Pelosi Uterine Manipulator

A member of the Reviews in Obstetrics & Gynecology editorial board reviewed the following devices. The views of the author are personal opinions and do not necessarily represent the views of Reviews in Obstetrics & Gynecology or MedReviews®, LLC.

Companies can submit a product for review by e-mailing Merilee Croft at mcroft@medreviews.com.

• Design/Functionality Scale

  • 1 = Poor design; many deficits
  • 2 = Solid design; many deficits
  • 3 = Good design; few flaws
  • 4 = Excellent design; few flaws
  • 5 = Excellent design; flaws not apparent
• Innovation Scale

  • 1 = Nothing new
  • 2 = Small twist on standard technology
  • 3 = Major twist on standard technology
  • 4 = Significant new technology
  • 5 = Game changer
• Value Scale

  • 1 = Added cost with limited benefit
  • 2 = Added cost with some benefit
  • 3 = Added cost but significant benefit
  • 4 = Marginal added cost but significant benefit
  • 5 = Significant cost savings
• Overall Scale

  • 1 = Don’t bother
  • 2 = Niche product
  • 3 = Worth a try
  • 4 = Must try
  • 5 = Must have

Design/Functionality: 4

Innovation: 2

Value: 4.5

Overall Score: 4

Continuing the theme of “where there’s a name, there’s a uterine manipulator,” one could hardly expect that the laparoscopic world would not have a version by the prolific inventor Marco Pelosi II, MD. As with many of Dr. Pelosi’s ideas, this device focuses on addressing a need with broad functionality, simplicity, and reusability.

Design/Functionality

The Pelosi Uterine Manipulator (Apple Medical Corporation, Marlborough, MA) is the reusable manipulator that does it all (almost). It is simple to assemble and insert, and, when used with a toothed tenaculum, it firmly adheres to the uterus for comfortable and reliable manipulation. Its pivotable head enables ante/retroflexion of the uterus and the hollow obturator allows for the instillation of dye for cavity assessment during myomectomies or chromopertubation. The optional shielded obturator with its cup-shaped design provides further cervical support and fornix delineation when needed.

In use by the author, the Pelosi was exactly what I thought it would be-simple, solid, and reliable. For general simple uterine manipulation, it is far superior to a Jarcho or Cohen cannula. For the more complex cases- particularly total laparoscopic hysterectomies-I was less impressed. The Pelosi was still very functional, but, in my opinion, the shielded obturator needs improvement. First, it only comes in one size whereas cervices come in many. Second, it cannot be used with a securing tenaculum, which makes it slightly less secure. Third, without the tenaculum, it is a lot more difficult to insert. Finally, it is constructed of stainless steel and conducts electricity, which potentially limits its use with electrocautery at the vaginal cuff. In sum, it is really good for everything except total laparoscopic hysterectomies.

Design/Functionality Score: 4

Innovation

The Pelosi uterine manipulator does not introduce any new technologies, but does combine many standard technologies into a much better mousetrap.

Innovation Score: 2

Value

As compared with some of the other multifunction uterine manipulators (ie, the HOHL), the Pelosi is a downright bargain. Considering the breadth of cases a surgeon can perform with this device, it is an excellent value proposition, especially if reducing the cost of disposables is a priority.

Value Score: 4.5

Summary

The Pelosi uterine manipulator is a Cohen cannula on steroids. It is very versatile and it gives good value for your buck. Although I believe it has some shortcomings for total laparoscopic hysterectomies, for almost every other gynecologic laparoscopic procedure, it is very solid. If I could only have one uterine manipulator, this might be it.

Overall Score: 4