodating at least a part of at least a surgical instrument comprising an end portion adapted to be received inside said cavity, wherein said attachment means is configured such that said end portion of said surgical instrument is positioned inside said cavity when said end portion of said elongated body is placed inside said cavity and when said end portion of said elongated body is introduced into said human or animal body; and (iii) an elongated body adapted to be placed at least partially in the vagina of a female patient, wherein said elongated body is configured to partially pass through the wall of the vagina such that an end portion of said elongated element is introduced into the rectouterine pouch; said elongated body comprising at least an attachment means for accommodating at least a part of at least a surgical instrument comprising an end portion adapted to be received inside the vagina, wherein said attachment means is configured such that said end portion of said surgical instrument is positioned inside the vagina when said end portion of said elongated body is placed inside the vagina and when said end portion of said elongated body is introduced into the rectouterine pouch is placed in the vagina before an elongated end portion of a surgical instrument is provided in the cavity of the uterus through the vagina. 
     
     
         10 . The method of  claim 8  wherein the uterus is repositioned or rotated with respect to the vagina before performing said incision, preferably such that the longitudinal axis of said elongated end portion of said surgical instrument and/or said uterus make an angle of about 90 degrees with respect to the longitudinal axis of the vagina and/or said elongated body of said apparatus. 
     
     
         11 . The method of  claim 5  wherein said surgical instrument is a uterus manipulator; wherein said elongated body is a trocar sleeve, or a cannula; wherein the incision is performed by a second surgical instrument inserted through one of said channels of said elongated body, the second surgical instrument being a trocar; and wherein said elongated element is introduced through one of said channels of said elongated body.