CN113576557A

CN113576557A - Surgical laparoscopic instrument, laparoscopic surgical instrument, and laparoscopic intervention kit

Info

Publication number: CN113576557A
Application number: CN202110815754.2A
Authority: CN
Inventors: 石红
Original assignee: Beijing Jisi Technology Co ltd
Current assignee: Beijing Jisi Technology Co ltd
Priority date: 2021-07-19
Filing date: 2021-07-19
Publication date: 2021-11-02

Abstract

The invention provides a surgical laparoscopic instrument, a laparoscopic surgical instrument and a laparoscopic intervention kit. A surgical laparoscopic instrument according to the present invention, comprising: a connection assembly having a shaft, a first end and a second end; an end effector having a rotational axis incident to the shaft of the linkage assembly at a second end of the linkage assembly, the end effector being mounted on the second end of the device linkage assembly; a manipulation unit having a rotation shaft incident to a shaft of the coupling assembly at a first end of the coupling assembly, the manipulation unit being mounted at the first end of the first coupling assembly; means for transmitting motion from the steering unit to an end effector.

Description

Surgical laparoscopic instrument, laparoscopic surgical instrument, and laparoscopic intervention kit

Technical Field

The invention relates to the field of medical instruments, in particular to a surgical laparoscopic instrument. More particularly, the present invention relates to a hand-held instrument equipped with a highly dexterous limb that allows very precise surgical performance as in a robotic system while maintaining very low cost for all hand-held surgical instruments. The invention also relates to a kit containing the laparoscopic surgical instrument, and an instrument holder, such as a trocar, for inserting the instrument through an incision into the abdominal cavity of a patient.

Background

Laparoscopic surgery, also known as Minimally Invasive Surgery (MIS), was a technique developed in the late 50 s. Due to laparoscopic surgery, surgeons can manipulate the internal tissues of patients, keeping their hands away from the surgical field. The surgical instrument is inserted into the patient's body through a small skin incision and a tool at both ends. Instruments are controlled by the surgeon, particularly laparoscopic instruments, through an instrument holder (also known as a trocar) into the abdominal cavity of the patient. A trocar is a surgical instrument that consists of an obturator, a cannula (i.e., a hollow tube), and a seal. In laparoscopic surgery, a trocar is placed through the abdominal cavity and used as an access port for subsequent placement of additional cannulae. The main advantage of the accessories of the instruments, such as graspers, scissors, staplers, etc., is that the laparoscopic technique provides the patient with less invasiveness of the operation (i.e. less pain and risk of bleeding and infection), which reduces the cost of the social health system due to the smaller incision and faster post-operative recovery time. It is well known that surgical instruments must meet several requirements such as small size, multiple degree of freedom efficiency, reliable/robust instrumentation, controllable cost. The surgeon can control the tool at the end of the instrument: (i) namely, the remote operation is carried out through a robot system; (ii) operated directly by a hand-held instrument. Laparoscopic instruments can be classified according to their type of motion. The trocar has four degrees of freedom: one translation along the quill and three rotations. The three rotations allowed are about the axis of the cannula and two perpendicular to the cannula. Each laparoscopic instrument can be inserted into a trocar, thus the four degrees of freedom mentioned above, also referred to as "gratuitous" degrees of freedom in the field.

That is, handheld instruments have only four "gratuitous" degrees of freedom, typically a fixed section or end effector, and most surgeons can only control the opening/closing of the instrument. Robotic systems instead typically use surgical instruments with smart limbs or end effectors, i.e., the surgeon may also control motions other than "gratuitous" degrees of freedom.

The main advantages of hand-held surgical instruments are cost-effectiveness, are cheaper than robotic systems employing instruments, and generally require less surgical time for a trained surgeon. On the other hand, the robotic system has the advantages of precision and repeatability in performing surgical tasks, stability of tools, force tool-tissue control and surgical-hand tremor reduction, while the main disadvantages are high procurement and maintenance costs of the robotic system, high property burden and high pre-operative time. In this context, it is highly desirable to design a hand-held surgical instrument that can better balance the requirements of high efficiency, low surgical time and cost. In other words, the high precision and execution control capabilities of hand-held instruments need to be made comparable to robotic systems.

Furthermore, the robots known in the prior art, besides the drawbacks involved in the high costs involved, have not only slight restrictions with respect to the movements allowed by the end-effector. Most surgical robotic tools provide a cylindrical and straight body for transferring robotic system console motions to the end effector. From the opening and closing (e.g., one clip) motion of the end effector and the four "gratuitous" degrees of freedom of the trocar, only one degree of freedom of motion is allowed, typically orthogonal to the axis of rotation of the circular body. In the most advanced robotic tools, also having end effectors that allow two degrees of rotational freedom, the instrument as a whole has more than four "gratuitous" degrees of freedom, compared to the opening and closing motions of other end effectors. The first degree of freedom of movement is rotation about a first axis and the second degree of freedom of movement is rotation about a second axis orthogonal to the first axis and to the center.

However, even with such advanced robots, movement of the end effector about its own axis is not allowed, and dexterity is limited without the first and second axes being incident on a unique point. The second axis and the first axis are obliquely straight lines, so that two predetermined rotations around a fixed center do not occur. Further, in this context, the possibility of the end effector rotating about its own axis is not possible when the latter is not aligned with the linear central body.

In other words, it is known that none of the known robots, or known smart limb instruments, provide a ball joint at the interface between the central body and the end effector to enable such movement of the end effector. Finally, it is desirable to allow the surgeon to perform a greater range of possible executable procedures and optimal control performance of the instrument. Therefore, the latest trend is that robotic systems need to constantly improve their surgical dexterity.

In addition to the above, in most known instruments (robotics and hand-held), only the opening and closing of the end effector is controllable by the surgeon, while the same opening takes place by means of a spring, without any possibility of control. In some instruments, a mechanism is provided to ensure control of the opening and closing operations of the end effector, but its complicated mechanism requires an increase in the size of the end effector or, more precisely, the spatial size of the connecting portion between the end effector and the central body. For these reasons, in the current state of the art, there is a great need for a mechanism that allows the surgeon to open and close the end-effector with good precision, while being simple in construction, being of moderate size, and not having an excessively long distance between the central body and the end-effector.

The last important issue that has not yet been addressed is how to deal with the forces exerted by the intersecting tissue during the suturing procedure. In fact, when performing surgical suturing, the surgeon needs to perform an action about a first axis and when the tissue is penetrated by the needle held by the end-effector, a torque may be generated on the end-effector due to the reaction force and thus on the central body. When the instrument is operated in this curved state, such torque can cause unintended rotation of the end effector, and even the central body, about its own axis. Therefore, there is a need to find a way to compensate for the unintended rotation of the tissue as the surgeon manipulates the tissue.

The main drawbacks of robotic systems are the high procurement and maintenance costs of the robotic systems, the high property burden and the high pre-operative time, with considerable restrictions with respect to allowing movement of the end-effector, in addition to the drawbacks involved in the high costs involved. There is a need to improve the surgical dexterity of robotic systems to achieve an optimal control that allows a wider range of possible surgeons and instruments to be performed.

In addition to the above, in most known instruments (robotics and hand-held), only the opening and closing of the end-effector is controllable by the surgeon, while the same opening takes place by means of springs, without any possibility of freedom control. Some mechanisms seem to add other degrees of freedom, but the mechanism complexity increases dramatically, increasing in size, leading to poor practicality.

In addition, when performing surgical stapling, the surgeon performs a motion about the first axis, and the same pressure on the end effector can produce a torque, and thus a torque on the central body, as the tissue is passed by the needle held by the end effector. When the instrument is operated in this bending condition, this torque causes the tip to perform an accidental rotation, while at the same time the central body also rotates about its own axis.

For these reasons, in the current state of the art, there is a great need for a mechanism that is low cost, simple in construction, of moderate size, capable of allowing the surgeon to open and close the end effector with good precision, has control capabilities for other necessary degrees of freedom, and compensates for the inadvertent rotation of the surgeon while manipulating the tissue.

For example, FIG. 1 is a schematic diagram of the degrees of freedom of a prior art trocar that allows any laparoscopic surgical instrument to be inserted into the trocar when in use. Referring to fig. 1, as mentioned above, prior art instruments are inserted in use into an instrument holder, referred to as a trocar 6, which guides laparoscopic surgical instruments through an incision into a patient's cavity. Thus, there are four degrees of freedom in the trocar 6, regardless of the instrument inserted therein. The first is the translational degree of freedom 3 along the axis of the linear cannula 5 of the trocar 6. The other three degrees of freedom are degrees of rotation. Specifically, they are: a first degree of rotation 4 about an axis parallel to the sleeve 5; a second degree of rotation 1 about a first axis perpendicular to the sleeve 5; and a third degree of rotation 2 about a second axis, the second axis being perpendicular to the first axis.

Disclosure of Invention

The present invention is directed to overcoming the above-mentioned problems of the prior art and providing a laparoscopic surgical instrument with improved control and more dexterous degrees of freedom of movement.

A first object of the present invention is to provide an instrument that combines the advantages of the prior art hand-held instruments with low operating time and low cost, while having the advantages of precision and controllability in the operation of the robotic system.

It is a second object of the invention to provide a hand-held instrument that expands the space available for the surgeon to perform maneuvers as compared to the range allowed for robotic system instruments.

In particular, the invention also provides an instrument that allows rotational motion of the end effector with at least two degrees of freedom, i.e., rotation about two axes of incidence. More specifically, the first rotational movement is about an axis that lies in an orthogonal plane, is connected to the central axis of the central body, and passes through the point of connection of the end effector to the central body, and the second rotational body is about the axis of the end effector itself. Because the centerbody is prismatic or cylindrical, the axis of the centerbody may be designated the "longitudinal axis".

It is a third object of the invention to provide a hand-held instrument. Including a mechanism for opening and closing the end effector that allows the surgeon fine control over both operations while having a small size and a distance between the central body and the end effector arm that is not too long.

A fourth object of the invention is to provide an instrument that is able to compensate for the unexpected rotation that occurs when the surgeon intervenes in the tissue operation, in particular the torque that occurs during the surgical stapling operation by crossing the tissues.

Specifically, according to the present invention, there is provided a surgical laparoscopic instrument comprising:

a connection assembly having a shaft, a first end and a second end;

an end effector having a rotational axis incident to the shaft of the linkage assembly at a second end of the linkage assembly, the end effector being mounted on the second end of the device linkage assembly;

a manipulation unit having a rotation shaft incident to a shaft of the coupling assembly at a first end of the coupling assembly, the manipulation unit being mounted at the first end of the first coupling assembly;

means for transmitting motion from the steering unit to an end effector;

wherein the means for transmitting motion comprise at least:

□ a first transfer device for performing a first rotary motion of the steering unit about a first axis belonging to said plane orthogonal to the axis of the linkage assembly and incident at the same angle to the axis of the linkage assembly at the first end of the linkage assembly and connected to the end effector in such a way that the end effector rotates about an axis orthogonal to the axis of the linkage assembly and incident to the axis of the linkage assembly at the second end of the linkage assembly; and

□ second transfer means for performing a second rotational movement of the manipulation unit about its own axis to the end effector to cause the end effector to rotate about its own axis, the axis of the end effector being parallel to the axis of the manipulation unit.

Preferably, the connecting assembly comprises a frame and the first transfer device comprises:

a first bevel gear connected to the manipulation unit, an apex of which is located at a position corresponding to the first end of the connection assembly;

a second bevel gear forming a first gear assembly with the first bevel gear such that rotation of the first bevel gear about its own axis causes rotation of the second bevel gear about its own axis;

a third bevel gear coupled with the end effector and having an apex corresponding to a second end of the coupling assembly;

a fourth bevel gear forming a second gear assembly with the third bevel gear such that rotation of the fourth bevel gear about its own axis causes rotation of the third bevel gear about its own axis; and

a hollow tube aligned with the axis of the connection assembly and nested within the frame, the tube cooperating with the second bevel gear and the fourth bevel gear such that rotation of the second bevel gear about its own axis causes rotation of the fourth bevel gear about its own axis.

Preferably, the second transfer device comprises:

a first shaft connected with the manipulation unit;

a second shaft connected to the end effector;

a third shaft aligned with the shaft of the connection assembly, the third shaft being received in the hollow tube; a first gimbal centered corresponding to the first end of the connection assembly; and

a second gimbal centered in correspondence with the second end of the connection assembly.

Preferably, the surgical laparoscopic instrument further comprises a stop mounted on the frame, the stop configured to prevent rotation of the frame about the axis of the connecting assembly when the first and third shafts are rotated and the first, third and second shafts are aligned with the axis along the connecting assembly.

Preferably, the manipulation unit includes: a handle and a drum brake connecting the handle to the first shaft; the drum brake includes: the clutch device comprises a suction pad, a compression pad, a spring for connecting a clutch plate and the compression pad, a roller pulley firmly connected with a first shaft and an operation ring; the handling ring is connected with the drum pulley, and rotation of the handling ring around its own axis causes rotation of the drum pulley and thus of the first shaft around its own axis.

Preferably, the first transfer means comprises: a first shaft connected with the manipulation unit; a second shaft connected to the end effector; a third shaft aligned with the axis of the linkage assembly, a first end of the third shaft coincident with the first end of the linkage assembly and a second end of the third shaft coincident with the second end of the linkage assembly; the fourth shaft is connected with the third shaft through a first flexible hinge, and the rotation center of the first flexible hinge is superposed with the first end of the third shaft; the fifth shaft is connected with the third shaft through a second flexible hinge, and the rotation center of the second flexible hinge is superposed with the second end of the third shaft; a sixth shaft connected to the first portion of the fourth shaft by a third flexible hinge and to the first portion of the fifth shaft by a fourth flexible hinge; and a seventh shaft connected to the second portion of the fourth shaft by a fifth flexible hinge and to the second portion of the fifth shaft by a sixth flexible hinge.

Preferably, the second transfer device comprises: a first shaft fixedly connected with the operating unit; a second shaft fixedly connected to the end effector; a third shaft aligned with the shaft of the linkage assembly; a first torque coil having a first end connected to the first end of the first shaft and a second end connected to the first end of the third shaft, the first end of the linkage assembly being located between the first and second ends of the first torque coil; and a second torque coil having a first end connected to the second end of the third shaft and a second end connected to the first end of the second shaft, the second end of the connection assembly being between the first and second ends of the second torque coil.

Preferably, the second torque coil is connected to the end effector by means for translating movement of the second torque coil along its own longitudinal axis.

The present invention also provides a laparoscopic surgical instrument comprising:

a connection assembly having a shaft, a first end and a second end;

an end effector mounted on a first end of the linkage assembly;

a manipulation unit mounted at a second end of the linkage assembly, the manipulation unit including a trigger;

a pulley connected to the trigger;

an idler pulley;

means for transmitting motion from the steering unit to the end effector;

a first shaft connected with the manipulation unit;

a second shaft connected to the end effector;

wherein, the end effector includes:

a first arm;

a second arm;

a pulley fixedly connected to the first arm;

a first gear connected to the second arm; and

a second gear forming a gear assembly with the first gear, the second gear concentric with and integrally connected to the pulley.

The present invention also provides a laparoscopic surgical instrument adapted to cooperate with an instrument holder to insert the laparoscopic surgical instrument at least partially into a patient cavity through an incision, the instrument comprising:

a connection assembly having a shaft, a first end and a second end, the connection assembly including a frame;

means for transmitting a rotational movement of the manipulation unit about its own axis to at least the end effector such that the end effector rotates about its own axis, the axis of the end effector being parallel to the axis of the manipulation unit;

the instrument includes a blocking device mounted on the frame, the blocking device configured to prevent the frame from inadvertently rotating about an axis of the connection assembly, the device including:

a support structure having means for docking the device to the instrument holder;

the two truncated cone rollers and the frame are arranged between the two truncated cone rollers; and

a lever configured to allow translation of the two truncated cone rollers from a first position in which the two truncated cone rollers are not in contact with the frame to a position in which the two truncated cone rollers are in contact with the frame, the frame being prevented from rotating about the axis of the connection assembly by friction, the translation of the frame along the axis of the connection assembly remaining allowed.

The present invention also provides a kit for laparoscopic intervention, comprising:

the aforementioned surgical laparoscopic instrument or the aforementioned laparoscopic surgical instrument;

an instrument holder for inserting the laparoscopic surgical instruments at least partially through an incision into a patient's cavity, said instrument holder having means for docking the instrument holder to a blocking device, the means for docking the instrument holder being configured to cooperate with the docking means of the support structure of the blocking device.

The use of the hand-held laparoscopic instruments and instruments with highly dexterous limbs of the present invention allows very precise surgical procedures to be performed as in a robotic system while maintaining very low cost for all hand-held surgical instruments. In addition, compared with the best existing handheld laparoscopic instrument technology, the invention has better control performance and more flexible motion freedom.

The instrument according to the invention allows a rotational movement of the end-effector with at least two degrees of freedom, which is enabled by means of an intermediate designed mechanism to allow rotation of the end-effector around two incident axes. Additionally, the end effector may also implement a mechanism for including opening and closing the end effector that allows the surgeon fine control over both operations while having a small size, the distance between the central body and the end effector arm is not too long. The instrument according to the invention makes it possible to compensate for the unexpected rotation of the surgeon operating on the tissue, in particular the torque generated by the crossing of the tissue during the surgical stapling operation, by means of the blocking means on the mounting frame.

Drawings

A more complete understanding of the present invention, and the attendant advantages and features thereof, will be more readily understood by reference to the following detailed description when considered in conjunction with the accompanying drawings wherein:

FIG. 1 is a schematic view of the degrees of freedom of a prior art trocar for inserting any laparoscopic surgical instrument into the trocar when in use;

FIG. 2 is a schematic view of the laparoscopic surgical instrument of the present invention illustrating the rotational movement from the manipulation unit to the end effector;

FIG. 3 is a side view of a fifth embodiment of the laparoscopic surgical instrument of the present invention showing a first shaft, a second shaft, and a third shaft aligned with the holder;

FIG. 4 is a side view of a fifth embodiment of the laparoscopic surgical instrument of the present invention showing a first shaft, a second shaft, and a third shaft aligned with the holder;

FIG. 5a is a top view of a fifth embodiment of the laparoscopic surgical instrument of the present invention, showing a first axis, a second axis about separate first axes U1 and U' 1;

FIG. 5b is a side view of a fifth embodiment of the laparoscopic surgical instrument of the present invention, showing the first axis, the second axis about separate first axes U1 and U' 1;

fig. 6a is a side view of a detail of a fifth embodiment of the invention, corresponding to the means for transmitting the first rotary motion, corresponding to the handling unit;

fig. 6b is a side view of a detail of a fifth embodiment of the instrument according to the invention, corresponding to the means for transmitting the first rotary motion, corresponding to the end effector;

FIG. 7a is a top view of a fifth embodiment 5 of the apparatus of the present invention, wherein the first and second shafts rotate about second axis U2 and axis U' 2, respectively;

FIG. 7b is a side view of a fifth embodiment of the apparatus of the present invention, the first and second shafts of the present invention rotating about second axis U2 and axis U' 2, respectively;

fig. 8a is a side view of a fifth embodiment of the apparatus according to the invention, the details of which relate to a second rotary movement of the means for transferring in correspondence with the handling unit;

FIG. 8b is a side view of a detail of a fifth embodiment of the apparatus according to the invention, wherein the detail relates to a second rotary movement relative to the end effector with respect to the means for transferring;

figure 9a is a side view of a detail of a fifth embodiment of the apparatus of the invention, the detail relating to a brake pad;

figure 9b is a top view of a detail of the fifth embodiment of the apparatus, the detail relating to the stop block;

FIG. 10a is a perspective view of a fifth embodiment of the apparatus of the present invention, including the first, second and third axes aligned;

fig. 10b is a perspective view of a fifth embodiment of the apparatus of the invention, the second shaft U3 coinciding with the shaft U3 of the connecting assembly when the first shaft is rotated about the second shaft U2 by an angle of less than 90 ° with respect to the third shaft;

fig. 10c is a perspective view of a fifth embodiment of the apparatus of the invention, the second shaft U2 coinciding with the shaft U3 of the connecting assembly when the first shaft is rotated through an angle of 90 ° about the second shaft U2 relative to the third shaft;

fig. 11 is a perspective view of a fifth embodiment of the inventive apparatus when the first shaft is rotated 90 ° about the second shaft U2 relative to the third shaft and about a fourth shaft U4 orthogonal to the shaft U3 and the first shaft U1, the second shaft U2 coinciding with the shaft U3 of the linkage assembly 5;

FIG. 12 is a schematic view of a sixth and thirteenth embodiments of the laparoscopic surgical instrument of the present invention;

FIG. 13 is a schematic illustration of a sixth and thirteenth detail of an embodiment of the laparoscopic surgical instrument of the present invention, the details relating to an example of a flexible hinge included in the means for transmitting the first rotational motion;

FIG. 14 is a schematic view of a sixth and thirteenth embodiments of the laparoscopic surgical instrument of the present invention;

FIG. 15 is a longitudinal section of a detail of the apparatus according to the invention, the detail relating to the handling unit;

FIG. 16a is a first perspective view of a detail of a fifth embodiment of the apparatus of the present invention, the detail being relative to an end effector;

FIG. 16b is a second perspective view of a detail of an end effector of a fifth embodiment of the instrument of the present invention, the detail being relative to the end effector;

FIG. 17 is a perspective view of a detail of the instrument of the invention, wherein the detail relates to the self-rotating mass element associated with the coupling assembly shaft of the invention;

FIG. 18a is a perspective view of a detail of the kit of the present invention, wherein the detail relates to a block element relative to a self-rotating shaft of the connection assembly of the present invention;

FIG. 18b is a perspective view of a detail of the kit of the present invention, the detail being relative to a trocar;

FIG. 19a is a side view of a detail of the apparatus of the invention, the detail relating to the first embodiment relative to the handle;

fig. 19b is a side view of a detail of the apparatus of the invention, the detail relating to a second embodiment of the handle.

It is to be noted, however, that the appended drawings illustrate rather than limit the invention. It is noted that the drawings representing structures may not be drawn to scale. Also, in the drawings, the same or similar elements are denoted by the same or similar reference numerals.

Detailed Description

In order that the present disclosure may be more clearly and readily understood, reference will now be made in detail to the present disclosure as illustrated in the accompanying drawings.

< first embodiment >

With reference to fig. 2, 3, 4, 6a, 6b, 8a, 8b, 12 and 14, the apparatus of the invention comprises:

□ a connection assembly 201 having an axis U3, a first end A and a second end B;

□ end effector 301 having an axis of rotation U' 2 incident on the axis U3 of linkage assembly 201 at the second end B of linkage assembly 201, the end effector 301 being mounted on the second end B of the device linkage assembly 201;

□ a steering unit 101 having a rotational axis U2 incident on the axis U3 of the linkage assembly 201 at a first end A of the linkage assembly 201, the steering unit 101 being mounted at the first end A of the first linkage assembly 201;

□, means (111, 211, 311, 411, 110, 210, 310, 400, 400 ', 310', 110', 210', 410, 510, 610, 710, 511, 611, 711, 811, 911,110 ", 210", 310 ", 91, 92) for transmitting movements from said handling unit 101 to the end effector 301;

wherein the means for transmitting motion comprise at least:

□ first transfer means (111, 211, 311, 411, 310', 110', 210', 410, 510, 610, 710, 511, 611, 711, 811, 911) for performing a first rotary movement of the steering unit 101 about a first axis U1, the first axis U1 belonging to said plane orthogonal to the axis U3 of the joining assembly 201 and being incident at the same angle to the axis U3 of the joining assembly 201 at the first end a of the joining assembly 201 and being connected to the end effector 301 in such a way that the end effector 301 rotates about an axis U' 1 orthogonal to the axis U3 of the joining assembly 201 and incident at the second end B of the joining assembly 201 to the axis U3 of the joining assembly 201; and

□ second transport means (110, 210, 310, 400, 400 ', 110 ", 210", 310 ", 91, 92) for carrying out a second rotary movement of the manipulation unit 101 about its own axis U2 are transmitted to the end effector 301 so that the end effector 301 is rotated about its own axis U ' 2, the axis U ' 2 of the end effector 301 being parallel to the manipulation unit 101 axis U2.

Thus, the instrument of the invention has at least two rotational degrees of freedom θ 1, θ 2, in addition to the degree of freedom ensured by the movement of the trocar, the instrument must be inserted into the trocar while in use during a surgical intervention. The first rotational degree of freedom θ 1 is associated with the above-described first rotational movement, and the second rotational degree of freedom θ 2 is associated with the second rotational movement. Assuming that the instrument is inserted into the patient cavity through the patient surface 10, the working area of the instrument is divided into two main areas: the first region 11 is outside the patient's cavity and the second region is inside the patient's cavity 11 '. The rotations θ 1, θ 2 of the manipulation unit 101 are applied in the first area 11 and transmitted to the end effector, which rotates into the second area 11', by means of a device coinciding with the connection assembly 201 or placed in the connection assembly 201. The connection assembly 201 is passed through the patient surface 10.

With reference to fig. 1, 2, 10a, 10b, 10c and 11, in addition to the two rotational degrees of freedom θ 1, θ 2 described above, the instrument of the invention can be used to transmit from the steering unit 101 to the end effector 301 another rotation θ 4 about a second axis U4 orthogonal thereto, orthogonal to the axis U3 of the linkage assembly 201, and incident on the axis U3 of the first end a of the linkage assembly 201. This further rotation θ 4 is transmitted to the end effector 301 in such a way that the end effector 301 rotates about an axis U4' parallel to the second axis U4 and is incident on the axis U3 of the linkage assembly 201 at the second end B of the linkage assembly 201.

This additional rotation θ 4 may be performed using the instrument as shown below. Starting from the position in which both the manipulating unit 101 own axis U2 and the end effector 301 own axis U' 2 are aligned with the axis U3 of the linkage assembly 201, the manipulating unit 101 can rotate 90 ° about its own axis U2 and then about the second axis U4, by using the same means that allow the manipulating unit 101 to rotate about the first axis U1. Furthermore, due to the same means for transmitting the first rotational movement from the manipulation unit 101 to the end effector 301, the rotation of the manipulation unit 101 about the second axis U4 may be transmitted to the end effector 301.

Referring to figures 2, 3, 4, 5a, 5b, 6a, 6b, 7a, 7b, 8a and 8b, a first embodiment of the apparatus of the present invention, the connection assembly 201 comprises a cylindrical frame 100. The first transfer device includes:

a first bevel gear 111 firmly coupled to the manipulation unit 101, having an apex at a position corresponding to the first end a of the coupling assembly 201;

a second bevel gear 211 forming a first gear assembly with the first bevel gear 111 such that rotation of the first bevel gear 111 about its own axis causes rotation of the second bevel gear 211 about its own axis;

a third bevel gear 311 fixedly connected to said end effector 301 and having an apex corresponding to a second end B of said connecting assembly 201;

fourth bevel gear 411 forming a second gear assembly with third bevel gear 311 such that rotation of fourth bevel gear 411 about its own axis causes rotation of third bevel gear 311 about its own axis; and

a hollow tube 70 aligned with the axis U3 of the connection assembly 201 and nested within the frame 100, said tube 70 cooperating with the second bevel gear 211 and the fourth bevel gear 411 such that rotation of the second bevel gear 211 about its own axis causes rotation of the fourth bevel gear 411 about its own axis.

The second transfer device includes:

a first shaft 110 firmly connected to the manipulation unit 101;

a second shaft 210 fixedly connected to the end effector 301;

a third shaft 310 aligned with axis U3 of connection assembly 201, said third shaft 310 being housed in hollow tube 70;

a first gimbal 400 centered in correspondence with the first end a of the connection assembly 201; and

a second gimbal 400' centered with respect to the second end B of the connection assembly 201.

Referring to fig. 9a and 9b, the first embodiment of the apparatus of the present invention further comprises a stop 60 mounted on the frame 100, said stop 60 being configured to prevent inadvertent rotation of the frame 100 about the axis U3 of the linkage assembly 201 when the first and

third shafts

110, 100 are rotated, and when the first, third and

second shafts

110, 310, 210 are aligned with the axis U3 along the linkage assembly 201.

< second embodiment >

With reference to fig. 2, 3, 4, 5a, 5b, 6a, 6b, 7a, 7b, 8a, 8b, 15, 19a and 19b, a second embodiment of the invention comprises all the features described above with respect to the first embodiment, but in addition the steering unit 101 of the second embodiment comprises:

□ handles 500, 500';

□ to connect the handle 500,500 'to the

first shaft

110, 110', 110 ", the drum brake comprising:

□ attraction pad 41

□ compression pad 42

□ spring 43 connecting the clutch plates and compression pad 42;

□, roller pulleys 44110,110', 110 ";

the steering rings 501, 501 ' are firmly connected with the drum pulley 44, rotation of the steering rings 501, 501 ' around their own axis causing rotation of the drum pulley 44 and thus the first shaft 110,110 ', 110 ″ around its own axis.

< third embodiment >

Referring to fig. 2, 3, 4, 15, 16a, 16b, 19a and 19b a third embodiment of the present invention comprises:

a connection assembly 201 having an axis U3;

an end effector 301 mounted on a first end of the linkage assembly 201, the end effector 301 comprising:

a first arm 161;

a second arm 162;

a pulley 171 fixedly secured to the first arm 161;

the first gear 152 is fixedly connected with the second arm 162;

a second gear 151 forming a

gear assembly

151, 152 with the first gear 152, the second gear 151 being concentrically and integrally connected with the pulley 171;

a manipulation unit 101 mounted at a second end of the connection assembly 201, the manipulation unit 101 comprising:

flip-flops 502, 502';

a pulley 503 fixedly attached to the triggers 502, 502'; and

an idler pulley 504; and

a first shaft fixedly connected to the manipulation unit 101;

a second shaft fixedly attached to end effector 301.

In order to allow the movement a of the two arms 161,162, determining the opening and closing of the end-effector 301, the instrument comprises means for transmitting the motion from the handling unit 101 to the end-effector 301, comprising a cable, not shown in the figures, connecting the pulley 503 of the handling unit 101 with the pulley 171 of the end-effector 301, said cable being divided into two parts by means of an idler pulley 504 before being wrapped around the pulley 503 of the handling unit 101.

In order to allow the movement a of the two arms 161,162, means of the end effector 301 are defined, which means comprise a cable, not shown in the figures, which connects the pulley 503 of the steering unit with the pulley 171 of the end effector, which cable is divided into two parts by means of an idler pulley 504 and then wrapped. Around the pulley 503 of the steering unit 101. In particular, the cable is inserted into a sheath of the connection assembly 201, the sheath having a first end fixedly connected to the first shaft and a second end fixedly connected to the second shaft.

In particular, the cable is inserted into the sheath of a connection assembly 201, the connection assembly 201 having a first end firmly connected to a first shaft and a second end firmly connected to a second shaft.

For purposes of this specification, the term "jacket" refers to "a flexible protective outer jacket over a cable". That is, the sheath and cable are similar to the sheath and wire of a bicycle brake transmission.

< fourth embodiment >

Referring to fig. 2, 3, 4, 5a, 5b, 6a, 6b, 7a, 7b, 8a, 8b, 15, 16a and 16b, a fourth embodiment of the present invention comprises:

□ A connecting assembly 201 having an axis U3, a first end A and a second end B;

□ end effector 301 having its own axis of rotation U' 2 incident at a second end B on the axis U3 of the linkage assembly 201, the end effector 301 being mounted on the second end B of the linkage assembly 201 and comprising:

□ first arm 161;

□ second arm 162;

□ are fixedly secured to the first arm 161;

□ the first gear 152 is fixedly connected to the second arm 162;

□ a second gear 151 forming a

gear assembly

151, 152 with the first gear 152, the second gear 151 being concentric with and integrally connected to the pulley 171;

□ steering unit 101, the rotation axis U2 of which is incident at a first end A on the axis U3 of the joining assembly 201, said steering unit 101 being mounted on the first end A of the joining assembly 201 and comprising

□ triggers 502, 502';

□, a pulley 503 fixedly connected to the triggers 502, 502'; and

□ idler pulley 504;

□ for transmitting a first rotary motion of 111, 211, 311, 411, 310', 110', 210', 410, 510, 610, 710, 411, 511, 611, 711, 811, 911 steering unit 101 about a first axis U1, which belongs to said plane orthogonal to axis U3 of linkage assembly 201 and is incident at the same angle to axis U3 of linkage assembly 201 at a first end a of linkage assembly 201, and is connected to end effector 301 in such a way that end effector 301 rotates about axis U' 1 orthogonal to axis U3 of linkage assembly 201 and incident to axis U3 of linkage assembly 201 at a second end B of linkage assembly 201;

□ for transferring a second rotary motion of the steering unit 101 about its own axis U2 to the means of the end effector 301, such that the end effector 301 rotates about its own axis U' 2.

Referring to fig. 2, 3, 4, 5a, 5b, 6a, 6b, 7a, 7b, 8a, 8b, 16a and 16b, the connection assembly 201 includes a cylindrical frame 100. The means for transmitting 111, 211, 311, 411 a first rotary motion comprise:

□ is firmly connected to the steering unit 101, the vertex of which is located in a position corresponding to the first end a of the connecting assembly 201;

□ second bevel gear 211 forming a first gear assembly with first bevel gear 111 such that rotation of first bevel gear 111 about its own axis causes rotation of second bevel gear 211 about its own axis;

□ a third bevel gear 311 fixedly connected to the end effector 301 and having an apex corresponding to the second end B of the linkage assembly 201;

□ with third bevel gear 311 forming a fourth bevel gear 411 of the second gear assembly, such that rotation of fourth bevel gear 411 about its own axis causes rotation of third bevel gear 311 about its own axis; and

□ hollow tube 70 aligned with axis U3 of connection assembly 201 and housed in frame 100, said tube 70 cooperating with said second bevel gear 211 and said fourth bevel gear 411 such that rotation of said second bevel gear 211 about its own axis causes rotation of said fourth bevel gear 411 about its own axis.

The means for transmitting 110, 210, 310, 400, 400' the second rotational movement comprise:

□ is fixedly connected to the first shaft 110 of the operating unit 101

□ fixedly attached to end effector 301;

□ aligned with the axis U3 of the connection assembly 201, the third axis 310 being housed in the tube 70;

□ a first gimbal 400 centered in correspondence with the first end a of the connection assembly 201; and

□ correspond to the second end B of the connecting member 201 and a second gimbal 400' centered therein.

In order to allow the movement a of the two arms 161,162, determining the opening and closing of the end-effector 301, the instrument comprises means for transmitting the movement from the manipulation unit 101 to the end-effector 301, the cable comprising the pulley 503 connected to the manipulation unit, not shown in the figure, the pulley 171 of the end-effector 301 of 101, said cable being divided into two parts by means of an idler pulley 504 before being wound around the pulley 503 of the manipulation unit 101. In particular, the cable is inserted into the sheath of a connection assembly 201, the connection assembly 201 having a first end firmly connected to a first shaft and a second end firmly connected to a second shaft.

Referring to fig. 9a and 9b, the fourth embodiment of the apparatus of the present invention further comprises a stop 60 mounted on the frame 100, the stop 60 being configured to prevent inadvertent rotation of the frame 100 about the axis U3 of the linkage assembly 201, the third and

second axes

310, 210 being aligned along the axis U3 of the linkage assembly 201 as the first axis 110 rotates.

< fifth embodiment >

With reference to fig. 2, 3, 4, 5a, 5b, 6a, 6b, 7a, 7b, 8a, 8b, 15, 16a, 16b and 19a and 19b, a fifth embodiment of the invention comprises all the features described above with respect to the fourth embodiment, but in addition the steering unit 101 of the fifth embodiment comprises:

□ handles 500, 500';

□ to connect the handle 500,500 'to the

first shaft

110, 110', 110 ", the drum brake comprising:

□ clutch plates 41;

□ compress the pad 42;

□ spring 43 connecting clutch plate and compression plate 42; and

□, a roller pulley 44 fixedly connected to the first shaft 110, 110';

< sixth embodiment >

With reference to fig. 2, 12, 13 and 14 in a sixth embodiment of the apparatus of the invention, the device for transmitting (5310', 110', 210', 410, 510, 610, 710, 411, 511, 611, 711, 811, 911) a first rotary motion comprises:

□ to the steering unit 101;

□ fixedly attached to the end effector 301;

□ the third shaft 310' is aligned with the axis U3 of the linkage assembly 201, the first end of the third shaft 310' coincides with the first end A of the linkage assembly 201, and the second end of the third shaft 310' coincides with the second end B of the linkage assembly 201;

□ a fourth shaft 410 connected to the third shaft 310 'by a first flexible hinge 411 whose centre of rotation coincides with the first end A of the third shaft 310';

□ a fifth shaft 510 connected to the third shaft 310 'by a second flexible hinge 511, the centre of rotation of the second flexible hinge coinciding with the second end B of the third shaft 310';

□ sixth shaft 610, connected to the first part H1A of the fourth shaft 410 by a third flexible hinge 611 and to the first part H4B of the fifth shaft 510 by a fourth flexible hinge 711; and

□ the seventh shaft 710 is connected to the second part AH2 of the fourth shaft 410 by a fifth flexible hinge 811 and to the second part BH3 of the fifth shaft 510 by a sixth flexible hinge 911.

First flexible hinge 411, second flexible hinge 511, third flexible hinge 611, fourth flexible hinge 711, fifth flexible hinge 811, and sixth flexible hinge 911 are preferably, but not limited to, circular flexible hinges.

In contrast, the means for transmitting the second rotary motion 110 ", 210", 310 ", 91,92 comprise:

□ to the steering unit 101;

□, and a second shaft 210 "fixedly attached to end effector 301;

□ aligned with axis U3 of connection assembly 201;

□ a first torque coil 91 having a first end a 'connected to the first end of the first shaft 110 ", a second end a" connected to the first end of the third shaft 310 ", the first end a of the connecting assembly 201 being comprised between the first end a' and the second end a" of the first torque coil 91; and

□ second torque coil 92 has a first end B 'connected to the second end of third shaft 310' and a second end B 'connected to the first end of second shaft 210', the second end B of linkage assembly 201 being included between the first end B 'and the second end B' of the second torque coil.

To perform the opening and closing of the end effector, the second torque coil 92 is connected to the end effector 301 by 900 for translating movement S of the second torque coil 92 along its own longitudinal axis, so that the opening/closing movement α of the two arms of the end effector translates the movement S of the second torque coil 92 along its own longitudinal axis, caused by the translation movement of the variator moving the first torque coil 91 along its own longitudinal axis through the third shaft 310 ″. The first torque coil 91 and the second torque coil 92 are inserted into the first sheath 91 'and the second sheath 92', respectively. The first shaft 110' is located within the first hollow tube 800, the second shaft 210 "is mounted within the second hollow tube 802, and the third shaft 310" is disposed within the third hollow tube 801. The first sheath 91' has a first end fixedly connected to the first hollow tube 800 and a second end connected to the third hollow tube 801. Second sheath 92' has a first end fixedly connected to third hollow tube 801 and a second end fixedly connected to second hollow tube 802.

< seventh embodiment >

Referring to fig. 2, 17, 18a, 18b, a seventh embodiment of the present invention, comprises:

□ a connection assembly 201 having an axis U3, a first end A and a second end B, the connection assembly including a frame 100;

□ end effector 301 having its own axis of rotation U' 2 incident at a second end B on the axis U3 of the linkage assembly 201, the end effector 301 being mounted at the second end B of the linkage assembly 201;

□ a steering unit 101, the rotation axis U2 of which is incident at a first end a on the axis U3 of the joining assembly 201, said steering unit 101 being mounted at the first end a of the joining assembly 201;

□ for transmitting the rotary motion of the steering unit 101 about its own axis U2 at least to the means of the end effector 301, so that the end effector 301 rotates about its own axis U '2, the axis U' 2 of the end effector 301 being parallel to the axis U2 of the steering unit 101;

□ A blocking device 50 mounted on a frame 100 and configured to prevent accidental rotation of the frame 100 about an axis U3 of a connection assembly 201, the device 50 comprising:

□ a support structure 30 having means for docking 31, 32 the device 50 to an instrument holder 80 with which an instrument can be engaged, the instrument holder 80 being configured to at least partially insert the laparoscopic surgical instrument through an incision into a patient cavity;

□ two

truncated cone rollers

81, 82, the frame 100 "being placed between the two

truncated cone rollers

81, 82; and

a lever 70 configured to allow translation of the two truncated-

cone rollers

81, 82 from a first position in which the two truncated-

cone rollers

81, 82 are not in contact with the frame 100, to a position in which the two truncated-

cone rollers

81, 82 are in contact with the frame 100, the frame 100 being prevented from rotating about the axis U3 of the connection assembly 201 by friction, the translation of the frame 100 remaining allowed along the axis U3 of the connection assembly 201.

< eighth embodiment >

With reference to fig. 2, 3, 4, 5a, 5b, 6a, 6b, 7a, 7b, 8a, 8b, 17, 18a and 18b, an eighth embodiment of the apparatus of the invention comprises:

□ has a linkage assembly 201 of axis U3, the linkage assembly 201 including a frame 100;

□ mounted on the frame 100, configured to avoid accidental rotation of the frame 100 about the axis U3 of the connection assembly 201, the device 50 comprising:

□ two

truncated cone rollers

81, 82, the frame 100 "being placed between the two

truncated cone rollers

81, 82; and

□ a lever 70 configured to allow translation of the two truncated-

cone rollers

81, 82 from a first position in which the two truncated-

cone rollers

81, 82 are in contact with the frame 100, the translation of the frame 100 along the axis U3 of the connection assembly 201 remaining allowed by preventing, by friction, the rotation of the frame 100 about the axis U3 of the connection assembly 201;

□ a first rotary movement of the handling unit 101 about a first axis U1 belonging to said plane orthogonal to the axis U3 of the joining assembly 201 and incident at the same angle to the axis U3 of the joining assembly 201 at the first end a of the joining assembly 201, and connected to the end effector 301, by the transmission means 111, 211, 311, 411, 310', 110', 210', 410, 510, 610, 710, 411, 511, 611, 711, 811, 911, in such a way that the end effector 301 rotates about the axis U' 1 orthogonal to the axis U3 of the joining assembly 201 and incident at the second end B of the joining assembly 201 to the axis U3 of the joining assembly 201, U3; and

□ are used to transmit a second rotary motion of the manipulation unit 101 about its own axis U2 to the end effector 301 such that the end effector 301 rotates about its own axis U ' 2, the axis U ' 2 of the end effector 301 being parallel to the axis U2 of the manipulation unit 101 of the axis U ' 2 of the end effector 301.

The connection assembly 201 includes a cylindrical frame 100. The means for transmitting 111, 211, 311, 411 a first rotary motion comprise:

□ are aligned with the axis U3 of the connecting assembly 201 and mounted in the housing 100 on a hollow tube 70, said tube 70 cooperating with the second bevel gear 211 and the fourth bevel gear 411 to rotate the second bevel gear 211 about its own axis and thus the fourth bevel gear 411 about its own axis of rotation.

The means for transmitting 110, 210, 310, 400' the second rotary motion comprise:

□ to the steering unit 101;

□ fixedly attached to end effector 301;

Referring to fig. 9a and 9b, eight embodiments of the apparatus of the present invention further comprise a stop 60 mounted on the frame 100, said stop 60 being configured to prevent inadvertent rotation of the frame 100 about the axis U3 of the linkage assembly 201 when the first shaft 110 is rotated, the third shaft 310 and the second shaft 210 being aligned along the axis U3 of the linkage assembly.

< ninth embodiment >

With reference to fig. 2, 3, 4, 5a, 5b, 6a, 6b, 7a, 7b, 8a, 8b, 15, 17, 18a, 18b, 19a and 19b, the ninth embodiment of the present invention comprises all the features described above with respect to the eighth embodiment, but in addition, the manipulation unit 101 of the ninth embodiment comprises:

handles 500, 500';

a drum brake coupling a handle 500,500 'and a

first shaft

110, 110', 110 ", the drum brake comprising:

a clutch plate 41;

a compression pad 42;

a spring 43 for connecting the clutch plate and the compression pad 42; and

a drum 44 fixedly connected to the

first shaft

110, 110', 110 ";

< tenth embodiment >

Referring to fig. 2, 3, 4, 15, 16a, 16b, 17, 18a and 18b, the tenth embodiment of the present invention includes:

□ a connection assembly 201 having an axis U3 of the connection assembly 201 and including a frame 100;

□ an end effector 301 having its own axis of rotation U' 2 incident on the axis U3 at the second end B of the linkage assembly 201, the end effector 301 being mounted to the second end B of the linkage assembly 201 and comprising:

□ first arm 161;

□ second arm 162;

□, a pulley 171 fixedly connected to the first arm 161;

□ the first gear 151 is fixedly connected with the first gear 152;

□ a second gear 151 forms a

gear assembly

151, 152 with the first gear 152, the second gear 151 being concentric and integrally connected with the pulley 171;

□ a steering unit 101, the rotation axis U2 of which is incident at a first end a on the axis U3 of the joining assembly 201, said steering unit 101 being mounted on the first end a of the joining assembly 201 and comprising:

□ triggers 502, 502';

□, a pulley 503 fixedly connected to the trigger 502, 502';

□ idler 504

□ to be firmly connected to the steering unit 101;

□ to be fixedly attached to the end effector 301;

□ A blocking device 50 mounted on a frame 100 and configured to prevent inadvertent rotation of the frame 100 about an axis U3 of a connection assembly 201, the device 50 comprising:

□ support structure 30 having means 31, 32 for docking the device 50 to the instrument holder 80;

□ two

truncated cone rollers

81, 82, the frame 100 "being placed between the two

truncated cone rollers

81, 82; and

□ lever 70 configured to allow translation of the two truncated-

cone rollers

81, 82 from a first position in which the two truncated-

cone rollers

81, 82 are in contact with the frame 100, the translation of the frame 100 along the axis U3 of the connection assembly 201 remaining allowed by preventing, by friction, the rotation of the frame 100 about the axis U3 of the connection assembly 201.

In order to allow the movement a of the two arms 161162, determining the opening and closing of the end effector 301, the instrument comprises means for transmitting the movement from the manipulation unit 101 to the end effector 301, including cables, not shown in the figures, connecting the pulley 503 of the manipulation unit 101 and the pulley 171 of the end effector 301. In particular, the cable is inserted into the sheath of a connection assembly 201, the connection assembly 201 having a first end firmly connected to a first shaft and a second end firmly connected to a second shaft. The cable comprises two branches which are looped around the pulley 503 of the handling unit 101 and the pulley 171 of the end effector 301, the two branches being separated by an idle pulley 504 and then wound around the pulley 503 of the handling unit 101. Instead, the two branches are separated before winding the pulley 171 of the end effector, since they slide on the wall of the sheath itself.

< eleventh embodiment >

Referring to fig. 2, 3, 4, 5a, 5b, 6a, 6b, 7a, 7b, 8a, 8b, 15, 16a, 16b, 17, 18a, 18b, the eleventh embodiment of the present invention includes:

□ an end effector 301 having its own axis of rotation U' 2 incident at a second end B on the axis U3 of the linkage assembly 201, the end effector 301 being mounted on the second end B of the linkage assembly 201 and comprising:

□ first arm 161;

□ second arm 162;

□, a pulley 171 fixedly connected to the first arm 161;

□ a first gear 152 fixedly connected to the second arm;

□ form a second gear 152 of the

gear assembly

151, 152, said second gear 151 being concentrically and integrally connected 171 with the pulley in the case of the first gear 152;

□ triggers 502, 502';

□, and a pulley 503 securely attached to the trigger 502

□ idler 504

□ for transmitting a first rotary motion of 111, 211, 311, 411, 310', 110', 210', 410, 510, 610, 710, 411, 511, 611, 711, 811, 911 steering unit 101 about a first axis U1, which belongs to said plane orthogonal to axis U3 of linkage assembly 201 and is incident at the same angle to axis U3 of linkage assembly 201 at a first end a of linkage assembly 201, and is connected to end effector 301 in such a way that end effector 301 rotates about axis U' 1 orthogonal to axis U3 of linkage assembly 201 and incident to axis U3 of linkage assembly 201 at a second end B of linkage assembly 201; and

□ for transferring a second rotary motion of the manipulation unit 101 about its own axis U2 to the end effector 301, such that the end effector 301 rotates about its own axis U' 2; and

□ two

truncated cone rollers

81, 82, the frame 100 "being placed between the two

truncated cone rollers

81, 82; and

□ lever 70 configured to allow translation of the two truncated-

cone rollers

81, 82 from a first position in which the two truncated-

cone rollers

Referring to fig. 2, 3, 4, 5a, 5b, 6a, 6b, 7a, 7b, 8a, 8b, 16a and 16b, the connection assembly 201 includes a cylindrical frame 100. The means for transmitting 111, 211, 311411 a first rotary motion comprise:

□, a first bevel gear 111 firmly connected to the operating unit 101, the vertex of which is located in a position corresponding to the first end a of the connecting member 201;

□ a second bevel gear 211 forming a first gear assembly with the first bevel gear 111 such that rotation of the first bevel gear 111 about its own axis causes rotation of the second bevel gear 211 about its own axis;

□ are aligned with the axis U3 of the connection assembly 201 and receive a hollow tube 70 in the frame 100, said tube 70 cooperating with the second bevel gear 211 and the fourth bevel gear 411 such that rotation of the second bevel gear 211 about its own axis causes rotation of the fourth bevel gear 411 about its own axis.

□ to the steering unit 101;

□ fixedly attached to end effector 301;

In order to allow the movement a of the two arms 161,162, determining the opening and closing of the end-effector 301, the instrument comprises means for transmitting the movement from the manipulation unit 101 to the end-effector 301, including cables, not shown in the figures, connecting the pulley 503 of the manipulation unit 101 and the pulley 171 of the end-effector 301. In particular, the cable is inserted into the sheath of a connection assembly 201, the connection assembly 201 having a first end firmly connected to a first shaft and a second end firmly connected to a second shaft. The cable comprises two branches looped around pulley 503 of the steering unit 101 and pulley 171 of the end effector 301, which are separated by an idler pulley 504 before looping around pulley 503 of the steering unit 101. Instead, the two branches are separated before winding the pulley 171 of the end effector, since they slide on the wall of the sheath itself.

Referring to fig. 9a and 9b, the eleventh embodiment of the apparatus of the present invention further comprises a stop 60 mounted on the frame 100, said stop 60 being configured to prevent inadvertent rotation of the frame 100 about the axis U3 of the linkage assembly 201, the third and

second axes

< twelfth embodiment >

With reference to fig. 2, 3, 4, 5a, 5b, 6a, 6b, 7a, 7b, 8a, 8b, 15, 16a, 16b and 19a and 19b, a twelfth embodiment of the invention comprises all the features described above with respect to the eleventh embodiment, but in addition the steering unit 101 of the twelfth embodiment comprises:

□ handles 500, 500';

□ connecting the handle 500,500 'to the

first shaft

110, 110', 110 ", the drum brake comprising:

□ clutch plates 41;

□ compress the pad 42;

□ spring 43 connecting the clutch plates and the clutch plates, compression pad 42;

□ are fixedly connected to the first shaft 110, 110' to the roller pulley 44;

< thirteenth embodiment >

With reference to fig. 2, 12, 13 and 14, 17, 18a and 18b, in a thirteenth embodiment of the invention, the apparatus comprises:

□ two

truncated cone rollers

81, 82, the frame 100 "being placed between the two

truncated cone rollers

81, 82; and

□ a lever 70 configured to allow translation of the two truncated-

cone rollers

81, 82 from a first position in which the two truncated-

cone rollers

□ for transmitting a first rotary motion of 111, 211, 311, 411, 310', 110', 210', 410, 510, 610710, 411, 511, 611, 711, 811, 911 steering unit 101 about a first axis U1, which belongs to said plane orthogonal to axis U3 of linkage assembly 201 and is incident at the same angle to axis U3 of linkage assembly 201 at a first end a of linkage assembly 201, and is connected to end effector 301 in such a way that end effector 301 rotates about axis U' 1 orthogonal to axis U3 of linkage assembly 201 and incident to axis U3 of linkage assembly 201 at a second end B of linkage assembly 201; and

□ is used to transmit a second

rotary motion

110, 210, 310, 400 ', 110', 210', 310', 91,92 of the manipulation unit 101 about its own axis U2 to the end effector 301 such that the end effector 301 rotates about its own axis U ' 2, the axis U ' 2 of the end effector 301 being parallel to the axis U2 of the manipulation unit 101 of the axis U ' 2 of the end effector 301.

The device (310', 110', 210', 410, 510, 610, 710, 411, 511, 611, 711, 811, 911) for transmitting the first rotary motion comprises:

□ to the steering unit 101;

□ fixedly attached to the end effector 301;

□ integrally connected to the first shaft 110', the fourth shaft 510 being connected to the third shaft 310' by a first flexible hinge 411, the centre of rotation of which coincides with the first end a of the third shaft 310 ';

□ a fifth shaft 510 is integrally connected to the second shaft 210', said fifth shaft 510 being connected by a second flexural hinge 511 having a connection to the third shaft 310', the centre of rotation of said third shaft 310 'coinciding with the second end B of the third shaft 310';

The first 411, second 511, third 611, fourth 711, fifth 811 and sixth 911 flexible hinges are preferably, but not limited to, circular flexible hinge transmission devices 110 ", 210", 310 ", 91,92, the second rotation movement comprising, in contrast:

□ to the steering unit 101;

□, and a second shaft 210 "fixedly attached to end effector 301;

□ aligned with axis U3 of connection assembly 201;

□ a first torque coil 91 having a first end A 'connected to the first end of the first shaft 110 ", a second end A" connected to the first end of the third shaft 310 ", the first end A of the linkage assembly 201 being located between the first end A' and the second end A" of the first torque coil 91; and

In order to perform the opening and closing of the end-effector, the instrument comprises a second torque coil 92 connected to the end-effector 301 by means 900 for converting a translational movement S of the second torque coil 92 along its own longitudinal axis in the opening/closing movement a of the two arms of the end-effector, the translational movement S of the second torque coil 92 along its own longitudinal axis being caused by the transmission of a translational movement of the first torque coil 91 along its own longitudinal axis through the third shaft 310 ". The first and second torque coils 91 and 92 may be inserted into the first and second sheaths 91 'and 92', respectively. The first shaft 110 "is housed within the first hollow tube 800, the second shaft 210" is housed within the second hollow tube 802, and the third shaft 310 "is housed within the third hollow tube 801. The first sheath 91' has a first end fixedly connected to the first hollow tube 800 and a second end fixedly connected to the first hollow tube 800 is connected to the third hollow tube 801. The second sheath 92' has a first end fixedly connected to the third hollow tube 801 and a second end fixedly connected to the second hollow tube 802.

In all embodiments of the above instrument, the end effector 301 may be a clip 301', 301' or a scissors or a grasper.

With reference to fig. 19a and 19b, the handling unit 101 can be designed according to two different embodiments. The first handle 500 is shown in fig. 19a and the second handle 500' is shown in fig. 19 b. The second embodiment of the handle 500 'differs from the first handle 500 in that it has an ergonomic shape that allows the surgeon to move the ring 501' with the thumb of the same hand that is manipulating the handle 500.

Finally, it is specified that it is also the subject of the present invention, also a kit for laparoscopic intervention, comprising:

□ the laparoscopic surgical instrument of any one of the seventh through thirteenth embodiments described above;

an instrument holder 80 for inserting said laparoscopic surgical instruments at least partially through an incision into a patient's cavity, said instrument holder 80 having means for docking the instrument holder 80 "80" to a blocking device 50, the means for docking the instrument holder 80', 80 "being configured to cooperate with the docking means 31, 32 of the support structure 30 of the blocking device 50.

It should be noted that the terms "first", "second", "third", and the like in the description are used for distinguishing various components, elements, steps, and the like in the description, and are not used for indicating a logical relationship or a sequential relationship between the various components, elements, steps, and the like, unless otherwise specified.

It is to be understood that while the present invention has been described in conjunction with the preferred embodiments thereof, it is not intended to limit the invention to those embodiments. It will be apparent to those skilled in the art from this disclosure that many changes and modifications can be made, or equivalents modified, in the embodiments of the invention without departing from the scope of the invention. Therefore, any simple modification, equivalent change and modification made to the above embodiments according to the technical essence of the present invention are still within the scope of the protection of the technical solution of the present invention, unless the contents of the technical solution of the present invention are departed.

Claims

1. A surgical laparoscopic instrument, comprising:

a connection assembly having a shaft, a first end and a second end;

means for transmitting motion from the steering unit to an end effector;

wherein the means for transmitting motion comprise at least:

2. The laparoscopic surgical instrument of claim 1, wherein the coupling assembly comprises a frame, and the first transfer device comprises:

3. The surgical laparoscopic instrument of claim 1 or 2, wherein the second transfer means comprises:

a first shaft connected with the manipulation unit;

a second shaft connected to the end effector;

a third shaft aligned with the shaft of the connection assembly, the third shaft being received in the hollow tube;

a first gimbal centered corresponding to the first end of the connection assembly; and

4. The laparoscopic surgical instrument of claim 1 or 2, further comprising a stop mounted on the frame, said stop being configured to prevent rotation of the frame about the axis of the connecting assembly when the first and third shafts are rotated and the first, third and second shafts are aligned with the axis along the connecting assembly.

5. The surgical laparoscopic instrument of claim 1 or 2, wherein the manipulation unit comprises: a handle and a drum brake connecting the handle to the first shaft; the drum brake includes: the clutch device comprises a suction pad, a compression pad, a spring for connecting a clutch plate and the compression pad, a roller pulley firmly connected with a first shaft and an operation ring; the handling ring is connected with the drum pulley, and rotation of the handling ring around its own axis causes rotation of the drum pulley and thus of the first shaft around its own axis.

6. A surgical laparoscopic instrument as claimed in claim 1 or 2, wherein the first transfer means comprises: a first shaft connected with the manipulation unit; a second shaft connected to the end effector; a third shaft aligned with the axis of the linkage assembly, a first end of the third shaft coincident with the first end of the linkage assembly and a second end of the third shaft coincident with the second end of the linkage assembly; the fourth shaft is connected with the third shaft through a first flexible hinge, and the rotation center of the first flexible hinge is superposed with the first end of the third shaft; the fifth shaft is connected with the third shaft through a second flexible hinge, and the rotation center of the second flexible hinge is superposed with the second end of the third shaft; a sixth shaft connected to the first portion of the fourth shaft by a third flexible hinge and to the first portion of the fifth shaft by a fourth flexible hinge; and a seventh shaft connected to the second portion of the fourth shaft by a fifth flexible hinge and to the second portion of the fifth shaft by a sixth flexible hinge.

7. The surgical laparoscopic instrument of claim 1 or 2, wherein the second transfer means comprises: a first shaft fixedly connected with the operating unit; a second shaft fixedly connected to the end effector; a third shaft aligned with the shaft of the linkage assembly; a first torque coil having a first end connected to the first end of the first shaft and a second end connected to the first end of the third shaft, the first end of the linkage assembly being located between the first and second ends of the first torque coil; and a second torque coil having a first end connected to the second end of the third shaft and a second end connected to the first end of the second shaft, the second end of the connection assembly being between the first and second ends of the second torque coil.

8. A laparoscopic surgical instrument comprising:

a connection assembly having a shaft, a first end and a second end;

an end effector mounted on a first end of the linkage assembly;

a pulley connected to the trigger;

an idler pulley;

means for transmitting motion from the steering unit to the end effector;

a first shaft connected with the manipulation unit;

a second shaft connected to the end effector;

wherein, the end effector includes:

a first arm;

a second arm;

a pulley fixedly connected to the first arm;

a first gear connected to the second arm; and

9. A laparoscopic surgical instrument adapted to cooperate with an instrument holder to insert the laparoscopic surgical instrument at least partially through an incision into a patient's cavity, the instrument comprising:

a connection assembly having a shaft, a first end and a second end, the connection assembly including a frame; an end effector having a rotational axis incident to the shaft of the linkage assembly at a second end of the linkage assembly, the end effector being mounted on the second end of the device linkage assembly;

10. A kit for laparoscopic intervention, comprising:

the surgical laparoscopic instrument of one of claims 1 to 7 or the laparoscopic surgical instrument of claim 8 or 9;