Classifications

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  • A61B1/00147—Holding or positioning arrangements
  • A61B1/00149—Holding or positioning arrangements using articulated arms
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
  • A61B1/313—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes
  • A61B1/3132—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes for laparoscopy
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• • A—HUMAN NECESSITIES
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  • A61B17/34—Trocars; Puncturing needles
  • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
  • A61B17/3421—Cannulas
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  • A61B2017/00738—Aspects not otherwise provided for part of the tool being offset with respect to a main axis, e.g. for better view for the surgeon
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  • A61B2017/2901—Details of shaft
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  • A61B2017/2926—Details of heads or jaws
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• • A—HUMAN NECESSITIES
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• • A—HUMAN NECESSITIES
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  • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
  • A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
  • A61B2090/309—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure using white LEDs
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
  • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
  • A61B2090/3937—Visible markers

Definitions

• the present invention relates generally to medical systems, tools, and methods. More particularly, the present invention relates to systems and tools for robotically assisted laparoscopic access, typically for access of multiple robotically manipulated tools through a single incision in the umbilicus or other location.
• systems for performing single port laparoscopic procedures include a transcutaneous seal and a plurality of tools.
• the tools comprise a substantially rigid tubular sleeve having a C-shaped central region and an effector core which is translatably and rotatably di sposed in the sleeve.
• the C-shaped central region of the tubular sleeve physically passes through the single port while a “center point” of the semicircle and i s aligned with a “virtual” insertion site on the patient’s abdominal wall for that tool.
• a virtual insertion site acts as a fulcrum point for the tool as it is manipulated even though the tool physically passes through a single port location offset from the virtual insertion site.
• Two, three, or even more such tools may have C-shaped central regions physically passing through the single port with their virtual remote centers positioned radially outwardly from a center defined by the single port.
• US2019/0307474 describes a method for rigidly attaching such laparoscopic tools, i.e., those having C-shaped central regions to robotic arms. Such rigid attachment, how ever, limits the ability of a physician to manually position the surgical arm and align the tool prior to commencing a robotic surgical procedure.
• laparoscopic tools having C-shaped central regions require that the center points of the C-shaped central regions be aligned with “virtual” remote centers of the robotic surgical systems, i.e., the sites where straight laparoscopic tools would have been inserted for manipulation by the robotic surgical systems.
• a laparoscopic tool is configured to be mounted on a surgical robotic arm which includes a fixed side mount (configured for detachably coupling to a straight laparoscopic or other cannula) and a driver interface.
• the laparoscopic tool comprises a shaft having (a) a straight proximal section, (b) a straight distal section axially aligned along a common axis with the straight proximal section, (c) a semicircular mid-portion having a center point on the common axis and located between and contiguous with the straight proximal and straight distal sections, and (d) a central passage extending therethrough.
• a flexible cable assembly is configured to pass through the central passage of the shaft and to accommodate the semicircular mid-portion as the flexible cable wire assembly is axially translated and rotated in the central passage of the shaft.
• a driven interface on the straight proximal section of the shaft is con figured to be detachably connected to the driver in terface on the robot arm to manipulate the flexible cable assembly, and a distal effector extends from the straight distal section of the shaft and is drivably coupled to a distal end of the flexible cable assembly.
• a rotatable side mount rotatably is coupled to the straight proximal section of the shaft, and the side mount is configured to detachably connect to the fixed side mount on the robot arm and to allow the common axis of the shaft to be rotated about al least two axes orthogonal to a longitudinal axis of the surgical robotic arm.
• the side mount is coupled to the straight proximal section of the shaft by a pair of orthogonally oriented rotational joints.
• the laparoscopic tool further comprises a telescoping section extending distally of the distal effector end of the shaft to accommodate extension and retraction of the flexible cable wire assembly.
• the segments of the telescoping section have alignment features that prevent relative rotation as the segments are extended and retracted.
• the flexible cable assembly is configured to be rotatably and translatably attached to the driver interface in the surgical robot arm so that said driver interface can axially and rotationally reposition a push, pull wire of the flexible cable wire assembly relative to the common axis of the shaft to actuate th e di stal effector.
• the flexible cable assembly may further comprise a bidirectional torque tube located coaxially over the push/pull and being configured to transmit torque and axial translation forces from the driver interface in the robot arm to the distal effector.
• a laparoscopic fool system for use with a surgical robot comprises a laparoscopic tool and an alignment tool.
• the laparoscopic too! may be configured in any of the ways described and claimed herein, and the alignment tool is typically coupled to the shaft of the laparoscopic tool and configured to visually “mark” the position of the center point of the semicircular mid-portion of the shaft and the remote center of the robotic arm, to which the tool is mounted to facilitate manual positioning of the surgical robot arm with mounted tool to place the center point at a target virtual point of insertion.
• the remote center corresponds to a ‘Virtual” fool insertion site, i.e., a site at which an abdominal wall or other cavity wall penetration would have been made to accommodate a straight laparoscopic tool.
• the “remote center” (also referred to as the “remote center of motion”) is the point in space where the cannula and inserted tool pass through the abdominal wall and enter the patient’s body. This point of entry serves as a fixed fulcrum which limits lateral repositioning of the cannula after insertion.
• each robotic ami and tool has a separate remote center and abdominal penetration.
• the tools of the present invention allow remote centers, i.e., virtual insertion points, to be moved without requiring additional penetrations and often without even removing the tool from the patient.
• the alignment tool is detachably coupled to the shaft.
• the alignment tool is an elongated body having a proximal end coupled to the shaft and a distal marking tip positioned at the center point when the proximal end is coupled to the shaft,
• the alignment tool is configured to project a pair of visible beams which cross at the center point of the semicircular mid-portion of the tool when the alignment tool is coupled to the shaft, In this way, the center point of the semicircular mid-portion of the tool aligned with the remote center of the robotic arm, to w hich the tool is mounted, can be positioned precisely at the virtual point of insertion on the patient’s abdominal wall by manually positioning the robotic arm so that the beams cross precisely at the desired location of the virtual insertion point on the patient’s abdomen or other skin region.
• a method for performing robotic surgery with at least one laparoscopic tool having an axis and remote center aligned with a target virtual point of insertion on a patient’s abdomen comprises providing (a) a surgical robotic system having at least one robotic arm which includes a fixed side mount and a driver interface and (b) at least one laparoscopic tool having a semicircular mid-portion with a center point on a common axis located between and contiguous with a straight proximal section and a straight distal section.
• the straight proximal section of the shaft is rotatably coupled to the fixed side mount on the robot arm such that the common axis of the shaft can be rotated about at least two axes orthogonal to a longitudinal axis of the surgical robotic arm.
• the semicircular mid-portion of the shaft of the at least one laparoscopic tool is positioned through a percutaneous passage, and the at least one robotic arm is disengaged from the surgical robot so that the at least one robotic arm can be manually positioned.
• the al leas! one robotic arm is manually posi tioned to locate the cen ter point of the semicircular mid-portion of the shaft (which is coincident with the remote center of the robot arm) of the at least one laparoscopic tool at the target ''virtual” point of insertion for the tool on the body surface. That is, even though the tool physically passes through a different location, such as a “single port” located through the patient’s umbilicus or other location, manipulations of the tool by the robot arm can be control led as if the tool were straight and passing through the ''virtual” point of insertion.
• the laparoscopic tool of the present invention is typically attached to the robot arm while the semicircular mid-portion remains positioned through the single port or other percutaneous passage, causing the common axis of the at least one laparoscopic tool to selfrotate and align relative to the longitudinal axis of the surgical robotic arm.
• the robotic arm is manipulated to cause an end effector on at least one laparoscopic tool to surgically interact with tissue while the mid-portion of the shaft remains positioned in the percutaneous passage and the center point remains located at the remote center previously set on the patent’s abdomen.
• manually positioning the at least one robotic arm to locate the center poi nt of the semicircular mid-portion of the shaft and coinciding remote center of the robotic arm, to which the tool is mounted of the at least one laparoscopic tool with the virtual insertion point on the patent’s abdomen comprises providing a visual marker of the location of the center point on the patient’s abdomen and aligning the visual marker with the location of a target virtual point of insertion.
• providing the visual marker of the location of the center point on the patient’s abdomen may comprise coupling an elongated body having a distal marking tip positioned at the center point to the shaft.
• providing a visual marker of the location of the center poi nt on the patient’s abdomen may comprise projecti ng a pair of vi sible beams which cross at the center point on the patient’s abdomen.
• rotatably coupling the straight proximal section of the shaft to the fixed side mount on the robot arm comprises detachably attaching a rotatable side mount rotatably coupled to the straight proximal section of the shaft to the fixed side mount on the robot arm.
• the rotatable side mount may be rotatably coupled to rotate about at least two axes orthogonal to a longitudinal axis of the surgical robotic arm.
• the method as described above may further comprise providing a second laparoscopic tool having a semicircular mid-portion with a center point on a common axis located between and contiguous with a straight proximal section and a straight distal section.
• the straight proximal section of the shaft of the second laparoscopic tool is rotatably coupled to a fixed side mount on a second robot arm of the surgical robot such tha t the common axis of the shaft of the second laparoscopic tool can be rotated about at least two axes orthogonal to a longitudinal axi s of the second surgical robotic arm.
• the semicircular mid-portion of the shaft of the second laparoscopic tool is positioned through the percutaneous passage, and the second robotic arm from the surgical robot is disengaged so that the second robotic arm can be manually positioned.
• the second robotic arm is manually positioned to locate the center point of the semicircular mid-portion of the shaft and coinciding remote center of the robotic amt, to which the tool is mounted of the second laparoscopic tool with a second virtual point of insertion on the patient’s abdomen while the semicircular mid-portion remains positioned through the percutaneous passage, causing the common axis of the second laparoscopic tool to self-rotate and align relative to the longitudinal axis of the second surgical robotic arm.
• the second robotic arm is then re-engaged with the surgical robot so that the second robotic arm is again manipulated by the surgical robot.
• the surgical robot is operated to manipulate the second robotic arm to cause an end effector on the second laparoscopic tool to surgical I y interact with tissue whi le the mid-portion of the shaft of the second laparoscopic tool remains positioned in the percutaneous passage and the center point and remote center of the second robotic arm remains located at the second virtual point of insertion on the patent’s abdomen.
• F ig, I illustrates a commercially available robotic surgical system of the type that can be used to manipulate the laparoscopic tools of the present invention.
• Fig. 2 illustrates a pair of laparoscopic tools intended for manual manipulation in surgical procedures where said tools are intended for single port access and are pivotally mounted in a support frame, with a repositioned view of one of the tools shown in broken li ne.
• Figs. 3 is a perspective view of a laparoscopic too! constructed in accordance with the principles of the present invention and configured for manipulation by the arm of a surgical robot,
• Figs. 4A-4D illustrate internal components of the laparoscopic tool of Fig. 3 with Figs. 4A and 4B showing an extended and a retracted telescopic distal extension, respectively, and Figs. 4C and 4D showing a flexible cable and wire configured to actuate an end effector.
• Fig. 5 is a detailed view' of a side connector attached to a proximal section of a shaft of the laparoscopic tool of Fig. 3 showing rotation of the side connector about a first axis transverse to the shaft in broken line.
• Fig. 6 is a detailed view of the side connector of the laparoscopic tool of Fig. 3 showing rotation of the side connector about a second axis transverse to the shaft in broken line.
• Fig. 7 illustrates a first embodiment of an alignment tool attachable to the shaft the laparoscopic tool of the present invention configured to allow’ a user to align a center point of the tool with a remote center utilized of the robotic system.
• Fig. 8 illustrates a second embodiment of an alignment too! attachable to the shaft the laparoscopic too! of the present invention configured to allow a user to align a center point of the tool with a remote center utilized of the robotic system,
• Fig. 9 illustrates a laparoscopic tool of the present invention adjacent to an arm of a surgical robotic system prior to mounting of the tool on the ami.
• F ig, 10 illustrates the laparoscopic tool and surgical robot arm of Fig. 9 with the too! mounted on the arm.
• FIG. 10A illustrates connection of a prior art straight laparoscopic tool to a tool holder of a robotic surgical system show ing the location of a “remote center” characteristic of the robotic surgical system marked on the straight laparoscopic tool.
• F ig, 10B illustrates connection of the laparoscopic tool of the present invention to a tool holder of a robotic surgical system showing the location of a “remote center” characteristic of the robotic surgical system coincident wi th the center point of semicircular mid-portion of the laparoscopic tool in free space.
• Figs. 1 1 A-l 1 E illustrate a method for performing robotic surgery with a laparoscopic tool having an axis aligned with a target remote center on a patient’s abdomen in accordance with the principles of the present invention.
• An exemplary robotic surgery system 10 includes a robotic station 12 that includes a plurality of robotic arms 14 (with three being illustrated) and a controller module 16 where a physician can view the procedure and control the surgical arms to manipulate the tools to perform a desired laparoscopic or other surgery.
• a prior art laparoscopic tool system 100 of the type described in US2016/0081752, previously incorporated herein by reference, comprises a tool attachment frame 112 having a first too! 1 14 and a second tool 120 pivotally attached thereto.
• the first tool has a mid-portion 116 and the second tool has a mid-portion 122, and both midportions extend generally inwardly from an axis 128 of the tool.
• Both mid-portions 116 and 122 are preferably circular and have a radius emanating from a virtual rotation point which is generally aligned with a pivot 152 of an assembly attached to an outer periphery of the tool attachment frame 112.
• the straight proximal section 204 and the straight distal section 206 are aligned along a common longitudinal axis, and the straight proximal section has a rotational connector 220 positioned proximal to the semicircular mid-portion 208 which allows the semicircular mid-portion and straight distal section to rotate relative to the straight proximal section 204 about the common longitudinal axis.
• the proximal section 204 includes a sleeve 244 which telescopically relieves another portion of the proximal section to allow length adjustment.
• the laparoscopic tool 200 further includes an end effector 214, such as forceps, cutters electrosurgical elements, or the like, al its distal end, and the distal section 206 will typical ly have a telescopic construction to allow its length to be adjusted.
• a rotatable side mount 240 is attached to the proximal section 204 of the shaft 202 at a location proximal to the rotational connector, and the rotatable side mount is configured to be removably attached to a robotic arm of a surgical robot, as will be described i n more detail below. I n this way, all portions of the shaft 202 distal to the rotatable connector 220 will be free to rotate about the longitudinal axis of the shaft, and in particular, the semicircular mid-portion 208 will be able to rotate to other positions as shown, for example, in broken line in FIG. 3.
• the shaft 202 has a hollow central passage which receives a flexible cable 210.
• the flexible cable 210 has a hollow lumen extending from a distal end to a proximal end thereof which recei ves a pull and/or push wire 212 having an end effector 214 at its distal end.
• the flexible cable 210 has a proximal attachment member 222 at its proximal end, and the pul! and/or push wire 212 has a proximal attachment member 224 at its proximal end.
• the distal section 206 of the shaft 202 is preferably joined as a telescoping structure having a plurality of segments 216 including a distal- most segment 218 that carries the end effector 214.
• the telescoping distal section may be axially extended and retracted to accommodate full axial extension of the flexible cable 210, as illustrated in Fig. 4A, as well as full axial retraction of the flexible cable, as illustrated in Fig. 4B.
• the flexible cable 210 by nature of its flexibility, provides a conformable central region 226 to accommodate bending as the cable passes through a preferred C-shaped mid-portion 208 of the shaft.
• the pull/push wire 212 will have a conforming region 228 to accommodate bending as it is extended and retracted through the conforming region 226 of the flexible cable 210,
• the surgical robot manipulates the end effector 214 via these internal components using a drive head 286 mounted on a tool holder 282 which connects to the robotic arm interface 242 on the laparoscopic tool 200 when the tool is mounted on the tool holder of the surgical robot, as shown in Fig. 10 described below.
• the robotic arm interface 242 allows the drive head 286 of robotic surgical system to mechanically drive the end effector 214 by manipulating the internal components of the laparoscopic tool 200.
• Axial translation of the cable and wire assembly (including the flexible cable 210 and pull/push wire 212) relative to the shaft 202 can be achieved by selectively tensioning the proximal attachment member 222 at the proximal end of the flexible cable 210.
• rotation of the cable and wire assembly about the assembly’s longitudinal axis can also be achieved by rotating the proximal attachment member 222 at the proximal end of the flexible cable 210.
• axial translation of the pul l/push wire 212 relati ve to the flexible cable 210 to actuate an end effector may be achieved by manipulation of the proximal attachment 224 at the proximal end of the pull/push wire 212.
• the proximal section 204 of the laparoscopic tool 200 is secured to tool the holder 282 through attachment of the robotic arm in terface 242 to the dri ve head 286, as seen in Figs. 9 and 10, while the distal section 206 of the laparoscopic tool is secured to tool the holder through attachment of the rotatable side mount 240 to a tool attachment head 284 at a lower end of the tool holder, as also seen in Figs. 9 and 10,
• the specific connection between the robotic arm interface 242 and the drive head 286 will depend on the nature of the laparoscopic tool and does not form part of the present invention. Usually, the specific connection pattern for the tools of the present invention will be arranged to match that of a corresponding conventional laparoscopic tool of the same type, e,g., all forceps all cutters will be interfaced similarly, and the
• the rotatable side mount 240 is designed to provide one or more rotational axes to facilitate connection of the laparoscopic tool 200 to the tool holder 282.
• the rotatable side mount 240 comprises a base cylinder 248, a base plate 250, and an insertable connector 252.
• the base cylinder 248 is crimped or other fixed to the outer surface of the proximal section 204 of the shaft 202 on a proximal side of the rotatable connector 220.
• the base plate 250 is pivotally attached to the base cylinder 248 at a pivot axis 254 so that it can tilt relative to the shaft as shown in broken line in Fig. 5.
• the insertable connector 252 is pivotally attached to the base plate 250 at a pivot axis 256 so that it can rotate relative to the shaft as shown in broken line in Fig, 6.
• the insertable connector 252 has two orthogonal pivot axes relative to the axis of the shaft 202 which allows the laparoscopic tool to be first connected at its lower end to the tool holder 282 and then reoriented as the robotic arm interface 242 is connected the drive head 286 at the upper end of the tool holder.
• an alignment tool is typically coupled to the shaft of the laparoscopic too! and configured to vi sually “mark” the position of the center point CP of the semicircular mid-portion of the shaft to facilitate manual positioning of the surgical robot arm to place the center polnt/remote center at a target “virtual point of insertion” on the patient’s body.
• an alignment tool 260 may be a simple straight rod or probe have a tip 262 with locates at the center point CP when a connector hub 264 is removably attached to the proximal section 204 of the shaft 202, as shown in broken line.
• an alignment tool 266 comprises a bar with a pair of light emitting diodes or other light sources 268 and 270 which are arranged to project beams 268a and 268b that cross at point 272 which is located at the center point CP of the semi-circular mid-portion of the shaft 202.
• Tire laparoscopic tool 200 can thus be aligned by manually moving the laparoscopic too! 200 and tool holder 282 until the tip 62 of alignment tool 260 or the cross poi nt 272 of alignment tool 266 is located at a target virtual point of insertion, as will be described in greater detail with reference to Figs. 1 1 A-.1 I E below.
• Fig, 9 illustrates the laparoscopic tool 200 of the present invention adjacent to a tool holder 282 carried by an. arm 280 of a surgical robotic system, such as that illustrated in Fig. 1 , prior to mounting of the tool on the arm.
• the laparoscopic tool 200 is mounted by inserting the insertable connector 252 of the rotatable side moun t 240 in to an attachment cavity 288 on one side of the attachmen t head 284 of the tool holder 282.
• Mount release le ver 290 allows the tool 200 to be released from the tool holder 282 after a procure has been completed.
• the rotatable side mount 240 of the laparoscopic tool 200 will attached to the attachmen t head 284 of the tool holder 282 prior to attaching the robotic inter lace 242 to the drive head 286.
• the shaft 202 of the laparoscopic tool 200 remains free to rotate relati ve to the mounting axes defined by the rotatable side mount 240, as described previously with reference to Figs. 5 and 6.
• the attachment head 284 is attached to the tool holder 282. as shown in Fig. 10, the laparoscopic tool 200 will be immobilized with respect to the tool holder 282, and the laparoscopic tool 200 and the tool holder 282 will be moved together as one unit by the surgical robot arm 280.
• the attachment head 284 of the tool holder 282 will typically include a clutch release (not shown) which allows the user to selectively disengage the surgical robot arm 282 so that it can be manually positioned relative to a patient for initial set up, as will be described in greater detail with reference to Figs. 11 A - 11 E.
• F ig, 10 A i llustrates connection of a straight laparoscopic tool, such as straight cannula SC, to the attachment head 284 of the tool holder of a robotic surgical system showing the location of a “remote center RC” characteristic of the robotic surgical system marked on the straight laparoscopic tool.
• the location of the remote center RC is marked on a shaft of the cannula SC so that a user may locate the remote center an actual abdominal wall penetration in a conventional robotic laparoscopic surgical procedure.
• the remote center is a characteristic of the particular surgical system being employed and is the fulcrum or pivot point of the tool shaft and i s used by the robotic surgical system to plan all manipulation, of the tool
• Fig. 10B illustrates connection of the laparoscopic tool of the present invention to the attachment head 284 of a tool holder of a robotic surgical system showing the location of a “remote center” characteristic of the robotic surgical system.
• the remote center RC will be coincident with the center point CP of sem icircular mid-portion of the laparoscopic tool which is located in free space.
• the remote center RC of the laparoscopic tools of the present invention will be positioned al a virtual insertion site without the need for an actual penetration.
• the robotic surgical system By dimensioning the laparoscopic tool of the present inven tion to locate the center point CP of the semicircular mid-portion al the remote center of the particular robotic surgical system to be used, the robotic surgical system will be able to manipulate the tool as if it were straight, so no modi fications to the robotic surgical system are necessary (although there may be instances where modifications might be useful).
• a laparoscopic port or seal S such as that described in commonly owned US2019/0380743, the full disclosure of which is incotporaied herein by reference, is placed through the umbilicus U in the patient’s abdomen A.
• the tool 200 is introduced into the distended abdomen to the level when semi-circular mid-portion segment 208 reaches the port seal S
• the user after engaging the clutch, brings the robot arm 282 to the proximity of the tool side mount 240, depresses the mount lever 290 on the robot arm 282, engages the tool side mount 240 and by releasing the mount lever 290 locks the tool 200 to the robotic arm. Holding the clutch engaged and not displacing the position of semi-circular mid-portion segment 208 within the seal S, the user moves the robot arm 282 to align the robotic interphase 242 with the drive head 286 and locks it,
• the user actuates the clutch to disengage the tool holder 282 and aligns the center point CP of the semi-circular midportion 208 with a virtual insertion point prior to beginning the surgery, as shown in Fig. 1 ID.
• an alignment tool such as alignment tools 260 and 266 previously described with reference to Fig, 7 and 8.
• the user can release the clutch release level, locking the too! and holder so that their motion will now be controlled by the robotic system (not manually).
• the laparoscopic tool 200 is then ready for use, although the surgery will often require that one, two, three, or even more laparoscopic tools be introduced through the seal, depending on the requirements of the surgery to be performed.
• the user may desire to reposition the center point CP of the semi-circular mid-portion 208 with a different target virtual insertion point, as shown for example in Fig, 11 E, Th user can perform such repositioning by simply decoupling the arm 280 and the tool holder 282 from the surgical robot using the clutch release which is part of the surgical robot (not shown). The tool 200 and holder 282 can then be manually repositioned until the center point CP of the tool 200 is located at a different virtual insertion point, as shown in Fig. 1 1E. Such repositioning is accomplished without removing the tool 200 from the port seal S and without the need to form a penetration through the patient’s abdomen at the new target virtual insertion point. While such repositioning is limited by the radius of the semi-circular midportion 208, a first tool can be exchanged for a second tool having a different semi-circular midportion radius, although tool removal will be necessary' in that case.
• the robotic system will reposition the robot arm and tool at many different angles in relation to the plane of penetration of the abdominal wall with the pivot at the level of abdominal wall (remote center ).
• the distance from a proxi mal portion of the laparoscopic tool held by the robotic arm to the virtual insertion point of this tool will typically remain the same.
• the initial distance is selected so a semi-circle center point and sharing the space remote center of the robotic arm 208 (Figs 7 and 8) is at the level of the virtual insertion point into the body cavity. From this time on, all movement of the robotic arm will maintain this distance so that the remote center remains the same location at the virtual insertion point into the abdominal wall.

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• 2023
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