A novel uterine manipulator incorporating non-local controls and lateral motion

Abstract

The work described in the paper was driven by a clinical need for a better uterine manipulator during laparoscopic gynecological procedures, including both hysterectomy and hysteroscopy. The primary purpose of the uterine manipulator is to provide a convenient means for the operators to position the patient's uterus from outside the body. Currently available manipulators are not adequate in two respects. First, no device allows for lateral as well as vertical manipulation. The lack of lateral motion often limits the surgeon during operations. Second, all devices require the operator to awkwardly hunch over the patient to reach the controls near the vagina during manipulation as opposed to a standing position at bedside. This situation usually results in the need for a dedicated assistant to hold the manipulator in place. In this paper, we present a prototype solution that successfully improved the features from the last prototype; addresses two essential needs: First, our manipulator allows for two complete degrees of freedom (lateral and vertical manipulation). Second, our manipulator features a cable-driven "non-local control" handle that can be clamped anywhere along the side of the operating table. Besides these two essential improvements, the surgeons are able to adjust the in and out motion of the manipulator from the foot pedal. With the improved end effector, it incorporates industry standard tips, cups and balloons. We have developed a uterine manipulator with increased functionality and enhanced physician control, which ultimately ensures patient safety and high quality of care.