Patent Publication Number: US-11638617-B2

Title: Robotic manipulator for guiding an endoscope having a parallel linkage

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a National Stage of International Patent App. No. PCT/EP2018/062306, filed on May 14, 2018, which claims priority to German Patent App. No. DE 10-2017-111-296.0, filed on May 23, 2017, the disclosures of which are incorporated by reference in their entirety. 
     FIELD OF THE INVENTION 
     The invention relates to a surgical manipulator device for positioning a surgical instrument, particularly an endoscope; to a method for positioning a surgical instrument, particularly an endoscope, by means of a surgical manipulator device; and to a coupling element for a surgical manipulator device. 
     BACKGROUND 
     Surgical manipulator devices are fundamentally known and are mounted particularly on a stand or mounting arm in surgery in order to hold particular surgical instruments during an operation or other examination. 
     Such a surgical manipulator device is known from EP 1 658 016 B1, for example. The device disclosed therein is provided for holding an endoscope and is fundamentally designed without a motor. The device comprises a frame having a suspension arm arrangement comprising at least two suspension arms and connecting the frame in an articulated manner to a first joint associated with the instrument, and having a second suspension arm arrangement comprising at least two suspension arms and connecting the frame in an articulated manner to a second joint associated with the first instrument, the suspension arms of the first suspension arm arrangement being pivotably supported relative to each other and relative to the frame about pivot axes, and the pivot axes running parallel to each other, and the two suspension arm arrangements being implemented so that the first joint is displaceable in a first motion plane and the second joint is displaceable in a second motion plane, characterized in that the first motion plane is displaceable relative to the second motion plane. Said arrangement is used in EP 1 658 016 for compensating for a changing distance of the first and second joints for different pivoting or displacing of the first and second suspension arm arrangements. This is necessary particularly because the instrument is directly connected to the joints. It is particularly disadvantageous for such a device that it is difficult to connect the frame to a stand, because the frame must also allow the displacement of the plane. The stability and rigidity of such a system is also not sufficient for some applications in surgery. 
     The surgical manipulator device of the present invention is particularly intended for mounting on a mounting arm, as described in DE 10 2014 016 823 A1, DE 10 2014 016 824 A1, DE 10 2015 104 810 A1, DE 10 2015 104 819 A1, and EP 3 130 305 A1. The disclosed contents thereof with respect to the mounting arm described therein is incorporated herein in their entirety. 
     SUMMARY OF THE INVENTION 
     One object of the present invention is therefore to provide a surgical manipulator device of the type indicated above, a method, and a coupling element for coupling to the mounting arm disclosed in DE 10 2014 016 823 A1, DE 10 2014 016 824 A1, DE 10 2015 104 810 A1, DE 10 2015 104 819 A1, and EP 3 130 305 A1, wherein the surgical manipulator provides high rigidity, small installation space, high precision for positioning, and a working and visual field as clear as possible for the surgeon. 
     The object is achieved for a surgical manipulator device of the type indicated above in that said device comprises: a frame, a first mount and a second mount for mounting an instrument socket for a surgical instrument, a first suspension arm arrangement supported on the frame and connecting the frame to the first mount in an articulated manner, and a second suspension arm arrangement connecting the frame to the second mount in an articulated manner, wherein the first and the second suspension arm arrangements are each displaceable relative to the frame in first and second motion planes parallel to each other and spaced apart, so that the first mount is displaceable in the first motion plane and the second mount is displaceable in the second motion plane, wherein the first suspension arm arrangement is coupled to the frame at four lever pivot points of the first suspension arm arrangement, and the second suspension arm arrangement is coupled to the frame at four lever pivot points of the second suspension arm arrangement. 
     According to the invention, a manipulator device is thus produced for displacing the first and second mounts in separate motion planes always disposed parallel to each other. Pivoting the planes relative to each other, as is proposed in the prior art, is not implemented by the present surgical manipulator device. A joint in the frame can thereby be eliminated and the frame can be more rigid overall. Each suspension arm arrangement is further coupled to the frame by means of four lever pivot points, whereby greater rigidity is achieved in turn. For purely positioning the first and second mount, two lever pivot points per suspension arm arrangement are fundamentally sufficient. The two further points provided according to the invention in each case then particularly serve for stabilizing. 
     The four first lever pivot points and the four second lever pivot points are preferably disposed in a V shape in each case. The suspension arm arrangements are thus prevented from assuming singularities. Due to the V-shaped arrangement of the four lever pivot points of each suspension arm arrangement, each position of the first and second mount is unique. Geometrically or statically indeterminate positions are avoided. The safety of the surgical manipulator device is thereby particularly substantially increased, because singularities cannot occur in the kinematics during an operation. An arrangement of the four first lever pivot points and the four second lever pivot points in a rectangle in each case is indeed preferred as part of the invention, but then other means should be provided for preventing singularities, such as a limit on freedom of motion. 
     The angle of the V preferably lies in a range from greater than 0° to 90° inclusive. It has been found that such an angle is particularly preferred. Furthermore, tendentially smaller angles, such as 45° or less, 30° or less, or 20° or less are preferable. The manipulator device is thereby more compact in design. 
     According to a first preferred embodiment, the second suspension arm arrangement is implemented substantially mirror-symmetrical to the first suspension arm arrangement. The first and second suspension arm arrangements are preferably intrinsically mirror symmetrical relative to a plane perpendicular to the planes of motion. The second suspension arm arrangement can be mirror-symmetrical to the first suspension arm arrangement in design, or identical to the first suspension arm arrangement and offset by a spacing. The number of parts is thereby reduced, and the number of identical parts can be increased. The manufacturing effort is thereby particularly reduced. 
     According to a further preferred embodiment, the four lever pivot points of the first suspension arm arrangement and the four lever pivot points of the second suspension arm arrangement are disposed on four common axes of rotation. That is, each joint of the first suspension arm arrangement has a common axis of rotation with a lever pivot point of the second suspension arm arrangement. For example, the first lever pivot point has a common axis of rotation with the fifth lever pivot point, the second lever pivot point has a common axis of rotation with the sixth lever pivot point, the third lever pivot point has a common axis of rotation with the seventh lever pivot point, and the fourth lever pivot point has a common axis of rotation with the eighth lever pivot point. The design is thereby further simplified and the suspension arm arrangements can be symmetrical in design. The freedom of motion and the working space of the surgical manipulator device is thereby particularly improved. 
     In a variant thereof, the four lever pivot points of the first suspension arm arrangement and the four lever pivot points of the second suspension arm arrangement are not disposed on four common axes of rotation. The axes of rotation are offset to each other in parallel. The initial orientation of the mounts relative to each other is thereby shifted, whereby an initial setting angle can be implemented. This has the advantage that an application-specific or patient-specific setting angle of the surgical instrument received by means of the mount can be implemented. The accessibility for instruments to an operating field can thereby be improved, for example, and/or the working space of the manipulator can be used more efficiently. 
     According to a further preferred embodiment, the first and second suspension arm arrangements are formed of a total of exactly three different suspension arm elements. Said three different elements are preferably levers, suspension arms, and bars. Said three different elements are described in more detail below. The inventors have determined that it is sufficient to use said three different elements in order to form the first and second suspension arm arrangements. The design is thereby simple and identical parts can be used. Costs are also thereby reduced. 
     The first suspension arm arrangement preferably comprises a first, a second, a third, and a fourth lever, each rotatably supported on first, second, third, and fourth lever pivot points of the first suspension arm arrangement on the frame. The first suspension arm arrangement further comprises a first suspension arm rotatably coupled to the first and second levers. Said arrangement further comprises a second suspension arm rotatably coupled to the third and fourth levers. The axes of rotation of the first and second levers preferably define a first leg of the V and the axes of rotation of the third and fourth levers preferably define a second leg of the V. 
     According to the invention, the first suspension arm arrangement comprises first and second bars rotatably coupled to the first suspension arm on one side and rotatably coupled to the first mount on the other side. The first suspension arm arrangement accordingly comprises third and fourth bars rotatably coupled to the second suspension arm on one side and rotatably coupled to the first mount on the other side. The first mount is thus coupled to the frame by means of the first suspension arm arrangement. 
     The first and second bars are preferably disposed parallel to each other. The third and fourth bars are also preferably disposed parallel to each other. 
     In a corresponding manner, the second suspension arm arrangement comprises a fifth, a sixth, a seventh, and an eighth lever, each rotatably mounted at fifth, sixth, seventh, and eighth lever pivot points of the second suspension arm arrangement on the frame. The second suspension arm arrangement comprises a third suspension arm rotatably coupled to the fifth and sixth levers and a fourth suspension arm rotatably coupled to the seventh and eighth levers. According to the invention, the second suspension arm arrangement comprises fifth and sixth bars rotatably coupled to the third suspension arm on one side and rotatably coupled to the second mount on the other side. In a corresponding manner, the second suspension arm arrangement comprises seventh and eighth bars rotatably coupled to the fourth suspension arm on one side and rotatably coupled to the second mount on the other side. In this manner, the second mount is coupled to the frame, as has already been described with respect to the first mount. 
     The fifth and sixth bars are preferably disposed parallel to each other. It is also preferable that the seventh and eighth bars are disposed parallel to each other. 
     According to a further preferred embodiment, the first suspension arm arrangement comprises a first, a second, a third, and a fourth parallelogram. The second suspension arm arrangement further preferably comprises a fifth, a sixth, a seventh, and an eighth parallelogram. 
     The first parallelogram is preferably formed by the first and second levers, the first suspension arm, and the frame. The second parallelogram is preferably formed by the first and second bars, the first suspension arm, and the first mount. 
     In a corresponding manner, the third parallelogram is preferably formed by the third and fourth levers, the second suspension arm, and the frame. The fourth parallelogram is preferably formed by the third and fourth bars, the second suspension arm, and the first mount. The third and fourth parallelograms are particularly provided for stabilizing and the first and second parallelograms for positioning the first mount. In the same manner, the fifth parallelogram is formed by the fifth and sixth levers, the third suspension arm, and the frame. The sixth Parallelogram is preferably formed by the fifth and sixth bars, the third suspension arm, and the second mount. The seventh parallelogram is preferably formed by the seventh and eighth levers, the fourth suspension arm, and the frame. The eighth Parallelogram is correspondingly preferably formed by the seventh and eighth bars, the fourth suspension arm, and the second mount. The sixth and eighth parallelogram also serve particularly for stabilizing, while the fifth and seventh parallelogram serve for positioning. 
     By connecting the parallelograms one after the other, the first mount is displaceable only in one plane, namely the first motion plane in the X and Y-directions. The second mount is accordingly displaceably only in the second motion plane, again in the X and Y-directions. 
     It is further preferable that the first and second parallelogram comprise a common joint. The third and fourth parallelogram further preferably comprise a common joint. The fifth and sixth and the seventh and eighth parallelogram also preferably each comprise a common joint. The design is thereby further simplified and the size of the surgical manipulator device is reduced. Because the parallelograms are each connected one after the other, the suspension arms each form an element of two parallelograms, so that it is possible to implement common joints. 
     According to a further preferred embodiment, the surgical manipulator device comprises a drive for the first and second suspension arm arrangements. It is thereby possible to drive the suspension arm arrangements in order to thus position the first and second mount in the first and second motion planes. 
     In a preferred refinement, the drive comprises a first and a second motor for the first suspension arm arrangement and a third and a fourth motor for the second suspension arm arrangement. The first, second, third, and fourth motors are preferably operable independently of each other. Said motors are preferably implemented as electric motors having a rotating output shaft. All four motors are preferably identical in design. 
     The first and second motors preferably drive the levers disposed distal to the first mount, and the third and fourth motors drive the levers disposed proximal to the second mount. That is, the first motor preferably drives the first lever, the second motor preferably drives the third lever, the third motor preferably drives the sixth lever, and the fourth motor preferably drives the eighth lever. If the levers altogether always share an axis of rotation in pairs, then an arrangement is achieved in which for each pair of levers sharing an axis of rotation, one lever is driven and the other lever is passive in each case. The size of the surgical manipulator device is thereby significantly reduced. The four motors of the drive can be disposed so that the axes of rotation thereof are each parallel to each other. It is not necessary for the individual motors to be disposed approximately coaxially and axially offset from one another, as no two motors share a common axis of rotation. 
     In a preferred variant or in addition, the surgical manipulator device comprises a braking device for actively braking the first and second suspension arm arrangements and a releasing unit for selectively releasing one or more degrees of freedom of the first and/or second suspension arm arrangement. The braking device comprises a first and a second brake for the first suspension arm arrangement and a third and a fourth brake for the second suspension arm arrangement. The first and second brakes preferably brake the levers disposed distal to the first mount, and the third and fourth brakes preferably brake the levers disposed proximal to the second mount. In this respect, the brakes are preferably disposed analogously to the motors described and can be inserted in the frame instead of the motors. A passive surgical manipulator device is thereby produced, the braking device thereof being particularly manually releasable by means of the releasing unit, in order to thus adjust the pose of the first and second suspension arm arrangements and the position of the first and second mount in the first and second motion planes. 
     The brakes of the braking device are preferably closed in the de-energized state. Said brakes are preferably implemented as electromagnetic brakes. By powering the brakes with electricity, said brakes are released and the pose of the first and second suspension arm arrangement can be adjusted. 
     The releasing unit preferably comprises a switch or the like and is coupled to the braking device. The braking device can have a braking control device controlling the brakes separately or jointly. The releasing unit is preferably implemented so that each brake can be released and locked separately and/or that all brakes can be released together. The releasing unit is preferably disposed apart from the frame, the braking device, and/or the first and second suspension arm arrangements, particularly on a surgical instrument being received, on a floor, or on an operating table, and is connected by means of a cable or wirelessly to the braking device for providing a releasing signal. The releasing unit can be implemented as a foot pedal, for example. In a further variant, the releasing unit comprises a switch and a base body and can be clipped to a surgical instrument received at the first and second mounts. It is thus possible for a user to actuate the releasing unit when picking up the surgical instrument, so that the brakes are released and the pose of the first and second suspension arm arrangements, and thus also the position of the surgical instrument, can be adjusted manually. Intuitive operation is thereby provided. In addition or alternatively, the releasing unit is wirelessly connected to the braking device or a braking control device of the braking device, for example by means of WIFI, Bluetooth, or a wireless transmitting system of a higher successive system. For example, the releasing unit comprises a software program for running on a handheld computer, for example a mobile telephone, a tablet PC, or the like. In a further variant, the releasing unit is implemented in the form of a remote control and provides the releasing signal to the releasing device by means of infrared radiation, said releasing device being equipped with a corresponding receiver for this purpose. It is also conceivable, however, that the releasing unit, in addition or alternatively, comprises a manually actuated switch disposed on the housing of the surgical manipulator device. 
     In a further preferred embodiment, the surgical manipulator device comprises an instrument receiving device coupled to the first and the second mount in an articulated manner. The instrument receiving device preferably comprises form-fit means set up for receiving a coupling element for the surgical instrument. According to the invention, the surgical instrument is not directly coupled to the first and second mounts, but rather an instrument receiving device is coupled to the first and the second mounts and the instrument can then be selectively connected to the instrument receiving device. It is conceivable that the surgical instrument is directly connected to the instrument receiving device, but it is preferable that the instrument is connected by means of a coupling element in turn connected to the instrument receiving device in a form-fit manner. 
     The instrument receiving device is preferably designed so as to allow a changing distance between the first and the second mount, due to the different positioning of the first and the second mounts in the first and the second motion planes. It is conceivable, for example, that the instrument receiving device is fixedly coupled to the first mount on one side, while a sliding guide and/or slip coupling is provided at the second mount, and the instrument receiving device is mounted on the second mount in said sliding guide or by means of the slip coupling. The sliding guide is preferably designed so that the instrument receiving device is displaceable relative to the second mount. Compensating for the changing distance between the first and the second mount is thereby possible without pivoting the first and the second motion planes relative to each other and without the first and second mounts having to depart the respective first and second motion planes. Tensions are thereby prevented. Furthermore, the torsional rigidity at the instrument receiving device is thereby increased, and the rigidity in the instrument receiving device is simultaneously reduced, which is advantageous for patient safety. 
     The coupling element is preferably formed from an insulating material in order to electrically insulate an instrument, if received in the coupling element, relative to the instrument receiving device. The safety of the surgical manipulator device is thereby substantially improved. 
     In a further preferred embodiment, the instrument receiving device comprises a linear drive for positioning the instrument at least partially perpendicular to the first and second motion planes. A further degree of freedom is thereby produced for the surgical manipulator device and the instrument can be displaced particularly perpendicular to the motion planes. This is advantageous particularly if an endoscope, a catheter, or a biopsy needle is received as the instrument, that is, instruments for displacing substantially along the longitudinal axis thereof during an examination. 
     In a preferred refinement, the linear drive comprises an elongated sleeve, a spindle drive disposed in the sleeve, and an output drive element supporting the form-fit means, wherein the spindle drive drives a magnetic driver disposed in the sleeve and the output drive element is supported externally and linearly displaceably on the sleeve and is coupled to the magnetic driver by means of magnetic force. In this manner, it is possible for the sleeve to be externally smooth and have no penetrations, grooves, or other recesses. Hygiene is thereby particularly improved. The magnetic driver in the interior of the sleeve is coupled to a spindle drive, and the spindle drive drives the magnetic driver and linearly displaces the same. A spindle drive has the advantage in general that high positioning accuracy can be achieved without introducing excessive electromagnetic fields, as would be the case for conventional electromagnetic linear drives, for example, A small electric motor is sufficient for driving the spindle and can be disposed at one end of the sleeve. Due to the purely magnetic coupling between the output drive element and the magnetic driver, it is also possible to remove the instrument and the output drive element from the instrument receiving device without fully disassembling the instrument receiving device. 
     According to a further preferred embodiment, the instrument receiving device comprises a rotary drive provided for rotating a received surgical instrument about an axis of rotation, wherein the axis of rotation preferably runs substantially parallel to a drive direction of the linear drive. A rotation of the surgical instrument about a further axis is thereby allowed. A surgical instrument is typically received at the instrument socket such that said instrument can be linearly driven along the longitudinal axis thereof, particularly with respect to an endoscope displaceable along the stick axis thereof. For angled optics, it is preferable to implement the rotary drive of the present embodiment in order to enlarge the field of vision. 
     According to a further preferred embodiment, the instrument receiving device comprises a force/moment sensor unit set up for capturing forces and moments acting on the instrument receiving device from a surgical instrument received at the instrument receiving device. The force/moment sensor unit is preferably coupled to the control unit of the surgical manipulator device and the control unit comprises software means set up for processing signals provided by the force/moment sensor unit and correspondingly controlling a drive of the surgical manipulator device and/or the linear drive of the instrument receiving device or another drive of the instrument receiving device. The force acting on the instrument receiving device from the instrument can represent a user&#39;s command. It is possible, for example, that a surgeon manually grasps the instrument received at the instrument receiving device and wishes to manually guide the instrument to a particular point. In this case, forces and moments act on the instrument receiving device from the instrument and are then captured by the force/moment sensor unit. Controlling in the present variant preferably comprises determining a motion and/or pose for the first and second suspension arm arrangements and/or the linear drive in order to compensate for forces and moments acting on the instrument receiving device, and controlling the drive and/or the linear drive corresponding to said motion or pose for performing or assuming said motion and/or pose. 
     For the case that the force on the received instrument is exerted by a patient instead of a user, for example because an operating error was made and the manipulator device has assumed a suboptimal pose or the patient has moved, said force is also reduced by said procedure and relief is provided. Safety is improved. 
     It is further preferable that the control unit receives signals from the force/moment sensor unit representing the weight of a mass received at the instrument socket. Said loading weight leads to a slight elastic deformation of the surgical manipulator device due to the finite rigidity of the system. In the present embodiment example, data representing the system rigidity is stored in the control unit of the surgical manipulator device. When determining the pose for achieving a desired specified position for the surgical instrument, the mass received at the instrument socket is preferably considered. In this case, the following steps are preferably performed for determining the pose: determining a deflection due to the received mass in the target pose of the first and second suspension arm arrangements; determining an adapted target pose based on the determined deflection; and displacing the first and second mounts by means of the first and second suspension arm arrangements to the adapted target pose for positioning the surgical instrument. 
     According to a further preferred embodiment, the surgical manipulator device comprises an electronic control unit having storage means and a processor for controlling a motion and positioning at least the first and second mounts. The electronic control unit is preferably also set up for controlling the linear drive of the instrument receiving device or another drive of the instrument receiving device. 
     It is further preferable that the surgical manipulator device comprises an electronic interface for receiving actuating signals from an upper-level control unit, particularly a surgical navigation system or a surgical mounting arm having the upper-level control unit. On one hand, it is conceivable that the surgical manipulator device receives actuating signals directly via the electronic interface for the drive of the first and second suspension arm arrangements and/or for the linear drive of the instrument receiving device or another drive of the instrument receiving device, and thus does not require intrinsic intelligence. On the other hand, it is also conceivable that the surgical manipulator device comprises the electronic control unit having storage means and a processor and is thus autonomously able to determine actuating signals for the drive and/or the linear drive of the instrument receiving device or another drive of the instrument receiving device, particularly based on inputs from a user or based on actuating signals received via the electronic interface. It is thus conceivable that a desired specified position of the surgical instrument is received via the electronic interface and the electronic control unit of the surgical manipulator device then determines corresponding actuating signals from said specified position for the drive and/or the linear drive of the instrument receiving device or another drive of the instrument receiving device, in order to control the drive and/or linear drive of the instrument receiving device or another drive of the instrument receiving device accordingly for causing the first and second suspension arm arrangements to displace and to position the first and second mounts and/or for controlling the linear drive of the instrument receiving device accordingly. The electronic interface can be implemented in one variant as a wired interface having physical contacts or as a wireless interface receiving the actuating signals wirelessly from the upper-level control unit. Wi-Fi interfaces, Bluetooth interfaces, infrared interfaces, or successor interfaces of a higher level of development are conceivable for this purpose. It is particularly preferred that the surgical manipulator device is coupled to a mounting arm as described above and the actuating signals are received from the mounting arm. The mounting arm can determine said actuating signals intrinsically in one embodiment, or the actuating signals are received by the mounting arm from an upper-level control system, such as a surgical navigation system, and provided to the surgical manipulator device. 
     It is further preferable that the surgical manipulator device comprises an integrated input system for receiving user entries. The integrated input system is preferably coupled to the control unit of the manipulator device, or the surgical manipulator device comprises a separate control unit for the integrated input system. In one variant, the integrated input system comprises a microphone for receiving spoken commands as user inputs. The control unit to which the integrated input system is preferably connected preferably comprises at least one processor and software means suitable for processing spoken commands in one variant and providing corresponding actuating signals to the drive of the first and second suspension arm arrangement, to the linear drive of the instrument receiving device, to another drive of the instrument receiving device, and/or to the braking device. It can be provided, for example, that when a “release” command is received, a corresponding release signal is provided to the braking device from the control unit connected to the integrated input system. In further variant, spoken commands of the user are simply recorded and saved in order to be able to output the same in an OP report. In this manner, it is possible to associate particular operation actions with particular user inputs, using settings of a surgical instrument. 
     It is further advantageous that the integrated input system comprises at least on camera observing the first and second suspension arm arrangements, the positions of the first and second mounts, a position of a surgical instrument received at the first and second mounts, and/or an OP field. Such a camera can, for example, detect which instruments are introduced into and removed from an operating area. In the present embodiment, the control unit preferably comprises software means implemented for detecting instruments introduced into and removed from the operating area using image recognition algorithms, for providing a time stamp for corresponding signals, and for saving and providing an OP record. 
     According to a further preferable embodiment, the surgical manipulator device comprises a housing having an indicator device for indicating one or more statuses of the surgical manipulator device. Such statuses can particularly comprise one or more of the following: displacing the first and/or second suspension arm arrangement, displacing a linear drive of an instrument socket, receiving signals, transmitting signals, reaching a specified position of the first and second mounts, reaching and/or exceeding a predefined working space of the surgical manipulator device, direction in which the first and/or second mounts are or are to be displaced, type of surgical instrument to be received, force acting on the surgical instrument when the surgical manipulator device is switched on, is in a standby mode, is waiting for a user input, and/or when receiving a software update, reaching or approaching a home position of the first and second suspension arm arrangements, the first and second suspension arm arrangements being present in or near an extreme position, the status of a coupling having a mounting arm, the status of a connection of a peripheral device to the electronic interface, the type of instrument received, particularly a 0° endoscope, 30° endoscope, 45° endoscope, exoscope, switchable angled optics, or specific devices from third-party companies, saving an assumed pose of the first and second suspension arm arrangement in an internal or external memory, the success of the saving, a graphic representation of the saved data (e.g., reproducing the saved pose), producing, using, and/or cutting a communications connection between the surgical manipulator device and an external input system, particularly a surgical navigation system, whether a translatory motion or rotary motion (pivoting and/or tilting motion) is performed by a received instrument, the distance between a received instrument and a target position, a preliminarily saved pose of the first and second suspension arm arrangements selected from an internal memory and for approaching and (e.g., reproducing the selected pose), a location of a pivot point of a received surgical instrument, a scaling factor for a motion of a received surgical instrument. 
     The indicator device is preferably set up for displaying a working space of the manipulator. To this end, the indicator device displays on a top side of the housing (relative to an initial setting of the manipulator) the working space for pivoting and tilting motions and for parallel displacement of the instrument in the plane. An upper and lower working space boundary of the instrument receiving device can also be shown by means of the indicator device using a corresponding pattern, a flashing frequency, a color, and/or an intensity of the illumination. A top indicator segment is preferably used for the upper working space boundary of the instrument receiving device, and a bottom indicator segment disposed at a bottom side of the housing (relative to the initial setting) lights up correspondingly for the lower working space boundary. The user can then very easily see whether and how much working space is available. 
     The indicator device is preferably set up for indicating how the working space of the surgical manipulator device is aligned relative to the original coordinate system thereof. For example, the working space must be rotated relative to a patient for the same alignment of the surgical manipulator device so that an alignment of a received surgical instrument to the patient is positioned sensibly and anatomically correctly. To this end, an angled instrument adapter having a corresponding angle correction can be used in some cases. Because the coordinate transformation is indicated, a user is always informed of the alignment. 
     The indicator device preferably comprises at least two, preferably at least four indicator segments, wherein each indicator segment is associated with a pair or one of the four lever pivot points of the first and/or second suspension arm arrangement. A first indicator segment is associated with the first and second lever pivot points of the first and second levers, for example, and a second indicator segment is associated with the third and fourth lever pivot points of the third and fourth levers. The indicator device can thereby indicate, for example, that the first and second levers are moving while the third and fourth levers are standing still. If the indicator device comprises four indicator segments, then the indicator device can also be used for indicating the motion of the fifth through eighth levers. The third segment can be used for indicating a motion of the fifth and sixth levers while the fourth indicator segment indicates a motion of the seventh and eighth levers. A user is thereby always informed whether the first and second suspension arm arrangements are moving and, if so, in which direction and which segment of the suspension arm arrangement is moving. The user can thus see whether the instrument is moving and in which direction the instrument is moving. 
     The indicator device preferably comprises one or more annular indicators. The indicator device preferably annularly surround the four lever pivot points. A simple optical association of the indicator device and particularly of individual indicator segments of the indicator device with lever pivot points is thereby possible, and intuitive understanding by the user is achieved. It is also conceivable that a separate annular indicator is provided for each lever pivot point coaxial to the joint axis. 
     It is further preferably that the indicator device is set up for indicating a motion of at least one part of the first and second suspension arm arrangements about a corresponding lever pivot point. 
     In a further consideration, the above object is achieved according to the invention by means of a method for positioning a surgical instrument, particularly an endoscope, by means of a surgical manipulator device, particularly according to any one of the preferred embodiments of a surgical manipulator device according to the first consideration of the invention described above, having the steps: determining a first vector for a first mount for mounting the surgical instrument and lying within a first motion plane; determining a second vector for a second mount for mounting the surgical instrument and lying within a second motion plane; displacing the first mount in correspondence with the first vector by means of a first suspension arm arrangement supported on the frame and connecting the frame to the first mount in an articulated manner; and displacing the second mount in correspondence with the second vector by means of a second suspension arm arrangement connecting the frame to the second mount in an articulated manner, wherein the first and second motion planes are always parallel to each other. It should be understood that the steps of the method can be performed simultaneously or one after the other, and that the sequence thereof need not necessarily correspond to that described. It should further be understood that the surgical manipulator device according to the first consideration of the invention and the method according to the second consideration of the invention have identical and similar refinements, as are particularly set forth in the dependent claims. In this respect, reference is made in full to the above description of the surgical manipulator device of the first consideration of the invention. 
     The method preferably also comprises the steps of determining a speed and sequence at which the first and second mounts are displaced in correspondence with the first and second vector. The method preferably further comprises the steps: determining a first rotation for the first mount; determining a second rotation for the second mount; rotating the first mount in correspondence with the first rotation by means of the first suspension arm arrangement supported on the frame; and rotating the second mount in correspondence with the second rotation by means of the second suspension arm arrangement; wherein the axes of rotation of the rotations are disposed perpendicular to the first and second motion planes. It should be understood that the axes of rotation of the first and second mounts are perpendicular to the motion planes. The axis of rotation of an instrument socket received at the mounts, however, need not be disposed perpendicular to the motion planes, rather said axis can also run at an angle. The displacing preferably corresponds to the first and second vectors and the rotating corresponds to the first and second rotations in an automated manner, particularly by means of an electrical drive provided in the surgical manipulator device. 
     It is further preferable that the method comprises the steps: receiving a first surgical instrument at the instrument socket; and capturing a pivot point of the first surgical instrument relative to an object by approaching the pivot point by means of the first and second mount and saving said position in a memory. The first surgical instrument can in this case also be a pivot point gage provided for determining the pivot point, or a probe instrument. A pivot point is generally understood to be a point of the surgical instrument substantially stationary relative to an object, for example the patient, or changing depending on the object, and about which the instrument must be rotated during an examination or operation. The endoscope for ENT surgery, for example, must be rotated about a particular pivot point, particularly lying approximately in the inlet region of the nasal atrium, substantially independently of the depth of penetration of the endoscope into the main nasal cavity. 
     Said pivot point is preferably saved in a memory. Specification are preferably also saved describing a change to the pivot point, for example depending on a depth of penetration of the surgical instrument into the body of the patient. The memory can be provided in the surgical manipulator device or separate therefrom. By saving the pivot point, said point can be used in subsequent operations or for determining motion paths, trajectories, and the like. Because the pivot point is approached by means of the instrument and by means of positioning the first and second mounts, the setting of the first and second suspension arm arrangements having a pivot point is known. Approaching a pivot point can be done manually, in that a surgeon guides the instrument to said location and the first and second suspension arm arrangements work passively in this case. Another possibility is approaching under manual control, in that a surgeon guides the instrument by means of a type of joystick or other operator control unit, for example, in order to guide the instrument to the pivot point. 
     According to a further preferred embodiment of the method, the determining of the first and second vectors is performed using the saved pivot point. The surgical manipulator can preferably be set in a pivot point mode and in a normal mode. In the pivot point mode, all motion paths and trajectories, particularly the first and second vectors and the sequential series of motions of the first and second suspension arm arrangement, are performed in correspondence with the first and second vectors considering the pivot point. That is, even for pivoting or other motions of the instrument, said instrument is always displaced about the pivot point. In normal mode, in contrast, the pivot point is not considered. The instrument can also be displaced outside of the pivot point, for example. 
     In this mode it is conceivable, for example, to displace the first and second suspension arm arrangement in relative motions to each other at a ratio of 1:1. That is, the instrument socket is not pivoted in this case, but only linearly displaced. The surgical manipulator is set to the pivot point mode and the normal mode preferably in response to a signal, for example initiated by a user by means of a switch on the surgical manipulator device or a switch disposed separately, for example a foot pedal. It is also conceivable that said signal is transmitted to the surgical manipulator device from an upper-level control unit, such as a surgical navigation system. This can be done by means of a wired connection or wirelessly. 
     A further preferred embodiment of the method comprises the steps: receiving a signal representing an approach request of the pivot point; and determining the first and second vector, such that a received surgical instrument is positioned at the pivot point. It is preferable that the saving of the pivot point takes place by means of a pivot point gage. Said pivot point gage is then removed from the socket after saving the pivot point, and another surgical instrument, in this case an endoscope or the like, is received at the instrument socket. The signal representing an approach request to the pivot point serves to then bring the tip of the endoscope to the pivot point again. Such an approach request signal can be initiated by a switch, for example, or by another external signal. The first and second vector are then determined such that the tip of the received surgical instrument is positioned at the pivot point. To this end, it can also be provided that an axial extent at least partially perpendicular to the first and second motion planes is considered. In this case, approaching the pivot point also preferably comprises actuating a linear drive of an instrument receiving device. 
     A further consideration of the method comprises the step: determining a transformation matrix between a base of the surgical manipulator device and the pivot point. In addition to the coordinates of the pivot point, a transformation matrix is preferably also determined and then comprises the current orientation of the surgical instrument in addition to the point coordinates, whereby a coordinate system can be represented at the pivot point. This is then particularly advantageous for graphic displays or further spatial transformations relative to the pivot point. The pivot point coordinates and transformation matrices are preferably defined relative to a base coordinate system defined by the surgical manipulator device or particularly preferably by a mounting device, such as a mounting arm or a stand, on which the surgical manipulator device is mounted. Such a base coordinate system is preferably relative to an operating table. 
     The coordinates of the pivot point and/or the transformation matrix are preferably provided at an interface, for example by means of a RESTful API interface. 
     According to a further embodiment of the method, the surgical instrument is preferably implemented as a probe instrument and the method comprises the steps: traveling to a first anatomical landmark of a patient by means of the probe instrument; saving first landmark data representing the pose of the first and second suspension arm arrangements and/or the position of the first and second mount; linking the first landmark data to first image data representing at least one prerecorded tomograph of the patient. Such prerecorded or preoperatively captured tomographs are typically produced by the patient for operations. Such tomographs can be captured by a CT device, for example. The method preferably further comprises the steps of traveling to a second anatomical landmark of a patient by means of the probe instrument; saving second landmark data representing the pose of the first and second suspension arm arrangements and/or the position of the first and second mounts at the second anatomical landmark of the patient; and linking the second landmark data to second image data representing at least one prerecorded tomograph of the patient. Third, fourth, and fifth or further anatomical landmarks can be processed in the same manner. In this manner, subsequent intra-operative collisions between the surgical instrument and surrounding tissues can be avoided and a planned motion path or trajectory can be implemented accordingly. 
     According to a third consideration of the invention, the object indicated above is achieved by a coupling element for a surgical manipulator device, particularly a surgical manipulator device according to any one of the preferred embodiments of a surgical manipulator device according to the first consideration of the invention described above, wherein the coupling element allows coupling a surgical instrument to an instrument receiving device, wherein the coupling element comprises a main body made of a flexible, electrically insulating material, wherein the main body comprises form-fit means for coupling to the instrument receiving device and a clamping segment for clampingly coupling to the surgical instrument. 
     A fourth consideration of the invention relates to an instrument receiving device for a surgical manipulator device, particularly according to any one of the preferred embodiments of a surgical manipulator device described above according to the first consideration of the invention and for receiving a surgical instrument, wherein the instrument receiving device comprises a linear drive for positioning the instrument, wherein the linear drive comprises an elongated sleeve, a spindle drive disposed in the sleeve, and an output drive element supporting the form-fit means, wherein the spindle drive drives a magnetic driver disposed in the sleeve and the output drive element is supported externally and linearly displaceably on the sleeve and is coupled to the magnetic driver by means of magnetic force. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The invention is described in more detail below, using an embodiment example and referencing the attached figures. Shown are: 
         FIG.  1    a perspective view of a robotic mounting arm having a surgical manipulator device according to the invention; 
         FIG.  2    a perspective view of the surgical manipulator device; 
         FIG.  3    a side view of the surgical manipulator device according to  FIG.  2   ; 
         FIG.  4    a plan view of the surgical manipulator device according to  FIG.  3   , but without a surgical instrument; 
         FIG.  5    a bottom view of the surgical manipulator device according to  FIG.  4   ; 
         FIG.  6    the surgical manipulator device according to  FIG.  4    in a second pose; 
         FIG.  7    the surgical manipulator device according to  FIG.  4    in a third pose; 
         FIG.  8    the surgical manipulator device according to  FIG.  4    in a fourth pose; 
         FIG.  9    the surgical manipulator device according to  FIG.  4    in a fifth pose; 
         FIG.  10    a magnified view of the linkage of the surgical manipulator device; 
         FIG.  11    a magnified view of a lever; 
         FIG.  12    a magnified view of a suspension arm; 
         FIG.  13    a magnified view of a bar; 
         FIG.  14    a magnified view of a mount; 
         FIG.  15    a magnified view of a cardan element; 
         FIG.  16    a side view of the surgical manipulator device without the housing and having a drive; 
         FIG.  17    a side view of the surgical manipulator device without the housing and having brakes for the linkage; 
         FIG.  18    a side view of an instrument receiving device; 
         FIG.  19    a full section through the instrument receiving device from  FIG.  18   ; 
         FIG.  20    a first view of a coupling element including an adapter; 
         FIG.  21    a second view of the coupling element from  FIG.  20   ; 
         FIG.  22    a schematic view of the manipulator device having peripheral devices; 
         FIG.  23    a perspective view of the surgical manipulator device having a pivot point gage received; 
         FIG.  24    a schematic view of the pivot point control system; 
         FIG.  25    a schematic view of a rotation of the surgical instrument about the pivot point; and 
         FIG.  26    a perspective view of a housing of the surgical manipulator device having an indicator device; 
     
    
    
     DETAILED DESCRIPTION 
     According to  FIG.  1   , a mounting device  1  in the form of a robotic mounting arm is shown, on which a surgical manipulator device  100  is received. The mounting device comprises a proximal end  2  for attaching the mounting device  1  to a base (not shown). The base according to the present embodiment example can be implemented as a standard rail of an operating table (the operating table is not shown in  FIG.  1   ). The mounting device  1  therefore comprises a clamping jaw  3  for manually clamping by means of a screw  3   a . The mounting device  1  further comprises a distal end  4  for receiving an attached device, implemented here as a surgical manipulator device  100  according to the invention. 
     The mounting device according to  FIG.  1    comprises seven arm segments  10 ,  12 ,  14 ,  16 ,  18 ,  20 ,  22 , wherein the joints  11 ,  13 ,  15 ,  17 ,  19 ,  21 ,  23  are provided between the individual arm segments  10  through  22 . The first arm segment  10  forms the proximal end  2  and comprises the clamping jaw  3 . A power switch  26  is further provided on the arm segment  10  for switching on the entire mounting device, two connectors by means of which the mounting device is supplied with power and data, such as actuating signals and the like, and by means of which the data is transferred from the mounting device to external units such as operating room systems, and an emergency stop switch. 
     The joints  11 ,  15 ,  19 , and  23  are implemented as rotary joints and the joints  13 ,  17 , and  21  as pivot joints. 
     The mounting device  1  comprises an indicator unit  32 ,  34 ,  36 ,  38 ,  40 ,  42 ,  44  at each joint  11 ,  13 ,  15 ,  17 ,  19 ,  21 ,  23 , each provided for indicating a status of the mounting device  1 . 
     The indicator units  32 ,  34 ,  36 ,  38 ,  40 ,  42 ,  44  according to said embodiment example are substantially annular light sources, particularly implemented as LED rings. The central axis of each ring runs substantially coaxially to each axis of rotation of the joint  11 ,  13 ,  15 ,  17 ,  19 ,  21 ,  23 . While one single LED ring is provided for each of the joints  11 ,  15 ,  19 ,  23 , two LED rings are provided for each of the joints  13 ,  17 , and  21 . The two LED rings are provided at the front and rear joint segments  17 ′,  17 ″ (labeled with reference numerals as examples only in  FIG.  1   ). Each display unit can always be detected in every position of the mounting device. 
     According to the present embodiment example, the mounting device further comprises an operator control device  50 . The mounting arm can be placed in a desired pose by means of the operator control device  50 , the operator control device  50  being set up for releasing the associated joint  11 ,  13 ,  15 ,  17 ,  19 ,  21 ,  23  upon contact between an operator and one of the seven arm segments  10 ,  12 ,  14 ,  16 ,  18 ,  20 ,  22 . To this end, the operator control device  50  according to the present embodiment example comprises five contact segments  52 ,  53 ,  54 ,  55 ,  56 , wherein each contact segment  52 ,  53 ,  54 ,  55 ,  56  is disposed on a different arm segment  11 ,  14 ,  16 ,  20 ,  22 . The individual contact segments are implemented as touch-sensitive surfaces or buttons, so that one or more associated joints are released upon contact between a user and a corresponding contact segment. 
     The association of the individual joints  11 ,  13 ,  15 ,  17 ,  19 ,  21 ,  23  is regulated as follows according to the present embodiment example: upon contact between a user and the arm segment  10 , that is, the contact segment  52 , the joint  11  is released. A user can now influence one degree of freedom. When a user makes contact with the arm segment  14 , the joint  15  is released; and upon contact with the contact means  54 , the joint  13 ; upon contact with the contact means  55  the joints  19  and  17 , and upon contact with the contact means  56  the joints  23  and  21 . It is thereby preferably provided that the corresponding indicator units  32 ,  34 ,  36 ,  40 ,  42 ,  44  indicate said releasing, that is, particularly by lighting up the LED ring. 
     The precise construction of the mounting device and the function thereof are described in detail in DE 10 2014 016 823 A1, DE 10 2014 016 824 A1, DE 10 2015 104 810 A1, DE 10 2015 104 819 A1, and EP 3 130 305 A1. The disclosed contents of said publications are incorporated herein by reference in their entirety relating to the mounting arm  1 . 
     The surgical manipulator device  100  in the present embodiment example holds an endoscope as the surgical instrument  102 . The surgical manipulator device  100  comprises a housing  104  having an interface (cf.  FIG.  23   ) by means of which the surgical manipulator device  100  is coupled to the distal end  4  of the mounting device  1 . The interface  106  is described below in greater detail with respect to  FIG.  23   . 
     The surgical manipulator device  100  (also referred to below only as “manipulator device  100 ”) further comprises a frame  108  (cf.  FIGS.  16  and  17   ) defining a structure of the manipulator device  100 . The frame is not visible in  FIG.  2   , as said frame is enclosed by the housing  104 . 
     A first suspension arm arrangement  110  and a second suspension arm arrangement  112  are supported on the frame  108 . The first suspension arm arrangement  110  is displaceable in a first motion plane B 1  and the second suspension arm arrangement  112  is displaceable in a second motion plane B 2  (cf.  FIG.  3   ). The motion planes B 1 , B 2  are parallel to each other and cannot be tilted relative to each other. 
     The first suspension arm arrangement  110  connects the frame  108  to a first mount  114  and the second suspension arm arrangement  112  connects the frame to a second mount  116 . An instrument receiving device  120  is attached by means of the mounts  114 ,  116  in the present embodiment example ( FIGS.  2  and  3   ) as is explained in greater detail with reference to  FIGS.  18  and  19   . 
     There can also be embodiments in which an instrument is directly connected to the first and second suspension arm arrangements  110 ,  112  without interconnecting an instrument receiving device  120 . It is particularly also conceivable that a surgical instrument  102  is integrally formed with the first and second mounts  114 ,  116 , and is particularly materially connected and cannot be non-destructively removed therefrom. For such a case, it can be preferable to provide a clip connection or the like between the first and second mounts  114 ,  116  and the corresponding first and second suspension arm arrangements  110 ,  112 , in order to thus be able to change out the surgical instrument  102  of the surgical manipulator device  100 . 
     The first suspension arm arrangement  110  is coupled to the frame  108  at four lever pivot points  121 ,  122 ,  123 ,  124  of the first suspension arm arrangement  110 , and the second suspension arm arrangement  112  is coupled to the frame  108  at four lever pivot points  125 ,  126 ,  127 ,  128  of the second suspension arm arrangement (cf.  FIG.  4 ,  5   ). 
     The first lever pivot point  121  comprises a first axis of rotation R 1 , the second lever pivot point  122  comprises a second axis of rotation R 2 , the third lever pivot point  123  comprises a third axis of rotation R 3 , and the fourth lever pivot point  124  comprises a fourth axis of rotation R 4 . The four lever pivot points  125 ,  126 ,  127 ,  128  of the second suspension arm arrangement  112  are labeled as the fifth lever pivot point  125 , sixth lever pivot point  126 , seventh lever pivot point  127 , and eighth lever pivot point  128 . In the present embodiment example (cf.  FIGS.  3 ,  4 , and  5   ), the four lever pivot points  121 ,  122 ,  123 ,  124  of the first suspension arm arrangement  110  comprise common axes of rotation R 1 , R 2 , R 3 , R 4  with the four second lever pivot points  125 ,  126 ,  127 ,  128  of the second suspension arm arrangement  112 . In this respect, the fifth lever pivot point  125  has the axis of rotation R 1 , the sixth lever pivot point  126  has the axis of rotation R 2 , the seventh lever pivot point  127  has the axis of rotation R 3 , and the eighth lever pivot point  128  has the axis of rotation R 4 . 
     The first and second suspension arm arrangements  110 ,  112  are implemented identically, but mirror-symmetrically, in the present embodiment example, as can be seen particularly in  FIGS.  3 ,  4 , and  5   ; in the bottom view ( FIG.  5   ) the second suspension arm arrangement  112  looks identical to the first suspension arm arrangement  110  of the plan view according to  FIG.  4   . 
     The first suspension arm arrangement  110  comprises first and second arm segments  80 ,  82 , in turn identical and mirror-symmetrical to each other (cf.  FIG.  4   ). The second suspension arm arrangement  112  comprises corresponding first and second arm segments  84 ,  86 , in turn identical and mirror-symmetrical to each other. 
     Each of the arm segments  80 ,  82 ,  84 ,  86  comprises two parallelograms, namely a first parallelogram  91 , a second parallelogram  92 , a third parallelogram  93 , and a fourth parallelogram  94 . The second lever pivot arrangement  112  comprises a fifth parallelogram  95 , a sixth parallelogram  96 , a seventh parallelogram  97 , and an eighth parallelogram  98 . 
     The first suspension arm arrangement  110  comprises a first lever  131 , a second lever  132 , a third lever  133 , and a fourth lever  134 , the rotary axes thereof each being the axes of rotation R 1 , R 2 , R 3 , R 4 . In a corresponding manner, the second suspension arm arrangement  112  comprises a fifth lever  135 , a sixth lever  136 , a seventh lever  137 , and an eighth lever  138 , the rotary axes thereof also being the four axes of rotation R 1 , R 2 , R 3 , R 4 . It should be understood that there are also embodiment examples wherein the axes of rotation of the levers  135 ,  136 ,  137 ,  138  and thus also the axes of rotation of the fifth, sixth, seventh, and eighth lever pivot points  125 ,  126 ,  127 ,  128  are offset parallel to the axes of rotation R 1 , R 2 , R 3 , R 4  and in this respect comprise four dedicated, separate axes of rotation. It is particularly conceivable that the lever pivot points  125 ,  126 ,  127 ,  128  are offset in the direction of the interface  106  in order to thus provide an initial setting angle for the surgical instrument  102  (cf.  FIG.  3   ). 
     All levers  131  through  138  are connected to a suspension arm  141 ,  142 ,  143 ,  144  at the output side, that is, at the end opposite the lever pivot points  121  through  128 . The first and second levers  131 ,  132  are connected to a first suspension arm  141  at the output side, the third and fourth levers  133 ,  134  are connected to a second suspension arm  142  at the output side, the fifth and sixth levers  135 ,  136  are connected to a third suspension arm  143  at the output side, and the seventh and eighth levers  137 ,  138  are connected to a fourth suspension arm  144  at the output side. 
     The first lever  131 , the second lever  132 , the first suspension arm  141 , and the frame  108  together form the first parallelogram  91 . The third lever  133 , the fourth lever  134 , the second suspension arm  142 , and the frame  108  together form the third parallelogram  93 . The fifth lever  135 , the sixth lever  136 , the third suspension arm  143 , and the frame  108  together form the fifth parallelogram, and the seventh lever  137 , the eighth lever  138 , the fourth suspension arm  144 , and the frame  108  together form the seventh parallelogram. 
     The first suspension arm arrangement  110  further comprises a first bar  151 , a second bar  152 , a third bar  153 , and a fourth bar  154 . The second suspension arm arrangement  112  comprises a fifth bar  155 , a sixth bar  156 , a seventh bar  157 , and an eighth bar  158 . The first and second bar  151 ,  52  connect the first suspension arm  141  to the first mount  114  in an articulated manner, and the third and fourth bar  153 ,  154  connect the second suspension arm  142  to the first mount  114  in an articulated manner. In a corresponding manner, the fifth bar  155  and the sixth bar  156  connect the third suspension arm  143  to the second mount  116  and the seventh and eighth bar  157 ,  158  connect the fourth suspension arm  144  to the second mount  116 . The structure is explained again in greater detail with reference to  FIG.  10   . 
     A first cardan element  146  is further received at the first mount  114  and a second cardan element  147  is received at the second mount  116 . The instrument receiving device  120  is held by means of the cardan elements  146 ,  147  as is described in detail below with reference to  FIGS.  17  and  19   . The first and second cardan elements  146 ,  147  are rotatably mounted in corresponding joint segments  148 ,  149  of the first and second mounts  114 ,  116 . 
       FIG.  6  through  9    illustrate four different positions of the first mount  114  in a plan view, that is, in the plane B 1 . While the first mount  114  is shifted to an extreme left position in  FIG.  6   , the first mount  114  is shifted to an extreme right position in  FIG.  7   , to an extreme front position in  FIG.  8   , and to an extreme rear position in  FIG.  9   . Rotating about an axis perpendicular to the first motion plan B 1  is not provided in  FIG.  6  through  9    and cannot be implemented due to the parallel kinematics used here. 
     Shifting to the left side ( FIG.  6   , cf. arrow above the cardan element  146 ) is carried out in that the first and second levers  131 ,  132  are rotated to the left relative to the axes of rotation R 1 , R 2 , while the third and fourth levers  133 ,  134  are also rotated to the left relative to the axes of rotation R 3 , R 4 . Correspondingly rotating the levers  131 ,  132 ,  133 ,  134  in the opposite direction brings about a shifting of the first mount  114  to the right relative to  FIG.  7   , as illustrated by the arrow above the cardan element  146 . If the levers  131 ,  132 ,  133 ,  134  are displaced in opposite directions in pairs, that is, the first and second levers  131 ,  132 , are rotated in the opposite direction relative to the third and fourth levers  133 ,  134 , then a shifting follows of the first mount  114  in an X-direction relative to the coordinate system shown within the first motion plane B 1 . This is also indicated by the arrow above the cardan element  146  ( FIG.  8   ) and to the left of the cardan element  146  ( FIG.  9   ). 
     As can be seen easily from  FIG.  6  through  9   , the suspension of the first mount  114  relative to the frame  108  is statically indeterminate. Just two levers, one suspension arm, and two bars would be sufficient for positioning the mount  114 . It is conceivable, for example, to use only the levers  132 ,  134  and the bars  152 ,  153  for positioning the mount. It would also be possible to use only the levers  131 , 132 , the suspension arm  141  and the bars  151 ,  152 . The use of the present complex first and second suspension arm arrangements  110 ,  112  as shown, however, achieves a particularly high rigidity and thus a high positioning precision and repeatability. 
       FIG.  10    shows the first suspension arm arrangement  110  including the first holder  114  and first cardan element  146  magnified again in order to better describe the geometry. The first, second, third, and fourth levers  131 ,  132 ,  133 ,  134 , the first and second suspension arms  141 ,  142 , and the first, second, third, and fourth bars  151 ,  152 ,  153 ,  154  are shown in turn. The first mount  114  and the first cardan element  146  are further shown. The first cardan element  146  is coupled to the socket  148  and is rotatable about an axis K 1  lying within the first motion plane B 1 . Said element can also be shifted parallel to the same. 
     As can be seen particularly in  FIG.  10   , the levers  131 ,  132 ,  133 ,  134  are entirely identical in design. The suspension arms  141 ,  142 ,  143 ,  144  are also identical in design; the suspension arm  142  is simply reversed relative to the suspension arm  141 , that is, disposed rotated 180 degrees about an axis parallel to the axis K 1 . The bars  151 ,  152 ,  153 ,  154  are also identical, wherein the bars  153 ,  154  are in turn rotated relative to the bars  151 ,  152 . The same suspension arms are also used for the second suspension arm arrangement  112 . This is not shown, as the illustration would be identical to illustration  10  and only the reference numerals would be changed. 
     The first, second, third, and fourth parallelograms  91 ,  92 ,  93 ,  94  are further drawn in  FIG.  10    by means of dashed lines. 
     A further detail shown in  FIG.  10    is the joints  160  through  169  of the first suspension arm arrangement  110 . The first lever  131  is connected in an articulated manner to the first mount  141  by means of a first joint  160 , and the second lever  132  is connected in an articulated manner to the first mount by means of a second joint  161 . The first bar  151  is connected in an articulated manner to the first suspension arm  141  by means of a third joint  162 , and the to the first mount  141  by means of a fourth joint  163 . The second bar  152  is connected in an articulated manner to the first mount  114  by means of a fifth joint and to the first suspension arm  141  on the other side, also by means of the second joint  161 . The second joint  161  thus forms a common joint for the first and second parallelograms  91 ,  92 . An angle β 1  is provided between the first and second parallelograms  91 ,  92  and defined by the geometry of the first suspension arm  141 , more precisely by the arrangement of the first, second, and third joints  160 ,  161 ,  162 . It has been found that the angle β 1  should lie within a range from 90° to &lt;180° in order to allow the use of identical parts, that is, of identical bars  151  through  158 , identical levers  131  through  138 , and identical suspension arms  141  through  144 . 
     For the second arm segment  82 , the same applies as for the first arm segment  80 . The third lever  133  is connected in an articulated manner to the second suspension arm  142  by means of a sixth joint, and the fourth lever  134  is connected in an articulated manner to the second suspension arm  142  by means of a seventh joint  166 . The third bar  153 , in turn, is connected in an articulated manner to the second suspension arm  142  by means of the seventh joint  167 , and to the first mount  114  by means of a tenth joint  169  on the other side. The fourth bar  154  is connected in an articulated manner to the second suspension arm  142  by means of an eighth joint  167 , and the fourth bar  154  is connected in an articulated manner to the first mount  114  by means of a ninth joint  168 . The third and fourth parallelograms  93 ,  94  in turn form an angle β 2  corresponding to the angle β 1 . 
     As can be further seen in  FIG.  10   , the lever pivot points  121 ,  122 ,  123 ,  124  are disposed in a V shape, and the axes of rotation R 1 , R 2 , R 3 , R 4  are disposed in a V shape. The V shape is described by the two axes V 1 , V 2  drawn in  FIG.  10    as dashed lines. The angle α of the V lies in a range from &gt;0° to 90°. The vertex  150  of the V, that is, the intersection of the axes V 1 , V 2  lies in the first mount  114  here, and thus in the working space of the linkage. The V-shaped arrangement of the lever pivot points  121 ,  122 ,  123 ,  124 ,  125 ,  126 ,  127 ,  128  avoids singularities of the first and second suspension arm arrangements  110 ,  112 . 
       FIG.  11  through  15    show the three elements (lever, suspension arm, and bar) of the suspension arm arrangements  110 ,  112  separately again and the mount and the Cardan element. Only the first of said elements are shown as examples, wherein the further elements are always identical in design. 
     The suspension arm  131  ( FIG.  11   ) is made as a single piece and comprises a round body  170  having a drive segment  171  and an output drive segment  172 . The drive segment  171  of the lever  131  is connected in an articulated manner to the frame and comprises three pass-through openings  173   a ,  173   b ,  173   c  for mounting, serving for receiving mounting screws. The three pass-through openings  173   a ,  173   b ,  173   c  are disposed in a circle and equidistant from the axis of rotation R 1 . A further pass-through opening  174  is implemented at the output drive segment  172  and serves for receiving the first joint  160 . An opening  175  is provided in the middle segment of the body  170  for weight reduction purposes. The levers  132  through  138  are identical in design. 
     The suspension arm  141  (cf.  FIG.  12   ) comprises a base body  176 . A first pass-through opening  177  for the first joint  160 , a second pass-through opening  178  for the second joint  161 , and a third pass-through opening  179  for the third joint  162  are implemented in the base body  176 . Said pass-through openings  177 ,  178 ,  179  are each designed for receiving corresponding joint bushings of the joints  160 ,  161 ,  162 . The pass-through openings  177 ,  178 ,  179  are disposed so as to enclose the angle β 1 , that is, the angle β 1  between the first and second parallelograms  91 ,  92 . The angle β 1  can be modified by a corresponding design of the first mount  141 . The angle β 1  also influences the geometry of the first mount  114 , for example, because the first mount  114  forms part of the second parallelogram  92 . 
     The body  176  further comprises two further pass-through openings  180 ,  181  also provided for weight purposes. The second, third, and fourth suspension arms  142 ,  143 ,  144  are in turn identical in design to the suspension arm  141 . 
     The first bar  151  (cf.  FIG.  13   ) comprises a base body  182 . Two end segments  183 ,  184  extend at slight angles, each at about a 45 degree angle from the middle part  185  of the bar  151 . Pass-through openings  186 ,  187  are made in the end segments  183 ,  184  for receiving the third joint  162  and the fourth joint  163 . The pass-through openings  186 ,  187  are in turn formed so that bearing bushings can be received. An elongated pass-through opening  188  is made in the middle part  185 , in turn substantially for weight purposes. The pass-through opening  188 , however, also provides an improved field of vision for the surgeon or user when using the surgical manipulator device  100  according to the invention. The other bars  152  through  158  are identical in design to the first bar  151 . The bar  151  is altogether implemented as a single piece and is milled from aluminum, for example. 
     The first mount  114  (cf.  FIG.  14   ) comprises a base body  189  and is altogether produced as a single piece. The mount  114  comprises a first and a second arm  190 ,  191 , wherein the first arm  190  is provided for the first and second bars  151 ,  152  and the second arm  191  for the third and fourth bars  153 ,  154 . A first and second pass-through opening  192 ,  193  are made in the first arm  190  for this purpose, serving for receiving joint bushings and forming a socket for the fourth and fifth joints  163 ,  164 . A third pass-through opening  194  is made between the first and second pass-through openings  192 ,  193  for weight reduction purposes. In a corresponding manner, the second arm  191  comprises a first and second through hole  195 ,  196  implemented for receiving joint bushings and serving for receiving the ninth and tenth joints  168 ,  169 . A third pass-through opening  197  is provided between said holes and is made for weight reduction purposes. The second mount  116  is identical in design. 
     The first Cardan element  146  (cf.  FIG.  15   ) is formed as a single piece, for example of aluminum. Said element comprises a shaft  198  for receiving in the socket  148 . A fork  199  extends from the shaft  198  and serves for receiving the instrument receiving device  120 . The fork  199  comprises penetrations  200   a ,  200   b  (not visible in  FIG.  15   ) to this end along an axis K 3  perpendicular to the axis K 1 . In this manner, the instrument receiving device  120  can be fully rotatably received at the first and second mounts  114 ,  116 . 
     In one embodiment of the surgical manipulator device  100 , said device comprises a drive  210  ( FIG.  16   ). The housing  104  and boards disposed within the housing  104  are left out of  FIG.  16    in order to make the drive  210  visible. The drive  210  in the present embodiment example comprises four motors  211 ,  212 ,  213 ,  214 . Of said four motors  211 ,  212 ,  213 ,  214 , the motors  212 ,  214  are covered in  FIG.  16    by the motors  211 ,  213 . While the first and second motors  211 ,  212  are provided for the first suspension arm arrangement  110 , the third and fourth motors  213 ,  214  are provided for the second suspension arm arrangement  112 . The motors  211 ,  212 ,  213 ,  214  are disposed having axes of rotation on the axes of rotation R 1 , R 2 , R 3 , R 4 . That is, the first motor  211  is coupled to the first lever  131 , and the second motor  212  is coupled to the third lever  133 . In a corresponding manner, the third motor  213  is coupled to the sixth lever  136  and the fourth motor  214  is coupled to the eighth lever  138 . The first and second motors  211 ,  212  thus drive the levers  131 ,  133  disposed distal to the first mount  114 , while the third and fourth motors  213 ,  214  drive the levers  136 ,  138  disposed proximal to the second mount  116 . A gearbox for changing the torque and rotary speed is preferably provided between the motors  211 ,  212 ,  213 ,  214  and the corresponding levers  131 ,  133 ,  136 ,  138 . The motors  211 ,  212 ,  213 ,  214  are implemented here as brushless DC motors. 
     Due to the special double parallel linkage of the first and second suspension arm arrangements  110 ,  112 , it is sufficient that only two levers of each of the four-lever suspension arm arrangement  110 ,  112  are driven. The motors  211 ,  212 ,  213 ,  214  can thereby also be placed such that said motors are adjacent to each other, parallel adjacent to each other, and not axially offset on a common axis of rotation. The size of the surgical manipulator device  100  can thereby be significantly reduced, as is particularly evident in  FIG.  16   . 
     A control unit is provided for controlling the motors  211 ,  212 ,  213 ,  214  and receives signals via the interface  106 . This is described in detail further below. 
       FIG.  17    shows a second embodiment of the manipulator device  100  comprising no drive  210  but rather a braking device  220  for actively braking the first and second suspension arm arrangements  110 ,  112 . The braking device  220  comprises four brakes  221 ,  222 ,  223 ,  224  mounted to the frame  108  in a similar matter to the motors  211 ,  212 ,  213 ,  214 . The first brake  221  in turn covers the second brake  222 , and the third brake  223  covers the fourth brake  224 . The brakes  221 ,  222 ,  223 ,  224  are each disposed coaxial to the axes of rotation R 1 , R 2 , R 3 , R 4 . The first brake  221  is coupled to the first brake  131 , and the second brake  22  correspondingly to the third brake  133 . In a corresponding manner, the third brake  223  is coupled to the sixth lever  136  and the fourth brake  224  is coupled to the eighth lever  138 . The brakes  221  through  224  are implemented as electromagnetic brakes and closed in the de-energized state. 
     The surgical manipulator device  100  comprises a releasing unit  225  for releasing the braking device. One or more degrees of freedom of the first and/or second suspension arm arrangement  110 ,  112  can be released by means of the releasing unit  225 . In the present embodiment example ( FIG.  17   ), the releasing unit  225  is implemented as a pushbutton  226  and is also disposed on the frame  108 , such that said pushbutton is accessible from outside the housing  204  (cf. particularly  FIG.  23   ). By pressing said pushbutton  226 , all brakes  221 ,  222 ,  223 ,  224  are released and the first and second suspension arm arrangements  110 ,  112  and thus also the positions of the first and second mounts  114 ,  116  can be adjusted. In this manner, a passive surgical manipulator device is formed and can be place in a desired pose by a user in a simple manner and locked in place, namely by pressing the pushbutton  226  and manually adjusting. The pushbutton  226  must merely be released for locking. The brakes  221 ,  222 ,  223 ,  224  are then de-energized and clamp closed. The pose of the first and second suspension arm arrangements  110 ,  112  is locked. 
     As mentioned above, an instrument receiving device  120  can be received at the first and second mounts  114 , 116 , optionally intermediately connected to the first and second Cardan elements  146 ,  147 . The instrument receiving device is also independently claimed according to the invention, as shown in  FIGS.  18  and  19   . The instrument receiving device  120  can also be used with different manipulators and not solely with the surgical manipulator device described in  FIGS.  1  through  17   . 
     The instrument receiving device  120  shown in the embodiment example according to  FIGS.  18  and  19    is not only usable as a rigid stand (although said use is preferable according to the invention) but also comprises a linear drive  230 . In detail, the instrument receiving device  120  initially comprises a foot housing  232 , the outside of which has a recess  233  (a further recess is disposed on the opposite side of the foot housing  232  with respect to  FIG.  18   ), by means of which the foot housing  232  can be received in a Cardan element  146 ,  147  in a form-fit manner but pivotably about the axis K 3 , particularly the bottom Cardan element  147  (cf.  FIGS.  2  and  15   ). A sleeve  234  fixedly connected to the foot housing  232  extends along a longitudinal axis L 1  upward with respect to  FIG.  18   . The sleeve  234  has a substantially rectangular or square base shape (cf.  FIG.  1   ) and is preferably made of a plastic or a non-magnetic material. 
     A second mounting point for the instrument receiving device  120  is formed by a sliding coupling  235  supported displaceably along the longitudinal axis L 1  on an exterior of the sleeve  234 , as indicated by the dashed lines of the sliding coupling  235 ′ in  FIG.  18   . The sliding coupling  235  further comprises two opposite recesses  236  as described previously with reference to the foot housing  232 . The sleeve  235  is connected to the first Cardan element  146  in a form-fit but rotatable manner by means of the recess  236  (cf.  FIG.  2   ). The sliding coupling  235  serves for compensating for a changing distance between the first recesses  233  and the second recesses  236  when the first and second suspension arm arrangements  110 ,  112  are pivoted not in conformity to each other. It is conceivable, for example, that the first suspension arm arrangement  110  is pivoted into a position as shown in  FIG.  6    and the second suspension arm arrangement  112  is pivoted into a position as shown in  FIG.  7   . In this case, the longitudinal axis L 1  would not extend perpendicular to the motion planes B 1 , B 2 , but rather at an angle thereto. In this case, the distance between the recesses  236 ,  233  would be increased relative to the situation when the longitudinal axis L 1  is perpendicular to the motion planes B 1 , B 2 . In order to compensate for said distance without introducing stresses or deformations to the first and second suspension arm arrangements  110 ,  112 , the sliding coupling  235  is disposed for displacing. 
     The sliding coupling  235  preferably has as close a fit as possible to the sleeve  234  but without producing too much friction. To this end, the sliding coupling  235  can be provided with appropriate materials on the inner side thereof. 
     The linear drive  230  in the present embodiment comprises a spindle drive  238  disposed in the sleeve  234 . The spindle drive  238  comprises a spindle  239  extending along the longitudinal axis L 1  in the interior of the sleeve  234 . At the top axial end  240  with respect to  FIG.  19   , the spindle  239  is received by means of a rotary bearing  241 . At the bottom end  242  with respect to  FIG.  19   , the spindle  239  is coupled to an electric motor  243  rotatably driving the spindle  239  about the longitudinal axis L 1 . A corresponding control unit  245  for the electric motor  243  and an interface  246  for transmitting signals to the control unit  245  are disposed in an extension  244  of the foot housing  232 . 
     A magnetic driver  250  is disposed on the spindle  239  and engages with the external thread of the spindle  239  by means of an internal thread  251 . By rotating the spindle  239 , the magnetic driver  250  can be displaced along the longitudinal axis L 1 . The magnetic driver  250  comprises a plurality of permanent magnets  252  at the radially outer side thereof. The linear drive  230  further comprises an output drive element  254  in the form of a bushing disposed in a sliding manner along the longitudinal axis at the outside of the sleeve  234 . The output drive element  254  supports a further plurality of permanent magnets  255  on the inner side thereof, corresponding to the permanent magnets  252 . In this manner, the output drive element  254  is coupled to the magnetic driver  250  and the output drive element  254  is thus displaceable back and forth along the longitudinal axis L 1  by rotating the spindle  239 . In this manner, the sleeve  234  can be fully closed in design and does not require any recesses or protrusions on the outside thereof, whereby the hygiene of the surgical manipulator device  100  of the present invention is substantially improved. 
     The drive element  254  further comprises a first coupling element  256 , in this case implemented as a hook-shaped retaining finger. The first coupling element  256  is connected to the bushing body of the output drive element  254  by means of a screw connection  257 . The first coupling element  256  is preferably made of an insulating plastic insulating a surgical instrument received by form-fit means  258  relative to the linear drive  230  and preferably relative to the bushing body of the output drive element  254 . 
     For the case that the instrument receiving device  120  comprises a force/moment sensor unit  260 , said unit is preferably mounted on the first coupling element  256 . All forces acting on the surgical manipulator device  100  from a surgical instrument  102  are guided by means of the first coupling element  256 . The force/moment sensor unit  260  can comprise a force/moment sensor, for example, disposed between the screw connection  257 . It is further conceivable that individual force sensors, such as strain gauges, are disposed directly on a surface of the first coupling element  256 . The force/moment sensor unit  260  is preferably connected to the control unit  245  and/or provides signals by means of the interface  246 . 
     The first coupling element  256  is shown again in  FIG.  20    in a perspective view. As shown in  FIG.  20   , the first coupling element  256  supports a second coupling element  262  provided for clampingly receiving a surgical instrument. 
     The coupling element  262  comprises a main body  264  made of a flexible, electrically insulating material comprising form-fit means  266  for coupling to the form-fit means  258  of the instrument receiving device  120 . Opposite the form-fit means  266 , the base body  264  forms a clamping segment  268 . The clamping segment  268  comprise a first and a second clamping jaw  269 ,  270  implemented mirror-symmetrically to each other. The clamping jaws  269  enclose a central axis K 4  in a partially circular manner. The partially circular segment of the clamping jaws  269 ,  270  corresponds approximately to three-quarters of a circle. The clamping jaws  269 ,  270  each comprise a tab  272 ,  273  at the end of the circular segment  271  having the same axial length as the clamping jaws  269 ,  270 . The tabs  272 ,  273  widen in that said tabs extend away from each other starting from the axis K 4 . Planes formed by the tabs  272 ,  273  preferably intersect at the central axis K 4 . The tabs  272 ,  273 , by means of the beveling thereof, serve for easily introducing the instrument into the space between the clamping jaws  269 ,  270 , and for easily removing the instrument  102  by manually grasping the tabs  272 ,  273  with the hands and pressing apart the clamping jaws  269 ,  270 . 
     The clamping jaws  269 ,  270  provide form-fit fixing of the surgical instrument  102  in the directions perpendicular to the central axis K 4 , but also allow shifting of the surgical instrument  102  in the direction of the central axis K 4 , as can be seen in  FIG.  2   , for example. 
     In the region of the form-fit means  266 , the coupling element  262  further comprises a clipping device  274  having a detent finger and a detent lug for engaging in a corresponding recess on the first coupling element  262 . The grip  275  can be used for lifting the detent lug out of the corresponding detent groove on the first coupling element  256  and thus releasing the form-fit connection between the second coupling element  262  and the first coupling element  256 . The form-fit means  266 ,  258  can be implemented as a dovetail guide or the like, for example. 
     In the schematic view ( FIG.  22   ), the surgical manipulator device  100  is shown having further peripheral devices. The surgical manipulator device  100  in turn comprises the first and second suspension arm arrangements  110 ,  112  shown simplified in  FIG.  22   . In a first variant, the manipulator device  100  comprises a drive  210  and corresponding first, second, third, fourth motors  211 ,  212 ,  213 ,  214 . In a second variant also shown in  FIG.  22   , the manipulator device  100  comprises a braking device  220  having corresponding first, second, third, and fourth brakes  221 ,  222 ,  223 ,  224 . Because the schematic design is not different with respect to the drive  210  and the braking device  210 , said components can be shown in other figures. 
       FIG.  22    is intended particularly for illustrating the electronic control unit  280 . The electronic control unit  280  comprises a memory  282  and a processor  284  for controlling the displacement and positioning of the first and second mounts  114 ,  116 . The electronic control unit  280  is connected to the interface  106  by means of a line  286  implemented as a mechatronic interface. By means of said interface  106 , the surgical manipulator device is connected to an upper-level control unit  290 . Said upper-level control unit  290  can be a surgical navigation system or the surgical mounting arm  1 . The connection between the upper-level control unit  290  and the manipulator device  100  can be physical, by means of a line or a contact  292  to the electronic interface  106 , or can be wireless by means of a wireless connection  394 . For example, the upper-level control unit  290  and the manipulator device  100  can communicate by means of infrared radiation and the mechatronic interface  106  in this case is equipped with a corresponding receiver. 
     The control unit  280  of the manipulator device  100  can receive actuating signals  51  for the drive  210  and/or the braking device  220  directly from the upper-level control unit  290 , for example. For the present embodiments, the control unit  280  does not require particular intelligence, but rather must merely provide corresponding actuating signals to the motors  211 ,  212 ,  213 ,  214  or the brakes  221 ,  222 ,  223 ,  224 . It can also be provided, however, that positioning request signals S 2  are provided by the upper-level control unit  290 , that is, a position at which a tool center point or the tip of the surgical instrument  102 , or a pivot point PT 1 , PT 2  of the surgical instrument  102  should be. For this case, data is saved in the memory  282  representing the first and second suspension arm arrangements  110 ,  112  or the entire linkage or kinematic model in the upper-level coordinate system, for example the coordinate system of a navigation system, to the corresponding tool center point TCP or pivot point PT 1 , PT 2 . 
     Software means  282  are further saved in the memory  282  for performing the following steps when executed by the processor  284 : determining a first vector and/or trajectory for a first mount  214 , determining a second vector and/or a second trajectory for the second mount  216 , providing actuating signals to the motors  111 ,  112 ,  113 ,  114  for displacing the first mount  14  in conformance with the first vector or the first trajectory and for displacing the second mount  16  in conformance with the second vector or second trajectory. A trajectory is typically preferably determined, as not only the destination is significant when displacing the instrument, but also the path from a current position to a target position must be considered. In this manner, it can occur that the surgical instrument  102  collides with parts of the patient&#39;s body, and for this reason a particular trajectory must be selected in order to avoid a collision. 
     For the case that a force/moment sensor unit  260  is provided, said unit is also connected to the control unit  280 . The connection can be wired or wireless. The control unit  280  preferably comprises corresponding software means in the memory  282  thereof set up for processing signals provided by the force/moment sensor unit  260  and for controlling the drive  210  and/or a linear drive of the instrument receiving device  120  or optionally the braking device  220  accordingly. The force acting on the instrument receiving device  120  from the instrument  102  can represent a user&#39;s command. It is possible, for example, that a surgeon grasps the surgical instrument  102  manually and wishes to guide the same to a particular point. In this case, forces F and moments M act on the instrument receiving device  120  from the instrument  102  and are then captured by means of the force/moment sensor unit. Corresponding signals are then provided to the control unit  280 . The software means are preferably implemented, when executed on the processor  284 , for causing the control unit  280  to determine displacements or a trajectory or vector for the first and second suspension arm arrangements  110 ,  112  and/or for a linear drive  238  of the instrument receiving device  120 , in order to compensate for the forces F and moments M acting on the instrument receiving device  120  and to provide control signals to the drive  210 , the linear drive  238 , and/or the braking device  220  conforming to said displacement, trajectory, or vector, in order to perform the displacement according to the trajectory or the vector. That is, the surgical manipulator  100  responds to the user&#39;s command and attempts to assume a pose for compensating for the forces F and moments M acting on the instrument receiving device  120 . 
     Because such a procedure is not desired at all times, it is preferable that the surgical manipulator  100  comprises an integrated input system  300 . The integrate input system  300  can comprise a microphone, for example, and/or a touch display for placing the surgical manipulator device  100  in said mode wherein the described software is executed. It can be provided, for example, that the user must enter a command “manual guide mode” or “follow mode” and said spoken command is captured by means of the microphone and corresponding signals are provided to the control unit  280 . Corresponding speech recognition software means provide actuating signals, so that the software means are executed on the processor  284 . 
     Alternatively or in addition, a foot pedal  302  can also be provided and in the present embodiment example is coupled to the upper-level control unit  290 . By means of the foot pedal  302 , a corresponding signal S 4  can be provided to the upper-level control unit  290 , so that the upper-level control unit  290  forwards the corresponding signal S 4  and provides the same to the control unit  280  of the manipulator device  100 . 
     In a further embodiment, it can be provided that the surgical manipulator device  100  communicates with a handheld mobile device  310 . The mobile device  310  can be a tablet PC, a mobile phone, or another device implemented in the manner of a remote control, for example. Signals S 5  can be transmitted wirelessly from the mobile device  310  to the control unit  280  comprising a corresponding receiver to this end. The mobile device  310  can also be implemented for displaying a representation of the pose of the manipulator device  100 , for example a simplified graphic image of the pose. It can be provided that software is executed on said mobile device for positioning the surgical instrument by means of drag &amp; drop, particularly by means of a touch display. If the patient is also depicted having particular landmarks on the mobile device, then the surgical instrument can be positioned in an automated manner by means of the mobile device  310  by selecting a particular landmark. The processing of the positioning request signals sent to the control unit  280  correspondingly as the signal S 5 , occurs in the manner described above. 
     In a similar manner, the integrated input system  300  can also comprise a display on which such representations are displayed. 
     It is also possible, of course, to output warning signals by means of the integrated input system  300  or the mobile device  301  if, for example, a predefined working space of the surgical manipulator device  100  is departed, for example if a user manually positions the surgical instrument  102  in the manual positioning mode, as described above, and it is thereby determined that said instrument is guided outside of a predefined working space. 
     A pushbutton  226  is disposed on the housing  104 . The pushbutton  226  has been described above with reference to the braking device  220 . The pushbutton can be assigned depending on the design of the surgical manipulator device, that is, whether a drive  210  or a braking device  220  is provided. If the braking device  220  is provided, then the pushbutton  226  is preferably parameterized as a releasing device  225  and the brakes  221 ,  222 ,  223 ,  224  can be released by means of the pushbutton  226 . 
     For the case that a drive  210  having motors  211 ,  212 ,  213 ,  214 , is provided, the pushbutton is preferably parameterized as what is known as a home button  312 . In the present embodiment, if the pushbutton is parameterized as a home button  312 , pressing the pushbutton causes the surgical manipulator device to travel to an initial, predefined pose saved in the memory  282 . In this manner, it is possible to travel to a predetermined and presaved pose simply by pressing the pushbutton  226 . It is preferably further provided that the presaved pose can be saved by means of the pushbutton  226 . To this end, the pushbutton  226  is pressed and held for a predetermined duration (for example, 3 seconds) and the current pose is saved as a presaved pose in the memory  282  in order to be called up and traveled to when the pushbutton  226  is pressed again. 
     In order to initially read in or define a pivot point for a surgical instrument  102 , a pivot point gage  320  can be received at the first and second mounts  114 ,  116  as a surgical instrument  102  according to the present invention. This is shown in  FIG.  23   . The pivot point gage  320  is more precisely received at the instrument receiving device  120  by means of the second coupling element  262  describe in detail with reference to  FIG.  21   . 
     The pivot point gage  320  comprises a shaft  322  and a narrow region  324 . The narrow region is implemented for being received between the clamping jaws  270 ,  269 . The axial extent of the narrow segment  224  corresponds to the axial length of the clamping jaws  269 ,  270  with respect to the axis K 4 . That is, the pivot point gage  320  has a defined position relative to the coupling element  262  and thus also relative to a coordinate system of the surgical manipulator device  100 . The axial length of the pivot point gage  320  is known and thus also the position of the probe head  324  implemented at an axial end of the pivot point gage  320 . For reading in a pivot point PT, the user guides the manipulator device  100  manually, or electrically controlled, to a pose in which the probe head  324  is disposed at the patient-specific pivot point of the patient. 
     The control unit  280  preferably comprises software means for this case for calculating, when executed on the processor  284 , the setting of the individual joints and the pose of the first and second suspension arm arrangements  110 ,  112 , and the position and setting of the instrument receiving device  120 , coordinates of the probe head  324 , and thus also of the pivot point PT. For saving said pivot point coordinates and/or for providing the pivot point coordinates to the interface  106 , a user preferably actuates a user input, for example pressing the pushbutton  226  parameterized for this purpose. It can also be provided that a pushbutton or the like is provided on the pivot point gage  320  for saving and/or providing the coordinates. 
     The control unit  280  is preferably further set up for calculating the pivot point with respect to the surgical instrument and displacing correspondingly along the longitudinal axis K 4  when a different surgical instrument  102  is received, having a different axial length from the shaft  322  of the pivot point gage  320 . If, for example, an endoscope is received (cf.  FIG.  2   ), then the axially lower tip of the endoscope can be positioned deviating from the probe head  324 . If the geometry of the endoscope is known, then the position of the pivot point can be transformed accordingly. 
       FIG.  24    again illustrates the determining of the pivot point PT and the corresponding calculation. The surgical manipulator device  100  is again shown schematically in  FIG.  24   , while detail A of the left side of  FIG.  24    is again shown magnified on the right side. The surgical manipulator device  100  in the present embodiment example is received in a mounting arm  1  as has already been fundamentally described with reference to  FIG.  1   . The schematic view of the manipulator device  100  is identical to the schematic view of the manipulator device  100  from  FIG.  24    and in this respect reference is made in full to the above description. Identical and similar elements also have identical reference numerals. 
     The mounting arm  1  is initially fixedly mounted on an operating table and has a coordinate system KS 0  as a base coordinate system. The patient is also present in the coordinate system KS 0 , as the position of the patient is typically not displaced relative to the base  10  of the mount arm  1  during an operation. 
     The described pivot point gage  320  can be sued for determining a tool center point coordinate system KS TCP  at the first pivot point PT 1 . The pivot point PT 1  is the pivot point defined by means of the pivot point gage  320  using the probe head  324 . The Z-axis of the coordinate system KS TCP  is aligned in the direction of the axis K 4  defined by the instrument receiving device  120 . The orientation of the axis K 4  is parallel to the axis L 1  of the linear drive and can run at an angle (as shown in  FIG.  22   ) to the first and second motion planes B 1 , B 2 . The setting angle γ between the axis K 4  and the first motion plane B 1  is defined by differentially actuating the first and second suspension arm arrangements  110 ,  112 . 
     If a different surgical instrument  112  is received, the pivot point PT 1  is initially located at the point read in using the pivot point gage  320 . The pivot point PT 1  can, however, also be shifted along the longitudinal axis K 4  by calculating. For example, the current pivot point shifts from pivot point PT 1  to pivot point PT 2  when the surgical instrument  102  is introduced into the body of a patient. The endoscope, for example, to be progressively guided along as the operation progresses in order to reproduce the operating area, can be displaced for what is known as a keyhole operation such that the pivot point is always located approximately in the region of the keyhole. In some cases, the pivot point can also be located outside of the axis K 4 . 
     A transformation matrix is also preferably determined between the base  10 , that is, the base coordinate system KS 0 , and one of the coordinate systems at the pivot point KS PVP  or the initial pivot point KS TCP . Said transformation matrix is preferably provided by means of the interface  106  and/or saved in the memory  282 . 
     The definition of the pivot point PT 1 , PT 2  and the saving thereof can also be used for cyclically pivoting the surgical instrument  102 . Such cyclical pivoting is used by users, for example, for obtaining a spatial impression of the field observed by the endoscope. For the case that an endoscope is received as the surgical instrument  102 , the following method is preferred and is explained in more detail with reference to  FIG.  25   : (1.) The user positions the endoscope; (2.) The user starts pivoting motions or the control unit  280  starts automatically after positioning; (3.) Support points  330   a ,  330   b ,  330   c ,  330   d  relative to the current pose are determined for an endoscope tip  103 , wherein the support points  330   a ,  330   b ,  330   c ,  330   d  together define a path  332 . The path  332  can thereby be planned, that is, can run continuously through the support points  330   a ,  330   b ,  330   c ,  330   d . Alternatively, the support points  330   a ,  330   b ,  330   c ,  330   d  are traveled to directly and discretely. The path  332  is preferably elliptical. The elliptical path  332  is preferably determined by the control unit  280  using the support points  330   a ,  330   b ,  330   c ,  330   d . The instrument  102  is then pivoted on the path  332 . A pivot approach path  334  is required for this purpose. The instrument  102  is then preferably displaced such that the tip  103  travels along the path  332  until a corresponding interrupt signal is received at the control unit  280  or is generated by the same. A pivot departure path  336  is then provided for pivoting out back the initial position. 
     If the instrument  102  is shifted along the longitudinal axis K 4  thereof in the Z-direction relative to the pivot point coordinate system KS PVP , the tip  103  comes to a point labeled as  103 ′ in  FIG.  25   , for example. The instrument  102  is thus shifted by a distance ΔZ. For this case, the path  332  is transformed to the path  332 ′ located on the enclosing sphere  338  defined between the pivot point PT 2  and the path  332 . The transformed path  332  is preferably determined by the control unit  280  using suitable software means. 
     The surgical manipulator device  100  further preferably comprises an indicator device  350  for indicating one or more statuses of the surgical manipulator device  100 . The general function of such an indicator device is also described in EP 3 130 305 A1 with reference to joints of the mounting arm disclosed and claimed therein, and the teaching thereof can be used analogously for the present manipulator device, particularly the joints thereof. 
     The indicator device  350  can fundamentally be implemented arbitrarily, for example comprising a display, or in the embodiment example shown in the figures, the indicator device comprises a plurality of indicator segments, namely initially a top indicator segment  352  ( FIG.  23   ) and a bottom indicator segment ( FIG.  5   ). The terms “top” and “bottom” in the present embodiment example relate to an initial setting of the surgical manipulator device  100 , wherein the first and second motion planes B 1 , B 2  are oriented substantially horizontally and the top indicator segment  352  faces upward. 
     The top and bottom indicator segments  352 ,  354  are implemented as annular light strips, and particularly as a plurality of LED elements. The two indicator segments  352 ,  354  are identical and mirror-symmetrical in design with respect to the first and second motion planes B 1 , B 2 . This has the advantage that for every orientation of the surgical manipulator device  100 , a user can see either the top indicator segment  352  or the bottom indicator segment  354 . 
     In addition, according to the present embodiment example, each of the top and bottom indicator segments  352 ,  354  has four individual segments  355 ,  356 ,  357 ,  358 . The first indicator segment  355  is thereby associated with the first lever pivot point  121 , the second indicator segment  356  is associated with the second lever pivot point  122 , the third indicator segment  357  is associated with the third lever pivot point  123 , and the fourth indicator segment  358  is associated with the fourth lever pivot point  124 . It is provided, for example, that when one of the lever pivot points  121 ,  122 ,  123 ,  124  or the corresponding lever  131 ,  132 ,  133 ,  134  is displaced, the correspondingly associated segment  355 ,  356 ,  357 ,  358  lights up to indicate the actuation. Because two each of the levers are connected together and cannot be displaced independently of each other, it can also be provided that the first segment  355  is associated with the first motor, the fourth indicator segment  352  is associated with the second motor, the second indicator segment  356  is associated with the third motor, and the third indicator segment  358  is associated with the fourth motor when a drive  210  is provided for the manipulator device  100 . In this manner, spatial association of the four indicator segments  355 ,  356 ,  357 ,  358  with the corresponding actuated motors  211 ,  212 ,  213 ,  214  is provided. In this manner, the user can see which of the motors  211 ,  212 ,  213 ,  214  is actuated and in which direction the instrument or the first and second mounts  114 , 1   16  and the surgical instrument  102  received thereon will be displaced. 
     It can also be provided that a point of light runs along the path of the annular top or bottom indicator segments for assistance purposes in order to indicate a direction of motion of a lever  131  through  139 . This is particularly preferable if the manipulator device  100  is implemented as a passive manipulator device  100  and comprise a braking device  220 . When the brakes  221 ,  222 ,  223 ,  224  are released, the point of light displacing around or along an indicator segment  355 ,  356 ,  357 ,  358  can be used in this manner for indicating a direction in which a user must displace the surgical instrument  102  in order to bring the same to a pivot point, for example, or to another predetermined pose. 
     Further options for indicating have been described above. Indicating is understood particularly in this sense to be placing the segments  352 ,  354  partially or completely in an illuminated state from a non-illuminated state; changing a color, changing an intensity, changing a flashing frequency or intensity variance frequency, indicating one or more partially circulating points of light by means of a higher or lower intensity or a different color. 
     In a further embodiment, it can also be provided that the indicator device  350  comprises one or more infrared light sources by means of which the indicator device  350  can communicate with a surgical navigation system. The infrared light is preferably connected with the remainder of the LEDs and thus indicates the same state as the indicator device  350  overall. This means that the infrared light can be used to inform a surgical navigation system that a motor has been activated, for example, or another state of the manipulator device  100  has been changed. 
     It can also be provided that said infrared light is used for wirelessly transmitting other data, particularly pivot point coordinates or the like, to the surgical navigation system. 
     Even though it is shown in the present embodiment example ( FIG.  25   ) that the segments  355 ,  356 ,  357 ,  358  together form a ring, in other embodiment examples it can also be provided that each of said segments  355 ,  356 ,  357 ,  358  is intrinsically annular and associate with a lever pivot point  121  through  129 . It can also be provided that the ring of the top and bottom indicator segments  352 ,  354  is not closed, or has a different geometry. It is also conceivable to provide further indicator devices or alternative indicator devices on the sides of the housing  104 . 
       FIG.  25    further shows the interface  106 . Said interface comprise a recess  360  at the center thereof having a plurality of flanks for coupling to a protrusion of a stand, mounting arm, or the like in a form-fit manner. A stud  362  is provided for locking the form-fit connection and engages in a corresponding recess on the protrusion of the mounting arm or stand, thus locking the form-fit connection. Said stud can be displaced upward with reference to 25 by pressing a pushbutton  364 . The pushbutton  365  is pretensioned in the locked position by means of a spring (cf.  FIG.  16 ,  17   ). 
     The interface  106  further comprises a plurality of electrical contacts reference in the present embodiment example overall as  366 . A collar  368  protrudes axially somewhat all around the interface  106 , and serves particularly for sealing off the interface relative to the surrounding area. The electrical contacts  366  are thus prevented from making contact with liquids or the like.