Krause intrauterine manipulator system consisting of two parts, a first part (i) comprising a manipulator and a second part (II) for containing co 2 gas pneumoperitoneum

Abstract

The present invention relates to a manipulator for Krause intrauterine laparoscopic hysterectomy, which comprises a handle or grip for holding and manipulating the uterus inside its cavity. This system solves some of the issues related to complexity of use and cost associated with current manipulators. The manipulator comprises two assembly parts: a reusable part and a disposable part, wherein the reusable part comprises a handle or grip, the end of which comprises a first cylindrical portion including a central threaded rod in the form of an adjustable nut, which extends along the longitudinal axis of the manipulator and can be used to open and close the articulated rhomboidal end of the manipulator, said handle or grip being made of a material selected from surgical nylon. From the adjustable nut portion, the manipulator extends towards its free end via an elongate cylindrical portion in the form of a handle or grip, which allows the manipulator to be manoeuvred and ends in a tapered cylindrical portion joined to a final smaller cylindrical portion, with a rigid surgical steel tube with a diameter of 6.35 mm, bent to form a stylised curve and counter curve that allow perfect manipulation and lifting of the uterus, through the inside of which a surgical steel rod moves inwards and outwards. The surgical steel rod is connected to the nut-forming cylindrical piece at one end and to the articulated rhomboidal end at the other end. A fixed metal cylindrical portion is located after the surgical plastic cylindrical portion of the handle or grip, around the surgical steel tube, this cylindrical piece comprising a central hole that is covered with a cover, and a second metal cylindrical portion is located towards the free end, said second portion having a larger diameter and smaller adjustable thickness, sliding about the surgical steel tube and being equipped with a threaded piece in the form of a cylindrical lock nut, allowing it to be adjusted in order to adjust the position of a tubular piece in the form of a flexible tubular rod. A cup-shaped vaginal fornix delineator and a teat-shaped flexible silicone cylindrical body which is intended to prevent the outflow of gas from the pneumoperitoneum are mounted on the disposable second part. The area between the first stylised curve and the end of the second stylised curve is lined or covered with the flexible plastic tubular piece with a 12 mm diameter. At the end opposite the handle or grip, the cup and the teat-shaped piece slide along the flexible plastic tubular piece, and these pieces are inserted under pressure into the patient's vagina together with the manipulator. Together, these pieces allow the CO2 gas pneumoperitoneum to be contained once the upper part of the vagina is incised.

Description

[0001] A KRAUSE INTRAUTERINE MANIPULATOR SYSTEM COMPRISING TWO PARTS, A FIRST PART (I) COMPRISING A MANIPULATOR AND A SECOND PART (II) FOR CONTAINING THE CO2 GAS IN THE PNEUMOPERITONEUM

[0002] Field of Invention

[0003] The present invention relates to the field of mobilizers / manipulators for performing a hysterectomy by means of a laparoscopic route, specifically with a Krause intrauterine manipulator for hysterectomy, which also comprises a novel and efficient system for containing the pneumoperitoneum of CO2 gas.

[0004] Background of the Invention

[0005] The following discussion of the prior art is intended to present the invention in an appropriate technical context and to allow its advantages to be properly appreciated. However, unless clearly stated otherwise, reference to any prior art in this specification should not be construed as an express or implied admission that such art is widely known or forms part of common knowledge in the field of intrauterine mobilizers.

[0006] The invention relates to the field of devices and systems for the surgical use of a mobilizer or manipulator for intrauterine hysterectomy by means of a laparoscopic approach.

[0007] Hysterectomy is a recommended surgery for patients who have pelvic pain and / or excessive bleeding.

[0008] In the vast majority of cases, surgeries are options to improve the health status of patients, as is the case with a hysterectomy.

[0009] This surgery consists of the removal of the uterus, preserving - or not - the ovaries depending on the age and the surgical indication.

[0010] Types of Hysterectomy:

[0011] Total laparoscopic hysterectomy (TLH)

[0012] TLH is the removal of the uterus and cervix through three to five small abdominal incisions. Depending on the individual patient's case, the ovaries and fallopian tubes may also be removed.

[0013] Laparoscopic supracervical hysterectomy (LSH)

[0014] This procedure involves laparoscopic removal of the uterus, and the patient may retain her cervix. The patient may also choose to have her ovaries removed or retained at the same time.

[0015] Laparoscopically assisted vaginal hysterectomy (LAVH)

[0016] LAVH is a surgical procedure that uses a laparoscope to guide the removal of the uterus and / or fallopian tubes and ovaries through the vagina.

[0017] Laparoscopic myomectomy for fibroids

[0018] This surgery involves the removal of fibroids (non-cancerous tumors in the muscle of the uterus) from the wall of the uterus.

[0019] In the field of mobilizers for hysterectomy and the types of devices used for this purpose, there is a continuous demand for a simple and safe manipulator that provides greater patient safety and greater dexterity for the physician. Several aspects are relevant to achieving these objectives, such as the effectiveness of the mobilizer. The design of the mobilizer for intrauterine hysterectomy via laparoscopy, which includes an articulated end for grasping and manipulating the uterus from within its cavity, can influence and improve some of the previously identified aspects. This is achieved by reducing the size of its adjustable, rhomboidal, articulated end for insertion and subsequent placement within the uterine cavity. The end can then be enlarged and maneuvered using a nut or knob located on the mobilizer's handle.Furthermore, the design and length of the stem, with its pronounced double curve, allow for a range of intra-abdominal uterine movement unmatched by any existing device or instrument. This enables angles and positions that facilitate and enhance the safety of the surgery. It is particularly effective in cases of large uteri.

[0020] Some types of manipulators: gripping, clamping, cutting and dissecting, electric, retraction

[0021] For prior art information, see US Patent No. US11413069B2, which relates to a functional uterine manipulator operable for separating the uterus and cervix from the vagina. The uterine manipulator may include a shaft, a handle, a tip assembly, and a cutting assembly.

[0022] Also, the North American patent document No. US8545513B2, related to a set of uterine manipulator, components and related methods, should be consulted.

[0023] A uterine manipulator includes an elongated shaft and a tip hub. The elongated shaft has a proximal and a distal end. The distal end is configured for insertion through the vagina. The tip hub is located at the distal end and is configured to freely receive and support a tip holder for attachment to a uterus. The elongated shaft includes one or more channels extending between the distal and proximal ends. The channels are configured to freely receive catheter tubing.

[0024] You should also consult the Danish patent for Lina Loop, the Bipolar Loop, Immediate Cut-Off Action and Improved Safety.

[0025] The UNA Bipolar Loop (Patented and Registered) is a safe and effective single-use electrical instrument used to section the uterus during laparoscopic supracervical hysterectomy (LSH) and myoma resection.

[0026] The Loop reduces the surgical time required for hysterectomy to just a few seconds. The loop ensures a clean incision of the cervix, leaving a clean hemostatic surface with minimal bleeding, thus eliminating the need for subsequent coagulation. Furthermore, this product is ideal for the removal of fibroids located outside the uterine wall (pedunculated subcutaneous fibroids).

[0027] Safety - Low energy, high effect

[0028] The new bipolar technology offers immediate cutting action and improved safety with only 55-70 watts of power

[0029] The visualization is supported by a new protective ceramic tip, allowing for optimal accuracy in loop positioning.

[0030] The ceramic tip, along with the gold insulation, isolates the cutting action of the tissue between the two electrodes, reducing heat dispersion.

[0031] No neutral / ground plate is needed.

[0032] Some of the most common drawbacks and risks of current high-cost manipulators (source: Complications caused by uterine manipulators based on the database and literature from MAUDE, FDA, Manufacturer and User Facility Device Experience):

[0033] Hohl, uterine rupture and intestinal penetration,

[0034] Clearview, Manipulator disintegration, parts left inside the patient, uterine perforation,

[0035] RUMI I, vaginal wall laceration, excessive hemorrhage, parts of the manipulator inside the patient, uterine perforation, loss of the cup during colpotomy, retroperitoneal hematoma caused by hyperinflation of the intrauterine balloon,

[0036] Vcare, disintegration upon removal of the manipulator, parts of the manipulator inside the patient, vaginal wall laceration, perforation of the vagina and cervix due to the cup, perforation of the uterus, repeated wounds.

[0037] Complications after manipulation by means of the previously mentioned devices, which require different procedures such as, for example, laparotomies for bowel repair, removal of objects from inside the patient by means of hysteroscopy, sutures, blood transfusion and other procedures originating from failures.

[0038] The most common failures today in most disposable and mixed manipulators are: they leak CO2 pneumophthaltomization gas, they are very difficult to use in large uteri, most do not allow rotation of the uterus when manipulated, and additionally they perforate the uterus.

[0039] Therefore, there remains a need for a low-cost, quick-to-install uterine manipulator system suitable for performing surgical interventions, most importantly, offering the most appropriate and safe range of movement, which will resolve some existing problems related to current manipulators and the different techniques that are being developed.

[0040] The Krause intrauterine manipulator also allows for better suturing angles when repairing the uterus following a myomectomy for the removal of fibroids located in the uterine wall. This is due to its range of motion and the ability to rotate the uterus.

[0041] The Krause manipulator facilitates and provides safety in the procedure, is low cost, provides good uterine elevation, perfect delineation of the vaginal vault, good control of the fundus of the uterus, and perfect containment of the CO2 gas pneumoperitoneum.

[0042] Brief Description of the Invention

[0043] The object of the invention is to provide a Krause intrauterine manipulator system comprising two parts, the first reusable (sterilize) part (I) related to a manipulator for intrauterine hysterectomy by means of a laparoscopic route and a second disposable part (II), a disposable vaginal part composed of a pacifier-like piece and a cup, which slide through a flexible plastic tubular piece of 12 mm in diameter, which are inserted into the patient's vagina, pieces which together allow demarcation of the vaginal fornices, and contain the pneumoperitoneum of CO2 gas once the upper part of it is cut.

[0044] This and other objectives, which will become evident below, are achieved by means of the manipulator system for intrauterine hysterectomy by means of a laparoscopic approach, as defined in claim 1.

[0045] A number of non-exhaustive embodiments, variants, or alternatives of the invention are defined by means of the dependent claims.

[0046] Effects of the invention

[0047] The present invention comprises a technological advantage over known systems by using a two-part system (I and II). The first part (I) consists of a Krause manipulator comprising a firm, double-curved stem with an articulated end. The second part (II), a disposable vaginal portion, consists of a first cylindrical portion shaped like a pacifier, which allows the containment of the CO2 gas pneumoperitoneum, and a second cylindrical piece shaped like a bowl, attached to a plastic tube once the upper part of the vagina is cut. This system is used to perform an intrauterine hysterectomy via laparoscopy. It is simple in design, effective, and low in production cost. It allows for perfect rotation of the uterus without the risk of perforation and is also applicable to other surgical interventions such as myomectomies, retrocervix removal, vascular pedicle removal, and endometriosis removal, among others.

[0048] Brief Description of the Figures

[0049] In order that the present invention may be more easily understood, reference will now be made to the accompanying figures which illustrate a preferred embodiment of the invention, in which:

[0050] Figure 1 shows a perspective view of the intrauterine manipulator with its articulated rhomboidal end closed, according to the invention.

[0051] Figure 2 shows a perspective view of the intrauterine manipulator with its open articulated rhomboidal end, according to the invention.

[0052] Figure 3 is a detailed view of the cylindrical, pacifier-like piece of the second part of the system, for containing the pneumoperitoneum of CO2 gas, according to the invention.

[0053] Figure 4 shows a detailed schematic view of a uterus being manipulated by means of the articulated rhomboidal end, according to the invention.

[0054] Figure 5 is a front perspective view of the first cylindrical portion of the left end that acts as a lock nut for regulating the opening and closing of the articulated rhomboidal end, according to the invention.

[0055] Figure 6 is a view of the cylindrical portion that acts as a fixing pin for adjusting the position of the plastic tube of the cup system, according to the invention. Figure 7 is a perspective view of the articulated rhomboidal end that allows manipulation of the uterus, according to the invention.

[0056] Figure 8 is a detailed view of the fixing bolt of the insert that carries the cup system, according to the invention.

[0057] Figure 9 shows a detailed view of the vaginal part (I) of the system being inserted through the vagina of a patient, according to the invention.

[0058] Detailed Description of the Invention

[0059] The present invention will now be described with reference to the following embodiments, which are to be considered in all respects as illustrative and not restrictive. In the figures, the corresponding features within the same embodiment or common to different embodiments have been assigned the same reference numbers.

[0060] The present invention consists of a Krause intrauterine manipulator system (1) for medical use in the field of laparoscopic surgical interventions, where it is required to manipulate the uterus organ (U) in the abdomen (A) of a patient (P) in an agile and safe manner so as to be able to extract the uterus (U) from the body of a patient (P), after a series of procedures through the intra-abdominal laparoscopic hysterectomy intervention.The intrauterine manipulator system (1) for laparoscopic hysterectomy is composed of two main parts (I and II), separate, which in turn comprise other movable parts arranged inside, where the first part (I) comprises a handle or grip (2) at the end of which is located a first cylindrical portion (3) which in its center comprises a threaded stem (4) in the form of an adjustable nut arranged in the direction of the longitudinal axis of the manipulator (1) (see figure 5) which allows the adjustment of the closing and opening of the rhomboidal articulated end of the manipulator (1) extends towards its free end, through the elongated cylindrical portion (2) in the form of a handle or grip, which allows the maneuverability of the manipulator (1), which limits in a tapered cylindrical portion of conical shape (6) joined to a last cylindrical portion (7) of smaller dimension.From this point the second part (II) is projected, vaginal part this second part (II) is disposable, it comprises a rigid surgical steel tube (8) of 6.35 mm diameter, bent into a stylized curve (9) and counter-curve (10) that allow perfect manipulation and elevation of the uterus, through whose interior a metal rod (11) moves in and out, which is connected at one end to the cylindrical piece in the form of a nut (3) which pushes or pulls it and at the other end to the rhomboidal articulated end (5).

[0061] From the cylindrical portion of surgical plastic of the handle or grip (2) is located a fixed cylindrical metal portion (12) around the surgical steel tube (8). This cylindrical piece (12) comprises a centered perforation (13) which is covered by a cap (14). Towards the free end is located a second cylindrical metal portion of larger diameter (15) and less thickness, which slides around the surgical steel tube (8). This portion has a threaded piece in the form of a cylindrical fixing nut (16), which allows its adjustment to regulate the position of a tubular piece (17) in the form of a flexible tubular stem. A flexible cylindrical silicone body (18) in the shape of a pacifier is inserted into this stem, which serves to prevent the escape of gas from the pneumophthalmometer.A vaginal fornix delineator in the form of a cup (19) and where from the first stylized curve (9) to the end of the second stylized curve (10) it is lined or covered by means of the flexible plastic tubular piece of 12 mm diameter (17) where at the opposite end from the handle or grip (2), the pacifier-like piece (18), and the cup (19) slide through the flexible plastic tubular piece (17), these pieces together with the manipulator are inserted under pressure into the vagina (V) of a patient (P), pieces which together allow to contain the pneumoperitoneum of CO2 gas once the upper part of the vagina (V) is cut.

[0062] In Figure 2, a view of the second part (II) of the manipulator (1) can be observed, the disposable vaginal part, which is formed by the plastic tube (17) of 12 mms in diameter and a length of 20 cms (see Figure 3) orients the larger diameter portion of the cone towards the inside of the vagina (V) or towards the abdomen (A) vaginal part that moves on the tubular metal stem, around this is located a cylindrical portion of smaller diameter (20) that opens outwards to form a semi-spherical piece (21) which limits in an edge in the form of a ring of larger diameter (22) around this plastic tube (17) is located a flexible cylindrical body of silicone (18) in the form of a pacifier that serves the function of preventing the escape of gas from the pneumopethony, and at its distal end is arranged the rigid cup (19).This second part (II) of the system is introduced through the vagina (V) by pressing the cup inside the cervix (C) first the cup and then the semi-spherical piece in the form of a pacifier (18), leaving part of the 12 mm diameter plastic tube (17) outside the vagina (V), so as to allow the pneumoperitoneum of CO2 gas to be contained once the upper part of the vagina (V) is cut.

[0063] In Figure 4, a view of a uterus (U) being manipulated by means of the articulated rhomboidal end (5) of the manipulator (1) is shown.

[0064] In Figure 5, an exploded perspective view of the handle (2) can be seen, showing the lock nut (3) at the left end of the manipulator (1), connected to a surgical steel stem (11), which allows pushing or pulling the surgical steel stem (11) to open or close the articulated rhomboidal end (5), so as to allow manipulation of the uterus (U).

[0065] In Figure 6, a perspective view can be seen of the metal cylindrical portion (12) fixed around the surgical steel tube (8), which has a perforation (13) comprising a cap (14), towards the free end is located the cylindrical portion of larger diameter (15) and less adjustable thickness which slides around the surgical steel tube (8), which has a threaded piece in the form of a cylindrical fixing nut (16), which allows its adjustment in order to regulate the position of the tubular piece (17) in the form of a flexible tubular stem, which carries the cylindrical portion in the form of a sucker (18) and at its distal end the cup (19).

[0066] In Figure 7, a perspective view of the articulated rhomboidal end (5) that allows manipulation of the uterus (U) can be observed. This uterus is formed by four fixed parts connected to each other in a movable manner (23, 24, 25 and 26) joined together by means of a metal pin (27) made of surgical steel of smaller dimensions, acting as a hinge that allows the opening and closing movement of the articulated rhomboidal end (5) from its base (28), which is connected to the metal stem (11) that moves through the interior of the surgical steel tube (8), inwards and outwards. On this base (28) are located the first two movable metal portions (23 and 24) joined to this base by means of a first metal pin (27) made of surgical steel, where the first upper movable piece (23) opens from 0 oThat is to say, folded, to a total opening angle of about 30°, the second upper movable piece (24) closes from a total opening angle of about 45° to 0 o to be folded, joined to the first movable piece, the third movable piece (25) opposite the second movable piece (24) opens from the 0 o up to a total opening angle of about 330° this third movable piece (25) is movably attached to a fourth movable piece (26) which closes from a total opening angle of about 325° to an angle of 0 o when folded. This articulated rhomboidal end (5) allows manipulation of the uterus (U).

[0067] In Figure 8, a detail of the fastening bolt (16) of the larger diameter cylindrical portion (15) and its threaded stem (28) can be observed, which allows the position of the cylindrical portion to be adjusted like a pacifier (18) and at its distal end the cup (19).

[0068] In Figure 9, a view of the second part (II) of the manipulator (1) can be observed, a disposable vaginal part, which is formed by a plastic tube (17) 12 mm in diameter and 20 cm long around which, at its left end (El), a vaginal insertion device is located, formed firstly by a semi-spherical piece (21) in the form of a pacifier (18) which limits in an edge in the form of a ring of greater diameter (22) where at its distal end there is a conical cylindrical piece in the form of a cup (19) which orients the portion of greater diameter of the cone towards the inside of the vagina (V) or towards the abdomen (A).

[0069] This second part (II) of the system is introduced through the vagina (V) by pressing the cup (19) inside the cervix (C) together with the semi-spherical piece as a pacifier (18), leaving the 12 mm diameter plastic tube (17) outside the vagina (V), so as to allow the pneumoperitoneum of CO2 gas to be contained once the upper part of the vagina (V) is cut, with the arrows and letters (D) and (F), the directions inside and outside are designated.

[0070] Additionally, the cup (19) made from rigid surgical plastic, helps in the identification of the vaginal fornices (1) once introduced around the cervix (C), where the design and length of the 6.35 mm surgical steel tube (8) formed by the stylized curve (9) and the stylized counter-curve (10), allows the entire second disposable part (II) to passively follow the movements exerted by the surgical steel tube (8), allowing a wide range of intrauterine movements, especially in large uteri (U).

[0071] Those skilled in the field will appreciate that the principles of this description are not limited to the specific example discussed or illustrated in the figures. For example, although the cylindrical tubular portions of steel (8) and plastic (17) respectively have diameters of 6.35 mm and 12 mm in terms of cross-section, other configurations for the tubular portions are feasible.

[0072] Approximation terms are intended to encompass ranges of values ​​that do not change the function or outcome of the described structure or process. For example, the term "around" generally refers to a range of numerical values ​​that someone skilled in the art would consider equivalent to the cited numerical value or to have the same function or outcome. Similarly, the antecedent "substantially" means largely, but not completely, the same form, mode, or degree, and the particular element will have a variety of configurations that someone with ordinary knowledge of the art would consider to have the same function or outcome. For example, "substantially parallel" need not be exactly 180 degrees but can also encompass slight variations of a few degrees depending on the context.

[0073] While aspects of this description have been shown and described in particular with reference to the preceding embodiments, those skilled in the art will understand that various additional embodiments can be achieved by modifying the machines, systems, and methods described without departing from the spirit and scope of the description. It is understood that such embodiments fall within the scope of this description as determined by the claims and any equivalents thereof.

[0074] Industrial Application

[0075] The present invention, according to its application, finds use in industry and in particular in the metalworking industries of precision surgery, the manufacture of medical / surgical parts and pieces, surgical rubbers and silicones for medical components, and medical supplies.

[0076] Reference list

[0077] Abdomen

[0078] D Inwards

[0079] F Outwards

[0080] ED Far right

[0081] The far left

[0082] Patient P

[0083] Uterus

[0084] Part I: Reusable handle

[0085] Part II Disposable Vaginal

[0086] 1 Krause Intrauterine Manipulator System

[0087] 2 Handle or grip

[0088] 3 First cylindrical portion

[0089] 4 Spun stem

[0090] 5 Articulated rhomboidal end

[0091] 6. Pointed cylindrical portion of conical shape

[0092] 7 Last cylindrical portion

[0093] 8 Rigid surgical steel tube 6.35 mm diameter

[0094] 9 Stylized curve

[0095] 10 Stylized counter-curve

[0096] 11 Surgical steel stem

[0097] 12. Metal cylindrical portion

[0098] 13 Perforation Lid

[0099] Second cylindrical metal portion of larger diameter. Cylindrical fixing nut.

[0100] Plastic tubular piece 12 mm diameter. Cylindrical body in the shape of a pacifier. Cylindrical portion in the shape of a bowl.

[0101] Cylindrical portion of smaller diameter

[0102] Semi-spherical piece

[0103] Larger diameter ring

[0104] First fixed part, rhomboidal articulated end. Second fixed part, rhomboidal articulated end. Third fixed part, rhomboidal articulated end. Fourth fixed part, rhomboidal articulated end. Metal pin, movable joint.

[0105] Base

Claims

AMENDED CLAIMS received by the International Bureau on May 14, 2025 (14.05.2025) 1. A Krause manipulator (1) for intrauterine hysterectomy via laparoscopy, comprising a handle (2) for grasping and manipulating a uterus (U) within its cavity in an agile and safe manner, which resolves some of the significant drawbacks related to the complexity of use, failures within the uterus of several manipulators with the well-known risks to a patient, and costs associated with current manipulators, thus comparatively improving upon what is currently available on the market, CHARACTERIZED in that it comprises: - a reusable main part (I) and - a disposable vaginal part (II), wherein the main reusable part (I) comprises a handle (2) at the end of which is located a first cylindrical portion (3) which in its center comprises a threaded stem (4) in the form of an adjustable nut arranged in the direction of the longitudinal axis of the manipulator (1) which allows the opening and closing of an articulated rhomboidal end (5) of the manipulator (1) to be adjusted when inside the uterine cavity, by means of the handle (2), from the portion in the form of an adjustable nut (4) the manipulator (1) extends towards its free end, through the elongated cylindrical portion in the form of a handle (2), which allows the maneuverability of the manipulator (1) additionally allows a wide range of movements (for example, rotational movement which none of the current manipulators allow) so that it is not limited to only one angle of position like the current manipulators,which is limited by a tapered, conical cylindrical portion (6) joined to a smaller cylindrical portion (7), this comprises a rigid surgical steel tube (8) 6.35 mm in diameter, bent into a stylized curve (9) and counter-curve (10) that allow perfect manipulation and elevation of the uterus (U), through whose interior a surgical steel rod (11) moves in and out, which is connected at one end to the piece, cylindrical in the form of a nut (3) and at the other end in the articulated rhomboidal end (5), from the cylindrical portion of surgical plastic of the handle or grip (2) is located a cylindrical metallic portion (12) fixed around the surgical steel tube (8), this cylindrical piece (12) comprises a centered perforation (13) which is covered by means of a cap (14), towards the free end is located a second cylindrical metallic portion of larger diameter (15) and less thickness adjustable which slides around the surgical steel tube (8), which has a threaded piece in the form of a cylindrical fixing nut (16), which allows its adjustment in order to regulate the position of a tubular piece (17) in the form of a flexible tubular stem, where in this second disposable part (II) is located inserted a flexible cylindrical body of silicone (18) in the form of a pacifier which fulfills the function of containing the pneumopethonation of CO2 gas,novel and efficient, improving upon what currently exists on the market and which has not been applied in any current manipulator, and a vaginal fornix delineator in the form of a cup (19) where from the first stylized curve (9) to the end of the second stylized curve (10) it is lined or covered by means of the flexible plastic tubular piece of 12 mm diameter (17) through which the pacifier-like piece (18) and the cup (19) slide.

2. The manipulator (1) for intrauterine hysterectomy, according to claim 1, CHARACTERIZED in that towards the free end is located the cylindrical portion of larger diameter (15) and less adjustable thickness which slides around the surgical steel tube (8), which has a threaded or spun piece in the form of a cylindrical fixing nut (16), which allows its adjustment in order to regulate the position of the tubular piece (17) in the form of a flexible tubular stem.

3. The manipulator (1) for intrauterine hysterectomy, according to claim 2, CHARACTERIZED in that the articulated rhomboidal end (5) is formed by four fixed parts connected to each other in a movable manner (23, 24, 25 and 26) joined together by means of a metal pin (27) in the form of a hinge that allows the opening and closing movement of the articulated rhomboidal end (5), From its base (28) which is connected to the surgical steel stem (11), the first two movable metal portions (23 and 24) are located, joined to this base by means of a first metal pin (27) where the first upper movable piece (23) opens from an angle of 0 o folded, to a full opening angle of about 30°, the second upper moving part (24) closes from a full opening angle of about 45° to 0 oto be folded, joined to the first movable piece, the third movable piece (25) opposite the second movable piece (24) opens from the 0 o up to a total opening angle of about 330° this third movable piece (25) is movably attached to a fourth movable piece (26) which closes from a total opening angle of about 325° to an angle of 0 o when folded.

Images