Abstract:
A medical instrument having a proximal control handle and a distal tool that are intercoupled by an elongated instrument shaft that is meant to pass internally of an anatomic body, proximal and distal movable members that respectively intercouple the proximal control handle and the distal tool with the instrument shaft, cable control means disposed between the movable members, an actuation member at the handle for controlling the distal tool through the movable members, and a coupler for selectively engaging or disengaging separable cable segments of the actuation member.

Description:
TECHNICAL FIELD 
       [0001]    The present invention relates in general to medical instruments, and more particularly to manually-operated surgical instruments that are intended for use in minimally invasive surgery or other forms of surgical or medical procedures or techniques. The instrument described herein is primarily for a laparoscopic procedure, however, it is to be understood that the instrument of the present invention can be used for a wide variety of other procedures, including intraluminal procedures. 
       BACKGROUND OF THE INVENTION 
       [0002]    Endoscopic and laparoscopic instruments currently available in the market are extremely difficult to learn to operate and use, mainly due to a lack of dexterity in their use. For instance, when using a typical laparoscopic instrument during surgery, the orientation of the tool of the instrument is solely dictated by the location of the target and the incision. These instruments generally function with a fulcrum effect using the patients own incision area as the fulcrum. As a result, common tasks such as suturing, knotting and fine dissection have become challenging to master. Various laparoscopic instruments have been developed over the years to overcome this deficiency, usually by providing an extra articulation often controlled by a separately disposed control member for added control. However, even so these instruments still do not provide enough dexterity to allow the surgeon to perform common tasks such as suturing, particularly at any arbitrarily selected orientation. Also, existing instruments of this type do not provide an effective way to hold the instrument in a particular position. Moreover, existing instruments require the use of both hands in order to effectively control the instrument. 
         [0003]    An improved instrument is shown in U.S. Pat. No. 7,147,650 having enhanced dexterity and including, inter alia, a rotation feature with proximal and distal bendable members. Even though this instrument has improved features there remains the need for a more economically feasible instrument, and one in which the handle can be re-used while the tip of the instrument is disposable or reposable. 
         [0004]    Accordingly, an object of the present invention is to provide an improved laparoscopic or endoscopic instrument in which a portion of the instrument is re-useable and a portion is disposable. In embodiments described herein the handle end of the instrument is re-useable and the distal portion or tip of the instrument is disposable. By being able to re-use the handle portion, the instrument is more economically feasible. 
         [0005]    A further object of the present invention is to provide an improved laparoscopic or endoscopic surgical instrument that allows the surgeon to manipulate the tool end of the surgical instrument with greater dexterity. 
         [0006]    Another object of the present invention is to provide an improved surgical or medical instrument that has a wide variety of applications, through incisions, through natural body orifices or intraluminally. 
         [0007]    Another object of the present invention is to provide a locking feature that is an important adjunct to the other controls of the instrument enabling the surgeon to lock the instrument once in the desired position. This makes it easier for the surgeon to thereafter perform surgical procedures without having to, at the same time, hold the instrument in a particular bent configuration. 
         [0008]    Still another object of the present invention is to provide an improved medical instrument that can be effectively controlled with a single hand of the user. 
         [0009]    Still another object of the present invention is to provide an improved medical instrument that is characterized by the ability to lock the position of the instrument in a pre-selected position while enabling rotation of the tip of the instrument while locked. 
       SUMMARY OF THE INVENTION 
       [0010]    To accomplish the foregoing and other advantages and features of the present invention there is provided a surgical instrument comprising: an instrument shaft having proximal and distal ends; a tool disposed from the distal end of the instrument shaft; a control handle coupled from the proximal end of the instrument shaft; a distal motion member for coupling the distal end of the instrument shaft to the distal tool; a proximal motion member for coupling the proximal end of the instrument shaft to the handle; actuation means extending between the distal and proximal motion members for coupling motion of the proximal motion member to the distal motion member for controlling the positioning of the tool; and an actuation cable extending from the handle to the tool for controlling the actuation of the tool. The actuation cable is separated into two inter-engagable cable segments that enable the proximal motion member to be disconnected from the control handle. 
         [0011]    In accordance with other aspects of the present invention the surgical instrument may further include a rotation means disposed adjacent the control handle and rotatable relative to the control handle for causing a corresponding rotation of the instrument shaft and tool; at least the proximal motion member may comprise a proximal bendable member, the rotation means may comprise a rotation knob that is adapted to rotate the tool about a distal tool roll axis and the rotation knob may be disposed between the control handle and proximal bendable member; an actuation lever may be supported from the handle at a pivot point on the handle and for controlling the actuation cable; a slider may be provided for capturing the proximal end of said tool actuation cable and an actuation lever supported at the handle for controlling the translation of the slider and, in turn, the operation of the tool; a locking mechanism may be provided for fixing the position of the tool at a selected position and having locked and unlocked states, the locking mechanism including a ball and socket arrangement disposed about the proximal motion member and a cinch member for locking the ball and socket arrangement; the socket member may comprise a split socket and the cinch member closes the split socket to lock the socket on the ball; a horn may be provided that is pivotally supported from the handle and that is operable to engage and disengage the cable segments; and a collet may be supported in the handle for closing about the cable segments. 
         [0012]    In accordance with another embodiment of the invention there is provided a medical instrument having a proximal control handle and a distal tool that are intercoupled by an elongated instrument shaft that is meant to pass internally of an anatomic body, proximal and distal movable members that respectively intercouple the proximal control handle and the distal tool with the instrument shaft, cable control means disposed between the movable members, an actuation member at the handle for controlling the distal tool through the movable members, and a coupler for selectively engaging or disengaging separable cable segments of the actuation member. 
         [0013]    In related aspects of the present invention the coupler may include a collet attached to one of the cable segments and a capture lug on the other of the cable segments, the collet for retaining the capture lug to engage the cable segments; a pivot member may be provided on the handle including at least one link that is operable to control a cam that sets open and closed positions of the collet; the pivot member may be in the form of a horn at the top of the handle to assist in a comfort grip of the handle; and collet may include a quick disconnect mechanism having a base in which the collet is positioned and a spring that biases the base to a closed position of the collet. 
         [0014]    In accordance with still another embodiment of the invention there is provided a method of controlling a medical instrument that has a proximal end including a control handle and a distal end including a distal tool, with the control handle and distal tool being intercoupled by an elongated instrument shaft and the tool actuated from a tool control cable. The method includes providing proximal and distal movable members that respectively intercouple the proximal control handle and the distal tool with the instrument shaft, the proximal and distal movable members being intercoupled so that a motion at the proximal movable member controls the distal movable member, dividing the tool control cable into separate cable segments and interlocking the separate cable segments so that the tool control cable is operable. A further step may include manually controlling, from the proximal end of the instrument, the rotation of the distal tool about its longitudinal distal tool axis. 
         [0015]    In accordance with another embodiment of the invention there is provided an instrument having a proximal control handle and a distal tool that are intercoupled by an elongated instrument shaft, proximal and distal movable members that respectively intercouple the proximal control handle and the distal tool with the instrument shaft, means disposed between the movable members so that a motion at the proximal movable member controls the distal movable member and, in turn, the distal tool, means supported at the handle for controlling the distal tool including a tool control cable that extends between the handle and distal tool, the tool control cable including separate control cable segments that are adapted to have one of an engaged state and a dis-engaged state. 
         [0016]    In accordance with still other aspects of the present invention there is provided a control member at the control handle and manipulable by a user to control, via the proximal and distal movable members, the rotation of the distal tool about its distal tool axis; the proximal motion member can be disconnected from the control handle when the control cable segments are in their dis-engaged state; including a coupler for selectively engaging or disengaging the separable cable segments; wherein the coupler may include a collet attached to one of the cable segments and a capture lug on the other of the cable segments, the collet for retaining the capture lug to engage the cable segments; and wherein the collet may include a quick disconnect mechanism having a base in which the collet is positioned and a spring that biases the base to a closed position of the collet. 
     
    
     
       DESCRIPTION OF THE DRAWINGS 
         [0017]    Numerous other advantages can be realized in accordance with the present invention by referring to the accompanying drawings, in which: 
           [0018]      FIG. 1  is a perspective view of a first embodiment of a surgical instrument constructed in accordance with the present invention with a disposable shaft portion and a reusable handle portion; 
           [0019]      FIG. 2  is a fragmentary exploded perspective view of the instrument and shaft of  FIG. 1 ; 
           [0020]      FIG. 3  is a partial cross-sectional side view of the instrument as taken along line  3 - 3  of  FIG. 1  and with the instrument in an engaged or locked position; 
           [0021]      FIG. 4  is a cross-sectional end view of the instrument taken along line  4 - 4  of  FIG. 3  showing a locked and a first released position of the cinch ring; 
           [0022]      FIGS. 4A and 4B  are further perspective views of respective positions of the release/lock lever; 
           [0023]      FIG. 5  is a cross-sectional view like that shown in  FIG. 3  but with the instrument shaft portion being released from the handle portion and with the handle moved upwardly; 
           [0024]      FIG. 6  is a cross-sectional view like that shown in  FIG. 5  but with the instrument shaft portion being removed from the handle portion; 
           [0025]      FIG. 7  is a fragmentary cross-sectional end view of the instrument taken along line  7 - 7  of  FIG. 6  showing a rotated and a second released position of the cinch ring and the shaft ball being removed; 
           [0026]      FIG. 8  is a cross-sectional view similar to that shown in  FIG. 6  but with the instrument shaft portion being fully removed from the handle portion; 
           [0027]      FIG. 9  is a fragmentary exploded perspective detail view of the instrument on a somewhat enlarged scale; 
           [0028]      FIG. 10  is an exploded perspective view of one embodiment of a coupling means for the end effector actuation cable; 
           [0029]      FIG. 11  is a cross-sectional end view of an actuation means for operating the coupling means of  FIG. 10  taken along line  11 - 11  of  FIG. 8 ; 
           [0030]      FIG. 12  is a cross-sectional end view of a means to lock the instrument shaft portion to the handle portion taken along line  12 - 12  of  FIG. 8 ; 
           [0031]      FIG. 13  is a cross-sectional plan view of the instrument shaft locking means and the cable coupling means engaged as taken along line  13 - 13  of  FIG. 3  but showing the end effector cable being pulled as in use; 
           [0032]      FIG. 14  is a cross-sectional plan view of the instrument shaft locking means and the cable coupling means in a released position as seen along line  14 - 14  of  FIG. 8 ; 
           [0033]      FIG. 15  is a fragmentary exploded perspective view of a second embodiment of a means to attach the instrument shaft to the handle portion; 
           [0034]      FIG. 16  is an exploded cross-sectional side view of the attachment means of  FIG. 15 ; 
           [0035]      FIG. 17  is a cross-sectional side view of the embodiment illustrated in  FIGS. 15 and 16  and showing the instrument shaft attached to the handle portion; 
           [0036]      FIG. 18  is a fragmentary exploded perspective view of a third embodiment of a means for attaching the instrument shaft to the handle portion; 
           [0037]      FIG. 19  is an exploded cross-sectional side view of the attachment means of  FIG. 18 ; 
           [0038]      FIG. 20  is a cross-sectional side view of the embodiment illustrated in  FIGS. 18 and 19  and showing the instrument shaft attached to the handle portion; 
           [0039]      FIG. 21  is a fragmentary cross-sectional view of a means to detach the cinch ring as taken along line  21 - 21  of  FIG. 18 ; 
           [0040]      FIG. 22  is a cross-sectional view similar to that illustrated in  FIG. 21  and showing the cinch ring partially detached; 
           [0041]      FIG. 23  is a fragmentary exploded perspective view of a fourth embodiment of a means to attach the instrument shaft to the handle portion; 
           [0042]      FIG. 24  is a fragmentary exploded side view of an indexing means to match the proper instrument shaft and end effector with the correct handle configuration; 
           [0043]      FIG. 25  is an end view of the proximal end of the instrument shaft as taken along line  25 - 25  of  FIG. 24 ; 
           [0044]      FIG. 26  is an end view of the distal end of the rotation knob and shaft receiver as taken along line  26 - 26 ; 
           [0045]      FIG. 27  is a schematic end view of a first alternate embodiment of an indexing means; 
           [0046]      FIG. 28  is a schematic end view of a second alternate embodiment of an indexing means; 
           [0047]      FIG. 29  is a fragmentary cross-sectional side view of an alternate embodiment of a cable coupling means; 
           [0048]      FIG. 30  is a cross-sectional view similar to that illustrated in  FIG. 29  but showing the end effector cable being pulled as in use; 
           [0049]      FIG. 31  is an exploded perspective view of the cable coupling means of  FIG. 29 ; 
           [0050]      FIG. 32  is a cross-sectional view similar to that illustrated in  FIG. 19  but showing the cable coupling means being released; 
           [0051]      FIG. 33  is an exploded cross-sectional view of the embodiment of  FIG. 32  and showing the instrument shaft portion removed from the handle portion; 
           [0052]      FIG. 34  is a cross-sectional side view of a further alternate embodiment of a cable coupling means; 
           [0053]      FIG. 35  is a cross-sectional view similar to that illustrated in  FIG. 34  but showing the end effector cable being pulled as in use; 
           [0054]      FIG. 36  is an exploded perspective view of the cable coupling means of  FIG. 34 ; 
           [0055]      FIG. 37  is a cross-sectional view similar to that illustrated in  FIG. 34  but showing the cable coupling means being released; and 
           [0056]      FIG. 38  is an exploded perspective view of the embodiment of  FIG. 37  and showing the instrument shaft portion removed from the handle portion. 
       
    
    
     DETAILED DESCRIPTION 
       [0057]    The present invention is illustrated in the drawings as a surgical instrument that has two portions such that a detachable instrument shaft portion may be disposable and a re-usable handle portion may be sterilized and reused numerous times. This allows for a higher quality instrument handle portion while keeping the overall price of the instrument reasonable. 
         [0058]    The instrument of the present invention may be used to perform minimally invasive procedures. “Minimally invasive procedure,” refers herein to a surgical procedure in which a surgeon operates through a small cut or incision, the small incision being used to access the operative site. In one embodiment, the incision length ranges from 1 mm to 20 mm in diameter, preferably from 5 mm to 10 mm in diameter. This procedure contrasts those procedures requiring a large cut to access the operative site. Thus, the flexible instrument is preferably used for insertion through such small incisions and/or through a natural body lumen or cavity, so as to locate the instrument at an internal target site for a particular surgical or medical procedure. The introduction of the surgical instrument into the anatomy may also be by percutaneous or surgical access to a lumen, vessel or cavity, or by introduction through a natural orifice in the anatomy. 
         [0059]    In addition to use in a laparoscopic procedure, the instrument of the present invention may be used in a variety of other medical or surgical procedures including, but not limited to, colonoscopic, upper GI, arthroscopic, sinus, thorasic, prostate, transvaginal, orthopedic and cardiac procedures. Depending upon the particular procedure, the instrument shaft may be rigid, semi-rigid or flexible. 
         [0060]    Although reference is made herein to a “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. 
         [0061]    There are a number of unique features embodied in the instrument that is described herein. For example, there is provided a locking mechanism that is constructed using a ball and socket arrangement disposed about the proximal motion member that follows the bending action and in which an annular cinch ring is used to retain the ball and socket arrangement in a fixed particular position, and thus also maintain the proximal and distal bendable members in a particular bent condition, or in other words locked in that position. The cinch ring includes a locking lever that is conveniently located adjacent to the instrument handle and that is easily manipulated to lock and unlock the cinch ring and, in turn, the position of the end effector. The cinch ring is also preferably rotatable to that the locking lever can be positioned conveniently or can be switched (rotated) between left and right handed users. This lock control allows the surgeon one less degree of freedom to concentrate on when performing certain tasks. By locking the bendable sections at a particular position, this enables the surgeon to be more hands-free for controlling other degrees of freedom of the instrument such as manipulation of the rotation knob to, in turn, control the orientation of the end effector. 
         [0062]    A main feature of the present invention relates to the ability of the instrument to be partially disposable and partially re-useable. In that way the instrument cost can be substantially reduced as it is not necessary to replace the entire instrument for each procedure. In one embodiment a disconnect means is provided at the handle where the distal motion member, tool, instrument shaft and proximal motion member are separable from the handle of the instrument. This enables the distal components to be engageable and dis-engageable from the handle. The handle portion of the instrument is re-useable and thus the cost of that part of the instrument is essentially spread over several instrument uses. 
         [0063]      FIG. 1  is a perspective view of one embodiment of the surgical instrument  10  of the present invention. In this surgical instrument both the tool and handle motion members or bendable members are capable of bending in any direction. They are interconnected via cables (preferably four cables) in such a way that a bending action at the proximal member provides a related bending at the distal member. The proximal bending is controlled by a motion or deflection of the control handle by a user of the instrument. In other words the surgeon grasps the handle and once the instrument is in position any motion (deflection) at the handle immediately controls the proximal bendable member which, in turn, via cabling controls a corresponding bending or deflection at the distal bendable member. This action, in turn, controls the positioning of the distal tool. 
         [0064]    The proximal bendable member is preferably generally larger than the distal bendable member so as to provide enhanced ergonomic control. In the illustrated embodiment the ratio of proximal to distal bendable member diameters may be on the order of three to one. In one version in accordance with the invention there may be provided a bending action in which the distal bendable member bends in the same direction as the proximal bendable member. In an alternate embodiment the bendable, turnable or flexible members may be arranged to bend in opposite directions by rotating the actuation cables through 180 degrees, or could be controlled to bend in virtually any other direction depending upon the relationship between the distal and proximal support points for the cables. 
         [0065]    As has been noted, the amount of bending motion produced at the distal bending member is determined by the dimension of the proximal bendable member in comparison to that of the distal bendable member. In the embodiment described the proximal bendable member is generally larger than the distal bendable member, and as a result, the magnitude of the motion produced at the distal bendable member is greater than the magnitude of the motion at the proximal bendable member. The proximal bendable member can be bent in any direction (about 360 degrees) controlling the distal bendable member to bend in either the same or an opposite direction, but in the same plane at the same time. Also, as depicted in  FIG. 1 , the surgeon is able to bend and roll the instrument&#39;s tool about its longitudinal axis to any orientation simply by rolling the axial rotation knob  24  about a rotation direction indicated in  FIG. 1  by the rotation arrow R 1 . 
         [0066]    In this description reference is made to bendable members. These members may also be referred to as turnable members, bendable sections or flexible members. In the descriptions set out herein, terms such as “bendable section,” “bendable segment,” “bendable member,” or “turnable member” refer to an element of the instrument that is controllably bendable in comparison to an element that is pivoted at a joint. The term “movable member” is considered as generic to bendable sections and joints. The bendable elements of the present invention enable the fabrication of an instrument that can bend in any direction without any singularity and that is further characterized by a ready capability to bend in any direction, all preferably with a single unitary or uni-body structure. A definition of a “unitary” or “uni-body” structure is—a structure that is constructed only of a single integral member and not one that is formed of multiple assembled or mated components—. 
         [0067]    A definition of these bendable members is—an instrument element, formed either as a controlling means or a controlled means, and that is capable of being constrained by tension or compression forces to deviate from a straight line to a curved configuration without any sharp breaks or angularity—. Bendable members may be in the form of unitary structures, such as of the type shown herein in  FIG. 3  for the proximal bendable member, may be constructed of engageable discs, or the like, may include bellows arrangements or may comprise a movable ring assembly. For several forms of bendable members refer to co-pending application Ser. No. 11/185,911 filed on Jul. 20, 2005; Ser. No. 11/505,003 filed on Aug. 16, 2006 and 11/523,103 filed on Sep. 19, 2006, all of which are hereby incorporated by reference herein in their entirety. 
         [0068]      FIG. 1  shows a preferred embodiment of the instrument of the present invention. Further details are illustrated in  FIGS. 2 through 14 .  FIG. 1  depicts the surgical instrument  10  in a perspective view, as may occur during a surgical procedure. For example, the instrument may be used for laparoscopic surgery through the abdominal wall. For this purpose there is provided an insertion site at which there is disposed a cannula or trocar. The shaft  14  of the instrument  10  is adapted to pass through the cannula or trocar so as to dispose the distal end of the instrument at the operative site. The end effector  16  is depicted in  FIG. 1 . The embodiment of the instrument shown in  FIG. 1  is typically used with a sheath  98  covering the distal member  20  to keep bodily fluids from entering the distal bending member  20 . The shaft  14  includes an outer shaft tube  32  and an inner shaft tube  34  as in previous applications incorporated herein. 
         [0069]      FIG. 2  shows a separate sheath  46  that is temporarily used to cover the entire distal bendable member and end effector. This sheath  46  is only used for shipping the instrument and may be discarded once the instrument is in place on the handle. The sheath  46  keeps the jaws in an open position, as illustrated in  FIG. 2 , and also keeps the distal bendable member in a substantially straight position. By doing that the actuation cable is maintained in a particular aligned position and ready for engagement with the handle portion of the instrument. Instead of using a pre-formed sheath one may alternatively use a biasing means in the instrument to maintain a predetermined position of the instrument cable, usually one in which the jaws are maintained open. 
         [0070]    A rolling motion can be carried out with the instrument of the present invention. This can occur by virtue of the rotation of the rotation knob  24  relative to the handle  12  about a longitudinal shaft axis. This is represented in  FIG. 1  by the rotation arrow R 1 . When the rotation knob  24  is rotated, in either direction, this causes a corresponding rotation of the instrument shaft  14 . This is depicted in  FIG. 1  by the rotational arrow R 2 . This same motion also causes a rotation of the distal bendable member and end effector  16  about an axis that corresponds to the instrument tip, depicted in  FIG. 1  as about the longitudinal tip or tool axis P. In  FIG. 1  refer to the rotational arrow R 3  at the tip of the instrument. 
         [0071]    Any rotation of the rotation knob  24  while the instrument is locked (or unlocked) maintains the instrument tip at the same angular position, but rotates the orientation of the tip (tool). For a further explanation of the tip rotational feature refer to co-pending application Ser. No. 11/302,654, filed on Dec. 14, 2005, particularly  FIGS. 25-28 , which is hereby incorporated by reference in its entirety. 
         [0072]    The handle  12 , via proximal bendable member  18 , may be tilted at an angle to the instrument shaft longitudinal center axis. This tilting, deflecting or bending may be considered as in the plane of the paper. By means of the cabling this action causes a corresponding bend at the distal bendable member  20  to a position wherein the tip is directed along an axis and at a corresponding angle to the instrument shaft longitudinal center axis. The bending at the proximal bendable member  18  is controlled by the surgeon from the handle  12  by manipulating the handle in essentially any direction including in and out of the plane of the paper in  FIG. 1 . This manipulation directly controls the bending at the proximal bendable member. For further descriptions relating to the bending refer to co-pending application Ser. Nos. 11/528,134 filed on Sep. 27, 2006 and 11/649,352 filed on Jan. 2, 2007, both of which are hereby incorporated by reference in their entirety. 
         [0073]    Thus, the control at the handle is used to bend the instrument at the proximal motion member to, in turn, control the positioning of the distal motion member and tool. The “position” of the tool is determined primarily by this bending or motion action and may be considered as the coordinate location at the distal end of the distal motion member. Actually, one may consider a coordinate axis at both the proximal and distal motion members as well as at the instrument tip. This positioning is in three dimensions. Of course, the instrument positioning is also controlled to a certain degree by the ability of the surgeon to pivot the instrument at the incision point or at the cannula or trocar. The “orientation” of the tool, on the other hand, relates to the rotational positioning of the tool, from the proximal rotation control member, about the illustrated distal tip or tool axis P. 
         [0074]    In the drawings a set of jaws is depicted, however, other tools or devices may be readily adapted for use with the instrument of the present invention. These include, but are not limited to, cameras, detectors, optics, scope, fluid delivery devices, syringes, etc. The tool may include a variety of articulated tools such as: jaws, scissors, graspers, needle holders, micro dissectors, staple appliers, tackers, suction irrigation tools and clip appliers. In addition, the tool may include a non-articulated tool such as: a cutting blade, probe, irrigator, catheter or suction orifice. 
         [0075]    The surgical instrument of  FIG. 1  shows a preferred embodiment of a surgical instrument  10  according to the invention in use and may be inserted through a cannula at an insertion site through a patient&#39;s skin. Many of the components shown herein, such as the instrument shaft  14 , end effector  16 , distal bending member  20 , and proximal bending member  18  may be similar to and interact in the same manner as the instrument components described in the co-pending U.S. application Ser. No. 11/185,911 filed on Jul. 20, 2005 and hereby incorporated by reference herein in its entirety. For example, the proximal bendable member  18  is a unitary slotted structure as shown in  FIG. 6  including discs  130 , nibs  131  and slots  132 . Many other components shown herein, particularly at the handle end of the instrument may be similar to components described in the co-pending U.S. application Ser. No. 11/528,134 filed on Sep. 27, 2006 and hereby incorporated by reference herein in its entirety. Also incorporated by reference in their entirety are U.S. application Ser. No. 10/822,081 filed on Apr. 12, 2004; U.S. application Ser. No. 11/242,642 filed on Oct. 3, 2005 and U.S. application Ser. No. 11/302,654 filed on Dec. 14, 2005, all commonly owned by the present assignee. 
         [0076]    As illustrated in, for example,  FIGS. 1-3 , the control between the proximal bendable member  18  and distal bendable member  20  is provided by means of the bend control cables  100 . In the illustrated embodiment four such control cables  100  may be provided in order to provide the desired all direction bending. However, in other embodiments of the present invention fewer or less numbers of bend control cables may be used. The bend control cables  100  extend through the instrument shaft  14  and through the proximal and distal bendable members. The bend control cables  100  may be constrained along substantially their entire length so as to facilitate both “pushing” and “pulling” action as discussed in further detail in the aforementioned co-pending application Ser. No. 11/649,352 filed on Jan. 2, 2007. The cables  100  may also be constrained as they pass over the conical cable guide portion of the proximal bendable member, and through the proximal bendable member itself. 
         [0077]    The locking means interacts with the ball and socket arrangement to lock and unlock the positioning of the cables which in turn control the angle of the proximal bending member and thus the angle of the distal bendable member and end effector. This lock control allows the surgeon one less degree of freedom to concentrate on when performing certain tasks. By locking the bendable sections at a particular position, this enables the surgeon to be more hands-free for controlling other degrees of freedom of the instrument such as manipulation of the rotation knob  24  and, in turn, orientation of the end effector. 
         [0078]    The instrument shown in  FIG. 1  is considered as of a pistol grip type. However, the principles of the present invention may also apply to other forms of handles such as a straight in-line handle. In  FIG. 1  there is shown a jaw clamping or actuation means  30  that is comprised mainly of the lever  22  which may have a single finger hole in the gimbaled ball  27 . The ball  27  is mounted at the free end of the lever  22 . The surgeon uses the ball  27  for controlling the lever  22 . There may also be provided a related release function controlled either directly by the lever  22  or a separate release button. The release function is used to release the actuated or closed tool or end effector. 
         [0079]    In the instrument that is illustrated the handle end of the instrument may be tipped or deflected in any direction as the proximal bendable member is constructed and arranged to preferably enable full 360 degree bending. This movement of the handle relative to the instrument shaft bends the instrument at the proximal bendable member  18 . This action, in turn, via the bend control cables  100 , bends the distal bendable member in the same direction. As mentioned before, opposite direction bending can be used by rotating or twisting the control cables through 180 degrees from one end to the other end thereof. 
         [0080]    In the main embodiment described herein, the handle  12  is in the form of a pistol grip and includes a horn  13  to facilitate a comfortable interface between the action of the surgeon&#39;s hand and the instrument. In this embodiment the horn has the other function of providing the actuation pivot for locking and unlocking the tool control cable, as described in more detail later. The tool actuation lever  22  is shown in  FIG. 1  pivotally attached at the base of the handle. The lever  22  actuates a slider  28  (see  FIG. 3 ) that controls the tool actuation cable  38  that extends from the slider to the distal end of the instrument. The cable  38  controls the opening and closing of the jaws, and different positions of the lever control the force applied at the jaws. The cable is depicted, for example, in  FIG. 8  as including proximal cable portion  38 A and distal cable portion  38 B. 
         [0081]    The instrument  10  has a handle portion  12  and a detachable shaft portion  14 , as shown in  FIG. 1 . The main components of the instrument may be like that shown in Ser. No. 11/649,352 filed on Jan. 2, 2007, particularly as to the construction of the bendable members, instrument shaft and end effector. This includes means for enabling rotation of the shaft and proximal bendable member within bearings or bearing surfaces  208  and  210  ( FIG. 3 ). The bearing  208  interfaces between the adaptor  26  and the ball  120 , while the bearing surface  210  is between the neck portion  206  and the instrument shaft. The separate portions  12  and  14 , or alternatively the assembled instrument, may be sealed in a sterile package or packages prior to storage or shipping. 
         [0082]    As shown in  FIG. 2 , the shaft portion  14  can be easily separated from the handle portion  12  by releasing the cinch ring  200 . The shaft portion includes a shaft connector  212 . The cable portion  38 B is provided with an end connector lug  40 . The shaft connector  212  and cable connector lug  40  are disengaged by raising the horn  13  about a pivot  272  thus enabling the shaft portion  14  and handle portion  12  to be disengaged from each other. A new shaft portion can then be easily attached to the sterilized handle by insertion and locking into the handle as described in further detail below.  FIG. 1  shows the shaft and handle portions engaged which happens when the horn  13  is pivoted to the locked or down position. See also the locked position in  FIG. 3 . 
         [0083]      FIG. 3  shows a somewhat schematic cross-sectional view of the connections between the shaft  14  and handle portion  12 . The split hub  202  is constructed and arranged to allow the ball  120  to be pulled out of the split hub  202 . The cinch ring  200  is used to lock and unlock the split hub  202 , as described in more detail later. For other details of the split hub  202  refer also to  FIGS. 2 and 9 . The proximal bending member  18  is mounted to the shaft connector  212  that is indexed with the handle portion, and particularly with the rotation knob  24 . In  FIG. 3 , the shaft connector  212  is shown connected to the rotation knob  24  by means of a shaft receiver portion  300  (see  FIG. 8 ) of the rotation knob  24 . The shaft connector  212  is locked into the handle portion  12  by means of the shaft locking assembly or means  260 . The shaft connector is locked linearly but the assembly  260  allows rotation of the shaft portion relative to the handle portion. In  FIG. 3  the jaw actuation distal cable portion  38 B (see also  FIG. 8 ) is shown terminated at the coupling lug  40 . It is the coupling lug  40  that is captured by the cable coupling member or means  320  so as to in essence connect together both portions  38 A and  38 B of the tool actuation cable  38 . 
         [0084]    The split hub portions or petals  202 A- 202 D each have a tapered face  378  (see  FIGS. 3 and 4 ) so as to function as a ramp to force the petals apart when the ball  120  is pushed proximally against them during an insertion of the shaft portion into the handle portion. These inward faces or edges of the portions  202 A- 202 D are beveled or tapered to allow easier passage of the ball. The split hub  202  is supported from the handle by means of struts  230  which are thinned as shown at  382  as illustrated in  FIGS. 6 and 9  so as to function as flexible living hinges to thus allow more ready expansion of the hub petals. This structure assists in the engagement and disengagement between the shaft and handle. 
         [0085]    The cinch ring  200  has two flanges  201 A and  201 B, shown in  FIG. 5  that ride in respective circumferential grooves  203 A and  203 B. The grooves  203 A and  203 B are disposed on the outer surface of the split hub  202 . This interface captures the cinch ring while allowing the split hub to be separated linearly as is discussed in more detail hereinafter. The cinch ring  200  is basically controlled from the angle locking member or means  140 , as shown in  FIGS. 2 and 9 . The angle locking member  140  is pivotally attached with the cinch ring  200 . The angle locking member  140  is constructed and arranged to allow the cinch ring  200  to, not only be loosened enough to adjust the angle of the shaft relative to the handle, but to also expand to a size that is sufficient to allow enough expansion of the split hub portions to thus allow the ball  120  to be removed or inserted in the split hub  202 , as illustrated in  FIGS. 6 and 7 . This enables the shaft portion to be dis-engaged from the handle portion. 
         [0086]    The cinch ring flanges  201 A and  201 B and grooves  203 A and  203 B are dimensioned so that when the cinch ring  200  is loosened enough for the ball  120  to be removed from the split hub, the cinch ring  200  cannot be removed from the split hub without detaching the ends  200 A and  200 B of the cinch ring  200 , as illustrated in the position of  FIG. 23 . The flanges  201  are approximately the same depth and the grooves are slightly deeper so as to not impede the pressure applied at surface  384  of the cinch ring on surface  386  of the split hub portions when the cinch ring is tightened, as in the position that is illustrated in  FIG. 3 . 
         [0087]    In the preferred embodiment of the instrument of the present invention there are actually considered to be three separate operational positions of the cinch ring  200 . Also, a fully disassembled position of the cinch ring  200  is illustrated in  FIG. 23 .  FIG. 4  shows the cinch ring in a locked first position in solid line. The phantom position shown in  FIG. 4  and the position shown in solid line in  FIG. 4A  depict a second position in which the cinch ring has been sufficiently released so that the shaft angle can be changed or, alternatively, the cinch ring can be rotated for left or right hand use. From the position of  FIG. 4A  the link  390  can be rotated clockwise as seen in  FIG. 4B  to a third position which further relaxes the cinch ring enough for the disposable shaft portion to be removed from the handle portion with the cinch ring still loosely attached to the split hub, as in  FIG. 15 , or to the ball portion of the shaft, as in  FIG. 18 . The fourth position is shown in  FIG. 23  where the cinch ring ends have been disconnected so It can be fully removed by itself from either the throw away shaft portion or from the handle portion. 
         [0088]    The connector  212  has an indexing feature that can be used to index the cables  100  to the rotation knob  24  and/or match shafts with different tools or end effectors to certain handles. As illustrated in FIGS.  8  and  24 - 26 , the shaft receiver portion  300  of rotation knob  24  is provided with ribs  302  (see also  FIG. 9 ) that mate with slots  306  on the outside surface of the connector  212 . There is also preferably provided a tapered end  304  on each of the ribs  302  and a taper  216  on connector  212  to help align these members during assembly. Different rib patterns can be used as well as different thicknesses such as ribs  302 A and slots  306 A shown in  FIG. 26 .  FIG. 27  schematically shows a pattern of three ribs  302 B spaced 120 degrees apart in the receiver  300  mating with three equally spaced grooves  306 B on the outside of the connector  212 , shown in phantom outline. One set of ribs and grooves may be wider than the others as a further indexing feature.  FIG. 28  depicts an arrangement of eight ribs  302 C mating with eight slots  306 C. When the connector is fully inserted in the receiver as shown in  FIG. 3 , the shoulder  308  on the connector  212  contacts seat  310  in the receiver and the cable crimps  102  sit in recess  312 . 
         [0089]    The rotation knob  24  is keyed to the proximal bending member  18  and when the rotation knob is rotated through rotation angle R 1 , the shaft portion  14  and proximal bending member rotate on bearings or bearing surfaces  208 ,  210 . There is also a rotation on bearing surfaces between the clearance hole  316  against post  214 . To retain the rotation knob and receiver portion in the correct position when the connector is absent there is provided a rim  234  on the proximal end of the rotation knob that fits loosely in the radial groove  236  in the handle halves, as shown in  FIGS. 3 and 8 . 
         [0090]    The shaft connector  212  is locked in place by actuation of shaft locking member or means  260  which include a gate  262  with a semi-circular rim  264  that loosely engages the groove  218  in the post  214  when the gate is in a down position. The gate  262  rides in slides  266  on wall  318 . A link  268  pivotally connects the gate  262  to a lug  270  on the horn  13 . When the horn is raised as shown in  FIGS. 8 and 12 , the rim  264  is clear of the groove  218  and the shaft connector is free to slide distally out of the receiver. The horn is hinged to the handle at pin  272  and has two positions as seen in respective  FIGS. 3 and 5 . There is a bump  274  on the horn that snaps into dimples  276  in the handle to hold the handle in either position. The horn structure includes a shroud  278  that closely fits the opening  280  in the handle to keep out contaminants. Other locking means may be used and may not be necessary if the split hub and cinch ring sufficiently contain the ball  120  within the split hub  202  when the lever  220  is in a relaxed position. 
         [0091]      FIGS. 15-17  show an alternate means of attachment between the cinch ring, hub and shaft portion. In this embodiment the split hub may be separated from the shaft portion by means of a detachable front portion or ring  420  that is removed along with the shaft portion  14  and ball  120 , as illustrated in  FIG. 15-17 . The ring  420  is shown as including a plurality of fingers  422  on the ring that each align with recesses  424  in the split hub. This arrangement provide alignment of the ring  420  with the split hub portions and the cinch ring flanges  201 A and  201 B with their respective grooves  203 A and  203 B. This construction also leaves a clearance space for the ends of the split hub portions  202 A- 202 D enabling them to flex without binding against the proximal surface of the ring  420 , as illustrated in  FIG. 17 . The fingers  422  are preferably attached to the ring  420  by living hinges  426  to allow them to flex with the split hub portions when the cinch ring  200  is tightened and the inside surface  384  of the ring exerts pressure on surfaces  386 . The flanges  201  and grooves  203  are dimensioned so that the ring  420  can be removed from the split hub and cinch ring, but the cinch ring can&#39;t be removed from the split hub unless the ends  200 A and  200 B are disconnected (refer to  FIGS. 21-23  for an illustration of the disconnection of the cinch ring itself). 
         [0092]    Reference is now made to  FIGS. 18-20  for still another embodiment for the connection and disconnection between the handle and shaft portions. The cinch ring  200  has different depth flanges  201 A and  201 B. The groove arrangement includes a groove  203 A in the ring  420  and a groove  203 B at the split hub. In this embodiment the flange  201 A has a greater depth than the flange  201 B so that the flange  201 B may clear the groove  203 B and allows the ring  420  to be removed along with the cinch ring  200  while retaining the cinch ring  200  on the ring  420 , as illustrated in  FIGS. 18 and 19 . As shown in  FIG. 23 , the cinch ring  200  can be totally detached from both the ring  420  and the split hub by detaching ends  200 A and  200 B. 
         [0093]    The angle locking member  140  is comprised primarily of the release/lock lever  220  which controls the length or outer circumference of the cinch ring  200 . For a further explanation of the function of the lever  220  refer to the two cross-sectional views of  FIGS. 4 and 7 , as well as the two perspective views of  FIGS. 4A and 4B .  FIG. 4  depicts the instrument in the position where the shaft portion is fully engaged with the handle portion and the cinch ring is locked.  FIG. 7  on the other hand depicts the instrument with the cinch ring at least partially released. In the later position an end  200 B of the cinch ring  200  can be further released, as illustrated in  FIG. 23 . 
         [0094]    As illustrated in  FIG. 4 , the lever  220  is pivoted at pin  222  which is connected to end  200 A of the cinch ring. The end  200 A is in the shape of a hook (see  FIGS. 4A and 4B ) and sits in a slot  226  in the lever. Pushing one end or the other of the lever  220  pivots the end  200 B of the cinch ring  200  over the center line of the pivot pin  222  either tightening the cinch ring as shown in solid line in  FIG. 4  or relaxing it as shown in phantom line in  FIG. 4 . In the solid line position of lever  220 , the angle of the end effector is locked in place. When the lever  220  is pivoted in the direction of arrow  410  in  FIG. 4  (see also  FIG. 4A ) the cinch ring  200  is relaxed as shown in the phantom line position in  FIG. 4 . In this relaxed or released position the angle of the end effector is free to be changed by rotation of the ball  120  in the split hub  202 . Also, in the released position the cinch ring  200  may be rotated in its grooves to allow a rotational adjustment of the position of the lever  220  for ease of use. Such an alternate rotational position is shown in the cross-sectional view of  FIG. 7  wherein the cinch ring has been rotated clockwise from the position of  FIG. 4 .  FIG. 7  also shows the lever  220  in its relaxed position. 
         [0095]    The lever  220  supports a link  390  which sits in slot  226  and pivots about pin  392  at one end. The other end of the link  390  carries opposite posts  394  that pass through holes in the end  200 B of the cinch ring  200 . These posts are capped off by means of knobs  400 . Knobs  400  retain the end  200 B of the cinch ring  200  in a rotational relationship to the link  390  but end  200 B can easily be released when the cinch ring is to be removed (see  FIG. 22 ). The post and hole arrangement also provides a grip to rotate link  390  between stations  406  and  408 . As shown in  FIGS. 4B and 7 , the link  390  has been rotated in the direction of arrow  412  from station  406  to station  408  which in effect loosens the cinch ring enough for the split hub to be expanded enough to remove the shaft and ball. From that position, the end  200 B of the cinch ring can be removed by indexing the knobs  400  by means of indicators  401  ( FIG. 23 ) in the direction of arrow  414 ( FIG. 22 ) so that lugs  396  on the respective posts  394  line up with keyways  402  at the end  200 B. Once aligned, the knobs  400  can be pulled outward in the direction of arrow  416  in  FIG. 22  and end  200 B can be detached as the recesses  398  in the knobs clear the posts  394 . Rims  404  on the knobs prevent the knobs from detaching from the end  200 B. The cinch ring  200  is then free to be completely removed from the split hub  202  and/or ring  420  as shown in  FIG. 23 . 
         [0096]    In previous instrument constructions, the proximal bending member  18  has been mounted directly to the rotation knob  24  but now a connector  212  and receiver  300  allow the bending member  18  to be removed from rotation knob  24 . The exploded cross-sectional view of  FIG. 8  depicts the separation of the shaft portion  14  along with the proximal bendable member  18 , ball  120  and connector  212  from the handle portion  12 . The connector  212  is attached to the proximal end of the bendable member  18  and the cables  100  are illustrated as passing through the proximal bendable member  18  and connector  212 . The cables terminate at the resilient pads  104  (or springs) and are crimped at  102 . Thus, the proximal ends of the bend control cables are terminated at the connector  212 . The connector  212  has a post  214  that passes through a clearance hole  314  in the rotation knob and a clearance hole  316  in the radial wall  318  of the handle. The post  214  has a taper  216  at its&#39; proximal end to aid in assembly. The post  214  also has a circumferential groove  218  that is engaged by the shaft locking member or means  260 . As depicted in  FIG. 8 , the proximal bendable member  18  and connector post  214  also carry the jaw actuation cable portion  38 B in a central bore thereof.  FIG. 8  also shows the cable end lug  40  that is attached to the very end of the cable portion  38 B and extends outwardly from the post  214 . 
         [0097]    As indicated previously, the horn  13  is shown in its locked position in  FIGS. 1 and 3  and is shown in its released position in  FIGS. 2 and 5 . As mentioned previously the pivoting of the horn causes the locking in of the shaft portion of the instrument relative to the handle portion thereof. Also, the pivoting of the horn is also used to control the inter-engagement between the cable portions by capturing the cable lug  40 . This is accomplished by a clamping or releasing via a cable coupling member or means  320  which is illustrated in at least  FIGS. 3 ,  10 ,  11 ,  13  and  14 . The clamping member or means  320  includes a main collet member having plurality of jaws  322  each with recesses  324  that capture the lug  40  on the cable  38 . The jaws are shown most clearly in the enlarged perspective view of  FIG. 10 . The jaws are disposed at the ends of respective spring arms  328  that are circumferentially disposed about the base  330  which may, in turn, be cemented to the handle portion  38 A of cable  38 . The jaws  322  are normally biased to an open position such as shown in  FIG. 14  by means of the action of the spring arms  328 . 
         [0098]    The jaws  322  of the clamping member  320  have ramped surfaces  326  on their outside surfaces that interact with the tapered surface  334  of the collet  332 . This interaction controls the opening and closing of the clamping member. The collet  332  is normally urged distally by spring  336  that is loaded against the wall of the carriage  338  as illustrated in  FIG. 13 . The spring  336  is disposed in a pocket between a seat at the proximal end of the jaw members  322  and a seat in the carriage  338 . The neck  340  of the carriage  338  is fixedly attached to the base  330  of the jaws  322 , as well as to the cable portion  38 B. This attachment may be by a number of different means such as by being cemented together. Refer to the cross-sectional view of  FIG. 13  illustrating the cementing at  342 . 
         [0099]    The carriage  338  is adapted for sliding motion inside of the guide  344  which is, in turn, fixed to the handle  12 . The guide  344  is supported by the sleeve  346  which is molded as part of the handle. In  FIG. 13  the spring  336  is shown urging the collet  332 , with its&#39; tapered surface  334 , against ramped surfaces  326  under the bias of the spring arms  328 . This action maintains the jaws closed, thus capturing the cable lug  40  therein and essentially thus joining together the separate cable portions  38 A and  38 B. Once the cable portions are joined then the actuation cable functions as a single operable cable that is controlled from the proximal part of the instrument. The carriage  338  enables the cable to slide in performing its tool actuation function. The carriage  338  is shown as pulled proximally in the direction of arrow  348  in  FIG. 13  to show the manner in which the carriage  338  with the closed jaws  322  is free to move proximally from the at rest position illustrated in  FIG. 3 . 
         [0100]    Refer now to  FIG. 14  for an illustration of the release function which enables the shaft portion of the instrument to be separated or detached from the handle portion of the instrument. The jaws  322  are opened to release the lug  40  by the action of the cams  352  against the face  354  of the collet  332 . The action of the cams  352  pushes the collet  332  proximally as illustrated in  FIG. 14  to release the jaws from about lug  40 . The spring arms  328  are constructed and arranged so as to normally urge the arms apart. 
         [0101]      FIG. 14  depicts a rest position of the instrument in which the slider  28  has normally urged the cable  38  in the direction of arrow  350 . This action places the face of the jaws  322  against posts  356 . This positioning ensures the proper alignment between the connector  212  and the cable coupling member  320 . This assures alignment at the cable lug  40  when the horn  13  is either raised or lowered. Raising the horn lifts the lug  270  and along with it the pin  372  as illustrated in  FIG. 11 . This action pulls up on arms  366  of the yoke  364  which spread around the connector  212 . Yoke  364  is supported at arms  370 . Arms  366  carry pivot pins  368  that are attached to the arms  362  of posts  356  that are, in turn, mounted on pins  358  protruding from bosses  360  molded to the sides of the handle. The posts  356  act as stops for the proximal end of the shaft connector  212  and the face of the jaws  322 . The posts  356  have cams  352  which engage and push against the face of the collet  354  when the horn  13  is raised, as depicted in  FIG. 14 . 
         [0102]    An alternate embodiment of cable coupling member is shown in  FIGS. 29-33 , as coupling member  460 . In this embodiment, the cable end lug  40  has been replaced with a spring loaded cable connector  440  that is contained in a passage  450  in the post  214  of the connector  212 . A spring  446  biases the connector  440  distally to maintain the end effector jaws in an open position when the shaft portion  14  is removed. The spring  446  pushes flange  448  against the proximal end of the bendable member  18 , such as depicted in  FIG. 29 . This eliminates a need for a sheath  46 , as in  FIG. 2 , and helps keep the jaws open at an at rest position. Connector  440  has a tapered end  444  to aid in assembly and a groove  442  that can be captured by a finger  462  that is shown engaged in the position of  FIGS. 29 and 30 , and is normally biased to an open position as illustrated in  FIG. 31 . 
         [0103]    The finger  462  is attached to sleeve  466  at a living hinge portion  464  that enables the finger  462  to flex inward when biased by flex arm  472  of the guide  470 . Movement of the guide  470  over the sleeve  466  drops the finger  462  into groove  442  and thus captures the connector  440 , as shown in  FIG. 30 . The finger  462  is molded as part of the sleeve  466  and has a key  480  that slides in keyway  478  of guide  470  to ensure proper alignment of the finger  462  and the flex arm  472 . The sleeve  466  is cemented at  468  to the cable  38  and slides in the guide  470  which is attached to the handle  12 . When the horn is raised, a cam surface  474  of the shroud  278  lifts off cam follower  476  on the end of the flex arm  472 , allowing it to return to its at rest position as illustrated in  FIG. 32 . This allows the finger  462  to return to its at rest position thus releasing the connector  440 .  FIG. 33  is an exploded cross-sectional view of the embodiment of  FIG. 32  and showing the instrument shaft portion removed from the handle portion. When the horn  13  is pushed down, the cam surface  474  pushes the flex arm  472  at the follower  476 , and likewise pushes the finger  462  to the position shown in  FIG. 29 . This is a locked position for the cable coupler. The sleeve  466  functions as a carriage as depicted in  FIG. 30  when the cable  38  is pulled by the slider  28 . 
         [0104]      FIGS. 29 and 30  both show the coupling lug  441  captured so that both proximal and distal portions of the actuation cable are interconnected.  FIG. 29  shows more of an at rest position while  FIG. 30  depicts the cable  38  pulled in the direction of arrow  443  so as to actuate the end effector. In  FIG. 30  the sleeve is shown moved to the right and the spring  446  more compressed.  FIG. 32  illustrates the horn having been raised to enable release of the distal portion of the instrument with the finger  462  and the flex arm  472  both released to a dis-engaged position. Finally, in  FIG. 33  the shaft portion is shown separated from the handle portion. 
         [0105]      FIGS. 34-38  show still a further alternate embodiment of a cable coupling member or means  500 . In this embodiment, the connector  440  with its end lug  441  is inserted into a bore  518  in block  502  which also functions as a carriage. A spring loaded gate  504  with a keyhole shaped opening  506  is slidably mounted in transverse passage  507  of the block  502 . The upper rim  508  of the keyhole opening is urged downward by spring  510  to engage groove  442  of the connector  440  in a rotational relationship. A neck  512  on the top of the gate  504  supports the spring  510  against a bracket  514  which, in turn, supports a stop  516  on the end of the neck  512 . This arrangement ensures that the gate  504  does not drop out of the block  502  when there is no connector  440  present. 
         [0106]    The carriage  502  travels in a slideway  520  which is affixed to the handle. A release means or member  522  is operated by rotating the horn. The member  522  includes a pusher  524  that riding in guides  526  and is connected to the horn  13  by link  528  which pivots in end bosses  530 . The at rest position which is also the clamp/release position is shown in  FIG. 34 . The shaft portion is shown abutting the distal end of the fixed position slideway  520 , the cable  38  is at rest, the spring  446  is at an extended position, the carriage  502  is at the distal end of the slideway  520  and the pusher  524  is shown lined up beneath the gate  504 . In the cross-sectional view of  FIG. 35  the connector  440  is clamped by means of the gate  504 .  FIG. 35  also illustrates the carriage  502  being pulled proximally, by arrow  534  by the cable  38  which, in turn, is connected to the slider  28 . The spring  510  keeps the gate  504  down and latched but the connector  440  is free to rotate within block  502 .  FIG. 37  shows the horn raised and the pusher  524  in contact with and pushing up on the gate to align the wide portion of the keyhole opening  506  with the connector shaft so the connector  440  can be withdrawn as shown in  FIG. 38 . 
         [0107]    After use of the surgical instrument of the present invention the used or contaminated shaft portion  14  can be easily detached from the handle portion  12  and disposed of as hereinafter described. In this regard reference is now made to the manner in which the shaft portion is readily detachable for the purpose of replacement thereof. For this explanation reference is made primarily to the first embodiment described herein. To release the shaft portion  14 , the cinch ring  200  is released as shown in  FIGS. 2 and 5  by manipulation of the angle locking means  140  to allow the split hub portions  202 A- 202 D to be able to expand enough to allow clearance for the spherical ball  120 . Once the cinch ring is released the spherical ball can be pulled out of the split hub  202  as the shaft portion  14  is withdrawn, and thus detached from the handle portion  12 . Before detaching the shaft portion, the horn  13  is raised upward as shown in  FIGS. 2 and 5 , releasing both the shaft locking member  260  and the cable coupling member  320 . The shaft portion  14  can then be grasped at the neck portion  206  of the ball  120  and pulled straight out of the handle portion  12  and disposed of. After sterilizing the handle portion  12 , a new shaft portion  14  can be easily attached to it. 
         [0108]    As shown in  FIG. 2 , the new shaft portion  14  may be fitted with a temporary sheath  46  that is semi-rigid and snugly fits over the end effector and the distal bending member  20  to hold the end effector jaws open which ensures that the lug  40  at the proximal end of the shaft portion  14  is fully inserted into the shaft connector  212 . This is needed for proper alignment of the cable coupling means  320  and the lug  40  when the shaft portion  14  is inserted into the handle portion  12 . The sheath  46  also holds the distal bending member  20  straight and thus the proximal bending member  18  straight with respect to the shaft and shaft connector  212  for correct alignment when the shaft portion  14  is inserted into the handle portion  12 . There is also preferably provided an indexing means described herein in the form of ribs and grooves that ensure that the shaft connector  212  rotates in a fixed relationship to the rotation knob  24  and may also provide a matching means to ensure the correct matching of specific end effectors or tools to the proper handle configurations. 
         [0109]    Next is described the step of insertion of a new shaft portion with the handle portion. As the shaft portion  14  enters the handle portion  12  the spherical surface  204  of the ball  120  contacts the beveled faces  378  of the respective split hub portions  202 A- 202 D and forces them apart until the spherical surface  204  can clear the points created on the inside diameter of the split hub and the angled surfaces  380 , as depicted in  FIGS. 6 and 7 . The angled surfaces  380  allow the spherical ball  120  to clear the split hub with less expansion of the portions  202 A- 202 D to make it easier to slip the ball into and out of the split hub. The struts  230  that attach the split hub portions to the handle have thinned areas  382  that create living hinges that facilitate expansion of the split hub portions.  FIG. 6 , although previously described as illustrating removal of the shaft portion, can also be considered as illustrative of the relative positioning when the shaft portion  14  is inserted into the handle portion  12 . 
         [0110]    Continuing with the insertion step, next the post  214  of the shaft connector  212  is guided into the clearance hole  314  of the shaft receiver portion  300  of the rotation knob  24  and the clearance hole  316  in the wall  318  of the handle with the assistance of the tapered surface  216  at the free end of the post  214 . The shaft  14  can be rotated until the indexing features, such as ribs  302  on the shaft receiver and grooves  306  on the shaft connector  212 , mate under the urging of the split hub portions trying to return to a memory position and exerting a proximal pressure on the distal side of the spherical ball  120 . The ribs  302  are tapered at  304  and the connector  212  is tapered at  216  to assist in the alignment. Once properly aligned, the shaft connector  212  can slide proximally until the shoulder  308  on the connector contacts the seat  310  of the shaft receiver portion  300  as depicted in  FIG. 5 . 
         [0111]    There is provided a recess  312  in the shaft receiver  300  to allow clearance for the terminal wire crimps  102  and resilient pads  104 . As the connector seats in the receiver, the cable connection lug  40  is guided into the cable coupling jaws  322  guided by the taper  42  on the lug. When the connector  212  is fully seated in the receiver  300  the end of the post  214  abuts and contacts one side of the posts  356 , as illustrated in  FIG. 14 . The faces of the jaws  322  abut the other side of the posts  356  as urged by the carriage spring  336 .  FIG. 14  also shows that the proper distance D is provided that ensures that the lug  40  is abutting and preferably contacting the portion of the cable  38  that is attached to the slider  28 . Also, this positioning provides alignment of the lug  40  with the recesses  324  in the jaws  322  so that when collet  332  is released, the jaws  322  capture the lug  40 . 
         [0112]    Once the shaft portion is properly seated then the shaft portion  14  is now ready to be locked to the handle. The horn  13  is rotated clockwise or downwardly to the position depicted in  FIG. 3 . This releases the collet  332  and the jaws  322  capture the lug  40  while the shaft locking means  260  locks the shaft connector  212  in a rotational relationship with respect to the handle. The cinch ring  200  is then tightened by the release/lock lever  220  and the sheath  46  can be removed while gently squeezing the jaw clamping lever  22  while pulling on the distal end of the sheath. The instrument is now ready for use. 
         [0113]    Having now described a limited number of embodiments relating to the principles of the present invention, it should now be apparent to one skilled in the art that numerous other embodiments and modifications thereof are contemplated as falling within the scope of the present invention, as defined by the appended claims. For example, although the horn member has been described as the means by which the cable coupling is initiated, it is to be understood that other existing instrument members or added members may be used to initiate this action. In one other example the tool actuation lever may be adapted for the cable coupling function.