Methods and apparatus for natural orifice vaginal hysterectomy

Abstract

A transuterine cannula through which an endoscope can be advanced into the peritoneal space to provide visualization of tissue cutting in the peritoneal space pursuant to a vaginal hysterectomy.

1 - 26 . (canceled) 
     
     
         27 . A transuterine cannula, comprising:
 a cannula body having a length sufficient to advance the transuterine cannula through the vagina of a patient to the distal wall of the uterus of the patient with at least a proximal segment of the transuterine cannula remaining outside the patient's body; and   at least one sealing member engaged with a distal segment of the transuterine cannula to hold the transuterine cannula against the distal wall of the uterus, wherein the transuterine cannula is formed with a distal neck defining a longitudinal axis and a shoulder proximal to the neck and adjoined thereto, the shoulder defining a longitudinal axis that is collinear with the axis defined by the neck, the shoulder being wider than the neck for abutting an inner surface of the distal wall of the uterus with the neck disposed in the opening thereof, the neck ending in a fenestrating element configured to puncture the uterine wall.   
     
     
         28 . The transuterine cannula of  claim 27 , the penetrating element being associated with the transuterine cannula to fenestrate the distal wall to form an opening therein. 
     
     
         29 . The transuterine cannula of  claim 27 , further comprising at least one endoscope advanceable through the cannula and opening in the distal wall of the uterus into a peritoneal space to provide visualization of anatomical structure in the peritoneal space. 
     
     
         30 . The transuterine cannula of  claim 29 , further comprising a veress cannula slidably engageable with a lumen of the endoscope. 
     
     
         31 . The transuterine cannula of  claim 29 , further comprising a dissecting device for cutting the anatomical structure in the peritoneal space for which the endoscope provides visualization. 
     
     
         32 . The transuterine cannula of  claim 29 , wherein one or more of the transuterine cannula and endoscope can articulate while in a patient. 
     
     
         33 . The transuterine cannula of  claim 29 , comprising a vacuum shroud surrounding a distal end of the endoscope and communicating with a source of vacuum to attract the distal wall of the uterus toward the endoscope to facilitate fenestration of the distal wall. 
     
     
         34 . The transuterine cannula of  claim 27 , further comprising a vaginal guide closely received in a vagina of a patient, the guide formed with at least one hole slidably supporting the transuterine cannula. 
     
     
         35 . The transuterine cannula of  claim 27 , comprising an obturator disposable in the transuterine cannula to facilitate advancing the transuterine cannula to the distal wall of the uterus. 
     
     
         36 . The transuterine cannula of  claim 35 , wherein the obturator has a frusto-conical distal segment terminating in a rounded distal tip, and at least the distal tip bears a bipolar electrode array for fenestrating the distal wall of the uterus. 
     
     
         37 . (canceled) 
     
     
         38 . The transuterine cannula of  claim 27 , comprising a uterine stabilizing balloon surrounding a portion of the transuterine cannula and having an inflatable configuration, wherein the stabilization balloon substantially fills the uterus to facilitate manipulation of the uterus, and a deflated configuration, wherein the stabilization balloon is configured to facilitate advancing the transuterine cannula into the uterus. 
     
     
         39 . The transuterine cannula of  claim 27 , wherein the transuterine cannula defines an outer surface and includes at least one working channel external to the outer surface. 
     
     
         40 . The transuterine cannula of  claim 27 , further comprising a vaginal positioning guide closely receivable in a vagina and receiving the transuterine cannula therethrough, the vaginal positioning guide bearing at least one tissue dissector for fenestrating the vagina. 
     
     
         41 . The transuterine cannula of  claim 40 , wherein the vaginal positioning guide includes a balloon inflatable to substantially fill the vagina to anchor the guide in the vagina when the transuterine cannula extends therethrough into the uterus. 
     
     
         42 . The transuterine cannula of  claim 28 , wherein the penetrating element is established by a distal tip of the transuterine cannula. 
     
     
         43 . The transuterine cannula of  claim 28 , wherein the penetrating element is established by a cutting device advanceable through the transuterine cannula. 
     
     
         44 . The transuterine cannula of  claim 27 , wherein the transuterine cannula is secured to the distal wall of the uterus using a gas seal. 
     
     
         45 . The transuterine cannula of  claim 44 , wherein the transuterine cannula is secured to the distal wall of the uterus using a pair of gas sealing devices. 
     
     
         46 . The transuterine cannula of  claim 45 , wherein the gas sealing devices are inflatable balloons. 
     
     
         47 . (canceled)