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GYN 55 09/2014-E
KECKSTEIN Uterine Manipulator
Extremely versatile
Introduction
The use of a uterine manipulator can considerably simplify laparoscopic surgery in the lesser
pelvis. Complex surgical sites, deep infiltrating endometriosis or large uteri often make access
to the operative field difficult. This results in more complex procedures (long operating times,
conversion to laparotomy etc.) as well as greater surgical risks.
The versatile and relatively light KECKSTEIN Uterine Manipulator makes gynecological
surgery in the lesser pelvis easier and safer. Presentation of the operative field during
hysterectomy as well as conservative surgery is greatly enhanced in comparison to
conventional manipulators thanks to the special configuration of the movable part at the
instrument tip (applicator).
Individually configurable inserts, including hysterectomy caps, offer the operating surgeon
completely new surgical possibilities, especially “if it proves difficult”.
Prof. Dr. Jörg Keckstein
Primarius Landeskrankenhaus Villach,
Austria
2 3
Benefits
• Suitable for all gynecological-laparoscopic interventions
• Maximum mobility (95° anteflexion / 30° retroflexion)
 Cap can also be inserted at an angle to allow precise surgical steps
• Various accessories enable adjustment to various anatomical structures
• Easy to use due to fewer components
• Ergonomic handle design
• Lightweight
Handling
Hysterectomy
The manipulator features a movable spiral insert for fixation of the uterus. A screw mechanism
enables the insert to be introduced into the cervix and fixed into place. A ceramic cap with a
sheath is pushed over the rod of the instrument and inserted into the vagina where it is directly
positioned and attached to the portio. By turning the manipulator handle, the cap can be
deflected towards the ventral (95 degrees) and dorsal (30 degrees) directions and fixed in any
position. This manipulation enables the uterus to be brought into a vertical, strong anteversion
or a retroversion position. Simultaneously tilting the manipulator handle (dorsal, ventral, right
and left) utilizes all degrees of freedom in the pelvis.
Access to the operative field (circular fornix vaginae, uterine vessels, etc.) is greatly simplified.
This is a decisive advantage, particularly in the case of adhesions and severe endometriosis as
well as large uteri.
The cap size and type can be individually selected to adequately prevent a loss of
pneumoperitoneum (see illustration) after opening the vagina during total laparoscopic
hysterectomy.
The KECKSTEIN uterine manipulator can be used on its own with an atraumatic tip for
laparoscopic supracervical hysterectomy without a cap.
Visualization of the fornix
Opening the lower
vaginal vault
Opening the upper
vaginal vault
For more information,
please scan the code
Fully detached uterus
4 5
Using the Manipulator for Conservative Surgery
Adhesions and deep infiltrating endometriosis
The manipulator with atraumatic insert can also be used for conservative surgery, with or
without a cap, particularly in the case of severe adhesions or extensive endometriosis. This
considerably facilitates presentation of the pouch of Douglas, the back of the uterus as well as
the posterior and anterior vaginal vaults. Surgical access to the ligamentous structures of the
uterus and vagina, especially in the case of endometriosis, is also improved. The KECKSTEIN
uterine manipulator is used to remove deep infiltrating endometriosis in the extraperitoneal
space as well as the uterus (adenomyosis).
The wide range of options for “uterus mobilization” is very useful for both radical and organpreserving procedures.
Organs adjacent to the uterus that are at risk during surgery such as the bowel, the ureter and
the bladder can be better visualized and exposed at a safe distance. This preserves the organs
and minimizes surgical risks.
Procedures for determining sterility
A special, atraumatic insert with the option for chromopertubation enables the manipulator
to be used to establish sterility or for conservative surgical procedures on the uterus or the
adnexa (optional). The manipulator is fixated to the anterior lip of the external uterine orifice via
a spring mechanism with a bullet forceps to ensure good maneuverability of the instrument tip.
KECKSTEIN Uterine Manipulator
26168 Z
KECKSTEIN Uterine Manipulator
including:
Handle
Manipulator Sheath
Cap, diameter 41 mm
Cap, diameter 46 mm
Spiral Insert, diameter 15 mm
Spiral Insert, diameter 20 mm
Working Insert, length 60 mm
Working Insert, length 40 mm
Cleaning Adaptor
Y-Tube, 190 mm
LUER-Lock Tube Connector, male, tube diameter 9 mm
Optional accessories for TLH:
26168 ZE
Cap, diameter 51 mm, length 30 mm, for use with
KECKSTEIN Uterine Manipulator 26168 Z
26168 ZF
Spiral Insert, diameter 12 mm, length 12.5 mm, for use with
KECKSTEIN Uterine Manipulator 26168 Z
26168 ZK
Working Insert, length 80 mm, diameter 6 mm, for use with
KECKSTEIN Uterine Manipulator 26168 Z
6 7
Optional atraumatic working inserts, also for chromopertubation:
26168 ZQ
Fixing Aid, for uterine tenaculum forceps
26168 ZM
Working Insert, for chromopertubation, atraumatic,
length 40 mm, diameter 2 mm
26168 ZN
Working Insert, for chromopertubation, atraumatic,
length 50 mm, diameter 2 mm
Optional accessories for LASH:
26168 ZQ
Fixing Aid, for uterine tenaculum forceps
26168 ZO
Working Insert, for LASH, length 80 mm, diameter 8 mm
26168 ZP
Working Insert, for LASH, length 110 mm, diameter 8 mm
It is recommended to check the suitability of the product for the intended procedure prior to use.
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96122046 GYN 55 09/2014/EW-E
KARL STORZ GmbH & Co. KG
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