Mangeshikar Type Uterine Manipulator

Mangeshikar Uterine Manipulator
The Mangeshikar uterine manipulator is a reusable, modular, and low-cost surgical instrument specifically designed for gynecological laparoscopic procedures, particularly total laparoscopic hysterectomy (TLH), laparoscopic supracervical hysterectomy (LASH), laparoscopic-assisted vaginal hysterectomy (LAVH), and hysterectomies for malignant pathology.
It is known for its ability to provide excellent uterine mobility, allowing the uterus to be manipulated in all directions, including anteversion, retroversion, lateral movement, elevation, and independent levorotation and dextrorotation along its long axis.
This unique rotational capability facilitates optimal exposure of the uterine vessels and the cul-de-sac, which is especially beneficial in complex surgeries like endometriosis.

The device consists of several components: an inner stem with two jaws that can be fixed to the cervix, an outer stem that locks into a handle, a working insert of varying length to fit different uterine sizes, and a detachable cup sheath that can be slid over the working element to delineate the vaginal fornices and maintain pneumoperitoneum.
The cup is available in different diameters to accommodate various cervical sizes.
The instrument is assembled just before surgery, and its design allows for precise control and protection of surrounding organs like the bladder and ureters during dissection.

The Mangeshikar manipulator is considered one of the most versatile instruments for advanced laparoscopic gynecological surgeries, particularly in cases requiring significant uterine mobilization, such as severe endometriosis affecting the recto-vaginal area.
It is marketed by Karl Storz and is recommended for use in procedures where optimal exposure and safety are paramount.
While some studies suggest it may be superior to other manipulators in terms of range of motion and exposure, no randomized controlled trials or cohort studies have definitively proven its superiority or role in preventing ureteric injury.
Despite its advantages, the device requires proper assembly and handling, which can be a learning curve for some surgeons.