Design and development of a uterine manipulator with a lighting system that facilitates colpotomy. Comparison with other uterine manipulators

Abstract

Hysterectomy is the most common elective surgery, typically performed for benign pathologies, with a preference for minimally invasive approaches. The uterine manipulator is essential for ensuring success, as it facilitates dissection and reduces complications. The aim of this study was to design and create a uterine manipulator prototype that meets the gynecologist's expectations and includes a lighting system to improve tissue dissection and colpotomy. The uterine manipulator was designed with a stainless steel rod coated and interchangeable cups based on requirements. The distal end features an inverted cup to prevent pneumoperitoneum loss and reduce the risk of perforation when elevating the uterus. 3D printing was used to develop the pieces, and it was tested during a laparoscopic hysterectomy, comparing it with other manipulators used in the unit. The insertion time of the manipulator was 2:25 minutes. Uterine mobility was adequate but limited by the size and weight of the uterus. The visualization of the cup during the hysterectomy was not as expected, and the ergonomics were acceptable, though there was more flexibility than anticipated. The lighting system did not function as expected, and colpotomy time was not measured. Despite the issues encountered, this uterine manipulator is the first national prototype, with a low cost and integrated lighting system. After addressing the issues, it is expected to become an effective device for minimally invasive gynecological surgery.