The newly designed uterine manipulator (Halder’s) is developed to simplify TLH with its inherent quality of ease of use and simplicity. Special feature of this manipulator is the Cervical Guard with rotational forward and backward movement which distinguishes it from the all available manipulators in the market.
The easy, smart and simple Halder’s uterine manipulator could be the option to do TLH, in reducing the complications and having more favourable operative outcomes. This manipulator can be used by less experienced persons at vaginal end.
The Halder's uterine manipulator is specially designed to make the uterine manipulation very easy, safe and smart. It is used in total laparoscopic hysterectomy (TLH), laparoscopic assisted vaginal hysterectomy and all other laparoscopic gynaecological operations. The device has several components- one rod with detachable handle, one colpotomy tube with 2 different sizes of cup, one colpotomy tube fixation screw, one cervical guard, and 3 sizes of cervical insert.
The special features are that the cervical insert of this manipulator is to be fixed at the tip of the rod by screwing movement. The insert is of 3 different length. After measuring the uterocervical length appropriate insert can be fit at the tip of the instrument.
As there are threads on the rod, during TLH, threads can easily be negotiated through the external OS if the uterine size is more than the longest insert (9 mm). It is of greatest advantage as tip length can be increased by rotating back the lock over the rod.
One colpotomy tube is there with an arm. It can be independently moved over the rod and the guard. So, during TLH, if the operating surgeon wants to keep the cup inside the vagina for delineation of the fornices. It can be fixed over the rod by fixing the arm with sctrewing movement. If he or she doesn’t wish to keep the cup inside, the tube can be kept outside the vagina over the rod. With the in-out movement of the colpotomy tube uterine pedicle dissection becomes easier. The colpotomy tube even helps to delineate the utero-vescical fold in difficult cases like post-caesarean uterus or with bad adhesions. The uterine cup is also of different sizes to cater different sizes cervices.
Another extraordinary feature of this manipulator is that it has detachable handle. If the colpotomy tube needs to be changed to a different size , or surgeon willing to put the colpotomy tube over the rod in the middle of operation, the handle can be removed and tube can be pushed from behind over the rod and again the handle can be reattached with screwing movement.
The most important issue with this instrument is that it is very handy, light-weight, easy articulation and comfortable for use and cleaning compared to other popular manipulators. TLH should be popular and should not only be done by selective surgeons but also by the new surgeons who are in trouble to perform the operation because of its inborn risk to injure the vital structures. What I found that if the uterine manipulation is of high standard the operation becomes easier with any type of energy source, and avoids its inborn risk of injuring the vital structures.
Many surgeons using the low-quality manipulator available in the market face the problem of uterine perforation, which makes the operation troublesome. None of the manipulators fulfil all the criteria to become the best manipulator.
The Halder's Uterine manipulator is reusable. The instrument is easy to assemble and clean and very much cost effective.
3 cervical inserts (4cm, 6cm, 8cm)
Shaft or Rod
Cervical guard with a hole (3 cm outer diameter)
Threads at rod tip (5.5 cm length)
2 cervical cups (35 & 40 mm in diameter) with ceramic margin
Colpotomy tube fixation screw
Rod handle – detachable
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