JPH08224248A - Mdical manipulator - Google Patents

Abstract

PURPOSE: To always set equally the corresponding position relation of a master manipulator side and a slave manipulator on a treating side and to improve operability by applying such control to detect the angle of the angle detecting means of each shaft of a master arm for movement and to move a manipulator for movement correspondingly. CONSTITUTION: A first controller 71 is electrically connected to the encoder 42 of the master arm 31 for movement, and the position of the tip of the master arm 31 for movement is detected by detecting an angle of rotation by the encoder 42. A second controller 72 is electrically connected to the encoders 55, 56 of an arm 32 for HMD(head mount display), and the direction of an HMD 54 is detected by detecting the angle of rotation of the encoders 55, 56. A third controller 73 is electrically connected to the encoders 74 of arms 33a, 33b for treating means operation, and the direction, position and opening angle of a gripper are detected by detecting the angle of rotation of the encoder 74.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention is, for example, by opening an insertion hole in a body wall such as an abdominal wall and inserting a surgical instrument such as an endoscope or a treatment tool mounted on a manipulator into the body cavity through the insertion hole. The present invention relates to a medical manipulator used in percutaneous endoscopic surgery for performing various procedures inside a body cavity.

[0002]

2. Description of the Related Art Conventionally, percutaneous endoscopic surgery has been performed, but such a surgical procedure is a minimally invasive procedure that does not require a large incision, for example, a cholecystectomy or a part of the lung is removed. It is widely used for surgery. Also, in this type of endoscopic surgery, a surgical manipulator that is equipped with a surgical instrument such as an endoscope and a treatment tool and operates the surgical instrument by remote control to perform an operation on a body part on behalf of the operator. A device is known from the unpublished Japanese patent application No. 5-274405. The surgical manipulator device includes an observation manipulator and a plurality of treatment manipulators each having an endoscope as a surgical instrument to be inserted into the body, and each of these manipulators is provided as a separate and individually independent manipulator. To be Further, as a means for operating them, an HMD (head mount display) provided with a three-dimensional position sensor for operating the observation manipulator and a plurality of master arms for operating each treatment manipulator are independently and individually provided. Is provided for the purpose.

[0003]

By the way, in the above-mentioned Japanese Patent Application No. 5-274405, the manipulator for observation to be inserted into the body and the plurality of manipulators for treatment to be inserted into the body are independent and independent from each other. In addition, the HMD, which is the operating means for remotely operating them, and the plurality of master arms are also individually independent.

Therefore, when this surgical operating apparatus is used, when the HMD and the master arm of the operating means are operated, the observation manipulator and the treatment manipulator corresponding thereto must be operated in the same direction. I won't. In order to match the positional relationship between the HMD and the master arm in accordance with the positional relationship between the observation manipulator and the treatment manipulator, it was necessary to adjust the positional relationship with a button, a lever, a keyboard or the like each time the use was started. However, it is very troublesome to make such preparations each time the surgical device is used.

The present invention has been made in view of the above-mentioned problems, and its object is to provide a medical device having good operability, because the corresponding positional relationship between the master manipulator side and the slave side manipulator on the treatment side is always the same. Is to provide a manipulator for use.

[0006]

According to the present invention, there is provided a slave manipulator comprising a treatment endoscope and a manipulator for movement supporting the endoscope, a master arm for movement operation, and an arm for HMD (head mount display).
In a medical manipulator provided with a master manipulator consisting of one treatment means operating arm and a control means for controlling them, the treatment endoscope is a solid-state imaging device provided at a tip of an insertion portion of the endoscope. The observation means and the two treatment means provided on the left and right of the insertion portion, the bending portion that bends the insertion portion vertically and horizontally, and the driving means for driving the bending operation of the bending portion. The respective treatment means extend along the insertion portion of the endoscope in the same direction and are arranged side by side. The rotatable arm portion is provided with curved portions at two locations in its longitudinal direction, and the treatment arm is provided at the distal end of the arm portion. And a motor with an encoder for driving the bending and rotation of the arm portion and the rotation of the treatment gripper.
Further, the moving manipulator supports the medical treatment endoscope, has a plurality of linear motion or rotation shafts, each shaft is provided with drive means, and the position and orientation of the distal end portion of the medical treatment endoscope. Can be changed. Further, the moving master arm has a plurality of rotating shafts, and each shaft is provided with an angle detecting means. Further, the HMD arm has a plurality of rotation shafts attached to a moving master arm and provided with angle detection means, and has an HMD for displaying an image picked up by the solid-state image pickup device at its tip. There is. Also, the treatment means arm is attached to a moving master arm,
It has a plurality of rotating shafts provided with angle detection means, and has an operation gripper provided with angle detection means at its tip. Further, the control means detects the angle of the angle detecting means of each axis of the moving master arm, controls the moving manipulator to move correspondingly, and detects the angle detecting means provided on the HMD arm. In response to this, control is performed so that the up / down / left / right bending of the observation means operates, and the angle detection means and the angle detection means of the operating gripper provided on the left arm for treatment means are detected, and correspondingly Then, the bending and rotation of the left treatment means and the opening and closing of the treatment gripper are controlled to operate, and the angle detection means and the angle detection means of the gripper provided on the right treatment means arm are detected. Correspondingly, the bending and rotation of the right treatment means and the opening and closing of the treatment gripper are controlled to operate. It is a medical manipulator characterized by including these.

According to the present invention, by adopting the constitution of the claims, the positional relationship between the HMD on the master manipulator side and the treatment instrument operating portion and the positional relationship between the endoscope tip and the treatment instrument tip on the slave manipulator side are always maintained. Can be made equal, and the tip of the endoscope moves as the HMD moves,
The treatment tool moves and operates easily as the treatment tool operating section.

[0008]

An embodiment of the present invention will be described below with reference to the drawings. (Structure) FIG. 1 schematically shows the overall structure of a medical manipulator system. This medical manipulator system controls a slave manipulator 1, a master manipulator 2, and related operations of both manipulators 1 and 2. 3 and 3.

The slave manipulator 1 is a surgical instrument 4 and a manipulator for movement (robot) that supports the surgical instrument 4.
5 is provided. The surgical instrument 4 is detachably mounted on the tip of the arm of the manipulator 5 for movement. The surgical instrument 4 here comprises a stereoscopic endoscope 6 and a pair of grasping forceps 7a and 7b as a pair of treatment means. The insertion portion 8 of the endoscope 6 and the pair of gripping forceps 7a and 7b are inserted into the common sheath 9 and arranged in the same direction, thereby forming an integral unit. That is, the arm portions of the pair of treatment tools 7a, 7b are arranged along the insertion portion 8 of the endoscope 6 and adjacent to the left and right positions of the insertion portion 8 side by side. As shown in FIG. 1, the sheath 9 for the surgical instrument 4 is inserted into the body cavity c through the insertion hole b formed in the body wall a of the patient. The distal end portions of the endoscope 6 and the grasping forceps 7a and 7b in the surgical instrument 4 are arranged so as to project into the body cavity c in substantially the same direction.

By the way, the endoscope 6 is provided with a bending portion 11 having two degrees of freedom in a middle portion on the distal end side of the insertion portion 8 protruding from the distal end of the sheath 9. The bending portion 11 has a vertical direction B.
By bending in two directions, i.e., 1 and the left-right direction B2, the direction of the tip portion 12 is changed to the vertical and horizontal directions.

The distal end portion 12 of the endoscope 6 is provided with a pair of left and right illumination windows 13 and a pair of left and right observation windows 14 and illuminates the visual field in the body cavity c with illumination light. Then, the inside of the visual field is observed through the pair of left and right observation windows 14. A solid-state image pickup device such as a CCD is installed inside each observation window 14, and each solid-state image pickup device is driven and controlled by a camera control circuit (not shown) to image each visual field obtained through each observation window 14.

Further, in each of the left and right gripping forceps 7a, 7b, curved portions 15, 16 are provided at two positions in the longitudinal direction in the middle of the arm portion protruding from the sheath 9, and the first curved portion 15 is in the C1 direction. The second bending portion 16 is bent in the C2 direction. The C1 direction in which the first bending portion 15 bends and the C2 direction in which the second bending portion 16 bends are curved in different directions in the same plane in normal operation, for example, in directions perpendicular to each other. There is. Further, in the grasping forceps 7a, 7b, the arm portion protruding from the sheath 9 is rotated by the rotating portion 17 provided on the proximal end side thereof to rotate the C3 around the self-axis.
Directional rotation is also possible. A gripper 18 for treatment work is provided at the tip of the arm of the grasping forceps 7a, 7b. In other words, the grasping forceps 7a and 7b have a bilaterally symmetrical structure with respect to the axis of the insertion portion 8 of the endoscope 6 and have the same degree of freedom.

The medical treatment endoscope 6 is provided with a drive unit 19 at its rear end, and the drive unit 19 is provided with an electromagnetic motor (not shown) having an encoder, and the drive force is applied to, for example, a wire (not shown). The bending of the bending portion 11 of the endoscope 6 and the bending portions 15 and 1 of the grasping forceps 7a and 7b by
It is possible to drive treatment operations such as the bending of 6, the rotation of the arm portion thereof, and the opening / closing of the gripper 18. FIG. 2A schematically shows a kinematic relationship in each part of the surgical instrument 4.

On the other hand, the moving manipulator 5 is a support mechanism installed on the bedside, and is composed of a multi-joint arm structure having a plurality of shafts having degrees of freedom of linear movement and rotation, as described below. There is. That is, this is the base 20, the first operating shaft 21 which operates in the horizontal turning direction A1 and the vertical moving direction A2, the horizontal moving direction A3 with respect to the first operating shaft 21, and the turning direction A4 around its own axis. Is provided with a rotatable second operating shaft 22, and the tip of the second operating shaft 22 has a turning direction A orthogonal to the axial direction thereof.
5 and the instrument mounting member 23 rotatable in a turning direction A6 around an axis orthogonal to the axis of the turning direction A5. The sheath 9 of the surgical instrument 4 is inserted through the instrument mounting member 23, and the surgical instrument 4 is supported in this state. FIG. 3 (a) conceptually shows the pair relationship of the link mechanism of the moving manipulator 5 with the same reference numerals corresponding to the respective directions A1 to A6. An actuator (not shown) such as an electromagnetic motor that drives in each direction, an absolute encoder (not shown) and a speed reducer (not shown) that detect the rotation angle thereof are provided on each axis of the moving manipulator 5. It is provided.

In addition, the endoscope 6 and a pair of gripping forceps 7a, 7
The unit of the surgical instrument 4 consisting of b is detachably attached to the instrument attachment member 23 provided at the tip of the moving manipulator 5. The structure of the detachable portion of the slave manipulator 1 is shown in FIG. That is, the instrument mounting member 23 is provided with a mounting hole 25 into which the base portion of the sheath 9 for holding the surgical instrument 4 is inserted and mounted, and a male screw portion 28 for screwing the female screw 27 of the nut 26 on the outer periphery of the base portion of the sheath 9. By fitting the base portion of the sheath 9 into the instrument mounting member 23 and tightening the nut 26, the distal end of the manipulator 5 for movement and the endoscope 6 side thereof can be coupled and separated.

On the other hand, the master manipulator 2 of the operating means comprises a moving master arm 31, an HMD arm 32 provided at the tip of the moving master arm 31, and a pair of treatment means operating arms 33a and 33b. The moving master arm 31 is composed of a link mechanism, is attached to a base 34 such as a wall portion or a pedestal of an operating room, and is rotated around a shaft thereof in a D1 direction.
A second shaft member 38 connected to the tip of the first shaft member 36 through a joint 37 so as to rotate in the D2 direction, and a D39 direction through a joint 39 at the tip of the second shaft member 38. A third shaft member 40 that is rotatably connected to the third shaft member 40 and a mounting tip member 41 that is rotatably connected to the D4 direction are connected to the tip of the third shaft member 40. The joints of the link mechanism of the moving master arm 31 are conceptually shown by the same reference numerals as the corresponding rotation directions A1 to A6, as shown in FIG. 3 (b). An encoder 42 is attached to each of these rotary shaft portions so as to detect its rotation angle, and the position and orientation of the tip of the moving master arm 31 can be detected by the detection data of the encoder 42. ing.

The HMD arm 32 comprises an arm 53 having two rotary joints 51 and 52, and an HMD (head mount display) 54 as a display means fixed to the tip of the arm 53. The rotation directions E1 and E2 of the rotary joints 51 and 52 of the arm 53 are orthogonal to each other as shown in FIG. 2B, and encoders 55 and 56 are provided on the respective HMDs.
The rotation amount of each of the rotation directions E1 and E2 of 54 can be detected.

In addition, one treatment means operating arm 33a
Is an arm 64 having three revolute joints 61, 62, 63
And an openable / closable operation gripper 65 provided at the tip of the arm 64. Each rotary joint 6
1, 62, and 63 are F3, F1, and F2, respectively.
It is possible to move in one direction. An encoder is provided on each of the three rotary joints 61, 62, 63 and the gripper 65, and each rotary joint 61, 62, 63 is provided with an encoder.
The rotation angle and the opening angle of the gripper 65 can be detected. The other treatment means operating arm 33b is rotated with respect to the one treatment means arm 33a in the rotation direction D
4 has a bilaterally symmetric structure with respect to the axis of rotation, and since both of them have the same structure, the other treatment means operating arm 3
The description of 3b is omitted.

The HMD arm 32 and the pair of treatment means operating arms 33a and 33b constitute an operation unit attached to the same connecting base portion 66, and the connecting base portion 66 is the tip of the moving master arm 31. Member 4
It is attached in a detachable manner with respect to 1. The structure of this attachment / detachment portion is shown in FIG. The tip member 41 of the moving master arm 31 is provided with an engagement protrusion 67 at the center of its tip surface and a nut 68 rotatably attached thereto. On the other hand, the HMD arm 32 and a pair of treatment means operating arms 3
A hole 69 into which the engaging projection 67 is fitted is formed in the base end surface of the same connection base 66 to which the operation units 3a and 33b are attached, and the nut 6 is formed on the outer periphery of the connection base 66.
A male screw 70 into which the female screw 68a of No. 8 is screwed is provided. Then, the tip member 41 of the moving master arm 31
The connection base 66 is butted against the above, the engaging projection 67 is fitted into the hole 69, and the nut 68 is screwed into the male screw 70 so that they can be coupled and separated from each other.

Next, the configuration of the control device 3 for controlling the related operations of the slave manipulator 1 and the master manipulator 2 will be described. As shown in FIG. 1, the control device 3 includes a first control device 71, a second control device 72, and a third control device 73. The first control device 71 is electrically connected to each encoder 42 of the moving master arm 31 and detects the rotation angle by the encoder 42,
The position of the tip of the moving master arm 31 can be detected. Further, the first control device 71 is electrically connected to each electromagnetic motor of the moving manipulator 5 and an encoder attached to this motor, drives the motor while detecting the moving amount by the encoder, and moves the manipulator 5 for moving. It is possible to determine the position of. The second control device 72 uses the encoders 55 and 56 of the HMD arm 32.
The direction of the HMD 54 can be detected by electrically connecting to the HMD 54 and detecting the rotation angles of the encoders 55 and 56. Further, the second control device 72 has a drive unit 19
Since the motor provided inside is electrically connected to the encoder attached to the motor and the motor can be driven while detecting the movement amount by the encoder, the bending portion of the medical treatment endoscope 6 in the designated direction. It is possible to bend 11.

The third control device 73 is electrically connected to the encoders 74 of the treatment means operating arms 33a and 33b, and detects the rotation angle of the encoders to determine the direction and position of the gripper and the opening / closing angle thereof. Can be detected. Further, the third control device 73 is electrically connected to each electromagnetic motor for driving the treatment means provided in the drive unit 19 and an encoder attached to the motor, and the motor is detected while the encoder detects the movement amount. Since it can be driven, it is possible to determine the position and direction of the treatment means.

The output of the CCD on the left side of the endoscope 6 is converted into a TV signal by a video processor (not shown), and the image can be displayed on the LCD of the left eye display unit of the HMD 54, for example. . Also, CC on the right
The output of D is converted into a TV signal by a video processor (not shown), and is displayed on the display unit of the right eye of the HMD 54, for example, LCD.
It is possible to display the video on. (Operation) Next, an operation when the above-described medical manipulator system is used will be described. First, the surgeon 80
Holds the HMD 54 on his head, holds the left gripper 65 with his left hand, and holds the right gripper 65 with his right hand. At this time, the operator 80 can stereoscopically view the image in the body cavity obtained by the endoscope 6 by the HMD 54.

Next, the operation of the operator 80 for observing the affected area will be described. When the operator 80 changes the position of the head, the encoder 42 of each axis of the moving master arm 31 detects the change of the position, and the first control device 71 thereby detects the position of the tip of the moving master arm 31. And calculate
In response to this, each electromagnetic motor of the slave manipulator 5 for movement is controlled so that the position of the tip of the insertion portion 8 in the endoscope 6 moves. At this time, control is performed such that the coordinate system 81 shown in FIG. 3A and the coordinate system 82 shown in FIG. 3B correspond to each other.

When the operator 80 changes the direction of the neck, the encoders 55 and 56 of the HMD arm 32 detect this movement, and the second controller 72 rotates the EMDs E1 and E2 of the HMD 54.
Then, the motor with an encoder (not shown) in the drive unit 19 is controlled so that the curves B1 and B2 of the endoscope 6 move in a one-to-one correspondence. As a result, the position and orientation of the medical treatment endoscope 6 move in accordance with the position and orientation of the head of the operator 80. It is possible to guide the endoscope 6 and stereoscopically observe the affected area from various angles.

Next, the operation when the operator 80 makes a treatment will be described. When the operator 80 changes the position of the right operation gripper 65 or opens and closes the gripper 65, the movement of the operation gripper 65 is controlled by the joints 61, 6 of the treatment means operating arm 33a.
The encoder 74 provided at 2, 63, etc. detects and
The control device 73 of the rotations F1, F2 and F3 of the right treatment means operating arm 33a and the rotation C1 of the right grasping forceps 7a,
C2 and C3 correspond one-to-one, and the operating gripper 6
The motor with encoder (not shown) in the drive unit 19 is controlled so that the opening / closing F4 of 5 operates in accordance with the opening / closing amount of the opening / closing C4 of the right treatment gripper 18. Further, the third control device 73c controls the motor with an encoder (not shown) in the drive unit 19 so that the left treatment means operating arm 33b and the right treatment grasping forceps 7b also move in a one-to-one correspondence. It is controlled, but the description is omitted because it is similar to the right side. In this way, the movement of the hand of the surgeon 80 and the movement of the treatment tool are 1
Since it corresponds to the pair 1, the operator 80, while observing the image of the HMD 54, presses the affected area with, for example, the left grasping forceps 7b,
The right gripping forceps 7a can perform operations such as peeling the affected area.

The treatment endoscope 6 of the slave manipulator 1 is integrally united as the grasping forceps 7a, 7b and the surgical instrument 4, and the HMD arm 32 of the master manipulator 2 and the treatment means operating arm 33a, Three
3b is also integrally unitized as an operation part. Since each unit is detachable, it is possible to use an endoscope and a treatment tool that are optimal for peeling when peeling, and optimal for suturing when suturing, and a master manipulator corresponding thereto. [Additional Notes] (1) A medical manipulator having the contents described in the claims.

(2) A treatment endoscope and a plurality of treatment means in the slave manipulator are used as a unit, and a mechanism for attaching and detaching the treatment endoscope and the moving manipulator is provided, and further, an HMD arm and two treatment means in the master manipulator. The manipulator for medical treatment according to item 2, wherein the arm for use is a unit, and a mechanism for attaching and detaching the arm for operation to and from the master arm for movement operation is provided.
According to this, the treatment endoscope of the slave manipulator, and the HMD arm and the treatment means arm of the master manipulator can be attached and detached respectively, so that the treatment endoscope and the master arm that are most suitable for the procedure can be obtained. Can be selected and used. According to this, the control of the manipulator for movement by the master arm for movement, the control of the stereoscopic endoscope by the arm for HMD, and the control of the two treatment tools by the arm for treatment means are independent of each other. The control is completed for each. This can simplify the configuration of the control device.

(3) The control means are the first control means and the second control means.
And a third control means, the first control means detects each angle detection means of the moving master arm,
The moving manipulator controls so as to operate correspondingly, and the second control means detects the angle detecting means of the HMD arm and controls so that the bending of the endoscope operates correspondingly. The third control means detects the angle detection means of the left and right treatment arms and controls the left and right treatment means to operate in response to the angle detection means. Medical manipulator. According to this,
Since the control of the movement manipulator by the movement master arm, the control of the stereoscopic endoscope by the HMD arm, and the control of the two treatment tools by the treatment means arm are independent of each other, the control is performed for each part. It's complete. This can simplify the configuration of the control device.

(4) The observation means of the medical treatment endoscope includes
Two left and right solid-state image pickup devices are provided, and the HMD individually displays images captured by the two solid-state image pickup devices on the left-eye display unit and the right-eye display unit, respectively. The medical manipulator according to claim 2 or 3. According to this, the operator can obtain a three-dimensional image of the inside of the body cavity by the HMD, so that the endoscopic surgery can be performed in a more realistic environment.

[0030]

As described above, according to the present invention, the positional relationship between the HMD on the master manipulator side and the treatment instrument operating portion and the positional relationship between the endoscope tip and the treatment instrument tip on the slave manipulator side are always the same. , The tip of the endoscope moves according to the movement of the surgeon's head, and the treatment instrument moves according to the movement of the hand, so that the surgeon can perform endoscopic surgery in the presence of being in a body cavity. Is possible.

[Brief description of drawings]

FIG. 1 is an explanatory diagram schematically showing the overall configuration of a medical manipulator system according to an embodiment of the present invention.

FIG. 2 (a) is an explanatory view showing a kinematic relationship of surgical instruments of a master manipulator in the medical manipulator system, and FIG. 2 (b) shows a kinematic relationship of an HMD arm and a treatment means arm in the medical manipulator system. Explanatory drawing.

FIG. 3 (a) is an explanatory diagram showing a kinematic relationship of the moving manipulators in the slave manipulator, and FIG.
FIG. 4 is an explanatory diagram showing a kinematic relationship of moving master arms in the master manipulator.

FIG. 4A is a cross-sectional view of a detachable portion of a unit of a surgical instrument, and FIG. 4B is a cross-sectional view of a detachable portion of the unit of the HMD arm and a pair of treatment means arms.

[Explanation of symbols]

DESCRIPTION OF SYMBOLS 1 ... Slave manipulator, 2 ... Master manipulator, 3 ... Control device, 4 ... Surgical instrument, 5 ... Manipulator for movement, 6 ... Endoscope for treatment, 7a, 7b ... Grasping forceps,
8 ... Insertion part, 9 ... Sheath, 23 ... Instrument mounting member, 25 ...
Mounting hole, 26 ... Nut, 27 ... Female thread, 28 ... Male thread, 31 ... Moving master arm, 32 ... HMD arm, 33a, 33b ... Treatment means operating arm, 41 ... Tip member, 66 ... Coupling base, 67 ... Engagement protrusion, 68 ... Nut, 69 ... Hole, 70 ... Male screw.

Claims (1)

[Claims] 1. A slave manipulator comprising a medical treatment endoscope and a manipulator for movement supporting the endoscope, a master arm for movement operation, an arm for HMD (head mount display), and two treatment means operation arms. In a medical manipulator having a master manipulator and a control means for controlling them, the treatment endoscope is an observation means consisting of a solid-state imaging device provided at the tip of the insertion portion of the endoscope and its insertion portion. 2 on the left and right
One treatment means, a bending portion that bends the insertion portion vertically and horizontally, and a driving means for driving the bending operation of the bending portion. The respective treatment means extend along the insertion portion of the endoscope in the same direction and are arranged side by side. The rotatable arm portion is provided with curved portions at two locations in its longitudinal direction, and the treatment arm is provided at the distal end of the arm portion. And a motor with an encoder for driving the bending and rotation of the arm portion and the rotation of the treatment gripper. Further, the moving manipulator supports the medical treatment endoscope, has a plurality of linear motion or rotation shafts, each shaft is provided with drive means, and the position and orientation of the distal end portion of the medical treatment endoscope. Can be changed. Also,
The moving master arm has a plurality of rotating shafts, and each shaft is provided with an angle detecting means. Further, the HMD arm has a plurality of rotation shafts attached to a moving master arm and provided with angle detection means, and has an HMD for displaying an image picked up by the solid-state image pickup device at its tip. There is. Further, the treatment means arm is attached to the moving master arm, has a plurality of rotation shafts provided with angle detection means, and has an operation gripper provided with angle detection means at its tip. Further, the control means detects the angle of the angle detecting means of each axis of the moving master arm, controls the moving manipulator to move correspondingly, and detects the angle detecting means provided on the HMD arm. In response to this, control is performed so that the up / down / left / right bending of the observation means operates, and the angle detection means and the angle detection means of the operating gripper provided on the left arm for treatment means are detected, and correspondingly Then, the bending and rotation of the left treatment means and the opening and closing of the treatment gripper are controlled to operate, and the angle detection means and the angle detection means of the gripper provided on the right treatment means arm are detected. Correspondingly, the bending and rotation of the right treatment means and the opening and closing of the treatment gripper are controlled to operate. A medical manipulator characterized by including these.