Abstract:
Provided is a medical robot system which includes a medical manipulator capable of handling organs such as a uterine of different shapes and sizes. The medical robot system includes a robot arm, a medical manipulator which is detachably provided in the robot arm and supports an organ to a predetermined position, and a controller unit operable by an operator to control the robot arm and the medical manipulator. The medical manipulator also includes a first arm portion in a base side thereof, a second arm portion in a front side thereof for supporting the organ, and a connection portion connecting the first arm portion with the second arm portion. The control unit adjusts a relative direction of the second arm portion and the first arm portion and a length of the second arm portion in a telescopic manner thereby being suitable for organs of various shapes and sizes.

Description:
BACKGROUND 
       [0001]    1. Field 
         [0002]    The embodiments discussed herein relate to a medical robot system which includes a medical manipulator for supporting an organ at a predetermined position. 
         [0003]    2. Background Art 
         [0004]    In laparoscopic surgery, a patient&#39;s abdomen or the like is perforated to make several small holes, an endoscope, forceps, and the like are inserted into the holes, and a surgical operator performs a surgical operation while watching a video of the endoscope through a monitor. In the laparoscopic surgery, in order to facilitate the surgical operation, a treatment target organ or an organ in the vicinity of the treatment target organ is supported at a predetermined position using a medical manipulator. 
         [0005]    For example, U.S. Pat. No. 5,520,698 discloses a medical manipulator including a frame which extends in one direction and a tip which includes an expandable balloon and is rotatably connected to a front end of the frame. When the tip is inserted into a uterine cavity and the balloon is expanded, the uterus is supported to a predetermined position. 
         [0006]    However, in general, there are differences among individuals in the shapes of organs such as a uterus. For this reason, in the medical manipulator disclosed in U.S. Pat. No. 5,520,698, when the tip is longer than appropriate for the size of the organ, the front end of the tip may come into contact with the organ to thereby damage the organ. On the other hand, when the tip is shorter than appropriate for the size and shape of the organ, the tip may not be disposed at a position where the organ is appropriately supported. 
       SUMMARY 
       [0007]    The present invention is contrived in consideration of the above-described problems, and an object of the invention is to provide a medical robot system which includes a medical manipulator capable of dealing with individual differences in the shape of organs to be supported without increasing in the number of components. 
         [0008]    According to a first aspect of the invention, there is provided a medical robot system including: a robot arm; a medical manipulator which is detachably provided in the robot arm and supports an organ from its inside to a predetermined position; and a manipulation unit which is used to manipulate the robot arm and the medical manipulator, wherein the medical manipulator includes: a first arm portion which is provided in a base portion of the medical manipulator; a second arm portion which is located to be closer to a front end of the medical manipulator than the first arm portion and supports the organ; and a connection portion which connects the first arm portion and the second arm portion to each other and is able to change a direction of the second arm portion relative to the first arm portion, and wherein the second arm portion is adapted to be movable in a telescopic manner in the length direction. 
         [0009]    In the medical robot system according to the first aspect of the invention, the medical manipulator including the first arm portion and the second arm portion is provided. Accordingly, in the case where the second arm portion is longer than an organ, when the second arm portion is shortened, it is possible to prevent such a problem that the front end of the second arm portion comes into contact with the organ to thereby damage the organ. On the other hand, in the case where the second arm portion is shorter than the organ, it is possible to dispose the second arm portion to an appropriate position by lengthening the second arm portion. Therefore, it is possible to reliably support the organ to a predetermined position. In addition, since it is not necessary to prepare another second arm portion (for example, a tip) having a different length, it is possible to prevent an increase in the number of components. Further, since the medical manipulator is provided in the robot arm, it is possible to further stably support the organ. 
         [0010]    According to a second aspect of the invention, in the medical robot system according to the first aspect, the second arm portion is provided with an expandable supporting balloon. 
         [0011]    In the medical robot system according to the second aspect of the invention, it is possible to press the supporting balloon against a support target portion (for example, an inner surface of a uterus) of the organ by expanding the supporting balloon. Accordingly, it is possible to easily support the organ. 
         [0012]    According to a third aspect of the invention, in the medical robot system according to the first or second aspect, the second arm portion is provided with a fixed portion which is connected to the connection portion and extends in one direction, and a movable portion which is movably fitted to the fixed portion, and the medical robot system further includes a movement mechanism which moves the movable portion in the length direction of the fixed portion. 
         [0013]    In the medical robot system according to the third aspect of the invention, since the movable portion is moved in the length direction of the fixed portion by the movement mechanism, it is possible to move the second arm portion in a telescopic manner. 
         [0014]    According to a fourth aspect of the invention, in the medical robot system according to any one of the first to third aspects, the first arm portion is provided with an expandable fixing balloon. 
         [0015]    In the medical robot system according to the fourth aspect of the invention, it is possible to press the fixing balloon against a portion (for example, an inner surface of a vagina) other than the support target portion by expanding the fixing balloon. Accordingly, since the first arm portion is fixed, it is possible to further stably support the organ compared with the case where the fixing balloon is not provided. 
         [0016]    According to a fifth aspect of the invention, in the medical robot system according to any one of first to fourth aspects, the manipulation unit is provided with an input mechanism which is used to operate the medical manipulator, and an input direction of the input mechanism is set to be opposite to a movement direction of the medical manipulator operated by an input operation of the input mechanism. 
         [0017]    In gynecology laparoscopic surgery, in the case where a surgical operation is performed on the organ supported by the medical manipulator with facing position, a surgical operator performs the surgical operation while seeing a video of an endoscopic front view of the organ. For this reason, for example, in the horizontal direction, the movement direction of the organ as moved by the medical manipulator is opposite to the movement direction of the organ displayed on the monitor. 
         [0018]    Therefore, in the medical robot system according to the fifth aspect of the invention, since the medical robot system is set so that the input direction of the input mechanism is opposite to the movement direction of the medical manipulator, the movement direction of the organ displayed on the monitor is equal to the movement direction of the medical manipulator. For example, the surgical operator may manipulate the input mechanism to the right direction when the organ displayed on the monitor needs to be moved to the right direction, and manipulate the input mechanism to the left direction when the organ needs to be moved to the left direction. Accordingly, it is possible to easily and intuitively dispose the organ displayed on the monitor to a predetermined position. 
         [0019]    According to the aspect of the invention, in the case where the second arm portion is longer than the organ, it is possible to prevent such a problem that the front end of the second arm portion comes into contact with the organ to thereby damage the organ by shortening the second arm portion. On the other hand, in the case where the second arm portion is shorter than the organ, it is possible to dispose the second arm portion to an appropriate position by lengthening the second arm portion. Accordingly, it is possible to reliably support the organ to a predetermined position. In addition, since it is not necessary to prepare another second arm portion having a different length, it is possible to suppress an increase in the number of components. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0020]      FIG. 1  is a schematic perspective view of a medical robot system according to a first embodiment. 
           [0021]      FIG. 2  is a partially sectional side view of a uterine manipulator according to the first embodiment. 
           [0022]      FIG. 3  is a plan view of a pulley and an arm. 
           [0023]      FIG. 4  is an exploded perspective view of a connection portion. 
           [0024]      FIG. 5A  is a sectional view illustrating a shortened state of a second arm portion according to the first embodiment, and  FIG. 5B  is a sectional view illustrating a lengthened state of the second arm portion according to the first embodiment. 
           [0025]      FIG. 6  is a schematic perspective view of a console. 
           [0026]      FIG. 7  is a diagram showing a state where a uterus is supported to a predetermined position. 
           [0027]      FIG. 8A  is a sectional view illustrating a shortened state of the second arm portion of the uterine manipulator according to a second embodiment, and  FIG. 8B  is a sectional view illustrating a lengthened state of the second arm portion of the uterine manipulator according to the second embodiment. 
       
    
    
     DETAILED DESCRIPTION 
       [0028]    As a countermeasure for such problems identified in the Background, it is possible to prepare a plurality of tips having different lengths in advance and to select a tip of an appropriate length in accordance with the shape of the organ to be supported. However, the number of components would have to increase and the exchange operation would be troublesome. Also, in a method of adjusting a position of the tip relative to the organ by reciprocating the medical manipulator, a connection portion between the frame and the tip would move together with the tip. As a result, the tip would not be sufficiently and appropriately rotated depending upon the shape of the organ in some cases. 
         [0029]    Hereinafter, a medical robot system according to embodiments of the present invention will be described with reference to  FIGS. 1 to 8A  and  8 B. 
         [0030]    First, a medical robot system according to a first embodiment will be described with reference to  FIGS. 1 to 7 . 
         [0031]    As shown in  FIG. 1 , a medical robot system  10  includes a uterine manipulator which is a medical manipulator for supporting a uterus of a patient  12  to a predetermined position, and is applied to, for example, a laparoscopic myomectomy (total hysterectomy) of patient  12 . 
         [0032]    Medical robot system  10  includes a station  16  which is provided in the vicinity of an operating table  14 , four units of robot arms  18 ,  20 ,  22 , and  24  which are provided in the station  16  and each of which has a predetermined mechanism provided in the front end, and a console  26  which performs general control of the entire system. Robot arms  18 ,  20 ,  22 , and  24  are connected to console  26  through communication channels operated by a wire communication, a wireless communication, a network, or a combination thereof. Console  26  need not be in charge of all the control of the medical robot system  10 . For example, each feedback control of robot arms  18 ,  20 ,  22 , and  24  may be performed on the side of each of robot arms  18 ,  20 ,  22 , and  24 . 
         [0033]    The front ends of robot arms  18  and  20  are provided with treatment manipulators  28  and  30 , the front end of robot arm  22  is provided with an endoscope  32 , and the front end of robot arm  24  is provided with a uterine manipulator  34  as a medical manipulator. Shafts  36  and  38  of treatment manipulators  28  and  30  and endoscope  32  are inserted into a body cavity  40 , and uterine manipulator  34  is inserted into a uterine cavity  42  (referring to  FIG. 7 ). Treatment manipulators  28  and  30  and uterine manipulator  34  are detachably provided for robot arms  18 ,  20 , and  24 , respectively. As described below, if the manipulators are not particularly distinguished, treatment manipulators  28  and  30  and uterine manipulator  34  are simply referred to as manipulators  28 ,  30 , and  34 . 
         [0034]    Each of robot arms  18 ,  20 ,  22 , and  24  includes a multi-link mechanism (for example, an independent six-axis mechanism), and is controlled by console  26  so that manipulators  28 ,  30 , and  34  and endoscope  32  take an arbitrary posture at an arbitrary position within the operation range. Each of the link mechanisms of robot arms  18 ,  20 , and  24  includes a rotation mechanism  44  which rotates each of manipulators  28 ,  30 , and  34 , respectively. 
         [0035]    Each of robot arms  18 ,  20 ,  22 , and  24  includes an elevation mechanism  46  which moves along station  16 . In addition, each of robot arms  18 ,  20 , and  24  includes a slide mechanism  48  which reciprocates each of manipulators  28 ,  30 , and  34  along the axis of the front end. Robot arms  18 ,  20 ,  22 , and  24  may have the same configuration, or may have different configurations in accordance with the types of manipulators  28 ,  30 , and  34  and endoscope  32 . 
         [0036]    Treatment manipulators  28  and  30  are mainly used to perform a direct treatment on patient  12 , and front end working portions  28   a  and  30   a  (referring to  FIG. 7 ) respectively provided in the front ends of shafts  36  and  38  are provided with, for example, grippers, scissors, electric knives, and the like. Uterine manipulator  34  is used to support the uterus (organ) A to a predetermined position where the surgery is easily performed (referring to  FIG. 7 ). 
         [0037]    Next, a configuration of uterine manipulator  34  and a connection portion between uterine manipulator  34  and robot arm  24  will be described. As shown in  FIGS. 2 to 5A  and  5 B, in uterine manipulator  34 , the width direction is set to the X direction, the height direction is set to the Y direction, and the length direction is set to the Z direction. When seen from the base end, the right direction is set to the X 1  direction, and the left direction is set to the X 2  direction. In  FIG. 2 , the up direction is set to the Y 1  direction, the down direction is set to the Y 2  direction, the forward direction is set to the Z 1  direction, and the backward direction is set to the Z 2  direction. 
         [0038]    As shown in  FIG. 2 , uterine manipulator  34  is detachably provided onto a slider  50  of the front end of robot arm  24 . Slider  50  is slidable by slide mechanism  48 . Slider  50  is provided with a pair of motors  52  and  54  for curving and a motor  56  for lengthening/shortening which are provided in parallel in the Z direction. 
         [0039]    Uterine manipulator  34  includes a base portion  58  which is detachably attached to the slider  50 , a first cylindrical arm portion  60  which extends from the base portion  58  in the Z 1  direction, a first balloon portion  62  which is provided around first arm portion  60 , a second arm portion  64  which is located to be closer to the front end than the first arm portion  60 , a second balloon portion  66  which is provided around second arm portion  64 , a connection portion  68  which connects first arm portion  60  to second arm portion  64 , and a lengthening/shortening mechanism  70  for lengthening or shortening second arm portion  64  in the length direction (insertion direction). 
         [0040]    The attachment/detachment operation and the exchange operation of base portion  58  provided onto slider  50  may be performed by a predetermined attachment/detachment mechanism. Base portion  58  is provided with pulleys  72  and  74  which are provided in parallel in the Z direction so as to engage with the pair of motors  52  and  54  for curving. One of motors  52  and  54  for curving, and pulleys  72  and  74 , for example, is provided with a non-circular convex portion (not shown), and the other is provided with a concave portion (not shown) which engages with the convex portion, thereby transmitting the rotation of motors  52  and  54  for curving to pulleys  72  and  74 . 
         [0041]    As shown in  FIGS. 2 and 3 , pulleys  72  and  74  respectively include arms  80  and  82  which are connected to wires  76  and  78  and extend in the X direction. When pulleys  72  and  74  rotate, one of two wires  76  and  78  extending in the horizontal direction is wound, and the other is drew out. Here, since wires  76  and  78  are not wound around pulleys  72  and  74 , neither of pulleys  72  and  74  has a function of a pulley in a strict sense, but they are called pulleys for convenience of description. 
         [0042]    As shown in  FIG. 2 , the inside of base portion  58  is provided with a pair of idlers  84  and  84  which guides wire  78  from arm  82  into first arm portion  60 . Each of the pair of idlers  84  and  84  is disposed at the inclined vertical position (a direction between the Z 1  direction and the Y 1  direction and a direction between the Z 1  direction and Y 2  direction) with respect to the arm  82  of the pulley  74 , and guides wire  78  into first arm portion  60 . 
         [0043]    As shown in  FIG. 2 , first balloon portion  62  includes a first balloon  88  which is an expandable balloon for supporting and a first fluid supply portion  90  which supplies a fluid to first balloon  88 . Second balloon portion  66  includes a second balloon  92  which is an expandable balloon for fixing formed to be smaller than first balloon  88  and a second fluid supply portion  94  which supplies a fluid to second balloon  92 . First balloon  88  is disposed in the vicinity of connection portion  68 , and second balloon  92  is disposed in the vicinity of the front end of second arm portion  64  (referring to  FIG. 7 ). First and second balloons  88  and  92  are made of, for example, a flexible and/or elastic material such as rubber. As a fluid supplied to first and second balloons  88  and  92 , for example, air or sterilized natural saline solution is used. 
         [0044]    As shown in  FIG. 4 , connection portion  68  has a configuration in which a plurality of joint rings  96  are stacked so as to be rotatable relative to each other. In addition, in  FIG. 4 , connection portion  68  is described as comprising three joint rings  96 , but the number of provided joint rings  96  is not limited thereto. For example, the number of joint rings  96  may be approximately four to thirty. 
         [0045]    One surface of each of joint rings  96  is provided with a pair of V-shaped grooves  98  facing each other around the center of joint ring  96 , and the other surface thereof is provided with a pair of semi-circular protrusion portions  100  facing each other around the center of joint ring  96  so as to be located at a position 90° out of phase from grooves  98 . In this case, adjacent joint rings  96  are disposed so as to have the position of grooves  98  90° out of phase from each other. Joint rings  96  are stacked to each other in such a manner that both protrusion portions  100  of one joint ring  96  are respectively inserted into both facing grooves  98  of the other joint ring  96 . 
         [0046]    In addition, in each of joint rings  96 , perforation holes  102  are respectively provided at the positions of both grooves  98  and both protrusion portions  100 . Wires  76  and  78  are respectively inserted through perforation holes  102  corresponding to each of joint rings  96 , and the front ends of wires  76  and  78  are connected to joint ring  96  which is disposed on the front end side (Z 1  side) of connection portion  68 . Accordingly, joint rings  96  are collected so as to be substantially integrated with each other. 
         [0047]    In connection portion  68 , since a gap is formed between adjacent joint rings  96  in the state where protrusion portions  100  are inserted in grooves  98 , the protrusion portions  100  are rotatable in the inside of grooves  98 , and hence the adjacent joint rings  96  are rotatable relative to each other. In this case, a rotation angle between a pair of adjacent joint rings  96  is small, but when plural angles of plural pairs of joint rings  96  are accumulated, a desired curve of the entire curving portion can be obtained, and the direction of second arm portion  64  with respect to first arm portion  60  is changeable. 
         [0048]    Thus, when pulleys  72  and  74  are appropriately rotationally driven under the control of console  26 , each of wires  76  and  78  are reciprocated by a predetermined distance, thereby curving connection portion  68  by a desired angle in the vertical and horizontal directions in the transverse section of first arm portion  60 . That is, connection portion  68  is actively bent or curved by an operation of pulling wires  76  and  78 . In this case, the curving direction or the degree of freedom is not particularly limited. In addition, although it is not shown in the drawings, the outer periphery of each joint ring  96  may be coated by, for example, a coating film made of an elastic or flexible material. 
         [0049]    As shown in  FIGS. 2 ,  4 ,  5 A, and  5 B, lengthening/shortening mechanism  70  includes a first rod portion  104  which is located inside first arm portion  60 , a second rod portion  106  which is located inside second arm portion  64 , a gear mechanism  108  which is provided in the base end of first rod portion  104  and transmits the rotation of lengthening/shortening motor  56  to the first rod portion  104 , a joint portion  110  which is located inside joint ring  96  and connects first rod portion  104  and second rod portion  106  to each other, and a screw portion  114  which is provided in the front end of second rod portion  106  with a stopper portion  112  therebetween. 
         [0050]    As understood from  FIGS. 2 and 4 , first rod portion  104  is formed to be longer than first arm portion  60 , and extends to the inside of base portion  58  so as to be connected to gear mechanism  108 . As understood from  FIGS. 4 ,  5 A, and  5 B, second rod portion  106  is formed to be slightly shorter than second arm portion  64 . 
         [0051]    As shown in  FIG. 2 , gear mechanism  108  located inside base portion  58  includes a first bevel gear  109  which engages with lengthening/shortening motor  56  and a second bevel gear  111  which is connected to first rod portion  104  and engages with first bevel gear  109 . 
         [0052]    As shown in  FIG. 4 , joint portion  110  is configured as a so-called universal joint including a first pin portion  116  which is connected to first rod portion  104 , a second pin portion  118  which is connected to second rod portion  106 , and an intermediate member  120  which connects first pin portion  116  and second pin portion  118  to each other. In addition, in  FIG. 4 , one intermediate member  120  is exemplified for the description. However, the number of provided intermediate members  120  is not limited thereto, but may be plural. 
         [0053]    Intermediate member  120  is connected to first pin portion  116  and second pin portion  118  so as to be movable in two directions (the X and Y directions in  FIG. 4 ) perpendicular to the movement direction of intermediate member  120 . Accordingly, it is possible to bend joint portion  110  in the transverse section of first arm portion  60  in the vertical and horizontal directions by a desired angle. That is, it is possible to change the direction of second rod portion  106  with respect to first rod portion  104 . As a result, in the case where connection portion  68  is bent, it is possible to bend joint portion  110  in accordance with the bending operation of connection portion  68 . 
         [0054]    As shown in  FIGS. 5A and 5B , second arm portion  64  includes a cylindrical stationary portion  122  (referring to  FIG. 2 ) which is connected to connection portion  68  and a hollow movable portion  124  which is fitted to the front end of fixed portion  122  and is slidable in the length direction of fixed portion  122 . 
         [0055]    Screw portion  114  and stopper portion  112  are located inside movable portion  124 . One end (front end) of movable portion  124  is formed as a hemispherical shape, and the other end of movable portion  124  is fixed with a limitation member  126  which allows stopper portion  112  to come into contact therewith. In addition, movable portion  124  is provided with a nut portion  128  which is threaded into screw portion  114  so as to be movable in the length direction of stationary portion  122 . 
         [0056]    Accordingly, when first bevel gear  109  is rotated under the control of console  26 , second bevel gear  111 , first rod portion  104 , joint portion  110 , second rod portion  106 , stopper portion  112 , and screw portion  114  are rotated together, thereby moving nut portion  128  in the length direction of stationary portion  122 . That is, second arm portion  64  is movable in a telescopic manner in the length direction. In addition, the movement of movable portion  124  in a direction in which second arm portion  64  is shortened is limited in such a manner that nut portion  128  comes into contact with stopper portion  112  (referring to  FIG. 5A ), and the movement of movable portion  124  in a direction in which second arm portion  64  is lengthened is limited in such a manner that stopper portion  112  comes into contact with limitation member  126  (referring to  FIG. 5B ). The length of screw portion  114  for determining the movement distance of movable portion  124  may be arbitrarily set in consideration of the depth of a uterus of a typical patient, for example. 
         [0057]    As shown in  FIG. 1 , console  26  is provided with a manipulation unit  130  which is used to manipulate the operations of robot arms  18 ,  20 , and  24 , treatment manipulators  28  and  30 , and uterine manipulator  34 , and with a monitor  131  which is used to display information such as an image captured by endoscope  32  thereon. 
         [0058]    As shown in  FIG. 6 , manipulation unit  130  includes two joysticks  132  and  132  which are provided at left and right positions where the joysticks are easily manipulated by both hands, a trackball  134  which is input means provided to be close to the center, a safety switch  136  which is disposed to be close to trackball  134  while substantially surrounding the half of the circumference thereof, a lengthening/shortening control switch  138  which is disposed to be close to safety switch  136 , and a return switch  140 . Joysticks  132  are configured to manipulate robot arms  18  and  20  and treatment manipulators  28  and  30 . Robot arm  22  and endoscope  32  may be manipulated by another input means (not shown). Trackball  134  is configured to manipulate robot arm  24  and uterine manipulator  34 . 
         [0059]    Lengthening/shortening control switch  138  includes a first switch  142  which rotates lengthening/shortening motor  56  so that movable portion  124  moves in the Z 1  direction (a direction in which second arm portion  64  is lengthened) shown in  FIG. 5B , and a second switch  144  which rotates lengthening/shortening motor  56  so that movable portion  124  moves in the Z 2  direction (a direction in which second arm portion  64  is shortened) shown in  FIG. 5A . 
         [0060]    Trackball  134  and lengthening/shortening control switch  138  are set to be manipulated only while safety switch  136  is being pushed. Accordingly, it is possible to prevent the movement of uterine manipulator  34  even when the operator contacts trackball  134  by mistake. Return switch  140  is a switch which returns uterine manipulator  34  to a predetermined position, for example, a position in uterus A where uterine manipulator  34  is initially inserted. 
         [0061]    When trackball  134  is manipulated in the horizontal direction, the vertical direction, and the rotation direction, second arm portion  64  of uterine manipulator  34  moves in the horizontal direction and the vertical direction in accordance with the manipulation, and entire uterine manipulator  34  rotates. In medical robot system  10 , the manipulation direction of trackball  134  is set to be opposite to the movement direction of uterine manipulator  34 . Specifically, in medical robot system  10 , the manipulation direction of trackball  134  is set to be same as the movement direction of uterine manipulator  34  in the vertical direction (Y direction), and the manipulation direction of trackball  134  is set to be opposite to the movement direction of uterine manipulator  34  in a direction including the component in the horizontal direction (the X direction). 
         [0062]    That is, in medical robot system  10  according to the embodiment, as shown in  FIG. 7 , since the video image from endoscope  32  disposed at a position facing uterus A is displayed on monitor  131 , the movement direction of uterus A displayed on monitor  131  is opposite to the actual movement direction of uterus A supported by the uterine manipulator  34  in the horizontal direction. 
         [0063]    Therefore, as described above, it is possible to allow the horizontal movement direction of uterus A displayed on monitor  131  to be equal to the manipulation direction of trackball  134  by setting the manipulation direction of the trackball  134  to be opposite to the horizontal movement direction of uterine manipulator  34 . Accordingly, the surgical operator may manipulate trackball  134  to the right direction when uterus A displayed on monitor  131  needs to be moved to the right direction, manipulate trackball  134  to the left direction when uterus A needs to be moved to the left direction, manipulate trackball  134  to the inclined right-up direction when uterus A needs to be moved to the inclined right-up direction, and manipulate trackball  134  to the inclined left-down direction when the uterus A needs to be moved to the inclined left-down direction. Accordingly, it is possible to easily and intuitively dispose uterus A displayed on monitor  131  to a desired position. 
         [0064]    Next, an operation of uterine manipulator  34  will be described with reference to  FIG. 7  in the case of a uterine myoma, for example. 
         [0065]    First, first and second balloons  88  and  92  are maintained in a shortened state, and uterine manipulator  34  is inserted into uterine cavity  42  of patient  12  so that connection portion  68  is disposed at a predetermined position. 
         [0066]    At this time, in the case where length L of second arm portion  64  is longer than uterus depth La (L&gt;La), second arm portion  64  is shortened by manipulating second switch  144 . Accordingly, it is possible to prevent such a problem that uterus A is damaged due to a contact of the front end of movable portion  124  with respect to uterus bottom B, and to easily ensure an optimal gap Lb. On the other hand, in the case where second arm portion  64  is shorter than uterus depth La ({La−L}&gt;Lb), second arm portion  64  is lengthened by manipulating first switch  142 . Accordingly, it is possible to dispose second arm portion  64  to an appropriate position inside uterus cavity  42 . That is, in the state where uterine manipulator  34  is inserted to be disposed at an appropriate position, it is possible to form a predetermined gap Lb between the front end of movable portion  124  and uterus bottom B. It is desirable that predetermined gap Lb is set in the range of, for example, 0.5 cm to 1.0 cm. 
         [0067]    When the insertion operation of uterine manipulator  34  is completed, a fluid is supplied from first and second fluid supply portions  90  and  94  to first and second balloons  88  and  92  so as to expand first and second balloons  88  and  92 . Accordingly, since first balloon  88  is pressed against the inner surface of vagina C and second balloon  92  is pressed against the inner surface of uterus A, first balloon  88  is fixed to vagina C, and second balloon  92  is fixed to uterus A. Stationary portion  122  and the portion other than the front end of movable portion  124  may come into contact with the inner surface of uterus A. In this case, since the contact area between second arm portion  64  and the inner surface of uterus A increases, it is possible to improve stability of uterine manipulator  34 . 
         [0068]    Subsequently, uterus A is disposed and supported to a position where a treatment thereof is easily performed in such a manner that second arm portion  64  is moved by manipulating trackball  134 . Accordingly, the uterine myoma is supported within an operation range of endoscope  32  and treatment manipulators  28  and  30 . Then, the uterine myoma is removed in such a manner that treatment manipulators  28  and  30  are moved by manipulating joysticks  132 . 
         [0069]    In medical robot system  10  according to the embodiment, since it is possible to dispose uterine manipulator  34  to an appropriate position inside uterine cavity  42  by lengthening or shortening second arm portion  64  of uterine manipulator  34  in the longitudinal direction (insertion direction), it is not necessary to prepare a plurality of second arm portions (tips)  64  having different lengths. For this reason, it is possible to avoid an increase in the number of components. In addition, since second balloon  92  is provided in second arm portion  64 , it is possible to easily support uterus A through second balloon  92 . 
         [0070]    In addition, since first balloon  88  is fixed to vagina C, it is possible to change the direction of second arm portion  64  by using first balloon  88  serving as a fulcrum. Accordingly, it is possible to more stably support uterus A through uterine manipulator  34  than in the case where first balloon  88  is not provided. In addition, since uterine manipulator  34  according to the embodiment is manipulated while being connected to robot arm  24  under the control of console  26 , in the case of the surgery lasting for a long time, it is possible to stabilize uterine manipulator  34  better than in the case where uterine manipulator  34  is manipulated by human hands. 
         [0071]    Next, a uterine manipulator  234  according to a second embodiment will be described with reference to  FIGS. 8A and 8B . In the second embodiment, the same reference numerals are given to the same constituents as those of the first embodiment, and the description thereof is omitted. In addition,  FIGS. 8A and 8B  correspond to  FIGS. 5A and 5B . 
         [0072]    As shown in  FIGS. 8A and 8B , in the second embodiment, a configuration of a second arm portion  264 , a second balloon portion  266 , and a lengthening/shortening mechanism  270  is different from that of the first embodiment. In detail, second arm portion  264  includes a stationary portion  222  and a movable portion  224  which is fitted around the outside of stationary portion  222  so as to be slidable in the longitudinal direction of stationary portion  222 . Stopper portion  112  and limitation member  126  of the first embodiment are omitted, and there are further provided a first limitation member  225  which is provided in the inner surface of movable portion  224  and a second limitation member  227  which is provided in the outer surface of stationary portion  222 . In addition, a second balloon  292  is provided around movable portion  224 , and a front end member  215  including a first screw portion  214  is provided in the front end of second rod portion  106 . A second screw portion  228  is provided in the inner surface of movable portion  224  so as to engage with first screw portion  214 . The front end of stationary portion  222  is provided with a notch (hole) within which a second fluid supply portion  294  and first limitation member  225  can move as movable portion  224  moves. 
         [0073]    In the embodiment having the above-described configuration, when first bevel gear  109  is rotated under the control of console  26 , second bevel gear  111 , first rod portion  104 , joint portion  110 , second rod portion  106 , and front end member  215  are rotated together, thereby moving movable portion  224  in the longitudinal direction of stationary portion  222 . That is, second arm portion  264  moves in a telescopic manner in the longitudinal direction. In addition, the movement of movable portion  224  in a direction to shorten second arm portion  264  is limited in such a manner that movable portion  224  comes into contact with second limitation member  227  (referring to  FIG. 8A ), and the movement of movable portion  224  in a direction to lengthen second arm portion  264  is limited in such a manner that front end member  215  comes into contact with first limitation member  225  (referring to  FIG. 8B ). The length of second screw portion  228  may be arbitrarily set as in the case of screw portion  114  according to the first embodiment. 
         [0074]    In the second embodiment, since second balloon  292  is provided around movable portion  224 , it is possible to change the relative position of second balloon  292  with respect to first arm portion  60  when movable portion  224  is moved in the longitudinal direction of stationary portion  222 . Accordingly, since it is possible to move second balloon  292  to a position where uterus A is easily supported, it is possible to more stably support uterus A. 
         [0075]    In the above-described embodiments, the position of second arm portion disposed inside the vagina of the uterus may be adjusted after expanding the first balloon on the side of the first arm portion. In this case, since the first balloon is fixed to the vagina, it is not possible to adjust the position of the second arm portion inside the uterine cavity in the case of the uterine manipulator in which the second arm portion cannot be shorten and lengthen in a telescopic manner, for example, the uterine manipulator in which the length of the second arm portion is adjusted by exchanging a plurality of second arm portions having different lengths. However, in the uterine manipulator according to the above-described embodiments, since it is possible to shorten and lengthen the second arm portion in a telescopic manner, it is possible to adjust the position of the second arm portion inside the uterine cavity even after having expanded the first balloon. 
         [0076]    The invention is not limited to the above-described preferred embodiments, but may be modified into various forms within the scope of the spirit of the invention. 
         [0077]    For example, in the medical manipulator according to the invention, at least any one of the first and second balloons may be omitted. In the case where the second balloon is omitted, a subject organ is supported to a predetermined position in the state where the portion other than the front end of the second arm portion comes into contact with the subject organ. In addition, the position of the first balloon relative to the first arm portion and the position of the second balloon relative to the second arm portion may be arbitrarily set. In the medical manipulator according to the invention, the invention is not limited to the example in which only one connection portion is provided, but a plurality of connection portions may be provided. The subject organ where the medical manipulator according to the invention is used is not limited to the uterus. For example, the medical manipulator may be used in other organs such as the stomach or intestine (large intestine). The joint portion of the lengthening/shortening mechanism is not limited to the example in which a universal joint is used, but may be formed in, for example, a bellows shape.