Abstract:
A robotic medical system comprises a medical instrument assembly having a retainer, a serial array of instruments disposed in the retainer, a chamber, and an instrument driver. The robotic medical system further comprises a user interface configured for generating at least one command signal, a drive unit coupled to the first mechanism, second mechanism, and instrument driver, and an electric controller configured, in response to the command signal(s), for directing the drive unit to linearly displace the array of instruments within the retainer, to displace a selected one of the instruments from the retainer into the chamber, and to distally advance the instrument driver within the chamber to engage the selected instrument.

Description:
RELATED APPLICATIONS 
       [0001]    This application is a continuation of U.S. application Ser. No. 11/762,758, filed Jun. 13, 2007, which is a a continuation of U.S. application Ser. No. 10/077,233, filed Feb. 15, 2002, now U.S. Pat. No. 7,297,142, which is a continuation-in-part of U.S. application Ser. No. 10/034,871, filed Dec. 21, 2001 (now U.S. Pat. No. 6,810,281), and U.S. application Ser. No. 09/827,503, filed Apr. 6, 2001 (now U.S. Pat. No. 6,432,112), which is a continuation of U.S. application Ser. No. 09/746,853, filed Dec. 21, 2000 (now U.S. Pat. No. 6,692,485), which is a divisional of U.S. application Ser. No. 09/375,666, filed Aug. 17, 1999 (now U.S. Pat. No. 6,197,017), which is a continuation of U.S. application Ser. No. 09/028,550, filed Feb. 24, 1998 (now abandoned). The application Ser. No. 10/077,233 is also a continuation-in-part of U.S. application Ser. No. 09/783,637, filed Feb. 14, 2001 (now abandoned), which is a continuation of PCT/US00/12553, filed May 9, 2000, which claims the benefit of priority from U.S. Application Ser. No. 60/133,407, filed May 10, 1999. The application Ser. No. 10/077,233 is also a continuation-in-part of PCT/US01/11376, filed Apr. 6, 2001, which claims priority from U.S. application Ser. No. 09/746,853, filed Dec. 21, 2000 (now U.S. Pat. No. 6,692,485, and Ser. No. 09/827,503, filed Apr. 6, 2001 (now U.S. Pat. No. 6,432,112). The application Ser. No. 10/077,233 is also a continuation-in-part of U.S. application Ser. No. 09/746,853, filed Dec. 21, 2000 (now U.S. Pat. No. 6,692,485), and Ser. No. 09/827,503, filed Apr. 6, 2001 (now U.S. Pat. No. 6,432,112). The application Ser. No. 10/077,233 is also a continuation-in-part of U.S. application Ser. No. 09/827,643, filed Apr. 6, 2001 (now U.S. Pat. No. 6,554,844), which claims priority to U.S. Application Ser. Nos. 60/257,869, filed Dec. 21, 2000, and 60/195,264, filed Apr. 7, 2000, and is also a continuation-in-part of PCT/US00/12553, filed May 9, 2000, from which U.S. application Ser. No. 09/783,637, filed Feb. 14, 2001 (now abandoned), claims priority. 
         [0002]    The application Ser. No. 10/077,233 also claims the benefit of priority from U.S. Application Ser. Nos. 60/332,287, filed Nov. 21, 2001, 60/344,124, filed Dec. 21, 2001, 60/293,346, filed May 24, 2001, 60/279,087, filed Mar. 27, 2001, 60/313,496, filed Aug. 21, 2001, 60/313,497, filed Aug. 21, 2001, 60/313,495, filed Aug. 21, 2001, 60/269,203, filed Feb. 15, 2001, 60/269,200, filed Feb. 15, 2001, 60/276,151, filed Mar. 15, 2001, 60/276,217, filed Mar. 15, 2001, 60/276,086, filed Mar. 15, 2001, 60/276,152, filed Mar. 15, 2001, 60/257,816, filed Dec. 21, 2000, 60/257,868, filed Dec. 21, 2000, 60/257,867, filed Dec. 21, 2000, and 60/257,869, filed Dec. 21, 2000. 
         [0003]    The application Ser. No. 10/077,233 further is a continuation-in-part of U.S. application Ser. No. 10/014,143 (now abandoned), Ser. No. 10/012,845 (now U.S. Pat. No. 7,169,141), U.S. Ser. No. 10/008,964 (now abandoned), Ser. No. 10/013,046 (now abandoned), Ser. No. 10/011,450 (now abandoned), Ser. No. 10/008,457 (now U.S. Pat. No. 6,949,106), Ser. No. 10/008,871 (now U.S. Pat. No. 6,843,793), Ser. No. 10/023,024 (now abandoned), Ser. No. 10/011,371 (now U.S. Pat. No. 7,090,683, Ser. No. 10/011,449 (now abandoned); Ser. No. 10/010,150 (now U.S. Pat. No. 7,214,230), Ser. No. 10/022,038 (now abandoned), and Ser. No. 10/012,586, (now U.S. Pat. No. 7,371,210) all filed on Nov. 16, 2001. 
         [0004]    This application is also related to application Ser. No. 11/762,755, filed Jun. 13, 2007, now U.S. Pat. No. 7,758,569. The entire disclosures of the above applications are expressly incorporated herein by reference in their entirety. 
     
    
     BACKGROUND OF THE INVENTION 
       [0005]    The present invention relates in general to medical instrumentation. More particularly, the present invention relates to a surgical instrumentation system that enables the interchange of any one of a number of different surgical instruments at an operative site. 
         [0006]    In open surgery a surgeon uses a variety of different surgical implements with the total number that are used being a function of the particular operation being performed. For the most part these instruments or implements are hand held devices directly held and manipulated by the surgeon through the open incision. Typical surgical instruments include forceps, needle drivers, scissors, scalpels, etc. A number of different instruments or implements may be used during an operation depending upon the complexity of the medical procedure being performed, and even a greater number of instrument exchanges occur. Thus, a great deal of time may be spent during the surgery simply in exchanging between different types of instruments. 
         [0007]    In minimally invasive surgery (MIS) there is likewise a requirement, depending upon the particular surgical procedure, to exchange instruments or implements during a medical procedure. The primary difference in minimally invasive surgery is that the incision or incisions are relatively small, typically 5 mm to 10 mm in diameter, in comparison to open surgery. Also, in current MIS instrumentation, such instruments as forceps, scissors, etc., are inserted into the body at the end of long slender push rods actuated by the surgeon from outside the patient. Due to the size and increased complexity of these instruments it may be even more difficult to carry out an exchange due to the need to extract and re-insert through a relatively small incision. 
         [0008]    Both open and MIS procedures involve control of the instrument directly by the human hand. In the case of open surgery, of course, the surgeon directly holds and manipulates the instrument, while in MIS the operable tool (scalpel, scissors, etc.) is controlled by hand, but through some type of mechanical transmission that intercouples from outside the patient to an internal operative site. 
         [0009]    In more recent years computer control of instrumentation systems has come into being, typically referred to as robotic surgical systems, in which a surgeon controls an instrument carrying an end effector from a remote site, and through an electronic controller or the like. These robotic systems do provide an improvement in the dexterity with which medical procedures can be performed. However, even in these more advanced systems there is still a need to manually exchange instruments during a procedure. 
         [0010]    Accordingly, it is an objective of the present invention to provide a system and associated method for the ready exchange or interchange between a plurality of different instruments at an operative site, whether it be in connection with open, MIS, robotic, or other types of surgical systems, apparatus, or procedures. 
       BRIEF SUMMARY OF THE INVENTION 
       [0011]    In accordance with a first aspect of the present inventions, a medical instrument assembly is provided. The medical instrument assembly comprises a retainer having a passage, a serial array of instruments disposed in the retainer passage, and a chamber. The instruments may have differing functions, and each of the instruments may have an end effector, such as an articulating tool. The medical instrument assembly further comprises a first mechanism configured for displacing a selected one of the instruments from the retainer passage into the chamber, and an instrument driver configured for being distally advanced within the chamber to engage the selected instrument. 
         [0012]    The instrument driver may be configured for interlocking with the selected instrument. In one embodiment, the retainer has a lateral port, the chamber is in communication with the lateral port, and the first mechanism is configured for displacing the selected instrument through the lateral port into the chamber. In this case, the retainer may have a lateral opening opposite to the lateral port, and the second mechanism may be configured for being displaced through the lateral opening to displace the selected instrument through the lateral port into the chamber. In another embodiment, the chamber has a proximal opening through which the instrument driver is configured for being introduced. The medical instrument assembly optionally comprises a second mechanism configured for linearly displacing the array of instruments within the retainer passage. The medical instrument assembly may also comprise an outlet guide tube extending distally from the chamber, and the instrument driver is configured for displacing the engaged instrument from the chamber into the outlet guide tube. In this case, the chamber may have a distal opening in communication with the outlet guide tube. 
         [0013]    In accordance with a second aspect of the present inventions, a robotic medical system is provided. The robotic medical system comprises a medical instrument assembly having a retainer, a serial array of instruments disposed in the retainer, a chamber, and an instrument driver. The details of the medical instrument assembly may be the same as those described above. The robotic medical system further comprises a user interface configured for generating at least one command signal, a drive unit (e.g., one having a motor array) coupled to the first mechanism, second mechanism, and instrument driver, and an electric controller configured, in response to the command signal(s), for directing the drive unit to linearly displace the array of instruments within the retainer, to displace a selected one of the instruments from the retainer into the chamber, and to distally advance the instrument driver within the chamber to engage the selected instrument. 
         [0014]    In one embodiment, the user interface is located remotely from the drive unit, and electrical controller is coupled to the drive unit via external cabling. In another embodiment, the robotic medical system further comprises a carriage on which the instrument driver is slidably disposed. In still another embodiment, the electrical controller, in response to the command signal(s), is configured for linearly displacing the array of instruments within the retainer. If the medical instrument assembly has an outlet guide tube extending distally from the chamber, the electric controller, in response to the at least one command signal, can be configured for directing the drive unit to distally advance the instrument driver within the chamber to displace the engaged instrument from the chamber into the outlet guide tube. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0015]    These and other features of the present invention are described in greater detail in the following detailed description, taken in conjunction with the accompanying drawings, in which: 
           [0016]      FIG. 1  is a perspective view of one embodiment of a robotic surgical system in which the interchangeable instrument principles of the present invention are applied; 
           [0017]      FIG. 2  is a perspective view showing a portion of the system of  FIG. 1 , particularly the storage chamber and the driving mechanism; 
           [0018]      FIG. 3  is a cross-sectional view illustrating the storage chamber, the driver and the associated positioning of components, and as taken along line  3 - 3  of  FIG. 2 ; 
           [0019]      FIG. 4  is a perspective view showing some further detail of the instrument in this first embodiment; 
           [0020]      FIG. 5  is a partial cross-sectional view showing further details of the driver and instrument in this first embodiment; 
           [0021]      FIG. 6  is a further cross-sectional view similar to that illustrated in  FIG. 5  but showing the driver and instrument in an interlocked position; 
           [0022]      FIG. 7  is a schematic cross-sectional perspective view that illustrates details of the instrument of the present invention; 
           [0023]      FIGS. 8A and 8B  are perspective views of the tool component of the surgical instrument illustrating the cabling scheme; 
           [0024]      FIG. 9  is a perspective view of an alternate embodiment of the present invention, providing linear registration rather than rotational registration; 
           [0025]      FIG. 10  is a perspective view of another embodiment of a robotic surgical system in which the interchangeable instrument principles of the present invention are applied; 
           [0026]      FIG. 11  is a perspective view at the slave station of the system of  FIG. 10  illustrating the interchangeable instrument concepts; 
           [0027]      FIG. 12  is a cross-sectional view through the storage chamber and as taken along line  12 - 12  of  FIG. 11 ; 
           [0028]      FIG. 13  is a longitudinal cross-sectional view, as taken along line  13 - 13  of  FIG. 11 ; 
           [0029]      FIG. 14  is a perspective schematic view of the indexing mechanism used in the embodiment illustrated in  FIGS. 10-13 ; 
           [0030]      FIG. 15  is a block diagram illustrating the steps taken to provide indexing for instrument interchange; and 
           [0031]      FIG. 16  is a schematic diagram of another alternate embodiment of the invention using a serial storage concept. 
       
    
    
     DETAILED DESCRIPTION 
       [0032]    In this detailed description there is described an apparatus for enabling the interchange, at an operative site, between different types of surgical instruments and in an automated fashion. In this way a substitution of one instrument for another can be readily accomplished, without manually withdrawing one instrument followed by manual insertion of another instrument. Further, with this apparatus, and the associated use of a guide tube, or the like, for receiving and guiding the instrument, the interchange can be carried out quickly and safely, thus enabling medical procedures to be performed in a far shorter period of time. The guide tube preferably extends to the operative site OS (see  FIG. 7 ) so that the instrument can transition safely thereto. Also, the guide tube preferably remains at the operative site even as the instruments are exchanged in the guide tube, so as to avoid any tissue or organ damage during an instrument exchange. The operative site may be defined as the general area in close proximity to where movement of the tool occurs in performing a surgical procedure, usually in the viewing area of the endoscope and away from the incision. 
         [0033]    In this description the instrument interchange principles are illustrated in association with two separate surgical systems, both of which are robotic systems, sometimes also referred to as telerobotic systems. However, the principles of this invention also apply to other surgical instrumentation, such as used in minimally invasive surgery (MIS), where a number of instrument exchanges are typical in performing a medical or surgical procedure. 
         [0034]    It is assumed, by way of example, that the systems disclosed herein are for use in laparoscopic surgery. Thus, one system is disclosed in  FIGS. 1 through 8A  and  8 B, while a second system is disclosed in  FIGS. 10-14 . A variation of the first system is illustrated in  FIG. 9 . It is noted that in  FIG. 9 , the instrument-to-driver registration is accomplished with a linear arrangement, while in the other versions described herein a rotating arrangement is employed, all to be described in further detail later. Also, in the embodiments described herein the driver has only linear translation while the instrument storage chamber rotates ( FIGS. 1 and 10 ) or slides ( FIG. 9 ). In an alternate embodiment the driver may rotate or otherwise move to different registration positions, as the instrument storage chamber remains stationary, as long as there is relative motion between the instrument driver and instrument storage chamber. 
         [0035]    Before reference is made to the detailed embodiments described herein, consideration is given to co-pending applications that are hereby incorporated by reference herein in their entirety, and that describe in further detail aspects of the several components that make up the overall robotic surgery system. In connection with descriptions set forth herein reference is made to the applications set forth in the related application part of this application as well as to pending U.S. application Ser. No. 09/783,637 (now abandoned), filed Feb. 14, 2001; U.S. application Ser. No. 10/014,143 (now abandoned), filed Nov. 11, 2001; as well as issued U.S. Pat. No. 6,197,017. 
         [0036]    The first embodiment of the invention is illustrated in  FIGS. 1-8 .  FIG. 1  shows a surgical instrument system  10  that performs surgical procedures. The system may be used to perform minimally invasive procedures. The system may also be used to perform open or endoscopic surgical procedures. The system  10  includes a surgeon interface  11 , computation system  12 , and drive unit  13 . The system controls the instrument so as to position the end effector (tool)  18  of the instrument  20  at the very distal end of and extending through the outlet guide tube  24 . During use, a surgeon may manipulate the handles  30  of the surgeon interface  11 , to effect desired motion of the end effector  18  within the patient, at the operative site which is schematically illustrated in  FIG. 7 . The movement of a handle  30  is interpreted by the computation system  12  to control the movement of the end effector (tool)  18 . 
         [0037]    The system may also include an endoscope with a camera to remotely view the operative site. The camera may be mounted on the distal end of the instrument, or may be positioned away from the site to provide additional perspective on the surgical operation. In certain situations, it may be desirable to provide the endoscope through an opening other than the one used by the instrument. 
         [0038]    The entire assembly illustrated in  FIG. 1  is shown supported over the surgical table  27 , and in a position so that the guide tube  24  can be inserted through an incision in the patient and directed to the operative site of the patient. The incision is represented in  FIG. 1  by the dashed line L. The surgical instrument system  10  of the present invention is preferably mounted on rigid post  19  which may be movably affixed to the surgical table  27 , at bracket  28 . 
         [0039]    The surgical system  10  includes two mechanical cable-in-conduit bundles  21  and  22 . These cable bundles  21  and  22  terminate at one end at the two connection modules(couplers)  23 A and  23 B, which removably attach to the drive unit  13 . The drive unit  13  is preferably located outside the sterile field, although it may be draped with a sterile barrier so that it may be operated within the sterile field. The other end of the bundles terminate at the surgical system  10 . These terminations are shown in further detail in the description of the second embodiment that is described later. Basically cables in the bundle  21  may control; the indexing for controlled rotation of the instrument storage chamber  40 ; rotation of the guide tube  24 ; as well as motion of the carriage  54  for control of the linear translation of the driver  50 . On the other hand the bundle  22  may control, for example, rotation of the instrument within the guide tube  24 , as well as actuation of the tool  18 . The instrument storage chamber is also referred to herein as an instrument retainer. 
         [0040]      FIG. 1  also shows the instrument storage chamber  40  that is illustrated as supported over the base piece  51 , which, in turn, is supported from the rigid post  19 . The cable bundle  21  couples to the base piece  51  and controls motion of the instrument storage chamber  40 , as well as the driver  50 . The guide tube  24  is supported at the outlet port side of the instrument storage chamber  40 , and is controlled for rotation relative to the instrument storage chamber  40 . Rotation of the guide tube  24  provides a corresponding rotation of the instrument and tool. The instrument storage chamber  40  has at its inlet side a port for receiving the driver  50 , and for permitting engagement of the driver with the one of the instruments in the instrument storage chamber  40  that is in registration with the driver  50 . The driver  50  is supported from the carriage  54  which transitions on rails  55 , and is controlled from cable bundle  22 . The driver may also be referred to herein as an instrument transporter. 
         [0041]    In accordance with the setup of the system of  FIG. 1 , the guide tube  24  of the surgical instrument system  10  is inserted into the patient usually through an incision. Usually, a cannula is positioned in the incision, is maintained in position and receives the guide tube  24 . This incision is illustrated in  FIG. 1  by the dashed line L. The system is then mounted to the rigid post  19 . The cable bundles  21  and  22  are then coupled to the drive unit  13 . The connection modules or couplers  23 A and  23 B at the end of respective cable bundles  21  and  22  are then engaged into the drive unit  13 . The system is then ready for use and control from the master station side at surgeon interface  11 . For further details of the entire slave side of the system, including the drive unit, detachability at the drive unit, the cabling and cable couplers, refer to U.S. Ser. Nos. 09/783,637; and 10/014,143, previously mentioned. 
         [0042]    Now, reference is made, not only to  FIG. 1  but also to  FIGS. 2 through 6  that illustrate further details depicting the interchangeable instrument concepts of the present invention.  FIG. 7  illustrates schematically a cabling scheme that may be used in the instrument.  FIG. 9  illustrates an alterative to the revolving chamber construction, in the form of a linearly translatable housing or chamber arrangement. 
         [0043]    The revolving instrument storage chamber  40  includes a base  42 , opposite end walls  43  and a cylindrical chamber or magazine  44 . In the embodiment illustrated herein, chamber  44  has six elongated passages  46  each for receiving an instrument. The chamber  44  is supported by a centrally disposed support rod  47 , such as illustrated in  FIG. 5 . The support rod  47  may be supported in bearings (not shown) at the opposite end walls  43 . The instrument storage chamber  40  has its rotation controlled at base piece  51  (see  FIG. 1 ) so that when an operator at interface  11  wants to change instruments, a command can be sent from the master to the slave side to rotate the magazine  44  so that a different instrument is in alignment with the driver  50 . Of course, this exchange only occurs when the driver has been withdrawn to its rest (disengaged) position. Specific sequences of the interchange action are described later. The command that is sent may be initiated by any one of several means, some of which are described in some detail later. 
         [0044]      FIGS. 2 and 3  also illustrate the outlet guide tube  24 . The tube  24  is secured to one of the end walls  43  and is essentially fixed in axial position relative to that end wall  43  of the rotating instrument storage chamber  40 , but is capable of rotation on its own axis, and relative to the chamber  40 . Details of this rotational support are described further in connection with the second embodiment described in  FIGS. 10-14 . The end walls  43  supporting the magazine  44  are fixed to the base  42 , which is supported over the base piece  51  which, in turn, is fixed to the rigid post  19 . Thus, in this particular embodiment the instrument storage chamber  40  rotates but does not have any significant linear movement toward or away from the operative site. Thus, in this first embodiment the instrument control has a somewhat limited number of degrees-of-freedom. The degrees-of-freedom can be increased by providing the guide tube with a curved distal end, like that illustrated in the second embodiment of the invention in  FIGS. 10-14 . 
         [0045]      FIGS. 1 through 6  also illustrates the instrument driver  50 . The instrument driver  50  is adapted to enter an end inlet port  49  in the wall  43  of the rotating chamber  40 . In this regard, refer to  FIG. 3  for the inlet port  49 . Also, as discussed previously in connection with  FIG. 1 , in the base piece  51  there is an indexing mechanism that controls the rotation of the rotating storage chamber  44  so that different ones of the passages  46  are adapted to be aligned with the input driver port  49 . This registration control may be carried out using a detent mechanism so that the proper instrument is aligned and selected from the chamber by the instrument driver  50 . Refer to  FIG. 2  and the cable bundle  21  that interconnects with the chamber  44  for selective and registered rotation thereof. Also, refer to  FIG. 14  for an example of an indexing mechanism. 
         [0046]    In a similar manner, at the opposite end wall  43  of the chamber  40 , there is provided an outlet port  48 , such as illustrated in  FIG. 3 , and that aligns with the outlet guide tube  24 . Also, in  FIGS. 2 and 3  there is illustrated the carriage  54  that carries the instrument driver  50  and that transitions along the support rails  55  to enable the driver to selectively engage with and drive the instrument forward through the guide tube  24  and toward the operative site. 
         [0047]      FIG. 3  illustrates a cross-sectional view of one embodiment of the interchangeable instrument apparatus of the present invention. An instrument  20  with its end effector (tool)  18  is illustrated disposed in one of the elongated chambers  46  of the rotating chamber  44 . In practice, each of the other passages  46  can contain other types of instruments, with a variety of different tool or end effectors. For the sake of clarity, only one of the instruments is illustrated in  FIG. 3 , it being understood that up to six other instruments of different types may be disposed in other ones of the elongated passages  46 . Also, the magazine  44  may be constructed with fewer or more instrument-receiving passages.  FIG. 3  also illustrates the driver  50  in a position where the end  56  thereof is positioned just entering the inlet port  49  with the end  56  about to engage the end  25  of the instrument  20 . The position of the instrument driver  50  is considered as a “rest position” when the end  57  is disposed in wall  43 , but has not yet entered the magazine  44  so that the magazine  44  is free to rotate. To interlock and align the driver and the instrument, there is provided a post  58  (see  FIG. 5 ) on the driver  50  and an accommodating recess  26  (see  FIG. 5 ) in the instrument end  25 . 
         [0048]    As mentioned previously, there are mechanical cables extending in bundles  21  and  22  illustrated in  FIG. 1 . The cables in bundle  22 , in particular, couple by way of pulleys and then extend the length of the driver  50  to the instrument  20 . The cabling and control pulley arrangements are disclosed in further detail in the second embodiment as shown in  FIGS. 10-14 . This cabling is for operating the end effector  18  illustrated in  FIG. 1 . To provide continuity of this mechanical control cabling, both the instrument driver as well as the instrument carry interconnecting cable connections. These are illustrated clearly in  FIGS. 4 through 6 . Also refer to the schematic perspective view of  FIG. 7  showing the manner in which the cables couple about pulleys  29  and extend through the driver to intercouple with cabling of the instrument  20 . These cable connections between the driver and instrument may also be considered as defining a coupling section or coupling interface  59  where the driver and instrument are releasably engageable. One may also consider the driver and instrument, such as illustrated in  FIGS. 1-6 , as collectively being an instrument member including a work section (instrument  20  and tool  18 ), and a driver section (driver  50 ). 
         [0049]    The instrument driver  50  has passages  61  (see  FIG. 4 ) for receiving a cable  62  (see  FIGS. 4 ,  5  and  6 ). As illustrated in  FIGS. 4 ,  5  and  6  the end of cable  62  terminates in a hook  64 . The hook  64  is adapted to engage with a similar-configuration hook  66  at the end of cable  68  as illustrated in  FIG. 6 .  FIG. 4  illustrates a series of slots or passages  61 , which in the illustrated embodiment comprise six such slots  61 . Each of these slots receives a cable  62  with its end hook  64 . 
         [0050]    Referring further to  FIG. 4 , this illustrates the end  25  of the instrument  20 . Also illustrated are the elongated slots  61  in the driver(transporter)  50 .  FIG. 4  illustrates the cables  68  and their associated hooks  66  associated with the instrument  20 . Also shown is the cable  62  with its hook  64  disposed in slot  61 . 
         [0051]      FIG. 5  illustrates the end  56  of the instrument driver  50  as the driver  50  is transitioning through the port  49  for engagement with the instrument  20 . The driver  50  has not yet engaged the instrument  20 , but has just left its rest position. The “rest” (disengaged) position for the instrument driver  50  is one in which the end  56  of the driver  50  is disposed in the end wall  43  and out of the passage  46  so that the chamber  44  is free to rotate. In the position of  FIG. 5 , the hook  66  associated with the instrument  20  is preferably biased to a somewhat outward deflected position. In this regard, it is noted that the passage  46  has an enlarged section  46 A that permits the hook  66  to deflect outwardly, as illustrated. The hooks are essentially spring biased outwardly so as to contact the inner wall surface of enlarged section  46 A. This enables the driver to pass by the hooks  66  for engagement with the instrument  20 . 
         [0052]    As the driver  50  proceeds from the position illustrated in  FIG. 5 , toward the position illustrated in  FIG. 6 , the hook  64  passes under the hook  66  and as the driver is driven further to the left, as viewed in  FIG. 3 , the hooks  64  and  66  become interlocked in the position illustrated in  FIG. 6  and there is thus cable continuity from cable  62  to cable  68 . As is discussed in further detail hereinafter, the operation of these cables provide operation of certain actions of the end effector  18 . As the driver end  56  engages the instrument end  25 , the post  58  engages with the recess  26  so as to properly align the driver and instrument. At the initial point of contact the hooks  66  are still out of engagement with the hooks  64 . However, as the driver moves further to the left the instrument starts to transition out of the storage chamber passage  46 , and the hooks  66  transition into the smaller diameter section of the passage  46 , causing them to deflect into engagement with the hooks  64 , such as illustrated in  FIG. 6 . The coupling interface  59  formed essentially between the hooks  64  and  66  is maintained as the instrument transitions out of the instrument storage chamber  40 . Refer to  FIG. 7 . 
         [0053]    The driver  50  is of a sufficient length so that the selected instrument  20  is driven out of the chamber  44  and into the outlet guide tube  24 . The instrument is then transitioned through the guide tube  24  to the position illustrated in  FIG. 1  where the end effector or tool  18  of the instrument extends from the distal end of the guide tube  24  at a position inside the body cavity (operative site). All the while that the instrument is being transitioned to the end of the guide tube  24 , the interconnecting cables are maintained in an interlocked position such as illustrated by the engaged hooks  64  and  66  in  FIG. 6 . 
         [0054]    When it is desired to change to a different instrument, the driver  50  is withdrawn or in other words is moved in a direction to the right in  FIG. 3 . This carries the instrument with the instrument driver to the right and when the instrument reaches a position approximately as illustrated in  FIG. 5 , because of the increased diameter of the section  46 A illustrated in  FIG. 5 , the hooks  66  are biased outwardly and disengage from the hooks  64 . This essentially disengages the driver from the instrument and the driver is then in a position to be withdrawn through the port  49 , no longer engaging with the instrument. This also leaves the instrument  20  in place in the instrument storage chamber  44  in readiness for a subsequent usage. 
         [0055]    With the driver disengaged from the instrument, the instrument storage chamber can then be rotated to align a different instrument with the driver. The cabling in bundle  21 , via base piece  51 , controls the position of chamber  40  so as to select a different instrument by rotating the chamber  44  so that a different instrument registers with the driver  50 . For an example of a registration mechanism refer to  FIG. 14 . A different instrument would also carry cabling similar to that illustrated in  FIG. 5 . Once the new instrument is in-line with the instrument driver  50  then the driver  50  may be engaged once again to pass through the port  49  engaging the new instrument and thus transitioning the new instrument out the outlet guide tube  24  to a position where the tool of the instrument is at the operative site in readiness for use and control from the master station surgeon interface. 
         [0056]    A wide variety of different instruments may be supported in the instrument storage chamber  40 . Tool  18  may include a variety of articulated tools, such as jaws, scissors, graspers, needle holders, micro dissectors, staple appliers, tackers, suction irrigation tools, clip appliers, that have end effectors driven by wire links, eccentric cams, push-rods or other mechanisms. In addition, tool  18  may comprise a non-articulated instrument, such as cutting blades, probes, irrigators, catheters or suction orifices. Alternatively, tool  18  may comprise an electrosurgical probe for ablating, resecting, cutting or coagulating tissue. 
         [0057]    To provide proper alignment of the instrument  20  in the chamber  40  and with the driver  50  there are preferably provided interlocking surfaces such as a tongue and groove (not shown) between the walls of the chamber passage and the outer surface off the instrument and/or driver. Interlocking or guiding surfaces may also be provided within the guide tube  24 . Thus, as the different instruments are moved in and out of the rotating chamber they will always be properly aligned with the driver so that the proper cabling is provided to control the instrument. 
         [0058]    Reference is now made to  FIG. 7  for a schematic illustration of the cabling as it extends from the bundle  22 , through the driver  50 , to the instrument  20 , and the tool  18 . The cabling extends about pulleys  29  and into the slots  61  in the instrument driver  50 .  FIG. 7  illustrates the driver  50  in a position in which it has entered the guide tube  24  and transitions to a location essentially at the end of the guide tube where the tool  18  is located and at the operative site OS. At the end of the driver where the cable hooks engage, such as illustrated in  FIGS. 5 and 6 , there is the coupling or interface section  59 .  FIG. 7  also illustrates the passages  46  and another non-selected tool within the instrument storage chamber. 
         [0059]    The construction of one form of tool is illustrated in  FIGS. 8A and 8B . This is in the form of a set of jaws or grippers. This tool is shown for the purpose of illustration, it being understood that a variety of other tool may be used.  FIG. 8A  is a perspective view showing the tool pivoted at the wrist while  FIG. 8B  is an exploded view of the tool. The tool  18  is comprised of four members including the base  600 , link  601 , upper grip or jaw  602  and lower grip or jaw  603 . The base  600  is affixed to the flexible stem section  302 . This flexible section may be constructed of a ribbed plastic. This flexible section may be used when a curved end guide tube (see  FIG. 11 ) is used so that the instrument will readily bend through the curved actuator tube  24 . 
         [0060]    The link  601  is rotatably connected to the base  600  about axis  604 .  FIG. 8B  illustrates a pivot pin at  620 . The upper and lower jaws  602  and  603  are rotatably connected to the link about axis  605 , where axis  605  is essentially perpendicular to axis  604 .  FIG. 8B  illustrates another pivot pin at  624 . 
         [0061]    Six cables  606 - 611 , shown schematically in  FIG. 8A  and  FIG. 8B , actuate the four members  600 - 603  of the tool. Cable  606  travels through the insert stem (section  302 ) and through a hole in the base  600 , wraps around curved surface  626  on link  601 , and then attaches on link  601  at  630 . Tension on cable  606  rotates the link  601 , and attached upper and lower grips  602  and  603 , about axis  604 (wrist pivot). Cable  607  provides the opposing action to cable  606 , and goes through the same routing pathway, but on the opposite sides of the insert. Cable  607  may also attach to link  601  generally at  630 . Cables  606  and  607  may be one continuous cable secured at  630 . 
         [0062]    Cables  608  and  610  also travel through the stem  302  and though holes in the base  600 . The cables  608  and  610  then pass between two fixed posts  612 . These posts constrain the cables to pass substantially through the axis  604 , which defines rotation of the link  601 . This construction essentially allows free rotation of the link  601  with minimal length changes in cables  608 - 611 . In other words, the cables  608 - 611 , which actuate the grips  602  and  623 , are essentially decoupled from the motion of link  601 . Cables  608  and  610  pass over rounded sections and terminate on grips  602  and  603 , respectively. Tension on cables  608  and  610  rotate grips  602  and  603  counter-clockwise about axis  605 . Finally, as shown in  FIG. 8B , the cables  609  and  611  pass through the same routing pathway as cables  608  and  610 , but on the opposite side of the instrument. These cables  609  and  611  provide the clockwise motion to grips or jaws  602  and  603 , respectively. At the jaws  602  and  603 , as depicted in  FIG. 8B , the ends of cables  608 - 611  may be secured at  635 . This securing may occur with the use of an adhesive such as an epoxy glue or the cables could be crimped to the jaw. 
         [0063]    Reference is now made to  FIG. 9 .  FIG. 9  schematically illustrated an alternate embodiment of the present invention. In  FIGS. 1-8  the different instruments are selected by means of a rotating arrangement. In  FIG. 9  the selection is made on an essentially linear basis. Thus, instead of the rotating member illustrated in  FIGS. 1-8 , there is a flat array  70  also having a series of elongated passages  72  extending therethrough. Each of these passages accommodates an instrument.  FIG. 9  also schematically illustrates, by the same reference characters, the instrument driver  50  and the outlet guide tube  24  such as previously illustrated in  FIGS. 1-8 . The flat array  70  may be driven selectively in the direction of arrow  74  so as to align different ones of the passages  72  with the driver  50  and guide tube  24 . Mechanisms for selective linear drive are well known, as are mechanisms for registration so as to provide proper alignment between the instrument and instrument driver. 
         [0064]    In connection with the aforementioned description of the cables/hooks, it is noted that the interchange system is designed preferably to have all cabling maintained in tension. In this way, as an instrument is engaged, all of the cabling running therethrough is in tension and properly operative to control the end effector whether it be a set of jaws as illustrated in  FIGS. 8A and 8B  or some other type of instrument. If an end effector has less degrees of movement than that illustrated in  FIGS. 8A and 8B  this is still effectively controlled, but with the use of fewer cable control signals (fewer cables will actually be activated). 
         [0065]    Reference is now made to the second robotic surgical system depicted in  FIGS. 10-14 , and that discloses a system having a greater number of degrees-of-freedom than the system described in  FIGS. 1-8 . In  FIGS. 10-14  the same reference characters are used for similar components as depicted in  FIGS. 1-8 . 
         [0066]    The surgical robotic system, as illustrated in  FIGS. 10-14 , although preferably used to perform minimally invasive surgery, may also be used to perform other procedures as well, such as open or endoscopic surgical procedures.  FIG. 10  illustrates a surgical instrument system  10  that includes a master station M at which a surgeon  2  manipulates an input device, and a slave station S at which is disposed a surgical instrument. In  FIG. 1  the input device is illustrated at  3  being manipulated by the hand or hands of the surgeon. The surgeon is illustrated as seated in a comfortable chair  4 . The forearms of the surgeon are typically resting upon armrests  5 . 
         [0067]      FIG. 10  illustrates a master assembly  7  associated with the master station M and a slave assembly  8  associated with the slave station S. Assembly  8  may also be referred to as a drive unit. Assemblies  7  and  8  are interconnected by means of cabling  6  with a controller  9 . As illustrated in  FIG. 10 , controller  9  typically has associated therewith one or more displays and a keyboard. Reference is also made to, for example, the aforementioned U.S. Ser. No. 10/014,143, for further detailed descriptions of the robotic controller operation and associated algorithm. 
         [0068]    As noted in  FIG. 10 , the drive unit  8  is remote from the operative site and is preferably positioned a distance away from the sterile field. The drive unit  8  is controlled by a computer system, part of the controller  9 . The master station M may also be referred to as a user interface vis--vis the controller  9 . Commands issued at the user interface are translated by the computer into an electronically driven motion in the drive unit  8 . The surgical instrument, which is tethered to the drive unit through the cabling connections, produces the desired replicated motion.  FIG. 10 , of course, also illustrates an operating table T upon which the patient P is placed. 
         [0069]    Thus, the controller couples between the master station M and the slave station S and is operated in accordance with a computer algorithm. The controller receives a command from the input device  3  and controls the movement of the surgical instrument so as to replicate the input manipulation. 
         [0070]    With further reference to  FIG. 10 , associated with the patient P is the surgical instrument  14 , which in the illustrated embodiment actually comprises two separate instruments one on either side of an endoscope E. The endoscope includes a camera to remotely view the operative site. The camera may be mounted on the distal end of the instrument insert, or may be positioned away from the site to provide additional perspective on the surgical operation. In certain situations, it may be desirable to provide the endoscope through an opening other than the one used by the surgical instrument  14 . In this regard, in  FIG. 10  three separate incisions are shown, two for accommodating the surgical instruments and a centrally disposed incision that accommodates the viewing endoscope. A drape is also shown with a single opening. 
         [0071]    The surgical instrument  14  is generally comprised of two basic components including a surgical adaptor or guide  15  and an instrument  14 .  FIG. 10  illustrates the surgical adaptor  15 , which is comprised primarily of the guide tube  24 . In  FIG. 10  the instrument  14  is not clearly illustrated but extends through the guide tube  24 . The instrument  14  carries at its distal end the tool  18 . Descriptions of the surgical instrument are found hereinafter in additional drawings, particularly  FIG. 11 . The surgical adaptor  15  is basically a passive mechanical device, driven by the attached cable array. 
         [0072]    In  FIG. 10  there is illustrated cabling  22  coupling from the instrument  14  to the drive unit  18 . The cabling  22  is preferably detachable from the drive unit  8 . Furthermore, the surgical adaptor  15  may be of relatively simple construction. It may thus be designed for particular surgical applications such as abdominal, cardiac, spinal, arthroscopic, sinus, neural, etc. As indicated previously, the instrument  14  couples to the adaptor  15  and essentially provides a means for exchanging the instrument tools. The tools may include, for example, forceps, scissors, needle drivers, electrocautery etc. 
         [0073]    Referring still to  FIG. 10 , the surgical system  10  may preferably be used to perform minimally invasive procedures, although it is to be understood that the system may also be used to perform other procedures, such as open or endoscopic surgical procedures. The system  10  includes a surgeon&#39;s interface  11 , computation system or controller  9 , drive unit  8  and the surgical instrument  14 . The surgical system  10 , as mentioned previously, is comprised of an adaptor or guide  15  and the instrument  14 . The system is used by positioning a tool  18  of the instrument, which is inserted through the surgical adaptor or guide  15 . During use, a surgeon may manipulate the input device  3  at the surgeon&#39;s interface  11 , to effect desired motion of the tool  18  within the patient. The movement of the handle or hand assembly at input device  3  is interpreted by the controller  9  to control the movement of the guide tube  24 , instrument, and tool  18 . 
         [0074]    The surgical instrument  14 , along with the guide tube  24  is mounted on a rigid post  19  which is illustrated in  FIG. 10  as removably affixed to the surgical table T. This mounting arrangement permits the instrument to remain fixed relative to the patient even if the table is repositioned. Although, in  FIG. 10  there are illustrated two such instruments, even a single surgical instrument may be used. 
         [0075]    As indicated previously, connecting between the surgical instrument  14  and the drive unit  8 , are cablings. These include two mechanical cable-in-conduit bundles  21  and  22 . These cable bundles  21  and  22  may terminate at two connection modules, not illustrated in  FIG. 10  (see  FIG. 1 ), which removably attach to the drive unit  8 . Although two cable bundles are described here, it is to be understood that more or fewer cable bundles may be used. Also, the drive unit  8  is preferably located outside the sterile field, although it may be draped with a sterile barrier so that it may be operated within the sterile field. 
         [0076]    In the preferred technique for setting up the system, and with reference to  FIG. 10 , the surgical instrument  14  is inserted into the patient through an incision or opening. The instrument  14  is then mounted to the rigid post  19  using a mounting bracket  31 . The cable bundles  21  and  22  are then passed away from the operative area to the drive unit  8 . The connection modules of the cable bundles are then engaged into the drive unit  8 . The separate instrument members of instrument  14  are then selectively passed through the guide tube  24 . This action is in accordance with the interchangeable instrument concepts of this invention. 
         [0077]    The instrument  14  is controlled by the input device  3 , which is be manipulated by the surgeon. Movement of the hand assembly produces proportional movement of the instrument  14  through the coordinating action of the controller  9 . It is typical for the movement of a single hand control to control movement of a single instrument. However,  FIG. 10  shows a second input device that is used to control an additional instrument. Accordingly, in  FIG. 10  two input devices are illustrated and two corresponding instruments. These input devices are usually for left and right hand control by the surgeon. 
         [0078]    The surgeon&#39;s interface  11  is in electrical communication with the controller  9 . This electrical control is primarily by way of the cabling  6  illustrated in  FIG. 10  coupling from the bottom of the master assembly  7 . Cabling  6  also couples from the controller  9  to the actuation or drive unit  8 . This cabling  6  is electrical cabling. The actuation or drive unit  8 , however, is in mechanical communication with the instrument  14 . The mechanical communication with the instrument allows the electromechanical components to be removed from the operative region, and preferably from the sterile field. The surgical instrument  14  provides a number of independent motions, or degrees-of-freedom, to the tool  18 . These degrees-of-freedom are provided by both the guide tube  24  and the instrument  14 . 
         [0079]      FIG. 10  shows primarily the overall surgical system.  FIGS. 11-14  show further details particularly of the interchangeable instrument concepts as applied to this system.  FIG. 15  illustrates a control algorithm for the system. The system of  FIG. 10  is adapted to provide seven degrees-of-freedom at the tool  18 . Three of the degrees-of-freedom are provided by motions of the adaptor  15 , while four degrees-of-freedom may be provided by motions of the instrument  14 . As will be described in detail later, the adaptor is remotely controllable so that it pivots, translates linearly, and has its guide tube rotate. The instrument also rotates (through the instrument driver), pivots at its wrist, and has two jaw motions at the tool. 
         [0080]    Now, reference is made to the more detailed drawings of  FIGS. 11-14 .  FIG. 11  is a perspective view at the slave station of the system of  FIG. 10  illustrating the interchangeable instrument concepts.  FIG. 12  is a cross-sectional view through the storage chamber and as taken along line  12 - 12  of  FIG. 11 .  FIG. 13  is a longitudinal cross-sectional view, as taken along line  13 - 13  of  FIG. 11 .  FIG. 14  is a perspective schematic view of the indexing and registration mechanism used in the embodiment illustrated in  FIGS. 10-13 . 
         [0081]    Reference is now made to  FIG. 11  which is a perspective view illustrating the instrument  14  and the adaptor  15  at the slave station S. This instrument system is secured in the manner illustrated in  FIG. 10  to the rigid post  19  that supports the surgical instrument by way of the mounting bracket  31  illustrated in  FIG. 10 , but not shown in  FIG. 11 .  FIG. 11  also shows several cables that may be separated into five sets for controlling different motions and actions at the slave station. These are individual cables of the aforementioned bundles  21  and  22  referred to in  FIG. 10 .  FIG. 11  also illustrates the support yoke  220  that is secured to the mounting bracket  31 , the pivot piece  222 , and support rails  224  for the carriage  226 . The rails are supported in end pieces  241  and  262  with the end piece  241  attached to the pivot piece  222 . The pivot piece  222  pivots relative to the support yoke  220  about pivot pin  225 . A base piece  234  is supported under the carriage  226  by means of the support post  228 . The support post  228  in essence supports the entire instrument assembly, including the adaptor  15  and the instrument  14 . 
         [0082]    As indicated previously, the support yoke  220  is supported in a fixed position from the mounting bracket  31 . The support yoke  220  may be considered as having an upper leg  236  and a lower leg  238 . In the opening  239  between these legs  236  and  238  is arranged the pivot piece  222 . Cabling extends into the support yoke  220 . This is illustrated in  FIG. 11  by the cable set  501 . Associated with the pivot piece  222  and the carriage  226  are pulleys (not shown) that receive the cabling for control of two degrees-of-freedom. This control from the cable set  501  includes pivoting of the entire instrument assembly about the pivot pin  225 . This action pivots the guide tube  24  essentially in a single plane. This pivoting is preferably about an incision of the patient which is placed directly under, and in line with, the pivot pin  225 . Other cables of set  501  control the carriage  226  in a linear path in the direction of the arrow  227 . See also the cables  229  extending between the carriage  226  and the end pieces  241  and  262 . The carriage moves the instrument and guide tube  24  back and forth in the direction of the operative site OS. Incidentally, in  FIG. 11  the instrument is in its fully advanced state with the tool at the operative site OS. 
         [0083]    The base piece  234  is the main support for the interchangeable instrument apparatus of the invention. Refer to  FIGS. 11-14 . The base piece  234  supports the guide tube  24 , the instrument storage chamber  540 , and the instrument driver  550 . The instrument driver  550  is supported from another carriage, depicted in  FIGS. 11 and 13  as the carriage  552 , and that, in turn, is supported for translation on the carriage rails  554 . The rails  554  are supported at opposite ends at end pieces  556  and  558 , in a manner similar to the support for the other carriage  226 . A support post  560  interconnects the carriage  552  with the instrument driver housing  570 . 
         [0084]    With further reference to  FIG. 11 , and as mentioned previously, there are a number of cable sets from bundles  21  and  22  coupled to and for controlling certain actions of the instrument system. Mention has been made of the cable set  501  for controlling instrument pivoting and translation, as previously explained. In addition,  FIG. 11  depicts four other cable sets  503 ,  505 ,  507 , and  509 . Cable set  503  controls rotation of the guide tube  24 . Cable set  505  controls the carriage  552 , and, in turn, the extending and retracting of the instrument driver for instrument exchange. Cable set  507  controls rotation of the instrument through rotation of the instrument driver. Finally, cable set  509  controls the tool via the instrument driver and instrument. There is also one other set of control cables not specifically illustrated in  FIG. 11  that controls the indexing motor  565 , to be discussed in further detail later. 
         [0085]      FIG. 13  shows a cross-sectional view through the interchangeable instrument portion of the overall instrument system. This clearly illustrates the internal cable and pulley arrangement for the various motion controls. There is a pulley  301  driven from the cable set  503  that controls rotation of the guide tube  24 . There is also a pulley  303  driven from cable set  505 , along with a companion pulley  305  that provides control for the carriage  552 .  FIG. 13  also illustrates another pulley  307  driven from cable set  507 , and for controlling the rotation of the instrument driver  550 , and, in turn, the selected instrument. 
         [0086]      FIG. 13  illustrates the guide tube  24  supported from the base piece  234 . The guide tube  24  is hollow and is adapted to receive the individual instruments or work sections  541  disposed in the instrument storage chamber  540 , as well as the instrument driver  550 . Refer to  FIG. 7  for an illustration of the instrument and instrument driver positioned in the guide tube  24 .  FIG. 13  shows the instrument driver  550  in its rest or disengaged position. The proximal end  24 A of the guide tube  24  is supported in the base piece  234  by means of a pair of bearings  235  so that the guide tube  24  is free to rotate in the base piece  234 . This rotation is controlled from the pulley  237  which is secured to the outer surface of the guide tube  24  by means of a set screw  231 . The pulley  237  is controlled to rotate by means of the cabling  310  that intercouples the pulleys  301  and  237  and that is an extension of the cabling  503 . Thus, by means of the cable and pulley arrangement, and by means of the rotational support of the guide tube  24 , the rotational position of the guide tube  24  is controlled from cable set  503 . Of course, this controlled rotation is effected from the master station via the controller  9 , as depicted in the system view of  FIG. 10 , and as a function of the movements made by the surgeon at the user interface  11 . 
         [0087]    As indicated before the proximal end  24 A of the guide tube  24  is supported from the base piece  234 . The distal end of the guide tube  24 , which is adapted to extend through the patient incision, and is disposed at the operative site OS illustrated about the tool  18  in  FIG. 11 , and where a medical or surgical procedure is to be performed. In the system shown in  FIG. 11  the distal end of the guide tube  24  is curved at  24 B. In this way by rotating the guide tube  24  about its longitudinal axis there is provided a further degree-of-freedom so as to place the end tool at any position in three-dimensional space. The rotation of the guide tube  24  enables an orbiting of the end tool about the axis of the guide tube  24 . The guide tube  24  is preferably rigid and constructed of a metal such as aluminum. The tool  18  illustrated in  FIG. 11  may be the same tool as illustrated in  FIGS. 8A and 8B . Also, when the instrument is fully engaged, as in  FIG. 11 , the cabling and cable interface is as illustrated in  FIG. 7 . 
         [0088]      FIG. 13  also illustrates a cross-section of the instrument storage chamber  540  including the storage magazine  549 , and showing two of the six instrument passages  542  in the storage magazine  549 . The instrument storage chamber may also be referred to herein as an instrument retainer. In  FIG. 13  one of the instruments  541  is about to be engaged by the instrument driver  550 . The other instrument  541  is in place (storage or rest position) in the instrument storage chamber  540 , and out of the path of the instrument driver  550 . One of the instruments  541  carries a gripper tool illustrated at  543 , while the other instrument carries a scissors  544 . Because these instruments are adapted to pass to the guide tube  24  and be positioned at the distal end  24 B thereof, the body  548  of the instrument is flexible so as to be able to curve with the curvature of the guide tube  24 . 
         [0089]    Although reference is made herein to the separate instrument and instrument driver, such as illustrated in  FIG. 13 , once they are engaged they function as a single piece instrument member. Accordingly reference is also made herein to the instrument driver  550  as a “driver section” of the overall one piece instrument member, and the instrument  541  as a “working” section of the instrument member. The instrument member has also been previously discussed as having a “coupling section” or “interface section”, which is defined between the working section and the driver section where the cables interlock by means of the engaging hook arrangement, such as clearly depicted in  FIGS. 5 and 6 . This is shown in  FIG. 13  at  559 . This is analogous to the interface  59  illustrated in  FIG. 7 . 
         [0090]    The carriage  552  illustrated in  FIG. 13  is moved linearly by the cables  555  that extend between pulleys  303  and  305 . These cables attach to the carriage  552 . The carriage movement is controlled from cable set  505 . It is the movement of the carriage  552  that drives the instrument driver(driver section)  550 . The instrument driver  550 , in its rest or disengaged position, is supported between the instrument driver housing  570  and the wall  562  that is used for support of the instrument storage chamber  540 . The instrument magazine  549  is rotationally supported by means of the axle or shaft  547 , with the use of bushings or bearings, not shown. This support is between walls  562  and  563 . 
         [0091]      FIG. 13  shows the very distal end  525  of the instrument driver (transporter)  550  supported at wall  562 . In the rest position of the instrument driver  550  the driver is out of engagement with the instruments and the magazine  549 , thus permitting rotation of the instrument storage chamber  540 . The proximal end  526  of the instrument driver  550  is supported at the instrument driver housing  570 . It may be rotationally supported by means of a bushing  527 . The instrument driver  550  is supported for rotation, but rotation is only enabled once the driver has engaged the instrument and preferably is at the operative site. The rotation of the instrument driver  550  is controlled from cable set  503  by way of the pulley  307 . 
         [0092]    In  FIG. 11  the cable set  509  is illustrated as controlling the instrument motions including tool actuation. These cables control a series of pulleys shown in  FIG. 13  as pulleys  529 . As indicted in  FIG. 13  these pulleys control cabling that extends through the instrument driver and the instrument for control of instrument and tool motions. The cables that are controlled from these pulleys may control three degrees-of-freedom of the instrument, including pivoting at the wrist and two for gripper action. For the details of the interlocking of the instrument and instrument driver refer to  FIGS. 5 and 6 . The same engagement arrangement can be used in this second embodiment of the invention including the mating hook arrangement, interlocked at interface  559  when the instrument driver and instrument are engaged. 
         [0093]    Reference has been made before to the indexing motor  565 . This motor is illustrated in  FIG. 11  positioned next to the base piece  234 , and is further illustrated in  FIG. 14  located for interaction with the instrument storage chamber  540 . The indexing motor  565  is controlled from the master station side, and accordingly there is another cable set (not shown) that actuates the indexing motor  565 . The indexing motor  565  may be a stepper motor having a degree of rotation that corresponds to the desired rotation of the instrument storage chamber  540 . The stepper motor may be designed to provide 60 degrees of rotation for each actuation, corresponding to an instrument storage chamber  540  having six passages (360 degrees divided by 6) for receiving instruments. 
         [0094]    In  FIG. 14  the stepper motor  565  has an output shaft  566  that supports an indexing disk  567 , shown also in dashed line in  FIG. 12 . The indexing disk  567  is fixed to the shaft  566  and so rotates with the shaft  566 .  FIG. 12  illustrates the disk  567  carrying four pins  568  disposed at the periphery of the disk  567 .  FIG. 14  also shows these pins  568 . The pins  568  selectively engage in indexing slots  569  in an end wall of the magazine  549 . To insure that the rotating chamber stays in proper registration with the instrument driver a spring and ball detent arrangement is employed. Refer to  FIGS. 11-14  illustrating a standard ball and spring member  575  supported in the wall  563 . The ball of member  575  is urged against an end wall surface  576  of the magazine  549 . This end wall has a series of detent dimples  577  (see  FIG. 14 ) disposed at locations corresponding to the passages in the magazine  549 . The stepper motor  565  is selectively operated under surgeon control from the master station. Each step rotates the disk  567  through 90 degrees. The engagement of the pins  568  with the slots  569  causes a corresponding rotation of the magazine  549  through 60 degrees. Each subsequent rotation of the stepper motor  565  causes a further 60 degree rotation of the magazine  549 . The stepper motor  565  is controllable in a manner so that, with proper decoding, there may be multiple step actuations to get from one instrument to the next selected instrument. 
         [0095]    The operation of the slave instrument is in a robotic manner from the master station, such as illustrated in  FIG. 10 . The surgeon can control several degrees-of-freedom of the instrument system. In addition, when the surgeon wishes to exchange instruments this can be done directly from the master station from an actuation member and at the proper time in the surgical procedure. One type of actuation member may be by means of a foot switch  410  illustrated in  FIG. 10  within access of the surgeon. The foot switch  410  couples to the controller  9 . Appropriate electrical signals are coupled from the master station to the slave station basically to control the stepper motor  565  for indexing the magazine  549 . 
         [0096]    The sequence of operation for the indexing is demonstrated in the flow chart of  FIG. 15 . This block diagram indicates the sequence of steps performed commencing with a rest position of the system in which the instruments are all in place in the storage chamber  540 , and the instrument driver is in the position substantially as illustrated in  FIG. 13 , just out of contact with the registered instrument and with the driver end  525  disposed in the wall  562 . It is this position that is illustrated in  FIG. 15  by box  420 . The next step is to check the registration of the instrument driver with the instrument itself. This is depicted by the box  422 . This step may involve the use of some known registration system, such as one using an optical sensing arrangement to determine proper registration between the instrument driver  550  and each of the passages in the magazine  549 , along with the instrument  541 . If proper registration is detected then the system proceeds to the next step indicated in  FIG. 15  by box  426 , which activates the instrument driver  550 . This starts the process of driving the instrument to the operative site OS. This involves mechanical control signals on the cable set  505  controlling the carriage  552 , and in turn, the instrument driver  550 . If an improper registration is detected then box  424  indicates the step of correcting the registration. This may be carried out in a well known manner with the use of an optical system to provide slight rotation to the instrument storage chamber  540  so as to obtain proper registration. This system may also use some type of a feedback system. 
         [0097]    The next step in the system is indicated in  FIG. 15  by the box  428  which simply detects the fully engaged position of the instrument driver and instrument. This is the position illustrated in  FIG. 11 . Again, this position can be readily detected by optical means. The next step illustrated in  FIG. 15  by box  430  is one that commences the interchange process. The intercoupled instrument and instrument driver are withdrawn. This involved movement of the carriage  552  in the opposite direction. Next, indicated by box  432 , is where the instrument and instrument driver have reached the position illustrated in  FIG. 13  previously referred to as the “rest position”. In that position the instrument driver (transporter)  550  is clear of the instrument storage chamber  540 , and thus the instrument storage chamber  540  can be indexed (rotated). This is shown in  FIG. 15  by the box  434 . Following these steps, from  FIG. 15  it is seen that there may be another registration check (box  436 ), and a correction (box  438 ), in a manner similar to the operation previously discussed regarding boxes  422  and  424 . The process can then repeat at a time determined by the surgeon&#39;s instrument selection sequence. 
         [0098]    There has to be some correlation between the indexing, what and where particular instruments are stored, and how the indexing is controlled from the master station. As indicated previously a foot switch can be used, such as the switch  410  illustrated in  FIG. 10 . In one version of the control the switch  410  may be comprised of six separate actuation buttons, each one corresponding to one of the six instruments disposed in the instrument storage chamber  540 . Indicia may be provided associated with the storage chamber to indicate what particular instrument is disposed in what particular instrument passage. In this way the surgeon would know what button to actuate to select the desired instrument. There could be corresponding indicia associated with the switch buttons so the surgeon knows what button corresponds exactly to what instrument. 
         [0099]    The control system for indexing may also include a decoding scheme so that when the surgeon makes a selection the decoder determines the number of rotations (such as of the stepper motor  565 ) necessary to bring the instrument driver into proper registration with the selected instrument. Because it may not always be clear as to the specific instrument sequence that the surgeon will use, the system has to determine how to index from one instrument to the next one selected. This selection process involves more than just sequencing from one instrument to an adjacent instrument. The process will have to accommodate a selection process in which the next selected instrument is not the adjacent instrument. Thus a simple decoder can be used to determine the number of stepper motor steps necessary to move the storage chamber to the next selected instrument. 
         [0100]    Another aid that can be provided to the surgeon is a visible display illustrated in  FIG. 10 , and on which there can be a diagram that matches the storage chamber pattern showing to the surgeon exactly where each instrument is placed including the type of instrument. This could be set up when the instruments are first selected the disposed in the instrument storage chamber  540 . In association with this display one could also provide, in place of the switch  410 , a voice activated system so that the surgeon simply indices by voice which instrument to select. This may be done by simply numbering the instruments, such as one through six. A further variation may use a touch screen so that the surgeon simply touches an area on the screen corresponding to the displayed image of the storage chamber with the stored instruments. In all of the above instances, there are electrical signals generated from the master station, through a touch screen, switch, etc. that are conveyed to the controller  9  and from there to the slave side. The activating signals at the slave side basically control the stepper motor  565  via a cable set not specifically shown in the drawings but that would couple to the stepper motor  565  illustrated in  FIGS. 11 ,  12  and  14 . 
         [0101]    Reference is now made to  FIG. 16  for a schematic representation of a further alternate embodiment of the invention. In  FIGS. 1 and 10  it is noted that the instruments are contained in a parallel array. In accordance with the invention the instruments may also be disposed in a series array, as depicted in the schematic diagram of  FIG. 16 . This embodiment includes a retainer  580  that is adapted to store a series of instruments  581  in a serial array, also referred to herein as a linear chamber or linear retainer. Means are provided to enable the array to move laterally in the directions indicated by arrows  585 . This movement can be of either the retainer or the instruments themselves. There is an alignment that occurs so that a selected instrument may align with a port  584  from which the instrument may then be moved to location  583 . This is by a lateral or transverse movement of the instrument out of the retainer  580 . This movement is indicated in  FIG. 16  by the arrow  587 . The instrument, once moved, is then in registration with the driver or transporter  580  which is moveable in the direction of arrow  588 . The driver is controlled as in previous embodiments to transition the instrument to the operative site, through the represented output port  586 . 
         [0102]    Although reference is made herein to “surgical instrument” it is contemplated that the principles of this invention also apply to other medical instruments, not necessarily for surgery, and including, but not limited to, such other implements as catheters, as well as diagnostic and therapeutic instruments and implements. Having now described certain embodiments of the present invention, it should be apparent to one skilled in the art that numerous other embodiments and modifications thereof can be made, some of which have already been described, and all of which are intended to fall within the scope of the present invention. For example, the coupling sections or interface sections have been disclosed as intercoupled cables with hook arrangements, such as shown in  FIG. 6 . In another arrangement a different mechanical coupling scheme may be employed using a different interlock between cables. Also, in place of mechanical couplings other technologies may be used for coupling action to the instrument and tool, such as SMA technology. Regarding the tool itself, one has been illustrated with a wrist pivot. Instead the tool may include a bendable section at or near its distal end. In place of the stepper motor other indexing arrangements can be used, such as a ratchet and pawl system. Also, encoders can be used at the rotating storage chamber to detect motions to provide feedback for controlling the overall system.