WO2013042107A1

WO2013042107A1 - A device and method for maneuvering endoscope

Info

Publication number: WO2013042107A1
Application number: PCT/IL2012/000342
Authority: WO
Inventors: Mordehai Sholev; Gal ATAROT
Original assignee: M.S.T. Medical Surgery Technologies Ltd.
Priority date: 2011-09-20
Filing date: 2012-09-20
Publication date: 2013-03-28

Abstract

The present invention provides a system for maneuvering an endoscope, comprising: a. a first mechanism, comprising: i. at least one first transmission means 101; ii. at least one second transmission means 102, rotatably connected to said first transmission means 101; and iii. at least one first means 106 adapted to rotate said first transmission means 101; where said first transmission means 101 transmits rotation to said second transmission means 102; and, b. a second mechanism, comprising: i. at least one third transmission means 103; ii. at least one fourth transmission means 104, rotatably connected to said third transmission means 103; iii. at least one fifth transmission means 105, rotatably connected to said fourth transmission means 104; iv. at least one second means 107 adapted to rotate said third transmission means 103 around said third axis of rotation;

Description

A DEVICE AND METHOD FOR MANEUVERING ENDOSCOPE

FIELD OF THE INVENTION

The present invention generally relates to means and methods for simply maneuvering an endoscope by an endoscope user. Moreover, this present invention discloses a compact configuration of devices used for different actions upon the endoscope.

BACKGROUND OF THE INVENTION

In laparoscopic surgery, the surgeon performs the operation through small holes using long instruments and observing the internal anatomy with an endoscope camera. The endoscope is conventionally held by a camera assistant since the surgeon must perform the operation using both hands. The surgeon's performance is largely dependent on the camera's position relative to the instruments and on a stable image shown by the monitor; also the picture shown must be in the right orientation. The main problem is the difficulty for the assistant in keeping the endoscope in the right spatial position, holding the endoscope steadily, and keeping the scene in the right orientation. To overcome these problems, several new technologies have been developed, using robots to hold the endoscope while the surgeon performs the procedure, e.g., Lapman, Endoassist, etc. But these technologies are expensive, difficult to install, uncomfortable to use, limit the dexterity of the surgeon and have physical dimension much bigger that all the operating tools. Relative to the required action, they also move in big increments with several arms moving. Another robot, LER, (which was developed by the TIMC-GMCAO Laboratory) is described in US. Patent application No. 200/6100501. It consists of a compact camera-holder robot that rests directly on the patient's abdomen and an electronic box containing the electricity supply and robot controllers. LER has relatively small dimensions but has a 110 mm diameter base ring that must be attached, or be very close to, the patient's skin. This ring occupies space over the patient's body, affecting the surgeon's activities: limiting the surgeon's choice of where to place other trocars, changing the surgeon's usual way of making the procedure, sometimes forcing the setup process to be as long as 40 minutes. Also the LER has only 3 degrees of freedom and has no ability to control the orientation of the picture shown to surgeon (the LER cannot rotate the endoscope around its longitudinal axis).

Laparoscopic surgery is becoming increasingly popular with patients because the scars are smaller and their period of recovery is shorter. Laparoscopic surgery requires special training for the surgeon or gynecologist and the theatre nursing staff. The equipment is often expensive and is not available in all hospitals. During laparoscopic surgery, it is often required to shift the spatial placement of the endoscope in order to present the surgeon with an optimal view. Conventional laparoscopic surgery makes use of either human assistants that manually shift the instrumentation or alternatively robotic automated assistants (such as JP patent No. 06063003).

However, even the improved technologies still limit the dexterity of the surgeon and fail to provide four degrees of freedom. Another disadvantage of those technologies is the lack of ability to control the spatial position of an endoscope tube to any orientation during the laparoscopic surgery, such that the surgeon reaches any desired area within the working envelope in the body being operated on.

Therefore, there is still a long felt need for a camera holder that would allow holding and controlling the endoscope steady without limiting the dexterity of the surgeon and that will provide four degrees of freedom. Furthermore, there is still a long felt need for a camera holder that will provide the ability to control the spatial position of an endoscope tube to any orientation during the laparoscopic surgery, such that the surgeon reaches any desired area within the working envelope in operated body.

SUMMARY OF THE INVENTION

An object of the invention is to disclose a system for maneuvering an endoscope, comprising: a. a first mechanism, comprising:

i. at least one first transmission means 101; said first transmission means 101 defines a first plane; said first transmission means 101 is characterized by a first axis of rotation; said first axis of rotation is substantially orthogonal to said first plane; ii. at least one second transmission means 102; said second transmission means 102 defines a second plane; said second transmission means is characterized by a second axis of rotation; said second axis of rotation is substantially orthogonal to said second plane; said second transmission means 102 is rotatably connected to said first transmission means 101 ; where said first plane is substantially orthogonal to second plane; and

iii. at least one first means 106 adapted to rotate said first transmission means 101 around said first axis of rotation;

where said first transmission means 101 transmits rotation to said second transmission means 102; and,

a second mechanism, comprising:

i. at least one third transmission means 103; said third transmission means 103 defines a third plane; said third transmission means 103 is characterized by a third axis of rotation; said third axis of rotation is substantially orthogonal to said third plane;

ii. at least one fourth transmission means 104; said fourth transmission means 104 defines a fourth plane; said forth transmission means defines a fourth axis of rotation; said fourth axis of rotation is substantially orthogonal to fourth plane; said fourth transmission means 104 is rotatably connected to said third transmission means 103; where said fourth plane is substantially orthogonal to said third plane;

iii. at least one fifth transmission means 105; said fifth transmission means 105 defines a fifth plane; said fifth transmission means defines a fifth axis of rotation; said fifth axis of rotation is substantially orthogonal to said fifth plane; said fifth transmission means 105 is rotatably connected to said fourth transmission means 104; where said fifth plane is substantially orthogonal to said fourth plane;

iv. at least one second means 107 adapted to rotate said third transmission means 103 around said third axis of rotation; where said third transmission means 103 transmit rotation to said fourth transmission means 104; where said fourth transmission means 104 transmit rotation to said fifth transmission means 105,

wherein said first mechanism and said second mechanism are adapted to rotate said endoscope around at least one said second axis of rotation being substantially orthogonal to said second plane; and around at least one said fifth axis of rotation being substantially orthogonal to said fifth plane, such that said second axis of rotation and said fifth axis of rotation are positioned at an angle A relative to each other.

It is another object of the invention is to disclose the system as defined above, wherein angle A between said first axis of rotation and said second axis of rotation is in the range of about 0 degrees to about 180 degrees.

It is another object of the invention is to disclose the system as defined above, additionally comprising at least one rotating means, in communication with said first mechanism and said second mechanism, said rotating means comprising:

a. at least one pivoting support adapted to be pivotally attached to said endoscope; said pivoting support is adapted to enable said endoscope to pivot around said pivoting support; b. at least one third mechanism for rotating said pivoting support independently around two orthogonal axes, said third mechanism mechanically connected to said pivoting support, thereby enabling said endoscope to rotate around an insertion point into a body of a subject; said endoscope pivotally attached to said rotating means can pivot at said insertion point independent of the distance between said pivoting support, said rotating means, and said insertion point;

where said third mechanism comprises at least one first joint coupled to said pivoting support; and at least one second joint in communication with said first joint and coupled to mechanism selected from a group consisting of: said first mechanism, said second mechanism and any combination thereof; each of said joints is adapted to provide rotation to said pivoting support in at least one of said orthogonal axes; wherein said second joint is located at a predetermined distance from said first joint.

It is another object of the invention is to disclose the system as defined above, wherein said system is characterized by at least two configurations: an automatic configuration, in which said system is motorized; and a manual configuration in which said system is maneuvered manually by said endoscope user via a manual control mechanism, preferably a joystick, and wherein said system can be additionally characterized by a third configuration, a wholly manual configuration, in which a human endoscope assistant maneuvers the endoscope.

It is another object of the invention is to disclose the system as defined above, additionally comprising at least one rotating means, in communication with said first mechanism and said second mechanism, said rotating means comprising: at least one fourth mechanism for rotating said endoscope independently around two orthogonal axes, said fourth mechanism mechanically connected to said pivoting support, thereby enabling said endoscope to rotate around an insertion point into a body of a subject; said endoscope pivotally attached to said rotating means can pivot at said insertion point independent of the distance between said rotating means, and said insertion point; where said fourth mechanism comprising at least one third joint coupled to said endoscope; and at least one fourth joint in communication with said third joint and coupled to mechanism selected from a group consisting of: said first mechanism, said second mechanism and any combination thereof; each of said joints is adapted to provide rotation to said endoscope in at least one of said orthogonal axes; wherein said third joint is located at a predetermined distance from said fourth joint.

It is another object of the invention is to disclose the system as defined above, further comprising at least one zoom mechanism, adapted to maneuver said endoscope along the main longitudinal axis of the same.

It is another object of the invention is to disclose the system as defined above, wherein said zoom mechanism comprises:

a. at least one first coupling means clasped to said endoscope; b. at least one first connecting means reversibly coupled to said endoscope at a first coupling position;

c. at least one second connecting means reversibly coupled to said first coupling means at a second coupling position;

wherein said coupling between said first connecting means, said second connecting means and said endoscope enables said endoscope to (i) pivot around said main longitudinal axis of said endoscope; and, (ii) to move along said longitudinal axis of the same.

It is another object of the invention is to disclose the system as defined above, wherein said clasping enables reversible reciprocating movement along said main longitudinal axis of said endoscope.

It is another object of the invention is to disclose the system as defined above, wherein said first connecting means and said second connecting means are connected to one another via joints.

It is another object of the invention is to disclose the system as defined above, wherein said zoom mechanism further comprises m coupling means adapted to couple said first connecting means to said second connecting means; where m is an integer greater than or equal to one.

It is another object of the invention is to disclose the system as defined above, wherein said m coupling means are rotatably coupled to each other.

It is another object of the invention is to disclose the system as defined above, wherein said m coupling means are selected from a group consisting of joints, rods, other zoom mechanisms and any combination thereof.

It is another object of the invention is to disclose the system as defined above, wherein said coupling of said endoscope to at least one of a group consisting of said first connecting means and said second connecting means is obtained by means selected from a group consisting of mechanical means, magnetic means and any combination thereof.

It is another object of the invention is to disclose the system as defined above, wherein said mechanical means are selected from a group consisting of a clip, a fastening element, tape, adhesive tape, a snap fastener, a button and any combination thereof. It is another object of the invention is to disclose the system as defined above, wherein said magnetic means comprise a magnetic device, said magnetic device comprising at least one magnet and at least one selected from a group consisting of: a ferromagnet and a paramagnet.

It is another object of the invention is to disclose the system as defined above, wherein said zoom mechanism is operable by at least one motor.

It is another object of the invention is to disclose the system as defined above, wherein said pivoting support is a gimbal.

It is another object of the invention is to disclose the system as defined above, where said third mechanism comprises a plurality of q joints, at least one of which is coupled to said pivoting support, and at least one of which is coupled to said second mechanism; where q is an integer greater than or equal to one.

It is another object of the invention is to disclose the system as defined above, where said fourth mechanism comprises a plurality of q joints, at least one of which is coupled to said endoscope, and at least one of which is coupled to said second mechanism; where q is an integer greater than or equal to one.

It is another object of the invention is to disclose the system as defined above, wherein said first transmission means, said second transmission means, said third transmission means, said fourth transmission means, and said fifth transmission means are selected from a group consisting of gearwheels, wheels, crown gears, bevel gears, spur gears, belts, and any combination thereof.

It is another object of the invention is to disclose the system as defined above, wherein said system comprises attaching means adapted to reversibly couple said system to a hospital bed.

It is another object of the invention is to disclose the system as defined above, wherein said attaching means is selected from a group consisting of mechanical means, magnetic means and any combination thereof.

It is another object of the invention is to disclose the system as defined above, wherein said mechanical means is selected from a group consisting of a clip, a fastening element, tape, adhesive tape, a snap fastener, a button and any combination thereof. It is another object of the invention is to disclose the system as defined above, wherein said magnetic means comprises a magnetic device, said magnetic device comprising at least one magnet and at least one selected from a group consisting of: a ferromagnet and a paramagnet; where said magnetic is attached to at least one member of a group consisting of: a hospital bed, said system, and any combination thereof, and said member of said group consisting of a ferromagnet and a paramagnet is attached to at least one member of a group consisting of: a hospital bed, said system, and any combination thereof.

It is another object of the invention is to disclose the system as defined above, wherein said rotation in said second plane defines an angle Θ.

It is another object of the invention is to disclose the system as defined above, wherein said angle Θ varies between about 0 and about 360 degrees, preferably between about 0 and about 160 degrees, when said system is in said automatic configuration or in said manual configuration.

It is another object of the invention is to disclose the system as defined above, wherein said rotation in said fifth plane defines an angle ψ.

It is another object of the invention is to disclose the system as defined above, wherein said angle ψ varies between about 0 and about 360 degrees, preferably between about 0 and about 140 degrees, when system is in said automatic configuration or in said manual configuration.

It is another object of the invention is to disclose the system as defined above, wherein said system additionally comprises a quick release handle adapted to disassemble said endoscope from said system when said system is in said automatic configuration or in said manual configuration.

It is another object of the invention is to disclose the system as defined above, wherein said first mechanism additionally comprises locking means adapted to maintain at least one selected from a group consisting of: said first transmission means, said second transmission means and any combination thereof in a predetermined orientation upon power failure; and to prevent any rotational movement of the same upon power failure.

It is another object of the invention is to disclose the system as defined above, wherein said second mechanism additionally comprises locking means adapted to maintain at least one selected from a group consisting of: said third transmission means, said fourth transmission means, said fifth transmission means, and any combination thereof in a predetermined orientation upon power failure and to prevent any rotational movement of the same upon power failure.

It is another object of the invention is to disclose the system as defined above, additionally comprising at least one manual override system (MOS), adapted upon activation of the same to switch reversibly between a manual configuration, in which the endoscope is moved manually by the operator and an automatic configuration, in which the endoscope is moved automatically by the system.

It is another object of the invention is to disclose the system as defined above, additionally comprising at least one joystick, coupled to said endoscope.

It is another object of the invention is to disclose the system as defined above, additionally comprising activation means adapted to activate at least one of a group consisting of said system, said joystick and any combination thereof.

It is another object of the invention is to disclose the system as defined above, wherein said MOS is enabled to be worn by said MOS operator.

It is another object of the invention is to disclose the system as defined above, additionally comprising at least one joystick, enabled to be worn by said joystick user.

It is another object of the invention is to disclose the system as defined above, wherein said activation means is enabled to be worn by said activation means user.

It is another object of the invention is to disclose the system as defined above, wherein said activation means is selected from a group consisting of a pressable button, a rotatable knob, a knob, and any combination thereof.

It is another object of the invention is to disclose the system as defined above, wherein said MOS enables rotation in said angles ψ and Θ.

It is another object of the invention is to disclose the system as defined above, wherein, when said joystick is moved in direction a, said endoscope moves in angular direction Θ and when said joystick is moved in direction β, said endoscope moves in angular direction ψ. It is another object of the invention is to disclose the system as defined above, wherein movement of said joystick in a direction selected from a group consisting of said a, said β and any combination thereof is proportional to movement of said endoscope in a direction selected from a group consisting of said ψ, said Θ and any combination thereof.

It is another object of the invention is to disclose the system as defined above, wherein said MOS additionally comprises means for controlling said endoscope's motion, adapted to restrain angular velocity in said Θ and ψ directions.

It is another object of the invention is to disclose the system as defined above, wherein said MOS additionally comprises n sensors, where n is an integer greater than or equal to one.

It is another object of the invention is to disclose the system as defined above, wherein said sensors are selected from of a group consisting of motion sensors, heat sensors, electric sensors, sound sensors, pressure sensors, optical sensors and any combination thereof.

It is another object of the invention is to disclose the system as defined above, wherein said n sensors are activated in case of power failure.

It is another object of the invention is to disclose the system as defined above, wherein said n sensors are activated when said system is connected to power.

It is another object of the invention is to disclose the system as defined above, wherein said motion sensors detect motion of said joystick.

It is another object of the invention is to disclose the system as defined above, wherein said motion detection of said joystick is used to deactivate said motion of said endoscope if said motion's speed is above a predetermined threshold.

It is another object of the invention is to disclose the system as defined above, wherein said joystick is characterized by an external surface.

It is another object of the invention is to disclose the system as defined above, wherein said motion sensors detect motion upon said external surface. It is another object of the invention is to disclose the system as defined above, wherein said motion upon said external surface is used to operate said endoscope according to said motion upon said external surface.

It is another object of the invention is to disclose the system as defined above, wherein said motion upon said external surface deactivates of said motion of said endoscope if said motion's speed is above a predetermined threshold.

It is another object of the invention is to disclose the system as defined above, wherein said heat sensors are adapted to sense temperature in the range of about 35 to about 42 degrees.

It is another object of the invention is to disclose the system as defined above, wherein said heat sensors enable the activation of said MOS when said heat sensors sense said temperature is in the range of about 35 to about 42 degrees.

It is another object of the invention is to disclose the system as defined above, wherein said heat sensors are adapted to provide a thermal image, where said heat sensors are coupled to a processing unit adapted to provide said endoscope user with said thermal image.

It is another object of the invention is to disclose the system as defined above, wherein said processing unit enables the activation of said MOS upon analysis of said image and detection of human hand.

It is another object of the invention is to disclose the system as defined above, wherein said electric sensors are adapted to sense power failure.

It is another object of the invention is to disclose the system as defined above, wherein said electric sensors are adapted to sense electrical conductivity of a human body.

It is another object of the invention is to disclose the system as defined above, wherein said human body conductivity sensed by said electric sensors enables activation of said MOS.

It is another object of the invention is to disclose the system as defined above, wherein said sound sensors are adapted to sense predetermined sound patterns.

It is another object of the invention is to disclose the system as defined above, wherein said predetermined sound patterns sensed by said sound sensors enable the activation of said MOS. It is another object of the invention is to disclose the system as defined above, wherein said sound sensors are used to operate said endoscope according to said predetermined sound patterns.

It is another object of the invention is to disclose the system as defined above, wherein said pressure sensors are adapted to sense pressure applied to said MOS.

It is another object of the invention is to disclose the system as defined above, wherein, when said pressure sensed by said pressure sensors is above a predetermined threshold, said MOS is activated.

It is another object of the invention is to disclose the system as defined above, wherein, when said pressure sensed by said pressure sensors is below a predetermined threshold, said MOS is de-activated.

It is another object of the invention is to disclose the system as defined above, wherein, when said pressure sensed by said pressure sensors is above a predetermined threshold, said MOS is de-activated.

It is another object of the invention is to disclose the system as defined above, wherein said optical sensors are adapted to sense visual changes according to predetermined visual patterns.

It is another object of the invention is to disclose the system as defined above, wherein said optical sensors enable the activation of said MOS according to said predetermined visual patterns.

It is another object of the invention is to disclose the system as defined above wherein said optical sensors are used to operate said endoscope according to said predetermined visual patterns.

It is another object of the invention is to disclose the system as defined above, additionally comprising a surgical tracking system for assisting an operator to perform a laparoscopic surgery of a human body, said surgical tracking system comprising:

a. at least one endoscope adapted to acquire real-time images of a surgical environment within said human body; b. a maneuvering subsystem adapted to control the spatial position of said endoscope during said laparoscopic surgery; and,

c. a tracking subsystem in communication with said maneuvering subsystem, adapted to control the maneuvering system so as to direct and modify the spatial position of said endoscope to a region of interest;

wherein said tracking subsystem comprises a data processor; said data processor is adapted to perform real-time image processing of said surgical environment and to instruct said maneuvering subsystem to modify the spatial position of said endoscope according to input received from a maneuvering function f(t); said maneuvering function f(t) is adapted to (a) receive input from at least two instructing functions gi(t), where i is Ι,. , .,η and n > 2; where t is time; i and n are integers; and, to (b) output instructions to said maneuvering subsystem based on said input from said at least two instructing functions gi(t), so as to spatially position said endoscope to said region of interest.

It is another object of the invention is to disclose the system as defined above, wherein each of said instructing functions gi(t) is provided with ai(t) where i is an integer greater than or equal to 1; where ai(t) are weighting functions of each gi(t), and a n is total number of instruction functions.

It is another object of the invention is to disclose the system as defined above, wherein said weighting functions ai(t) are time-varying functions, wherein the value of which is determined by said operators.

It is another object of the invention is to disclose the system as defined above, wherein each of said instructing functions gi(t) is selected from a group consisting of: most used tool function, right tool function, left tool function, field of view function, no fly zone function, proximity function, collision prevention function, preferred volume zone function, preferred tool function, tool detection function, movement detection function, organ detection function, operator input function, prediction function, past statistical analysis function, tagged tool function, and any combination thereof.

It is another object of the invention is to disclose the system as defined above, wherein said most used tool function comprises a communicable database counting the amount of movement of each surgical tool located within said surgical environment; said most used tool function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to constantly position said endoscope to track the movement of the most moved surgical tool.

It is another object of the invention is to disclose the system as defined above, wherein said right tool function is adapted to detect surgical tool positioned to right of said endoscope and to output instructions to said tracking subsystem to instruct said maneuvering system to constantly direct said endoscope on said right tool and to track said right tool.

It is another object of the invention is to disclose the system as defined above, wherein said left tool function is adapted to detect surgical tool positioned to left of said endoscope and to output instructions to said tracking subsystem to instruct said maneuvering system to constantly direct said endoscope on said left tool and to track said left tool.

It is another object of the invention is to disclose the system as defined above, wherein said field of view function comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said n 3D spatial positions provides a predetermined field of view; said field of view function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to at least one 3D spatial position substantially within said n 3D spatial positions so as to maintain a constant field of view.

It is another object of the invention is to disclose the system as defined above, wherein said no fly zone function comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions define a predetermined volume within said surgical environment; said no fly zone function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to at least one 3D spatial position substantially different from all said n 3D spatial positions.

It is another object of the invention is to disclose the system as defined above, wherein said proximity function is adapted to define a predetermined distance between at least two surgical tools; and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said two surgical tools if the distance between said two surgical tools is less than said predetermined distance.

It is another object of the invention is to disclose the system as defined above, wherein said proximity function is adapted to define a predetermined angle between at least three surgical tools; and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said three surgical tools if the angle between said three surgical tools is less than or greater than said predetermined angle.

It is another object of the invention is to disclose the system as defined above, wherein said collision prevention function is adapted to define a predetermined distance between said at least one surgical tool and an anatomical element within said surgical environment; and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said surgical tool and said anatomical element within said surgical environment if the distance between said at least one surgical tool and said anatomical element is less than said predetermined distance.

It is another object of the invention is to disclose the system as defined above, wherein said preferred volume zone function comprises communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions provide said preferred volume zone; said preferred volume zone function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said preferred volume zone.

It is another object of the invention is to disclose the system as defined above, wherein said preferred tool function comprises a communicable database, said database stores a preferred tool; said preferred tool function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to constantly direct said endoscope to said preferred tool, such that said endoscope constantly tracks said preferred tool.

It is another object of the invention is to disclose the system as defined above, wherein said tool detection function is adapted to detect surgical tools in said surgical environment and to output instruction to said tracking subsystem to instruct said maneuvering system to direct said endoscope on said detected surgical tools. It is another object of the invention is to disclose the system as defined above, wherein said movement detection function comprises a communicable database comprising the real-time 3D spatial positions of each of the surgical tool in said surgical environment; is adapted to detect movement of said at least one surgical tool when a change in at least one of said 3D spatial positions is received, and is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope on said moved surgical tool.

It is another object of the invention is to disclose the system as defined above, wherein said organ detection function is adapted to detect organs in said surgical environment and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope on said detected organs.

It is another object of the invention is to disclose the system as defined above, wherein said anatomical element is selected from a group consisting of tissue, organ, another surgical tool and any combination thereof.

It is another object of the invention is to disclose the system as defined above, wherein said operator input function comprises a communicable database; said communicable database is adapted to receive an input from said operator of said system; said input comprising n 3D spatial positions; n is an integer greater than or equal to 2; and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said at least one 3D spatial position received.

It is another object of the invention is to disclose the system as defined above, wherein said prediction function comprises a communicable database storing each 3D spatial position of each surgical tool within said surgical environment, such that each movement of each surgical tool is stored; said prediction function is adapted to (a) to predict the future 3D spatial position of each of said surgical tools; and (b) to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said future 3D spatial position.

It is another object of the invention is to disclose the system as defined above, wherein said past statistical analysis function comprises a communicable database storing each 3D spatial position of each of surgical tool within said surgical environment, such that each movement of each surgical tool is stored; said past statistical analysis function is adapted to (a) statistically analyze said 3D spatial positions of each of said surgical tools; and, (b) to predict the future 3D spatial position of each of said surgical tools; and (c) to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said future 3D spatial position.

It is another object of the invention is to disclose the system as defined above, wherein said tagged tool function comprises means adapted to tag at least one surgical tool within said surgical environment and to output instructions to said tracking subsystem to instruct said maneuvering system to constantly direct said endoscope to said tagged surgical tool.

It is another object of the invention is to disclose the system as defined above, wherein said means are adapted to apply a continuing tag to said at least one surgical tool within said surgical environment.

It is another object of the invention is to disclose the system as defined above, wherein said means are adapted to re-tag said at least one of said surgical tools until a desired tool is selected.

It is another object of the invention is to disclose the system as defined above, additionally comprising means adapted to toggle between said surgical tools.

It is another object of the invention is to disclose the system as defined above, wherein toggling is performed manually or automatically.

It is another object of the invention is to disclose the system as defined above, wherein said image processing is obtained by at least one algorithm selected from a group consisting of: image stabilization algorithm, image improvement algorithm, image compilation algorithm, image enhancement algorithm, image detection algorithm, image classification algorithm, image correlation with the cardiac cycle of said human body, image correlation with the respiratory cycle of said human body, smoke detection algorithm, vapor detection algorithm, algorithm for reducing steam from said endoscope and any combination thereof.

It is another object of the invention is to disclose the system as defined above, wherein said endoscope comprises an image acquisition device selected from a group consisting of: a camera, a video camera, an electromagnetic sensor, a computer tomography imaging device, a fluoroscopic imaging device, an ultrasound imaging device, and any combination thereof. It is another object of the invention is to disclose the system as defined above, further comprising a display adapted to accept input from or provide output to said operator regarding operation of said system.

It is another object of the invention is to disclose the system as defined above, wherein said display is used for visualizing said region of interest by said operator.

It is another object of the invention is to disclose the system as defined above, wherein said display is adapted to output said acquired real-time images of a surgical environment with augmented reality elements.

It is another object of the invention is to disclose the system as defined above, wherein said image processing algorithm is adapted to analyze 2D or 3D representation rendered from said real-time images of the surgical environment.

It is another object of the invention is to disclose the system as defined above, wherein said data processor is further adapted to operate a pattern recognition algorithm for assisting the operation of said instructing functions gi(t).

It is another object of the invention is to disclose the system as defined above, additionally comprising at least one location estimating means for locating the position of at least one surgical tool in said surgical environment.

It is another object of the invention is to disclose the system as defined above, wherein said at least one location estimating means is an interface subsystem between a surgeon and the at least one surgical tool, the interface subsystem comprising:

a. at least one array comprising N regular or pattern light sources, where N is a positive integer;

b. at least one array comprising M cameras, where M is a positive integer;

c. optional optical markers and means for attaching at least one said optical marker to the at least one surgical tool; and,

d. a computerized algorithm operable via the controller, the computerized algorithm adapted to record images received by each camera of each of the M cameras and to calculate therefrom the position of each of the tools, and further adapted to provide automatically the results of the calculation to the human operator of the interface.

It is another object of the invention is to disclose the system as defined above, further comprising a surgical controlling system, comprising: a. at least one surgical tool adapted to be inserted into a surgical environment of a human body for assisting a surgical procedure; b. at least one location estimating means adapted to locate in real-time the 3D spatial position of said at least one surgical tool at any given time t; c. at least one movement detection means communicable with a movement's database and with said location estimating means; said movement's database is adapted to store said 3D spatial position of said at least one surgical tool at time tf and at time to', where tf > to', said movement detection means is adapted to detect movement of said at least one surgical tool if the 3D spatial position of said at least one surgical tool at time tf is different from said 3D spatial position of said at least one surgical tool at time ¾; and, d. a controller having a processing means communicable with a controller's database, said controller adapted to control the spatial position of said at least one surgical tool; said controller's database is in communication with said movement detection means; wherein said controller's database is adapted to store a predetermined set of rules according to which ALLOWED and RESTRICTED movements of said at least one surgical tool are determined, such that each detected movement by said movement detection means of said at least one surgical tool is determined as either an ALLOWED movement or as a RESTRICTED movement according to said predetermined set of rules.

It is another object of the invention is to disclose the system as defined above, wherein said predetermined set of rules comprises at least one rule selected from a group consisting of: most used tool rule, right tool rule, left tool rule, field of view rule, no fly zone rule, route rule, proximity rule; collision prevention rule, preferred volume zone rule, preferred tool rule, movement detection rule, operator input rule, environment rule, history-based rule, tool- dependent ALLOWED and RESTRICTED movements rule, tagged tool rule and any combination thereof.

It is another object of the invention is to disclose the system as defined above, wherein said most used tool rule comprises a communicable database counting the amount of movement of each of said surgical tools; said most used tool rule is adapted to constantly position said endoscope to track the movement of the most moved surgical tool.

It is another object of the invention is to disclose the system as defined above, wherein said right tool rule is adapted to determine said ALLOWED movement of said endoscope according to the movement of the surgical tool positioned to right of said endoscope; further wherein said left tool rule is adapted to determine said ALLOWED movement of said endoscope according to the movement of the surgical tool positioned to left of said endoscope.

It is another object of the invention is to disclose the system as defined above, wherein said field of view rule comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said n 3D spatial positions provides a predetermined field of view; said field of view rule is adapted to determine said ALLOWED movement of said endoscope within said n 3D spatial positions so as to maintain a constant field of view, such that said ALLOWED movements are movements in which said endoscope is located substantially in at least one of said n 3D spatial positions, and said RESTRICTED movements are movements in which the location of said endoscope is substantially different from said n 3D spatial positions

It is another object of the invention is to disclose the system as defined above, wherein said no fly zone rule comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions define a predetermined volume within said surgical environment; said no fly zone rule is adapted to determine said RESTRICTED movement if said movement is within said no fly zone and ALLOWED movement if said movement is outside said no fly zone, such that said RESTRICTED movements are movements in which said at least one of said surgical tool is located substantially in at least one of said n 3D spatial positions, and said ALLOWED movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions.

It is another object of the invention is to disclose the system as defined above, wherein said route rule comprises a communicable database storing at least one predefined route in which said at least one surgical tool is adapted to move within said surgical environment; said predefined route comprises n 3D spatial positions of said at least one surgical tool; n is an integer greater than or equal to 2; said ALLOWED movements are movements in which said at least one surgical tool is located substantially in at least one of said n 3D spatial positions of said predefined route, and said RESTRICTED movements are movements in which said location of said at least one surgical tool is substantially different from said n 3D spatial positions of said predefined route.

It is another object of the invention is to disclose the system as defined above, wherein said proximity rule is adapted to define a predetermined distance between at least two surgical tools; said ALLOWED movements are movements which are within the range or out of the range of said predetermined distance, and said RESTRICTED movements which are out of the range or within the range of said predetermined distance.

It is another object of the invention is to disclose the system as defined above, wherein said proximity rule is adapted to define a predetermined angle between at least three surgical tools; said ALLOWED movements are movements which are within the range or out of the range of said predetermined angle, and said RESTRICTED movements which are out of the range or within the range of said predetermined angle.

It is another object of the invention is to disclose the system as defined above, wherein said collision prevention rule is adapted to define a predetermined distance between said at least one surgical tool and an anatomical element within said surgical environment; said ALLOWED movements are movements which are in a range that is larger than said predetermined distance, and said RESTRICTED movements are movements which are in a range that is smaller than said predetermined distance.

It is another object of the invention is to disclose the system as defined above, wherein said anatomical element is selected from a group consisting of tissue, organ, another surgical tool and any combination thereof. It is another object of the invention is to disclose the system as defined above, wherein said preferred volume zone rule comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions provides said preferred volume zone; said preferred volume zone rule is adapted to determine said ALLOWED movement of said endoscope within said n 3D spatial positions and RESTRICTED movement of said endoscope outside said n 3D spatial positions, such that said ALLOWED movements are movements in which said endoscope is located substantially in at least one of said n 3D spatial positions, and said RESTRICTED movements are movements in which the location of said endoscope is substantially different from said n 3D spatial positions.

It is another object of the invention is to disclose the system as defined above, wherein said preferred tool rule comprises a communicable database, said database stores a preferred tool; said preferred tool rule is adapted to determine said ALLOWED movement of said endoscope to constantly track the movement of said preferred tool.

It is another object of the invention is to disclose the system as defined above, wherein said movement detection rule comprises a communicable database comprising the real-time 3D spatial positions of each of said surgical tool; said movement detection rule is adapted to detect movement of said at least one surgical tool when a change in said 3D spatial positions is received, such that said ALLOWED movements are movements in which said endoscope is redirected to focus on the moving surgical tool.

It is another object of the invention is to disclose the system as defined above, wherein said operator input rule comprises a communicable database; said communicable database is adapted to receive an input from the operator of said system regarding said ALLOWED and RESTRICTED movements of said at least one surgical tool.

It is another object of the invention is to disclose the system as defined above, wherein said input comprises n 3D spatial positions; n is an integer greater than or equal to 2; wherein at least one of which is defined as ALLOWED location and at least one of which is defined as RESTRICTED location, such that said ALLOWED movements are movements in which said at least one surgical tool is located substantially in at least one of said n 3D spatial positions, and said RESTRICTED movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions.

It is another object of the invention is to disclose the system as defined above, wherein said input comprises at least one rule according to which ALLOWED and RESTRICTED movements of said at least one surgical tool are determined, such that the spatial position of said at least one surgical tool is controlled by said controller according to said ALLOWED and RESTRICTED movements.

It is another object of the invention is to disclose the system as defined above, wherein said predetermined set of rules comprises at least one rule selected from a group consisting of: most used tool, right tool rule, left tool rule, field of view rule, no fly zone rule, route rule, environment rule, operator input rule, proximity rule; collision prevention rule, preferred volume zone rule, preferred tool rule, movement detection rule, history-based rule, tool-dependent ALLOWED and RESTRICTED movements rule, and any combination thereof.

It is another object of the invention is to disclose the system as defined above, wherein said operator input rule converts an ALLOWED movement to a RESTRICTED movement and a RESTRICTED movement to an ALLOWED movement.

It is another object of the invention is to disclose the system as defined above, wherein said environment rule comprises a communicable database; said communicable database is adapted to receive at least one real-time image of said surgical environment and is adapted to perform realtime image processing of the same and to determine the 3D spatial position of hazards or obstacles in said surgical environment; said environment rule is adapted to determine said ALLOWED and RESTRICTED movements according to said hazards or obstacles in said surgical environment, such that said RESTRICTED movements are movements in which said at least one surgical tool is located substantially in at least one of said 3D spatial positions of hazards or obstacles, and said ALLOWED movements are movements in which the location of said at least one surgical tool is substantially different from said 3D spatial positions of hazards or obstacles. It is another object of the invention is to disclose the system as defined above, wherein said hazards or obstacles in said surgical environment are selected from a group consisting of tissue, a surgical tool, an organ, an endoscope and any combination thereof.

It is another object of the invention is to disclose the system as defined above, wherein said history-based rule comprises a communicable database storing each 3D spatial position of each of said surgical tool, such that each movement of each surgical tool is stored; said history-based rule is adapted to determine said ALLOWED and RESTRICTED movements according to historical movements of said at least one surgical tool, such that said ALLOWED movements are movements in which said at least one surgical tool is located substantially in at least one of said 3D spatial positions, and said RESTRICTED movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions.

It is another object of the invention is to disclose the system as defined above, wherein said tool- dependent allowed and RESTRICTED movements rule comprises a communicable database; said communicable database is adapted to store predetermined characteristics of at least one of said surgical tools; said tool-dependent ALLOWED and RESTRICTED movements rule is adapted to determine said ALLOWED and RESTRICTED movements according to said predetermined characteristics of said surgical tool; such that allowed movements are movements of said endoscope which tracks said surgical tool having said predetermined characteristics.

It is another object of the invention is to disclose the system as defined above, wherein said predetermined characteristics of said surgical tool are selected from a group consisting of: physical dimensions, structure, weight, sharpness, and any combination thereof.

It is another object of the invention is to disclose the system as defined above, wherein said tagged tool rule comprises means adapted to tag at least one surgical tool within said surgical environment and to determine said ALLOWED movement of said endoscope to constantly track the movement of said tagged surgical tool.

It is another object of the invention is to disclose the system as defined above, wherein at least one of the following is being held true (a) said system additionally comprises an endoscope; said endoscope is adapted to provide real-time image of said surgical environment; (b) at least one of said surgical tools is an endoscope adapted to provide real-time image of said surgical environment. .

It is another object of the invention is to disclose the system as defined above, wherein said controller's database comprises n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said n 3D spatial positions provides a predetermined field of view; said field of view rule is adapted to relocate said endoscope if movement of at least one of said surgical tools has been detected by said detection means, such that said field of view is maintained.

It is another object of the invention is to disclose the system as defined above, wherein said system further comprises a maneuvering subsystem communicable with said controller, said maneuvering subsystem is adapted to spatially reposition said at least one surgical tool during a surgery according to said predetermined set of rules; further wherein said system is adapted to alert the physician of said RESTRICTED movement of said at least one surgical tool.

It is another object of the invention is to disclose the system as defined above, wherein said alert is selected from a group consisting of audio signaling, voice signaling, light signaling, flashing signaling and any combination thereof.

It is another object of the invention is to disclose the system as defined above, wherein said ALLOWED movement is permitted by said controller and said RESTRICTED movement is denied by said controller.

It is another object of the invention is to disclose the system as defined above, further comprising a maneuvering subsystem communicable with said controller, said maneuvering subsystem is adapted to spatially reposition said at least one surgical tool during a surgery according to said predetermined set of rules, such that if said movement of said at least one surgical tool is a RESTRICTED movement, said maneuvering subsystem prevents said movement.

It is another object of the invention is to disclose the system as defined above, wherein said at least one location estimating means comprises at least one endoscope adapted to acquire realtime images of said surgical environment within said human body; and at least one surgical instrument spatial location software adapted to receive said real-time images of said surgical environment and to estimate said 3D spatial position of said at least one surgical tool. It is another object of the invention is to disclose the system as defined above, wherein said at least one location estimating means comprises (a) at least one element selected from a group consisting of optical imaging means, radio frequency transmitting and receiving means, at least one mark on said at least one surgical tool and any combination thereof; and (b) at least one surgical instrument spatial location software adapted to estimate said 3D spatial position of said at least one surgical tool by means of said element.

It is another object of the invention is to disclose the system as defined above, wherein said at least one location estimating means is an interface subsystem between a surgeon and the at least one surgical tool, the interface subsystem comprises:

b. at least one array comprising M cameras, where M is a positive integer;

c. none or more optical markers and means for attaching said optical markers to the at least one surgical tool; and;

d. a computerized algorithm operable via said controller, said computerized algorithm adapted to record images received by each camera of each of the M cameras and to calculate therefrom the position of each of the tools, and further adapted to provide automatically the results of the calculation to a human operator of said interface.

It is an object of the invention is to disclose a method for maneuvering an endoscope, said method comprising steps of:

a. providing a system comprising:

i. a first mechanism, comprising:

a) at least one first transmission means 101 ; said first transmission means 101 defines a first plane; said first transmission means 101 is characterized by a first axis of rotation; said first axis of rotation is substantially orthogonal to said first plane; b) at least one second transmission means 102; said second transmission means 102 defines a second plane; said second transmission means defines a second axis of rotation; said second axis of rotation is substantially orthogonal to said second plane; said second transmission means 102 is rotatably connected to said first transmission means 101 ; where said first plane is substantially orthogonal to second plane; and

c) at least one first means 106 adapted to rotate said first transmission means 101 around said first axis of rotation;

a second mechanism, comprising:

a) at least one third transmission means 103; said third transmission means 103 defines a third plane; said third transmission means 103 is characterized by a third axis of rotation; said third axis of rotation is substantially orthogonal to said third plane;

b) at least one fourth transmission means 104; said fourth transmission means 104 defines a fourth plane; said fourth transmission means defines a fourth axis of rotation; said fourth axis of rotation is substantially orthogonal to said fourth plane; said fourth transmission means 104 is rotatably connected to said third transmission means 103; said fourth plane is substantially orthogonal to said third plane;

c) at least one fifth transmission means 105; said fifth transmission means 105 defines a fifth plane; said fifth transmission means defines a fifth axis of rotation; said fifth axis of rotation is substantially orthogonal to said fifth plane; said fifth transmission means 105 is rotatably connected to said fourth transmission means 104; said fifth plane is substantially orthogonal to said fourth plane;

d) at least one second means 107 adapted to rotate said third transmission means 103 around said third axis of rotation; b. positioning said first transmission means orthogonal to said second transmission means; said positioning enables transmission of rotation between said first transmission means and said second transmission means;

c. positioning said third transmission means orthogonal to said fourth transmission means; said positioning enables transmission of rotation between said third transmission means and said fourth transmission means.

d. positioning said fourth transmission means orthogonal to said fifth transmission means; said positioning enables transmission of rotation between said fourth transmission means and said fifth transmission means.

e. coupling said second transmission means to said endoscope and said fifth transmission means to said endoscope; said coupling enables rotation of said endoscope proportional to rotation of said second transmission means and said fifth transmission means; and, f. maneuvering said endoscope in at least two degrees of freedom (DOF); said maneuvering of said endoscope in said at least two degrees of freedom are in said second axis of rotation and in said fifth axis of rotation;

wherein maneuvering in a first DOF of said at least two DOF is performed by a step of rotating said first transmission means 101 thereby transmitting rotation to said endoscope; wherein maneuvering in a second DOF of at least two DOF is performed by a step of rotating said third transmission means 103 thereby transmitting rotation to said endoscope.

It is another object of the invention is to disclose the method as defined above, further comprising a step of defining an angle A between said second axis of rotation and said fifth axis of rotation, said angle A is in the range of about 0 degrees to about 180 degrees.

It is another object of the invention is to disclose the method as defined above, further comprising steps of

a. providing at least one rotating means comprising

i. at least one pivoting support adapted to be pivotally attached to said endoscope; said pivoting support is adapted to enable said endoscope to pivot around said pivoting support; and ii. at least one third mechanism for rotating said pivoting support independently around two orthogonal axes, comprising at least one first joint coupled to said pivoting support; and at least one second joint in communication with said first joint and coupled to mechanism selected from a group consisting of: said first mechanism, said second mechanism and any combination thereof; each of said joints is adapted to provide rotation to said pivoting support in at least one of said orthogonal axes; wherein said second joint is located at a predetermined distance from said first joint and said third mechanism is mechanically connected to said pivoting support, thereby enabling said endoscope to rotate around an insertion point into a body of a subject;

b. communicating said rotating means with said first mechanism and said second mechanism; said endoscope pivotally attached to said rotating means can pivot at said insertion point independent of the distances between said pivoting support, said rotating means, and said insertion point.

It is another object of the invention is to disclose the method as defined above, further comprising a step of providing said system with at least two configurations: an automatic configuration, in which said system is motorized; and a manual configuration in which said system is maneuvered manually by said endoscope user via a manual control mechanism, preferably a joystick, and wherein said system can be additionally provided with a third configuration, a wholly manual configuration, in which a human endoscope assistant maneuvers the endoscope.

a. providing at least one rotating means comprising at least one fourth mechanism for rotating said endoscope independently around two orthogonal axes, comprising at least one first joint coupled to said endoscope support; and at least one second joint in communication with said first joint and coupled to mechanism selected from a group consisting of: said first mechanism, said second mechanism and any combination thereof; each of said joints is adapted to provide rotation to said endoscope in at least one of said orthogonal axes; wherein said second joint is located at a predetermined distance from said first joint and said fourth mechanism is mechanically connected to said endoscope, thereby enabling said endoscope to rotate around an insertion point into a body of a subject;

b. communicating said rotating means with said first mechanism and said second mechanism; said endoscope pivotally attached to said rotating means can pivot at said insertion point independent of the distance between said endoscope, said rotating means, and said insertion point.

a. providing at least one zoom mechanism; and

b. maneuvering said endoscope along the main longitudinal axis of the same.

It is another object of the invention is to disclose the method as defined above, further comprising steps of providing said zoom mechanism with:

a. at least one first coupling means clasped to said endoscope,

b. at least one first connecting means reversibly coupled to said endoscope at a first coupling position;

wherein said coupling between said first connecting means, said second connecting means and said endoscope enables said first and said second connecting means (i) to pivot around said main longitudinal axis of said endoscope; and (ii) to move along said longitudinal axis of the same.

It is another object of the invention is to disclose the method as defined above, further comprising a step of enabling said first coupling means clasped to said endoscope to move with a reversible reciprocating movement along the main longitudinal axis of said endoscope.

It is another object of the invention is to disclose the method as defined above, further comprising a step of connecting said first connecting means and said second connecting means to one another via joints. It is another object of the invention is to disclose the method as defined above, further comprising a step of providing said zoom mechanism with m coupling means adapted to couple said first connecting means to said second connecting means; where m is an integer larger or equal to one.

It is another object of the invention is to disclose the method as defined above, further comprising a step of rotatably coupling said m coupling means to each other.

It is another object of the invention is to disclose the method as defined above, further comprising a step of selecting said m coupling means from a group consisting of: joints, rods, other zoom mechanisms and any combination thereof.

It is another object of the invention is to disclose the method as defined above, further comprising a step of selecting said coupling means from a group consisting of mechanical means, magnetic means and any combination thereof.

It is another object of the invention is to disclose the method as defined above, further comprising a step of selecting said mechanical means from a group consisting of a clip, a fastening element, tape, adhesive tape, a snap fastener, a button and any combination thereof.

It is another object of the invention is to disclose the method as defined above, further comprising a step of operating said zoom mechanism by at least one motor.

It is another object of the invention is to disclose the method as defined above, further comprising a step of selecting said pivoting support to be a gimbal.

It is another object of the invention is to disclose the method as defined above, further comprising a step of providing said third mechanism with a plurality of q joints, at least one of which is coupled to said pivoting support, and at least one of which is coupled to said second mechanism; where q is an integer greater than or equal to one.

It is another object of the invention is to disclose the method as defined above, further comprising a step of providing said fourth mechanism with a plurality of q joints, at least one of which is coupled to said endoscope, and at least one of which is coupled to said second mechanism; where q is an integer greater than or equal to one. It is another object of the invention is to disclose the method as defined above, further comprising a step of selecting said first transmission means, said second transmission means, said third transmission means, said fourth transmission means, and said fifth transmission means from a group consisting of gearwheels, wheels, crown gears, bevel gears, spur gears, belts, and any combinations thereof.

It is another object of the invention is to disclose the method as defined above, further comprising a step of providing said system with attaching means adapted to reversibly couple said system to a hospital bed.

It is another object of the invention is to disclose the method as defined above, further comprising a step of selecting said attaching means from a group consisting of mechanical means, magnetic means and any combination thereof.

It is another object of the invention is to disclose the method as defined above, further comprising a step of providing, as said magnetic means, a magnetic device comprising at least one magnet and at least one selected from a group consisting of a ferromagnet and a paramagnet; where said magnet is attached to any member of a group consisting of: a hospital bed, said system, and any combination thereof, and said at least one selected from a group consisting of a ferromagnet and a paramagnet is attached to at least one member of a group consisting of: a hospital bed, said system, and any combination thereof.

It is another object of the invention is to disclose the method as defined above, further comprising a step of defining an angle Θ for said rotation in said second plane.

It is another object of the invention is to disclose the method as defined above, further comprising a step of defining said angle Θ angle to vary between about 0 and about 360 degrees, preferably between about 0 and about 160 degrees, when said system is in said automatic configuration or in said manual configuration. It is another object of the invention is to disclose the method as defined above, further comprising a step of defining an angle ψ for said rotation in said fifth plane.

It is another object of the invention is to disclose the method as defined above, further comprising a step of defining said angle ψ to vary between about 0 and about 360 degrees, preferably between about 0 and about 140 degrees, when said system is in said automatic configuration or in said manual configuration.

It is another object of the invention is to disclose the method as defined above, further comprising a step of additionally providing said system with a quick release handle adapted to disassemble said endoscope from said system when said system is in said automatic configuration or in said manual configuration.

It is another object of the invention is to disclose the method as defined above, further comprising a step of providing said first mechanism with locking means adapted to maintain at least one selected from a group consisting of: said first transmission means, said second transmission means and any combination thereof in a predetermined orientation upon power failure; and to prevent any rotational movement of the same upon power failure.

It is another object of the invention is to disclose the method as defined above, further comprising a step of providing said second mechanism additionally with locking means adapted to maintain at least one selected from a group consisting of: said third transmission means, said fourth transmission means, said fifth transmission means, and any combination thereof in a predetermined orientation upon power failure and to prevent any rotational movement of the same upon power failure.

It is another object of the invention is to disclose the method as defined above, further comprising a step of providing at least one manual override system (MOS), adapted upon activation of the same to switch reversibly between a manual configuration, in which the endoscope is moved manually by the operator and an automatic configuration, in which the endoscope is moved automatically by the system.

It is another object of the invention is to disclose the method as defined above, further comprising a step of providing at least one joystick, coupled to said endoscope. It is another object of the invention is to disclose the method as defined above, further comprising a step of providing activation means adapted to activate said MOS.

It is another object of the invention is to disclose the method as defined above, further comprising a step of enabling said MOS to be worn by said MOS operator.

It is another object of the invention is to disclose the method as defined above, further comprising steps of providing at least one joystick, and of enabling said joystick to be worn by said joystick user.

It is another object of the invention is to disclose the method as defined above, further comprising a step of enabling said activation means to be worn by said activation means user.

It is another object of the invention is to disclose the method as defined above, further comprising a step of selecting said activation means from a group consisting of a pressable button, a rotatable knob, a knob, and any combination thereof.

It is another object of the invention is to disclose the method as defined above, further comprising a step of enabling said MOS to rotate in said angles ψ and Θ.

It is another object of the invention is to disclose the method as defined above, further comprising a step of defining angles a and β such that said endoscope moves in angular direction Θ when said joystick is moved in direction a, and said endoscope moves in angular direction ψ when said joystick is moved in direction β.

It is another object of the invention is to disclose the method as defined above, wherein movement of said joystick in a direction selected from a group consisting of said a, said β and any combination thereof, is proportional to movement of said endoscope in angular directions said ψ, said Θ and any combination thereof.

It is another object of the invention is to disclose the method as defined above, further comprising a step of providing said MOS with means for controlling said endoscope motion, adapted to restrain angular velocity in said Θ and ψ directions.

It is another object of the invention is to disclose the method as defined above, further comprising a step of providing said MOS with n sensors, where n is an integer greater than or equal to one. It is another object of the invention is to disclose the method as defined above, further comprising a step of selecting said sensors from of a group consisting of: motion sensors, heat sensors, electric sensors, sound sensors, pressure sensors, optical sensors and any combination thereof.

It is another object of the invention is to disclose the method as defined above, further comprising a step of activating said n sensors in case of power failure.

It is another object of the invention is to disclose the method as defined above, further comprising a step of activating said n sensors when said system is connected to power.

It is another object of the invention is to disclose the method as defined above, further comprising step of detecting said motion of said joystick with motion sensors.

It is another object of the invention is to disclose the method as defined above, further comprising a step of using said motion detection of said joystick for deactivation of said motion of said endoscope if said motion's speed is above a predetermined threshold.

It is another object of the invention is to disclose the method as defined above, further comprising a step of characterizing said joystick by an external surface.

It is another object of the invention is to disclose the method as defined above, further comprising a step of operating said motion sensors to detect motion upon said external surface.

It is another object of the invention is to disclose the method as defined above, further comprising a step of operating said endoscope according to said motion upon said external surface.

It is another object of the invention is to disclose the method as defined above, further comprising a step of deactivation of said motion of said endoscope when said motion's speed along said joystick is above a predetermined threshold.

It is another object of the invention is to disclose the method as defined above, further comprising a step of adapting said heat sensors to sense temperatures in the range of about 35 to about 42 degrees. It is another object of the invention is to disclose the method as defined above, further comprising a step of enabling the activation of said MOS when said heat sensors sense temperature is in the range of about 35 to about 42 degrees.

It is another object of the invention is to disclose the method as defined above, further comprising a step of adapting said heat sensors to provide at least one thermal image, where said heat sensors are coupled to a processing unit, adapted to provide said endoscope user with said thermal image.

It is another object of the invention is to disclose the method as defined above, further comprising a step of enabling the activation of said MOS by said processing units upon analysis of said image and detection of a human hand.

It is another object of the invention is to disclose the method as defined above, further comprising a step of adapting said electric sensors to sense power failure.

It is another object of the invention is to disclose the method as defined above, further comprising a step of adapting said electric sensors to sense electrical conductivity of human body.

It is another object of the invention is to disclose the method as defined above, further comprising a step of enabling the activation of said MOS upon sensing said human body conductivity by electric sensors.

It is another object of the invention is to disclose the method as defined above, further comprising a step of adapting said sound sensors to sense predetermined sound patterns.

It is another object of the invention is to disclose the method as defined above, further comprising a step of enabling activation of said MOS upon sensing of said predetermined sound patterns by said sound sensors.

It is another object of the invention is to disclose the method as defined above, further comprising a step of operating said endoscope according to predetermined sound patterns sensed by said sound sensors.

It is another object of the invention is to disclose the method as defined above, further comprising a step of adapting said pressure sensors to sense pressure applied to said MOS. It is another object of the invention is to disclose the method as defined above, further comprising a step of activating said MOS when said pressure sensed by said pressure sensors is above a predetermined threshold.

It is another object of the invention is to disclose the method as defined above, further comprising a step of de-activating said MOS, when said pressure sensed by said pressure sensors is below a predetermined threshold.

It is another object of the invention is to disclose the method as defined above, further comprising a step of de-activating said MOS, when said pressure sensed by said pressure sensors is above a predetermined threshold.

It is another object of the invention is to disclose the method as defined above, further comprising a step of adapting said optical sensors to sense visual changes according to predetermined visual patterns.

It is another object of the invention is to disclose the method as defined above, further comprising a step of enabling the activation of said MOS according to detection of said predetermined visual patterns.

It is another object of the invention is to disclose the method as defined above, further comprising a step of operating said endoscope according to predetermined visual patterns detected by said sensors.

It is another object of the invention is to disclose the method as defined above, further comprising a step of adapting said endoscope to acquire real-time images of a surgical environment within said human body.

It is another object of the invention is to disclose the method as defined above, additionally comprising a step of providing a surgical tracking system (STS) for assisting an operator to perform laparoscopic surgery on a human body; the STS comprising steps of:

a. providing a surgical tracking system, comprising: (i) at least one endoscope adapted to acquire real-time images of a surgical environment within said human body; (ii) a maneuvering subsystem in communication with said endoscope; and, (iii) a tracking subsystem in communication with said maneuvering subsystem, said tracking subsystem comprises a data processor;

b. performing real-time image processing of said surgical environment; and

c. controlling said maneuvering system via said tracking subsystem, thereby directing and modifying the spatial position of said endoscope to a region of interest according to input received from a maneuvering function f(t);

wherein said maneuvering function f(t) is adapted to (a) receive input from at least two instructing functions gi(t), where i is Ι,. , .,η and n > 2; where t is time; i and n are integers; and, to (b) output instructions to said maneuvering subsystem based on said input from said at least two instructing functions gi(t), so as to spatially position said endoscope to said region of interest.

It is another object of the invention is to disclose the method as defined above, wherein each of said instructing functions gi(t) is provided with ai(t) where i is an integer greater than or equal to 1 ; where ori(t) are weighting functions of each gi(t), and a n is total number of instruction functions.

It is another object of the invention is to disclose the method as defined above, wherein said weighting functions ai(t) are time-varying functions, wherein the value of which is determined by said operators.

It is another object of the invention is to disclose the method as defined above, wherein each of said instructing functions gi(t) is selected from a group consisting of: most used tool function, right tool function, left tool function, field of view function, no fly zone function, proximity function, collision prevention function, preferred volume zone function, preferred tool function, tool detection function, movement detection function, organ detection function, operator input function, prediction function, past statistical analysis function, tagged tool function and any combination thereof.

It is another object of the invention is to disclose the method as defined above, wherein said most used tool function comprises a communicable database counting the amount of movement of each surgical tool located within said surgical environment; said most used tool function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to constantly position said endoscope to track the movement of the most moved surgical tool.

It is another object of the invention is to disclose the method as defined above, wherein said right tool function is adapted to detect surgical tool positioned to right of said endoscope and to output instructions to said tracking subsystem to instruct said maneuvering system to constantly direct said endoscope on said right tool and to track said right tool.

It is another object of the invention is to disclose the method as defined above, wherein said left tool function is adapted to detect surgical tool positioned to left of said endoscope and to output instructions to said tracking subsystem to instruct said maneuvering system to constantly direct said endoscope on said left tool and to track said left tool.

It is another object of the invention is to disclose the method as defined above, wherein said field of view function comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said n 3D spatial positions provides a predetermined field of view; said field of view function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to at least one 3D spatial position substantially within said n 3D spatial positions so as to maintain a constant field of view.

It is another object of the invention is to disclose the method as defined above, wherein controller's database comprises n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said n 3D spatial positions provides a predetermined field of view; said field of view rule is adapted to relocate said endoscope if movement of at least one of said surgical tools has been detected by said detection means, such that said field of view is maintained.

It is another object of the invention is to disclose the method as defined above, wherein said no fly zone function comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions define a predetermined volume within said surgical environment; said no fly zone function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to at least one 3D spatial position substantially different from all said n 3D spatial positions.

It is another object of the invention is to disclose the method as defined above, wherein said proximity function is adapted to define a predetermined distance between at least two surgical tools; and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said two surgical tools if the distance between said two surgical tools is less than said predetermined distance.

It is another object of the invention is to disclose the method as defined above, wherein said proximity function is adapted to define a predetermined angle between at least three surgical tools; and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said three surgical tools if the angle between said two surgical tools is less than or greater than said predetermined angle.

It is another object of the invention is to disclose the method as defined above, wherein said collision prevention function is adapted to define a predetermined distance between said at least one surgical tool and an anatomical element within said surgical environment; and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said surgical tool and said anatomical element within said surgical environment if the distance between said at least one surgical tool and an anatomical element is less than said predetermined distance.

It is another object of the invention is to disclose the method as defined above, wherein said anatomical element is selected from a group consisting of tissue, organ, another surgical tool and any combination thereof.

It is another object of the invention is to disclose the method as defined above, wherein said preferred volume zone function comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions provide said preferred volume zone; said preferred volume zone function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said preferred volume zone. It is another object of the invention is to disclose the method as defined above, wherein said preferred tool function comprises a communicable database, said database stores a preferred tool; said preferred tool function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to constantly direct said endoscope to said preferred tool, such that said endoscope constantly tracks said preferred tool.

It is another object of the invention is to disclose the method as defined above, wherein said tool detection function is adapted to detect surgical tools in said surgical environment and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope on said detected surgical tools.

It is another object of the invention is to disclose the method as defined above, wherein said movement detection function comprises a communicable database comprising real-time 3D spatial positions of each said surgical tool in said surgical environment; and to detect movement of said at least one surgical tool when a change in said 3D spatial positions is received, and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope on said moved surgical tool.

It is another object of the invention is to disclose the method as defined above, wherein said organ detection function is adapted to detect organs in said surgical environment and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope on said detected organs.

It is another object of the invention is to disclose the method as defined above, wherein said operator input function comprises a communicable database; said communicable database is adapted to receive an input from said operator of said system; said input comprising n 3D spatial positions; n is an integer greater than or equal to 2; and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said at least one 3D spatial position received from said operator.

It is another object of the invention is to disclose the method as defined above, wherein said prediction function comprises a communicable database storing each 3D spatial position of each of surgical tool within said surgical environment, such that each movement of each surgical tool is stored; said prediction function is adapted to (a) to predict the future 3D spatial position of each of said surgical tools; and (b) to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said future 3D spatial position.

It is another object of the invention is to disclose the method as defined above, wherein said past statistical analysis function comprises a communicable database storing each 3D spatial position of each of surgical tool within said surgical environment, such that each movement of each surgical tool is stored; said past statistical analysis function is adapted to (a) statistically analyze said 3D spatial positions of each of said surgical tools; and, (b) to predict future 3D spatial positions of each of said surgical tools; and (c) to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to at least one said future 3D spatial position.

It is another object of the invention is to disclose the method as defined above, wherein said a tagged tool function comprises means adapted to tag at least one surgical tool within said surgical environment and to output instructions to said tracking subsystem to instruct said maneuvering system to constantly direct said endoscope to said tagged surgical tool.

It is another object of the invention is to disclose the method as defined above, wherein said means are adapted to apply a continuing tag to said at least one of surgical tool within said surgical environment.

It is another object of the invention is to disclose the method as defined above, wherein means are adapted to re-tag said at least one of said surgical tools until a desired tool is selected.

It is another object of the invention is to disclose the method as defined above, additionally comprising a step of providing means adapted to toggle between said surgical tools.

It is another object of the invention is to disclose the method as defined above, wherein said toggling is performed manually or automatically.

It is another object of the invention is to disclose the method as defined above, wherein said image processing is obtained by at least one algorithm selected from a group consisting of: image stabilization algorithm, image improvement algorithm, image compilation algorithm, image enhancement algorithm, image detection algorithm, image classification algorithm, image correlation with the cardiac cycle or the respiratory cycle of said human body, smoke detection algorithm, vapor detection algorithm, algorithm to reduce steam from said endoscope and any combination thereof.

It is another object of the invention is to disclose the method as defined above, wherein said endoscope comprises an image acquisition device selected from a group consisting of: a camera, a video camera, an electromagnetic sensor, a computer tomography imaging device, a fluoroscopic imaging device, an ultrasound imaging device, and any combination thereof.

It is another object of the invention is to disclose the method as defined above, further comprising a step of providing a display adapted to accept input from or provide output to said operator regarding the operation of said system.

It is another object of the invention is to disclose the method as defined above, wherein said display is used for visualizing said region of interest by said operator.

It is another object of the invention is to disclose the method as defined above, wherein said display is adapted to output said acquired real-time images of a surgical environment with augmented reality elements.

It is another object of the invention is to disclose the method as defined above, wherein said image processing algorithm is adapted to analyze 2D or 3D representations rendered from said real-time images of said surgical environment.

It is another object of the invention is to disclose the method as defined above, wherein said data processor is further adapted to operate a pattern recognition algorithm for assisting the operation of said instructing functions gi(t).

It is another object of the invention is to disclose the method as defined above, additionally comprising a step of preliminarily tagging at least one of said surgical tools.

It is another object of the invention is to disclose the method as defined above, additionally comprising step of applying a continuing tag to at least one of said surgical tools.

It is another object of the invention is to disclose the method as defined above, additionally comprising a step of re-tagging said at least one of said surgical tools until a desired tool is selected. It is another object of the invention is to disclose the method as defined above, additionally comprising a step of toggling between said surgical tools.

It is another object of the invention is to disclose the method as defined above, additionally comprising a step of locating the 3D position of at least one surgical tool in said surgical environment.

It is another object of the invention is to disclose the method as defined above, wherein said step of locating the 3D position of said at least one surgical tool is provided by at least one location estimating means; said at least one location estimating means is an interface subsystem between a surgeon and said at least one surgical tool, the interface subsystem comprising:

b. at least one array comprising M cameras, where M is a positive integer;

c. none or more optical markers and means for attaching said optical marker to said at least one surgical tool; and

d. a computerized algorithm operable via said controller, the computerized algorithm adapted to record images received by each of the M cameras and to calculate therefrom the position of each of the tools, and further adapted to provide automatically the results of the calculation to the human operator of the interface.

It is another object of the invention is to disclose the method as defined above, additionally comprising a step of providing a surgical controlling system (SCS) for assisting an operator to perform laparoscopic surgery on a human body; the SCS comprising steps of:

a. providing a surgical controlling system, comprising: (i) at least one surgical tool; (ii) at least one location estimating means; (iii) at least one movement detection means; and (iv) a controller having a processing means communicable with said controller's database;

b. inserting said at least one surgical tool into a surgical environment of a human body; c. estimating in real-time the location of said at least one surgical tool within said surgical environment at any given time t; and, d. detecting that there is movement of said at least one surgical tool when the 3D spatial position of said at least one surgical tool at time tf is different from said 3D spatial position of said at least one surgical tool at time to', e. controlling the spatial position of said at least one surgical tool within said surgical environment by means of said controller; wherein said step of controlling is performed by storing a predetermined set of rules in a controller's database; said predetermined set of rules comprises ALLOWED and RESTRICTED movements of said at least one surgical tool, such that each detected movement by said movement detection means of said at least one surgical tool is determined as either an ALLOWED movement or as a RESTRICTED movement according to said predetermined set of rules.

It is another object of the invention is to disclose the method as defined above, further comprising a step of selecting said predetermined set of rules from a group consisting of: most used tool, right tool rule, left tool rule, field of view rule, no fly zone rule, route rule, proximity rule; collision prevention rule, preferred volume zone rule, preferred tool rule, movement detection rule, operator input rule, environment rule, history-based rule, tool-dependent ALLOWED and RESTRICTED movements rule, tagged tool rule and any combination thereof.

It is another object of the invention is to disclose the method as defined above, wherein said most used tool rule comprises a database counting the amount of movement of each of said surgical tools; said most used tool rule is adapted to constantly position said endoscope to track the movement of the most moved surgical tool.

It is another object of the invention is to disclose the method as defined above, wherein said right tool rule is adapted to determine said ALLOWED movement of said endoscope according to the movement of the surgical tool positioned to right of said endoscope; further wherein said left tool rule is adapted to determine said ALLOWED movement of said endoscope according to the movement of the surgical tool positioned to left of said endoscope. It is another object of the invention is to disclose the method as defined above, wherein said field of view rule comprises n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said n 3D spatial positions provides a predetermined field of view; said field of view rule is adapted to determine said ALLOWED movement of said endoscope within said n 3D spatial positions so as to maintain a constant field of view, such that said ALLOWED movements are movements in which said endoscope is located substantially in at least one of said n 3D spatial positions, and said RESTRICTED movements are movements in which the location of said endoscope is substantially different from said n 3D spatial positions.

It is another object of the invention is to disclose the method as defined above, wherein said no fly zone rule comprises n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions define a predetermined volume within said surgical environment; said no fly zone rule is adapted to determine said RESTRICTED movement if said movement is within said no fly zone and said ALLOWED movement if said movement is outside said no fly zone, such that said RESTRICTED movements are movements in which said at least one surgical tool is located substantially in at least one of said n 3D spatial positions, and said ALLOWED movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions.

It is another object of the invention is to disclose the method as defined above, wherein said route rule comprises a communicable database storing predefined route in which said at least one surgical tool is adapted to move within said surgical environment; said predefined route comprises n 3D spatial positions of said at least one surgical tool; n is an integer greater than or equal to 2; said ALLOWED movements are movements in which said at least one surgical tool is located substantially in at least one of said n 3D spatial positions of said predefined route, and said RESTRICTED movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions of said predefined route.

It is another object of the invention is to disclose the method as defined above, wherein said proximity rule is adapted to define a predetermined distance between at least two surgical tools; said ALLOWED movements are movements which are within the range or out of the range of said predetermined distance, and said RESTRICTED movements which are out of the range or within the range of said predetermined distance.

It is another object of the invention is to disclose the method as defined above, wherein said proximity rule is adapted to define a predetermined angle between at least three surgical tools; said ALLOWED movements are movements which are within the range or out of the range of said predetermined angle, and said RESTRICTED movements which are out of the range or within the range of said predetermined angle.

It is another object of the invention is to disclose the method as defined above, wherein said collision prevention rule is adapted to define a predetermined distance between said at least one surgical tool and an anatomical element within said surgical environment; said ALLOWED movements are movements which are in a range that is larger than said predetermined distance, and said RESTRICTED movements are movements which are in a range that is smaller than said predetermined distance.

It is another object of the invention is to disclose the method as defined above, wherein said preferred volume zone rule comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions provides said preferred volume zone; said preferred volume zone rule is adapted to determine said ALLOWED movement of said endoscope within said n 3D spatial positions and RESTRICTED movement of said endoscope outside said n 3D spatial positions, such that said ALLOWED movements are movements in which said endoscope is located substantially in at least one of said n 3D spatial positions, and said RESTRICTED movements are movements in which the location of said endoscope is substantially different from said n 3D spatial positions.

It is another object of the invention is to disclose the method as defined above, wherein said preferred tool rule comprises a communicable database, said database stores a preferred tool; said preferred tool rule is adapted to determine said ALLOWED movement of said endoscope to constantly track the movement of said preferred tool. It is another object of the invention is to disclose the method as defined above, wherein said movement detection rule comprises a communicable database comprising the real-time 3D spatial positions of each of said surgical tools; and said movement detection rule detects movement of said at least one surgical tool when a change in said 3D spatial position is received, such that said ALLOWED movements are movements in which said endoscope is directed to focus on the moving surgical tool.

It is another object of the invention is to disclose the method as defined above, wherein said operator input rule comprises a communicable database; said communicable database is adapted to receive an input from the operator of said system regarding said ALLOWED and said RESTRICTED movements of said at least one surgical tool.

It is another object of the invention is to disclose the method as defined above, wherein said input comprises n 3D spatial positions; n is an integer greater than or equal to 2; wherein at least one of which is defined as ALLOWED location and at least one of which is defined as RESTRICTED location, such that said ALLOWED movements are movements in which said at least one surgical tool is located substantially in at least one of said n 3D spatial positions, and said RESTRICTED movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions.

It is another object of the invention is to disclose the method as defined above, wherein said input comprises at least one predetermined rule according to which ALLOWED and RESTRICTED movements of said at least one surgical tool are determined, such that the spatial position of said at least one surgical tool is controlled by said controller according to said ALLOWED and RESTRICTED movements.

It is another object of the invention is to disclose the method as defined above, wherein said predetermined rule is selected from a group consisting of: most used tool, right tool rule, left tool rule, field of view rule, no fly zone rule, route rule, proximity rule; collision prevention rule, preferred volume zone rule, preferred tool rule, movement detection rule, operator input rule, environment rule, history-based rule, tool-dependent ALLOWED and RESTRICTED movements rule, tagged tool rule and any combination thereof. It is another object of the invention is to disclose the method as defined above, wherein said environment rule comprises a communicable database; said communicable database is adapted to received at least one real-time image of said surgical environment and is adapted to perform realtime image processing of the same and to determine the 3D spatial position of hazards or obstacles in said surgical environment; said environmental rule is adapted to determine said ALLOWED and RESTRICTED movements according to said hazards or obstacles in said surgical environment, such that said RESTRICTED movements are movements in which said at least one surgical tool is located substantially in at least one of said 3D spatial positions of said hazards or obstacles, and said ALLOWED movements are movements in which the location of said at least one surgical tool is substantially different from said 3D spatial positions of said hazards or obstacles.

It is another object of the invention is to disclose the method as defined above, wherein said hazards or obstacles in said surgical environment are selected from a group consisting of tissue, a surgical tool, an organ, an endoscope and any combination thereof.

It is another object of the invention is to disclose the method as defined above, wherein said history-based rule comprises a communicable database storing each 3D spatial position of each of said surgical tools, such that each movement of each surgical tool is stored; said history-based rule is adapted to determine said ALLOWED and RESTRICTED movements according to historical movements of said at least one surgical tool, such that said ALLOWED movements are movements in which said at least one surgical tool is located substantially in at least one of said 3D spatial positions, and said RESTRICTED movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions.

It is another object of the invention is to disclose the method as defined above, wherein said tool- dependent allowed and RESTRICTED movements rule comprises a communicable database; said communicable database is adapted to store predetermined characteristics of at least one of said surgical tools; said tool-dependent allowed and RESTRICTED movements rule is adapted to determine said ALLOWED and RESTRICTED movements according to said predetermined characteristics of said surgical tool. It is another object of the invention is to disclose the method as defined above, wherein said predetermined characteristics of said surgical tool are selected from a group consisting of: physical dimensions, structure, weight, sharpness, and any combination thereof.

It is another object of the invention is to disclose the method as defined above, wherein said tagged tool rule comprises means adapted to tag at least one surgical tool within said surgical environment and to determine said ALLOWED movement of said endoscope to constantly track the movement of said tagged surgical tool.

It is another object of the invention is to disclose the method as defined above, wherein said operator input rule converts said ALLOWED movement to said RESTRICTED movement and said RESTRICTED movement to said ALLOWED movement.

It is another object of the invention is to disclose the method as defined above, wherein at least one of the following is being held true (a) said system additionally comprises an endoscope; said endoscope is adapted to provide real-time image of said surgical environment; (b) at least one of said surgical tools is an endoscope adapted to provide real-time image of said surgical environment.

It is another object of the invention is to disclose the method as defined above, wherein said controller's database comprises n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said n 3D spatial positions provides a predetermined field of view; said field of view rule is adapted to relocate said endoscope if movement of at least one of said surgical tools has been detected by said detection means, such that said field of view is maintained.

It is another object of the invention is to disclose the method as defined above, additionally comprising a step of alerting said physician of a RESTRICTED movement of said at least one surgical tool.

It is another object of the invention is to disclose the method as defined above, wherein said step of alerting is performed by at least one selected from a group consisting of an audio signal, a voice signal, a light signal, a flashing signal and any combination thereof. It is another object of the invention is to disclose the method as defined above, wherein said ALLOWED movement is permitted by said controller and said RESTRICTED movement is denied by said controller.

It is another object of the invention is to disclose the method as defined above, further comprising a step of providing a maneuvering subsystem communicable with said controller, said maneuvering subsystem is adapted to spatially reposition said at least one surgical tool during surgery according to said predetermined set of rules, such that if said movement of said at least one surgical tool is a RESTRICTED movement, said maneuvering subsystem prevents said movement.

It is another object of the invention is to disclose the method as defined above, wherein said at least one location estimating means comprises at least one endoscope adapted to acquire realtime images of a surgical environment within said human body; and at least one surgical instrument spatial location software adapted to receive said real-time images of said surgical environment and to estimate said 3D spatial position of said at least one surgical tool.

It is another object of the invention is to disclose the method as defined above, wherein said at least one location estimating means comprises (a) at least one element selected from a group consisting of optical imaging means, radio frequency transmitting and receiving means, at least one mark on said at least one surgical tool and any combination thereof; and (b) at least one surgical instrument spatial location software adapted to estimate said 3D spatial position of said at least one surgical tool by means of said element.

It is another object of the invention is to disclose the method as defined above, wherein said at least one location estimating means is an interface subsystem between a surgeon and said at least one surgical tool, the interface subsystem comprising:

b. at least one array comprising M cameras, where M is a positive integer;

c. none or more optical markers and means for attaching said optical marker to said at least one surgical tool; and, d. a computerized algorithm operable via the controller, said computerized algorithm adapted to record images received by each of the M cameras and to calculate therefrom the position of each of the tools, and further adapted to provide automatically the results of the calculation to the human operator of the interface.

BRIEF DESCRIPTION OF THE FIGURES

In order to understand the invention and to see how it may be implemented in practice, a few preferred embodiments will now be described, by way of non-limiting example only, with reference to be accompanying drawings, in which

Fig. 1 presents a system for maneuvering an endoscope;

Fig. 2a and 2b shows two configurations of a system for maneuvering an endoscope attached to a rotating means;

Figs 3a-c, 4a-b and 5a-b demonstrate more configurations of a system for maneuvering an endoscope.

Fig. 6 presents an endoscope attached to a pivoting support;

Figs. 7a and 7b depict a zoom mechanism in two configurations;

Fig. 8 presents a configuration of system with a hospital bed and an endoscope;

Figs. 9a-9b present the MOS system 130;

Figs. 10a and 10b present wearable manual override systems;

Figs. 11-14 show different configurations for the motors of a system for maneuvering an endoscope;

Fig. 15 shows an examining room configuration adapted to use a system for maneuvering an endoscope;

Fig. 16 depicts another configuration of the system in an operating room, with an emphasis on movement range;

Fig. 17 presents a means adapted to rotate the endoscope around its longitudinal axis;

Fig. 18a-18d schematically illustrates operation of an embodiment of a tracking system with collision avoidance system; Fig. 19a-19d schematically illustrates operation of an embodiment of a tracking system with no fly zone rule/function;

Fig. 20a-20d schematically illustrates operation of an embodiment of a tracking system with preferred volume zone rule/function;

Fig. 21 schematically illustrates operation of an embodiment of the organ detection function/rule; Fig. 22 schematically illustrates operation of an embodiment of the tool detection function/rule; Fig. 23a-23b schematically illustrates operation of an embodiment of the movement detection function/rule;

Fig. 24a-24d schematically illustrates operation of an embodiment of the prediction function/rule;

Fig. 25 schematically illustrates operation of an embodiment of the right tool function/rule;

Fig. 26a-26b schematically illustrates operation of an embodiment of the field of view function/rule;

Fig. 27 schematically illustrates operation of an embodiment of the tagged tool function/rule; Fig. 28a-28c schematically illustrates operation of an embodiment of the proximity function/rule; and

Fig. 29a-29b schematically illustrates operation of an embodiment of the operator input function/rule.

DETAILED DESCRIPTION OF THE INVENTION

Before explaining at least one embodiment of the invention in detail, it is to be understood that the invention is not limited in its application to the details of construction and the arrangement of the components set forth in the following description or illustrated in the drawings. The invention is applicable to other embodiments or of being practiced or carried out in various ways. Also, it is to be understood that the phraseology and terminology employed herein is for the purpose of description and should not be regarded as limiting.

The present invention discloses a system for maneuvering an endoscope, comprising:

a. a first mechanism, comprising: i. at least one first transmission means; the first transmission means defines a first plane and is characterized by a first axis of rotation which is substantially orthogonal to the first plane;

ii. at least one second transmission means; the second transmission means defines a second plane and second axis of rotation; the second axis of rotation is substantially orthogonal to the second plane; and the second transmission means is rotatably connected to the first transmission means; where the first plane is substantially orthogonal to the second plane; and

iii. at least one first means adapted to rotate the first transmission means around the first axis of rotation;

where the first transmission means transmits rotation to the second transmission means; and,

a second mechanism, comprising:

i. at least one third transmission means which defines a third plane and is characterized by a third axis of rotation; the third axis of rotation is substantially orthogonal to the third plane;

ii. at least one fourth transmission means which defines a fourth plane and s fourth axis of rotation; the fourth axis of rotation is substantially orthogonal to the fourth plane; and the fourth transmission means is rotatably connected to the third transmission means 103; where the fourth plane is substantially orthogonal to the third plane;

iii. at least one fifth transmission means which defines a fifth plane and a fifth axis of rotation; the fifth axis of rotation is substantially orthogonal to the fifth plane; the fifth transmission means is rotatably connected to the fourth transmission means and is substantially orthogonal to the fourth plane;

iv. at least one second means adapted to rotate the third transmission means around the third axis of rotation; where the third transmission means transmits rotation to the fourth transmission means; the fourth transmission means transmits rotation to the fifth transmission means,

wherein the first mechanism and the second mechanism are adapted to rotate the endoscope around at least one second axis of rotation substantially orthogonal to the second plane; and around at least one fifth axis of rotation substantially orthogonal to the fifth plane, such that the second axis of rotation and the fifth axis of rotation are positioned at an angle A relative to each other.

The present invention additionally provides a method for maneuvering an endoscope comprising steps of:

a. providing a system comprising:

i. a first mechanism, comprising:

a) at least one first transmission means which defines a first plane; and is characterized by a first axis of rotation; the first axis of rotation is substantially orthogonal to the first plane;

b) at least one second transmission means which defines a second plane and a second axis of rotation; the second axis of rotation is substantially orthogonal to the second plane; the second transmission means is rotatably connected to the first transmission means and the first plane is substantially orthogonal to the second plane; and

c) at least one first means adapted to rotate the first transmission means around the first axis of rotation;

ii a second mechanism, comprising:

a) at least one third transmission means which defines a third plane; the third transmission means is characterized by a third axis of rotation; the third axis of rotation is substantially orthogonal to the third plane;

b) at least one fourth transmission means which defines a fourth plane and a fourth axis of rotation; the fourth axis of rotation is substantially orthogonal to the fourth plane; the fourth transmission means is rotatably connected to the third transmission means such that the fourth plane is substantially orthogonal to the third plane;

c) at least one fifth transmission means which defines a fifth plane and a fifth axis of rotation; the fifth axis of rotation is substantially orthogonal to the fifth plane; the fifth transmission means is rotatably connected to the fourth transmission means such that the fifth plane is substantially orthogonal to the fourth plane; and

d) at least one second means adapted to rotate the third transmission means around the third axis of rotation;

b. positioning the first transmission means orthogonal to the second transmission means; where this positioning enables transmission of rotation between the first transmission means and the second transmission means;

c. positioning the third transmission means orthogonal to the fourth transmission means; where this positioning enables transmission of rotation between the third transmission means and the fourth transmission means;

d. positioning the fourth transmission means orthogonal to the fifth transmission means; where this positioning enables transmission of rotation between the fourth transmission means and the fifth transmission means;

e. coupling the second transmission means to the endoscope and the fifth transmission means to the endoscope; where the coupling enables rotation of the endoscope proportional to the rotation of the second transmission means and to the fifth transmission means; and

f. maneuvering the endoscope in at least two degrees of freedom (DOF);

wherein maneuvering in a first DOF of the at least two DOFs is performed by a step of rotating the first transmission means 101 thereby transmitting rotation to the endoscope; wherein maneuvering in a second DOF of the at least two DOFs is performed by a step of rotating the third transmission means 103 thereby transmitting rotation to the endoscope.

The term 'tool' or 'surgical instrument' refers hereinafter to any instrument or device introducible into the human body. The term may refer to any location on the tool. For example it can refer to the tip of the same, the body of the same and any combination thereof. It should be further pointed that the following description may refer to a surgical tool/instrument as an endoscope.

The term 'region of interest' refers hereinafter to any region within the human body which may be of interest to the operator of the system of the present invention. The region of interest may be, for example, an organ to be operated on, a RESTRICTED area to which a surgical instrument is RESTRICTED to approach, a surgical instrument, or any other region within the human body.

The term 'surgical environment' refers hereinafter to any anatomical part within the human body which may be in the surroundings of a surgical instrument. The environment may comprise: organs, body parts, walls of organs, arteries, veins, nerves, a region of interest, or any other anatomical part of the human body.

The term 'endoscope' refers hereinafter to any means adapted for looking inside the body for medical reasons. This may be any instrument used to examine the interior of a hollow organ or cavity of the body. The endoscope may also refer to any kind of a laparascope.

The term 'spatial position' refers hereinafter to a predetermined spatial location and/or orientation of an object (e.g., the spatial location of the endoscope, the angular orientation of the endoscope, and any combination thereof).

The term "Degrees of freedom" (DOF) refers hereinafter to a set of independent displacements that specify completely the displaced position of the endoscope or laparoscope as defined above. In three dimensional space, there are six DOFs, three DOFs of linear displacement and three rotational DOFs, namely, moving up and down, moving left and right, moving forward and backward, tilting up and down, turning left and right, tilting side to side. According to some embodiments, the present invention refers to a system essentially comprising means for at least seven DOF selected from any of those that will be described hereinafter.

The term 'prohibited area' refers hereinafter to a predetermined area to which a surgical tool (e.g., an endoscope) is prohibited to be spatially positioned in.

The term 'preferred area' refers hereinafter to predetermined area to which a surgical tool (e.g., an endoscope) is allowed and/or preferred to be spatially positioned in. The term "about" refers hereinafter to a range of +-25% of the discussed quantity.

The term "operator" refers hereinafter to a user of the system. Examples of operators are the surgeon, the operating medical assistant, the surgeon's colleagues, etc.

The term 'toggle' refers hereinafter to switching between one tagged surgical tool to another.

The term 'automated assistant' refers hereinafter to any mechanical device (including but not limited to a robotic device) that can maneuver and control the position of a surgical or endoscopic instrument, and that can in addition be adapted to receive commands from a remote source.

The term 'provide' refers hereinafter to any process (visual, tactile, or auditory) by which an instrument, computer, controller, or any other mechanical or electronic device can report the results of a calculation or other operation to a human operator.

The term 'automatic' or 'automatically' refers to any process or action that proceeds without the necessity of direct intervention or action on the part of a human being.

The term 'manual' or 'manually' refers to any process or action necessitating direct intervention or action on the part of a human being. For a non-limiting example, an endoscope moved by a motor is under manual control when a human operator instructs the motor as to the movements of the endoscope. Such instructions can be, for example, via a movements of a joystick or via voice commands.

The term 'wholly manual' or 'wholly manually' refers to any process or action where the process or action is carried out by a human being without mechanical intervention or assistance. For example, an endoscope assistant provides wholly manual control of an endoscope, maneuvering it directly and without mechanical assistance in response to, for example, voice commands by a physician.

The term 'motor' refers hereinafter to anything that produces or imparts motion. A motor includes, but is not limited to, an engine, an electric motor, an induction motor, a reciprocating engine, a Wankel engine, a hydraulic engine, devices employing shape memory alloys, and traction engines.

The term 'transmission means' refers hereinafter to anything that transmits movement from a motor to an object to be moved. Transmission means include, but are not limited to, gears, pulleys, gearwheels, wheels, crown gears, bevel gears, spur gears, belts, and any combination thereof,

The term 'ALLOWED movement' refers hereinafter to any movement of a surgical tool which is permitted according to a predetermined set of rules.

The term 'RESTRICTED movement' refers hereinafter to any movement of a surgical tool which is forbidden according to a predetermined set of rules. For example, one rule, according to the present invention, provides a preferred volume zone rule which defines a favored zone within the surgical environment. Thus, according to the present invention an allowed movement of a surgical tool (or an endoscope) is a movement which maintains the surgical tool within the favored zone; and a RESTRICTED movement of a surgical tool (or an endoscope) is a movement which extracts (or moves) the surgical tool outside the favored zone.

The term 'time step' refers hereinafter to the working time of the system. At each time step, the system receives data from sensors and commands from operators and processes the data and commands and executes actions. The time step size is the elapsed time between time steps. The following abbreviations are used throughout the disclosure:

DOF refers to degree(s) of freedom;

MOS refers to manual override system;

FTM refers to first transmission means;

STM refers to second transmission means;

TTM refers to third transmission means;

FOTM refers to fourth transmission means; and,

FTTM refers to fifth transmission means.

One of the main objects of the present invention is to disclose an endoscope maneuvering device in which the working angle of the endoscope can be substantially small. Namely the physician would be able to maneuver the endoscope at angles which are tangent to the patient treated (namely about 0-30 degrees relative to the upper surface of the patient's treated organ).

Reference is now made to Fig. 1, which shows in a non-limiting manner, a system 100 for maneuvering an endoscope 200. The system comprises a first mechanism for maneuvering an endoscope in one DOF. The first mechanism comprises: (i) At least one first transmission means (FTM) 101, where the FTM is characterized by a first axis of rotation and a first plane substantially orthogonal to the first axis of rotation, (ii) At least one second transmission means (STM) 102, where the STM is characterized by a second axis of rotation and a second plane substantially orthogonal to the second axis of rotation 141. Additionally, the STM is rotatably connected to the FTM. (iii) At least one first means 106 (especially a motor) adapted to rotate FTM 101 around a first axis of rotation. The FTM 101 transmits the rotation to the STM 102. Additionally, the system also comprises a second mechanism for maneuvering an endoscope 200 at a second DOF. The second mechanism comprises: (i) At least one third transmission means (TTM) 103, where the TTM 103 is characterized by a third axis of rotation and a third plane substantially orthogonal to the third axis of rotation, (ii) At least one fourth transmission means (FOTM) 104, where the FOTM is characterized by a fourth plane, and a fourth axis of rotation substantially orthogonal to the fourth plane, and the FOTM is rotatably connected to the TTM 103. The connection is such that the fourth plane is substantially orthogonal to the third plane, (iii) At least one fifth transmission means (FTTM) 105. The FTTM 105 defines a fifth plane and a fifth axis of rotation 142 substantially orthogonal to the fifth plane, and the FTTM 105 is rotatably connected to the FOTM 104. The connection is such that the fifth plane is substantially orthogonal to the fourth plane, (iv) At least one second means 107 (especially a motor) adapted to rotate TTM 103 around the third axis of rotation. The TTM 103 transmits rotation to FOTM 104, the FOTM 104 than transmits rotation to the FTTM 105. The system then maneuvers the endoscope 200 by adapting the first mechanism to rotate the endoscope 200 in one DOF substantially orthogonal to the second plane (i.e. second axis of rotation 141), and adapting the second mechanism to rotate the endoscope 200 in a second DOF substantially orthogonal to the fifth plane (i.e. fifth axis of rotation 142). The two DOF define two axes of rotation with angle A between them. The angle A is in the range of 0 to 180 degrees.

In some embodiments, at least some of the FTM, STM, TTM, FOTM and FTTM are coaxial, so that at least two transmission means share the same axis of rotation. A non-limiting example of coaxial transmission means would be transmission means linked by a universal joint, where the two transmission means transmit rotations in two perpendicular directions. In other embodiments, at least one of the FTM, STM, TTM, FOTM and FTTM comprises a plurality of coaxial transmission means.

In the best embodiment, both the first means 106 and the second means 107 are static, in that both are mounted in fixed positions. The system has been designed so that the transmission means, especially FOTM and FTTM, can be driven by said means (106 and 107) with the means 106 and 107 in fixed positions.

This reduces the number of moving parts in the system, thereby improving its reliability. It is also more difficult for the system to get out of alignment, and for the gears to jam, as the main between alignments between the FTM, STM, TTM, FOTM and FTTM are fixed at the time of manufacture and do not vary during use. It also enables the system to be more compact, as there is no need to allow space for a mechanism to move within.

Reference is now made to Figs. 2a and 2b, which present in a non-limiting manner a rotating means in communication with the first mechanism and the second mechanism. The rotating means comprises (i) at least one pivoting support 111 adapted to be pivotally attached to endoscope 200, pivoting support 111 is adapted to enable endoscope 200 to pivot around pivoting support 111; (ii) least one third mechanism 112 for rotating pivoting support 111 independently around two orthogonal axes, third mechanism 112 mechanically connected to pivoting support 111, thereby enabling endoscope 200 to rotate around an insertion point in the body of a subject.

Endoscope 200 pivotally attached to the third mechanism 112 can pivot at the insertion point independent of the distance between pivoting support 111, rotating means 112, and the insertion point.

Additionally, third mechanism 112 comprising at least one first joint 113 coupled to the pivoting support; and at least one second joint 114 in communication with first joint 113 and coupled to a mechanism selected from a group consisting of the first mechanism, the second mechanism and any combination thereof.

Each of the joints is adapted to provide rotation to pivoting support 111 in at least one of the orthogonal axes; wherein second joint 114 is located at a predetermined distance 180 from first joint 113. In the best embodiment, gimbals at first joint 113 and second joint 114 enable endoscope 200 to pivot about its insertion point in the body of the patient without applying force on the patient at the insertion point, especially if the line of application of force to move the endoscope is not completely collinear with the axis of the endoscope. The pair of gimbals at joints 113 and 114 enable sufficient flexibility that the insertion point can remain fixed without the application of force by the body of the patient.

It should be emphasized that the addition of the second joint 114 is to make sure that no force is applied on the penetration point when the system's center of movement is misaligned with the penetration point.

It should be further emphasized that while moving (rotating) the first mechanism (which comprises the first transmission means 101 and the second transmission means 102), the second mechanism (which comprises the third transmission means 103, the fourth transmission means 104 and the fifth transmission means 105) is moved (rotated) in the opposite direction and vice versa. Such reverse movement is highly important to compensate any unwanted /parasitic movement that would be created when moving only one mechanism.

Zoom mechanism 115 is connected to endoscope 111.

Reference is now made again to Fig. 2a which demonstrates in a non-limiting manner another object of the present invention.

In this figure a mechanism with sides forming a parallelogram for transforming the rotational movement to the endoscope is presented. As can be seen in the figure the parallelogram comprises rod 171 and 172. Rod 172 is adapted to transform rotation around the second axis of rotation 141 to the endoscope and two rods 171 are adapted to transform rotation around fifth axis of rotation 142, wherein the two rods 171 are connected to rod 172.

Rods 171, 172 and 173 form a parallelogram.

Reference is now made to Fig. 3a, 3b and 3c, which illustrate in a non-limiting manner a parallelogram adapted to communicate between the different transmission means and the endoscope.

In the figures, the above mentioned parallelogram is characterized by having at least one non- straight rib. As can be seen, at least one rib is shaped as an arced rod. It is within the core concept of the present invention to provide an arc shaped parallelogram, namely one characterized by at least one arc-shaped side. According to one embodiment of the present invention, the arc shaped parallelogram provides the endoscope with a wide range of angular movements and maneuverability when compared to a parallelogram with all sides straight, a non-arc shaped parallelogram.

In addition, Fig. 3a describes two additional (and 'intermediate') means 191, 192 constructed upon second transmission means 102 and fifth transmission means.

It is within the core concept of the present invention to provide the first and second mechanisms having at least one first transmission 101 (but there could be several interconnected transmissions); at least one second transmission 102 (but there could be several communicating transmissions); at least one third transmission 103 (but there could be several communicating transmissions); at least one second fourth transmission 104 (but there could be several communicating transmissions); at least one fifth transmission 105 (but there could be several communicating transmissions) and any combination thereof.

Reference is now made to Figs. 4a, and 4b, which illustrate in a non-limiting manner another embodiment of the parallelogram described above. The figures illustrate an embodiment in which ribs 171 comprise a dent (i.e., groove) 175 and an embodiment in which ribs 171 are not provided with dent 175.

Fig. 4a demonstrates the failure of rods 171 to achieve a maximum 180 degrees angle with respect to rod 172. Such a failure is the result of the collision of ribs 171 with each other.

In Fig. 4b a solution is suggested in a form of a dent 175 in rods 171 which enables a larger angular movement of ribs 171. By providing the dent (i.e., groove) 175, a further angular movement is achieved.

Reference is now made to Figs. 5a and 5b, which illustrate in a non-limiting manner the predetermined distance 180 at 2 different lengths.

Fig. 5a illustrates a relatively small predetermined distance 180, such that the same limits the range of motion of the endoscope 200; Fig. 5b illustrates a larger predetermined distance 180, such that the same enables the full range of motion of the endoscope 200.

In other embodiments of the present invention, system 100 is characterized in a non-limiting manner by at least two configurations: an automatic configuration, in which system 100 is motorized; and a manual configuration in which system 100 is maneuvered manually by an endoscope user via a manual control mechanism, preferably a joystick. The system can also be characterized by a third configuration, a wholly manual configuration, in which a human endoscope assistant maneuvers the endoscope without mechanical assistance.

In another embodiment of the present invention, system 100 additionally comprises in a non- limiting manner a rotating means as described in Fig. 2 without pivoting support 111.

Reference is now made to Fig. 6 which illustrates, in a non-limiting manner, pivoting support 111 as a gimbal coupled to endoscope 200.

As described above, according to one embodiment, the zoom mechanism 115 (which enables the endoscope 200 to zoom along its main longitudinal axis) can be coupled to the pivoting support 111 (see for example Figs. 2a-2b).

Reference is now made to Fig. 7a which illustrates a closer view of the zoom mechanism 115. according to this embodiment, the zoom mechanism 115 comprises (i) at least one first coupling means 121 clasped to endoscope 200; (ii) at least one first connecting means 122 reversibly coupled to endoscope 200 at a first coupling position; (iii) at least one second connecting means 123 reversibly coupled to first coupling means 122 at a second coupling position. Coupling between first connecting means 122, second connecting means 123 and endoscope 200 enables the first 122 and second 123 connecting means to (i) pivot around the main longitudinal axis of the endoscope 200; and, (ii) move along the longitudinal axis of the endoscope 200.

Reference is now made to Figs. 7a-7b which illustrate, in a non-limiting manner, the zoom mechanism 115 as described above in two different positions of the first 122 and second 123 connecting means.

According to another embodiment of the current invention, zoom mechanism 115 comprises clasping means adapted to enable reversible reciprocating movement along the main longitudinal axis of endoscope 200.

In another embodiment of the current invention, first connecting means 122 and second connecting means 123 are connected to one another via a joint.

In another embodiment of the current invention, zoom mechanism 115 further comprises, in a non-limiting manner, m coupling means adapted to couple first connecting means 122 to second connecting means 123; where m is an integer greater than or equal to one. In another embodiment of the current invention, m coupling means are rotatably coupled to each other.

In another embodiment of the current invention, coupling means are selected in a non-limiting manner from a group consisting, for example, of joints, rods, other zoom mechanisms and any combination thereof.

In another embodiment of the current invention, coupling of first connecting means 122 or second connecting means 123 to endoscope 200 is obtained by means selected in a non-limiting manner from a group consisting, for example, of mechanical means, magnetic means and any combination thereof.

In another embodiment of the current invention, the mechanical means are selected in a non- limiting manner from a group consisting, for example, of a clip, a fastening element, tape, adhesive tape, a snap fastener, a button and any combination thereof.

In another embodiment of the current invention, the magnetic means comprises in a non-limiting manner at least one magnet and at least one ferromagnet or at least one paramagnet.

According to another embodiment of the present invention, the zoom mechanism may be operated manually or automatically.

According to another embodiment of the present invention, the zoom mechanism may be operated by means of at least one motor. Such an embodiment is illustrated in Fig. 9. As can be seen from the figure, the zoom mechanism 115 is operable by motor 121.

We will now refer to the third mechanism 112. According to another embodiment of the current invention, the third mechanism 112 additionally comprises in a non-limiting manner a plurality of second joints 114, wherein each of the second joints 114 in each of third mechanisms 112 is located at a substantially different distance from first joint 113.

In another embodiment of the current invention, third mechanism 112 additionally comprises in a non-limiting manner a plurality of q joints, at least one of which is coupled to pivoting support 111 and at least one of which is coupled to the second mechanism, where q is an integer greater than or equal to one. In another embodiment of the current invention, third mechanism 112 without the gimbal also additionally comprises in a non-limiting manner a plurality of q joints, at least one of which is coupled to pivoting support 111 and at least one of which is coupled to the second mechanism, where q is an integer greater than or equal to one.

In another embodiment of the current invention, FTM 101, STM 102, TTM 103, FOTM 104 and FTTM 105 are selected in a non-limiting manner from a group consisting, for example, of gearwheels, wheels, crown gears, bevel gears, spur gears, belts, and any combination thereof.

In another embodiment of the current invention, the second plane defines in a non-limiting manner angle Θ and the fifth plane defines in a non-limiting manner the angle ψ. The angle Θ varies between about 0 and about 360 degrees, preferably between about 0 and about 160 degrees, when system 100 is in automatic configuration or in manual configuration. Additionally, angle ψ varies between about 0 and about 360 degrees, preferably between about 0 and about 140 degrees, when system 100 is in automatic configuration or in manual configuration.

Reference is now made to Fig. 8, which presents, in a non-limiting manner, attaching means adapted to reversibly couple system 100 to a hospital bed. Attaching means are selected in a non- limiting manner from a group consisting, for example, of mechanical means as defined above, magnetic means as defined above and any combination thereof. Fig. 8 also illustrates the main core concept of the invention, which enables the utilization of the endoscope substantially tangential to the upper surface of the treated organ (e.g. the abdominal cavity).

In another embodiment of the current invention, system 100 additionally comprises in a non- limiting manner a quick release handle adapted to disassemble endoscope 200 from system 100 when system 100 is in automatic configuration or in manual configuration

In another embodiment of the current invention, the first mechanism additionally comprises in a non-limiting manner locking means adapted to maintain at least one selected from a group consisting, for example, of: FTM 101, STM 102 and any combination thereof in a predetermined orientation upon power failure; and to prevent any rotational movement of the same upon power failure. In another embodiment of the current invention, the second mechanism additionally comprises in a non-limiting manner locking means adapted to maintain at least one selected from a group consisting, for example, of: TTM 103, FOTM 104, FTTM 105 and any combination thereof in a predetermined orientation upon power failure; and to prevent any rotational movement of the same upon power failure.

Reference is now made to Figs. 9a-9b, which present the manual override system (MOS) 130, which is adapted, upon activation, to switch reversibly between manual configuration of the system and automatic configuration of the system. In some embodiments, the MOS has a third setting, which enables the operator to switch reversibly between automatic, manual and wholly manual operation.

MOS 130 comprises an activation means and a joystick 170 coupled to endoscope 200, used to manually maneuver endoscope 200 in any direction defined by either one of ψ and Θ as defined above and any combination thereof.

In the manual configuration the physician maneuvers the endoscope (and controls the movement of the same) by means of joystick 170. According to one embodiment of the present invention, the movement of the joystick is translated into movement of the endoscope.

Fig. 9b illustrates a closer view of joystick 170. Upon pressing on the joystick 170 in the directions of arrow 1701, the endoscope moves forward or backward. Upon pressing on the joystick 170 in the directions of arrow 1702 the endoscope moves left or right.

The transformation of system form the automatic configuration to the manual configuration, or to the wholly manual means, is obtained by the activation means.

According to another embodiment of the present invention, the MOS 130 may be wearable by the user. Reference is now made to Figs. 10a and 10b, which depict, in a non-limiting manner, activation means wearable by a user.

In other embodiments of the current invention, any one of MOS 130, joystick 170 and activation means are wearable by user. In another embodiment of the current invention, the activation means are selected in a non- limiting manner from a group consisting, for example, of a pressing button, a rotatable knob, a knob, and any combination thereof.

In another embodiment of the current invention, MOS 130 additionally comprises in a non- limiting manner means for controlling movement of endoscope 200, adapted to restrain angular velocity in the Θ and ψ directions.

In another embodiment of the current invention, MOS 130 additionally comprises in a non- limiting manner n sensors, where n is an integer greater than or equal to one. Sensors are selected in a non-limiting manner from a group consisting, for example, of motion sensors, heat sensors, electric sensors, sound sensors, pressure sensors, optical sensors and any combination thereof. Sensors are adapted to activate in case of power failure or when connected to power.

In another embodiment of the current invention, joystick 170 is characterized in a non-limiting manner by an external surface.

In another embodiment of the current invention, motion sensors detect motion of joystick 170. Furthermore, motion detection of joystick 170 is used for deactivation of motion of endoscope 200 if the motion's speed is above a predetermined threshold.

In another embodiment of the current invention, motion sensors detect in a non-limiting manner motion upon the external surface of the joystick. Furthermore, motion upon the joystick's external surface is used to operate endoscope 200 in accordance with the motion. Additionally, detection of motion along the joystick is used for deactivation of the motion of endoscope 200 if the speed of the motion along the joystick is above a predetermined threshold.

In another embodiment of the current invention, heat sensors are adapted in a non-limiting manner to sense temperatures in the range of about 35 to about 42 degrees. Said heat sensors are adapted to sense whether a human hand/fingers are activating (i.e., touching) the joystick.

Furthermore, heat sensors enable in a non-limiting manner the activation of MOS 130 when the heat sensors sense temperature is in the range of about 35 to about 42 degrees.

Additionally, heat sensors are adapted in a non-limiting manner to provide a thermal image, where heat sensors are coupled to a processing unit adapted to provide the endoscope user with a thermal image, and the processing unit enables the activation of MOS 130 upon analysis of the image and detection of human hand.

In another embodiment of the current invention, electric sensors are adapted in a non-limiting manner to detect, for example, any of power failure, the electrical conductivity of a human body and any combination thereof. Additionally, human body conductivity sensed by electric sensors enables the activation of the MOS.

In another embodiment of the current invention, sound sensors are adapted in a non-limiting manner to sense predetermined sound patterns. Furthermore, predetermined sound patterns sensed by sound sensors enable the activation of the MOS 130. Additionally, sound sensors are used to operate endoscope 200 according to predetermined sound patterns (e.g., human voice, predetermined movement commands).

In another embodiment of the current invention, pressure sensors are adapted in a non-limiting manner to sense pressure applied to MOS 130.

Additionally, when pressure sensed by the pressure sensors is above a predetermined threshold, MOS 130 is either activated or de-activated, and, when the pressure sensed by pressure sensors is below a predetermined threshold, MOS 130 is either activated or de-activated.

In another embodiment of the current invention, optical sensors are adapted in a non-limiting manner to sense visual changes according to predetermined visual patterns. Furthermore, optical sensors enable the activation of MOS 130 according to predetermined visual patterns. Additionally, optical sensors are used to operate endoscope 200 according to predetermined visual patterns.

Reference is now made to Figs. 11a and lib, illustrating in a non-limiting manner, from different points of view, the first mechanism and the second mechanism assembled in a horizontal configuration.

Reference is now made to Figs. 12a and 12b, illustrating in a non-limiting manner different points of view of the first mechanism and the second mechanism assembled in a vertical configuration. Reference is now made to Figs. 13a and 13b, illustrating in a non-limiting manner, from different points of view, the first mechanism and the second mechanism assembled in a compact vertical configuration.

Reference is now made to Fig. 14 which depicts, in a non-limiting manner, one configuration of the first mechanism and the second mechanism, where first rotation means 106 and second rotation means 107 (shown in Fig. 1 ) are unified to a single rotation means 500.

Said single rotation means 500 is provided with means adapted to switch between rotating first transmission means 101 and third transmission means 103 by a clutch 501.

In another embodiment of the current invention, the endoscope is adapted in a non-limiting manner to acquire real-time images of a surgical environment within human body.

In another embodiment of the current invention, system 100 additionally comprises in a non- limiting manner a surgical tracking system (STS) for assisting an operator to perform laparoscopic surgery on a human body, the surgical tracking system comprising (i) a maneuvering subsystem adapted to control the spatial position of endoscope 200 during laparoscopic surgery; and (ii) a tracking subsystem in communication with the maneuvering subsystem, adapted to controlling the maneuvering subsystem so as to direct and modify the spatial position of endoscope 200 to a region of interest. The tracking subsystem comprises a data processor that is adapted to perform real-time image processing of the surgical environment and modify the spatial position of endoscope 200 according to a rule based approach. The rule based approach comprises a maneuvering function f(t) which is calculated according to at least two instructing functions g,(t), where / is Ι,. , .,η and n > 2; where t is time.

In another embodiment of the current invention, the rule based approach of the maneuvering function f(t) is a function of a,(t)*g_i(t) i=l,...,n where g,(t) are the instructing functions, a,(t) are weighting functions of each g,(t), and n is the total number of instruction functions, n > 2.

In another embodiment of the current invention, each of the instructing functions g,(t) is selected in a non-limiting manner from a group consisting of: most used tool function, a right tool function, left tool function, field of view function, no fly zone function, a tool detection function, movement detection function, organ detection function, collision detection function, operator input function, prediction function, past statistical analysis function, and any combination thereof.

In another embodiment of the current invention, weighting functions a,(t) are, for example, time- varying functions, the value of which is determined by the operator or the output of the instructing functions g,(t).

In another embodiment of the current invention, the tool detection function is adapted in a non- limiting manner to detect surgical tools in the surgical environment and to classify the detected tools as prohibited areas and preferred areas. The surgical tools are selected in a non-limiting manner from a group consisting of: the tip of a surgical instrument, a grasper, a surgical instrument, a non-surgical instrument, and any combination thereof.

In another embodiment of the current invention, the tip of a surgical instrument is classified in a non-limiting manner as a preferred area and the grasper is classified as a prohibited area.

In another embodiment of the current invention, the movement detection function is adapted in a non-limiting manner to detect physiological or a non-physiological movements in the surgical environment and to classify the detected movements as prohibited areas and preferred areas.

In another embodiment of the current invention, the organ detection function is adapted in a non- limiting manner to detect physiological organs in the surgical environment and to classify the detected organs as prohibited areas and preferred areas.

In another embodiment of the current invention, the right tool function is adapted in a non- limiting manner to constantly track the movement of the right tool.

In another embodiment of the current invention, the left tool function is adapted in a non- limiting manner to constantly track the movement of the left tool.

In another embodiment of the current invention, the field of view function is adapted in a non- limiting manner to maintain a constant field of view of the endoscope.

In another embodiment of the current invention, the no fly zone function is adapted in a non- limiting manner to instruct the maneuvering subsystem to prevent movement of the endoscope into a no fly zone. In another embodiment of the current invention, the most used tool function is adapted in a non- limiting manner to instruct the maneuvering subsystem to constantly position the endoscope to track the movement of the most moved tool.

In another embodiment of the current invention, the collision detection function is adapted in a non-limiting manner to detect prohibited areas within the surgical environment so as to prevent collisions between the endoscope and the prohibited areas.

In another embodiment of the current invention, the operator input function is adapted in a non- limiting manner to receive an input from the operator. The input is selected in a non-limiting manner from a group consisting, for example, of: an input regarding prohibited areas in the surgical environment, an input regarding allowed areas in the surgical environment, and input regarding the region of interest.

In another embodiment of the current invention, the operator input function further comprises in a non-limiting manner a selection algorithm for selection of areas, where the areas are selected in a non-limiting manner from a group consisting, for example, of: prohibited areas, allowed areas, region of interest, and any combination thereof

In another embodiment of the current invention, image processing comprises algorithms selected in a non-limiting manner from a group consisting, for example, of: image stabilization algorithms, image improvement algorithms, image compilation algorithms, image enhancement algorithms, image detection algorithms, image classification algorithms, smoke detection algorithms, vapor detection algorithms, steam detection algorithms, algorithms to reduce steam from the endoscope and any combination thereof.

In another embodiment of the current invention, the endoscope comprises in a non-limiting manner an image acquisition device selected in a non-limiting manner from a group consisting, for example, of: a camera, a video camera, an electromagnetic sensor, a computer tomography imaging device, a fluoroscopic imaging device, an ultrasound imaging device, and any combination thereof.

In another embodiment of the current invention, the system additionally comprises a display adapted in a non-limiting manner to provide input or output to the operator regarding the operation of the STS. In another embodiment of the current invention, the display is adapted in a non-limiting manner to output the acquired real-time images of the surgical environment with augmented reality elements.

In another embodiment of the current invention, the STS further comprises in a non-limiting manner an endoscope controller adapted to control the operation of the endoscope by performing operations selected from a group consisting, for example, of: acquire real-time images, zoom-in to a predetermined area, and any combination thereof.

In another embodiment of the current invention, the STS additionally comprises in a non- limiting manner means adapted to apply a preliminary tag to at least one of the surgical tools.

In another embodiment of the current invention, the STS additionally comprises means adapted in a non-limiting manner to apply a constant tag at least one of the surgical tools.

In another embodiment of the current invention, the STS additionally comprises means adapted in a non-limiting manner to re-tag at least one of the surgical tools until a desired tool is selected.

In another embodiment of the current invention, the STS additionally comprises means adapted in a non-limiting manner to toggle between the surgical tools.

In another embodiment of the current invention, toggling is performed manually or automatically.

In another embodiment of the current invention, the STS additionally comprises a surgical controlling system (SCS), comprising (i) at least one location estimating means adapted to estimate the location of the at least one surgical tool; and (ii) a controller having a processing means communicable with a database, the controller adapted to control the spatial position of the at least one surgical tool. The database is adapted to store a predetermined set of rules according to which ALLOWED and RESTRICTED movements of at least one surgical tool are determined, such that the spatial position of at least one surgical tool is controlled by the controller according to the ALLOWED and RESTRICTED movements.

In another embodiment of the current invention, the predetermined set of rules is selected in a non-limiting manner from a group consisting, for example, of: most used tool, right tool rule, left tool rule, field of view rule, no fly zone rule, route rule, environment rule, operator input rule, proximity rule; collision prevention rule, history based rule, tool-dependent ALLOWED and RESTRICTED movements rule, and any combination thereof.

In another embodiment of the current invention, the route rule comprises in a non-limiting manner a predefined route in which the at least one surgical tool is adapted to move within the surgical environment; the ALLOWED movements are movements in which the at least one surgical tool is located within the borders of the predefined route, and the RESTRICTED movements are movements in which the at least one surgical tool is located outside of the borders of the predefined route.

In another embodiment of the current invention, the environment rule is adapted in a non- limiting manner to determine the ALLOWED and RESTRICTED movements according to hazards or obstacles in the surgical environment as received from an endoscope or other sensing means.

In another embodiment of the current invention, the operator input rule is adapted in a non- limiting manner to receive an input from operator of the SCS regarding the ALLOWED and RESTRICTED movements of the at least one surgical tool.

In another embodiment of the current invention, the operator input rule is adapted in a non- limiting manner to convert an ALLOWED movement to a RESTRICTED movement and a RESTRICTED movement to an ALLOWED movement.

In another embodiment of the current invention, the proximity rule is adapted in a non-limiting manner to define a predetermined distance between the at least one surgical tool and at least one other surgical tool; the ALLOWED movements are movements which are within the range or out of the range of the predetermined distance, and the RESTRICTED movements are movements which are within the range or out of the range of the predetermined distance; the ALLOWED movements and RESTRICTED movements are defined according to different ranges.

In another embodiment of the current invention, the collision prevention rule is adapted to, in a non-limiting manner, define a predetermined distance between the at least one surgical tool and an anatomical element within the surgical environment; the ALLOWED movements are movements which are in a range that is larger than the predetermined distance, and the RESTRICTED movements are movements which are in a range that is smaller than the predetermined distance.

In another embodiment of the current invention, the anatomical element is selected in a non- limiting manner from a group consisting for example of: tissue, an organ, another surgical tool and any combination thereof.

In another embodiment of the current invention, the surgical tool is an endoscope.

In another embodiment of the current invention, the right tool rule is adapted in a non-limiting manner to determine the ALLOWED movement of the endoscope according to the movement of the right tool.

In another embodiment of the current invention, the left tool rule is adapted in a non-limiting manner to determine the ALLOWED movement of the endoscope according to the movement of the left tool.

In another embodiment of the current invention, the field of view rule is adapted in a non- limiting manner to determine the ALLOWED movement of the endoscope so as to maintain a constant field of view.

In another embodiment of the current invention, the no fly zone rule is adapted in a non-limiting manner to define a movement as a RESTRICTED movement if the movement is within the no fly zone and as an ALLOWED movement if the movement is outside the no fly zone.

In another embodiment of the current invention, the most used tool function is adapted in a non- limiting manner to instruct the maneuvering subsystem to constantly position the endoscope to track the movement of the most moved tool.

In another embodiment of the current invention, the SCS is adapted in a non-limiting manner to alert the physician of a RESTRICTED movement of the at least one surgical tool.

In another embodiment of the current invention, the alert is selected in a non-limiting manner from a group consisting, for example, of audio signaling, voice signaling, light signaling, flashing signaling and any combination thereof. In another embodiment of the current invention, an ALLOWED movement is permitted in a non-limiting manner by the SCS and a RESTRICTED movement is denied by the SCS.

In another embodiment of the current invention, the history based rule is adapted in a non- limiting manner to determine ALLOWED and RESTRICTED movements according to historical movements of the at least one surgical tool in at least one previous surgery.

In another embodiment of the current invention, the tool-dependent ALLOWED and RESTRICTED movements rule is adapted in a non-limiting manner to determine the ALLOWED and RESTRICTED movements according to predetermined characteristics of the surgical tool; the predetermined characteristics of the surgical tool are selected from a group consisting, for example, of: physical dimensions, structure, weight, sharpness, and any combination thereof.

In another embodiment of the current invention, the maneuvering subsystem is adapted in a non- limiting manner to spatially reposition at least one surgical tool during surgery according to the predetermined set of rules.

Reference is now made to Figs. 15-16 which present, in a non-limiting manner, a possible configuration of system 100, endoscope 200, zoom mechanism 115, and hospital bed 150. As illustrated in Fig. 8, the system of the present invention enables the operation of the endoscope while the same is substantially parallel to the upper surface of the treated organ (e.g., the abdominal cavity).

Reference is now made to Fig. 16 which presents, in a non-limiting manner, a possible angle of the endoscope 200, in which the same is almost parallel to hospital bed.

Reference is now made to Fig. 17, which illustrates, in a non-limiting manner, means 600 adapted to rotate an endoscope around the endoscope's main longitudinal axis.

Means 600 comprises at least one transmission means 601 in communication with the endoscope 200; a transmission means 602 in communication with transmission means 601, and a motor 603 in communication with transmission means 602, adapted to activate the transmission means 602. Once motor 603 is activated, transmission means 602 is actuated; and transmission means 601 is rotated. Once transmission means 601 is activated, the endoscope is rotated around its main longitudinal axis.

According to another embodiment of the present invention a method of maneuvering an endoscope is also provided.

It is another object of the invention to disclose a method for maneuvering an endoscope, the method comprising steps of:

a. providing a system comprising:

i. a first mechanism, comprising:

a) at least one first transmission means; the first transmission means defines a first plane; the first transmission means is characterized by a first axis of rotation; the first axis of rotation is substantially orthogonal to the first plane;

b) at least one second transmission means; the second transmission means defines a second plane and a second axis of rotation; the second axis of rotation is substantially orthogonal to the second plane; the second transmission means is rotatably connected to the first transmission means; where the first plane is substantially orthogonal to second plane; and c) at least one first means adapted to rotate the first transmission means around the first axis of rotation;

ii. a second mechanism, comprising:

a) at least one third transmission means; the third transmission means defines a third plane; the third transmission means is characterized by a third axis of rotation; the third axis of rotation is substantially orthogonal to the third plane;

b) at least one fourth transmission means; the fourth transmission means defines a fourth plane and a fourth axis of rotation; the fourth axis of rotation is substantially orthogonal to the fourth plane; the fourth transmission means is rotatably connected to the third transmission means; where the fourth plane is substantially orthogonal to the third plane;

c) at least one fifth transmission means; the fifth transmission means defines a fifth plane and a fifth axis of rotation; the fifth axis of rotation is substantially orthogonal to the fifth plane; the fifth transmission means is rotatably connected to the fourth transmission means; where the fifth plane is substantially orthogonal to the fourth plane; and

b. positioning the first transmission means orthogonal to the second transmission means; the positioning enables transmission of rotation between the first transmission means and the second transmission means;

c. positioning the third transmission means orthogonal to the fourth transmission means; the positioning enables transmission of rotation between the third transmission means and the fourth transmission means.

d. positioning the fourth transmission means orthogonal to the fifth transmission means; the positioning enables transmission of rotation between the fourth transmission means and the fifth transmission means.

e. coupling the second transmission means to the endoscope and the fifth transmission means to the endoscope; the coupling enables rotation of the endoscope proportional to rotation of the second transmission means and to the fifth transmission means; and, f. maneuvering the endoscope in at least two degrees of freedom (DOF)

wherein maneuvering in a first DOF of the at least two DOF is performed by a step of rotating the first transmission means, thereby transmitting rotation to the endoscope; wherein maneuvering in a second DOF of at least two DOF is performed by a step of rotating the third transmission means, thereby transmitting rotation to the endoscope.

It is another object of the invention to disclose the method as described above, further comprising a step of defining an angle A between said second axis of rotation and said fifth axis of rotation, said angle A is in the range of about 0 degrees to about 180 degrees.

It is another object of the invention to disclose the method, further comprising steps of a. providing at least one rotating means comprising

i. at least one pivoting support adapted to be pivotally attached to the endoscope; the pivoting support is adapted to enable the endoscope to pivot around the pivoting support;

ii. at least one third mechanism for rotating the pivoting support independently around two orthogonal axes, comprising at least one first joint coupled to the pivoting support; and at least one second joint in communication with the first joint and coupled to a mechanism selected from a group consisting of: the first mechanism, the second mechanism and any combination thereof; each of the joints is adapted to provide rotation to the pivoting support in at least one of the orthogonal axes; wherein the second joint is located at a predetermined distance from the first joint the third mechanism is mechanically connected to the pivoting support, thereby enabling the endoscope to rotate around an insertion point into the body of a subject;

b. communicating the rotating means with the first mechanism and the second mechanism; the endoscope pivotally attached to the rotating means can pivot at the insertion point independent of the distances between the pivoting support, the rotating means, and the insertion point;

It is another object of the invention to disclose the method as defined above, further comprising a step of providing the system with at least two configurations: an automatic configuration, in which the system is motorized; and a manual configuration in which the system is maneuvered manually by the endoscope user via a manual control mechanism, preferably a joystick, and wherein said system can be additionally provided with a third configuration, a wholly manual configuration, in which a human endoscope assistant maneuvers the endoscope.

It is another object of the invention to disclose the method, further comprising steps of

providing at least one rotating means comprising at least one third mechanism for rotating the endoscope independently around two orthogonal axes, the third mechanism comprising at least one first joint coupled to the endoscope support; and at least one second joint in communication with the first joint and coupled to a mechanism selected from a group consisting of: the first mechanism, the second mechanism and any combination thereof; each of the joints is adapted to provide rotation to the endoscope in at least one of the orthogonal axes; wherein the second joint is located at a predetermined distance from the first joint and the third mechanism is mechanically connected to the endoscope, thereby enabling the endoscope to rotate around an insertion point into a body of a subject;

communicating the rotating means with the first mechanism and the second mechanism; the endoscope pivotally attached to the rotating means can pivot at the insertion point independent of the distances between the endoscope, the rotating means, and the insertion point;

It is another object of the invention to disclose the method as defined above, further comprising steps of a. providing at least one zoom mechanism; and b. maneuvering the endoscope along the main longitudinal axis of the same.

It is another object of the invention to disclose the method as defined above, further comprising a step of providing the zoom mechanism with:

a. at least one first coupling means clasped to the endoscope;

at least one first connecting means reversibly coupled to the endoscope at a first coupling position;

at least one second connecting means reversibly coupled to the first coupling means at a second coupling position;

wherein the coupling between the first connecting means, the second connecting means and the endoscope enables the first and the second connecting means (i) to pivot around the main longitudinal axis of the endoscope; and (ii) to move along the longitudinal axis of the same.

It is another object of the invention to disclose the method as defined above, further comprising a step of clasping the first coupling means to the endoscope, thereby enabling a reversible reciprocating movement of the endoscope along the main longitudinal axis of the endoscope. It is another object of the invention to disclose the method as defined above, further comprising a step of connecting the first connecting means and the second connecting means to one another via joints. It is another object of the invention to disclose the method as defined above, further comprising a step of providing the zoom mechanism with m coupling means adapted to couple the first connecting means to the second connecting means; where m is an integer greater than or equal to one.

It is another object of the invention to disclose the method as defined above, further comprising a step of rotatably coupling the m coupling means to each other.

It is another object of the invention to disclose the method as defined above, further comprising a step of selecting the m coupling means from a group consisting of: joints, rods, other zoom mechanisms and any combination thereof.

It is another object of the invention to disclose the method as defined above, further comprising a step of selecting means for coupling the first connecting means or the second connecting means to the endoscope from a group consisting of mechanical means, magnetic means and any combination thereof.

It is another object of the invention to disclose the method as defined above, further comprising a step of selecting the mechanical means from a group consisting of a clip, a fastening element, tape, adhesive tape, a snap fastener, a button and any combination thereof.

It is another object of the invention to disclose the method as defined above, further comprising a step of providing, as the magnetic means, at least one magnet selected from a group consisting of a ferromagnet and a paramagnet; where the magnetic means is attached to at least one member of a group consisting of: a hospital bed, the system, and any combination thereof.

It is another object of the invention to disclose the method as defined above, further comprising a step of operating the zoom mechanism by at least one motor.

It is another object of the invention to disclose the method as defined above, further comprising a step of selecting the pivoting support to be a gimbal.

It is another object of the invention to disclose the method as defined above, further comprising a step of providing the third mechanism with a plurality of q joints, at least one of which is coupled to the pivoting support, and at least one of which is coupled to the second mechanism; where q is an integer greater than or equal to one.

It is another object of the invention to disclose the method as defined above, further comprising a step of providing the fourth mechanism with a plurality of q joints, at least one of which is coupled to the endoscope, and at least one of which is coupled to the second mechanism; where q is an integer greater than or equal to one.

It is another object of the invention to disclose the method as defined above, further comprising a step of selecting the first transmission means, the second transmission means, the third transmission means, the fourth transmission means, and the fifth transmission means from a group consisting of gearwheels, wheels, crown gears, bevel gears, spur gears, belts, and any combinations thereof.

It is another object of the invention to disclose the method as defined above, further comprising a step of providing the system with attaching means adapted to reversibly couple the system to a hospital bed.

It is another object of the invention to disclose the method as defined above, further comprising a step of selecting the attaching means from a group consisting of mechanical means, magnetic means and any combination thereof.

It is another object of the invention to disclose the method as defined above, further comprising a step of providing the magnetic means with at least one magnet and at least one ferromagnet or at least one paramagnet; where the magnetic device is attached to any member of a group consisting of: a hospital bed, the system, and any combination thereof, and the ferromagnet or the paramagnet is attached to any member of a group consisting of: a hospital bed, the system, and any combination thereof.

It is another object of the invention to disclose the method as defined above, further comprising a step of defining an angle Θ angle for the rotation in the second plane.

It is another object of the invention to disclose the method as defined above, further comprising a step of defining angle Θ to vary between about 0 and about 360 degrees, preferably between about 0 and about 160 degrees, when the system is in either the automatic configuration or in the manual configuration. It is another object of the invention to disclose the method, further comprising step of defining an angle ψ for the rotation in the fifth plane.

It is another object of the invention to disclose the method as defined above, further comprising a step of defining angle ψ to vary between about 0 and about 360 degrees, preferably between about 0 and about 140 degrees, when the system is in either the automatic configuration or in the manual configuration.

It is another object of the invention to disclose the method, further comprising a step of additionally providing the system with a quick release handle adapted to disassemble the endoscope from the system when the system is in either the automatic configuration or in the manual configuration.

It is another object of the invention to disclose the method as defined above, further comprising a step of providing the first mechanism with locking means adapted to maintain at least one selected from a group consisting of: the first transmission means, the second transmission means and any combination thereof in a predetermined orientation upon power failure; and to prevent any rotational movement of the same during power failures.

It is another object of the invention to disclose the method as defined above, further comprising a step of providing the second mechanism additionally with locking means adapted to maintain at least one selected from a group consisting of: the third transmission means, the fourth transmission means, the fifth transmission means, and any combination thereof in a predetermined orientation upon power failure and to prevent any rotational movement of the same during power failures.

It is another object of the invention to disclose the method as defined above, further comprising a step of providing at least one manual override system (MOS), adapted upon activation of the same to switch reversibly between an automatic configuration and a manual configuration operating via a manual control mechanism, preferably a joystick, and further adapted to enable switching reversibly to a third configuration, a wholly manual configuration, in which a human endoscope assistant maneuvers the endoscope.

It is another object of the invention to disclose the method as defined above, further comprising a step of providing at least one joystick coupled to the endoscope. It is another object of the invention to disclose the method as defined above, further comprising a step of providing activation means adapted to activate the joystick.

It is another object of the invention to disclose the method as defined above, further comprising a step of wearing the MOS is by the MOS operator.

It is another object of the invention to disclose the method as defined above, further comprising a step of providing at least one joystick, and wearing the joystick by the joystick user.

It is another object of the invention to disclose the method as defined above, further comprising a step of wearing the activation means by the activation means user.

It is another object of the invention to disclose the method, further comprising a step of selecting the activation means from a group consisting of a pressable button, a rotatable knob, a knob, and any combination thereof.

It is another object of the invention to disclose the method as defined above, further comprising a step of enabling the MOS to rotate in angle ψ and angle Θ.

It is another object of the invention to disclose the method as defined above, wherein amovement of the joystick is selected from a group consisting of controlling angle ψ, controlling angle Θ and any combination thereof, movement of the endoscope is proportional to movement of the joystick, and both movements are in the same direction.

It is another object of the invention to disclose the method as defined above, further comprising a step of providing the MOS with means for controlling the endoscope's motion, adapted to restrain velocity in the angular directions Θ and ψ.

It is another object of the invention to disclose the method as defined above, further comprising a step of providing the MOS with n sensors, where n is an integer greater than or equal to one. It is another object of the invention to disclose the method as defined above, further comprising a step of selecting the sensors from of a group consisting of: motion sensors, heat sensors, electric sensors, sound sensors, pressure sensors, optical sensors and any combination thereof. It is another object of the invention to disclose the method as defined above, further comprising a step of activating the n sensors in case of power failure.

It is another object of the invention to disclose the method as defined above, further comprising a step of activating the n sensors when the system is connected to power. It is another object of the invention to disclose the method as defined above, further comprising a step of detecting the motion of the joystick with motion sensors.

It is another object of the invention to disclose the method as defined above, further comprising a step of using the motion detection of the joystick for deactivation of the motion of the endoscope if the motion's speed is above a predetermined threshold.

It is another object of the invention to disclose the method as defined above, further comprising a step of characterizing the joystick by an external surface.

It is another object of the invention to disclose the method as defined above, further comprising a step of operating the motion sensors to detect motion upon the external surface.

It is another object of the invention to disclose the method as defined above, further comprising a step of operating the endoscope according to the motion upon the external surface.

It is another object of the invention to disclose the method as defined above, further comprising a step of deactivation of the motion of the endoscope when detection of the motion's speed along the joystick is above a predetermined threshold.

It is another object of the invention to disclose the method as defined above, further comprising a step of adapting the heat sensors to sense temperatures in the range of about 35 to about 42 degrees.

It is another object of the invention to disclose the method as defined above, further comprising a step of enabling the activation of the MOS when the heat sensors sense temperature is in the range of about 35 to about 42 degrees.

It is another object of the invention to disclose the method as defined above, further comprising a step of adapting the heat sensors to provide a thermal image, where the heat sensors are coupled to a processing unit, adapted to provide the endoscope user with the thermal image. It is another object of the invention to disclose the method as defined above, further comprising a step of enabling the activation of the MOS by the processing units upon analysis of the image and detection of human hand.

It is another object of the invention to disclose the method as defined above, further comprising a step of adapting the electric sensors sense power failure.

It is another object of the invention to disclose the method as defined above, further comprising a step of adapting the electric sensors to sense the electrical conductivity of the human body. It is another object of the invention to disclose the method as defined above, further comprising a step of enabling the activation of the MOS upon sensing the human body conductivity by the electric sensors.

It is another object of the invention to disclose the method as defined above, further comprising a step of adapting the sound sensors to sense predetermined sound patterns.

It is another object of the invention to disclose the method as defined above, further comprising a step of enabling activation of the MOS upon sensing of the predetermined sound patterns by the sound sensors.

It is another object of the invention to disclose the method as defined above, further comprising a step of operating the endoscope according to the predetermined sound patterns sensed by the sound sensors.

It is another object of the invention to disclose the method as defined above, further comprising a step of adapting the pressure sensors to sense pressure applied to the MOS.

It is another object of the invention to disclose the method as defined above, further comprising a step of activating the MOS when the pressure sensed by the pressure sensors is above a predetermined threshold.

It is another object of the invention to disclose the method as defined above, further comprising a step of de-activating the MOS when the pressure sensed by the pressure sensors is below a predetermined threshold.

It is another object of the invention to disclose the method as defined above, further comprising a step of de-activating the MOS when the pressure sensed by the pressure sensors is above a predetermined threshold.

It is another object of the invention to disclose the method as defined above, further comprising a step of adapting the optical sensors to sense visual changes according to predetermined visual patterns.

It is another object of the invention to disclose the method as defined above, further comprising a step of enabling the activation of the MOS according to detection of the predetermined visual patterns. It is another object of the invention to disclose the method as defined above, further comprising a step of operating the endoscope according to the predetermined visual patterns which are detected.

It is another object of the invention to disclose the method as defined above, further comprising a step of adapting the endoscope to acquire real-time images of a surgical environment within the human body.

b. performing real-time image processing of said surgical environment;

It is another object of the invention is to disclose the method as defined above, wherein each of said instructing functions gi(t) is provided with ai(t) where i is an integer greater than or equal to 1 ; where ori(t) are weighting functions of each gi(t), and a n is total number of instruction functions. It is another object of the invention is to disclose the method as defined above, wherein said weighting functions ai(t) are time-varying functions, wherein the value of which is determined by said operators.

It is another object of the invention is to disclose the method as defined above, wherein said preferred volume zone function comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions provide said preferred volume zone; said preferred volume zone function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said preferred volume zone.

It is another object of the invention is to disclose the method as defined above, wherein said preferred tool function comprises a communicable database, said database stores a preferred tool; said preferred tool function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to constantly direct said endoscope to said preferred tool, such that said endoscope constantly tracks said preferred tool.

It is another object of the invention is to disclose the method as defined above, wherein said means are adapted to apply a continuing tag to said at least one of surgical tool within said surgical environment. It is another object of the invention is to disclose the method as defined above, wherein means are adapted to re-tag said at least one of said surgical tools until a desired tool is selected.

It is another object of the invention is to disclose the method as defined above, wherein said image processing algorithm is adapted to analyze 2D or 3D representations rendered from said real-time images of said surgical environment. It is another object of the invention is to disclose the method as defined above, wherein said data processor is further adapted to operate a pattern recognition algorithm for assisting the operation of said instructing functions gi(t).

It is another object of the invention is to disclose the method as defined above, additionally comprising a step of re-tagging said at least one of said surgical tools until a desired tool is selected.

It is another object of the invention is to disclose the method as defined above, additionally comprising a step of toggling between said surgical tools.

b. at least one array comprising M cameras, where M is a positive integer;

c. none or more optical markers and means for attaching said optical marker to said at least one surgical tool; and, a computerized algorithm operable via said controller, the computerized algorithm adapted to record images received by each of the M cameras and to calculate therefrom the position of each of the tools, and further adapted to provide automatically the results of the calculation to the human operator of the interface.

It is another object of the invention is to disclose the method as defined above, additionally comprising a step of providing a surgical controlling system (SCS) for assisting an operator to perform laparoscopic surgery on a human body; the SCS comprising steps of: a. providing a surgical controlling system, comprising: (i) at least one surgical tool; (ii) at least one location estimating means; (iii) at least one movement detection means; and (iv) a controller having a processing means communicable with said controller's database; b. inserting said at least one surgical tool into a surgical environment of a human body; c. estimating in real-time the location of said at least one surgical tool within said surgical environment at any given time t; and, d. detecting that there is movement of said at least one surgical tool when the 3D spatial position of said at least one surgical tool at time tf is different from said 3D spatial position of said at least one surgical tool at time to', e. controlling the spatial position of said at least one surgical tool within said surgical environment by means of said controller; wherein said step of controlling is performed by storing a predetermined set of rules in a controller's database; said predetermined set of rules comprises ALLOWED and RESTRICTED movements of said at least one surgical tool, such that each detected movement by said movement detection means of said at least one surgical tool is determined as either an ALLOWED movement or as a RESTRICTED movement according to said predetermined set of rules.

It is another object of the invention is to disclose the method as defined above, wherein said right tool rule is adapted to determine said ALLOWED movement of said endoscope according to the movement of the surgical tool positioned to right of said endoscope; further wherein said left tool rule is adapted to determine said ALLOWED movement of said endoscope according to the movement of the surgical tool positioned to left of said endoscope.

It is another object of the invention is to disclose the method as defined above, wherein said field of view rule comprises n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said n 3D spatial positions provides a predetermined field of view; said field of view rule is adapted to determine said ALLOWED movement of said endoscope within said n 3D spatial positions so as to maintain a constant field of view, such that said ALLOWED movements are movements in which said endoscope is located substantially in at least one of said n 3D spatial positions, and said RESTRICTED movements are movements in which the location of said endoscope is substantially different from said n 3D spatial positions.

It is another object of the invention is to disclose the method as defined above, wherein said no fly zone rule comprises n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions define a predetermined volume within said surgical environment; said no fly zone rule is adapted to determine said RESTRICTED movement if said movement is within said no fly zone and said ALLOWED movement if said movement is outside said no fly zone, such that said RESTRICTED movements are movements in which said at least one surgical tool is located substantially in at least one of said n 3D spatial positions, and said ALLOWED movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions. It is another object of the invention is to disclose the method as defined above, wherein said route rule comprises a communicable database storing predefined route in which said at least one surgical tool is adapted to move within said surgical environment; said predefined route comprises n 3D spatial positions of said at least one surgical tool; n is an integer greater than or equal to 2; said ALLOWED movements are movements in which said at least one surgical tool is located substantially in at least one of said n 3D spatial positions of said predefined route, and said RESTRICTED movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions of said predefined route.

It is another object of the invention is to disclose the method as defined above, wherein said preferred tool rule comprises a communicable database, said database stores a preferred tool; said preferred tool rule is adapted to determine said ALLOWED movement of said endoscope to constantly track the movement of said preferred tool.

It is another object of the invention is to disclose the method as defined above, wherein said movement detection rule comprises a communicable database comprising the real-time 3D spatial positions of each of said surgical tools; and said movement detection rule detects movement of said at least one surgical tool when a change in said 3D spatial position is received, such that said ALLOWED movements are movements in which said endoscope is directed to focus on the moving surgical tool.

It is another object of the invention is to disclose the method as defined above, wherein said input comprises n 3D spatial positions; n is an integer greater than or equal to 2; wherein at least one of which is defined as ALLOWED location and at least one of which is defined as RESTRICTED location, such that said ALLOWED movements are movements in which said at least one surgical tool is located substantially in at least one of said n 3D spatial positions, and said RESTRICTED movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions. It is another object of the invention is to disclose the method as defined above, wherein said input comprises at least one predetermined rule according to which ALLOWED and RESTRICTED movements of said at least one surgical tool are determined, such that the spatial position of said at least one surgical tool is controlled by said controller according to said ALLOWED and RESTRICTED movements.

It is another object of the invention is to disclose the method as defined above, wherein said predetermined rule is selected from a group consisting of: most used tool, right tool rule, left tool rule, field of view rule, no fly zone rule, route rule, proximity rule; collision prevention rule, preferred volume zone rule, preferred tool rule, movement detection rule, operator input rule, environment rule, history-based rule, tool-dependent ALLOWED and RESTRICTED movements rule, tagged tool rule and any combination thereof.

It is another object of the invention is to disclose the method as defined above, wherein said environment rule comprises a communicable database; said communicable database is adapted to received at least one real-time image of said surgical environment and is adapted to perform realtime image processing of the same and to determine the 3D spatial position of hazards or obstacles in said surgical environment; said environmental rule is adapted to determine said ALLOWED and RESTRICTED movements according to said hazards or obstacles in said surgical environment, such that said RESTRICTED movements are movements in which said at least one surgical tool is located substantially in at least one of said 3D spatial positions of said hazards or obstacles, and said ALLOWED movements are movements in which the location of said at least one surgical tool is substantially different from said 3D spatial positions of said hazards or obstacles.

It is another object of the invention is to disclose the method as defined above, wherein said tool- dependent allowed and RESTRICTED movements rule comprises a communicable database; said communicable database is adapted to store predetermined characteristics of at least one of said surgical tools; said tool-dependent allowed and RESTRICTED movements rule is adapted to determine said ALLOWED and RESTRICTED movements according to said predetermined characteristics of said surgical tool.

It is another object of the invention is to disclose the method as defined above, wherein said predetermined characteristics of said surgical tool are selected from a group consisting of: physical dimensions, structure, weight, sharpness, and any combination thereof.

It is another object of the invention is to disclose the method as defined above, wherein said step of alerting is performed by at least one selected from a group consisting of an audio signal, a voice signal, a light signal, a flashing signal and any combination thereof.

It is another object of the invention is to disclose the method as defined above, wherein said ALLOWED movement is permitted by said controller and said RESTRICTED movement is denied by said controller.

It is another object of the invention is to disclose the method as defined above, wherein said at least one location estimating means comprises (a) at least one element selected from a group consisting of optical imaging means, radio frequency transmitting and receiving means, at least one mark on said at least one surgical tool and any combination thereof; and (b) at least one surgical instrument spatial location software adapted to estimate said 3D spatial position of said at least one surgical tool by means of said element. It is another object of the invention is to disclose the method as defined above, wherein said at least one location estimating means is an interface subsystem between a surgeon and said at least one surgical tool, the interface subsystem comprising:

b. at least one array comprising M cameras, where M is a positive integer;

c. none or more optical markers and means for attaching said optical marker to said at least one surgical tool; and,

d. a computerized algorithm operable via the controller, said computerized algorithm adapted to record images received by each of the M cameras and to calculate therefrom the position of each of the tools, and further adapted to provide automatically the results of the calculation to the human operator of the interface.

The present invention also discloses a surgical tracking system which is adapted to guide and relocate an endoscope to a predetermined region of interest in an automatic and/or a semiautomatic manner. This operation is assisted by an image processing algorithm(s) which is adapted to analyze the received data from the endoscope in real time, and to assess the surgical environment of the endoscope.

According to an embodiment, the system comprises a "smart" tracking subsystem, which receives instructions from a maneuvering function f(t) (t is the time) as to where to direct the endoscope and which instructs the maneuvering subsystem to relocate the endoscope to the required area.

The maneuvering function f(t) receives, as input, output from at least two instructing functions g,(t), analyses their output and provides instruction to the "smart" tracking system (which eventually re-directs the endoscope). According to some embodiments, each instructing function g,(t) is also given a weighting function, a,(t).

The instructing functions g,(t) of the present invention are functions which are configured to assess the environment of the endoscope and the surgery, and to output data which guides the tracking subsystem for controlling the spatial position of the maneuvering subsystem and the endoscope. The instructing functions g,(t) may be selected from a group consisting of:

a. a tool detection function gi(t);

b. a movement detection function g₂(t);

c. an organ detection function g^(t);

d. a collision detection function g^t);

e. an operator input function g₅(t);

f. a prediction function gg(t); g- a past statistical analysis function gz(t);

h. a most used tool function gg(t);

i. a right tool function gi>(t); j- a left tool function gio(t);

k. a field of view function gii(t);

1. a preferred volume zone function gn -)',

m. a no fly zone function g ^(t);

n. a proximity function g^O ;

o. a tagged tool function g ₅(t);

P- a preferred tool function gig(t).

Thus, for example, the maneuvering function f(t) receives input from two instructing functions: the collision detection function g*(t) (the function providing information whether the distance between two elements is smaller than a predetermined distance) and from the most used tool function gg(t) (the function counts the number of times each tool is moved during a surgical procedure and provides information as to whether the most moved or most used tool is currently moving). The output given from the collision detection function g^(t) is that a surgical tool is dangerously close to an organ in the surgical environment. The output given from the most used tool function gg(t) is that the tool identified statistically as the most moved tool is currently moving.

The maneuvering function f(t) then assigns each of the instructing functions with weighting functions a,(t). For example, the most used tool function gg(t) is assigned with a greater weight than the weight assigned to the collision detection function g^t).

After the maneuvering function f(t) analyses the information received from the instructing functions g,(t) and the weighting functions a,(t) of each, the same outputs instructions to the maneuvering subsystem to re-direct the endoscope (either to focus on the moving tool or on the tool approaching dangerously close to the organ).

It should be emphasized that all of the above (and the following disclosure) is enabled by constantly monitoring and locating/identifying the 3D spatial location of each element/tool in the surgical environment.

The identification is provided by conventional means known to any skilled in the art (e.g., image processing, optical means etc.).

According to some embodiments, the surgical tracking subsystem comprises:

a. at least one endoscope adapted to acquire real-time images of a surgical environment within the human body;

b. a maneuvering subsystem adapted to control the spatial position of the endoscope during the laparoscopic surgery; and,

c. a tracking subsystem in communication with the maneuvering subsystem, adapted to control the maneuvering subsystem so as to direct and modify the spatial position of the endoscope to a region of interest.

According to this embodiment, the tracking subsystem comprises a data processor. The data processor is adapted to perform real-time image processing of the surgical environment and to instruct the maneuvering subsystem to modify the spatial position of the endoscope according to input received from a maneuvering function f(t); the maneuvering function f(t) is adapted to (a) receive input from at least two instructing functions g,(t), where / is Ι,. , . ,η and n > 2 and where t is time; i and n are integers; and (b) to output instructions to the maneuvering subsystem based on the input from the at least two instructing functions g,(t), so as to spatially position the endoscope to the region of interest.

According to one embodiment, the tool detection function gi(t) is adapted to detect tools in the surgical environment. According to this embodiment, the tool detection function is adapted to detect surgical tools in the surgical environment and to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the detected surgical tools.

According to some embodiments, the functions g,(t) may rank the different detected areas in the surgical environment according to a ranking scale (e.g., from 1 to 10) in which prohibited areas (i.e., areas which are defined as area to which the surgical tools are forbidden to 'enter) receive the lowest score (e.g., 1) and preferred areas (i.e., areas which are defined as area in which the surgical tools should be maintained) receive the highest score (e.g., 10).

According to a preferred embodiment, one function gi(t) is adapted to detect tools in the surgical environment and inform the maneuvering function f(t) if they are in preferred areas or in prohibited areas.

According to some embodiments, the movement detection function g2(t) comprises a communicable database comprising the real-time 3D spatial positions of each of the surgical tools in the surgical environment; means to detect movement of the at least one surgical tool when a change in the 3D spatial positions is received, and means to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the moved surgical tool.

According to some embodiments, the organ detection function g^(t) is adapted to detect physiological organs in the surgical environment and to classify the detected organs as prohibited areas or preferred areas. For example, if the operator instructs the system that the specific surgery is kidney surgery, the organ detection function g^(t) will classify the kidneys (or one kidney, if the surgery is specified to be on a single kidney) as a preferred area and other organs will be classified as prohibited areas. According to another embodiment, the organ detection function is adapted to detect organs in the surgical environment and to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the detected organs. According to some embodiments, the right tool function is adapted to detect surgical tool positioned to right of the endoscope and to output instructions to the tracking subsystem to instruct the maneuvering system to constantly direct the endoscope on the right tool and to track the right tool.

According to another embodiment, the left tool function is adapted to detect surgical tool positioned to left of the endoscope and to output instructions to the tracking subsystem to instruct the maneuvering system to constantly direct the endoscope on the left tool and to track the left tool.

According to some embodiments, the collision detection function g^(t) is adapted to detect prohibited areas within the surgical environment so as to prevent collisions between the endoscope and the prohibited areas. For example, if the endoscope is located in a narrow area in which a precise movement of the same is preferred, the collision detection function g^(t) will detect and classify different areas (e.g., nerves, veins, walls of organs) as prohibited areas. Thus, according to this embodiment, the collision prevention function is adapted to define a predetermined distance between the at least one surgical tool and an anatomical element within the surgical environment; and to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the surgical tool and the anatomical element within the surgical environment if the distance between the at least one surgical tool and an anatomical element is less than the predetermined distance. According to one embodiment of the present invention the anatomical element is selected from a group consisting of tissue, organ, another surgical tool and any combination thereof.

According to some embodiments, the operator input function g5(t) is adapted to receive an input from the operator. The input can be, for example: an input regarding prohibited areas in the surgical environment, an input regarding allowed areas in the surgical environment, or an input regarding the region of interest and any combination thereof. The operator input function g5(t) can receive instructions from the operator before or during the surgery, and respond accordingly. According to some embodiments, the operator input function may further comprise a selection algorithm for selection of areas selected from a group consisting of: prohibited areas, allowed areas, regions of interest, and any combination thereof. The selection may be performed via an input device (e.g., a touch screen).

According to some embodiments, the operator input function gs(t) comprises a communicable database; the communicable database is adapted to receive an input from the operator of the system; the input comprising n 3D spatial positions; n is an integer greater than or equal to 2; and to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the at least one 3D spatial position received.

According to some embodiments, the prediction function gg(t) is adapted to provide data regarding a surgical environment at a time tf > to, wherein to is the present time and tf is a future time. The prediction function gg(t) may communicate with a database which stores data regarding the environment of the surgery (e.g., the organs in the environment). This data may be used by the prediction function gg(t) for the prediction of expected or unexpected events or expected or unexpected objects during the operation. Thus, according to this embodiment, the prediction function gg(t) comprises a communicable database storing each 3D spatial position of each of surgical tool within the surgical environment, such that each movement of each surgical tool is stored; the prediction function is adapted to (a) to predict the future 3D spatial position of each of the surgical tools (or each object); and, (b) to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the future 3D spatial position.

According to some embodiments, the past statistical analysis function gz(t) is adapted to provide data regarding the surgical environment or the laparoscopic surgery based on past statistical data stored in a database. The data regarding the surgical environment may be for example: data regarding prohibited areas, data regarding allowed areas, data regarding the region of interest and any combination thereof. Thus, according to this embodiment, the past statistical analysis function gg(t) comprises a communicable database storing each 3D spatial position of each of surgical tool within the surgical environment, such that each movement of each surgical tool is stored; the past statistical analysis function gg(t) is adapted to (a) perform statistical analysis on the 3D spatial positions of each of the surgical tools in the past; and, (b) to predict the future 3D spatial position of each of the surgical tools; and, (c) to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the future 3D spatial position. Thus, according to the past statistical analysis function gz(t), the past movements of each tool are analyzed and, according to this analysis, a prediction of the tool's next move is provided.

According to another embodiment, the most used tool function gg(t) comprises a communicable database counting the amount of movement of each surgical tool located within the surgical environment; the most used tool function is adapted to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to constantly position the endoscope to track the movement of the most moved surgical tool. The amount of movement of a tool can be defined as the total number of movements of that tool or the total distance the tool has moved.

According to some embodiments, the right tool function gi>(t) is adapted to detect at least one surgical tool in a specified position in relation to the endoscope, preferably positioned to right of the endoscope and to output instructions to the tracking subsystem to instruct the maneuvering subsystem to constantly direct the endoscope to the right tool and to track the same. According to preferred embodiments, the right tool is defined as the tool positioned to the right of the endoscope; according to other embodiments, any tool can be defined as the right tool.

According to another embodiment, the left tool function gio(t) is adapted to detect at least one surgical tool in a specified position in relation to the endoscope, preferably positioned to left of the endoscope and to output instructions to the tracking subsystem to instruct the maneuvering subsystem to constantly direct the endoscope to the left tool and to track the same. According to preferred embodiments, the left tool is defined as the tool positioned to the left of the endoscope; according to other embodiments, any tool can be defined as the left tool. .

According to another embodiment, the field of view function gn(t) comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of the n 3D spatial positions provides a predetermined field of view; the field of view function is adapted to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to at least one 3D spatial position substantially within the n 3D spatial positions so as to maintain a constant field of view.

According to another embodiment, the preferred volume zone function gnit) comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; the n 3D spatial positions provide the preferred volume zone; the preferred volume zone function gn -) is adapted to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to at least one 3D spatial position substantially within the preferred volume zone.

According to another embodiment, the no fly zone function g ^(t) comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; the n 3D spatial positions define a predetermined volume within the surgical environment; the no fly zone function g ^(t) is adapted to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to at least one 3D spatial position substantially different from all the n 3D spatial positions.

According to some embodiments, the proximity function g^t) is adapted to define a predetermined distance between at least two surgical tools; and to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the two surgical tools if the distance between the two surgical tools is less than or if it is greater than the predetermined distance.

According to another embodiment, the proximity function g it) is adapted to define a predetermined angle between at least three surgical tools; and to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the three surgical tools if the angle between the two surgical tools is less than or if it is greater than the predetermined angle.

According to another embodiment, the preferred volume zone function comprises communicable database comprising n 3D spatial positions; n is an integer greater than or equals to 2; the n 3D spatial positions provides the preferred volume zone; the preferred volume zone function is adapted to output instructions to the tracking subsystem to instruct the maneuvering system to direct the endoscope to the preferred volume zone.

According to another embodiment, the field of view function comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equals to 2; the combination of all of the n 3D spatial positions provides a predetermined field of view; the field of view function is adapted to output instructions to the tracking subsystem to instruct the maneuvering system to direct the endoscope to at least one 3D spatial position substantially within the n 3D spatial positions so as to maintain a constant field of view.

According to another embodiment, the no fly zone function comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equals to 2; the n 3D spatial positions define a predetermined volume within the surgical environment; the no fly zone function is adapted to output instructions to the tracking subsystem to instruct the maneuvering system to direct the endoscope to at least one 3D spatial position substantially different from all the n 3D spatial positions.

According to another embodiment, the most used tool function comprises a communicable database counting the amount of movement of each surgical tool located within the surgical environment; the most used tool function is adapted to output instructions to the tracking subsystem to instruct the maneuvering system to direct the endoscope to constantly position the endoscope to track the movement of the most moved surgical tool.

According to some embodiments, the prediction function gg(t) is adapted to provide data regarding a surgical environment in a time tf > t, wherein t is the present time and tf is the future time. The prediction function gg(t) may communicate with a database which stores data regarding the environment of the surgery (e.g., the organs in the environment). This data may be used by the prediction function gg(t) for the prediction of expected or unexpected events or object during the operation. Thus, according to this embodiment, the prediction function comprises a communicable database storing each 3D spatial position of each of surgical tool within the surgical environment, such that each movement of each surgical tool is stored; the prediction function is adapted to (a) to predict the future 3D spatial position of each of the surgical tools; and, (b) to output instructions to the tracking subsystem to instruct the maneuvering system to direct the endoscope to the future 3D spatial position.

According to some embodiments, the past statistical analysis function g₇(t) is adapted to provide data regarding the surgical environment or the laparoscopic surgery based on past statistical data stored in a database. The data regarding the surgical environment may be for example: data regarding prohibited areas, data regarding allowed areas, data regarding the region of interest. Thus, according to this embodiment, the past statistical analysis function comprises a communicable database storing each 3D spatial position of each of surgical tool within the surgical environment, such that each movement of each surgical tool is stored; the past statistical analysis function is adapted to (a) statistical analyze the 3D spatial positions of each of the surgical tools in the past; and, (b) to predict the future 3D spatial position of each of the surgical tools; and, (c) to output instructions to the tracking subsystem to instruct the maneuvering system to direct the endoscope to the future 3D spatial position. Thus, according to the past statistical analysis function gz(t), the past movements of each tool are analyzed and according to this analysis a future prediction of the tool's next move is provided.

According to some embodiments, preferred tool function comprises a communicable database, the database stores a preferred tool; the preferred tool function is adapted to output instructions to the tracking subsystem to instruct the maneuvering system to constantly direct the endoscope to the preferred tool, such that said endoscope constantly tracks said preferred tool.

Thus, according to the preferred tool function the endoscope constantly tracks the preferred tool, such that the field of view, as seen from the endoscope, is constantly maintained on said preferred tool. It should be noted that the user may define in said preferred tool function to constantly tack the tip of said preferred tool or alternatively, the user may define in said preferred tool function to constantly track the body or any location on the preferred tool.

According to some embodiments, the tagged tool function gisit) comprises means adapted to tag at least one surgical tool within the surgical environment and to output instructions to the tracking subsystem to instruct the maneuvering subsystem to constantly direct the endoscope to the tagged surgical tool. Thus, according to the tagged tool function the endoscope constantly tracks the preferred (i.e., tagged) tool, such that the field of view, as seen from the endoscope, is constantly maintained on said preferred (tagged) tool. It should be noted that the user may define in said tagged tool function to constantly tack the tip of said preferred (tagged) tool or alternatively, the user may define in said tagged tool function to constantly track the body or any location on the preferred (tagged) tool.

According to some embodiments, the means are adapted to constantly tag the at least one of surgical tool within the surgical environment.

According to some embodiments, the preferred tool function g g(t) comprises a communicable database. The database stores a preferred tool; and the preferred tool function is adapted to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the preferred tool.

According to some embodiments, the system further comprises means adapted to re-tag the at least one of the surgical tools until a desired tool is selected.

According to some embodiments, the system further comprises means adapted to toggle the surgical tools. According to some embodiments, the toggling is performed manually or automatically.

According to different embodiments of the present invention, the weighting functions a,(t) are time-varying functions (or constants), the value of which is determined by the operator or the output of the instructing functions g,(t). For example, if a specific function g,(t) detected an important event or object, its weighting functions a,(t) may be adjusted in order to elevate the chances that the maneuvering function f(t) will instruct the maneuvering subsystem to move the endoscope towards this important event or object.

According to different embodiments of the present invention, the tracking subsystem may implement various image processing algorithms which may also be algorithms that are well known in the art. The image processing algorithms may be for example: image stabilization algorithms, image improvement algorithms, image compilation algorithms, image enhancement algorithms, image detection algorithms, image classification algorithms, image correlations with the cardiac cycle or the respiratory cycle of the human body, smoke reduction algorithms, vapor reduction algorithms, steam reduction algorithms and any combination thereof. Smoke, vapor and steam reduction algorithms may be needed as it is known that, under certain conditions, smoke, vapor or steam may be emitted by or from the endoscope. The image processing algorithm may also be implemented and used to analyze 2D or 3D representations which may be rendered from the real-time images of the surgical environment.

According to different embodiments, the endoscope may comprise an image acquisition device selected from a group consisting of: a camera, a video camera, an electromagnetic sensor, a computer tomography imaging device, a fluoroscopic imaging device, an ultrasound imaging device, and any combination thereof.

According to some embodiments, the system may also comprise a display adapted to provide input or output to the operator regarding the operation of the system. The display may be used to output the acquired real-time images of a surgical environment with augmented reality elements. The display may also be used for the definition of the region of interest by the operator.

According to some embodiments, the endoscope may be controlled be an endoscope controller for performing operations such as: acquiring the real-time images and zooming-in to a predetermined area. For example, the endoscope controller may cause the endoscope to acquire the real-time images in correlation with the cardiac cycle or the respiratory cycle of a human body.

According to different embodiments, the data processor of the present invention may operate a pattern recognition algorithm for assisting the operation of the instructing functions g,(t). The pattern recognition algorithm may be used as part of the image processing algorithm.

The present invention further discloses a method for assisting an operator to perform a surgical procedure, comprising steps of: a. providing a surgical controlling system, comprising: (i) at least one surgical tool; (ii) at least one location estimating means; and (iii) a controller having a processing means communicable with a database; b. inserting the at least one surgical tool into a surgical environment of a human body; c. estimating the location of the at least one surgical tool within the surgical environment; and, d. controlling the spatial position of the at least one surgical tool within the surgical environment by means of the controller; wherein the step of controlling is performed by storing a predetermined set of rules in the database where the predetermined set of rules comprises ALLOWED and RESTRICTED movements of the at least one surgical tool, such that the spatial position of the at least one surgical tool is controlled by the controller according to the ALLOWED and RESTRICTED movements.

The present invention also discloses a method for assisting an operator to perform laparoscopic surgery on a human body. The method comprises steps of: a. providing a surgical tracking system, comprising: (i) at least one endoscope adapted to acquire real-time images of a surgical environment within the human body; (ii) a maneuvering subsystem in communication with the endoscope; and (iii) a tracking subsystem in communication with the maneuvering subsystem, the tracking subsystem comprising a data processor; b. performing real-time image processing of the surgical environment; c. controlling the maneuvering subsystem via the tracking subsystem, thereby directing and modifying the spatial position of the endoscope to a region of interest according to input received from a maneuvering function f(t); the maneuvering function f(t) is adapted to (a) receive input from at least two instructing functions g,(t), where / is Ι ,. , .,η and n > 2; where t is time; i and n are integers; and (b) to output instructions to the maneuvering subsystem based on the input from the at least two instructing functions g,(t), so as to spatially position the endoscope to the region of interest. It should be emphasized that all of the above (and the following disclosure) is enabled by constantly monitoring and locating/identifying the 3D spatial location of each element/tool in the surgical environment.

The present invention further discloses a surgical controlling system, comprising:

a. at least one endoscope adapted to provide real-time image of surgical environment of a human body;

b. at least one processing means, adapted to real time define n element within the realtime image of surgical environment of a human body; each of the elements is characterized by predetermined characteristics;

c. image processing means in communication with the endoscope, adapted to image process the real-time image and to provide real time updates of the predetermined characteristics;

d. a communicable database, in communication with the processing means and the image processing means, adapted to store the predetermined characteristics and the updated characteristics;

the system is adapted to notify the operator if the updated characteristics are substantially different from the predetermined characteristics.

Thus, according to this embodiment, each element in the surgical environment is characterized. The characteristics are constantly monitored. If the characteristics change substantially, the system notifies the user.

For example, the element that is monitored could be an organ and the characteristic being monitored is its contours. Once the contours have significantly changed (which could imply that the organ has been e.g., carved) the system alerts the user.

It should be emphasized that all of the above is enabled by constantly monitoring and locating/identifying the 3D spatial location of each element/tool in the surgical environment. The identification is provided by conventional means known to any skilled in the art (e.g., image processing, optical means etc.).

According to another embodiment, the predetermined characteristics are selected from a group consisting of: color of the element, 3D spatial location of the element, contours of the element, and any combination thereof.

According to another embodiment, the system additionally comprises at least one surgical tool adapted to be inserted into a surgical environment of a human body for assisting a surgical procedure.

According to another embodiment, the system additionally comprises at least one location estimating means adapted to estimate the location of the at least one surgical tool.

According to another embodiment, the system additionally comprises a controller having a processing means communicable with a database, the controller adapted to control the spatial position of the at least one surgical tool.

The present invention further provides a method for controlling surgery, comprising steps of: a. obtaining a system comprising:

i. at least one endoscope adapted to provide real-time image of a surgical environment in a human body;

ii. at least one processing means, adapted to define in real time n elements within the realtime image of the surgical environment of a human body, n is an integer greater than 0; each of the elements characterized by predetermined characteristics;

iii. image processing means in communication with the endoscope, adapted to process the real-time image and to provide real time updates of the predetermined characteristics; iv. a communicable database, in communication with the processing means and the image processing means, adapted to store the predetermined characteristics and the updated characteristics;

b. providing a real-time image of a surgical environment in a human body;

c. defining the n elements; d. characterizing each of the elements by the predetermined characteristics;

e. providing a real-time update of the predetermined characteristics;

f. notifying the user if the updated characteristics are substantially different from the predetermined characteristics.

According to another embodiment, the predetermined characteristics are selected from a group consisting of: color of the element, 3D spatial location of the element, contours of the element and any combination thereof.

According to another embodiment, the method additionally comprises a step of providing at least one surgical tool adapted to be inserted into a surgical environment of a human body for assisting a surgical procedure.

According to another embodiment, the method additionally comprises a step of providing at least one location estimating means adapted to estimate the location of the at least one surgical tool.

According to another embodiment, the method additionally comprises a step of providing a controller having a processing means communicable with a database, the controller adapted to control the spatial position of the at least one surgical tool.

According to another embodiment, the system of the present invention additionally comprises an image processing unit. According to another embodiment, the image processing unit is adapted to reduce 'noise' from the received image by reducing the visibility in the image of the smoke caused by e.g., coagulation. According to another embodiment, the image processing unit is adapted to reduce 'noise' from the received image by reducing the visibility in the image of vapor or steam accumulated on the endoscope.

According to another embodiment, the right tool function is adapted to instruct the maneuvering subsystem to constantly position the endoscope to track the movement of the right tool (i.e., the tool positioned to the right of the endoscope).

According to another embodiment, the left tool function is adapted to instruct the maneuvering subsystem to constantly position the endoscope to track the movement of the left tool (i.e., the tool positioned to the left of the endoscope). According to another embodiment, the field of view function is adapted to instruct the maneuvering subsystem to constantly position the endoscope so as to maintain a constant field of view.

According to another embodiment, the no fly zone function is adapted to define (either real-time, during the procedure or prior to the procedure) a no fly zone and to instruct the maneuvering subsystem to restrict entrance of the endoscope to the no fly zone.

According to another embodiment, the most used tool function is adapted to define (either realtime, during the procedure or prior to the procedure) which tool is the most used tool (i.e., the tool which is moved the most during the procedure) and to instruct the maneuvering subsystem to constantly position the endoscope to track the movement of the most-used tool.

The following figures provide examples of several of the above mentioned rules and functions.

Reference is made now to Fig. 1 , which is a general schematic view of a specific embodiment of a surgical tracking system 100. In this figure are illustrated surgical instruments 17b and 17c and an endoscope 21 which may be maneuvered by means of maneuvering subsystem 19 according to the instructions received from a tracking subsystem operable by computer 15.

According to one embodiment of the present invention as defined in the above, the user may define the field of view function as constantly monitoring at least one of surgical instruments 17b and 17c.

According to this embodiment, the surgical tracking system 100 may also comprise one or more button operated wireless transmitters 12a, which transmit, upon activation, a single code wave 14 through aerial 13 to connected receiver 11 that produces a signal processed by computer 15, thereby directing and modifying the spatial position of endoscope 21 to the region of interest, as defined by the field of view function.

Alternatively, according to the proximity rule, if the distance between the surgical instruments 17b and 17c is smaller than a predetermined distance (as defined by the collision prevention rule), the system alerts the user that any movement of either one of the surgical instruments 17b and 17c that will reduce the distance is a RESTRICTED movement. Reference is made now to Fig. 2, which schematically illustrates the operation of the present invention. According to this figure, the system of the present invention comprises a display 30 in which the overall procedure is presented to the operator. In this figure an endoscope is automatically spatially repositioned towards a region of interest 38.

The region of interest to which the endoscope is repositioned comprises tools 37b and 37c, which are automatically detected by the tracking subsystem (not shown) of computer 15. According to different embodiments, the repositioning of the endoscope may be automatic or semi-automatic. For example, according to Fig. 2, a light depression of the button on generic code-emitting wireless transmitter 12a causes transmission of a code that is received by receiver aerial 13 communicated through connected receiver 11 to computer 15. This operation causes the endoscope of the present invention to be spatially repositioned to the predefined region of interest (e.g., the location in which the working tools are located). According to this embodiment of the present invention, the operator may define the region of interest as the region in which a tip 35b of tool 37b is found.

According to another embodiment, the operator can define one of the surgical instruments 17b and 17c as a preferred tool. Thus, according to the preferred tool rule, the endoscope will constantly monitor and track the body of the selected tool. According to another embodiment, the user can define the preferred tool rule to constantly reposition the endoscope on the tip of the same (see tip 35b in Fig. 2).

According to the embodiment illustrated in Fig. 2, the activation of the system is provided by a button that signals to the system that it is to be activated.

According to another embodiment of the present invention, the button can be coupled to the desired tool to be monitored, such that the endoscope will monitor the tool to which the button is coupled (and from which signal 12a is emitted).

Referring again to Fig. 2, once a region of interest has been defined, the tracking subsystem is adapted to look for tip 35b within the region of interest by performing image processing. When tip 35b is not detected by the tracking subsystem, the system can move the endoscope in a forward direction along a predefined track. When tip 35b is detected by the tracking subsystem, the endoscope automatically focuses of the region of interest. While performing the surgery, the surgeon often changes the position of his tools and even their insertion point. In order to realize a position and range system, many well-known technologies may be used. For example, the tools may be equipped with switches. If the switches emit wireless signals, then an array of antennas may be used to compare the power of the signal received at each antenna in order to determine the angle of the switch and its approximate range to the camera holder mechanism. If the switch emits ultrasound then ultrasound-sensitive microphones can be used to triangulate the position of the switch. The same is true for a light- emitting switch. In a preferred embodiment of the invention, a single wireless emission code is utilized and choice is achieved by a visible graphic representation on a conventional viewing screen.

In another preferred embodiment, each instrument is fitted with a unique code wireless transmitter, and selection is achieved by depressing its button.

According to different embodiments, the tracking subsystem of the present invention may be used in any conventional camera-assisted laparoscopic surgery system which comprises an endoscope. Upon depression of at least one button on a transmitter for activating the tracking subsystem, either a generic or a unique code is transmitted to a receiving device connected to a computer that instructs the maneuvering subsystem to reposition the endoscope to a region of interest.

For example, the system of the present invention may be used to allow an operator (e.g., a surgeon) to present the surgical instrument to surgical colleagues and staff. By identifying the surgical instrument via the tracking subsystem, the endoscope directs the view to the predefined region of interest.

According to some embodiments, the tracking subsystem may identify a surgical tool after characterization of the same prior to the surgery. The characteristics of the surgical tool may be stored in a database for further use in the image processing algorithm. Upon depression of at least one button, the tracking subsystem may instruct the maneuvering subsystem to move the endoscope so as to achieve the desired focus on a specific region of interest.

The device of the present invention has many technological advantages, among them:

• Simplifying the communication interface between surgeon and mechanical assistants. • Seamless interaction with conventional computerized automated endoscope systems.

• Simplicity of construction and reliability.

• User-friendliness.

Additional features and advantages of the invention will become apparent from the following drawings and description.

To improve the control of the endoscope, the system of the present invention comprises a maneuvering subsystem. Many maneuvering systems are known in the art and many of them have several degrees of freedom:

(a) one degree of freedom enables the system to move the endoscope or laparoscope forward and backwards;

(b) another degree of freedom enables the system to move the endoscope or laparoscope in a zoom movement i.e. in and out of the patient's body through the penetration point;

(c) another degree of freedom enables the system to move the endoscope or laparoscope to the right and left;

(d) another degree of freedom enables the system to fine tune endoscope or laparoscope movements to the right and to the left;

(e) another degree of freedom enables the system to fine tune endoscope or laparoscope movements forward and backwards;

(f) another degree of freedom enables the system to rotate the camera with respect to the endoscope's long axis. This degree of freedom is necessary to keep the horizon of the image from changing when using an endoscope with "angled edge".

Such maneuvering systems are utilized by the present invention so as to reposition the endoscope to the desired location.

It will be apparent to one skilled in the art that there are several embodiments of the invention that differ in details of construction, without affecting the essential nature thereof, and therefore the invention is not limited by that which is illustrated in the figures and described in the specification, but only as indicated in the accompanying claims, with the proper scope determined only by the broadest interpretation of the claims.

EXAMPLES

Examples are given in order to prove the embodiments claimed in the present invention. The example, which is a clinical test, describes the manner and process of the present invention and set forth the best mode contemplated by the inventors for carrying out the invention, but are not to be construed as limiting the invention.

In the examples below, similar numbers refer to similar parts in all of the figures.

Example 1 - Tracking system with collision avoidance system

One embodiment of such a rule-based system will comprise the following set of commands:

Detection (denoted by Gd):

Gdl Tool location detection function

Gd2 Organ (e.g. Liver) detection function

Gd3 Movement (vector) calculation and estimation function

Gd4 Collision probability detection function

Tool Instructions (denoted Gt):

Gtl Move according to manual command

Gt2 Stop movement

The scenario - manual move command by the surgeon:

Locations Gdl(t) and Gd2(t) are calculated in real time at each time step (from an image or location marker). Tool movement vector Gd3(t) is calculated from Gdl(t) as the difference between the current location and at least one previous location (probably also taking into account previous movement vectors).

The probability of collision - Gd4(t) - is calculated, for example, from the difference between location Gdl and location Gd2 (the smaller the distance, the closer the proximity and the higher the probability of collision), from movement vector Gd3(t) indicating a collision, etc.

Tool Instructions Gtl Weight function a_/(t) = 1 If Gtl(t) < a predetermined threshold and 0 otherwise

Tool Instructions Gt2 Weight function a,2(t) = 1 If Gt2(t) > a predetermined threshold and 0 otherwise

Tool Instructions = ¾(t) * Gtl + a₂(t) * Gt2(t);

In reference to Fig. 18, which shows, in a non-limiting manner, an embodiment of a tracking system and collision avoidance system. The system tracks a tool 1810 and the liver 1820, in order to determine whether a collision between the tool 1810 and the liver 1820 is possible within the next time step. Figs. 18a and 18b show how the behavior of the system depends on the distance 1830 between the tool 1810 and the liver 1820, while Figs. 18c and 18d show how movement of the tool 1810 affects the behavior. In Fig. 18a, the distance 1830 between the tool 1810 and the liver 1820 is large enough that a collision is not possible in that time step. Since no collision is possible, no movement of the tool is commanded. In Fig. 18b, the distance 1830 between the tool 1810 and the liver 1820 is small enough that a collision is likely. In the embodiment illustrated, a movement 1840 is commanded to move the tool 1810 away from the liver 1820. In other embodiments, the system prevents movement 1850, but does not command movement 1840; in such embodiments, the tool 1810 will remain close to the liver 1820. In yet other embodiments, the system warns/signals the operator that the move is RESTRICTED, but does not restrict movement 1850 or command movement 1840 away from the liver. Such a warning/signaling can be visual or aural, using any of the methods known in the art.

Figs. 18c and 18d illustrate schematically the effect of the movement of tool 1810 on the collision avoidance system. In Figs. 18c and 18d, the tool 1810 is close enough to the liver 1820 that a collision between the two is possible. If the system tracked only the positions of the tool 1810 and the liver 1820, then motion of the tool 1810 away from the liver 1820 would be commanded. Fig. 18c illustrates the effect of a movement 1850 that would increase the distance between tool 1810 and liver 1820. Since the movement 1850 is away from liver 1820, no collision is possible in this time step and no movement of the tool 1810 is commanded.

In Fig. 18d, tool 1810 is the same distance from liver 1820 as in Fig. 18c. However, in Fig. 18d, the movement 1850 of the tool 1810 is toward the liver 1820, making a collision between tool 1810 and liver 1820 possible. In some embodiments, a movement 1840 is commanded to move the tool 1810 away from the liver 1820. In other embodiments, the system prevents movement 1850, but does not command movement 1840; in this embodiment the tool 1810 will remain close to the liver 1820. In yet other embodiments, the system warns the operator that move is RESTRICTED, but does not restrict movement 1850 or command movement 1840 away from the liver. Such a warning can be visual or aural, using any of the methods known in the art.

As a non-limiting example, in an operation on the liver, the collision detection function can warn the operator that a collision between a tool and the liver is likely but not prevent the collision. In an operation on the gall bladder, the collision detection function can prevent a collision between the tool and the liver, either by preventing the movement or by commanding a movement redirecting the tool away from the liver,

Example 2 - Tracking system with soft control - fast movement when nothing is nearby, slow movement when something is close

One embodiment of such rule-based system comprises the following set of commands:

Detection (denoted by Gd):

Main Tool location detection function (denoted by GdM);

Gd-tooll-K - Tool location detection function;

Gd-organ2-L - Organ (e.g. Liver) detection function;

Gd3 Main Tool Movement (vector) calculation and estimation function;

Gd4 Proximity probability detection function;

Tool Instructions (denoted Gt): Gtl Movement vector (direction and speed) according to manual command

The scenario - manual move command by the surgeon:

Locations GdM(t), Gd-tooll-K(t) and Gd-organ2-L(t) are calculated in real time at each time step (from image or location marker).

Main Tool Movement Vector Gd3(t) is calculated per GdM (t) as the difference between the current location and at least one previous location (probably also taking into account previous movement vectors)

The proximity of the main tool to other tools - Gd4(t) - is calculated, for example, as the smallest of the differences between the main tool location and the other tools' locations.

Tool Instructions Gtl Weight function a_/(t) is proportional to tool proximity function Gd4(t), the closer the tool the slower the movement so that, for example

(¾(t) = Gd4 / maximum(Gd4)

or

( 2(t) = log (Gd4 / maximum(Gd4)) where maximum(Gd4) is the maximum distance which is likely to result in a collision given the distances, the speed of the tool and the movement vector.

Tool Instructions = a_/(t) * Gtl.

Example 3 - Tracking system with no-fly rule/function

In reference to Fig. 19, which shows, in a non-limiting manner, an embodiment of a tracking system with no-fly rule. The system tracks a tool 1810 with respect to a no-fly zone (1960), in order to determine whether the tool will enter the no-fly zone (1960) within the next time step. In this example, the no-fly zone 1960 surrounds the liver.

Figs. 19a and 19b show how the behavior of the system depends on the location of the tool tip with respect to the no-fly zone, while Figs. 19c and 19d show how movement of the tool affects the behavior.

In Fig. 19a, the tool 1810 is outside the no-fly zone rule/function 1960 and no movement of the tool is commanded. In Fig. 19b, the tool 1810 is inside the no-fly zone 1960. The no-fly zone rule/function performs as follows:

In the embodiment illustrated, a movement 1850 is commanded to move the tool 1810 away from the no-fly zone 1960. In other embodiments, the system prevents movement further into the no-fly zone (refers as movement 1840, see Fig. 19c), but does not command movement 1840; in such embodiments, the tool 1810 will remain close to the no-fly zone 1960.

In yet other embodiments, the system warns/signals the operator that the move is RESTRICTED, but does not restrict movement further into the no-fly zone or command movement 1840 away from the no-fly zone 1960. Such a warning/signaling can be visual or aural, using any of the methods known in the art.

Figs. 19c and 19d illustrate schematically the effect of the tool's movement on operation of the no-fly zone rule/function. In Figs. 19c and 19d, the tool 1810 is close enough to the no-fly zone 1960 (distance 1830 is small enough) that it is possible for the tool to enter the no-fly zone during the next time step. Fig. 19c illustrates the effect of a movement 1840 that would increase the distance between tool 1810 and no-fly zone 1960. Since the movement 1840 is away from no-fly zone 1960, no collision is possible in this time step and no movement of the tool 1810 is commanded.

In Fig. 19d, tool 1810 is the same distance from no-fly zone 1960 as in Fig. 19c. However, in Fig. 19d, the movement 1840 of the tool is toward no-fly zone 1960, making it possible for tool 1810 to enter no-fly zone 1960. In the embodiment illustrated, a movement 1850 is commanded to move the tool 1810 away from the no-fly zone 1960. In other embodiments, the system prevents movement 1840, but does not command movement 1850; in such embodiments, the tool 1810 will remain close to the no-fly zone 1960. In yet other embodiments, the system warns/signals the operator that the move is RESTRICTED, but does not restrict movement 1840 or command movement 1850 away from the no-fly zone rule/function 1960. Such a warning/signaling can be visual or aural, using any of the methods known in the art.

Example 4 - Tracking system with preferred volume zone rule/function

In reference to Fig. 20, which shows, in a non-limiting manner, an embodiment of a tracking system with a preferred volume zone function/rule. The system tracks a tool 1810 with respect to a preferred volume zone (2070), in order to determine whether the tool will leave the preferred volume (2070) within the next time step.

In this example, the preferred volume zone 2070 extends over the right lobe of the liver. Figs. 20a and 20b show how the behavior of the system depends on the location of the tool tip with respect to the preferred volume zone 2070, while Figs. 20c and 20d show how movement of the tool affects the behavior (i.e., the preferred volume zone rule/function).

In Fig. 20a, the tool 1810 is inside the preferred volume zone 2070 and no movement of the tool is commanded. In Fig. 20b, the tool 1810 is outside the preferred volume zone 2070.

In the embodiment illustrated, a movement 1840 is commanded to move the tool 1810 away from the preferred volume zone 2070. In other embodiments, the system prevents movement 1840; in such embodiments, the tool 1810 will remain close to the preferred volume zone 2070. In yet other embodiments, the system warns/signals the operator that the move 1840 is RESTRICTED. Such a warning/signaling can be visual or aural, using any of the methods known in the art.

Figs. 20c and 20d illustrate schematically the effect of the tool's movement on operation of the preferred volume rule/function. In Figs. 20c and 20d, the tool 1810 is close enough to the edge of preferred volume zone 2070 that it is possible for the tool to leave the preferred volume zone during the next time step.

Fig. 20c illustrates the effect of a movement 1850 that would take the tool 1810 deeper into preferred volume zone 2070. Since the movement 1850 is into preferred volume 2070, said movement is an allowed movement.

In Fig. 20d, the movement 1850 of the tool is out of the preferred volume 2070, making it possible for tool 1810 to leave preferred volume 2070.

According to one embodiment illustrated, a movement 1840 is commanded to move the tool 1810 into the preferred volume zone 2070. In other embodiments, the system prevents movement 1850, but does not command movement 1840; in such embodiments, the tool 1810 will remain close to the preferred volume zone 2070. In yet other embodiments, the system warns/signals the operator that the move is RESTRICTED, but does not restrict movement 1850 or command movement 1840 away from the preferred volume zone 2070. Such a warning/signaling can be visual or aural, using any of the methods known in the art.

Example 5 - Organ/tool Detection Function

In reference to Fig. 21, which shows, in a non-limiting manner, an embodiment of an organ detection system (however, it should be noted that the same is provided for detection of tools, instead of organs).

For each organ, the 3Ό spatial positions of the organs stored in a database. In Fig. 21, the perimeter of each organ is marked, to indicate the edge of the volume of 3D spatial locations stored in the database.

In Fig. 21, the liver 2110 is labeled with a dashed line. The stomach 2120 is labeled with a long- dashed line, the intestine 2130 with a solid line and the gall bladder 2140 is labeled with a dotted line.

In some embodiments, a label or tag visible to the operator is also presented. Any method of displaying identifying markers known in the art can be used. For non-limiting example, in an enhanced display, colored or patterned markers can indicate the locations of the organs, with the marker either indicating the perimeter of the organ or the area of the display in which it appears.

Example 6 - Tool Detection Function

In reference to Fig. 22, which shows, in a non-limiting manner, an embodiment of a tool detection function. For each tool, the 3Ό spatial positions of the tools stored in a database. In Fig. 22, the perimeter of each tool is marked, to indicate the edge of the volume of 3D spatial locations stored in the database. In Fig. 22, the left tool is labeled with a dashed line while the right tool is labeled with a dotted line.

In some embodiments, a label or tag visible to the operator is also presented. Any method of displaying identifying markers known in the art can be used. For non-limiting example, in an enhanced display, colored or patterned markers can indicate the locations of the tools, with the marker either indicating the perimeter of the tool or the area of the display in which it appears. Example 7 - Movement Detection Function/rule

In reference to Fig. 23, which shows, in a non-limiting manner, an embodiment of a movement detection function/rule. Fig. 23a schematically illustrates a liver 2310, a left tool 2320 and a right tool 2330 at a time t. Fig. 23b schematically illustrates the liver 2310, left tool 2320 and right tool 2330 at a later time t + At, where At is a small time interval. In this example, the left tool 2320 has moved downward (towards the direction of liver 2310) in the time interval At.

The system has detected movement of left tool 2320 and labels it. This is illustrated schematically in Fig. 23b by a dashed line around left tool 2320.

Example 8 - Prediction Function

In reference to Fig. 24, which shows, in a non-limiting manner, an embodiment of the above discussed prediction function.

Fig. 24a shows a left tool 2420 and a right tool 2430 at a time t.

Fig. 24b shows the same tools at a later time t + At, where At is a small time interval. Left tool 2420 is moving to the right and downward, while right tool 2430 is moving to the left and upward. If the motion continues (shown by the dashed line in Fig. 24c), then by the end of the next time interval, in other words, at some time between time t + At and time t + 2At, the tools will collide, as shown by tool tips within the dotted circle 2450 in Fig. 24c.

In this embodiment, the system automatically prevents predicted collisions and, in this example, the system applies a motion 2440 to redirect left tool 2420 so as to prevent the collision.

In other embodiments, the system warns/signals the operator that a collision is likely to occur, but does not alter the movement of any tool. Such a warning/signaling can be visual or aural, using any of the methods known in the art.

In other embodiments, the prediction function can be enabled to, for non-limiting example, alter the field of view to follow the predicted movement of a tool or of an organ, to warn of (or prevent) predicted motion into a no-fly zone, to warn of (or prevent) predicted motion out of a preferred zone. Example 9 - Right Tool Function/rule

In reference to Fig. 25, which shows, in a non-limiting manner, an embodiment of a right tool function. Fig. 25 schematically illustrates a liver 2510, a left tool 2520 and a right tool 2530. The right tool, illustrated schematically by the dashed line 2540, is labeled and its 3D spacial location is constantly and real-time stored in a database. Now, according to the right tool function/rule the endoscope constantly tracks the right tool.

It should be pointed out that the same rule/function applies for the left tool (the left tool function/rule).

Example 10 - Field of View Function/rule

In reference to Fig. 26, which shows, in a non-limiting manner, an embodiment of a field of view function/rule.

Fig. 26a schematically illustrates a field of view of the abdomen at a time t. In the field of view are the liver 2610, stomach 2620, intestines 2630 and gall bladder 2640.

The gall bladder is nearly completely visible at the left of the field of view. Two tools are also in the field of view, with their tips in proximity with the liver. These are left tool 2650 and right tool 2660. In this example, the field of view function/rule tracks left tool 2650. In this example, left tool 2650 is moving to the right, as indicated by arrow 2670.

Fig. 26b shows the field of view at time t + At. The field of view has moved to the right so that the tip of left tool 2650 is still nearly at the center of the field of view. It can be seen that much less of gall bladder 2640 is visible, while more of right tool 2660 has entered the field of view.

The field of view function/rule can be set to follow a selected tool, as in this example or to keep a selected organ in the center of the field of view. It can also be set to keep a particular set of tools in the field of view, zooming in or out as necessary to prevent any of the chosen tools from being outside the field of view.

Alternatively, the field of view function/rule defines n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said n 3D spatial positions provides a predetermined field of view. Each movement of the endoscope or the surgical tool within said n 3D spatial positions is an allowed movement and any movement of the endoscope or the surgical tool outside said n 3D spatial positions is a restricted movement.

Alternatively, said the field of view function/rule defines n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said n 3D spatial positions provides a predetermined field of view.

According to the field of view function/rule, the endoscope is relocated if movement has been detected by said detection means, such that said field of view is maintained.

Example 11 - Tagged Tool Function/rule (or alternatively the preferred tool rule)

In reference to Fig. 27, which shows, in a non-limiting manner, an embodiment of a tagged tool function/rule.

Fig. 27 shows three tools (2720, 2730 and 2740) in proximity to the organ of interest, in this example, the liver 2710.

The tool most of interest to the surgeon, at this point during the operation, is tool 2740. Tool 2740 has been tagged (dotted line 2750); the 3D spacial location of tool 2740 is constantly stored in a database and this spacial location has been labeled as one of interest.

The system can use this tagging for many purposes, including, but not limited to, keeping tool 2740 in the center of the field of view, predicting its future motion, keeping it from colliding with other tools or keeping other tools from colliding with it, instructing the endoscope to constantly monitor and track said tagged tool 2750 and so on.

It should be noted that in the preferred tool rule, the system tags one of the tools and performs as in the tagged tool rule/function.

Example 12 - Proximity Function/rule

In reference to Fig. 28, which shows, in a non-limiting manner, an embodiment of a proximity function/rule. Fig. 28a schematically illustrates two tools (2810 and 2820) separated by a distance 2830 which is greater than a predefined proximity distance. Since tool 2810 is not within proximity of tool 2820, the field of view (2880) does not move.

Fig. 28b schematically illustrates two tools (2810 and 2820) separated by a distance 2830 which is less than a predefined proximity distance.

Since tool 2810 is within proximity of tool 2820, the field of view 2880 moves upward, illustrated schematically by arrow 2840, until the tips of tool 2810 and tool 2820 are in the center of field of view 2880 (Fig. 28c).

Alternatively the once the distance 2830 between the two tool 2820 and 2810 is smaller than a predetermined distance, the system alerts the user of said proximity (which might lead to a collision between the two tools). Alternatively, the system moves one of the tools away from the other one.

Example 13 - Operator Input Function/rule

In reference to Fig. 29, which shows, in a non-limiting manner, an embodiment of an operator input function/rule. According to this embodiment, input is received from the operator.

In the following example, the input received from the operator is which tool to track.

Fig. 29a schematically illustrates an endoscope with field of view 2980 showing a liver 2910 and two tools 2920 and 2930. A wireless transmitter 2960 is enabled to transmit coded instructions through receiver 2970. Operator 2950 first selects the tip of the left tool as the region of interest, causing the system to tag (2940) the tip of the left tool.

As illustrated in Fig. 29b, the system then directs and modifies the spatial position of the endoscope so that the tagged tool tip 2940 is in the center of the field of view 2980.

Another example of the operator input function/rule is the following:

If a tool has been moved closely to an organ in the surgical environment, according to the proximity rule or the collision prevention rule, the system will, according to one embodiment, prevent the movement of the surgical tool. According to one embodiment of the present invention, once the surgical tool has been stopped, any movement of said tool in the direction is interpreted as input from the operator to continue the movement of said surgical tool in said direction.

Thus, according to this embodiment, the operator input function/rule receives input from the operator (i.e., physician) to continue the move of said surgical tool (even though it is "against" the collision prevention rule). Said input is simply in the form of the continued movement of the surgical tool (after the alert of the system or after the movement prevention by the system).

In the foregoing description, embodiments of the invention, including preferred embodiments, have been presented for the purpose of illustration and description. They are not intended to be exhaustive or to limit the invention to the precise form disclosed. Obvious modifications or variations are possible in light of the above teachings. The embodiments were chosen and described to provide the best illustration of the principals of the invention and its practical application, and to enable one of ordinary skill in the art to utilize the invention in various embodiments and with various modifications as are suited to the particular use contemplated. All such modifications and variations are within the scope of the invention as determined by the appended claims when interpreted in accordance with the breadth they are fairly, legally, and equitably entitled.

Claims

1. A system for maneuvering an endoscope, comprising:

a. a first mechanism, comprising:

i. at least one first transmission means 101; said first transmission means 101 defines a first plane; said first transmission means 101 is characterized by a first axis of rotation; said first axis of rotation is substantially orthogonal to said first plane;

ii. at least one second transmission means 102; said second transmission means 102 defines a second plane; said second transmission means is characterized by a second axis of rotation; said second axis of rotation is substantially orthogonal to said second plane; said second transmission means 102 is rotatably connected to said first transmission means 101; where said first plane is substantially orthogonal to second plane; and

hi. at least one first means 106 adapted to rotate said first transmission means 101 around said first axis of rotation;

b. a second mechanism, comprising:

iv. at least one second means 107 adapted to rotate said third transmission means 103 around said third axis of rotation;

where said third transmission means 103 transmit rotation to said fourth transmission means 104; where said fourth transmission means 104 transmit rotation to said fifth transmission means 105,

2. The system according to claim 1, wherein angle A between said first axis of rotation and said second axis of rotation is in the range of about 0 degrees to about 180 degrees.

3. The system according to claim 1, additionally comprising at least one rotating means, in communication with said first mechanism and said second mechanism, said rotating means comprising:

a. at least one pivoting support adapted to be pivotally attached to said endoscope; said pivoting support is adapted to enable said endoscope to pivot around said pivoting support;

b, at least one third mechanism for rotating said pivoting support independently around two orthogonal axes, said third mechanism mechanically connected to said pivoting support, thereby enabling said endoscope to rotate around an insertion point into a body of a subject;

said endoscope pivotally attached to said rotating means can pivot at said insertion point independent of the distance between said pivoting support, said rotating means, and said insertion point;

where said third mechanism comprises at least one first joint coupled to said pivoting support; and at least one second joint in communication with said first joint and coupled to mechanism selected from a group consisting of: said first mechanism, said second mechanism and any combination thereof;

each of said joints is adapted to provide rotation to said pivoting support in at least one of said orthogonal axes; wherein said second joint is located at a predetermined distance from said first joint.

4. The system according to claims 1 or 3, wherein said system is characterized by at least two configurations: an automatic configuration, in which said system is motorized; and a manual configuration in which said system is maneuvered manually by said endoscope user and wherein said system is optionally characterized by an third, wholly manual, configuration, in which said system is maneuvered by an endoscope assistant.

5. The system according to claim 1, additionally comprising at least one rotating means, in communication with said first mechanism and said second mechanism, said rotating means comprising: at least one fourth mechanism for rotating said endoscope independently around two orthogonal axes, said fourth mechanism mechanically connected to said pivoting support, thereby enabling said endoscope to rotate around an insertion point into a body of a subject; said endoscope pivotally attached to said rotating means can pivot at said insertion point independent of the distance between said rotating means, and said insertion point; where said fourth mechanism comprises at least one third joint coupled to said endoscope; and at least one fourth joint in communication with said third joint and coupled to mechanism selected from a group consisting of: said first mechanism, said second mechanism and any combination thereof; each of said joints is adapted to provide rotation to said endoscope in at least one of said orthogonal axes; wherein said third joint is located at a predetermined distance from said fourth joint.

6. The system according to either one of claims 1 , 3 or 5, further comprising at least one zoom mechanism, adapted to maneuver said endoscope along the main longitudinal axis of the same.

7. The system according to claim 6, wherein said zoom mechanism comprises:

a. at least one first coupling means clasped to said endoscope;

b. at least one first connecting means reversibly coupled to said endoscope at a first coupling position; c. at least one second connecting means reversibly coupled to said first coupling means at a second coupling position;

wherein said coupling between said first connecting means, said second connecting means and said endoscope enables said endoscope to (i) pivot around said main longitudinal axis of said endoscope; and (ii) to move along said longitudinal axis of the same.

8. The system according to claim 7, wherein said clasping enables reversible reciprocating movement along said main longitudinal axis of said endoscope.

9. The system according to claim 7, wherein said first connecting means and said second connecting means are connected to one another via joints.

10. The system according to claim 7, wherein said zoom mechanism further comprises m coupling means adapted to couple said first connecting means to said second connecting means; where m is an integer greater than or equal to one.

11. The system according to claim 10, wherein said m coupling means are rotatably coupled to each other.

12. The system according to claim 10, wherein said m coupling means are selected from a group consisting of joints, rods, other zoom mechanisms and any combination thereof.

13. The system according to claim 7, wherein said coupling of said endoscope to at least one of a group consisting of said first connecting means and said second connecting means is obtained by means selected from a group consisting of mechanical means, magnetic means and any combination thereof.

14. The system according to claim 13, wherein said mechanical means are selected from a group consisting of a clip, a fastening element, tape, adhesive tape, a snap fastener, a button and any combination thereof.

15. The system according to claim 13, wherein said magnetic means comprise a magnetic device, said magnetic device comprising at least one magnet and at least one selected from a group consisting of: a ferromagnet and a paramagnet.

16. The system according to claim 6, wherein said zoom mechanism is operable by at least one motor.

17. The system according to claim 3, wherein said pivoting support is a gimbal.

18. The system according to claim 3, where said third mechanism comprises a plurality of q joints, at least one of which is coupled to said pivoting support, and at least one of which is coupled to said second mechanism; where q is an integer greater than or equal to one.

19. The system according to claim 5 where said fourth mechanism comprises a plurality of q joints, at least one of which is coupled to said endoscope, and at least one of which is coupled to said second mechanism; where q is an integer greater than or equal to one.

20. The system according to claim 1, wherein said first transmission means, said second transmission means, said third transmission means, said fourth transmission means, and said fifth transmission means are selected from a group consisting of gearwheels, wheels, crown gears, bevel gears, spur gears, belts, and any combination thereof.

21. The system according to claim 1, wherein said system comprises attaching means adapted to reversibly couple said system to a hospital bed.

22. The system according to claim 21, wherein said attaching means is selected from a group consisting of mechanical means, magnetic means and any combination thereof.

23. The system according to claim 22, wherein said mechanical means is selected from a group consisting of a clip, a fastening element, tape, adhesive tape, a snap fastener, a button and any combination thereof.

24. The system according to claim 22, wherein said magnetic means comprises a magnetic device, said magnetic device comprising at least one magnet and at least one selected from a group consisting of: a ferromagnet and a paramagnet; where said magnet is attached to at least one member of a group consisting of: a hospital bed, said system, and any combination thereof, and said member of said group consisting of a ferromagnet and a paramagnet is attached to at least one member of a group consisting of: a hospital bed, said system, and any combination thereof.

25. The system according to claim 1, wherein said rotation in said second plane defines an angle Θ.

26. The system according to claims 4 and 25, wherein said angle Θ varies between about 0 and about 360 degrees, preferably between about 0 and about 160 degrees, when said system is in said automatic configuration or in said manual configuration.

27. The system according to claim 1 wherein said rotation in said fifth plane defines an angle ψ.

28. The system according to claims 4 and 27, wherein said angle ψ varies between about 0 and about 360 degrees, preferably between about 0 and about 140 degrees, when system is in said automatic configuration or in said manual configuration.

29. The system according to claim 4, wherein said system additionally comprises a quick release handle adapted to disassemble said endoscope from said system when said system is in said automatic configuration or in said manual configuration.

30. The system according to claim 1, wherein said first mechanism additionally comprises locking means adapted to maintain at least one selected from a group consisting of: said first transmission means, said second transmission means and any combination thereof in a predetermined orientation upon power failure; and to prevent any rotational movement of the same upon power failure.

31. The system according to claim 1, wherein said second mechanism additionally comprises locking means adapted to maintain at least one selected from a group consisting of: said third transmission means, said fourth transmission means, said fifth transmission means, and any combination thereof in a predetermined orientation upon power failure and to prevent any rotational movement of the same upon power failure.

32. The system according to claim 4, additionally comprising at least one manual override system (MOS), adapted upon activation of the same to switch reversibly between a manual configuration, in which the endoscope is moved manually by the operator and an automatic configuration, in which the endoscope is moved automatically by the system, and optionally adapted to switch reversibly to a wholly manual configuration, in which the endoscope is moved wholly manually by an endoscope assistant.

33. The system according to claim 32, additionally comprising at least one joystick, coupled to said endoscope.

34. The system according to claim 32, additionally comprising activation means adapted to activate at least one of a group consisting of said system, said joystick and any combination thereof.

35. The system according to claim 32, wherein said MOS is enabled to be worn by said MOS operator.

36. The system according to claim 32, additionally comprising at least one joystick, enabled to be worn by said joystick user.

37. The system according to claim 34, wherein said activation means is enabled to be worn by said activation means user.

38. The system according to claim 34, wherein said activation means is selected from a group consisting of a pressable button, a rotatable knob, a knob, and any combination thereof.

39. The system according to claims 25, 27 and 32, wherein said MOS enables rotation in said angles ψ and Θ.

40. The system according to claims 33 or 36, wherein, when said joystick is moved in direction a, said endoscope moves in angular direction Θ and when said joystick is moved in direction β, said endoscope moves in angular direction ψ.

41. The system according to claim 40, wherem movement of said joystick in a direction selected from a group consisting of said a, said β and any combination thereof is proportional to movement of said endoscope in a direction selected from a group consisting of said ψ, said Θ and any combination thereof.

42. The system according to claim 32, wherein said MOS additionally comprises means for controlling said endoscope's motion, adapted to restrain angular velocity in said Θ and ψ directions.

43. The system according to claim 32, wherein said MOS additionally comprises n sensors, where n is an integer greater than or equal to one.

44. The system according to claim 43, wherein said sensors are selected from of a group consisting of: motion sensors, heat sensors, electric sensors, sound sensors, pressure sensors, optical sensors and any combination thereof.

45. The system according to claim 43, wherein said n sensors are activated in case of power failure.

46. The system according to claim 43, wherein said w sensors are activated when said system is connected to power.

47. The system according to claim 44, wherein said motion sensors detect motion of said joystick.

48. The system according to claim 47, wherein said motion detection of said joystick is used to deactivate said motion of said endoscope if said motion's speed is above a predetermined threshold.

49. The system according to claim 33 or 36, wherein said joystick is characterized by an external surface.

50. The system according to claims 44 and 49, wherein said motion sensors detect motion upon said external surface.

51. The system according to claim 50, wherein said motion upon said external surface is used to operate said endoscope according to said motion upon said external surface.

52. The system according to claim 51, wherein said motion upon said external surface deactivates of said motion of said endoscope if said motion's speed is above a predetermined threshold.

53. The system according to claim 44, wherein said heat sensors are adapted to sense temperature in the range of about 35 to about 42 degrees.

54. The system according to claim 53, wherem said heat sensors enable the activation of said MOS when said heat sensors sense said temperature is in the range of about 35 to about 42 degrees.

55. The system according to claim 44, wherein said heat sensors are adapted to provide a thermal image, where said heat sensors are coupled to a processing unit adapted to provide said endoscope user with said thermal image.

56. The system according to claim 55, wherein said processing unit enables the activation of said MOS upon analysis of said image and detection of human hand.

57. The system according to claim 44, wherein said electric sensors are adapted to sense power failure.

58. The system according to claim 44, wherein said electric sensors are adapted to sense electrical conductivity of a human body.

59. The system according to claim 58, wherein said human body conductivity sensed by said electric sensors enables activation of said MOS.

60. The system according to claim 44, wherein said sound sensors are adapted to sense predetermined sound patterns.

61. The system according to claim 60, wherein said predetermined sound patterns sensed by said sound sensors enable the activation of said MOS.

62. The system according to claim 60, wherein said sound sensors are used to operate said endoscope according to said predetermined sound patterns.

63. The system according to claim 44, wherein said pressure sensors are adapted to sense pressure applied to said MOS.

64. The system according to claim 63, wherein, when said pressure sensed by said pressure sensors is above a predetermined threshold, said MOS is activated.

65. The system according to claim 63, wherein, when said pressure sensed by said pressure sensors is below a predetermined threshold, said MOS is de-activated.

66. The system according to claim 63, wherein, when said pressure sensed by said pressure sensors is above a predetermined threshold, said MOS is de-activated.

67. The system according to claim 44, wherein said optical sensors are adapted to sense visual changes according to predetermined visual patterns.

68. The system according to claim 67, wherein said optical sensors enable the activation of said MOS according to said predetermined visual patterns.

69. The system according to claim 68, wherein said optical sensors are used to operate said endoscope according to said predetermined visual patterns.

70. The system of claim 1, additionally comprising a surgical tracking system for assisting an operator to perform a laparoscopic surgery of a human body, said surgical tracking system comprising:

a. at least one endoscope adapted to acquire real-time images of a surgical environment within said human body;

b. a maneuvering subsystem adapted to control the spatial position of said endoscope during said laparoscopic surgery; and, c. a tracking subsystem in communication with said maneuvering subsystem, adapted to control the maneuvering system so as to direct and modify the spatial position of said endoscope to a region of interest;

wherein said tracking subsystem comprises a data processor; said data processor is adapted to perform real-time image processing of said surgical environment and to instruct said maneuvering subsystem to modify the spatial position of said endoscope according to input received from a maneuvering function f(t); said maneuvering function f(t) is adapted to (a) receive input from at least two instructing functions g,{t), where i is 1,...,n and n > 2; where t is time; i and n are integers; and, to (b) output instructions to said maneuvering subsystem based on said input from said at least two instructing functions g;(t), so as to spatially position said endoscope to said region of interest.

71. The system of claim 70, wherein each of said instructing functions g,(t) is provided with ,{t) where i is an integer greater than or equal to 1 ; where j(t) are weighting functions of each g,(t), and a n is total number of instruction functions.

72. The system of claim 70 or 71, wherein said weighting functions a_r{t) are time-varying functions, wherein the value of which is determined by said operators.

The system of claim 70 or 71, wherein each of said instructing functions g,-(t) is selected from a group consisting of: most used tool function, right tool function, left tool function, field of view function, no fly zone function, proximity function, collision prevention function, preferred volume zone function, preferred tool function, tool detection function, movement detection function, organ detection function, operator input function, prediction function, past statistical analysis function, tagged tool function, and any combination thereof.

73. The system of claim 72, wherein said most used tool function comprises a communicable database counting the amount of movement of each surgical tool located within said surgical environment; said most used tool function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to constantly position said endoscope to track the movement of the most moved surgical tool.

74. The system of claim 72, wherein said right tool function is adapted to detect surgical tool positioned to right of said endoscope and to output instructions to said tracking subsystem to instruct said maneuvering system to constantly direct said endoscope on said right tool and to track said right tool.

75. The system of claim 72, wherein said left tool function is adapted to detect surgical tool positioned to left of said endoscope and to output instructions to said tracking subsystem to instruct said maneuvering system to constantly direct said endoscope on said left tool and to track said left tool.

76. The system of claim 72, wherein said field of view function comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said n 3D spatial positions provides a predetermined field of view; said field of view function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to at least one 3D spatial position substantially within said « 3D spatial positions so as to maintain a constant field of view.

77. The system of claim 72, wherein said no fly zone function comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions define a predetermined volume within said surgical environment; said no fly zone function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to at least one 3D spatial position substantially different from all said n 3D spatial positions.

78. The system of claim 72, wherein said proximity function is adapted to define a predetermined distance between at least two surgical tools; and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said two surgical tools if the distance between said two surgical tools is less than said predetermined distance.

79. The system of claim 72, wherein said proximity function is adapted to define a predetermined angle between at least three surgical tools; and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said three surgical tools if the angle between said three surgical tools is less than or greater than said predetermined angle.

80. The system of claim 72, wherein said collision prevention function is adapted to define a predetermined distance between said at least one surgical tool and an anatomical element within said surgical environment; and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said surgical tool and said anatomical element within said surgical environment if the distance between said at least one surgical tool and said anatomical element is less than said predetermined distance.

81. The system of claim 72, wherein said preferred volume zone function comprises communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions provide said preferred volume zone; said preferred volume zone function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said preferred volume zone.

82. The system of claim 72, wherein said preferred tool function comprises a communicable database, said database stores a preferred tool; said preferred tool function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to constantly direct said endoscope to said preferred tool, such that said endoscope constantly tracks said preferred tool.

83. The system of claim 72, wherein said tool detection function is adapted to detect surgical tools in said surgical environment and to output instruction to said tracking subsystem to instruct said maneuvering system to direct said endoscope on said detected surgical tools.

84. The system of claim 72, wherein said movement detection function comprises a communicable database comprising the real-time 3D spatial positions of each of the surgical tool in said surgical environment; is adapted to detect movement of said at least one surgical tool when a change in at least one of said 3D spatial positions is received, and is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope on said moved surgical tool.

85. The system of claim 72, wherein said organ detection function is adapted to detect organs in said surgical environment and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope on said detected organs.

86. The system according to claim 86, wherein said anatomical element is selected from a group consisting of tissue, organ, another surgical tool and any combination thereof.

87. The system of claim 72, wherein said operator input function comprises a communicable database; said communicable database is adapted to receive an input from said operator of said system; said input comprising n 3D spatial positions; n is an integer greater than or equal to 2; and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said at least one 3D spatial position received.

88. The system of claim 72, wherein said prediction function comprises a communicable database storing each 3D spatial position of each surgical tool within said surgical environment, such that each movement of each surgical tool is stored; said prediction function is adapted to (a) to predict the future 3D spatial position of each of said surgical tools; and (b) to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said future 3D spatial position.

89. The system of claim 72, wherein said past statistical analysis function comprises a communicable database storing each 3D spatial position of each of surgical tool within said surgical environment, such that each movement of each surgical tool is stored; said past statistical analysis function is adapted to (a) statistically analyze said 3D spatial positions of each of said surgical tools; and, (b) to predict the future 3D spatial position of each of said surgical tools; and (c) to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said future 3D spatial position.

90. The system of claim 72, wherein said tagged tool function comprises means adapted to tag at least one surgical tool within said surgical environment and to output instructions to said tracking subsystem to instruct said maneuvering system to constantly direct said endoscope to said tagged surgical tool.

91. The system of claim 90, wherein said means are adapted to apply a continuing tag to said at least one surgical tool within said surgical environment.

92. The system of claim 90, wherein said means are adapted to re-tag said at least one of said surgical tools until a desired tool is selected.

93. The system of claim 90, additionally comprising means adapted to toggle between said surgical tools.

94. The system of claim 90, wherein toggling is performed manually or automatically.

95. The system of claim 70, wherein said image processing is obtained by at least one algorithm selected from a group consisting of: image stabilization algorithm, image improvement algorithm, image compilation algorithm, image enhancement algorithm, image detection algorithm, image classification algorithm, image correlation with the cardiac cycle of said human body, image correlation with the respiratory cycle of said human body, smoke detection algorithm, vapor detection algorithm, algorithm for reducing steam from said endoscope and any combination thereof.

96. The system of claim 70, wherein said endoscope comprises an image acquisition device selected from a group consisting of: a camera, a video camera, an electromagnetic sensor, a computer tomography imaging device, a fluoroscopic imaging device, an ultrasound imaging device, and any combination thereof.

97. The system of claim 70, further comprising a display adapted to accept input from or provide output to said operator regarding operation of said system.

98. The system of claim 97, wherein said display is used for visualizing said region of interest by said operator.

99. The system of claim 97, wherein said display is adapted to output said acquired real-time images of a surgical environment with augmented reality elements.

100. The system of claim 70, wherein said image processing algorithm is adapted to analyze 2D or 3D representation rendered from said real-time images of the surgical environment.

101. The system of claim 70, wherein said data processor is further adapted to operate a pattern recognition algorithm for assisting the operation of said instructing functions g_/(t).

102. The system of claim 70, additionally comprising at least one location estimating means for locating the position of at least one surgical tool in said surgical environment.

103. The system of claim 102, wherein said at least one location estimating means is an interface subsystem between a surgeon and the at least one surgical tool, the interface subsystem comprising:

b. at least one array comprising M cameras, where M is a positive integer;

104. The system of claim 70, further comprising a surgical controlling system, comprising: a. at least one surgical tool adapted to be inserted into a surgical environment of a human body for assisting a surgical procedure; b. at least one location estimating means adapted to locate in real-time the 3D spatial position of said at least one surgical tool at any given time t c. at least one movement detection means communicable with a movement's database and with said location estimating means; said movement's database is adapted to store said 3D spatial position of said at least one surgical tool at time t/and at time ¾ where tf > to; said movement detection means is adapted to detect movement of said at least one surgical tool if the 3D spatial position of said at least one surgical tool at time tf is different from said 3D spatial position of said at least one surgical tool at time to, and, d. a controller having a processing means communicable with a controller's database, said controller adapted to control the spatial position of said at least one surgical tool; said controller's database is in communication with said movement detection means; wherein said controller's database is adapted to store a predetermined set of rules according to which ALLOWED and RESTRICTED movements of said at least one surgical tool are determined, such that each detected movement by said movement detection means of said at least one surgical tool is determined as either an ALLOWED movement or as a RESTRICTED movement according to said predetermined set of rules.

105. The system according to claim 104, wherein said predetermined set of rules comprises at least one rule selected from a group consisting of: most used tool rule, right tool rule, left tool rule, field of view rule, no fly zone rule, route rule, proximity rule; collision prevention rule, preferred volume zone rule, preferred tool rule, movement detection rule, operator input rule, environment rule, history-based rule, tool-dependent ALLOWED and RESTRICTED movements rule, tagged tool rule and any combination thereof.

106. The system according to claim 105, wherein said most used tool rule comprises a communicable database counting the amount of movement of each of said surgical tools; said most used tool rule is adapted to constantly position said endoscope to track the movement of the most moved surgical tool.

107. The system according to claim 105, wherein said right tool rule is adapted to determine said ALLOWED movement of said endoscope according to the movement of the surgical tool positioned to right of said endoscope; further wherein said left tool rule is adapted to determine said ALLOWED movement of said endoscope according to the movement of the surgical tool positioned to left of said endoscope.

108. The system according to claim 105, wherein said field of view rule comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said n 3D spatial positions provides a predetermined field of view; said field of view rule is adapted to determine said ALLOWED movement of said endoscope within said « 3D spatial positions so as to maintain a constant field of view, such that said ALLOWED movements are movements in which said endoscope is located substantially in at least one of said n 3D spatial positions, and said RESTRICTED movements are movements in which the location of said endoscope is substantially different from said « 3D spatial positions

109. The system according to claim 105, wherein said no fly zone rule comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions define a predetermined volume within said surgical environment; said no fly zone rule is adapted to determine said RESTRICTED movement if said movement is within said no fly zone and ALLOWED movement if said movement is outside said no fly zone, such that said RESTRICTED movements are movements in which said at least one of said surgical tool is located substantially in at least one of said n 3D spatial positions, and said ALLOWED movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions.

110. The system according to claim 105, wherein said route rule comprises a communicable database storing at least one predefined route in which said at least one surgical tool is adapted to move within said surgical environment; said predefined route comprises n 3D spatial positions of said at least one surgical tool; n is an integer greater than or equal to 2; said ALLOWED movements are movements in which said at least one surgical tool is located substantially in at least one of said n 3D spatial positions of said predefined route, and said RESTRICTED movements are movements in which said location of said at least one surgical tool is substantially different from said n 3D spatial positions of said predefined route.

111. The system according to claim 105, wherein said proximity rule is adapted to define a predetermined distance between at least two surgical tools; said ALLOWED movements are movements which are within the range or out of the range of said predetermined distance, and said RESTRICTED movements which are out of the range or within the range of said predetermined distance.

112. The system according to claim 105, wherein said proximity rule is adapted to define a predetermined angle between at least three surgical tools; said ALLOWED movements are movements which are within the range or out of the range of said predetermined angle, and said RESTRICTED movements which are out of the range or within the range of said predetermined angle.

113. The system according to claim 105, wherein said collision prevention rule is adapted to define a predetermined distance between said at least one surgical tool and an anatomical element within said surgical environment; said ALLOWED movements are movements which are in a range that is larger than said predetermined distance, and said RESTRICTED movements are movements which are in a range that is smaller than said predetermined distance.

114. The system according to claim 113, wherein said anatomical element is selected from a group consisting of tissue, organ, another surgical tool and any combination thereof.

115. The system according to claim 105, wherein said preferred volume zone rule comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions provides said preferred volume zone; said preferred volume zone rule is adapted to determine said ALLOWED movement of said endoscope within said « 3D spatial positions and RESTRICTED movement of said endoscope outside said « 3D spatial positions, such that said ALLOWED movements are movements in which said endoscope is located substantially in at least one of said n 3D spatial positions, and said RESTRICTED movements are movements in which the location of said endoscope is substantially different from said n 3D spatial positions.

116. The system according to claim 105, wherein said preferred tool rule comprises a communicable database, said database stores a preferred tool; said preferred tool rule is adapted to determine said ALLOWED movement of said endoscope to constantly track the movement of said preferred tool.

117. The system of claim 105, wherein said movement detection rule comprises a communicable database comprising the real-time 3D spatial positions of each of said surgical tool; said movement detection rule is adapted to detect movement of said at least one surgical tool when a change in said 3D spatial positions is received, such that said ALLOWED movements are movements in which said endoscope is re-directed to focus on the moving surgical tool.

118. The system according to claim 105, wherein said operator input rule comprises a communicable database; said communicable database is adapted to receive an input from the operator of said system regarding said ALLOWED and RESTRICTED movements of said at least one surgical tool.

119. The system according to claim 117, wherein said input comprises « 3D spatial positions; n is an integer greater than or equal to 2; wherein at least one of which is defined as ALLOWED location and at least one of which is defined as RESTRICTED location, such that said ALLOWED movements are movements in which said at least one surgical tool is located substantially in at least one of said n 3D spatial positions, and said RESTRICTED movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions.

120. The system according to claim 117, wherein said input comprises at least one rule according to which ALLOWED and RESTRICTED movements of said at least one surgical tool are determined, such that the spatial position of said at least one surgical tool is controlled by said controller according to said ALLOWED and RESTRICTED movements.

121. The system according to claim 119, wherein said predetermined set of rules comprises at least one rule selected from a group consisting of: most used tool, right tool rule, left tool rule, field of view rule, no fly zone rule, route rule, environment rule, operator input rule, proximity rule; collision prevention rule, preferred volume zone rule, preferred tool rule, movement detection rule, history-based rule, tool-dependent ALLOWED and RESTRICTED movements rule, and any combination thereof.

122. The system according to claims 117-120, wherein said operator input rule converts an ALLOWED movement to a RESTRICTED movement and a RESTRICTED movement to an ALLOWED movement.

123. The system according to claim 105, wherein said environment rule comprises a communicable database; said communicable database is adapted to receive at least one real-time image of said surgical environment and is adapted to perform real-time image processing of the same and to determine the 3D spatial position of hazards or obstacles in said surgical environment; said environment rule is adapted to determine said ALLOWED and RESTRICTED movements according to said hazards or obstacles in said surgical environment, such that said RESTRICTED movements are movements in which said at least one surgical tool is located substantially in at least one of said 3D spatial positions of hazards or obstacles, and said ALLOWED movements are movements in which the location of said at least one surgical tool is substantially different from said 3D spatial positions of hazards or obstacles.

124. The system according to claim 123, wherein said hazards or obstacles in said surgical environment are selected from a group consisting of tissue, a surgical tool, an organ, an endoscope and any combination thereof.

125. The system according to claim 105, wherein said history-based rule comprises a communicable database storing each 3D spatial position of each of said surgical tool, such that each movement of each surgical tool is stored; said history-based rule is adapted to determine said ALLOWED and RESTRICTED movements according to historical movements of said at least one surgical tool, such that said ALLOWED movements are movements in which said at least one surgical tool is located substantially in at least one of said 3Ό spatial positions, and said RESTRICTED movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions.

126. The system according to claim 105, wherein said tool-dependent allowed and RESTRICTED movements rule comprises a communicable database; said communicable database is adapted to store predetermined characteristics of at least one of said surgical tools; said tool-dependent ALLOWED and RESTRICTED movements rule is adapted to determine said ALLOWED and RESTRICTED movements according to said predetermined characteristics of said surgical tool; such that allowed movements are movements of said endoscope which tracks said surgical tool having said predetermined characteristics.

127. The system according to claim 126, wherein said predetermined characteristics of said surgical tool are selected from a group consisting of: physical dimensions, structure, weight, sharpness, and any combination thereof.

128. The system according to claim 105, wherein said tagged tool rule comprises means adapted to tag at least one surgical tool within said surgical environment and to determine said ALLOWED movement of said endoscope to constantly track the movement of said tagged surgical tool.

129. The system according to claim 105, wherein at least one of the following is being held true (a) said system additionally comprises an endoscope; said endoscope is adapted to provide real-time image of said surgical environment; (b) at least one of said surgical tools is an endoscope adapted to provide real-time image of said surgical environment. .

130. The system of claim 129, wherein said controller's database comprises n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said n 3D spatial positions provides a predetermined field of view; said field of view rule is adapted to relocate said endoscope if movement of at least one of said surgical tools has been detected by said detection means, such that said field of view is maintained.

131. The system according to any one of claims 105-126 or 128, wherein said system further comprises a maneuvering subsystem communicable with said controller, said maneuvering subsystem is adapted to spatially reposition said at least one surgical tool during a surgery according to said predetermined set of rules; further wherein said system is adapted to alert the physician of said RESTRICTED movement of said at least one surgical tool.

132. The system according to claim 131, wherein said alert is selected from a group consisting of audio signaling, voice signaling, light signaling, flashing signaling and any combination thereof.

133. The system according to any one of claims 105-131, wherein said ALLOWED movement is permitted by said controller and said RESTRICTED movement is denied by said controller.

134. The system according to claim 105, further comprising a maneuvering subsystem communicable with said controller, said maneuvering subsystem is adapted to spatially reposition said at least one surgical tool during a surgery according to said predetermined set of rules, such that if said movement of said at least one surgical tool is a RESTRICTED movement, said maneuvering subsystem prevents said movement.

135. The system according to claim 105, wherein said at least one location estimating means comprises at least one endoscope adapted to acquire real-time images of said surgical environment within said human body; and at least one surgical instrument spatial location software adapted to receive said real-time images of said surgical environment and to estimate said 3D spatial position of said at least one surgical tool.

136. The system of claim 105, wherein said at least one location estimating means comprises (a) at least one element selected from a group consisting of optical imaging means, radio frequency transmitting and receiving means, at least one mark on said at least one surgical tool and any combination thereof; and (b) at least one surgical instrument spatial location software adapted to estimate said 3D spatial position of said at least one surgical tool by means of said element.

137. The system of claim 105, wherein said at least one location estimating means is an interface subsystem between a surgeon and the at least one surgical tool, the interface subsystem comprises:

b. at least one array comprising M cameras, where is a positive integer;

138. A method for maneuvering an endoscope, said method comprising steps of: a. providing a system comprising:

i. a first mechanism, comprising:

a) at least one first transmission means 101; said first transmission means 101 defines a first plane; said first transmission means 101 is characterized by a first axis of rotation; said first axis of rotation is substantially orthogonal to said first plane;

b) at least one second transmission means 102; said second transmission means 102 defines a second plane; said second transmission means defines a second axis of rotation; said second axis of rotation is substantially orthogonal to said second plane; said second transmission means 102 is rotatably connected to said first transmission means 101; where said first plane is substantially orthogonal to second plane; and

ii. a second mechanism, comprising:

b) at least one fourth transmission means 104; said fourth transmission means

104 defines a fourth plane; said fourth transmission means defines a fourth axis of rotation; said fourth axis of rotation is substantially orthogonal to said fourth plane; said fourth transmission means 104 is rotatably connected to said third transmission means 103; said fourth plane is substantially orthogonal to said third plane;

d) at least one second means 107 adapted to rotate said third transmission means 103 around said third axis of rotation;

b. positioning said first transmission means orthogonal to said second transmission means; said positioning enables transmission of rotation between said first transmission means and said second transmission means;

e. coupling said second transmission means to said endoscope and said fifth transmission means to said endoscope; said coupling enables rotation of said endoscope proportional to rotation of said second transmission means and said fifth transmission means; and,

f. maneuvering said endoscope in at least two degrees of freedom (DOF); said maneuvering of said endoscope in said at least two degrees of freedom are in said second axis of rotation and in said fifth axis of rotation;

139. The method according to claim 138, further comprising a step of defining an angle A between said second axis of rotation and said fifth axis of rotation, said angle A is in the range of about 0 degrees to about 180 degrees.

140. The method according to claim 138, further comprising steps of

a. providing at least one rotating means comprising i, at least one pivoting support adapted to be pivotally attached to said endoscope; said pivoting support is adapted to enable said endoscope to pivot around said pivoting support; and

ii. at least one third mechanism for rotating said pivoting support independently around two orthogonal axes, comprising at least one first joint coupled to said pivoting support; and at least one second joint in communication with said first joint and coupled to mechanism selected from a group consisting of: said first mechanism, said second mechanism and any combination thereof; each of said joints is adapted to provide rotation to said pivoting support in at least one of said orthogonal axes; wherein said second joint is located at a predetermined distance from said first joint and said third mechanism is mechanically connected to said pivoting support, thereby enabling said endoscope to rotate around an insertion point into a body of a subject;

141. The method according to claims 138 or 140, further comprising a step of providing said system with at least two configurations: an automatic configuration, in which said system is motorized and is moved automatically by the system; and a manual configuration in which said system is maneuvered manually by said endoscope user, and optionally comprising a step of providing said system with a third, wholly manual configuration, in which the endoscope is moved wholly manually by an endoscope assistant.

142. The method according to claim 138, further comprising steps of

143. The method according to any of claims 138, 140 or 142, further comprising steps of

a. providing at least one zoom mechanism; and

b. maneuvering said endoscope along the main longitudinal axis of the same.

144. The method according to claim 143, further comprising steps of providing said zoom mechanism with:

a. at least one first coupling means clasped to said endoscope,

145. The method according to claim 144, further comprising a step of enabling said first coupling means clasped to said endoscope to move with a reversible reciprocating movement along the main longitudinal axis of said endoscope.

146. The method according to claim 144, further comprising a step of connecting said first connecting means and said second connecting means to one another via joints.

147. The method according to claim 144, further comprising a step of providing said zoom mechanism with m coupling means adapted to couple said first connecting means to said second connecting means; where m is an integer greater than or equal to one.

148. The method according to claim 147, further comprising a step of rotatably coupling said m coupling means to each other.

149. The method according to claim 147, further comprising a step of selecting said m coupling means from a group consisting of: joints, rods, other zoom mechanisms and any combination thereof.

150. The method according to claim 144, further comprising a step of selecting said coupling means from a group consisting of mechanical means, magnetic means and any combination thereof.

151. The method according to claim 150, further comprising a step of selecting said mechanical means from a group consisting of a clip, a fastening element, tape, adhesive tape, a snap fastener, a button and any combination thereof.

152. The method according to claim 143, further comprising a step of operating said zoom mechanism by at least one motor.

153. The method according to claim 140, further comprising a step of selecting said pivoting support to be a gimbal.

154. The method according to claim 140, further comprising a step of providing said third mechanism with a plurality of q joints, at least one of which is coupled to said pivoting support, and at least one of which is coupled to said second mechanism; where q is an integer greater than or equal to one.

155. The method according to claim 142 further comprising a step of providing said fourth mechanism with a plurality of q joints, at least one of which is coupled to said endoscope, and at least one of which is coupled to said second mechanism; where q is an integer greater than or equal to one.

156. The method according to claim 138, further comprising a step of selecting said first transmission means, said second transmission means, said third transmission means, said fourth transmission means, and said fifth transmission means from a group consisting of gearwheels, wheels, crown gears, bevel gears, spur gears, belts, and any combinations thereof.

157. The method according to claim 138, further comprising a step of providing said system with attaching means adapted to reversibly couple said system to a hospital bed.

158. The method according to claim 157, further comprising a step of selecting said attaching means from a group consisting of mechanical means, magnetic means and any combination thereof.

159. The method according to claim 158, further comprising a step of selecting said mechanical means from a group consisting of a clip, a fastening element, tape, adhesive tape, a snap fastener, a button and any combination thereof.

160. The method according to claim 158, further comprising a step of providing, as said magnetic means, a magnetic device comprising at least one magnet and at least one selected from a group consisting of a ferromagnet and a paramagnet; where said magnet is attached to any member of a group consisting of: a hospital bed, said system, and any combination thereof, and said at least one selected from a group consisting of a ferromagnet and a paramagnet is attached to at least one member of a group consisting of: a hospital bed, said system, and any combination thereof.

161. The method according to claim 138, further comprising a step of defining an angle Θ for said rotation in said second plane.

162. The method according to claims 142 and 161, further comprising a step of defining said angle Θ angle to vary between about 0 and about 360 degrees, preferably between about 0 and about 160 degrees, when said system is in said automatic configuration or in said manual configuration.

163. The method according to claim 138 further comprising a step of defining an angle ψ for said rotation in said fifth plane.

164. The method according to claims 138 and 163, further comprising a step of defining said angle ψ to vary between about 0 and about 360 degrees, preferably between about 0 and about 140 degrees, when said system is in said automatic configuration or in said manual configuration.

165. The method according to claim 142, further comprising a step of additionally providing said system with a quick release handle adapted to disassemble said endoscope from said system when said system is in said automatic configuration or in said manual configuration.

1 6. The method according to claim 138, further comprising a step of providing said first mechanism with locking means adapted to maintain at least one selected from a group consisting of: said first transmission means, said second transmission means and any combination thereof in a predetermined orientation upon power failure; and to prevent any rotational movement of the same upon power failure.

167. The method according to claim 138, further comprising a step of providing said second mechanism additionally with locking means adapted to maintain at least one selected from a group consisting of: said third transmission means, said fourth transmission means, said fifth transmission means, and any combination thereof in a predetermined orientation upon power failure and to prevent any rotational movement of the same upon power failure.

168. The method according to claim 142, further comprising a step of providing at least one manual override system (MOS), adapted upon activation of the same to switch reversibly between a manual configuration, in which the endoscope is moved manually by the operator and an automatic configuration, in which the endoscope is moved automatically by the system and optionally further comprising a step of enabling the same to switch reversibly to a third configuration, in which the endoscope is moved wholly manually by an endoscope assistant.

169. The method according to claim 168, further comprising a step of providing at least one joystick, coupled to said endoscope.

170. The method according to claim 168, further comprising a step of providing activation means adapted to activate said MOS.

171. The method according to claim 168, further comprising a step of enabling said MOS to be worn by said MOS operator.

172. The method according to claim 168, further comprising steps of providing at least one joystick, and of enabling said joystick to be worn by said joystick user.

173. The method according to claim 170, further comprising a step of enabling said activation means to be worn by said activation means user.

174. The method according to claim 170, further comprising a step of selecting said activation means from a group consisting of a pressable button, a rotatable knob, a knob, and any combination thereof.

175. The method according to claims 168, further comprising a step of enabling said MOS to rotate in said angles ψ and Θ.

176. The method according to claim 175, further comprising a step of defining angles a and β such that said endoscope moves in angular direction Θ when said joystick is moved in direction a, and said endoscope moves in angular direction ψ when said joystick is moved in direction β.

177. The method according to claim 176, wherein movement of said joystick in a direction selected from a group consisting of said a, said β and any combination thereof, is proportional to movement of said endoscope in angular directions said ψ, said Θ and any combination thereof.

178. The method according to claim 168, further comprising a step of providing said MOS with means for controlling said endoscope motion, adapted to restrain angular velocity in said Θ and ψ directions.

179. The method according to claim 168, further comprising a step of providing said MOS with n sensors, where n is an integer greater than or equal to one.

180. The method according to claim 179, further comprising a step of selecting said sensors from of a group consisting of: motion sensors, heat sensors, electric sensors, sound sensors, pressure sensors, optical sensors and any combination thereof.

181. The method according to claim 179, further comprising a step of activating said n sensors in case of power failure.

182. The method according to claim 179, further comprising a step of activating said n sensors when said system is connected to power.

183. The method according to claim 180, further comprising step of detecting said motion of said joystick with motion sensors.

184. The method according to claim 183, further comprising a step of using said motion detection of said joystick for deactivation of said motion of said endoscope if said motion's speed is above a predetermined threshold.

185. The method according to claim 169 or 172, further comprising a step of characterizing said joystick by an external surface.

186. The method according to claims 180 or 185, further comprising a step of operating said motion sensors to detect motion upon said external surface.

187. The method according to claim 186, further comprising a step of operating said endoscope according to said motion upon said external surface.

188. The method according to claim 186, further comprising a step of deactivation of said motion of said endoscope when said motion's speed along said joystick is above a predetermined threshold.

189. The method according to claim 180, further comprising a step of adapting said heat sensors to sense temperatures in the range of about 35 to about 42 degrees.

190. The method according to claim 189, further comprising a step of enabling the activation of said MOS when said heat sensors sense temperature is in the range of about 35 to about 42 degrees.

191. The method according to claim 189, further comprising a step of adapting said heat sensors to provide at least one thermal image, where said heat sensors are coupled to a processing unit, adapted to provide said endoscope user with said thermal image.

192. The method according to claim 191, further comprising a step of enabling the activation of said MOS by said processing units upon analysis of said image and detection of a human hand.

193. The method according to claim 180, further comprising a step of adapting said electric sensors to sense power failure.

194. The method according to claim 180, further comprising a step of adapting said electric sensors to sense electrical conductivity of human body.

195. The method according to claim 194, further comprising a step of enabling the activation of said MOS upon sensing said human body conductivity by electric sensors.

196. The method according to claim 180, further comprising a step of adapting said sound sensors to sense predetermined sound patterns.

197. The method according to claim 196, further comprising a step of enabling activation of said MOS upon sensing of said predetermined sound patterns by said sound sensors.

198. The method according to claim 196, further comprising a step of operating said endoscope according to predetermined sound patterns sensed by said sound sensors.

199. The method according to claim 180, further comprising a step of adapting said pressure sensors to sense pressure applied to said MOS.

200. The method according to claim 199, further comprising a step of activating said MOS when said pressure sensed by said pressure sensors is above a predetermined threshold.

201. The method according to claim 199, further comprising a step of de-activating said MOS, when said pressure sensed by said pressure sensors is below a predetermined threshold.

202. The method according to claim 199, further comprising a step of de-activating said MOS, when said pressure sensed by said pressure sensors is above a predetermined threshold.

203. The method according to claim 180, further comprising a step of adapting said optical sensors to sense visual changes according to predetermined visual patterns.

204. The method according to claim 203, further comprising a step of enabling the activation of said MOS according to detection of said predetermined visual patterns.

205. The method according to claim 203, further comprising a step of operating said endoscope according to predetermined visual patterns detected by said sensors.

206. The method according to claim 138, further comprising a step of adapting said endoscope to acquire real-time images of a surgical environment within said human body.

207. The method of claim 206, additionally comprising a step of providing a surgical tracking system (STS) for assisting an operator to perform laparoscopic surgery on a human body; the STS comprising steps of:

b. performing real-time image processing of said surgical environment;

c. controlling said maneuvering system via said tracking subsystem, thereby directing and modifying the spatial position of said endoscope to a region of interest according to input received from a maneuvering function f(t); wherein said maneuvering function f(t) is adapted to (a) receive input from at least two instructing functions g_/(t), where / is 1 ,...,« and n > 2; where t is time; i and n are integers; and, to (b) output instructions to said maneuvering subsystem based on said input from said at least two instructing functions g_;{t), so as to spatially position said endoscope to said region of interest.

208. The method of claim 207, wherein each of said instructing functions g,(t) is provided with a,{t) where i is an integer greater than or equal to 1 ; where <¼(.) are weighting functions of each gi(t), and a n is total number of instruction functions.

209. The method of claim 208, wherein said weighting functions ;(t) are time-varying functions, wherein the value of which is determined by said operators.

210. The method of claim 207 or 208, wherein each of said instructing functions g,{t) is selected from a group consisting of: most used tool function, right tool function, left tool function, field of view function, no fly zone function, proximity function, collision prevention function, preferred volume zone function, preferred tool function, tool detection function, movement detection function, organ detection function, operator input function, prediction function, past statistical analysis function, tagged tool function and any combination thereof.

211. The method of claim 210, wherein said most used tool function comprises a communicable database counting the amount of movement of each surgical tool located within said surgical environment; said most used tool function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to constantly position said endoscope to track the movement of the most moved surgical tool.

212. The method of claim 210, wherein said right tool function is adapted to detect surgical tool positioned to right of said endoscope and to output instructions to said tracking subsystem to instruct said maneuvering system to constantly direct said endoscope on said right tool and to track said right tool.

213. The method of claim 210, wherein said left tool function is adapted to detect surgical tool positioned to left of said endoscope and to output instructions to said tracking subsystem to instruct said maneuvering system to constantly direct said endoscope on said left tool and to track said left tool.

214. The method of claim 210, wherein said field of view function comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said « 3D spatial positions provides a predetermined field of view; said field of view function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to at least one 3D spatial position substantially within said n 3D spatial positions so as to maintain a constant field of view.

215. The method of claim 210, wherein controller's database comprises n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said n 3D spatial positions provides a predetermined field of view; said field of view rule is adapted to relocate said endoscope if movement of at least one of said surgical tools has been detected by said detection means, such that said field of view is maintained.

216. The method of claim 210, wherein said no fly zone function comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions define a predetermined volume within said surgical environment; said no fly zone function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to at least one 3D spatial position substantially different from all said n 3D spatial positions.

217. The method of claim 210, wherein said proximity function is adapted to define a predetermined distance between at least two surgical tools; and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said two surgical tools if the distance between said two surgical tools is less than said predetermined distance.

218. The method of claim 210, wherein said proximity function is adapted to define a predetermined angle between at least three surgical tools; and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said three surgical tools if the angle between said two surgical tools is less than or greater than said predetermined angle.

219. The method of claim 210, wherein said collision prevention function is adapted to define a predetermined distance between said at least one surgical tool and an anatomical element within said surgical environment; and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said surgical tool and said anatomical element within said surgical environment if the distance between said at least one surgical tool and an anatomical element is less than said predetermined distance.

220. The method of claim 219, wherein said anatomical element is selected from a group consisting of tissue, organ, another surgical tool and any combination thereof.

221. The method of claim 210, wherein said preferred volume zone function comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions provide said preferred volume zone; said preferred volume zone function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said preferred volume zone.

222. The method of claim 210, wherein said preferred tool function comprises a communicable database, said database stores a preferred tool; said preferred tool function is adapted to output instructions to said tracking subsystem to instruct said maneuvering system to constantly direct said endoscope to said preferred tool, such that said endoscope constantly tracks said preferred tool.

223. The method of claim 210, wherein said tool detection function is adapted to detect surgical tools in said surgical environment and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope on said detected surgical tools.

224. The method of claim 210, wherein said movement detection function comprises a communicable database comprising real-time 3D spatial positions of each said surgical tool in said surgical environment; and to detect movement of said at least one surgical tool when a change in said 3D spatial positions is received, and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope on said moved surgical tool.

225. The method of claim 209, wherein said organ detection function is adapted to detect organs in said surgical environment and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope on said detected organs.

226. The method of claim 210, wherein said operator input function comprises a communicable database; said communicable database is adapted to receive an input from said operator of said system; said input comprising n 3D spatial positions; n is an integer greater than or equal to 2; and to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said at least one 3D spatial position received from said operator.

227. The method of claim 210, wherein said prediction function comprises a communicable database storing each 3D spatial position of each of surgical tool within said surgical environment, such that each movement of each surgical tool is stored; said prediction function is adapted to (a) to predict the future 3D spatial position of each of said surgical tools; and (b) to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to said future 3D spatial position.

228. The method of claim 210, wherein said past statistical analysis function comprises a communicable database storing each 3D spatial position of each of surgical tool within said surgical environment, such that each movement of each surgical tool is stored; said past statistical analysis function is adapted to (a) statistically analyze said 3D spatial positions of each of said surgical tools; and, (b) to predict future 3D spatial positions of each of said surgical tools; and (c) to output instructions to said tracking subsystem to instruct said maneuvering system to direct said endoscope to at least one said future 3D spatial position.

229. The method of claim 210, wherein said a tagged tool function comprises means adapted to tag at least one surgical tool within said surgical environment and to output instructions to said tracking subsystem to instruct said maneuvering system to constantly direct said endoscope to said tagged surgical tool.

230. The method of claim 229, wherein said means are adapted to apply a continuing tag to said at least one of surgical tool within said surgical environment.

231. The method of claim 229, wherein means are adapted to re-tag said at least one of said surgical tools until a desired tool is selected.

232. The method of claim 229, additionally comprising a step of providing means adapted to toggle between said surgical tools.

233. The method of claim 232, wherein said toggling is performed manually or automatically.

234. The method of claim 210, wherein said image processing is obtained by at least one algorithm selected from a group consisting of: image stabilization algorithm, image improvement algorithm, image compilation algorithm, image enhancement algorithm, image detection algorithm, image classification algorithm, image correlation with the cardiac cycle or the respiratory cycle of said human body, smoke detection algorithm, vapor detection algorithm, algorithm to reduce steam from said endoscope and any combination thereof.

235. The method of claim 210, wherein said endoscope comprises an image acquisition device selected from a group consisting of: a camera, a video camera, an electromagnetic sensor, a computer tomography imaging device, a fluoroscopic imaging device, an ultrasound imaging device, and any combination thereof.

236. The method of claim 209, further comprising a step of providing a display adapted to accept input from or provide output to said operator regarding the operation of said system.

237. The method of claim 236, wherein said display is used for visualizing said region of interest by said operator.

238. The method of claim 236, wherein said display is adapted to output said acquired real-time images of a surgical environment with augmented reality elements.

239. The method of claim 210, wherein said image processing algorithm is adapted to analyze 2D or 3D representations rendered from said real-time images of said surgical environment.

240. The method of claim 210, wherein said data processor is further adapted to operate a pattern recognition algorithm for assisting the operation of said instructing functions g,(t).

241. The method of claim 210, additionally comprising a step of preliminarily tagging at least one of said surgical tools.

242. The method of claim 210, additionally comprising step of applying a continuing tag to at least one of said surgical tools.

243. The method of claim 209, additionally comprising a step of re-tagging said at least one of said surgical tools until a desired tool is selected.

244. The method of claim 209, additionally comprising a step of toggling between said surgical tools.

245. The method of claim 244, wherein said toggling is performed manually or automatically.

246. The method of claim 210, additionally comprising a step of locating the 3D position of at least one surgical tool in said surgical environment.

247. The method of claim 246, wherein said step of locating the 3D position of said at least one surgical tool is provided by at least one location estimating means; said at least one location estimating means is an interface subsystem between a surgeon and said at least one surgical tool, the interface subsystem comprising:

b. at least one array comprising M cameras, where is a positive integer;

248. The method according to claim 207, further comprising a step of providing a surgical controlling system (SCS) for assisting an operator to perform laparoscopic surgery on a human body; the SCS comprising steps of: a. providing a surgical controlling system, comprising: (i) at least one surgical tool; (ii) at least one location estimating means; (iii) at least one movement detection means; and (iv) a controller having a processing means communicable with said controller's database;

b. inserting said at least one surgical tool into a surgical environment of a human body; c. estimating in real-time the location of said at least one surgical tool within said surgical environment at any given time t; and, d. detecting that there is movement of said at least one surgical tool when the 3D spatial position of said at least one surgical tool at time tf is different from said 3D spatial position of said at least one surgical tool at time to, e. controlling the spatial position of said at least one surgical tool within said surgical environment by means of said controller; wherein said step of controlling is performed by storing a predetermined set of rules in a controller's database; said predetermined set of rules comprises ALLOWED and RESTRICTED movements of said at least one surgical tool, such that each detected movement by said movement detection means of said at least one surgical tool is determined as either an ALLOWED movement or as a RESTRICTED movement according to said predetermined set of rules.

249. The method according to claim 248, further comprising a step of selecting said predetermined set of rules from a group consisting of: most used tool, right tool rule, left tool rule, field of view rule, no fly zone rule, route rule, proximity rule; collision prevention rule, preferred volume zone rule, preferred tool rule, movement detection rule, operator input rule, environment rule, history-based rule, tool-dependent ALLOWED and RESTRICTED movements rule, tagged tool rule and any combination thereof.

250. The method according to claim 249, wherein said most used tool rule comprises a database counting the amount of movement of each of said surgical tools; said most used tool rule is adapted to constantly position said endoscope to track the movement of the most moved surgical tool.

251. The method according to claim 249, wherein said right tool rule is adapted to determine said ALLOWED movement of said endoscope according to the movement of the surgical tool positioned to right of said endoscope; further wherein said left tool rule is adapted to determine said ALLOWED movement of said endoscope according to the movement of the surgical tool positioned to left of said endoscope.

252. The method according to claim 249, wherein said field of view rule comprises n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said n 3D spatial positions provides a predetermined field of view; said field of view rule is adapted to determine said ALLOWED movement of said endoscope within said n 3D spatial positions so as to maintain a constant field of view, such that said ALLOWED movements are movements in which said endoscope is located substantially in at least one of said n 3D spatial positions, and said RESTRICTED movements are movements in which the location of said endoscope is substantially different from said n 3D spatial positions.

253. The method according to claim 249, wherein said no fly zone rule comprises n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions define a predetermined volume within said surgical environment; said no fly zone rule is adapted to determine said RESTRICTED movement if said movement is within said no fly zone and said ALLOWED movement if said movement is outside said no fly zone, such that said RESTRICTED movements are movements in which said at least one surgical tool is located substantially in at least one of said n 3D spatial positions, and said ALLOWED movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions.

254. The method according to claim 249, wherein said route rule comprises a communicable database storing predefined route in which said at least one surgical tool is adapted to move within said surgical environment; said predefined route comprises « 3D spatial positions of said at least one surgical tool; n is an integer greater than or equal to 2; said ALLOWED movements are movements in which said at least one surgical tool is located substantially in at least one of said n 3D spatial positions of said predefined route, and said RESTRICTED movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions of said predefined route.

255. The method according to claim 249, wherein said proximity rule is adapted to define a predetermined distance between at least two surgical tools; said ALLOWED movements are movements which are within the range or out of the range of said predetermined distance, and said RESTRICTED movements which are out of the range or within the range of said predetermined distance.

256. The method according to claim 249, wherein said proximity rule is adapted to define a predetermined angle between at least three surgical tools; said ALLOWED movements are movements which are within the range or out of the range of said predetermined angle, and said RESTRICTED movements which are out of the range or within the range of said predetermined angle.

257. The method according to claim 249, wherein said collision prevention rule is adapted to define a predetermined distance between said at least one surgical tool and an anatomical element within said surgical environment; said ALLOWED movements are movements which are in a range that is larger than said predetermined distance, and said RESTRICTED movements are movements which are in a range that is smaller than said predetermined distance.

258. The method according to claim 257, wherein said anatomical element is selected from a group consisting of tissue, organ, another surgical tool and any combination thereof.

259. The method according to claim 249, wherein said preferred volume zone rule comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions provides said preferred volume zone; said preferred volume zone rule is adapted to determine said ALLOWED movement of said endoscope within said n 3D spatial positions and RESTRICTED movement of said endoscope outside said n 3D spatial positions, such that said ALLOWED movements are movements in which said endoscope is located substantially in at least one of said « 3D spatial positions, and said RESTRICTED movements are movements in which the location of said endoscope is substantially different from said « 3D spatial positions.

260. The method according to claim 249, wherein said preferred tool rule comprises a communicable database, said database stores a preferred tool; said preferred tool rule is adapted to determine said ALLOWED movement of said endoscope to constantly track the movement of said preferred tool.

261. The method according to claim 249, wherein said movement detection rule comprises a communicable database comprising the real-time 3D spatial positions of each of said surgical tools; and said movement detection rule detects movement of said at least one surgical tool when a change in said 3D spatial position is received, such that said ALLOWED movements are movements in which said endoscope is directed to focus on the moving surgical tool.

262. The method according to claim 249, wherein said operator input rule comprises a communicable database; said communicable database is adapted to receive an input from the operator of said system regarding said ALLOWED and said RESTRICTED movements of said at least one surgical tool.

263. The method according to claim 262, wherein said input comprises n 3D spatial positions; n is an integer greater than or equal to 2; wherein at least one of which is defined as ALLOWED location and at least one of which is defined as RESTRICTED location, such that said ALLOWED movements are movements in which said at least one surgical tool is located substantially in at least one of said n 3D spatial positions, and said RESTRICTED movements are movements in which the location of said at least one surgical tool is substantially different from said « 3D spatial positions.

264. The method according to claim 262, wherein said input comprises at least one predetermined rule according to which ALLOWED and RESTRICTED movements of said at least one surgical tool are determined, such that the spatial position of said at least one surgical tool is controlled by said controller according to said ALLOWED and RESTRICTED movements.

265. The method according to claim 264, wherein said predetermined rule is selected from a group consisting of: most used tool, right tool rule, left tool rule, field of view rule, no fly zone rule, route rule, proximity rule; collision prevention rule, preferred volume zone rule, preferred tool rule, movement detection rule, operator input rule, environment rule, history- based rule, tool-dependent ALLOWED and RESTRICTED movements rule, tagged tool rule and any combination thereof.

266. The method according to claim 249, wherein said environment rule comprises a communicable database; said communicable database is adapted to received at least one real-time image of said surgical environment and is adapted to perform real-time image processing of the same and to determine the 3D spatial position of hazards or obstacles in said surgical environment; said environmental rule is adapted to determine said ALLOWED and RESTRICTED movements according to said hazards or obstacles in said surgical environment, such that said RESTRICTED movements are movements in which said at least one surgical tool is located substantially in at least one of said 3D spatial positions of said hazards or obstacles, and said ALLOWED movements are movements in which the location of said at least one surgical tool is substantially different from said 3D spatial positions of said hazards or obstacles.

267. The method according to claim 266, wherein said hazards or obstacles in said surgical environment are selected from a group consisting of tissue, a surgical tool, an organ, an endoscope and any combination thereof.

268. The method according to claim 249, wherein said history-based rule comprises a communicable database storing each 3D spatial position of each of said surgical tools, such that each movement of each surgical tool is stored; said history-based rule is adapted to determine said ALLOWED and RESTRICTED movements according to historical movements of said at least one surgical tool, such that said ALLOWED movements are movements in which said at least one surgical tool is located substantially in at least one of said 3D spatial positions, and said RESTRICTED movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions.

269. The method according to claim 249, wherein said tool-dependent allowed and RESTRICTED movements rule comprises a communicable database; said communicable database is adapted to store predetermined characteristics of at least one of said surgical tools; said tool-dependent allowed and RESTRICTED movements rule is adapted to determine said ALLOWED and RESTRICTED movements according to said predetermined characteristics of said surgical tool.

270. The method according to claim 269, wherein said predetermined characteristics of said surgical tool are selected from a group consisting of: physical dimensions, structure, weight, sharpness, and any combination thereof.

271. The method according to claim 249, wherein said tagged tool rule comprises means adapted to tag at least one surgical tool within said surgical environment and to determine said ALLOWED movement of said endoscope to constantly track the movement of said tagged surgical tool.

272. The method according to claims 249-271, wherein said operator input rule converts said ALLOWED movement to said RESTRICTED movement and said RESTRICTED movement to said ALLOWED movement.

273. The method according to claim 248, wherein at least one of the following is being held true (a) said system additionally comprises an endoscope; said endoscope is adapted to provide real-time image of said surgical environment; (b) at least one of said surgical tools is an endoscope adapted to provide real-time image of said surgical environment.

274. The method according to claim 273, wherein said controller's database comprises n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said n 3D spatial positions provides a predetermined field of view; said field of view rule is adapted to relocate said endoscope if movement of at least one of said surgical tools has been detected by said detection means, such that said field of view is maintained.

275. The method according to any of claims 248-272, additionally comprising a step of alerting said physician of a RESTRICTED movement of said at least one surgical tool.

276. The method according to claim 275, wherein said step of alerting is performed by at least one selected from a group consisting of an audio signal, a voice signal, a light signal, a flashing signal and any combination thereof.

277. The method according to any of claims 248-272, wherein said ALLOWED movement is permitted by said controller and said RESTRICTED movement is denied by said controller.

278. The method according to claim 248 further comprising a step of providing a maneuvering subsystem communicable with said controller, said maneuvering subsystem is adapted to spatially reposition said at least one surgical tool during surgery according to said predetermined set of rules, such that if said movement of said at least one surgical tool is a RESTRICTED movement, said maneuvering subsystem prevents said movement.

279. The method according to claim 248, wherein said at least one location estimating means comprises at least one endoscope adapted to acquire real-time images of a surgical environment within said human body; and at least one surgical instrument spatial location software adapted to receive said real-time images of said surgical environment and to estimate said 3D spatial position of said at least one surgical tool.

280. The method according to claim 248, wherein said at least one location estimating means comprises (a) at least one element selected from a group consisting of optical imaging means, radio frequency transmitting and receiving means, at least one mark on said at least one surgical tool and any combination thereof; and (b) at least one surgical instrument spatial location software adapted to estimate said 3D spatial position of said at least one surgical tool by means of said element.

281. The method of claim 248, wherein said at least one location estimating means is an interface subsystem between a surgeon and said at least one surgical tool, the interface subsystem comprising:

b. at least one array comprising cameras, where M is a positive integer;

d. a computerized algorithm operable via the controller, said computerized algorithm adapted to record images received by each of the M cameras and to calculate thereirom the position of each of the tools, and further adapted to provide automatically the results of the calculation to the human operator of the interface.