A comparative survey of various uterine manipulators used in operative laparoscopy

Abstract

This survey compares seven commonly used uterine manipulators in various laparoscopic procedures. These devices were compared with each other in respect of the various movement ranges they offered with anteversion, retroversion, lateral movement, elevation, and any special movement. It also compares the ability of the uterine manipulators with regard to the presentation of the vaginal fornices, and the ease of assembly, handling, and maintenance of the pneumoperitoneum. The information about the instruments was collected form the instrument manufacturer's websites and other related articles. No single uterine manipulator seems to have all the attributes of an ideal manipulator and the choice of uterine manipulator need to be individualized according to the surgical procedure in which it is used. The Clermont-Ferrand model provides a 140° range of uterine movements and it allows the uterus to flex on itself, but it requires cervical dilatation prior to insertion and is difficult to assemble. The RUMI with the KOH colpotomizer has a 140° range of uterine manipulation and delineates the vaginal fornices nicely, but has restricted elevation of the uterus and is difficult to assemble. The Hourcabie is easy to use and allows easy stapling of the uterine pedicles, but is poor in maintaining the pneumoperitoneum. The Endopath and Vcare are single-use manipulators and are useful only in laparoscopic assisted vagina hysterectomy (LAVH) or laparoscopic assisted supra-cervical hysterectomy (LASH) procedures, as they cannot delineate the vaginal fornices. The HOHL and TLH-Dr Mangeshikar manipulators provide a 130° range and have good uterine elevation; hence, they are useful for total laparoscopic hysterectomy (TLH) and endometriosis procedures. Ultimately, the TLH-Dr Mangeshikar and the Clermont-Ferrand model come close to being versatile. © 2006 Springer-Verlag.