Abstract:
A method comprises receiving a surgical instrument into engagement with a grip actuator of a teleoperational activation system. The surgical instrument includes movable jaws, and the surgical instrument is received in a prearranged gripping configuration with the jaws gripping a surgical accessory. The method includes generating a first control signal for manipulating the surgical instrument while maintaining the surgical instrument in the prearranged gripping configuration. The method further includes generating a second control signal for manipulating the surgical instrument to move from the prearranged gripping configuration to a second configuration.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims the benefit of U.S. Provisional Application 61/726,415 filed Nov. 14, 2012, which is incorporated by reference herein in its entirety. 
    
    
     FIELD 
     The present disclosure is directed to surgical systems and methods for use in minimally invasive teleoperational surgery, and more particularly to systems and methods for implementing a dual-control surgical instrument. 
     BACKGROUND 
     Minimally invasive medical techniques are intended to reduce the amount of extraneous tissue that is damaged during diagnostic or surgical procedures, thereby reducing patient recovery time, discomfort, and deleterious side effects. Minimally invasive telesurgical systems have been developed to increase a surgeon&#39;s dexterity and to avoid some of the limitations on traditional minimally invasive techniques. In telesurgery, the surgeon uses some form of remote control, e.g., a servomechanism or the like, to manipulate surgical instrument movements, rather than directly holding and moving the instruments by hand. In telesurgery systems, the surgeon can be provided with an image of the surgical site at the surgical workstation. While viewing a two or three dimensional image of the surgical site on a display, the surgeon performs the surgical procedures on the patient by manipulating master control devices, which in turn control motion of the servomechanically operated instruments. 
     In telesurgery, the surgeon typically operates a master controller to control the motion of surgical instruments at the surgical site from a location that may be remote from the patient (e.g., across the operating room, in a different room, or a completely different building from the patient). The master controller usually includes one or more hand input devices, such as hand-held wrist gimbals, joysticks, exoskeletal gloves or the like, which are operatively coupled to the surgical instruments that are releasably coupled to a patient side surgical manipulator (“the slave”). The master controller controls the instrument&#39;s position, orientation, and articulation at the surgical site. The slave is an electro-mechanical assembly which includes a plurality of arms, joints, linkages, servo motors, etc. that are connected together to support and control the surgical instruments. In a surgical procedure, the surgical instruments (including an endoscope) may be introduced directly into an open surgical site or more typically through cannulas into a body cavity. 
     For minimally invasive surgical procedures, the surgical instruments, controlled by the surgical manipulator, may be introduced into the body cavity through a single surgical incision site or through multiple closely spaced incision sites on the patient&#39;s body. These minimally invasive procedures may present multiple challenges. For example, some procedures that require the manual introduction of surgical implements such as sutures, gauze, sponges, clamps, and needles, may require the use of separate instruments. A teleoperated instrument may be removed from the surgical manipulator and a manual instrument inserted into the patient to hand off a surgical accessory to another teleoperated instrument. The manual instrument is then removed so that the teleoperated instrument may be reintroduced. This type of hand off procedure is time consuming and requires the use of separate manual and teleoperated instruments. Improved systems and methods are needed to improve efficiency in procedures that involve the introduction of surgical implements, while maintaining safety and accuracy throughout the surgery. 
     SUMMARY 
     The embodiments of the invention are summarized by the claims that follow below. 
     In one embodiment, a method comprises receiving a surgical instrument into engagement with a grip actuator of a teleoperational activation system. The surgical instrument includes movable jaws, and the surgical instrument is received in a prearranged gripping configuration with the jaws gripping a surgical accessory. The method includes generating a first control signal for manipulating the surgical instrument while maintaining the surgical instrument in the prearranged gripping configuration. The method further includes generating a second control signal for manipulating the surgical instrument to move from the prearranged gripping configuration to a second configuration. 
     In another embodiment, a surgical system comprises an instrument body including an end effector sized to grip a surgical accessory and a dual-control instrument activation system coupled to the instrument body. The dual-control instrument activation system includes a lever operable, in response to manual manipulation, to move between a first position in which the end effector is in an open configuration for receipt of a surgical accessory and a second position in which the end effector is in a closed gripping configuration. The surgical system further comprises an instrument operation system responsive to teleoperational signals. The instrument operation system includes a lever capture mechanism to engage the lever in the second position to maintain the closed gripping configuration. The lever capture mechanism also moves the lever to the first position. 
     In another embodiment, a surgical system comprises an instrument including an end effector sized to grip a surgical accessory. The surgical system also comprises a dual-control instrument activation system to control the end effector. The dual-control instrument activation system includes a ratchet assembly coupled to a lever. In response to manual manipulation, the lever moves the ratchet assembly to a gripping position in which the end effector is arranged to grip the surgical accessory. The surgical system also comprises an instrument operation system that is responsive to teleoperational signals. The instrument operation system includes a lever capture mechanism to engage the lever to move the ratchet assembly to a release position in which the end effector is arranged to release the surgical accessory. 
    
    
     
       BRIEF DESCRIPTIONS OF THE DRAWINGS 
       Aspects of the present disclosure are best understood from the following detailed description when read with the accompanying figures. It is emphasized that, in accordance with the standard practice in the industry, various features are not drawn to scale. In fact, the dimensions of the various features may be arbitrarily increased or reduced for clarity of discussion. In addition, the present disclosure may repeat reference numerals and/or letters in the various examples. This repetition is for the purpose of simplicity and clarity and does not in itself dictate a relationship between the various embodiments and/or configurations discussed. 
         FIG. 1  illustrates a schematic view of a teleoperated surgical system according to one embodiment of the present disclosure. 
         FIG. 2  illustrates a diagrammatic perspective view of a patient side manipulator according to one embodiment of the present disclosure. 
         FIG. 3  illustrates a perspective view of a cluster of surgical instruments for use with the teleoperated surgical system of  FIG. 2 . 
         FIG. 4  is a partially schematic illustration of a dual-control surgical instrument according to an embodiment of this disclosure. 
         FIG. 5  illustrates a side view of a dual-control surgical instrument with an end effector in a closed position according to one embodiment of the present disclosure. 
         FIG. 6  illustrates a side view of the dual-control surgical instrument of  FIG. 5  with the end effector in an open position according to one embodiment of the present disclosure. 
         FIG. 7  is a partial cross-section view of the instrument of  FIGS. 5 and 6 . 
         FIG. 8  is a partial internal view of the dual-control surgical instrument of  FIGS. 5 and 6 . 
         FIG. 9  is a partial side view of the dual-control surgical instrument of  FIGS. 5 and 6  coupled to a grip actuator. 
         FIG. 10  is a flow chart illustrating a method of operating a dual-control surgical instrument according to another embodiment of the present disclosure. 
         FIG. 11  illustrates a partial side view of a dual-control surgical instrument according to another embodiment of the present disclosure. 
         FIG. 12  illustrates a partial side view of a dual-control surgical instrument according to another embodiment of the present disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     In the following detailed description of the embodiments of the invention, numerous specific details are set forth in order to provide a thorough understanding of the disclosed embodiments. However, it will be obvious to one skilled in the art that the embodiments of this disclosure may be practiced without these specific details. In other instances well known methods, procedures, components, and circuits have not been described in detail so as not to unnecessarily obscure aspects of the embodiments of the invention. 
       FIG. 1  illustrates a schematic view of a teleoperated surgical system  10  according to one embodiment of the present disclosure. The system  10  includes a master surgeon console or workstation  12  for inputting a surgical procedure and a patient side cart (or “PSC”)  14  for moving surgical instruments, via teleoperational control, at a surgical site within a patient. The teleoperated surgical system  10  is used to perform minimally invasive teleoperated surgery. One example of a teleoperated surgical system that can be used to implement the systems and techniques described in this disclosure is a da Vinci® Surgical System commercialized by Intuitive Surgical, Inc. of Sunnyvale, Calif. Those skilled in the art will understand that the inventive aspects disclosed herein may be embodied and implemented in various ways, including teleoperated and non-teleoperated embodiments and implementations. Implementations on da Vinci® Surgical Systems are merely exemplary and are not to be considered as limiting the scope of the inventive aspects disclosed herein. Further details of these exemplary teleoperated surgical systems are provided, for example, in pending U.S. patent application Ser. No. 12/855,461, the full disclosure of which is incorporated herein by reference. 
     The system  10  is used by a system operator, generally a surgeon, who performs a minimally invasive surgical procedure on a patient. The system operator sees images captured by an image system  16  and presented for viewing at the master console  12 . In response to the surgeon&#39;s input commands, a computer system  18  effects servomechanical movement of surgical instruments coupled to the teleoperated patient-side manipulator system  14  (a cart-based system in this example). 
     Computer system  18  will typically include data processing hardware and software, with the software typically comprising machine-readable code. The machine-readable code will embody software programming instructions to implement some or all of the methods described herein. While computer system  18  is shown as a single block in the simplified schematic of  FIG. 1 , the system may comprise a number of data processing circuits (e.g., on the surgeon&#39;s console  12  and/or on the patient-side manipulator system  14 ), with at least a portion of the processing optionally being performed adjacent an input device, a portion being performed adjacent a manipulator, and the like. Any of a wide variety of centralized or distributed data processing architectures may be employed. Similarly, the programming code may be implemented as a number of separate programs or subroutines, or may be integrated into a number of other aspects of the teleoperated systems described herein. In one embodiment, computer system  18  may support wireless communication protocols such as Bluetooth, IrDA, HomeRF, IEEE 802.11, DECT, and Wireless Telemetry. 
     The PSC  14  may be mobile (e.g., including wheels) or stationary. PSC  14  includes a manipulator arm  20  that effects movement of a surgical instrument  22  for manipulation of tissues. An instrument operation system  24  is coupled to the manipulator arm  20  and includes actuation components to control the movement of the surgical instrument  22 . The instrument  22  includes a dual-control instrument activation system  26  and an instrument body  28 . As will be described in greater detail below, the instrument body  28  may include a shaft and an end effector. The dual-control instrument activation system  26  functions as an actuating component of the instrument operation system  24  but is separable from other actuating components of the instrument operation system. When the surgical instrument  22  is decoupled from the instrument operation system  24 , the dual-control instrument activation system  26  may be used to manually control the operation of the surgical instrument  22 . 
     For example, a surgical assistant may decouple a gripping surgical instrument and dual-control instrument activation system  26  from the instrument operation system  24 . The assistant may manually manipulate the dual-control instrument activation system  26  to cause the surgical instrument to grip a surgical accessory such as a needle or a clamp. The surgical assistant may then reconnect the dual-control instrument activation system  26  and surgical instrument, now gripping the surgical accessory, to the instrument operation system  24 . The instrument operation system  24 , via the dual-control instrument activation system  26 , maintains the grip of the surgical instrument on the surgical accessory while the surgical instrument is moved into and within the surgical site. Thus, the dual-control instrument activation system  26  may be controlled by manual operator inputs and by teleoperational inputs. 
     The actuation components of the instrument operation system  24  may include a grip output controlling a gripping end effector, a joggle output controlling the side-to-side and up-down motion of the end effector, a wrist output controlling yaw and pitch motions of the end effector, and a roll output controlling a roll output of the end effector. Components for one or more of these actuations may be included in the dual-control instrument activation system  26 . 
     The PSC may include all of the actuation components, including motors, the power sourced and control systems, that control the instrument. In alternative embodiments, some or all of the motors may be in the instrument with the PSC supplying the power and the control signals to the instrument. In still another alternative, the instrument may be battery powered with the PSC providing only control signals to the instrument 
       FIG. 2  illustrates a diagrammatic perspective view of a PSC  100  according to an illustrative embodiment of the PSC  14  described above with reference to  FIG. 1 . In this embodiment, the PSC  100  includes a floor-mounted base  102 . The base may be movable or fixed (e.g., to the floor, ceiling, wall, or other sufficiently rigid structure). Base  102  supports an arm assembly  104 . The arm assembly  104  includes active joints and links for manipulator arm configuration and movement, instrument manipulation, and instrument insertion. 
     The arm assembly  104  includes a manipulator assembly disk or platform  106 . An instrument cluster  108  is mounted to platform  106 . The center of platform  106  is coincident with a manipulator assembly roll axis  110 , as shown by the dashed line that extends through the center of manipulator platform  106 . The instrument cluster  108  includes instrument shafts  108   a  mounted to instrument actuators  108   b . Each instrument shaft  108   a  is mounted on a distal face of an instrument actuator  108   b , in one embodiment. 
     As shown in  FIG. 3 , instrument cluster  108  includes four instrument actuators  108   b . Each instrument actuator  108   b  supports and actuates an associated surgical implement. For example, one instrument actuator  108   b  is configured to actuate a camera instrument, and three instrument actuators  108   b  are configured to actuate various other interchangeable surgical end effectors that perform surgical and/or diagnostic work at the surgical site. Articulated end effectors may include jaws, scissors, graspers, needle holders, micro-dissectors, staple appliers, tackers, suction irrigation tools, and clip appliers, that may be driven by wire links, eccentric cams, push-rods, or other mechanisms. In addition, the surgical instruments may comprise a non-articulated instrument, such as cutting blades, probes, irrigators, catheters or suction devices. Alternatively, the surgical tool may comprise an electrosurgical probe for ablating, resecting, cutting or coagulating tissue. Examples of applicable adaptors, tools or instruments, and accessories are described in U.S. Pat. Nos. 6,331,181, 6,491,701, and 6,770,081, the full disclosures of which (including disclosures incorporated by reference therein) are incorporated by reference herein for all purposes. Applicable surgical instruments are also commercially available from Intuitive Surgical, Inc. of Sunnyvale, Calif. More or fewer instrument actuators may be used. In some operational configurations, one or more actuators may not have an associated surgical instrument during some or all of a surgical procedure. 
     The instruments  108  are mounted so that shafts  108   a  are clustered around manipulator assembly roll axis  110 . Each shaft  108   a  extends distally from the instrument&#39;s force transmission mechanism, and all shafts may extend through a single cannula placed at a port into the patient surgical site. Each instrument actuator  108   b  is movable to allow insertion and withdrawal of the surgical instrument(s). 
       FIG. 4  is a partially schematic illustration of a dual-control surgical instrument  150  according to an embodiment of this disclosure. Instrument  150  is an illustrative embodiment of an instrument  22 ,  108  described above with reference to  FIGS. 1 and 3 , respectively. The dual-control surgical instrument  150  includes a parallel motion mechanism  152  with a tube  153  having joints at each end, coupled to a wrist joint  154 , which is coupled to the end effector  156 . In this embodiment, the end effector  156  includes jaws  158 . In some aspects, the parallel motion mechanism  152  and wrist joint  154  function such that the position of a reference frame at the distal end of the mechanism may be changed with respect to a reference frame at the proximal end of the mechanism without changing the orientation of the distal reference frame. Details of an applicable parallel motion assembly including related joints of an applicable instrument are further disclosed in U.S. patent application Ser. No. 11/762,165 filed Jun. 13, 2007, disclosing “Minimally Invasive Surgical System” and U.S. Pat. No. 7,942,868 filed Jun. 13, 2007, disclosing “Surgical Instrument with Parallel Motion Mechanism,” which are incorporated by reference herein in their entirety. 
     The parallel motion mechanism  152  is coupled to a distal end of a shaft  160 . The proximal end of the shaft  160  is coupled to an instrument body  163 . A lever  162  is coupled to the body  163  by a pivot joint  165 . As will be described in other embodiments, the lever  162  may be manually or teleoperationally actuated. The lever  162  is coupled to a drive element  164 . In this embodiment, the drive element is a single rod  164  which may be formed of nitinol, stainless steel, or another suitable medical-grade metal, ceramic, or polymer. Alternatively, the rod  164  may include more than one material. For example, a more flexible material may be used in areas that extend through the joints. In one embodiment, a distal portion of the rod may include a tungsten cable with an ethylene tetrafluoroethylene (ETFE) covering and a proximal portion formed of stainless steel. Optionally, a fluorinated ethylene propylene (FEP) covering may extend over all or a portion of the rod. The rod  164  may extend through the shaft  160  to couple with the end effector  156 . In this embodiment, counter-clockwise rotation of the lever  162  about the pivot joint  165  advances the rod  164  linearly (i.e., moves the rod in the distal direction) to open the jaws of the end effector  156 . Clockwise rotation of the lever  162  about the pivot joint  165  retracts the rod  164  linearly (i.e., moves the rod in the proximal direction) to close the jaws of the end effector  156 . In an alternative embodiment, the rotation of the lever may have the opposite influence on the rod (i.e. counter-clockwise rotation retracts the rod and clockwise rotation advances the rod). In various embodiments, the rod may be configured such that advancement may either open or close the end effector. Likewise, the retraction may either open or close the end effector. The instrument  150  also includes a securing component  166  (e.g., one or more springs, a ratchet mechanism) which holds or biases the lever  162  in a position such that the jaws of the end effector  156  are held in a prearranged gripping position without a manual or teleoperated actuator providing a force to the lever. The lever  162  may be actuated by a force received by an actuator  168 . The force provided by the actuator  168  may overcome the securing force provided by the securing component  166  to move the lever  162  and thus move the end effector from the prearranged closed gripping configuration to a released open configuration. 
       FIG. 5 . illustrates a side view of a dual-control surgical instrument  200  with an end effector  202  in a closed position. Instrument  200  is an illustrative embodiment of an instrument  22 ,  108  described above with reference to  FIGS. 1 and 3 , respectively. The dual-control surgical instrument  200  includes a parallel motion mechanism  204  with a tube  207  having joints at each end, coupled to a wrist joint  203 , which is coupled to the end effector  202 . In this embodiment, the end effector  202  includes jaws  205 . In some aspects the parallel motion mechanism  204  and wrist joint  203  function such that the position of a reference frame at the distal end of the mechanism may be changed with respect to a reference frame at the proximal end of the mechanism without changing the orientation of the distal reference frame. Details of an applicable parallel motion assembly including related joints of an applicable instrument are further disclosed in U.S. patent application Ser. No. 11/762,165 filed Jun. 13, 2007, disclosing “Minimally Invasive Surgical System” and U.S. Pat. No. 7,942,868 filed Jun. 13, 2007, disclosing “Surgical Instrument with Parallel Motion Mechanism,” which are incorporated by reference herein in their entirety. 
     The parallel motion mechanism  204  is coupled to a distal end of a shaft  206 . The dual-control surgical instrument  200  further includes dual-control instrument activation system  208 . The proximal end of the shaft  206  is coupled to a dual-control instrument activation system  208 . The system  208  includes a lever  210  pivotally connected to a housing  212  by a pivot connector  214 . In this embodiment, the dual-control instrument activation system  208  is operational to open and close the end effector  202  in response to pivotal movement of the lever  210 . As shown in  FIG. 6 , the lever  210  is rotated (clockwise in this embodiment) about the pivot connector  214  to open the gripping end effector  202  to receive a surgical accessory such as a needle  215 . The lever  210  is rotated in the opposite direction (counter-clockwise in this embodiment) to close the end effector  202  to firmly grasp the needle  215  within the jaws  205  of the end effector. The lever  210  may be manually operated by a user or may be manipulated by a teleoperated actuator as will be described below. In an alternative embodiment, the rotation of the lever may have the opposite influence on the rod (i.e. counter-clockwise rotation advances the rod and clockwise rotation retracts the rod). In various embodiments, the rod may be configured such that advancement may either open or close the end effector. Likewise, the retraction may either open or close the end effector. 
       FIG. 7  is a partial cross-sectional view and  FIG. 8  is a partial internal view of the dual-control instrument activation system  208 . In these views, the lever  210  is biased toward the position shown in  FIG. 5 , in which the end effector  202  is closed. The lever  210  is biased by a spring  216 , which in this embodiment is a coil spring. In alternative embodiments, other biasing elements, including other types of springs, elastomeric material components, or shape-memory material elements may be used. The lever  210  is coupled to a drive element  218  by a clamp  220 . In this embodiment, the drive element is a single rod  218  which may be formed of nitinol, stainless steel, or another suitable medical-grade metal, ceramic, or polymer. Alternatively, the rod  218  may include more than one material. For example, a more flexible material may be used in areas that extend through the joints. In one embodiment, a distal portion of the rod may include a tungsten cable with an ETFE covering and a proximal portion formed of stainless steel. Optionally, an FEP covering may extend over all or a portion of the rod. The rod  218  may extend through the housing  212  and through the shaft  206  to couple with the end effector  202 . The clamp  220  grips the rod  218  and can rotate within the lever  210  to avoid excess bending of the rod. In this embodiment, clockwise rotation of the lever  210  compresses the spring  216  and advances the rod  218  linearly in the direction  222  to open the jaws of the end effector  202 . Counter-clockwise rotation of the lever  210  retracts the rod  218  linearly in the direction  224  to close the jaws of the end effector  202 . The bias of the spring  216  may be sufficiently strong that the rod  218  will be biased to return to the closed position if the lever is not held in the open position by an outside force. In alternative embodiments, the dual-control instrument activation system may bias the end effector to an open position. 
     The  208  further includes a driver holder  226  and a spring  228  which applies gentle axial compression on the driver holder  226 . A cylindrical bearing  230  holds the spring  228  in place within the housing  212 . The activation system  208  further includes gimbal assemblies (e.g.,  234  in  FIG. 8 , others not shown) and other mechanisms which operate cables, rods or other drive mechanisms (not shown) to actuate the roll, parallel motion, and wrist joint components through the translation of pitch, yaw, and roll movements. Further aspects of the gimbal assemblies for use in teleoperated surgical activation systems may be found in U.S. patent application Ser. No. 12/060,104 filed Mar. 31, 2008, disclosing “Coupler to Transfer Controller Motion from a Robotic Activation system to an Attached Instrument;” U.S. patent application Ser. No. 11/762,165 filed Jun. 13, 2007, disclosing “Minimally Invasive Surgical System;” and U.S. patent application Ser. No. 12/780,758 filed May 14, 2010, disclosing “Force Transmission for Robotic Surgical Instrument,” which are incorporated by reference herein in their entirety. Some gimbal assemblies may be horizontally arranged gimbal assemblies that function to translate or copy inputs from one gimbal assembly to another horizontally aligned gimbal assembly via a translation components. Translation components may include gears, levers, cables, pulleys, cable guides or other components to transfer or copy the mechanical motion between gimbal assemblies. Other gimbal assemblies may be vertically arranged gimbal assemblies that function to translate inputs from one gimbal assembly to another vertically aligned gimbal assembly. Translation components such as those described above may be used to transfer the mechanical motion between vertically arranged gimbal assemblies. 
     In this embodiment, the drive rod  218  that actuates the grasping action of the end effector  202  passes through a central opening in vertically aligned gimbal assemblies. In alternative embodiments, the drive element  218  may be a pair of cables, where one is pulled to open the jaws of the end effector and one is pulled to close the jaws of the end effector. In some embodiments, the gripping drive element  218  may be a multi-component drive element with, for example, a rigid or semi-rigid rod at the proximal end near the lever and a more flexible component at the distal end where the drive element passes through the parallel motion mechanism and wrist joints. The flexible component of the rod may be a thin wire (e.g., nitinol), a coated or uncoated cable, or a pair of coated cables that cooperate together. As the flexible component passes through the parallel motion mechanism and/or the wrist joints, a sheath may be used to prevent buckling. Alternatively, the flexible components may be guided by the inner diameters of the parallel motion mechanism and/or wrist joints. 
     As shown in  FIG. 9 , the dual-control instrument activation system  208  can be a component of an instrument operation system  250 . The instrument operation system  250  also includes a grip actuator  252  which couples to and moves the lever  210  about the pivot connector  214 . The grip actuator include rotary and/or linear motion encoders  254 . One or more motors  256 , such as servomotors, drive an associated ball screw  258 , which moves an actuator housing  260  linearly forward or backward along a path generally parallel to the axis of the ball screw  258 . A lever capture mechanism  262 , which in this embodiment has a hook shape, is sized to receive and couple with an end portion of the lever  210 . In alternative embodiments, the capture mechanism may be a socket, a clamp, or other mechanism configured to hold and move the lever  210 . A bias component  264 , such as a spring, is housed within the actuator housing  260  and exerts a biasing force that presses the lever capture mechanism  262  toward the lever  210 . A support slide  266  provides linear support to the grip actuator  252 . 
     The surgical instrument  200  may be used for minimally invasive teleoperated surgery performed through multiple surgical incisions or through a single incision. As shown in  FIG. 10 , a flow chart  300  illustrates a method of operating the surgical instrument  200 . During the course of a teleoperational surgical procedure, a surgeon may desire to introduce a surgical accessory such as a needle, gauze, a sponge, a clamp, or other useful accessory into the surgical site. At step  302 , a user, such as a surgical assistant, grasps the surgical accessory  215  within the jaws of the end effector  202  by moving the lever  210  about the pivot connector  214  to compress the spring  216 . The movement of the lever  210  advances the rod  218 , causing the jaws of the end effector  202  to open. The surgical assistant then places the surgical accessory  215  between the jaws of the end effector  202 . The surgical assistant releases the lever  210 , allowing the lever to return to a prebiased position corresponding to a closed position of the end effector  202 . A closed position includes the configurations of the end effector  202  in which the jaws  205  are closed onto or around the surgical accessory or are in closed contact with each other. The surgical instrument  200  is now in a prearranged gripping configuration with the surgical accessory gripped between the jaws of the end effector  202 . 
     At step  304 , the surgical assistant couples the surgical instrument  200  to the grip actuator  252 . More specifically, the grip actuator  252  receives the end of the lever  210  in the lever capture mechanism  262 . The instrument  200  remains in the closed gripping configuration while the end effector  202  and the gripped surgical accessory  216  are introduced into the surgical site. The introduction of the instrument  200  and the surgical accessory  215  may be through a cannula and/or other types of access ports leading into the surgical site in the patient. 
     At step  306 , the surgical instrument  200  is moved by the operation system  250  while the instrument continues to grip the surgical accessory  215 . One or more control signals are generated by and sent from the computer system  18  to instruct the operation system to maintain the surgical instrument in the gripping configuration. While the grip is maintained, the parallel motion mechanism  204  or the wrist joint  203  may be moved, causing the gripped surgical accessory  215  to be moved into position within the surgical site. To release or readjust the surgical accessory  215 , at step  308 , the instrument is moved from the closed gripping configuration to a release or loosened grip configuration. One or more control signals are generated by and sent from the computer system  18  to instruct the operation system to move from the closed gripping configuration to an open or loosened configuration. More specifically, the grip actuator  252  moves the lever capture mechanism  262 , causing the captured lever  210  to pivot about the pivot connector  214  to open or loosen the jaws of the end effector  202 . 
     In an alternative embodiment, the surgical accessory may be a device that should be introduced into the surgical site in a held-open configuration. For example, a surgical clip may need to be held open until it surrounds a blood vessel to be occluded. In this embodiment, an instrument that includes a clip applier may be introduced with the clip applier held in an open position. A user may manually manipulate the dual-control activation system to grip the clip applier and an attached surgical clip in an open gripping position. The dual-control activation system may be transferred to the control of the instrument operation system with the dual-control activation system continuing to be held in the open gripping position. The dual-control activation system may be biased toward an open position. Alternatively, the dual-control activation system may be biased toward a closed position with the operator and teleoperated forces applied to maintain the instrument in the open position against the bias. 
     In still another alternative, the dual-control activation system may be actuated manually even after it is attached to the teleoperated instrument operation system. Such an embodiment may be used, for example, to deliver a manual force more powerful than can be delivered by the motors of the PSC. One such example of a manual override may be for a large stapler that requires a short burst of force that may be most efficiently provided with manual actuation rather than with teleoperated actuation. 
       FIG. 11  illustrates a partial side view of a dual-control surgical instrument  400  according to another embodiment of the present disclosure. Instrument  400  is an illustrative embodiment of an instrument  22 ,  108  described above with reference to  FIGS. 1 and 3 , respectively. The dual-control surgical instrument  400  includes a parallel motion mechanism  402 , coupled to a wrist joint  404 , which is coupled to an end effector  406 . In this embodiment, the end effector  406  includes jaws  408 . The parallel motion mechanism  402  is coupled to a distal end of a shaft  410 . The proximal end of the shaft  410  is coupled to an actuator  414  which is pivotally connected to a housing (not shown) by a pivot connector  418 . The actuator  414  includes an elongated slot  420  sized to receive an elongated portion of a ratchet button  422 . A ratchet pin  424  is coupled to or integrally formed at a distal end of the ratchet button  422 . A toothed ratchet arm  426  is coupled to the housing. The teeth of the ratchet arm  426  are sized to receive the ratchet pin  424  therebetween. A spring  427  extends between the ratchet button  422  and the actuator  414 . A lever  428  is pivotally connected to the actuator  414 . Alternatively the lever  428  could be connected to the housing. A drive member  432 , which in this embodiment is a rod, is clamped to the actuator  414  by a clamp  434 . 
     In one example of use, the ratchet button  422  is depressed (for example, manually) causing the pin  424  to move from between a pair of teeth of the ratchet arm  426 . The actuator  414  is pivoted clockwise about the pivot connector  418  and the rod  432  is retracted, moving the jaws  408  to a closed configuration. With the button  422  released and the spring  427  relaxed, the pin  424  is biased into engagement with the ratchet arm  426  and the rod  432  is locked in position with the jaws  408  in the closed configuration. 
     The movement of the rod  432  may be transferred to teleoperated instrument control while maintaining the jaws  408  in the closed and locked position. For example, an instrument activation system (manual or teleoperated) including a biasing member  430  (e.g., a spring-loaded plunger) and a grip actuator  436  may be used to control the instrument  400 . The lever  428  is engaged by the grip actuator  436  and is pivoted clockwise while the biasing member  430  provides a reaction force against the movement of the actuator  414 . The clockwise motion of the lever  428  eventually engages and depresses the button  422 , releasing the pin  424  from the ratchet arm  426 , thus allowing the further movement of the  436  to rotate the actuator  414  about the pivot connector  418  either clockwise to retract the rod  432  to close the jaws  408  or counter-clockwise to advance the rod and open the jaws. The biasing member  430  biases the actuator  414  to an advanced position in which the jaws  408  are open. 
       FIG. 12  illustrates a partial side view of a dual-control surgical instrument  450  according to another embodiment of the present disclosure. The surgical instrument  450  is similar to the instrument  400  of  FIG. 400  and similar components will retain the same reference numerals. In this embodiment, an actuation component  452  provides a force on the actuator  414  and an actuation component  454  provides a force on the button  422 . The actuation components  452 ,  454  may be separate actuation components or may be part of a common actuation component. When the actuation component  454  depresses the button  422  to release the pin  424  from the ratchet arm  42  and the activation system  452  exerts a force on the actuator  414 , the actuator  414  moves clockwise and depresses the bias member  430 . The actuator  414  thus retracts the rod  432  and the jaws  408  are closed. When the force provided by the activation system  452  is withdrawn or lessened while the pin  424  is disengaged from the ratchet arm  426 , the bias member  430  moves the actuator counter-clockwise, and the rod  432  is advanced, opening the jaws  408 . In the embodiment of  FIG. 12 , the surgical instrument  450  may be locked and unlocked, repeatedly, by the activation system  454  using a dedicated actuator (e.g., a motor or solenoid). In  FIG. 11 , when the instrument  400  is unlocked by lever  428 , it remains unlocked. 
     While certain exemplary embodiments of the invention have been described and shown in the accompanying drawings, it is to be understood that such embodiments are merely illustrative of and not restrictive on the broad invention, and that the embodiments of the invention not be limited to the specific constructions and arrangements shown and described, since various other modifications may occur to those ordinarily skilled in the art.