JP2015526172A - Surgical tool positioning system - Google Patents

Abstract

Described is a tool positioning system comprising an introduction device, a first tool support and a second tool support. The introduction device is configured and arranged to slidably receive the articulating probe. The first tool support has at least one guide element configured and arranged to slidably receive the first tool. The first tool support faces the first operator position. The second tool support has at least one guide element configured and arranged to slidably receive the second tool. The second tool support faces the second operator position.

Description

(Related application)
This application is an application claiming benefits based on US Provisional Patent Application No. 61 / 681,340 dated Aug. 9, 2012, the entire contents of which are incorporated herein by this reference.

  This application is an application claiming benefits based on US Provisional Patent Application No. 61/751498, Jan. 11, 2013, the entire contents of which are incorporated herein by this reference.

  This application claims the benefit based on US Provisional Patent Application No. 61/825297 dated May 20, 2013, the entire contents of which are incorporated herein by this reference.

  This application is an application claiming benefits based on US Provisional Patent Application No. 61 / 818,878, dated May 2, 2013, the entire contents of which are incorporated herein by this reference.

  This application is an application related to International Patent Application No. PCT / US2012 / 040414 dated June 1, 2012, the entire contents of which are incorporated herein by this reference.

  This application is related to US Provisional Patent Application No. 61/492578, dated June 2, 2011, the entire contents of which are incorporated herein by this reference.

  This application is related to International Patent Application No. PCT / US2012 / 032279 dated April 5, 2012, the entire contents of which are incorporated herein by this reference.

  This application is related to US Provisional Patent Application No. 61/472344, Apr. 6, 2011, the entire contents of which are incorporated herein by this reference.

  This application is an application related to International Patent Application No. PCT / US2011 / 060214 dated November 10, 2011, the entire contents of which are incorporated herein by this reference.

  This application is related to US Provisional Patent Application No. 61/41733, dated November 11, 2010, the entire contents of which are incorporated herein by this reference.

  This application is an application related to International Patent Application No. PCT / US2012 / 054802 dated September 12, 2012, the entire contents of which are incorporated herein by this reference.

  This application is related to US Provisional Patent Application No. 61/534032 dated September 13, 2011, the entire contents of which are incorporated herein by this reference.

  This application is related to US Provisional Patent Application No. 61 / 406,032 dated October 22, 2010, the entire contents of which are incorporated herein by this reference.

  This application is an application related to International Patent Application No. PCT / US2011 / 057282 dated October 21, 2011, the entire contents of which are incorporated herein by this reference.

  This application is related to US Provisional Patent Application No. 61 / 368,257 dated July 28, 2010, the entire contents of which are incorporated herein by this reference.

  This application is an application related to International Patent Application No. PCT / US2011 / 044811 dated July 21, 2011, the entire contents of which are incorporated herein by this reference.

  This application is related to International Patent Application No. PCT / US2012 / 070924 dated December 20, 2012, the entire contents of which are incorporated herein by this reference.

  This application is related to US Provisional Patent Application No. 61/578582 dated 21 December 2011, the entire contents of which are incorporated herein by this reference.

  This application is an application related to International Patent Application No. PCT / US2013 / 043858 dated June 3, 2013, the entire contents of which are incorporated herein by this reference.

  This application is an application related to US Patent Application No. 11/630279, published on December 20, 2006, as Patent Document 1, and the entire contents thereof are incorporated herein by this reference.

(Technical field)
The present invention relates generally to the field of robotics, and more particularly to a multi-operator robot system for medical applications.

  As minimally invasive medical techniques and procedures become more widespread, medical workers such as surgeons and other clinicians need articulating surgical tools to perform the minimally invasive medical techniques and procedures from outside the human body Would.

US Patent Application Publication No. 2009/0171151 US Patent Application Publication No. 2008/0039690

  Conventional articulating surgical tools such as endoscopes and the like have been operable by surgeons and other clinicians at a single operator position.

  An embodiment of a tool positioning system is configured to slidably receive an articulating probe and an introduction device arranged and arranged to slidably receive a first tool. And a first tool support having at least one arranged guide element, the first tool support being directed towards the first operator location and the second tool being slidable A second tool support having at least one guide element configured and arranged to be dynamically acceptable, the second tool support being directed toward a second operator location .

  In certain embodiments, at least one of the first tool and the second tool is positioned relative to the patient so that the patient can perform a medical procedure.

  In certain embodiments, the medical procedure includes an oral surgical procedure.

  In certain embodiments, the oral surgical procedure includes resection at or near at least one of the tongue base, tonsils, skull base, hypopharynx, pharynx, trachea, esophagus, stomach and small intestine.

  In certain embodiments, the medical procedure includes single or multi-port transaxilla, thoracoscopic, pericardial, laparoscopic, transgastric, transenteric, transanal and transvaginal. Includes at least one of the procedures.

  In certain embodiments, the single or multi-port transaxillary procedure includes pharyngectomy.

  In certain embodiments, the single or multi-port thoracoscopic procedure includes a mediastinal nodal dissection.

  In certain embodiments, the single or multi-port pericardial procedure includes arrhythmia measurement and treatment.

  In certain embodiments, the single or multi-port laparoscopic procedure includes a revision of bariatric lap-band procedure.

  In certain embodiments, the single or multi-port transgastric or enteral procedure includes at least one of cholecystectomy and spleen removal.

  In certain embodiments, the single or multiport transanal or vaginal procedure includes at least one of hysterectomy, ovariectomy, cystectomy, and colectomy.

  In certain embodiments, the first tool support is coupled to the second tool support.

  In certain embodiments, the first tool support and the second tool support are coupled together at a common element.

  In some embodiments, the distance between the first tool support and the second tool support is kept constant by the connection at the common element.

  In some embodiments, the difference in orientation between the first tool support and the second tool support is kept constant by the connection in the common elements.

  In certain embodiments, the at least one of the first and second tool supports moves linearly relative to the common element.

  In certain embodiments, the positions of the first tool support and the second tool support are fixed to each other.

  In a tool positioning system according to certain embodiments, the positions of the first and second tool supports are maintained during operation.

  In certain embodiments, the orientations of the first tool support and the second tool support are fixed to each other.

  In a tool positioning system according to certain embodiments, the orientation of the first and second tool supports is maintained during operation.

  In certain embodiments, at least one of the first tool support and the second tool support is pivotable relative to the other.

  In certain embodiments, at least one of the first tool support and the second tool support is pivotable relative to the other at a common element to which the first and second tool supports are respectively coupled. .

  In certain embodiments, at least one of the first and second tool supports is locked in a fixed position relative to the common element.

  The system according to certain embodiments further includes a locking mechanism that locks the at least one of the first and second tool supports in a fixed position.

  In certain embodiments, at least one of the first tool support and the second tool support is anchored directly to the introduction device.

  In certain embodiments, at least one of the first tool support and the second tool support is joined to the introduction device.

  In certain embodiments, at least one of the first tool support and the second tool support is welded to the introduction device.

  The system according to certain embodiments further includes a base to which the first tool support and the second tool support are coupled.

  In certain embodiments, the introduction device is coupled to the base.

  In certain embodiments, the base has a collar (collar) that surrounds at least a portion of the introducer device.

  In certain embodiments, the collar extends transversely to the direction of extension of the introduction device.

  In certain embodiments, the collar has first and second openings aligned with the first and second tool supports.

  In certain embodiments, the collar has first and second openings through which the first and second tool supports extend.

  In certain embodiments, at least one of the first tool support and the second tool support has at least one guide element that is pivotally connected to the base.

  In certain embodiments, the at least one of the first tool support and the second tool support has a gimbal that is pivotally connected to the at least one guide element at a base.

  In certain embodiments, the first tool support of the at least one guide element is pivotally connected to the base at its mid-portion.

  In certain embodiments, the first tool support is pivotally connected to the base and the second tool support is pivotally connected to the base.

  In certain embodiments, the at least one guide element provided on the first tool support is fixedly attached to the base.

  In certain embodiments, the first tool support of the at least one guide element is pivotally connected to the base at an intermediate portion thereof.

  In certain embodiments, the at least one of the first and second tool supports moves linearly with respect to the base.

  A system according to certain embodiments is configured and arranged to slidably receive two tools.

  A system according to certain embodiments is configured and arranged to slidably receive three tools.

  A system according to certain embodiments is configured and arranged to slidably receive four tools.

  A system according to certain embodiments is configured and arranged to slidably receive five or more tools.

  In certain embodiments, the at least one guide element on the first tool support is configured and arranged to receive a shaft of the first tool, and the first of the at least one guide element is the first of the at least one guide element. The two-tool support is configured and arranged to receive the shaft of the second tool.

  In certain embodiments, the first tool is positioned on the first side of the articulating probe tip and the second tool is on the second side or first side of the articulating probe tip. Positioned on the opposite side.

  In certain embodiments, the first tool is operated by an operator at a first operator position on a first side of the tip of the articulating probe, and the second tool is a second side of the tip of the articulating probe. Is operated by the operator at the second operator position.

  In certain embodiments, the first tool and the third tool are positioned on the first side of the tip of the articulating probe, and the second tool and the fourth tool are on the second side of the tip of the articulating probe, i.e. Positioned on the opposite side to the first side.

  In certain embodiments, the first and third tools are operated by an operator at a first operator position on the first side of the tip of the articulating probe, and the second and fourth tools are operated by the articulating probe. Operated by an operator at a second operator position on the second side of the tip of the.

  In certain embodiments, at least one of the first tool support and the second tool support has a funnel shaped proximal end.

  In certain embodiments, at least one guide element included in at least one of the first tool support and the second tool support has an inner guide element and an outer guide element.

  In certain embodiments, the outer guide element has a first tube and the inner guide element has a second tube slidably disposed within the first tube.

  In certain embodiments, the inner guide element extends movably from the outer guide element.

  In certain embodiments, at least a portion of the inner guide element is flexible.

  The system according to certain embodiments further includes a third tool support having at least one guide element configured and arranged to slidably receive the third tool.

  In certain embodiments, the third tool support is directed toward the first operator position.

  The system according to certain embodiments further includes a connector coupled to the first tool support and the third tool support that is configured and arranged to maintain a relative position between the first tool support and the third tool support. Connector.

  The system according to certain embodiments further includes a fourth tool support having at least one guide element configured and arranged to slidably receive the fourth tool.

  In certain embodiments, the fourth tool support is directed toward the second operator position.

  The system according to certain embodiments further includes a connector coupled to the second tool support and the fourth tool support that is configured and arranged to maintain a relative position between the second tool support and the fourth tool support. Connector.

  The system according to certain embodiments further includes a connector coupled to a proximal end of each of the first and third tool supports and a connector attached to the proximal end of each of the second and fourth tool supports. .

  The system according to certain embodiments may further include a connector coupled to the first tool support and the second tool support configured and arranged to maintain a relative position between the first tool support and the second tool support. Connector.

  In certain embodiments, the connector is pivotally coupled to the first tool support.

  In certain embodiments, a connector is pivotally coupled to the first tool support and the second tool support.

  In certain embodiments, connectors are attached to the proximal ends of the first and second tool supports.

  In certain embodiments, the connector extends in a direction transverse to the extending direction of the proximal ends of the first and second tool supports.

  The system according to certain embodiments further includes a fixation point on the connector that is configured and arranged for attachment to a stabilizing brace.

  The system according to certain embodiments further includes a third tool support, coupled to the first, second and third tool supports and maintaining a relative position between the first, second and third tool supports. And a connector arranged and arranged to be able to.

  In certain embodiments, the at least one guide element provided on the first tool support or the second tool support comprises a hollow elongate member.

  In certain embodiments, the hollow elongate member has a structure selected from a hollow tube, a coil such as a helical coil, a plastic tube such as a knitted plastic tube, and combinations thereof.

  In certain embodiments, at least a portion of the hollow elongate member is rigid.

  In certain embodiments, at least a portion of the hollow elongate member is flexible.

  In certain embodiments, the first operator position and the second operator position have a side-by-side positional relationship.

  In certain embodiments, the first tool support is configured and arranged to allow tool access to the patient's head.

  In certain embodiments, the first tool support is configured and arranged to allow tool access to the patient's esophagus.

  In certain embodiments, the first operator position and the second operator position have an opposite positional relationship.

  In certain embodiments, the first tool support is configured and arranged to allow tool access to at least one of the patient chest and patient abdomen.

  The system according to certain embodiments further comprises a fixed point configured and arranged for attachment to the stabilizing brace.

  In certain embodiments, the fixed point is provided in the first tool support.

  The system according to certain embodiments further includes a connector coupled to the first tool support and the second tool support.

  In certain embodiments, the connector is configured and arranged to hold a relative position between the first tool support and the second tool support, and the fixing point is provided on the connector.

  In certain embodiments, the fixed point is provided on the introduction device.

  The system according to certain embodiments further includes a base connecting the first tool support and the second tool support, the base having the fixing point.

  The system according to certain embodiments further comprises a brace attachable to the fixed point.

  In certain embodiments, the brace can be further attached to a location selected from the floor, patient operating table, articulating probe feeder, and combinations thereof.

  The system according to certain embodiments further comprises a second fixed point configured and arranged for attachment to the stabilizing brace.

  The system according to certain embodiments further comprises a first brace for attachment to the first fixed point and a second brace for attachment to the second fixed point.

  The system according to certain embodiments further comprises an articulating probe.

  In certain embodiments, the articulating probe has a distal link.

  In certain embodiments, the tip link has at least one first side port coupled to the first tool support and a second side port coupled to the second tool support.

  The system according to certain embodiments further comprises a third tool support, the tip link being at least one first side port coupled to the first tool support, and a second coupled to the second tool support. A side port and a third side port coupled to the third tool support.

  In certain embodiments, the first, second and third side ports are symmetrically spaced around the edge of the tip link.

  In certain embodiments, the first, second and third side ports are asymmetrically spaced around the edge of the tip link.

  In certain embodiments, the first and second side ports are spaced 30 ° to 180 ° around the edge of the tip link.

  The system according to certain embodiments further comprises a fourth tool support, the tip link further having a fourth side port coupled to the fourth tool support.

  The system according to certain embodiments further includes a fifth tool support, the tip link further having a fifth side port coupled to the fifth tool support.

  The system according to certain embodiments further comprises a controller configured and arranged to operate the articulating probe.

  The system according to certain embodiments further comprises a first interpersonal interface device directed toward a first operator position, the first interpersonal interface being received by a controller for operating the articulating probe. A first control signal is generated.

  The system according to certain embodiments further comprises a tool having the first interpersonal interface device.

  The system according to certain embodiments further includes a second interpersonal interface device directed toward the second operator position, wherein the second control signal is received by a controller for operating the articulating probe. A second interpersonal interface device configured and arranged to be generated.

  The system according to certain embodiments further comprises a tool having the second interpersonal interface device.

  The system according to certain embodiments further includes a connector coupled to the first tool support and the second tool support so that the connector can maintain a relative position between the first tool support and the second tool support. Configured and arranged, the first interpersonal interface device is located on the connector.

  In certain embodiments, the interpersonal interface device on the connector communicates with the controller via a wireless connection.

  The system according to certain embodiments further comprises at least one tool configured and arranged to be slidably received by at least one of the first tool support and the second tool support.

  In certain embodiments, the at least one tool includes at least two tools such that each tool can be slidably received by at least one of the first tool support and the second tool support. It has a shaft that is constructed and arranged.

  In certain embodiments, the at least one tool is an aspirator, ventilator, light source, camera, grasper, laser, cauterizer, clip applier, scissors, needle, needle holder, scalpel, RF energy supply device. A tool selected from among cryogenic energy supply devices and combinations thereof.

  A tool positioning system according to another aspect is a first tool support having at least one guide element configured and arranged to slidably receive a first tool, toward the first operator position. A second tool support having a directed first tool support and at least one guide element configured and arranged to slidably receive a second tool, and directed toward a second operator position A second tool support, and a base connecting the first tool support and the second tool support.

  The system according to certain embodiments further comprises an introduction device coupled to the base.

  In certain embodiments, the base has a collar that surrounds at least a portion of the introducer device.

  In certain embodiments, the collar extends transverse to the direction of extension of the introduction device.

  In certain embodiments, the collar has first and second openings aligned with the first and second tool supports.

  In certain embodiments, the collar has first and second openings through which the first and second tool supports extend.

  In certain embodiments, at least one of the first tool support and the second tool support has at least one guide element that is pivotally connected to the base.

  In certain embodiments, the at least one of the first tool support and the second tool support has a gimbal that is pivotally connected to the at least one guide element at a base.

  In certain embodiments, the first tool support of the at least one guide element is pivotally connected to the base at an intermediate portion thereof.

  In certain embodiments, the first tool support is pivotally connected to the base and the second tool support is pivotally connected to the base.

  In certain embodiments, the first tool support of the at least one guide element is fixedly attached to the base.

  In certain embodiments, the first tool support of the at least one guide element is pivotally connected to the base at an intermediate portion thereof.

  A tool positioning system according to another aspect includes a first tool support having at least one first guide element configured and arranged to slidably receive a first tool, and a slidable second tool. A second tool support having at least one second guide element configured and arranged to be dynamically received, and a first connector attached to the first tool support and the second tool support; A connector configured and arranged to hold a distance between the support and the second tool support.

  In certain embodiments, the first connector is fixedly attached to at least one of the first tool support and the second tool support.

  In certain embodiments, the first connector is pivotally attached to at least one of the first tool support and the second tool support.

  The system according to certain embodiments further comprises a gimbal pivotally connected to the at least one of the first and second guide elements at the base.

  In certain embodiments, the first connector has a first opening and a second opening each configured and arranged to be operatively connected to a tool support of the first and second tool supports.

  In certain embodiments, the first opening and the second opening are configured and arranged such that the first tool support and the second tool support can be positioned according to a non-parallel configuration.

  In certain embodiments, at least one of the first opening and the second opening has a funnel-shaped opening.

  In certain embodiments, the first connector further includes a third opening configured and arranged to be operably connected to the third tool support.

  In certain embodiments, a single operator operates a tool that extends from each of the first, second, and third tool supports from a single operator position.

  In certain embodiments, the first connector has a rigid structure.

  In certain embodiments, at least a portion of the first connector is flexible.

  In certain embodiments, the first connector has an operator shapeable structure.

  In certain embodiments, the first connector has a mariable structure (adaptable structure).

  In certain embodiments, the first connector has a hinge portion.

  In certain embodiments, the first connector is configured and arranged so that it can be molded after heating and / or heat removal.

  In certain embodiments, the first connector is configured and arranged to attach to at least one of the first tool support and the second tool support.

  In certain embodiments, the first connector is configured and arranged to be removable from at least one of the first tool support and the second tool support.

  The system according to certain embodiments is further configured to be a second connector attachable to the first tool support and the second tool support so as to maintain a relative position between the first tool support and the second tool support. And an arranged second connector.

  In certain embodiments, the first connector is configured and arranged such that the first tool support and the second tool support can be positioned according to the first geometry, and the second connector is according to a second geometry different from the first geometry. The first tool support and the second tool support are configured and arranged so that they can be positioned.

  In certain embodiments, the first connector differs from the second connector in at least one of length, shape, and curvature.

  The system according to certain embodiments further includes a third tool support having at least one guide element configured and arranged to slidably receive the shaft of the tool.

  In certain embodiments, the first connector further maintains a relative position of the third tool support relative to the first tool support and the second tool support.

  The system according to certain embodiments further includes a fourth tool support having at least one guide element configured and arranged to slidably receive the shaft of the tool.

  The system according to certain embodiments further includes a second connector configured and arranged to hold a relative position between the second tool support and the fourth tool support, wherein the first connector includes the first tool support, A system configured and arranged to maintain a relative position between third tool supports.

  In certain embodiments, a single operator operates a tool that extends from each of the first, second, and third tool supports from a single operator position.

  In certain embodiments, the first operator operates a tool extending from two of the first, second, and third tool supports, and the second operator includes the first, second, and third tool supports. Operate tools extending from others.

  In certain embodiments, the first connector can be removably coupled to the first and second tool supports.

  In certain embodiments, the first connector is replaced with a third connector having a different dimension than the first connector.

  Certain embodiments of the present invention comprise an articulating probe described with reference to the drawings.

  Certain embodiments of the present invention comprise a surgical tool described with reference to the drawings.

  Certain embodiments of the present invention comprise a controller described with reference to the drawings.

  Certain embodiments of the present invention have a robot system control method described with reference to the drawings.

  Certain embodiments of the present invention comprise an interpersonal interface device described with reference to the drawings.

  Certain embodiments of the present invention have a medical procedure execution method described with reference to the drawings.

  BRIEF DESCRIPTION OF THE DRAWINGS The foregoing and other objects, configurations and advantages of embodiments of the present invention are apparent from the more specific description of the preferred embodiment depicted in the accompanying drawings in which like references refer to the same elements throughout the several views. It will be. The drawings are not necessarily equivalent reductions, but rather focus on drawing the mechanism of the preferred embodiment.

It is a top view of the tool positioning system for medical procedure execution concerning the embodiment of the present invention. It is a top view of the tool positioning system for medical procedure execution concerning other embodiments of the present invention. 1 is a perspective view of a tool positioning system according to an embodiment of the present invention. It is front sectional drawing of the tool positioning system which concerns on embodiment of this invention. 1 is a perspective view of a tool positioning system having a plurality of connectors according to an embodiment of the present invention. 1 is a perspective view of a tool positioning system having three tools in communication with a connector according to an embodiment of the present invention. FIG. It is a perspective view of the front-end | tip of the tool positioning system which concerns on one Embodiment of this invention. It is a perspective view of the tip link concerning one embodiment of the present invention which has a plurality of side ports. It is a perspective view of the tip link concerning one embodiment of the present invention which has a plurality of side ports. It is a perspective view of the tip link concerning one embodiment of the present invention which has a plurality of side ports. It is a perspective view of the tip link concerning one embodiment of the present invention which has a plurality of side ports.

  The terminology employed in this application is intended to describe a specific embodiment and is not intended to limit the present invention. As used in this application, the singular expressions “a”, “one”, and “that” are intended to encompass a plurality of expressions unless the context clearly dictates otherwise. Further, as can be appreciated, as used herein, the terms “comprising”, “having”, “including” and / or “with” refer to the presence of a feature, object, step, action, element and / or member referred to. It does not exclude the presence or addition of one or more other features, objects, steps, actions, elements, members and / or collections thereof.

  As can be appreciated, the present application uses terms such as first, second, third, etc. to describe various constraints, elements, members, regions, layers and / or portions, depending on those terms. The elements, members, regions, layers and / or parts are not limited. These terms are only used to distinguish one constraint, element, member, region, layer or part from another constraint, element, member, region, layer or part. Accordingly, even if the first constraint, element, member, region, layer, or portion described later is replaced with the second constraint, element, member, region, layer, or portion, it does not depart from the teaching of the present application.

  In addition, as you can see, when an element is said to be “on” or “connected” or “coupled” to another element, that element There may or may not be direct contact, coupling or coupling, or there may be intervening elements. In contrast, if an element is said to be “directly above” or “directly connected” or “directly coupled” to another element, there are no intervening elements present. Other words used to describe the relationship between elements should be interpreted in the same way (eg “between” vs. “sandwiched”, “near” vs “adjacent”, etc.) . In this application, when an element is described as “facing” another element, the element may be above, below or other than the other element. There may be direct coupling, intervening elements may be present, or the elements may be separated by spaces or gaps.

  FIG. 1 is a top view of a tool positioning system 100 for performing a medical procedure according to an embodiment of the present invention. The tool positioning system 100 is configured and arranged to position one or more tools (not shown in FIG. 1) for performing a medical procedure, such as an oral robotic surgical procedure or the like, on a patient P. Yes. The medical procedure may include a surgical procedure involving the insertion of one or more tools into the patient (P) cavity or into the patient (P) incision or opening site. The surgical procedure can include one or more oral procedures. Oral procedures typically include excision and other procedures performed at or near the site selected from the base of the tongue, tonsils, skull base, hypopharynx, pharynx, trachea, esophagus, stomach, small intestine and combinations thereof. included. Other procedures include, but are not limited to, single or multiport transaxilla procedures such as pharyngectomy, single or multiport thoracoscopic procedures such as mediastinal nodal dissection, single or Multiport pericardial procedures such as those involved in arrhythmia measurement and treatment, single or multiport laparoscopic procedures such as the revision of bariatric lap-band procedure, single or multiport transgastric or enteral There may be transenteric procedures such as cholecystectomy or spleen removal and / or single or multiport transanal or vaginal procedures such as hysterectomy, ovariectomy, cystectomy and colectomy.

  The tool positioning system 100 includes an introduction device 250, a first tool support 260a, and a second tool support 260b. Although two tool supports 260a, 260b (collectively 260) are shown, the tool positioning system 100 may be configured and arranged to have more than two tool supports 260. The tool positioning system 100 according to one embodiment includes two, three, or four tool supports 260 that are each configured and arranged to slidably receive a tool, eg, a tool shaft, as shown in FIG. Prepare. The tool positioning system 100 according to another embodiment includes five or more tool supports 260 each configured and arranged to slidably receive a tool.

  As shown in FIG. 4, the introduction device 250 can slidably receive an articulating probe, such as the articulating probe 10, and support, stabilize, and support the articulating probe 10. And / or can be configured and arranged to guide the region of interest. The region of interest may be a lumen or lumen of the patient (P) body, for example, a cavity in the patient's head (H) such as the nose or mouth, or may be an opening formed by incision. Typical areas of interest for clinical use include, but are not limited to, intra-gastrointestinal sites such as the esophagus, intrapericardial sites, intraperitoneal sites, and combinations thereof. Alternatively, the region of interest may be a mechanical device, building, or other open or closed environment in which the probe 10 can be used.

  The articulating probe 10 can be configured to guide one or more surgical tools, for example during a medical procedure. The articulating probe 10 can include inner and outer sleeves that can be advanced or retracted relative to each other during operation of the articulating probe 10. For example, the inner and outer sleeves of the articulating probe 10, for example, those having a plurality of inner links and a plurality of outer links (see FIG. 4), a limp mode so that the articulating probe 10 can be easily operated. And one of the rigid modes. For example, the inner and outer sleeves can be configured in one of the limp mode and the rigid mode via one or a plurality of steering cables (not shown) provided in the articulation probe 10.

  The articulating probe 10 is a highly articulated probe, for example, Patent Document 1 (name: STEERABLE, FOLLOW THE LEADER DEVICE), which is incorporated in its entirety by this reference, Patent Document 2 (Name: STEERABLE MULTI LINKED DEVICE HAVING MULTIPLE WORKING PORTS) or International Patent Application No. PCT / US2011 / 044811 (Name: SURGICAL POSITIONING AND SUPPORT SYSTEM)) and may be a highly articulated probe. The articulating probe 10 may include one or more light sources and / or imaging devices, such as a camera, located at the distal end of the articulating probe 10 and / or near the tip of the tool support 260. .

  The articulating probe 10 includes one or more cables in the outer sleeve of the probe 10, for example, a cable (not shown) extending to a distal link such as the distal link 631 shown in FIG. A feeder 110 is provided for controllable advancement. The feeder 110 may include one or more cable cable control assemblies, such as a bobbin drive motor, and one or more link translation assemblies, such as a linear cart.

  In turn, the first tool support 260a in FIG. 1 can be configured and arranged to slidably receive a tool shaft (not shown). The first tool support 260a is directed toward the first operator location (L1). The second tool support 260b may also be configured and arranged to slidably receive a tool shaft (not shown). The second tool support 260b is directed toward the second operator location (L2). The first and second tool supports 260a and 260b can be configured in the same manner or in different configurations, for example, different lengths. The first and second tool supports 260 a and 260 b may be attached to one place or a plurality of places on the distal end side of the probe 10. In certain embodiments, tool supports 260a, 260b are disposed on the opposite side across the tip of the probe 10. In certain embodiments, the tool support 260a is attached to the operator position L1 location side (eg, the left side of the paper) of the probe 10 and the tool support 260b is attached to the operator position L2 side of the probe 10 (eg, the right side of the paper). ). Alternatively, the tool support 260a is attached to the side of the probe 10 where the operator position L1 is not located (eg, the right side of the paper), and the tool support 260b is attached to the tip of the probe 10 where the operator position L2 is not located (eg, the left side of the paper). It is done. One operator can operate the first tool extending from the tip of the articulating probe 10 on one side of the introduction device 250. The other operator can operate the second tool located on the other side of the tip of the articulating probe 10. In other embodiments, both operators can position the tool on the tip of articulating probe 10 and on both sides of introduction device 250.

  Tool positioning system 100 may include a base 285. The base 285 may be provided with openings to receive the tool support 260 and introducer 250, and the tool support and introducer may be attached to the base 285 at its midportion or tip. In the first tool support 260a and the second tool support 260b, the relative position between the first tool support 260a and the second tool support 260b and / or the orientation difference between the first tool support 260a and the second tool support 260b is kept constant. It is connected to its base 285 so that it can.

  Base 285 may have a collar (collar) or the like surrounding at least a portion of introducer device 250. This collar may extend along a direction transverse to the direction of extension of the introduction device 250. As shown in FIG. 4, the base 285 may include an opening 287 aligned with the guide element 261 of each tool support 260. The guide element 261 can be fixed to an opening 287 provided in the base 285.

  The tool positioning system 100 may include a connector 280 coupled to the first tool support 260a and the second tool support 260b, also known as a dog bone connector. The connector 280 is configured and arranged so that the relative position between the first tool support 260a and the second tool support 260b can be maintained. In certain embodiments, the connector 280 is configured and arranged such that the relative orientation between the first tool support 260a and the second tool support 260b can be maintained.

  The connector 280 may have a rigid structure. At least a part of the connector 280 may be flexible. The connector 280 may have an operator shapeable structure (operator manufacturable structure). The connector 280 may have a mariable structure (adaptive structure). The connector 280 may comprise two segments connected by a hinge such as a butt hinge, a butterfly hinge, a barrel hinge or a hinge with a flexible portion between the two rigid portions. For example, the connector 280 may have a telescopic adjustable structure so that the tool supports 260a and 260b can be separated. The connector 280 may comprise two segments connected by a pivotable connector such as a universal joint.

  The connector 280 can be configured and arranged so that it can be molded, molded, etc. after heating. The connector 280 may be configured and arranged to attach to at least one of the first tool support 260a and the second tool support 260b. The connector 280 may be configured and arranged to be removable from at least one of the first tool support 260a and the second tool support 260b.

  An alternative connector that can be attached to the first tool support 260a and the second tool support 260b, for example, a connector 280 "shown in FIG. 5, may be prepared. The alternative connector 280" is provided with the first tool support 260a and the second tool support. It can be configured and arranged to maintain a relative position between 260b. The original connector 280 is configured and arranged so that the first tool support 260a and the second tool support 260b can be positioned according to the first geometry, and the first tool support 260a and the second tool support 260b according to a second geometry different from the first geometry. The alternative connector 280 "may be configured and arranged for positioning. The original connector 280 may differ from the alternative connector 280" in at least one of length, shape, and curvature.

  The connector 280 has a first opening and a second opening configured and arranged to be operably connected to the guide elements of the first and second tool supports 260a and 260b, respectively. The first and second openings can be configured and arranged to position the first tool support 260a and the second tool support 260b according to a non-parallel configuration. At least one of the first opening and the second opening, for example, a funnel-shaped opening for receiving the guide element 261, more specifically, a funnel-like end of the outer guide element 262 shown in FIG. -shaped proximal end) 264 may be provided.

  The tool positioning system 100 may have at least one fixed point, 133a-133e (collectively 133) in the figure, each configured and arranged for attachment to a stabilizing brace. The fixing point 133a may be disposed on the introduction device 250. The fixing point 133b may be disposed on the base 285. The fixing point 133c may be disposed on the first tool support 260a. The fixing point 133d may be disposed on the second tool support 260b. The fixing point 133e may be disposed on the connector 280. A brace 132, also known as a support, can be attached to the fixed point 133a. The other end of the brace 132 can be attached to other locations associated with the tool positioning system 100, such as the operating room floor, the patient operating table (T), and / or the articulating probe feeder 110. The brace 132 may comprise a clamping device or the like that can be clamped to a floor, table or other support object. A plurality of braces may be connected to several fixed points 133. For example, a brace (not shown) could be connected between a fixed point 133b on the base 285 and a fixed point 133c on the first tool support 260a. Another brace 131 could be attached to the feeder 110 and clamped to a floor, table or other stable object.

  The system 100 may include a first interpersonal interface device (HID) 80a and a second HID 80b that communicate with the controller 85. As shown in FIG. 1, the first HID 80a can be arranged near the first operator position (L1) or can be directed to the first operator position (L1), and the second HID 80b can be arranged near the second operator position (L2). It is possible to do or point in that direction. In another embodiment, the first and second HIDs 80a, 80b are located at one or more operator positions such as position (L1) as part of the same hardware platform, and an operator at position L1 or L2 There may be an embodiment in which the HIDs 80a and 80b at the same position can be accessed. Part or all of the first HID 80a and / or the second HID 80b may be integrated with a tool inserted into the tool support 260. The system 100 according to an embodiment includes a third HID 880c that is integrally attached to the dog bone connector 280 and that performs wired or wireless communication with the controller 85.

  One or a plurality of HIDs 80a, 80b, 80c (generally 80) can operate the articulating probe 10, the tool support 260, one or a plurality of tools inserted into the tool support 260, or a combination thereof. As such, it may be configured and arranged. In the system 100 of FIG. 1, the first HID 80a is directed toward the first operator position (L1). The second HID 80b is directed toward the second operator position (L2). The first operator, for example, a medical employee, operates the articulating probe 10 via the HID 80a to control the function and movement of the articulating probe 10 via a command transmitted to the controller 85, for example, the probe 10 Can be steered and moved forward or backward. The light source, camera and other devices attached to the articulating probe can be activated in response to a control signal generated by the HID 80a. Alternatively or in addition, the second operator operates the articulating probe 10 via the second HID 80b and controls the function and movement of the articulating probe 10 via a command transmitted to the controller 85, for example, the probe 10 Can be steered and moved forward or backward. Light sources, cameras, and other devices attached to the articulating probe can be activated in response to control signals generated by the HID 80b. The first HID 80a and / or the second HID 80b may include an apparatus selected from a haptic controller, a joystick, a trackball, a mouse, and an electromechanical device. The articulating probe 10 can be operated via the HID 80, and the surgical tool can be operated via a tool handle, for example the tool handle in FIG. One or more HIDs 80 may communicate with the controller through a physical connector such as a conductive wire, or may communicate via a wireless connection such as a Bluetooth (registered trademark) connection. A switch, joystick, button, or the like may be provided in the HID 80 so that a force related to the movement of the articulating probe 10 shown in FIG. 4 can be applied. In other embodiments, a force sensor, such as a strain gauge, may be provided on the HID 80 that can detect forces applied to the dogbone connector 280, such as pushing, pulling and / or twisting forces. By applying such force, the articulating probe 10 shown in FIG. 4 can be controlled, for example, the probe 10 can be advanced, retracted or steered.

  When performing a medical procedure, for example, the patient (P) will lie on the operating table (T) with his face up as shown in FIG. In one embodiment, as shown in FIG. 1, the first operator position (L1) and the second operator position (L2) are arranged side by side, that is, two or more operators can each operate one or more tools. Will be placed next to each other. The first tool support 260a and / or the second tool support 260b may be configured and arranged to allow tool access to the patient's head (H). For example, the first tool support 260a can provide tool access through the patient's mouth to the patient's esophagus. The first tool support 260a and / or the second tool support 260b may be configured and arranged to allow tool access to at least one of the patient chest and the patient abdomen.

  FIG. 2 is a top view of a tool positioning system 100 for performing a medical procedure according to another embodiment of the present invention. Many of the elements described with reference to FIG. 1 are the same or similar to those of FIG. 2 and will not be described again for the sake of brevity.

  In the embodiment of FIG. 2, the first operator position (L1) and the second operator position (L2) are set so that the operator at the first operator position (L1) and the operator at the second operator position (L2) can face each other. Opposite positions, such as the operating table (T), are on opposite sides of each other. The first tool support 260a can extend in a direction toward the first operator position (L1) on the first side of the operating table (T), and the second tool support 260b can be extended to the first table of the operating table (T). It is possible to extend in the direction toward the second operator position (L2) on the side opposite to the second side, that is, the first side. The first tool support 260a and / or the second tool support 260b may be configured and arranged to allow tool access to a region of the patient (P) 's body, such as at least one of the patient's chest and patient's abdomen.

  As shown in FIG. 3, the first tool support 260a and the second tool support 260b may be fixedly connected to the surface of the introduction device 250 instead of the base. In one embodiment, the first tool support 260a and / or the second tool support 260b are directly coupled to the introduction device 250 by attachment mechanisms, such as corresponding welding points 286a, 286b. Alternatively, other joining techniques such as adhesives or the like may be applied. This connection in the introduction device 250 maintains a fixed distance relationship and / or a fixed orientation relationship between the first tool support 260a and the second tool support 260b. In certain embodiments, tool supports 260a and 260b may be pivotally attached to each other and / or the base so that a fixed distance relationship is maintained but a fixed orientation relationship is not maintained. The positions of the first tool support 260a and the second tool support 260b may be fixed to each other. In that case, the position of the first and second tool supports 260a, 260b is maintained while the tool positioning system 100 is operating.

  At least one of the first tool support 260a and the second tool support 260b may include first and second guide elements 261a and 261b, respectively. The first guide element 261a may include an outer guide element 262a, a different name proximal guide element, an inner guide element 263a, a different name distal guide element. The second guide element 261b may include an outer guide element 262b and an inner guide element 263b. At least a portion of the inner guide elements 263a, 263b (collectively 263) is flexible. The inner guide element 263 may be formed of plastic or a similar material. Materials include, but are not limited to, fluoropolymers (eg, polytetrafluoroethylene), fluorinated ethylene propylene, polyether block amide, high density polyethylene, low density polyethylene and / or nickel titanium alloys. sell. The inner guide element 263 may comprise a laser cut tube (eg, polymer tube or metal tube) and / or a plastic or metal braid or coil. In certain embodiments, the inner guide element 263 comprises a polytetrafluoroethylene liner. In certain embodiments, the inner guide element 263 comprises a stainless steel coil. In certain embodiments, the inner guide element 263 comprises a coil coated with a polyether block amide. In certain embodiments, the inner guide element 263 may be configured with a tube whose durometer hardness varies along its length, for example, so that its stiffness varies along its length. At least a portion of the outer guide elements 262a, 262b (collectively 262) is rigid and has little or no flexibility. As shown in FIG. 3, the outer guide elements 262a, 262b may be anchored (fixed) directly to the introduction device 250 by welding 286a, 286b, respectively.

  The outer guide element 262 may comprise a first tube. The inner guide element 263 can comprise a second tube, a portion of which is located within the first tube of the outer guide element 262 and can move relative to the first tube. In this configuration, the inner guide element 263 can be movably extended from the outer guide element 262, for example in a telescopic form.

  As shown in FIG. 4, the tool support 260 can be pivotally connected to the base 285. Although only one tool support 260 is shown in FIG. 4, any tool support described herein (eg, first tool support 260a, second tool support 260b, third tool support 260c, and / or fourth tool support). 260d) can also be configured as shown. When the tool support 260 is connected to the base 285 by the gimbal 630, the tool support 260 can be rotated with respect to the base 285, for example, a three-degree-of-freedom motion between the tool support 260 and the base 285 (for example, two-dimensional (X− Y) It is possible to enable rotation in addition to movement. Such a gimbal 630 or other pivoting mechanism or ball-and-joint mechanism allows the guide element 261 of the tool support 260 to be connected to the base 285 in a dynamic or fixed manner, for example in the middle of the guide element 261. it can. In an embodiment in which the tool support 260 can be slidably adjusted, that is, in an embodiment in which a portion of the support 260 that is connected to the dog bone connector 280 can be shortened, the dog bone connector 280 has adjustability with respect to the distance between the connector openings. May be required. Depending on the desired relative orientation of each support 260 to the support 260 and whether it is parallel or angled, the adjustability of the connector 280 with respect to the distance between the openings will occur along a straight or curved path. Alternatively, the guide element 261 of the tool support 260 may be fixedly attached to the base, for example, at an intermediate portion of the guide element 261. Tool support 260 may be locked in a fixed position relative to base 285. The system 100 can include a locking mechanism 635 that locks at least one tool support 260 in a fixed position. The locking mechanism can be configured to hold the position of the tool support 260 relative to the base 285 so that when one or more operators are moving the tool, the tool support 260 moves axially, for example sliding. Can be prevented.

  The outer guide element 262 of the guide element 261 provided on the tool support 260 can be configured and arranged to have a hollow elongate member. The hollow elongate member can be constructed and arranged as a structure known to those skilled in the art (so-called persons skilled in the art), such as a hollow tube, a coil such as a helical coil, or a combination thereof. In one embodiment, the entire hollow elongated member is rigid. In other embodiments, at least a portion of the hollow elongate member can be rigid. The inner guide element 263 can similarly be configured and arranged to have a hollow elongate member. In one embodiment, the entire hollow elongated member can be a flexible tube. Or it is good also considering at least one part of a hollow elongate member as a flexible part. The inner guide element 263 can be slid along the inner surface of the opening provided in the outer guide element 262 in which the inner guide element 263 is disposed.

  The outer guide element 262 may have a funnel-shaped proximal end 264. The inner guide element 263 may similarly have a funnel-shaped proximal end 265. One or both of the funnels 264, 265 may be configured to guide the tool to the tool support 260 quickly and automatically. As shown in FIG. 3, the funnel-shaped base ends 264 a and 264 b of the tool supports 260 a and 260 b can be respectively arranged around the opening provided in the connector 280.

  The outer guide element 262 and / or the inner guide element 263 provide a support for the tool shaft so that the tool shaft can be guided to a side port 637 connected to the outer surface of the articulating probe 10. Can be configured and arranged to provide, eg, guide.

  The side port 637 can be connected to the distal link 631 of the articulating probe 10. The side port 637 can be formed in a flange on the articulating probe 10. A plurality of side ports may be disposed along the outer sleeve of the articulating probe 10 so that one or more guiding elements 261 that articulate similarly to the articulating probe 10 can be guided. Alternatively, the inner guide element 263 may be fixedly attached to the outer surface of the articulating probe 10, for example, the distal link 631 with an adhesive, a mechanical fastener, or the like.

  FIG. 5 is a perspective view of a tool positioning system 100 having a plurality of connectors 280, 280 'according to one embodiment.

  The tool positioning system 100 also includes a first tool support 260a, a second tool support 260b, a third tool support 260c, and a fourth tool support 260d. Each tool support 260a-260d may be provided with a funnel-shaped opening 264a-264d on its proximal end side. Tool supports 260 a-260 d and introduction device 250 are fixedly attached to base 285. The third tool support 260c may comprise at least one guide element 261c, for example, similar to the guide elements 261a and 261b described above. For example, the guide element 261c can comprise an outer guide element 262c and an inner guide element 263c. The fourth tool support 260d may comprise at least one guide element 261d, for example similar to the guide elements 261a and 261b described above. For example, the guide element 261d can include an outer guide element 262d and an inner guide element 263d.

  The first tool support 260a and the third tool support 260c may be oriented in the same or similar direction, eg, toward the first operator position. The second tool support 260b and the fourth tool support 260d may be oriented in the same or similar direction, eg, toward the second operator position. Tools (not shown) extending from the first and third tool supports 260a and 260c, respectively, are on the first side and the second side of the tip of the articulating probe 10, respectively, and the second and fourth tools respectively. Tools (not shown) extending from the supports 260b and 260d are on the first side and the second side of the tip of the articulating probe 10 in the figure (the first side is the opposite side of the second side). In another embodiment, although not shown, tools extending from the first and third tool supports 260a and 260c, respectively, can be disposed on the first side of the tip of the articulating probe 10, and the second and fourth tool supports 260b, respectively. , 260 d can be disposed on the second side of the tip of the articulating probe 10.

  The outer guide element 262a of the first tool support 260a and the outer guide element 262c of the third tool support 260c may be oriented in the same or similar direction, eg, toward the first operator position. The outer guide element 262b of the second tool support 260b and the outer guide element 262d of the fourth tool support 260d may be oriented in the same or similar direction, eg, toward the first operator position. However, the first and second inner guide elements 263a and 263b may be juxtaposed, and the third and fourth inner guide elements 263c and 263d may be juxtaposed.

  The tool positioning system 100 may include a connector 280 attached to the proximal ends of the first tool support 260a and the third tool support 260c. The connector 280 is configured and arranged so that the relative position between the first tool support 260a and the third tool support 260c can be maintained. The tool positioning system 100 may also include a second connector 280 'attached to the proximal ends of the second tool support 260b and the fourth tool support 260d. The connector 280 'is configured and arranged so that the relative position between the second tool support 260b and the fourth tool support 260d can be maintained. In other embodiments, the first connector 280 may be attached to the proximal ends of the first tool support 260a and the second tool support 260b, and the second connector 280 ′ may be attached to the proximal ends of the third tool support 260c and the fourth tool support 260d. Can be attached to.

  Connector 280, aka first connector or first dogbone connector, and / or connector 280 ', aka second connector or second dogbone connector can be removed from tool support 260 and replaced with another connector 280 ". The connector 280 ″ may have different configuration parameters than the connectors 280, 280 ′, for example, may have different lengths or may have an opening for receiving the funnel-shaped guide element 261.

  FIG. 6 is a perspective view of a tool positioning system 100 having three tools 201, 202, 203 in communication with a connector 280, according to one embodiment. One operator can operate the tool positioning system 100 including any or all of the three tools 201, 202, and 203. Alternatively, two or more operators may operate the tool positioning system 100 in FIG. 6 including any or all of the three tools 201, 202, and 203.

  Three tool supports 260a, 260c, and 260e extend between the base 285 and the connector 280. Each tool support 260a, 260c and 260e may be provided with a funnel-shaped opening 264a, 264c and 264e on its proximal side, respectively. Base 285 includes a collar having first, second and third openings aligned with first, second and third tool supports 260a, 260c and 260e, respectively. The guide elements 261a, 261c, and 261e (collectively 261) of the first, second, and third tool supports 260a, 260c, and 260e are positioned such that the intermediate portion of the guide element 261 is located in the opening during operation. As such, it can be extended through the first, second and third openings, respectively. Base 285 may have a fourth opening for receiving introducer device 250.

  At least one of the tools 201, 202, 203 can be provided with a shaft, which is inserted in the tool supports 260a, 260c and 260e, respectively, and is slidable by the corresponding tool support 260. Are arranged and arranged to be acceptable. One or more tools 201, 202, 203 include: aspirator, ventilator, light source, camera, grasspa, laser, cauterizer, clip applier, scissors, needle, needle holder, scalpel, RF energy supply device, It can be selected from among cryogenic energy supply devices and combinations thereof. Tools 201, 202, 203 may comprise a rigid tool shaft and / or a flexible tool shaft.

  The connector 280 is attached to the first, second and third tool supports 260a, 260c, 260e and can be configured and arranged to maintain a relative distance between the tool supports 260a, 260c, 260e. The connector 280 may be fixedly attached to one or more of the tool supports 260. Alternatively, the connector 280 may be pivotally attached to one or more of the tool supports 260. The connector 280 holds the relative position of the third tool support 260e with respect to the first tool support 260a and the second tool support 260c.

  The base 285 may be fixedly attached to one or more of the tool supports 260. Alternatively, the base 285 may be pivotally attached to one or more of the tool supports 260. A gimbal (see FIG. 4) may be provided on the base 285, and the base 285 may be pivotally connected to one or a plurality of guide elements 261.

  The operator may be one of the tools 201 extending from the first tool support 260a, the tool 202 extending from the second tool support 260c, and / or the tool 203 extending from the third tool support 260e, for example, from a single operator position. One or more can be manipulated. Alternatively, two of the tools 201, 202, and 203 may be operated by one of the operators, and the remaining tools 201, 202, and 203 may be operated by another operator.

  As shown in FIG. 7, the first tool 201 is arranged on the first side of the tip of the articulating probe 10, that is, the left side of the paper surface, and the second tool 202 is the second side of the tip of the articulating probe 10, It is arranged on the right side of the page (the side opposite to the first side). In addition, the third tool 203 may be disposed between the first tool 201 and the second tool 202 at the tip of the probe 10. The first tool 201 is inserted into a first tool support having an inner guide element 263a. The inner guide element 263a passes through the base 285 with a gimbal behind the probe 10, for example, not shown. The second tool 202 is inserted into a second tool support having an inner guide element 263c. The inner guide element 263c passes through the base 285 with the gimbal 630c therebetween. The third tool 203 is inserted into a third tool support having an inner guide element 263e. The inner guide element 263e passes through the base 285 with the gimbal 630e therebetween. The first tool 201 can be operated by an operator on the corresponding side of the articulating probe 10, that is, on the left side / first side of the paper. Alternatively, an operator on the opposite side of the articulating probe 10, that is, on the right side / second side of the paper surface, can operate the first tool 201. The second tool 202 can be operated by an operator on the corresponding side of the articulating probe 10, that is, on the right side / second side of the paper surface. Alternatively, an operator on the opposite side of the articulating probe 10, that is, on the left side / first side of the paper surface, can operate the second tool 202. The operator on the first side and the operator on the second side may be the same operator or different operators at different positions, and these separate operators are arranged side by side as shown in FIG. It is possible that the person is in the opposite direction as shown in FIG.

  As described above, the articulating probe 10 includes the tip link 631, which can be arranged around the articulating probe 10. As shown in FIGS. 7 and 8A to 8D, the distal link 631 includes at least three side ports 637. 8B can include three side ports 637 that can be connected to three tool supports, for example, tool supports 260a, 260c, and 260e as shown in FIGS. 6 and 7, respectively.

  In another embodiment shown in FIG. 8C, the tip link 631 "'is provided with four side ports 637 that can be connected to four tool supports, eg, tool supports 260a-260d, respectively, as shown in FIG.

  In another embodiment shown in FIG. 8A, the distal link 631 ′ has five side ports 637 that can be coupled to five tool supports, eg, two tool supports facing one operator position and another operator position. There are five side ports that can be connected to the three tool supports facing.

  In another embodiment shown in FIG. 8B, the side ports 637 are symmetrically spaced around the edge of the tip link 631 ″. In the embodiment shown in FIG. 8D, the side port 637 is the edge of the tip link 631 ″ ″. Are asymmetrically spaced around.

  The side ports 637 may be arranged around the edge of the connector 280 and separated from each other by 30 ° to 180 °. For example, as shown in FIG. 8D, the first and second side ports 637 can be disposed at a distance of less than 180 °, for example, 150 °, and the third side port 637 can be separated from the first and second side ports 637 respectively. It can be arranged between the first side port and the second side port so that the distance to the third side port 637 is less than 90 °. One or more tool supports 260 facing the operator position on the same or different side as the side port 637 can be attached to the side port 637.

  While the invention has been particularly shown and described with reference to exemplary embodiments thereof, it will be understood by those skilled in the art that, as will be appreciated by those skilled in the art, the essence and Various modifications may be made in form and detail without departing from the technical scope.

Claims (258)

A tool positioning system,
An introduction device constructed and arranged to slidably receive the articulating probe;
A first tool support having at least one guide element configured and arranged to slidably receive the first tool, the first tool support being directed toward a first operator position;
A second tool support having at least one guide element configured and arranged to slidably receive the second tool, the second tool support being directed toward a second operator position;
A system comprising:   The system of claim 1, wherein at least one of the first tool and the second tool is positioned relative to a patient so that the patient can perform a medical procedure.   The system of claim 2, wherein the medical procedure includes an oral surgical procedure.   4. The system of claim 3, wherein the oral surgical procedure includes excision at or near at least one of the tongue base, tonsils, skull base, hypopharynx, pharynx, trachea, esophagus, stomach and small intestine.   3. The system of claim 2, wherein the medical procedure is at least one of single or multiport transaxillary, thoracoscopic, pericardial, laparoscopic, transgastric, enteral, transanal and transvaginal procedures. Including system.   6. The system of claim 5, wherein the single or multi-port transaxillary procedure includes a pharyngectomy.   6. The system of claim 5, wherein the single or multi-port thoracoscopic procedure includes a mediastinal incision.   6. The system of claim 5, wherein the single or multiport pericardial procedure includes arrhythmia measurement and treatment.   6. The system of claim 5, wherein the single or multi-port laparoscopic procedure comprises an obesity correction lapband procedure.   6. The system of claim 5, wherein the single or multi-port transgastric or enteral procedure includes at least one of cholecystectomy and spleen removal.   6. The system of claim 5, wherein the single or multiport transanal or vaginal procedure includes at least one of hysterectomy, ovariectomy, cystectomy, and colectomy.   The system of claim 1, wherein the first tool support is coupled to the second tool support.   13. The system according to claim 12, wherein the first tool support and the second tool support are connected to each other by a common element.   14. The system according to claim 13, wherein the distance between the first tool support and the second tool support is kept constant by the connection of the common elements.   14. The system according to claim 13, wherein a difference in orientation between the first tool support and the second tool support is kept constant by connection in common elements.   14. The system of claim 13, wherein at least one of the first and second tool supports moves linearly with respect to a common element.   The system according to claim 12, wherein the positions of the first tool support and the second tool support are fixed to each other.   The system of claim 17, wherein the position of the first and second tool supports is maintained during operation of the tool positioning system.   The system according to claim 12, wherein the orientations of the first tool support and the second tool support are fixed to each other.   20. The system of claim 19, wherein the orientation of the first and second tool supports is maintained during operation of the tool positioning system.   13. The system according to claim 12, wherein at least one of the first tool support and the second tool support is pivotable relative to the other.   22. The system of claim 21, wherein at least one of the first tool support and the second tool support is reversible with respect to the other at a common element to which the first and second tool supports are respectively connected. System that is dynamic.   23. The system of claim 22, wherein at least one of the first and second tool supports is locked in a fixed position relative to the common element.   24. The system of claim 23, further comprising a locking mechanism that locks the at least one of the first and second tool supports in a fixed position.   13. The system of claim 12, wherein at least one of the first tool support and the second tool support is directly anchored to the introduction device.   26. The system of claim 25, wherein at least one of the first tool support and the second tool support is joined to the introduction device.   26. The system of claim 25, wherein at least one of the first tool support and the second tool support is welded to the introduction device.   The system of claim 1, further comprising a base, wherein the first tool support and the second tool support are coupled to the base.   30. The system of claim 28, wherein the introduction device is coupled to the base.   30. The system of claim 29, wherein the base has a collar surrounding at least a portion of the introducer device.   32. The system of claim 30, wherein the collar extends transversely to the direction of extension of the introduction device.   32. The system of claim 30, wherein the collar has first and second openings aligned with the first and second tool supports.   32. The system of claim 30, wherein the collar has first and second openings and the first and second tool supports extend through the first and second openings.   30. The system of claim 28, wherein at least one of the first tool support and the second tool support has at least one guide element pivotally connected to the base.   35. The system of claim 34, wherein the at least one of the first tool support and the second tool support includes a gimbal that is pivotally connected to the at least one guide element at a base.   35. The system according to claim 34, wherein among the at least one guide element, the first tool support is rotatably connected to the base at an intermediate portion thereof.   35. The system of claim 34, wherein the at least one guide element provided on a first tool support is fixedly attached to a base.   35. The system according to claim 34, wherein among the at least one guide element, the first tool support is rotatably connected to the base at an intermediate portion thereof.   29. The system of claim 28, wherein the first tool support is pivotally connected to the base and the second tool support is pivotally connected to the base.   30. The system of claim 28, wherein the at least one of the first and second tool supports moves linearly with respect to the base.   The system of claim 1, wherein the system is configured and arranged to slidably receive two tools.   The system of claim 1, wherein the system is configured and arranged to slidably receive three tools.   The system of claim 1, wherein the system is configured and arranged to slidably receive four tools.   The system of claim 1, wherein the system is configured and arranged to slidably receive five or more tools.   The system of claim 1, wherein the at least one guide element on the first tool support is configured and arranged to receive a shaft of the first tool, the at least one guide element. Of which the second tool support is configured and arranged to receive the shaft of the second tool.   2. The system of claim 1, wherein the first tool is positioned on a first side of the tip of the articulating probe and the second tool is relative to a second side or first side of the tip of the articulating probe. A system positioned on the opposite side.   47. The system of claim 46, wherein the first tool is operated by an operator at a first operator position on the first side of the tip of the articulating probe and the second tool is at the tip of the articulating probe. A system operated by an operator at a second operator position on the second side.   The system of claim 1, wherein the first tool and the third tool are positioned on the first side of the tip of the articulating probe, and the second tool and the fourth tool are the first of the tip of the articulating probe. A system that is positioned on the opposite side of the second or first side.   49. The system of claim 48, wherein the first and third tools are operated by an operator at a first operator position on the first side of the tip of the articulating probe, and the second and fourth tools are A system operated by an operator at a second operator position on the second side of the tip of the curating probe.   The system of claim 1, wherein at least one of the first tool support and the second tool support has a funnel-shaped proximal end.   The system according to claim 1, wherein at least one guide element provided in at least one of the first tool support and the second tool support includes an inner guide element and an outer guide element.   52. The system of claim 51, wherein the outer guide element has a first tube and the inner guide element has a second tube slidably disposed within the first tube.   53. The system of claim 52, wherein the inner guide element extends movably from the outer guide element.   52. The system of claim 51, wherein at least a portion of the inner guide element is flexible.   The system of claim 1, further comprising a third tool support, wherein the third tool support comprises at least one guide element configured and arranged to slidably receive the third tool. System with.   56. The system of claim 55, wherein the third tool support is directed toward the first operator position.   56. The system of claim 55, further comprising a connector coupled to the first tool support and the third tool support so that the connector can maintain a relative position between the first tool support and the third tool support. Structured and arranged system.   56. The system of claim 55, further comprising a fourth tool support, the fourth tool support comprising at least one guide element configured and arranged to slidably receive the fourth tool. System with.   59. The system of claim 58, wherein the fourth tool support is directed toward the second operator position.   59. The system of claim 58, further comprising a connector coupled to the second tool support and the fourth tool support so that the connector can maintain a relative position between the second tool support and the fourth tool support. Structured and arranged system.   59. The system of claim 58, further comprising a connector coupled to a proximal end of each of the first and third tool supports, and a connector attached to a proximal end of each of the second and fourth tool supports. system.   The system according to claim 1, further comprising a connector coupled to the first tool support and the second tool support so that the connector can hold a relative position between the first tool support and the second tool support. Structured and arranged system.   64. The system of claim 62, wherein the connector is pivotally connected to the first tool support.   64. The system of claim 62, wherein the connector is pivotally connected to the first tool support and the second tool support.   64. The system of claim 62, wherein the connector is attached to the proximal ends of the first and second tool supports.   64. The system of claim 62, wherein the connector extends in a direction transverse to the extending direction of the proximal ends of the first and second tool supports.   64. The system of claim 62, further comprising a securing point on the connector configured and arranged for attachment to the stabilizing brace.   The system of claim 1, further comprising a third tool support and a connector coupled to the first, second, and third tool support, wherein the connector includes the first, second, and third connectors. System configured and arranged to maintain relative position between tool supports.   The system according to claim 1, wherein the at least one guide element provided on the first tool support or the second tool support has a hollow elongated member.   70. The system of claim 69, wherein the hollow elongate member has a structure selected from a hollow tube, a coil such as a helical coil, a plastic tube such as a knitted plastic tube, and combinations thereof.   70. The system of claim 69, wherein at least a portion of the hollow elongate member is rigid.   70. The system of claim 69, wherein at least a portion of the hollow elongate member is flexible.   The system according to claim 1, wherein the first operator position and the second operator position have a side-by-side positional relationship.   74. The system of claim 73, wherein the first tool support is configured and arranged to allow tool access to the patient's head.   75. The system of claim 74, wherein the first tool support is configured and arranged to allow tool access to the patient's esophagus.   The system according to claim 1, wherein the first operator position and the second operator position have an opposite positional relationship.   77. The system of claim 76, wherein the first tool support is configured and arranged to allow tool access to at least one of the patient chest and the patient abdomen.   The system of claim 1, further comprising a fixed point configured and arranged for attachment to a stabilizing brace.   79. The system of claim 78, wherein the first tool support has its fixation point.   79. The system of claim 78, further comprising a connector coupled to the first tool support and the second tool support so that the connector can maintain a relative position between the first tool support and the second tool support. A system that is configured and arranged and whose connector has the fixed point.   79. The system of claim 78, wherein the introduction device has its fixation point.   79. The system of claim 78, further comprising a base connecting the first tool support and the second tool support, the base having the fixed point.   79. The system of claim 78, further comprising a brace attachable to the fixed point.   84. The system of claim 83, wherein the brace is further attachable to a location selected from a floor, a patient operating table, an articulating probe feeder, and combinations thereof.   79. The system of claim 78, further comprising a second fixed point configured and arranged for attachment to a stabilizing brace.   86. The system of claim 85, further comprising a first brace for attachment to the first fixed point and a second brace for attachment to the second fixed point.   The system of claim 1, further comprising an articulating probe.   90. The system of claim 87, wherein the articulating probe has a tip link.   90. The system of claim 88, wherein the tip link has at least one first side port coupled to the first tool support and a second side port coupled to the second tool support.   90. The system of claim 88, further comprising a third tool support, wherein the tip link is at least one first side port coupled to the first tool support and a second coupled to the second tool support. A system having a side port and a third side port coupled to a third tool support.   92. The system of claim 90, wherein the first, second and third side ports are symmetrically spaced around the edge of the tip link.   94. The system of claim 90, wherein the first, second and third side ports are asymmetrically spaced around the edge of the tip link.   94. The system of claim 90, wherein the first and second side ports are disposed 30 [deg.] To 180 [deg.] Around the edge of the tip link.   94. The system of claim 90, further comprising a fourth tool support, wherein the tip link further comprises a fourth side port coupled to the fourth tool support.   95. The system of claim 94, further comprising a fifth tool support, wherein the tip link further comprises a fifth side port coupled to the fifth tool support.   90. The system of claim 87, further comprising a controller configured and arranged to operate the articulating probe.   99. The system of claim 96, further comprising a first interpersonal interface device directed toward a first operator position, the first interpersonal interface being received by a controller for operating the articulating probe. A system for generating a first control signal.   98. The system of claim 97, further comprising a tool, the tool having the first interpersonal interface device.   98. The system of claim 97, further configured to generate a second control signal directed toward a second operator position and received by a controller for operating the articulating probe. And a system comprising a second interpersonal interface device arranged.   100. The system of claim 99, further comprising a tool, the tool having the second interpersonal interface device.   98. The system of claim 97, further comprising a connector coupled to the first tool support and the second tool support so that the connector can maintain a relative position between the first tool support and the second tool support. A system configured and arranged wherein a first interpersonal interface device is located on the connector.   102. The system of claim 101, wherein the interpersonal interface device on the connector communicates with the controller via a wireless connection.   The system of claim 1, further comprising at least one tool configured and arranged to be slidably received by at least one of the first tool support and the second tool support.   104. The system of claim 103, wherein the at least one tool includes at least two tools, each tool slidably received by at least one of a first tool support and a second tool support. System having a shaft configured and arranged to be able to be made.   104. The system of claim 103, wherein the at least one tool is an aspirator, ventilator, light source, camera, grasper, laser, cauterizer, clip applier, scissors, needle, needle holder, scalpel, RF A system comprising a tool selected from an energy supply device, a cryogenic energy supply device, and combinations thereof. A tool positioning system,
A first tool support having at least one guide element configured and arranged to slidably receive the first tool, the first tool support being directed toward a first operator position;
A second tool support having at least one guide element configured and arranged to slidably receive the second tool, the second tool support being directed toward a second operator position;
A base connecting the first tool support and the second tool support;
A system comprising:   107. The system of claim 106, further comprising an introduction device coupled to the base.   108. The system of claim 107, wherein the base has a collar surrounding at least a portion of the introducer device.   109. The system of claim 108, wherein the collar extends transversely to the direction of extension of the introduction device.   109. The system of claim 108, wherein the collar has first and second openings aligned with the first and second tool supports.   109. The system of claim 108, wherein the collar has first and second openings, and the first and second tool supports extend through the first and second openings.   107. The system of claim 106, wherein at least one of the first tool support and the second tool support has at least one guide element that is pivotably connected to the base.   113. The system of claim 112, wherein the at least one of the first tool support and the second tool support comprises a gimbal that is pivotally connected to the at least one guide element at a base.   113. The system of claim 112, wherein among the at least one guide element, a first tool support is pivotally connected to a base at an intermediate portion thereof.   113. The system of claim 112, wherein the at least one guide element provided on a first tool support is fixedly attached to a base.   119. The system of claim 115, wherein the first tool support of the at least one guide element is pivotally connected to the base at an intermediate portion thereof.   113. The system of claim 112, wherein the first tool support is pivotally connected to the base and the second tool support is pivotally connected to the base. A tool positioning system,
A first tool support having at least one first guide element configured and arranged to slidably receive the first tool;
A second tool support having at least one second guide element configured and arranged to slidably receive the second tool;
A first connector attached to the first tool support and the second tool support, wherein the connector is configured and arranged to maintain a distance between the first tool support and the second tool support;
A system comprising:   119. The system of claim 118, wherein the first connector is fixedly attached to at least one of the first tool support and the second tool support.   119. The system of claim 118, wherein the first connector is pivotally attached to at least one of the first tool support and the second tool support.   119. The system of claim 118, further comprising a gimbal pivotally connected to the at least one of the first and second guide elements at the base.   119. The system of claim 118, wherein the first connector is configured and arranged to be operatively connected to a tool support of the first and second tool supports, respectively. System with 2 openings.   123. The system of claim 122, wherein the first opening and the second opening are configured and arranged such that the first tool support and the second tool support can be positioned according to a non-parallel configuration.   The system of claim 122, wherein at least one of the first opening and the second opening has a funnel-shaped opening.   123. The system of claim 122, wherein the first connector further comprises a third opening configured and arranged to be operably connected to the third tool support.   126. The system of claim 125, wherein a single operator operates a tool extending from each of the first, second, and third tool supports from a single operator position.   119. The system of claim 118, wherein the first connector has a rigid structure.   119. The system of claim 118, wherein at least a portion of the first connector is flexible.   119. The system of claim 118, wherein the first connector has an operator-shaped structure.   130. The system of claim 129, wherein the first connector has a mariable structure.   129. The system of claim 129, wherein the first connector has a hinge portion.   129. The system of claim 129, wherein the first connector is configured and arranged such that it can be molded after at least one of heating and heat removal.   119. The system of claim 118, wherein the first connector is configured and arranged to attach to at least one of the first tool support and the second tool support.   119. The system of claim 118, wherein the first connector is configured and arranged to be removable from at least one of the first tool support and the second tool support.   119. The system of claim 118, further comprising a second connector attachable to the first tool support and the second tool support, the second connector providing a relative position between the first tool support and the second tool support. A system configured and arranged to hold.   135. The system of claim 135, wherein the first connector is configured and arranged such that the first tool support and the second tool support can be positioned according to the first geometry, and the second connector is different from the first geometry. A system configured and arranged such that the first tool support and the second tool support can be positioned according to two geometries.   136. The system of claim 136, wherein the first connector differs from the second connector in at least one of length, shape, and curvature.   119. The system of claim 118, further comprising a third tool support having at least one guide element configured and arranged to slidably receive the shaft of the tool.   138. The system of claim 138, wherein the first connector further maintains a relative position of the third tool support relative to the first tool support and the second tool support.   138. The system of claim 138, further comprising a fourth tool support having at least one guide element configured and arranged to slidably receive the shaft of the tool.   142. The system of claim 140, further comprising a second connector configured and arranged to hold a relative position between the second tool support and the fourth tool support, wherein the first connector comprises the first tool support, A system configured and arranged to maintain a relative position between the third tool supports.   138. The system of claim 138, wherein a single operator operates a tool extending from each of the first, second, and third tool supports from a single operator position.   138. The system of claim 138, wherein the first operator operates a tool extending from two of the first, second, and third tool supports, and the second operator controls the first, second, and third tools. A system that operates tools extending from other parts of the support.   119. The system of claim 118, wherein the first connector is removably connectable to the first and second tool supports.   119. The system of claim 118, wherein the first connector is replaced with a third connector having a different dimension than the first connector.   A method for performing a medical procedure using the surgical tool of claim 1. A tool positioning system,
An introduction device constructed and arranged to slidably receive the articulating probe;
A first tool support having at least one guide element configured and arranged to slidably receive the first tool, the first tool support being directed toward a first operator position;
A second tool support having at least one guide element configured and arranged to slidably receive the second tool, the second tool support being directed toward a second operator position;
Tool positioning system with.   148. A tool positioning system according to at least one of claims 1-145 and 147, wherein at least one of the first tool and the second tool is positioned with respect to the patient so as to perform a medical procedure on the patient. Tool positioning system.   149. A tool positioning system according to at least one of claims 1-145 and 147-148, wherein the medical procedure comprises an oral surgical procedure.   150. A tool positioning system according to at least one of claims 1 to 145 and 147 to 149, wherein the oral surgical procedure comprises the tongue base, tonsils, skull base, hypopharynx, pharynx, trachea, esophagus, stomach and small intestine A tool positioning system including ablation at or near at least one of them.   150. A tool positioning system according to at least one of claims 1-145 and 147-150, wherein the medical procedure comprises single or multi-port transaxillary, thoracoscopic, pericardial, laparoscopic, transgastric, A tool positioning system including at least one of enteral, transanal and vaginal procedures.   158. A tool positioning system according to at least one of claims 1-145 and 147-151, wherein the single or multi-port transaxillary procedure includes a pharyngectomy.   157. A tool positioning system according to at least one of claims 1-145 and 147-152, wherein the single or multi-port thoracoscopic procedure comprises a mediastinal incision.   154. A tool positioning system according to at least one of claims 1-145 and 147-153, wherein the single or multi-port pericardial procedure includes arrhythmia measurement and treatment.   157. A tool positioning system according to at least one of claims 1-145 and 147-154, wherein the single or multi-port laparoscopic procedure comprises an obesity correction lapband procedure.   165. A tool positioning system according to at least one of claims 1-145 and 147-155, wherein the single or multi-port transgastric or enteral procedure comprises at least one of cholecystectomy and spleen removal. system.   157. A tool positioning system according to at least one of claims 1-145 and 147-156, wherein the single or multi-port transanal or vaginal procedure is at least one of hysterectomy, ovariectomy, cystectomy and colectomy Tool positioning system including one kind.   158. A tool positioning system according to at least one of claims 1 to 145 and 147 to 157, wherein the first tool support is coupled to the second tool support.   159. A tool positioning system according to at least one of claims 1 to 145 and 147 to 158, wherein the first tool support and the second tool support are connected to each other by a common element.   159. The tool positioning system according to at least one of claims 1 to 145 and 147 to 159, wherein the distance between the first tool support and the second tool support is kept constant by connection in common elements thereof. .   The tool positioning system according to at least one of claims 1 to 145 and 147 to 160, wherein the difference in orientation between the first tool support and the second tool support is kept constant by the connection in the common elements. system.   170. A tool positioning system according to at least one of claims 1-145 and 147-161, wherein the at least one of the first and second tool supports moves linearly relative to a common element.   The tool positioning system according to at least one of claims 1 to 145 and 147 to 162, wherein the positions of the first tool support and the second tool support are fixed to each other.   164. A tool positioning system according to at least one of claims 1-145 and 147-163, wherein the position of the first and second tool supports is maintained during operation of the tool positioning system.   The tool positioning system according to at least one of claims 1 to 145 and 147 to 164, wherein the orientations of the first tool support and the second tool support are fixed to each other.   168. A tool positioning system according to at least one of claims 1-145 and 147-165, wherein the orientation of the first and second tool supports is maintained during operation of the tool positioning system.   170. A tool positioning system according to at least one of claims 1-145 and 147-166, wherein at least one of the first tool support and the second tool support is pivotable relative to the other. system.   168. A tool positioning system according to at least one of claims 1-145 and 147-167, wherein at least one of the first tool support and the second tool support is the first and second tool support respectively. Tool positioning system that is pivotable relative to the other, with the connected common elements.   170. A tool positioning system according to at least one of claims 1-145 and 147-168, wherein at least one of the first and second tool supports is locked in a fixed position relative to its common element. Positioning system.   170. A tool positioning system according to at least one of claims 1-145 and 147-169, further comprising a locking mechanism that locks the at least one of the first and second tool supports in a fixed position. Positioning system.   170. A tool positioning system according to at least one of claims 1-145 and 147-170, wherein at least one of the first tool support and the second tool support is directly anchored to the introduction device. Tool positioning system.   178. A tool positioning system according to at least one of claims 1-145 and 147-171, wherein at least one of a first tool support and a second tool support is joined to an introduction device.   173. A tool positioning system according to at least one of claims 1-145 and 147-172, wherein at least one of the first tool support and the second tool support is welded to the introduction device.   174. A tool positioning system according to at least one of claims 1-145 and 147-173, further comprising a base, wherein the first tool support and the second tool support are coupled to the base.   175. A tool positioning system according to at least one of claims 1 to 145 and 147 to 174, wherein the introduction device is coupled to the base.   178. A tool positioning system according to at least one of claims 1-145 and 147-175, wherein the base has a collar surrounding at least a portion of the introduction device.   178. A tool positioning system according to at least one of claims 1-145 and 147-176, wherein the collar extends transversely to the extension direction of the introduction device.   180. A tool positioning system according to at least one of claims 1-145 and 147-177, wherein the collar has first and second openings aligned with the first and second tool supports.   178. A tool positioning system according to at least one of claims 1-145 and 147-178, wherein the collar has first and second openings, and the first and second tool supports are first and second thereof. Tool positioning system that extends through the opening.   179. A tool positioning system according to at least one of claims 1-145 and 147-179, wherein at least one of the first tool support and the second tool support is pivotally connected to the base. Tool positioning system with one guide element.   185. A tool positioning system according to at least one of claims 1-145 and 147-180, wherein the at least one of the first tool support and the second tool support is the at least one guide at the base. A tool positioning system with a gimbal pivotally connected to the element.   188. A tool positioning system according to at least one of claims 1 to 145 and 147 to 181 wherein the at least one guide element provided in a first tool support is reversible at a base at its intermediate portion. Dynamically linked tool positioning system.   185. A tool positioning system according to at least one of claims 1-145 and 147-182, wherein the at least one guide element is pivotally connected to a base and at least one second tool support. A tool positioning system in which the guide elements of the machine are pivotally connected to the base.   188. A tool positioning system according to at least one of claims 1 to 145 and 147 to 183, wherein a tool of the at least one guide element provided in a first tool support is fixedly attached to a base. Positioning system.   185. A tool positioning system according to at least one of claims 1 to 145 and 147 to 184, wherein the at least one guide element provided in a first tool support is reversible at a base portion thereof. Dynamically linked tool positioning system.   186. A tool positioning system according to at least one of claims 1-145 and 147-185, wherein the at least one of first and second tool supports moves linearly with respect to the base.   187. A tool positioning system according to at least one of claims 1-145 and 147-186, wherein the tool positioning system is configured and arranged to slidably receive two tools.   188. A tool positioning system according to at least one of claims 1-145 and 147-187, wherein the tool positioning system is configured and arranged to slidably receive three tools.   188. A tool positioning system according to at least one of claims 1-145 and 147-188, wherein the tool positioning system is configured and arranged to slidably receive four tools.   190. A tool positioning system according to at least one of claims 1-145 and 147-189, wherein the tool positioning system is configured and arranged to slidably receive five or more tools.   190. A tool positioning system according to at least one of claims 1-145 and 147-190, wherein the at least one guide element on the first tool support receives the shaft of the first tool. A tool positioning system configured and arranged such that the at least one guide element on the second tool support is configured and arranged to receive a shaft of the second tool.   194. A tool positioning system according to at least one of claims 1-145 and 147-191, wherein the first tool is positioned on the first side of the tip of the articulating probe and the second tool is articulated. A tool positioning system positioned on the second side of the tip of the rating probe, that is, on the opposite side to the first side.   195. A tool positioning system according to at least one of claims 1 to 145 and 147 to 192, wherein the first tool is operated by an operator at a first operator position on the first side of the tip of the articulating probe. A tool positioning system in which the second tool is operated by an operator at a second operator position on the second side of the tip of the articulating probe.   194. A tool positioning system according to at least one of claims 1-145 and 147-193, wherein the first tool and the third tool are positioned on the first side of the tip of the articulating probe, and the second tool And a tool positioning system in which the fourth tool is positioned on the second side or the first side of the tip of the articulating probe.   195. A tool positioning system according to at least one of claims 1-145 and 147-194, wherein the first and third tools are in a first operator position on a first side of the tip of the articulating probe. A tool positioning system operated by an operator, wherein the second and fourth tools are operated by an operator in a second operator position on the second side of the tip of the articulating probe.   196. A tool positioning system according to at least one of claims 1-145 and 147-195, wherein at least one of the first tool support and the second tool support has a funnel-shaped proximal end.   195. A tool positioning system according to at least one of claims 1-145 and 147-196, wherein at least one guide element on at least one of the first tool support and the second tool support is an inner guide element. And a tool positioning system having an outer guide element.   198. A tool positioning system according to at least one of claims 1-145 and 147-197, wherein the outer guide element has a first tube and the inner guide element is slidable within the first tube. A tool positioning system having a second tube disposed therein.   199. A tool positioning system according to at least one of claims 1-145 and 147-198, wherein the inner guide element extends movably from the outer guide element.   199. A tool positioning system according to at least one of claims 1-145 and 147-199, wherein at least a part of the inner guiding element is flexible.   200. A tool positioning system according to at least one of claims 1-145 and 147-200, further comprising a third tool support, the third tool support slidably receiving the third tool. A tool positioning system having at least one guide element arranged and arranged in a flexible manner.   202. A tool positioning system according to at least one of claims 1-145 and 147-201, wherein the third tool support is directed towards the first operator position.   223. A tool positioning system according to at least one of claims 1-145 and 147-202, further comprising a connector coupled to the first tool support and the third tool support, the connector comprising the first tool support. Tool positioning system configured and arranged to hold relative position between support and third tool support.   204. A tool positioning system according to at least one of claims 1-145 and 147-203, further comprising a fourth tool support, the fourth tool support slidably receiving the fourth tool. A tool positioning system having at least one guide element arranged and arranged in a flexible manner.   205. A tool positioning system according to at least one of claims 1-145 and 147-204, wherein the fourth tool support is directed towards the second operator position.   A tool positioning system according to at least one of claims 1-145 and 147-205, further comprising a connector coupled to the second tool support and the fourth tool support, the connector comprising a second tool support. Tool positioning system configured and arranged to hold relative position between support and fourth tool support.   207. A tool positioning system according to at least one of claims 1-145 and 147-206, further comprising a connector coupled to the respective proximal ends of the first and third tool supports, and a second and fourth tool. A tool positioning system comprising a connector attached to the proximal end of each support.   207. A tool positioning system according to at least one of claims 1-145 and 147-207, further comprising a connector coupled to the first tool support and the second tool support, the connector comprising the first tool support. A tool positioning system constructed and arranged to maintain a relative position between the support and the second tool support.   209. A tool positioning system according to at least one of claims 1 to 145 and 147 to 208, wherein the connector is pivotally connected to the first tool support.   209. A tool positioning system according to at least one of claims 1-145 and 147-209, wherein the connector is pivotally connected to the first tool support and the second tool support.   230. A tool positioning system according to at least one of claims 1-145 and 147-210, wherein the connector is attached to the proximal ends of the first and second tool supports.   The tool positioning system according to at least one of claims 1 to 145 and 147 to 211, wherein the connector extends in a direction transverse to the extending direction of the proximal ends of the first and second tool supports.   234. A tool positioning system according to at least one of claims 1-145 and 147-212, further comprising a securing point on the connector configured and arranged for attachment to a stabilizing brace. .   145. A tool positioning system according to at least one of claims 1-145 and 147-213, further comprising a third tool support and a connector coupled to the first, second and third tool support. A tool positioning system, wherein the connector is configured and arranged to hold a relative position between the first, second and third tool supports.   215. A tool positioning system according to at least one of claims 1-145 and 147-214, wherein the at least one guide element provided on the first tool support or the second tool support comprises a hollow elongate member. Positioning system.   146. A tool positioning system according to at least one of claims 1-145 and 147-215, wherein the hollow elongated member is a hollow tube, a coil such as a helical coil, a plastic tube such as a knitted plastic tube and combinations thereof. A tool positioning system with a structure selected from   217. A tool positioning system according to at least one of claims 1-145 and 147-216, wherein at least a portion of the hollow elongate member is rigid.   218. A tool positioning system according to at least one of claims 1-145 and 147-217, wherein at least a portion of the hollow elongate member is flexible.   The tool positioning system according to at least one of claims 1 to 145 and 147 to 218, wherein the first operator position and the second operator position have a side-by-side positional relationship.   220. A tool positioning system according to at least one of claims 1-145 and 147-219, wherein the first tool support is configured and arranged to allow tool access to the patient's head. system.   231. A tool positioning system according to at least one of claims 1-145 and 147-220, wherein the first tool support is constructed and arranged to allow tool access to the patient's esophagus. .   The tool positioning system according to at least one of claims 1 to 145 and 147 to 221, wherein the first operator position and the second operator position have an opposite positional relationship.   234. A tool positioning system according to at least one of claims 1-145 and 147-222, wherein the first tool support is configured to allow tool access to at least one of the patient chest and the patient abdomen and Arranged tool positioning system.   242. A tool positioning system according to at least one of claims 1 to 145 and 147 to 223, further comprising a fixed point configured and arranged for attachment to a stabilizing brace.   251. A tool positioning system according to at least one of claims 1 to 145 and 147 to 224, wherein the first tool support has its fixing point.   260. A tool positioning system according to at least one of claims 1 to 145 and 147 to 225, further comprising a connector coupled to the first tool support and the second tool support, the connector comprising the first tool support. A tool positioning system configured and arranged to hold a relative position between the support and the second tool support, and the connector having the fixing point.   270. A tool positioning system according to at least one of claims 1-145 and 147-226, wherein the introduction device has its fixation point.   260. A tool positioning system according to at least one of claims 1-145 and 147-227, further comprising a base connecting the first tool support and the second tool support, the base having the fixing point. Tool positioning system.   129. A tool positioning system according to at least one of claims 1 to 145 and 147 to 228, further comprising a brace attachable to a fixed point.   The tool positioning system of at least one of claims 1-145 and 147-229, wherein the brace is further selected from among a floor, a patient operating table, an articulating probe feeder, and combinations thereof. Tool positioning system that can be installed at a location.   230. A tool positioning system according to at least one of claims 1 to 145 and 147 to 230, further comprising a second fixed point configured and arranged for attachment to a stabilizing brace.   250. A tool positioning system according to at least one of claims 1 to 145 and 147 to 231, further comprising a first brace for attachment to the first fixed point and a first brace for attachment to the second fixed point. A tool positioning system comprising two braces.   234. A tool positioning system according to at least one of claims 1 to 145 and 147 to 232, further comprising an articulating probe.   234. A tool positioning system according to at least one of claims 1-145 and 147-233, wherein the articulating probe has a tip link.   145. A tool positioning system according to at least one of claims 1-145 and 147-234, wherein the tip link has at least one first side port coupled to the first tool support and a second tool support. And a second side port coupled to the tool positioning system.   146. A tool positioning system according to at least one of claims 1-145 and 147-235, further comprising a third tool support, wherein the tip link is coupled to the first tool support. A tool positioning system having a side port, a second side port coupled to a second tool support, and a third side port coupled to a third tool support.   147. A tool positioning system according to at least one of claims 1-145 and 147-236, wherein the first, second and third side ports are symmetrically spaced around the edge of the tip link. system.   245. A tool positioning system according to at least one of claims 1-145 and 147-237, wherein the first, second and third side ports are asymmetrically spaced around the edge of the tip link. system.   240. A tool positioning system according to at least one of claims 1 to 145 and 147 to 238, wherein the first and second side ports are spaced 30 [deg.] To 180 [deg.] Around the edge of the tip link. system.   240. A tool positioning system according to at least one of claims 1-145 and 147-239, further comprising a fourth tool support, wherein the tip link is further connected to the fourth tool support. A tool positioning system.   245. A tool positioning system according to at least one of claims 1-145 and 147-240, further comprising a fifth tool support, wherein the tip link is further connected to the fifth tool support. A tool positioning system.   242. A tool positioning system according to at least one of claims 1-145 and 147-241, further comprising a controller configured and arranged to operate the articulating probe.   246. A tool positioning system according to at least one of claims 1-145 and 147-242, further comprising a first interpersonal interface device directed toward a first operator position, the first interpersonal interface being A tool positioning system for generating a first control signal received by a controller for operating the articulating probe.   244. A tool positioning system according to at least one of claims 1-145 and 147-243, further comprising a tool, the tool comprising the first interpersonal interface device.   251. A tool positioning system according to at least one of claims 1-145 and 147-244, further configured to generate a second control signal received by a controller for operating an articulating probe. And a tool positioning system comprising an arranged second interpersonal interface device directed towards a second operator position.   249. A tool positioning system according to at least one of claims 1-145 and 147-245, further comprising a tool, the tool comprising the second interpersonal interface device.   258. A tool positioning system according to at least one of claims 1-145 and 147-246, further comprising a connector coupled to the first tool support and the second tool support, the connector comprising the first tool support. A tool positioning system configured and arranged to maintain a relative position between the support and the second tool support, wherein the first interpersonal interface device is located on the connector.   249. A tool positioning system according to at least one of claims 1-145 and 147-247, wherein a human interface device on a connector communicates with a controller via a wireless connection.   251. A tool positioning system according to at least one of claims 1 to 145 and 147 to 248, further capable of being slidably received by at least one of a first tool support and a second tool support. A tool positioning system comprising at least one tool configured and arranged.   249. A tool positioning system according to at least one of claims 1-145 and 147-249, wherein the at least one tool includes at least two tools, each tool comprising a first tool support and a second tool support. A tool positioning system having a shaft configured and arranged to be slidably received by at least one of the tool supports.   251. A tool positioning system according to at least one of claims 1-145 and 147-250, wherein the at least one tool is an aspirator, ventilator, light source, camera, grasspa, laser, cauterizer, clip applier. , A tool positioning system including a tool selected from a scissors, needle, needle holder, scalpel, RF energy supply device, cryogenic energy supply device, and combinations thereof.   The system described with reference to the drawings.   The articulating probe described with reference to the drawings.   The surgical tool described with reference to the drawings.   Controller described with reference to the drawings.   The robot system control method demonstrated with reference to drawings.   Interpersonal interface device described with reference to the drawings.   The medical procedure execution method demonstrated with reference to drawings.

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