Patent Publication Number: US-2006020167-A1

Title: Medical devices for minimally invasive surgeries and other internal procedures

Description:
FIELD OF THE INVENTION  
      In certain embodiments, the present invention relates to medical devices for internal use in a patient&#39;s body and, in particular, devices related to minimally invasive surgeries and other medical procedures.  
     BACKGROUND OF THE INVENTION  
      Various tools and procedures are known for use in minimally-invasive surgery. These tools and procedures are favored over “open” surgical techniques as the minimally-invasive techniques reduce patient discomfort and facilitate rapid healing and recovery. “Open” surgical techniques typically require the use of large incisions to gain entry to the interior of the body. “Open” surgeries also typically require a longer post-operative hospital stay and cause increased post-operative pain. The large incisions of “open” surgeries may leave large and sometimes unsightly scars.  
      Minimally-invasive surgical procedures, on the other hand, may often be conducted on an outpatient basis. Minimally invasive surgeries are often performed with relatively small surgical incisions or ports which, in contrast with the large incisions of “open surgery” have a decreased risk of infection. Minimally invasive surgery is also desirable for the benefit of generally avoiding much of the internal damage resulting from the larger incisions of “open” surgeries, such as the cutting of abdominal muscle and other tissue required to gain access to the abdominal body cavity in an “open” surgery. Because it is not as disruptive as “open surgery”, minimally invasive surgery may be used as a diagnostic tool, enabling a physician to visually inspect, and even sample, certain tissues.  
      The presently available devices for minimally invasive surgical procedures all have certain inherent disadvantages, including, without limitation, difficulty and/or discomfort in use of the devices, limited features, and sensory and sensitivity loss between the operator and the material being examined or manipulated. The presently available devices are also somewhat difficult to use due to the limited vision provided by the cameras that are available for a surgeon to see his or her work.  
      These disadvantages combine to sometimes render minimally invasive surgical procedures more difficult than is desirable. The difficulty of the procedures, the lack of tactile perception, and the limited working area may increase the likelihood of accidental damage to the organs, vessels, and other tissues surrounding the surgical area.  
      A need exists for minimally invasive surgical devices that provide a surgeon with a wider variety of options than is presently available. Further, it is desirable to provide minimally invasive surgical devices that do not include the disadvantages of the presently-available devices.  
     SUMMARY OF THE INVENTION  
      One object of the present invention is to provide new devices useful for minimally invasive surgeries and other procedures which are performed within a patient&#39;s body that allow a surgeon to minimize unnecessary damage to the organs, vessels, and other tissues surrounding the surgical area.  
      A further object of the invention is to provide devices which facilitate an expanded field of vision during minimally invasive surgeries and other internal procedures.  
      Another object of the invention is to provide devices which facilitate easier handling and manipulation of instruments for minimally invasive surgeries and other internal procedures.  
      Another object of the invention is to provide devices for minimally invasive surgeries and other internal procedures which facilitate increased tactile and/or visual perception for the surgeon.  
      Yet another object of the invention is to provide devices for minimally invasive surgeries and other internal procedures which expand the range of options available to a surgeon.  
      According to one embodiment of the invention, an optical device is provided for minimally invasive medical procedures that facilitates stereoimagery through the use of multiple image acquisition devices. The optical device includes a plurality of linear image acquisition devices, and at least two of the linear image acquisition devices are adapted to receive an image from within a patient&#39;s body. The optical device also includes a linear housing laterally surrounding the linear image acquisition devices so that the linear image acquisition devices extend toward one end of the housing. The housing is such that at least a portion of it may be inserted within a patient&#39;s body and the housing is also adapted for cleaning. At least one input adjustment device is disposed upon at least one end of the plurality of linear image acquisition devices and the input adjustment device may include a lens and/or a reflective surface.  
      According to another embodiment of the invention, a medical device is provided with a hand piece, an instrument portion including a tool, and one or more control elements. The control elements are useful to operate or manipulate features of the device. One of the control elements may be a trigger. The hand piece may be configured for a right hand of a user, or a left hand of a user, or for use by either hand of a user.  
      According to another embodiment of the invention, a device for minimally invasive medical procedures is provided. The device includes a scissor-type hand piece with a first elongated portion and a second elongated portion. The first elongated portion is adapted for manipulation by a user&#39;s thumb and the second elongated portion is adapted for manipulation by one or more of a user&#39;s first, second, third, and fourth fingers. A temperature control element may also be provided to generate a signal upon manipulation of the control element. A tool is also provided, and is responsive to the signal generated by the temperature control element. In response to the signal of the temperature control element, at least a portion of the tool heats up, so as to be useful to cauterize tissue. Optionally, the tool may be detachable from the device.  
      According to another embodiment of the invention, a tool for use in minimally invasive medical procedures is provided. The tool includes an elongated first element, an elongated second element, and an elongated third element. The first and second element are opposed to the third element. The first element is configured to mimic the functionality of a first finger of a user, and the second element is configured to mimic the functionality of a second finger of a user. The third element is configured to mimic the functionality of a third finger of a user. Each of the first element, second element, and third element are configured to transmit a pressure sensation from that element to a user&#39;s finger.  
      According to another embodiment of the invention, an automated device for minimally invasive medical procedures, is provided. The device includes a robotic console, a plurality of control features, and one or more robotic limbs. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       FIG. 1   a  shows a cross-sectional view of an optical device in accordance with one embodiment of the invention;  
       FIG. 1   b  shows a cross-sectional view of an optical device in accordance with another embodiment of the invention;  
       FIG. 2   a  depicts a portion of an optical device in accordance with an embodiment of the present invention;  
       FIG. 2   b  depicts a portion of an optical device in accordance with another embodiment of the present invention;  
       FIG. 2   c  depicts a portion of an optical device in accordance with another embodiment of the present invention;  
       FIG. 3  shows a block diagram of a system according to an embodiment of the invention;  
       FIG. 4   a  shows a lateral view of certain components of an optical device in accordance with an embodiment of the invention;  
       FIG. 4   b  shows a cross-sectional view of an optical device in accordance with one embodiment of the invention;  
       FIG. 4   c  shows a top view of an optical device in accordance with one embodiment of the invention;  
       FIGS. 4   d ,  4   e ,  4   f ,  4   g ,  4   h ,  4   i ,  4   j  and  4   k  show a lateral views of a portion of an optical device in accordance with an embodiment of the invention;  
       FIG. 5   a  shows a lateral view of certain components of a medical device in accordance with an embodiment of the invention;  
       FIG. 5   b  shows a lateral view of certain components of a medical device in accordance with an embodiment of the invention;  
       FIG. 5   c  shows a schematic diagram of certain components of a medical device in accordance with an embodiment of the invention;  
       FIG. 6  shows a lateral view of certain components of a medical device in accordance with an embodiment of the invention;  
       FIG. 7   a  shows a lateral view of a medical device in accordance with an embodiment of the invention;  
       FIG. 7   b  shows a lateral view of the medical device of  FIG. 7   a  in a different position;  
       FIG. 8  shows a lateral view of a medical device in accordance with an embodiment of the invention;  
       FIG. 9  shows a lateral view of a medical device in accordance with an embodiment of the invention;  
       FIGS. 10   a ,  10   b ,  10   c ,  10   d , and  10   e  show various lateral views of components for use as part of medical devices in accordance with certain embodiments of the invention;  
       FIGS. 11   a ,  11   b ,  11   c , and  11   d  show lateral views of components for use as part of a medical device in accordance with certain embodiments of the invention;  
       FIGS. 12   a ,  12   b  and  12   c  show lateral views of tools for use as part of a medical device in accordance with certain embodiments of the invention;  
       FIG. 13   a  shows a lateral view of an ultrasonic device in accordance with one embodiment of the invention;  
       FIG. 13   b  shows a screen image for use with the ultrasonic device of  FIG. 13   a , in accordance with one embodiment of the invention;  
       FIG. 13   c  shows two ultrasonic probes for use with an embodiment of the invention;  
       FIG. 14   a  shows an laser in accordance with an embodiment of the invention;  
       FIG. 14   b  shows a screen image for use with the laser device of  FIG. 14   a , in accordance with an embodiment of the invention;  
       FIG. 15   a  shows a lateral view of a medical device in accordance with an embodiment of the invention;  
       FIG. 15   b  shows a lateral view of another medical device in accordance with an embodiment of the invention;  
       FIG. 16  depicts a variety of components for use with certain medical devices of the present invention;  
       FIG. 17  shows a variety of different cautery devices for use in accordance with certain embodiments of the invention;  
       FIGS. 18   a  and  18   b  depict a device for use in accordance with certain embodiments of the invention;  
       FIGS. 19   a ,  19   b  and  19   c  depict another device for use in accordance with certain embodiments of the invention;  
       FIGS. 20   a  and  20   b  depict arrangements for stapling tissue in accordance with certain embodiments of the invention;  
       FIG. 21   a  depicts a suturing device in accordance with an embodiment of the invention;  
       FIG. 21   b  depicts a portion of the suturing device of  FIG. 21   a;    
       FIGS. 21   c  and  21   d  depict a lateral view of a suturing device in accordance with an embodiment of the invention;  
       FIGS. 21   e ,  21   f  and  21   g  depict views of a portion of another suturing device in accordance with an embodiment of the invention;  
       FIG. 21   h  depicts a lateral view of a suturing device in accordance with an embodiment of the invention;  
       FIGS. 21   i  and  21   j  depict views of a portion of the suturing device of  FIG. 21   h;    
       FIGS. 21   k  and  21   l  depict cross-sectional views of a portion of the suturing device of  FIG. 21   h;    
       FIGS. 21   m ,  21   n ,  21   o ,  21   p ,  21   q ,  21   r , and  21   s  depict lateral views of various portions of devices in accordance with certain embodiments of the invention;  
       FIG. 22   a  depicts a bobbit-style suture holder device for use in accordance with certain embodiments of the invention;  
       FIG. 22   b  depicts a base for use in accordance with a suturing device such as that depicted in  FIG. 21   a , and a bobbit assembly such as that depicted in  FIG. 22   a;    
       FIG. 22   c  depicts an arrangement similar to that shown in  FIG. 22   a , with an external bobbit assembly;  
       FIG. 22   d  depicts a suture catcher for use in accordance with certain embodiments of the invention;  
       FIGS. 22   e ,  22   f ,  22   g ,  22   h ,  22   i ,  22   j ,  22   k ,  221 ,  22   m ,  22   n ,  22   p ,  22   o ,  22   q ,  22   r ,  22   t ,  22   s ,  22   u  and  22   v  depict views of portions of a suturing device in accordance with an embodiment of the invention;  
       FIG. 23   a  depicts a rivet driver in accordance with another embodiment of the invention;  
       FIG. 23   b  depicts the components of a fastener in accordance with an embodiment of the invention;  
       FIG. 23   c  depicts another view of the components of a fastener, such as that shown in  FIG. 23   b;    
       FIG. 23   d  depicts another view of the components of a fastener, such as that shown in  FIG. 23   b;    
       FIG. 23   e  depicts another view of the components of a fastener, such as that shown in  FIG. 23   b;    
       FIG. 23   f  depicts a cartridge for a group of fasteners such as the fastener shown in  FIG. 23   b;    
       FIGS. 23   g ,  23   h ,  23   i , and  23   j  depict views of various portions of fastening devices in accordance with certain embodiments of the invention;  
       FIG. 24   a  depicts a needle driver for use in accordance with certain embodiments of the invention;  
       FIG. 24   b  depicts a needle similar to that shown in  FIG. 24   a , with the bevel lock in an open position;  
       FIG. 24   c  depicts a needle similar to that shown in  FIG. 24   a , however the needle of  FIG. 24   c  has an inverted bevel;  
       FIG. 24   d  depicts the needle of  FIG. 24   c , with the bevel lock in an open position;  
       FIG. 24   e  depicts various needles for use in accordance with certain embodiments of the invention;  
       FIG. 25   a  depicts various needles for use in accordance with certain embodiments of the invention;  
       FIGS. 25   b ,  25   c ,  25   d ,  25   e ,  25   f  and  25   g  depicts cross-sectional views of certain needles for use in accordance with certain embodiments of the invention;  
       FIG. 26  depicts a pistol-style ligation device in accordance with certain embodiments of the invention;  
       FIG. 27   a  depicts one embodiment of a grasping rod for use in accordance with one embodiment of the invention;  
       FIG. 27   b  depicts another embodiment of a manipulation or grasping rod for use in accordance with an embodiment of the invention;  
       FIG. 27   c  depicts a manipulation or grasping rod for use in accordance with an embodiment of the invention;  
       FIG. 27   d  depicts an adhesive ligation staple rod for use in accordance with an embodiment of the invention;  
       FIG. 27   e  depicts an adhesive stapler loading device in accordance with an embodiment of the invention;  
       FIG. 27   f  depicts an injector which injects an adhesive substance into a compressor mold in accordance with one embodiment of the invention;  
       FIG. 27   g  depicts an injector similar to that shown in  FIG. 27   f;    
       FIG. 28   a  depicts a fastener for use in accordance with an embodiment of the invention;  
       FIG. 28   b  depicts the fastener of  FIG. 28   a  in a closed position;  
       FIG. 28   c  depicts a view of a fastener similar to that shown in  FIG. 28   a , in a different position;  
       FIG. 29   a  depicts a fastener similar to that depicted in  FIG. 28   a  for use in accordance with an embodiment of the invention;  
       FIG. 29   b  depicts the fastener of  FIG. 29   a  in a closed position;  
       FIG. 29   c  depicts the fastener  FIG. 29   a  in another closed position;  
       FIG. 30   a  depicts a circular stapler device in accordance with an embodiment of the invention;  
       FIG. 30   b  shows the circular stapler device of  FIG. 30   a  in another position;  
       FIGS. 31   a ,  31   b , and  31   c  depict portions of a circular stapler similar to the circular stapler shown in  FIGS. 30   a  and  30   b.    
       FIGS. 32   a  and  32   b  depict views of a circular staple head;  
       FIG. 33  depicts a portion of a circular stapler in accordance with an embodiment of the invention;  
       FIG. 34  depicts a side view of a portion of a circular stapler in accordance with an embodiment of the invention;  
       FIG. 35  depicts a side view of a surgical device in accordance with an embodiment of the invention;  
       FIG. 36   a  depicts a side view of a surgical device similar to that shown in  FIG. 35 ;  
       FIG. 36   b  depicts a side view of a portion of the surgical device of  FIG. 36   a;    
       FIG. 37   a  depicts a portion of a medical device in accordance with an embodiment of the invention;  
       FIGS. 37   b ,  37   c ,  37   d ,  37   e , and  37   f  depict views of different embodiments of a components for use with a medical device similar to that shown in  FIG. 37   a;    
       FIG. 38  shows a side view of a portion of a medical device for use in accordance with an embodiment of the invention;  
       FIG. 39  shows a side view of a medical device in accordance with another embodiment of the invention;  
       FIG. 40   a  depicts a view of a medical device in accordance with another embodiment of the invention;  
       FIG. 40   b  depicts a view of a portion of a medical device for use in accordance with a device similar to that shown in  FIG. 40   a;    
       FIGS. 40   c  and  40   d  depict a view of a portion of a medical device for use in accordance with a device similar to that shown in  FIG. 40   b;    
       FIG. 40   e  depicts a view of a device for use in accordance with a medical device similar to that shown in  FIG. 40   b;    
       FIG. 41  depicts a view of a device similar to that shown in  FIG. 40   a , in accordance with an embodiment of the invention;  
       FIG. 42  depicts a view of a device for use in accordance a medical device similar to that shown in  FIG. 41 , in accordance with another embodiment of the invention. 
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS  
      The present invention may be understood by reference to the following detailed description of particular embodiments of the invention. The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting.  
      In one embodiment, the present invention provides an optical device for minimally invasive surgery that allows the user to view multiple images in a variety of arrangements or formats. The device achieves this by using multiple image acquisition devices. Each image acquisition device obtains an image and transmits it to a display device capable of displaying the images in multiple formats. In one embodiment, the device allows a user to switch between binocular and trinocular image presentation.  
      In one embodiment, an optical device is provided with two image acquisition devices.  FIG. 1   a  presents a cross-sectional view of such an optical device  2 . A housing  4  laterally surrounds two linear image acquisition devices  6   a  and  6   b . The housing  4  extends linearly along the image acquisition devices  30   a  and  6   b . At least a portion of the housing  4  is configured so that it may be inserted within a patient&#39;s body. Similarly, at least a portion of the housing  4  may be adapted for cleaning and sterilization so that the optical device  2  may be cleaned, sterilized, and reused.  
      The linear image acquisition devices  6   a  and  6   b  may be configured in accordance with any suitable means for image acquisition. For instance, the image acquisition devices  6   a  and  6   b  may be fiber optic cables or cameras which digitally capture an image and transmit it electronically. In the case of the later embodiment, the cameras are positioned at one end of the linear housing  4  with wiring or some other suitable means for transmission of an electronic signal extending through the linear housing  4 .  
      Image information may be transmitted with wireless transmitters: (electronic or optical). Electronic data is preferably set to a specific wavelength and frequency to keep it secure and avoid interference with other equipment, for instance nearby medical equipment such as electromagnetic imaging equipment. A short range optic “wireless” transmission may also be used, especially where wireless electronic transmission is or could be problematic.  
       FIG. 1   b  shows a cross-sectional view of another embodiment of an optical device wherein three image acquisition devices  6   a ,  6   b , and  6   c  are protected by a housing  4 , which laterally surrounds the linear image acquisition devices  6   a ,  6   b  and  6   c . This embodiment allows the optical device to collect three images for presentation to the user. In another embodiment (not shown) one or more light sources may be provided to provide lighting for the image acquisition devices  6   a ,  6   b , and  6   c . Alternatively, any of the image acquisition devices, for instance  6   b , may be replaced with a light source to provide illumination for image acquisition devices  6   a  and  6   c.    
       FIG. 2   a  depicts a view of a portion of an optical device such as that shown in  FIG. 1   a . In the portion of the optical device shown in  FIG. 2   a , two image acquisition devices  6   a  and  6   b  are provided. Each image acquisition device  6   a  and  6   b  is provided with an image adjustment device  8   a  and  8   b . The image adjustment device  8   a  and  8   b  may be any device suitable for manipulating an image, such as a prism, a lens, a reflecting mirror, or a combination of the foregoing.  
       FIG. 2   b  depicts a view of a portion of an optical device similar to that depicted in  FIG. 2   a . The portion of the optical device shown in  FIG. 2   b  includes two image acquisition devices  6   a  and  6   b . The image adjustment devices  8   a  and  8   b  are similar, to those shown in  FIG. 2   a , however in  FIG. 2   b , the image adjustment devices  8   a  and  8   b  are oriented differently so as to provide a different field of view for each of the image adjustment devices  8   a  and  8   b.    
       FIG. 2   c  depicts another view of a portion of an optical device similar to that depicted in  FIGS. 2   a  and  2   b , however in  FIG. 2   c , a single image adjustment device  10  is provided. This single image adjustment device  10  may be oriented so as to provide two images. One of each of the images is provided to a separate image acquisition device (not shown).  
       FIG. 3  depicts a system diagram of one embodiment of an imaging system  18  in accordance with the present invention. In this embodiment, a optical device  20  consists of a plurality of linear image acquisition devices  22   a ,  22   b , and  22   c  and at least one input adjustment device  24 . A controller  26  is provided for receiving and responding to instructions to control the imaging system  18 . In particular, the controller  26  may be in communication with the input adjustment device  24  and the display system  28 . The controller  26  may control any number of a variety of features related to image acquisition, for instance, focusing the image or rotating a mirror disposed on the image acquisition devices so as to rotate or change the view displayed by the imaging system  18 . Additionally, or alternatively, the controller  26  may operate to control the display system  28 . In such an embodiment, the controller  26  may control a variety of different features associated with a display device, for instance, the tint, color, brightness, sharpness, contrast or any of a variety of other features known to be adjustable in image acquisition devices. Further, the controller  26  may direct what display format the images acquired by the optical device  20  are displayed in. For instance, where two image acquisition devices (not shown) are used, the image may be displayed in either a single image or a left/right image format as two images beside each other. Where three image acquisition devices  22   a - c  are utilized, the third image may be presented as a screen insert. In yet another alternative where multiple image acquisition devices are used, images from any one or combination of the image acquisition devices may be selected for presentation on the display system  28 .  
      The display system  28  may be either a traditional television style display device with a monitor and a screen, a goggle style display device with an eyeglass-type frame that presents a separate image to each eye of the user, or a combination of one or more of these. In the latter case, the images may vary between the eyes so that the left eye receives a left image provided one linear image acquisition device and the right eye receives a right image obtained by a different linear image acquisition device. Alternatively, a third image may be presented in one or both of the left eye and right eye image as an insert or, where desired by the user, as a complete replacement for either the left or right eye. Any of these options may be selected by the user through the operation of the controller  26 . Where the display system  28  includes an eyeglass-frame type display device, it may optionally be configured so that the display screen of one or both eyes may be slipped up or down so as to be moved in front of entirely clear of one or both eyes of the user. In one embodiment, multiple display devices are provided.  
      In one embodiment, the controller  26  operates through voice activation so that the user need only verbally audibilize commands directing the controller  26  to perform some function or change in the operation of the imaging system  18 . Alternatively, or in combination with voice operation, the controller  26  may provide features for manual manipulation by the user, including various control elements such as buttons, switches, dials, or any other control element which allow a user to control one or more functions of the imaging system  18 .  
       FIG. 4   a  depicts two linear image acquisition devices  6   a  and  6   b , each of them with an input adjustment device  36   b  and  36   b  disposed at the end of the linear image acquisition device  6   a  and  6   b . Each input adjustment device  36   a  and  36   b  provides a mechanism to manipulate the image it acquires through the image acquisition device  6   a  or  6   b . The input adjustment device  36   a  and  36   b  may be either a mirror or a lens or a combination of one or more of both of them to amplify and/or focus the image. In one embodiment, lenses are provided which enable magnification of the image in a range from 0 to 40 times magnification. This magnification capability can be applied to all lenses or to a single lens. In the case of a binocular optical device which includes two image acquisition devices  6   a  and  6   b  or where only two of a plurality of image acquisition devices are selected for operation, the magnification may be applied to a single lens. This lens may provide magnification adjustable between zero and up to 40 times. This may be useful to provide multiple views of the same subject or collection of subjects. In another embodiment, the input adjustment devices  36   a  and  36   b  may be configured to provide digital manipulation of the image to amplify, magnify or focus as desired by the user. This digital manipulation may be provided in combination with, or as a substitute for, one or more mirrors and/or lenses for manipulation of an image.  
       FIG. 4   b  depicts various views that may be obtained where three image acquisition devices are provided. In  FIG. 4   b , the right view field  42   a  is depicted R, and the left view field  42   b  is depicted L, while the rear or posterior view field  42   c  is depicted P. A lens  44   a ,  44   b , or  44   c  is associated with each of the respective view fields,  42   a ,  42   b , or  42   c . From  FIG. 4   b  it can be appreciated how a user would be provided an advantage over systems which include only two view fields, by way of an additional viewing field with the posterior view  42   c . One can also appreciate how the left view field  42   b  and the right view field  42   a  may combine to give a complete, or seamless view field. In one embodiment, the left view field  42   b  and the right view field  42   a  combine to give a field from approximately 0 to 180° while the posterior  42   c  view field may be used to give a view field from approximately 190 to 350°. Alternatively, the various fields  42   a ,  42   b , and  42   c  may be configured so that one or more of them overlap, or so that each of them is entirely separate.  
       FIG. 4   c  provides another depiction of the various views  42   a ,  42   b , and  42   c  that may be obtained in accordance with certain embodiments of the invention. As can be seen in  FIG. 4   c , the optical device (not shown) may be arranged so that the various views  42   a ,  42   b  and  42   c  are essentially contiguous with one another. Alternatively, two or more of the views  42   a ,  42   b , and  42   c  may overlap, or the views  42   a ,  42   b , and  42   c  may be entirely separate from one another.  
       FIG. 4   d  shows a lateral internal view of an optical device  50  in accordance with an embodiment of the invention. The optical device  50  is provided with at least one image transmission apparatus such as optic cable  52 , which is preferably flexible. The optical cable  52  may optionally be provided with an image capture mechanism  54 , such as a camera or lens. One or more light sources  56   a  and  56   b  may also be provided to illuminate the area under examination or surgery. Reflective surfaces, such as mirrors  58   a  and  58   b , may also be provided as necessary or desirable. The mirrors  58   a  and  58   b  may be used to redirect the light from the light sources  56   a  and  56   b  or to redirect an image into the image transmission apparatus such as optic cable  52 . A lens  60  may be provided to further modify and adjust one or both of the light from the light sources  56   a  and  56   b  or the image being directed to the image transmission apparatus such as optic cable  52 . Further, a protective lens  62  may be provided on or near the outside of the optical device  50 .  
      Thus, one can appreciate that multiple lenses may be used to increase the viewing field of the device. These multiple lenses may be or may include a spheroid lens cover or a spheroid lens. The spheroid lens cover  64   a  and spheroid lens  64   b  are shown in  FIGS. 4   e  and  4   f , respectively. Each of these may serve as a wider optical lens which will amplify and/or expand the viewing field  66  of the internal lens  68 . In particular, the spheroid lens cover  64   a  and/or spheroid lens  64   b  may be used to expand the visual field  66 , for instance, to 180°, effectively expanding the visual field  66  into a trapezoidal shape with a greater width at the edge further away from the internal lens  68 . The internal lens  68  may be used to magnify or otherwise modulate the viewing field  66 .  
      Further, the spheroid lens cover  64   a  and/or spheroid lens  64   b  may be stacked as shown in  FIGS. 4   g ,  4   h  and  4   i , along with stacked internal lenses  68   a  and  68   b . As shown in  FIG. 4   h , the internal lenses  68   a  and  68   b  are positioned at an angle relative to each other and two spheroid lens covers  64   a  are provided.  FIG. 4   i  depicts another arrangement, wherein the internal lenses  68   a  and  68   b  are positioned laterally so that the viewing fields  66  overlap.  
       FIGS. 4   j  and  4   k  depict spheroid lens  64   b  arrangements similar to those shown in  FIG. 4   i , with the exception that the embodiments shown in  FIGS. 4   j  and  4   k  use a single internal lens  68   a  with multiple spheroid lenses  64   b . As one skilled in the art would appreciate, a variety of arrangements are feasible. In  FIG. 4   j , the spheroid lenses  64   b  are stacked to arrive at generally adjacent viewing fields  66 .  FIG. 4   k  shows the spheroid lenses  64   b  stacked so that the result in overlapping viewing fields  66 .  
      The stacking concept described above may be applied to any variety of optic faces as desirable or necessary. Additionally, the spheroid lenses and lens covers described above may be provided with further protective lens covers which are shaped so as to provide no optical modulation or distortion. Rather, these protective lens covers serve to protect the optics from their external environment.  
      In another aspect of the invention, a medical device is provided which allows a surgeon to manipulate one or more tools inside a patient, while inserting little more than the tool portion of the device within the patient.  FIG. 5   a  depicts a medical device  80  in accordance with such an embodiment of the invention; In this embodiment, a hand piece  82  is provided that accepts either a right hand, or a left hand of a user. In certain embodiments, the hand piece  82  is configured to accept a gloved hand. The hand piece  82  may also be configured bilaterally, to universally accept either hand of a user. In certain embodiments, the hand piece  82  may be sized so as to accept a particular hand size, for instance, a size 6-8 hand as measured for surgeon&#39;s gloves. The hand piece  82  may include separate portions for a user&#39;s fingers  84   a - e . One or more of these portions for a user&#39;s fingers  84   a - e  may optionally be combined, so that a user&#39;s fingers rest within a mitten-like area (not shown).  
      In one embodiment, one or more pressure sensors  86   a - d  are provided. Each pressure sensor  86   a - d  detects the amount of pressure being applied by the relevant finger. This information is passed along to a mechanism (not shown) associated with the instrument portion (not shown) which operates a tool (not shown). The mechanism is responsive to the amount of pressure being applied by a particular finger and adjusts the operation of the tool accordingly. In this way, when a user exerts more force upon a pressure sensor  86   a - d , a greater force is implemented by the tool. In such an embodiment, the tool may be such that one aspect of the tool is fixed. For instance, where the tool is forceps, one prong of the forceps may be fixed, and the other mobile. Alternatively, or in combination with this pressure system, the tool and mechanism may be configured to transmit to the user any resistance to the pressure being applied by that user. For instance, if the tool is a forceps, once the forceps reach a point at which they can no longer close any further due to the complete compression of the tissue or other material being grasped, the lever  88  being used to operate the forceps would similarly not close any further. In this way, the user experience is as though the user were working directly with the material being manipulated, rather than through the various mechanical or electronic linkages provided by the medical device  80 .  
      The medical device includes an instrument portion  100  (shown in  FIG. 5   b ), and one or more devices or control elements to allow a user to manipulate a tool (not shown). The tool is associated with the instrument portion  100  or some other feature of the medical device  80 . In one embodiment, a trigger (not shown) and a lever  88  are provided to manipulate the tool. In an embodiment with a trigger, the trigger may be manipulated by squeezing a finger of a user by to cause some operation of the tool. For instance, squeezing the trigger may cause a tool to rotate. The lever  88  may be operated by squeezing one or more fingers, thereby also manipulating the tool. In alternate embodiments, the operations of the lever  88  and the trigger may be reversed or may be otherwise provided by buttons or switches or some other control element or combination of control elements.  
      In  FIG. 5   b , the instrument portion  100  is shown. The instrument portion  100  houses and includes mechanisms for manipulation and operation of a tool  102 . A trigger (not shown) may operate to cause the tool  102  to rotate in the direction of arrow B, from position I to position II. In one embodiment, the tool  102  rotates to one of several preset positions, for instance, the tool  102  may be at an angle of 0, 45, or 90 degrees in relation to the instrument portion  100 . When set at an angle of 0 degrees, the tool  102  is in a straight line in relation to the instrument portion  100 . In another embodiment, the tool  102  may be set at anywhere between an angle of from 0 degrees to about 90 degrees in relation to the instrument portion  100 .  
      Referring to  FIGS. 5   a  and  5   b , the interaction of the various components of the device may be more fully appreciated. A transcutaneous shaft  104  engages an internal shaft  106 . The internal shaft  106  is optionally removably attached to the transcutaneous shaft  104  and linearly extends away from the transcutaneous shaft  104 . The internal shaft  106  is attached to the tool  102 . The tool  102  may optionally be detachable from the internal shaft  106 . A knob  108  may be provided and is operable to cause the internal shaft  106 , and any attached tool  102 , to rotate, for instance in the direction of arrow A. Alternatively, the knob  108  may be provided further up the transcutaneous shaft  104 , or the function of the knob  108  may be provided by some other control element provided with the hand piece  82 .  
      In the embodiment of  FIG. 5   b , the tool  102  is depicted as forceps. In accordance with the present invention, the tool  102  may be a wide variety of other useful devices, especially where such devices are useful in medical procedures. For instance the tool  102  may be forceps, flat scissors, curved scissors, right angle scissors, DeBakey-type forceps, right angle forceps, blunt forceps, curved clamps, angular clamps, an ultrasound probe, a laser, a cautery device, a staplers, a knife, a suturing device, a rivet driver, a ligation device, an aspiration device, an injection device, a biopsy device, a radiotherapy device; or a radioactive emitter loading device. The tool is preferably one of three types. The first type of tool is configured for a single use on a patient and is then discarded. A second tool type is replaceable and preferably sterilizable. In such a device the entire instrument may be cleaned and sterilized for repeated use or the tool itself may be removed for cleaning and sterilization. In a third tool type, a variety of different tools may be interchangeably used with a single device, and may be detached and reattached to the device as required by a user.  
       FIG. 5   c  depicts an schematic showing an arrangement of pressure sensors that may be used in accordance with certain embodiments of the invention. In the arrangement of  FIG. 5   c , pressure sensors  116   a - d  are provided for the thumb and first three fingers, respectively. As described above, the mechanism which operates the tool is responsive to the amount of pressure being applied by a particular finger and adjusts the operation of the tool accordingly. The mechanism which operates the tool may be either mechanical or electrical in nature, or may be a combination of both.  
      Pressure sensors  118   a  and  118   b  may also be provided for the tool of a medical device, in accordance with certain embodiments of the invention. In one embodiment, the tool is a pair of forceps, one of which is fixed and the other mobile. The pressure sensors  118   a  and  118   b  may be used in such an arrangement to detect the pressure being placed upon the forceps. The pressure sensors  118   a  and  188   b  are configured so that the pressure they sense is transmitted back to the user, through a mechanical or electrical mechanism, as previously described. Alternatively, the mechanism used to transmit the pressure signal generated by the pressure sensors  118   a  and  118   b  is both mechanical and electrical in nature.  
      Referring to  FIG. 6 , another embodiment of a medical device  130  is depicted. This device  130  includes a cauterization button  132 . The cauterization button  132  is associated with a mechanism in the tool (not shown) which causes at least a portion of the tool to heat up so as to permit a user to cauterize tissue. In one embodiment activation of the cauterization button  132  closes an electrical circuit (not shown) so that a voltage is delivered to the tool which is then ready to provide electro-cautery to tissue. Once the cauterization button  132  is deactivated, the electricity is no longer delivered to the tool and the tool cools off. The medical device  130  is generally insulated from the electric circuit so that an electrical charge is not unintentionally transmitted to other parts of the medical device  130  or to the user. Optionally, the function of the cauterization button  132  may be provided by a different control element or feature.  
      Where the hand piece  134  includes separate finger portions  136   a - d , the hand piece  134  may be configured so that a user&#39;s hand fits entirely or partially with the hand piece  134 . In such an embodiment, the hand piece  134  includes an interior portion (not shown) configured to accept a user&#39;s hand, and preferably to accept a gloved hand. The interior portion is accessed through an opening  138  in the hand piece  134  of sufficient size to allow a user&#39;s hand, or part of a hand, to enter the interior portion of the hand piece  134 . The trigger  140  and trigger guard  142  are positioned for easy access by the user&#39;s index finger. A grip, or palm rest  144  may also be provided within the interior space of the hand piece  134 . The grip or palm rest  144  facilitates easy manipulation of the medical device  130 , and helps to provide the user a firm grasp of the device  130 , and prevent slippage. A rotation knob  146  for the internal shaft  148  is also depicted in this view.  
       FIG. 7   a  depicts a medical device  160  in accordance with another embodiment of the invention. A scissor-type hand piece  162  is provided with a first elongated portion  164   a  and a second elongated portion  164   b . Together, the first elongated portion  164   a  and the second elongated portion  164   b  are moveable towards each other, much like the operation of the handle of a pair of scissors. Movement of these elongated portions  164   a  and  164   b  in the path of arrow C operates the tool  166 . A cauterization button  168  is provided and operates in a manner similar to that previously described. Another button  170  rotates the tool  166  at an angle relative to the device  160 . This button  170  operates in a manner similar to that previously described with respect to the trigger of other embodiments of the invention. This embodiment is depicted with an alternative single shaft  172 , which is rotatable in relation to the hand piece  162 , for instance in the path of arrow D. A rotation knob  174  is provided to facilitate a user&#39;s rotating the shaft  172 . As with the other embodiments, the control elements are not limited to the particular arrangement shown.  
       FIG. 7   b  shows a lateral view of the medical device  160  of  FIG. 7   a  in a different position. In  FIG. 7   b , the scissor-type hand piece  162  is in a closed position. In particular, the first elongated portion  164   a  and the second elongated portion  164   b  are moved toward each other.  
       FIG. 8  depicts a pistol-handled medical device  186  in accordance with another embodiment of the invention. In this device  186  a pistol style handle  188  is provided which fits into the palm of a user&#39;s hand. In other respects, the medical device  186  is similar to those previously depicted. A cauterization button  190  is provided, as is a lever  192  for operation of the tool  194 . A trigger guard  196  is also provided, as is a trigger  198  for rotation of the tool  194  in relation to the device  186 . This embodiment is depicted with a single transcutaneous shaft  200  and a detachable tool  194  affixed to the end of the single shaft  200 . A rotation knob  202  is also provided to facilitate rotation of the single shaft  200  and the tool  194  thereon.  
       FIG. 9  depicts another medical device  214  with a palm/wrist circumferential band  216  and sleds  218   a - d  for the thumb and middle, ring, and little fingers. The band  216  is useful to secure the device  214  to a user&#39;s hand and to prevent slippage. In other respects, the medical device  214  is similar to that depicted in  FIG. 8 . A handle (not shown) may be provided for a user to grip with the hand much like the pistol style handle of the embodiment shown in  FIG. 8 . A cauterization button  220  is provided, as is a lever  222  for operation of the tool (not shown). A trigger guard  224  is also provided, as is a trigger  226  for rotation of the tool in relation to the device  214 . This embodiment is depicted with a single transcutaneous shaft  228 , and a rotation knob  230  is also provided to facilitate rotation of the shaft  228  and the tool thereon.  
      The sleds  218   a - d  may be provided with pressure sensors  232   a - d  in the medical device  214  of  FIG. 9 . These pressure sensors  232   a - d  operate in substantially the same manner as that previously described in  FIGS. 5   a  and  5   c , providing sensory input between the user and the device with regard to the tissue density being encountered by the tool (e.g., soft tissue, firm tissue or bone) or the pressure being applied by the user upon the device  214 . The sleds may be constructed so as to achieve functionality similar to that achieved with the glove-handle of  FIG. 5   a.    
      Referring to  FIGS. 10   a ,  10   b ,  10   c ,  10   d  and  10   e  a variety of scissors-type tools for use with certain embodiments of the present invention are provided.  FIG. 10   a  shows a flat scissors tool  244  with a first cutting element  245   a  and a second cutting element  245   b . This scissors tool  244  may be provided in a variety of sizes, for instance as a small version of Mayo-type scissors. The scissors tool  244  may be rotated, for instance in the direction of arrow E. After such a rotation the scissors tool  244  may be in the position shown in  FIG. 10   b .  FIG. 10   c  shows a right-angled scissors tool  246  with a first cutting element  248   a  and a second cutting element  248   b . This scissors tool  246  may be provided in a variety of sizes and may function similar to Potts-style scissors. Further, this scissors tool  246  may be rotated, for instance in the direction of arrow F.  FIG. 10   d  shows a curved scissors tool  250  with a first cutting element  252   a  and a second cutting element  252   b . Each of the first cutting element  252   a  and second cutting element  252   b  are provided with a curved shape. This scissors tool  250  may also be provided in a variety of sizes and may function similar to dissection scissors, such as Metzenbaum-type scissors.  FIG. 10   e  shows a cauterizing scissors tool  254  with a first cutting element  256   a  and a second cutting element  256   b . Additionally, each cutting element  256   a  and  256   b  includes a heating element  258   a  and  258   b . Any of the foregoing scissors tools may be configured with heating elements for cauterizing tissue. Further, many of the other tools contemplated for use with the various medical devices of the invention may be provided with heating elements for cauterizing tissue. Each of the scissors tools  244 ,  246 ,  250 , and  254  may be rotated. This rotation may include both rotation about the axis of the shaft to which the tools are mounted and about an axis at an angle to that shaft, as described with respect to the previous tool embodiments.  
      Referring to  FIGS. 11   a ,  11   b , and  11   c , a variety of forceps tools for use with certain embodiments of the present invention are provided.  FIG. 11   a  shows a DeBakey style forceps tool  270  with a first grasping arm  472   a  and a second grasping arm  472   b . This forceps tool  270  may be configured so that it is suitable for vascular work, and other fine tissue handling. For delicate work, the forceps tool  270  may be configured to deliver only limited amounts of force, and need not be configured to deliver a crushing level of force. In one embodiment, the forceps tool  270  is provided with pressure sensors  274   a  and  274   b  which are useful to transmit a pressure sensation from the forceps tool  270  back to the user, as previously described, especially with reference to  FIGS. 5   a  and  5   c .  FIG. 11   b  shows the forceps tool  270  of  FIG. 11   a  in a closed position.  
       FIG. 11   c  depicts a right-angled forceps tool  276  with a first grasping arm  278   a  and a second grasping arm  278   b . Preferably this forceps tool  276  is constructed from a material with characteristics that are or are similar to metal or metallic materials, especially with regard to the material&#39;s density, strength, and flexibility. The tips of the forceps tool  276  may be configured in a variety of shapes, including fine, sharp tips, larger smooth blunt tips, or large blunt curved or right-angled tips.  
       FIG. 11   d  shows a blunt forceps tool  280  with a first grasping arm  282   a  and a second grasping arm  282   b . This forceps tool  280  may be configured similarly to blunt tip clamps often used in open procedures, such as a Babcock-style clamp. Each of the forceps tools  270 ,  276 , and  280  may be rotated as described above, both about the axis of the shaft to which they are mounted and about an axis at an angle to that shaft, as described with respect to the previous tool embodiments.  
      Preferably, the forceps tools  270 ,  276 , and  280  may be configured to mimic the action, and provide the sensation and operation of a common “open handed” forceps tool. The forceps tools  270 ,  276 , and  280  may be provided with spring action which must be overcome in order to close or approximate the forceps tool  270 ,  276 , and  280 . This spring action may provide a user with feedback useful to determine the mechanical pressure needed to close the forceps tool  270 ,  276 , and  280 . The forceps tools  270 ,  276 , and  280  may otherwise be provided with pressure sensors such as those depicted in  FIG. 11   a  as part of an electrical or mechanical pressure sensor-based feedback mechanism, as described previously. Further, the forceps tools  270 ,  276 , and  280  may include a combination of pressure sensors based feedback mechanisms and purely mechanical feedback mechanisms. An example of such a purely mechanical feedback mechanism would be the resultant feedback provided by a mechanical linkage as the tool reaches the limit of its range of motion. Where the control is mechanically linked to the tool, movement of the control is limited as the movement of the tool is limited.  
      Referring to  FIGS. 12   a  and  12   b , clamp tools for use with certain embodiments of the present invention are provided.  FIG. 12   a  shows a Cooley style clamp tool  300  with a first clamping arm  302   a  and a second clamping arm  302   b .  FIG. 12   b  shows a Satinski style clamp tool  304  with a first clamping arm  306   a  and a second clamping arm  306   b . This clamp tool  304  includes at least one angle in the clamping arms  306   a  and  306   b , which in some embodiments is from about 75 to 85 degrees. Each of the clamp tools  300  and  304  may be rotated as described above, both about the axis of the shaft to which they are mounted and about an axis at an angle to that shaft, as described with respect to the previous tool embodiments.  FIG. 12   c  depicts clamp tool  304  of  FIG. 12   b , in a different position, after the clamp tool was rotated.  
      While the clamp tools  300  and  304  may be configured similarly to the style of clamps used in open surgery, they are specially adapted for minimally invasive surgery. In certain embodiments the clamp tools  300  and  304  are adapted to collapse into a small size so as to fit through a trocar port, or other surgical incision, and then to expand upon deployment within a patient&#39;s body. A mechanical mechanism or combination of mechanisms may be provided to close or approximate the tips of the clamp tools  300  and  304 . The mechanical mechanism or mechanisms transmit the force of pressure applied by the user and preferably are adapted to provide the user feedback on the amount of resistance delivered to the clamp tools  300  and  304 . The clamp tools  300  and  304  may be configured so that they may be locked at a particular degree of closure or approximation.  
      Referring to  FIG. 13   a , an ultrasonic medical device  320  is provided. The ultrasonic medical device  320  is useful to image various tissues and structures of a patient. The device  320  can image solid, hollow, or blood or fluid filled structures. The device  320  can also measure the flow rate of vascular structures and can be used to provide graphic diagrams of tissue based on the selection of a user. For instance, a user may elect to view hepatic, lung, bone, bowel, spleen, vessel, ovary, uterine, or a variety of other types of tissue. The device  320  may be configured with a probe tip  322  that is smaller than that currently available for use with ultrasonic devices. Further, the device  320  is adapted for manipulation with a single hand so that it is easy to position and use.  
      The ultrasonic medical device  320  may be used in combination with an optical medical device, or other minimally invasive medical device as described herein. When use with an optical medical device the images produced by the devices may be combined in a single display for the convenience of the user.  FIG. 13   b  depicts a screen image with a combination of an visual image  330 , such as that obtained by a camera, and an inset ultrasonic image  332 . The ultrasonic image  332  may replace the visual image  330  entirely and the ultrasonic image  332  may include a diagrammatic depiction of the subject being imaged. For instance, the ultrasonic image  332  may include an outline of vessels with the pulse and/or flow rate determined and displayed along with the ultrasonic image  332 . The volume or size of fluid filled and other structures may also be calculated and depicted along with the ultrasonic image  332 .  
       FIG. 13   c  depicts two ultrasonic probe types for use in accordance with certain embodiments of the invention. One is a curvilinear probe  334  which images a cone shaped area  336  that progressively increases with increasing distance from probe  470 . A second type is a spherical probe  338  which images a rounded area  340  that generally extends in a 180 degree arc away from the spherical probe  338 . A third type of probe suitable for use with certain embodiments of the invention is a flat probe (not shown) which is useful for imaging vascular structures. In one embodiment, an ultrasonic device is provided that has may be used with multiple detachable probes, such that any of a variety of ultrasonic probes may be used.  
       FIG. 14   a  depicts a laser  350  in accordance with another embodiment of the invention. The laser  350  may be any suitable type of laser, and in one embodiment is an argon laser. The laser  350  is specially adapted for minimally invasive surgery to apply laser energy to a target selected by the user. The laser  350  is equipped with a tip  352  that is mobile, so that the user may maneuver it. In this way, the laser  350  may be positioned for delivery of laser energy in the vision field provided by a second medical device. The tip  352  may be attached to a flexible wand  354  which further facilitates convenient manipulation and direction of the laser energy. The laser  350  may be multi-directional such that laser energy is directed into one of several discreet areas surrounding the tip  352 .  
       FIG. 14   b  depicts a display screen  364  showing a control panel useful for controlling a laser, such as that depicted in  FIG. 14   a . The control panel is associated with a controlling computer (not shown) and allows a user to select from various laser intensity levels and effective distances from the laser tip. The control panel also provides a user the ability to select the direction of emission of the laser energy in relation to the laser tip. The control panel may be touch sensitive, or it may be provided with a separate keyboard and/or pointing device, such as a mouse (not shown) for the user to input instructions to the controlling computer.  
      In another embodiment, the present invention provides tools for tissue cautery.  FIG. 15   a  depicts a view of one embodiment of a forceps-type cautery device  380 . A scissors-style handle is provided with a first elongated portion  382   a  and a second elongated portion  382   b  similar to that shown in  FIGS. 7   a  and  7   b . A variety of controlling elements  384   a - c  such as knobs, buttons, or switches are provided to control the tool  386 . A first controlling element  384   a  may be used to activate or deactivate cautery. A second control element  384   b  may be used to orient the tool  386 , for instance rotating the tool  386  at an angle relative to the shaft  388  to which the tool  386  is mounted. A third control element  384   c  may be used to cause the tool  386  to retract or advance relative to the cautery device  380 . The tool  386  shown in the embodiment in  FIG. 15   a  is a forceps tool  386 , however a variety of other tools might also be used.  
       FIG. 15   b  depicts another cautery device  390 . This cautery device  390  is similar to that depicted in  FIG. 15   a , however a wand-type handle  392  is provided. This handle  392  allows the device  390  to be used by either hand singularly. The tool  394  in this embodiment is a cylindrical cautery tool. A variety of controlling elements  396   a - c  may also be provided. A separate cautery controller  398  may also be provided and is connected to the cautery device  390  by a cord  400 . The cautery controller  398  may include a variety of controller elements  402   a  and  402   b  which allow a user to adjust the intensity of the energy delivered to cauterize tissue or to turn the cautery function on or off, or to control some other aspect of the cautery device  390 . Although only described with reference to cautery device  390 , the cautery controller  398  may be used with a wide variety of cautery devices.  
       FIG. 16  shows a variety of different cautery tool tip types. These cautery tool tip types include the following: a flat tool  412  which is a dull square blade; a forceps tool  414  similar to the forceps cautery tool used in open surgery; a spherical ball tool  416  which provides a greater surface area for cauterizing more tissue; a rounded tool  418  which is blunt and may be provided as a relatively small tool; and a needle tool  420  for cutting or performing fine dissections. These cautery tools are configured so that they be used for probing, touching, and moving tissue without damage until the cautery function is activated by the user.  
       FIG. 17  depicts a stapler  440  in accordance with an embodiment of the invention. The stapler  440  is constructed to staple tissue and/or cut between the staple lines. The stapler  440  allows a user to simply staple tissue, or staple and then cut the stapled tissue. Alternatively, a user may decide to staple tissue and then cut the tissue using a cautery scissor or cautery wand to divide the tissue between the staple lines. The stapler  440  provides superior staple lines and is appropriately sized to be of particular use in minimally invasive surgical techniques. The stapler  440  includes a knife (not shown) that may cut in either a cold (ambient temperature) setting or a hot (e.g., a cautery temperature) setting. The stapler  440  may be configured for single handed operation.  
      In the stapler  440 , a handle  442  is provided that, in one embodiment, may be gripped by either the right or left hand of the user. A double lever system with a close lever  444  and a staple lever  446  is also provided. The close lever  444  operates to close the stapler about the tissue to be stapled. The staple lever  446  operates to actually staple the tissue together. A cut controlling element, for instance a button or switch  448 , engages the cutting function of the stapler  440  and a position controlling element  450  allows a user to rotate the position of the stapler tool  452  in relation to the stapler shaft  454 . The staple function and the cutting function of the stapler  440  may be manually or automatically driven. When the staple function is automatic, it may be either gas or electric or any other suitable method of automatically driving staples.  
      In one embodiment, the stapler tool  452  may be positioned at an adjustable angle from 0 to 90 degrees in relation to the stapler shaft  454 . In an alternate embodiment, the stapler tool  452  may be positioned at a preset angle of either 0, 45, or 90 degrees in relation to the stapler shaft  454 .  
      The stapler tool  452  may also include a lock function which operates to ensure that the tissue to be stapled and/or cut is not squeezed out before being stapled. If the tissue is squeezed out as the stapler is closed, a complication may arise resulting in bleeding or leakage from the staple line.  FIG. 18   a  depicts an embodiment where a lock  460  functions to substantially hold and secure the tissue in place before stapling and/or cutting. In  FIG. 18   a , the lock  460  is shown in an open position.  FIG. 18   b  depicts the same embodiment as FIG.  18   a , with the lock  460  in a closed position. In the closed position, the lock  460  is dropped on the two anvils  462   a  and  462   b  to hold the tissue in place. The anvils  462   a  and  462   b  are mounted in a V-configuration in relation to each other and one end of each of anvils  462   a  and  462   b  moves toward the other in order to staple tissue together. The use of the lock significantly increases the integrity and security of the staple line.  
       FIGS. 19   a ,  19   b  and  19   c  depict an alternate embodiment of a portion of a stapler device  470 . In this embodiment, the anvils  472   a  and  472   b  are mounted in a parallel arrangement to each other and the entire anvil  472   a  or  472   b  moves toward the other anvil  472   a  or  472   b  in order to staple tissue together.  FIG. 19   a  depicts a stapler  470  with the anvils  472   a  and  472   b  in an open position. The lock mechanism  474  is also in an open position. The lock mechanism of  FIGS. 19   a ,  19   b , and  19   c  operates similarly to that of  FIGS. 18   a  and  18   b , wherein the lock mechanism prevents tissue from being squeezed out of position when the anvils  472   a  and  472   b  are closed, but before the tissue is stapled.  FIG. 19   b  depicts the anvils  472   a  and  472   b  in an open position, with the lock mechanism  474  closed. In the position shown in  FIG. 19   b , the tissue is held in position by the lock mechanism  474 , however the anvils  472   a  and  472   b  are not yet closed together to effect driving a staple through the tissue.  FIG. 19   c  depicts an embodiment of a stapler  470  with parallel anvils  472   a  and  472   b  in a closed position. In  FIG. 19   c , anvils  472   a  and  472   b  are positioned almost immediately next to one another.  
      Optionally, the stapler  470  may staple and cut the tissue. In one embodiment the cut is performed with an unheated razor blade (not shown). Alternatively, the cut may be performed with a heated razor blade so that the tissue is cauterized as it is cut. Simultaneously cauterizing and cutting the tissue discourages excess bleeding from the cut tissue. Electrical energy may be applied to the blade or a separate cautery element (not shown) in order to sufficiently heat the tissue for cauterization.  
       FIGS. 20   a  and  20   b  depict arrangements for stapling tissue in accordance with certain embodiments of the invention. A double row of staple lines  490   a  and  490   b  is applied to one side of the cut  492  while a second double row of staple lines  494   a  and  494   b  is applied to the other side of the cut  492 . The cut  492  is separate from the edges of the nearer staple lines  490   b  and  494   b.    
       FIG. 20   b  depicts an additional option, where the tissue is compressed along a tissue compression lines  496   a  and  496   b  on the outermost side of the staple lines  490   a  and  494   a . With this option, the tissue is compressed prior to stapling or cutting so as to reduce blood flow to the region before stapling or cutting. This has the added effect of increasing the success of the stapling to control and restrict blood flow in all vessels (arteries, veins, and capillaries). Further, the compression may help to keep the tissue immobile for the stapling procedure, thereby assuring the stapling procedure creates a strong and secure fastener for the tissue or tissues being joined or closed.  
       FIG. 21   a  depicts a suturing device  740  in accordance with an embodiment of the invention. A firing gun  742  is provided with a needle  744  which is adapted to push suture material through tissue and withdraw it. The firing gun  742  includes a trigger  746  which, with each pull, causes the firing gun  742  to push the needle  744  and attached suture material through the tissue and then withdraw it. Alternatively, each pull of the trigger  746  may cause only a portion of the needle&#39;s movement, for instance the pushing of the needle  744  through the tissue. Then a separate pull of the trigger  746  would cause the needle  744  to be withdrawn from the tissue. A shaft  748  may be used to secure the firing gun  742  to a base  750  with a bobbit  752 . An internal bobbit  752  is depicted, although an external bobbit (not shown) may also be used.  
       FIG. 21   b  depicts a portion of the suturing device of  FIG. 21   a  as it operates. In operation the suture material  754  is grasped by the needle  744  upon passage to the bobbit assembly  752  and is then pulled through the tissue  756 . The needle  744  moves in the direction of arrow G. The needle  744  advances and after advancement, comes to a stop. With another trigger pull, the needle  744  withdraws. A portion of the suture material  754  is then on the other side of the tissue  756  (opposite the bobbit assembly  752 ) and is left in this position by the needle  744 . The needle  744  is then moved laterally along the tissue  756  and may descend through the tissue  756  to retrieve another portion of suture material  754 .  
       FIGS. 21   c  and  21   d  depict a needle driver device  500 . The needle driver device  500  is constructed to accept a straight needle and/or a curved needle. It includes two driver arms  502   a  and  502   b  which are pivotally attached, for instance by a hinge. A retractable guard  504  may also be provided. A separate hinge  506  may also be provided for one or more of the needle holders  508   a  and  508   b.    
       FIGS. 21   e ,  21   f  and  21   g  show a garrot style needle holder  520 .  FIG. 21   e  shows the garrot style needle holder  520  empty. A holder base  522  is provided, as is a garrot  524 . In  FIG. 21   e , the garrot is in a loose position, while in  FIG. 21   f , the garrot  524  is tight around the needle  526 .  FIG. 21   g  shows an end view of the garrot style needle holder  520 . The garrot in this embodiment is depicted as two components, a noose spring  526  and a noose  528 . Preferably the noose  528  is constructed from a generally flexible material such as wire or nylon.  
       FIGS. 21   m - 21   s  depict yet another variety of a needle driver: an anvil-style needle holder  540 . In  FIG. 21   m , a portion of an anvil-style needle holder  540  is shown. In this embodiment, a first jaw  542  is shown as an elongated jaw. A second jaw  544  is shown with a pivotal hinge  546  provided in the middle. The hinge  546  permits a portion of the second jaw  544  to move relative to the first jaw  542 . Each of the jaws  542  and  544  is provided with a pivotally attached anvil  548 .  FIG. 21   n  shows a complete anvil-style needle holder  540 . The two jaws  542  and  544  of  FIG. 21   m  are shown, along with two rings  550  for grasping and manipulating the device. An anvil switch  552  is provided for each anvil  548 , and is used to actuate the respective anvil  548 .  FIG. 21   o  shows a side view of a portion of an anvil-style needle holder with the jaws apart and the anvils  548  open.  FIG. 21   p  shows a side view of a portion of an anvil-style needle holder with the jaws apart and one anvil  548   a  closed and one anvil open  548   b .  FIG. 21   q  shows a side view of a portion of an anvil-style needle holder with the jaws closed and one anvil  548   b  closed and one anvil  548   a  open.  FIG. 21   r  shows a side view of a portion of an anvil-style needle holder with an anvil switch  552 .  FIG. 21   s  shows a system of pulleys and hin  
      A variety of needle sizes are suitable for use with certain embodiments of the present invention including: 6-0, 5-0, 4-0, 3-0, 2-0, 0-0, 1, and 2. Similarly, the needle  744  may be any of a variety of suitable types, including blunt, sharp, standard bevel, or inverted bevel. Suitable suture materials include dexon, polyglactic  910  (sold by Ethicon, Inc. under the tradename VICRYL), polydioxanone (sold by Ethicon, Inc. under the tradenames PDS and PDS II), nylon, stainless steel, or a monofilament material such as that sold by Ethicon, Inc., under the tradename Proline.  
       FIG. 21   c  depicts another arrangement for a suturing device  743 . In this generally gun-shaped suturing device  743 , a bobbit box cartridge  745  may be placed or loaded into the suturing device  743 . Preferably the bobbit box cartridge  745  is constructed to snap into place. Various control elements are provided on the suturing device  743 . In the particular arrangement shown, a button  747  is provided to cause a suture catcher  749  to advance. A handle lever  751  is provided to cause the needle  753  to advance. A trigger  755  is used to actuate the closing or opening of a bevel  757  on the needle  753 . Preferably the needle  753  and suture catcher rod  749  are provided through the barrel  759  of the suturing device  743 . This snap-in construction for the bobbit box cartridge  745  facilitates changing suture material and reuse of the suturing device  743  in a patient for multiple suture materials, for instance in different tissues.  
       FIGS. 21   d  and  21   e  depict arrangements for the bobbit box cartridge  745 . In the arrangement shown in  FIG. 21   d , the bobbit suture  761  is a double strand which works in conjunction with the needle  753 . The arrangement shown in  FIG. 21   e  shows the bobbit suture  761  as a single strand which again, works in conjunction with the needle  753 . Generally, the bobbit is optional and is preferably constructed to conserve space and minimize entanglement.  
       FIGS. 21   f  and  21   g  show cross-sectional views of the barrel  759 . In  FIG. 21   f , the bobbit box cartridge  745  is shown installed in the barrel  759 . The suture catcher rod  749  and needle  753  are also shown in  FIGS. 21   f  and  21   g .  FIG. 21   g  depicts a cross-sectional view of the barrel  759  taken further down the barrel  759 , away from the handle of the device (not shown) as compared to  FIG. 21   f . A guide slot  763  is shown in  FIG. 21   g  and provides an area for the suture material (not shown) to pass.  
       FIG. 22   a  depicts a bobbit-style suture holder device  758 . The suture holder device  758  includes two bobbits  760   a  and  760   b  which hold the suture material  754 . The suture material  754  can be drawn between the bobbits  760   a  and  760   b  from left to right or right to left. The bobbits  760   a  and  760   b  are interconnected by a hollow tube  762  containing suture material (not visible) and are also interconnected by external suture material  754 , which is free to be caught by the needle.  
       FIG. 22   b  depicts a base  750  secured to the shaft  748 . In this embodiment, the shaft  748  includes a needle guide  764 . The bobbits  760   a  and  760   b  of  FIG. 22   b  may be snapped into place in the base  750  thereby facilitating easy switching among different suture materials and suture sizes.  
       FIG. 22   c  depicts an arrangement similar to that of  FIG. 22   a , but with an external bobbit assembly  766 . The external bobbit assembly  766  is optional and may be placed near the end of the needle guide  764 .  
       FIGS. 22   d - 22   v  depict various embodiments of a suture catcher for use in accordance with certain embodiments of the invention. The suture catcher functions to hold the suture after the needle advances to the full extent (i.e. after it passes through tissue, or is reloading). The needle opens the bevel to release a suture it holds, or it can open the bevel to receive and then close to take the suture held by the suture catcher. In the embodiment shown in  FIGS. 22   e - h  and  22   v , the suture catcher is on a rod which may be triply-hinged and springed-loaded. When advanced, the rod forms a “C” shape to reach around the tissue, to meet the needle on the opposite side. When the needle is advanced by the user, at full advance it will rotate as shown in  FIG. 22   u  and the bevel is then opened (for instance by pulling the trigger) and the suture catcher can then grasp the suture from the needle. Preferably, the needle penetrates the catcher in the final 0.5 to 0.2 cm of the full needle advance distance. Preferably, the catcher is similar to tissue, in that the needle easily penetrates and pushes the suture catcher open. This avoids any significant friction or force which might tear or rip the suture. The catches at the end of the suture catcher may be “U” shaped, see  FIGS. 22   i - k , or “U” shaped with barbs, see  FIGS. 22   l - m , or in the form of a closed loop or “0” shape, see  FIGS. 22   n - 22   t . In one embodiment of the closed loop shape, the catcher is hinged to fold closed, see  FIGS. 22   n - 22   q . Preferably the suture catcher is constructed so that when the needle retracts or is not present, the catcher spring hinge design closes the catcher. When the catcher shaft is retracted into the barrel of the device, the hinged joints are leveled to form a straight shaft. When the catcher is advanced the spring hinged elbow joints may form the open “C”, “U”, or “O” shape. In operation, for instance, the suture catcher of  FIGS. 22   n  and  22   p  may be advanced out of the barrel with the advancing of the needle. With the needle bevel open and the needle withdrawn, the suture catcher may close on the suture, and in this way hold it.  
      With particular reference to the Figures showing the suture catcher embodiments,  FIG. 22   e  shows the suture catcher  767  with the needle  753  advanced.  FIG. 22   f  shows the embodiment of  FIG. 22   e  with the suture catcher  767  advanced.  FIG. 22   g  shows a similar embodiment in the closed position, with the suture catcher  767  and the needle  753  inside the barrel  759 .  FIG. 22   h  shows a similar embodiment, with the needle  753  advanced to release a suture to the suture catcher  767 .  FIGS. 22   i - k  show different positions of one embodiment of the suture catcher  767  as it goes from an open position,  FIG. 22   i , to a partially open position  FIG. 22   j , to a closed position,  FIG. 22   k .  FIGS. 22   n  and  22   o  show a triangle-shaped suture catcher in an open and closed position, respectively.  FIGS. 22   p  and  22   q  show a quadrangle suture catcher in an open and closed position, respectively.  FIGS. 22   r  and  22   t  show a flat “hole” suture catcher in a closed and open position, respectively, and  FIG. 22   s  shows side views of the flat “hole” catcher.  FIG. 22   u  shows the circular movement action of the needle  753  which may be used to release a suture from an open bevel, and to reload a suture and close the bevel. Finally,  FIG. 22   v  shows a close-up view of a hinge for a suture catcher, with a catcher shaft  763  and multiple springs  765 .  
       FIG. 23   a  depicts a rivet driver  768  in accordance with another embodiment of the invention. The rivet driver  768  is configured to drive and crimp a fastener across tissue. The rivet driver  768  may be used to fasten or close dense tissue such as fascia, or the diaphragmatic crus during esophageal hernia repairs. The rivet driver  768  may include a rotation knob  769   a  and certain control levers  769   b  and  769   c  to provide a user control over the disposition and operation of the rivet driver  768 . The rivet driver  768  also includes a handle  770  attached to an elongated shaft  772 . One of the control levers  769   b  may control, for instance, the closing of elongated members  774   a  and  774   b  which make up the rivet tool.  
      Each elongated member  774   a  and  774   b  may include one or more claws or barbs  776   a - d . The barbs  776   a - d  are useful to help keep the tissue together or to keep the tissue in position prior to the rivet fastener or nail traversing the tissue. The barbs  776   a - d  may have sharp thin teeth (not shown). In one embodiment, the barbs  776   a - d  are very short, which allows easy withdrawal from tissue and avoids damage to the tissue grasped by the barbs  776   a - d.    
      In one embodiment, the rivet driver  768  pushes the fastener, which is made up of two rivet portions  778   a  and  778   b  together so that the rivet portions  778   a  and  778   b  will not disengage once released by the rivet driver  768 . A rivet portion  778   a  or  778   b  fits in each elongated member  774   a  and  774   b . In certain embodiments (not shown) multiple rivet portions (not shown) may be stored in a channel or a cartridge assembly which automatically loads a new rivet portion upon releasing a used rivet portion. Alternatively, a nail be used instead of rivet portions  778   a  and  778   b . A crimper button or lever  771  may be provided to allow a user to separately control the crimping of a rivet, with a crimper  783 , as described below.  
       FIG. 23   b  depicts rivet portions  778   a  and  778   b  which may be constructed from non-absorbable material including stainless steel, nylon, or plastic, or an absorbable material such as polyglactic  910  (sold by Ethicon, Inc. under the tradename VICRYL), polydioxanone (sold by Ethicon, Inc. under the tradenames PDS and PDS II), chromic material, a polymer material such as polyethylene, or any other suitable material. Each rivet portion  778   a  and  778   b  is configured to be complimentary to and engage its complimentary rivet portion  778   a  or  778   b . The rivet portion  778   a  on the left includes a narrow portion with a tip  780  which penetrates tissue. The tip  780  may be blunt, or bulbous, or sharpened. A flat, disc-shaped head  782   a  is also provided and helps to anchor the rivet portion  778   a  to the tissue the rivet portion  778   a  is driven through.  
      The partner rivet portion  778   b  has a similar diameter, but is slightly larger, in order to accommodate the complimentary rivet portion  778   a . One end of the partner rivet portion  778   b  is open to provide access to a hollow tube  784   a . Hollow tube  784   a  includes an internal indentation, notch or ring  784   b  which the tip  780  of the rivet portion  778   a  will engage once the rivet portions  778   a  and  778   b  are pushed together. This indentation  784   b  helps to prevent disengagement once the rivet portions  778   a  and  778   b  are pushed together. One end of rivet portion  778   b  may also be provided with a flat, disc-shaped head  782   b.    
       FIG. 23   c  depicts a pair of rivet portions  778   a  and  778   b  which have been partially pushed together. In the configuration depicted in  FIG. 23   c , the rivet portions  778   a  and  778   b  are engaged and from this position, they may normally be more fully pushed together so as to form secured fastener. The position of the heads  782   a  and  782   b  of the rivet portions  778   a  and  778   b  is visible in this drawing as being useful to provide an anchor in the tissue the rivet portions  778   a  and  778   b  are driven through.  
       FIG. 23   d  depicts rivet portions  778   a  and  778   b  in a closed position. Additionally, a crimper  783  is provided for use with rivet portions  778   a  and  778   b . The crimper  783  compresses the middle portion of the fastener formed by the rivet portions  778   a  and  778   b , between the two heads  782   a  and  782   b  of the rivet portions  778   a  and  778   b . The crimper  783  helps to assure the rivet portions  778   a  and  778   b  join solidly to form a secure fastener.  
       FIG. 23   e  depicts the rivet portions  778   a  and  778   b  in a closed position after application of the crimper  783  to secure the rivet portions  778   a  and  778   b  together. In this embodiment, the compression of the rivet portions  778   a  and  778   b  by the crimper  783  is clearly visible.  
       FIG. 23   f  depicts a rivet holder or cartridge  786  which may be fitted into a rivet driver such as rivet driver  768  shown in  FIG. 23   a . The rivet holder  786  may include a channel  788  with a riveting zone from which the rivets may be applied. The channel  788  holds the rivet portions  787   a - d  until they are ready for use. The channel  786  may also include an opening  790  which allows the rivet portions  787   a - d  to be released as they are used, one at a time. The rivet holder  786  may be configured to hold multiple rivets. In one embodiment, the rivet holder  786  is configured to hold up to 10 rivet portions  787   a - d.    
       FIG. 23   g  depicts a two rivet portions  778   a  and  778   b , which are similar to those described above, however in this embodiment internal fastener rivet portion  778   a  splits at an angle (preferably about ninety degrees) inside the receiving rivet portion  778   b , when closed, as is shown in  FIG. 23   h . The split, caused by the mechanical compressive force of the device pushing the fasteners together is not reversible through mild to moderate traction force. Thus, the rivet portions  778   a  and  778   b  are held together in this fashion.  FIG. 23   i  depicts various ways the rivet portion  778   a  might be constructed to split, for instance into halves, thirds or quarters. In another alternative, rivet portion  778   a  may be used alone, without a complementary rivet portion  778   b , as shown in  FIG. 23   j . In this embodiment, the part of the rivet portion  778   a  that splits is used to secure tissue.  
      Table 1 below shows suitable rivet sizes for use in accordance with certain embodiments of the invention. These sizes refer to an assembled and compressed rivet.  
               TABLE 1                          RIVET SIZES                         Gauge   Head Diameter (cm)   Length (cm)                                 4   0.5-1   0.5-2       6   0.5-1   0.5-2       8   0.5-1   0.5-2       10   0.5-1     0.5-1.5       12   0.5-1     0.5-1.5       16   0.5-1     0.5-1.5       18    0.25-0.5   0.5-1       20    0.25-0.5   0.5-1                  
 
      Additionally, rivets portions  778   a  and  778   b  may be provided in the following dimensions: a shaft length of 0.5 cm with a total length when closed of 0.7 cm. The diameter of the rivet head may be 0.4-0.8 cm and the thickness 0.1 cm. The tip head may be 0.3-0.5 cm with a hollow tube diameter of 0.1 cm and an inner ring diameter of 0.08 cm and an exterior diameter of 0.1 cm.  
       FIG. 24   a  depicts a needle driver  792  with a handle  794  and an elongated shaft  796  with a needle  798  mounted thereto. Numerous control elements  800   a - d  are provided to control operation of the needle driver  792 . A bevel lock  802  may also be provided to close the bevel  804  on the needle  798 . The bevel lock  802  may be operated by one or more of the control elements  800   a - d , for instance a lever  800   a  and a button  800   b  may be used to open or close the bevel lock  802  over the bevel  804 . Levers  800   c  and  800   d  may be used to advance the needle  798 .  
       FIG. 24   b  depicts the needle  798  of  FIG. 24   a , with the bevel lock  802  in an open position.  
       FIG. 24   c  depicts a needle  806  similar to that shown in  FIG. 24   a , however the needle  806  of  FIG. 24   c  has an inverted bevel  808 . In  FIG. 24   c , the bevel lock  802  is shown in a closed position.  
       FIG. 24   d  depicts the needle  806  of  FIG. 24   c , with the bevel lock  802  in an open position.  
       FIG. 24   e  depicts various needles  810   a - h  for use in accordance with certain embodiments of the invention, particularly the needle driver of  FIG. 24   a  and the suturing device of  FIG. 21   a . Needles  810   a - 810   d  all include a blunt tip, while needles  810   e - h  include a sharp tip, which may be either a smooth circular or a cutting type of tip. The needles  810   a - 810   h  also vary in some instances in the bevel type  812  of the particular needle  810   a - 810   h . Needles  810   a  and  810   e  have a traditional open bevel  812 . This allows suture material (not shown) to slide in or out of the needle&#39;s grasp. Needles  810   b  and  810   f  have an inverted bevel  812 . This arrangement is similar to that of the open variety, however the edges of the bevel  812  are turned inward, giving the needles  810   b  and  810   f  a different grasp of suture material. Needles  810   c  and  810   g  have a pusher style bevel  812 . In this arrangement the suture material is generally held in place while the needles  810   c  and  810   g  push through a tissue, and the suture material is left behind as the needles  810   c  and  810   g  exit the tissue. Needles  810   d  and  810   h  have a puller-style bevel  812 . These needles  810   d  and  810   h  are similar the needles  810   c  and  810   g , however they work in the opposite directions. Thus, needles  810   d  and  810   h  pull suture material through tissue as they exit the tissue and leave the suture material behind as the needles enter and push through tissue. Preferably the needles are constructed from stainless steel, however they may also be constructed from other suitable materials.  
      Where a needle is intended for use with the suturing device of  FIG. 21   a , the pusher-style and puller-style needles are particularly useful. When the suturing device uses an internal bobbit, the puller style needles  810   d  and  810   h  are useful. When the suturing device uses an external bobbit, the pusher style needles  810   c  and  810   g  are useful.  
      In certain embodiments, the needles  810   a - 810   h  are provided in the following dimensions: a needle gauge of 6, 8, 10, 12, 14, 16, 18, 19, 20, 22, 24, 28, 30, 32; a bevel length of from 0.25 cm to 1 cm; and an overall needle length of from 2 cm to 15 cm, with the portion of the needle intended to be internal to the device being from 1 cm to 10 cm and the portion of the needle external to the device ranging from 1 cm to 5 cm. Needles of other dimensions may also be used in accordance with the invention.  
       FIG. 25   a  depicts needles  816   a - h  for use with certain embodiments of the invention. These needles  816   a - h  include locking features for their bezels. Needle  816   a  includes a sheath  820  which is a hollow tube that slides laterally along the needle  816   a  to cover and close the bezel  818 . In one embodiment, the sheath does not cover the tip  822  of the needle  816   a . The sheath  820  may also slide along the needle to an open position, as is depicted with needle  816   b . A needle  816   c  may also be provided with a pusher or mounting rod  824 . In this embodiment, various needles are exchangeable and may be mounted to the pusher  824  as desired by the user. Alternatively, the needle and the pusher  824  may be fused together.  
      A needle  816   e  may also be provided with a bevel lock mechanism incorporating a wire  826 . The wire  826  may slide from an open position to a closed position over the bevel  818 . As can be seen in with respect to needle  816   e , the wire serves to partially close access to the bevel  818 , thereby preventing any suture material from entering or leaving the bevel  818 , as the case may be. A wire guide channel  827  may be provided in which the wire  826  may at least partially rest.  
      A needle  816   f  may alternatively be provided with a bevel lock mechanism based on a slidable plate  828 . Needle  816   f  is shown with a slidable plate  828  in a closed position. Needle  816   g  is shown with a slidable plate  828  in an open position, away from the bevel  818 . Needle  816   h  is depicted from a lateral view and is shown with a slidable plate  828  in a closed position over the bevel  818 .  
       FIGS. 25   b  and  25   c  depict a cross-sectional view of a needle  816   d  which uses a wire-type bevel lock. In  FIG. 25   b , the cross-section is taken above the bevel. A wire guide channel  827  is shown which may be used to provide a guide space for the wire  826 .  FIG. 25   c  shows a cross-sectional view similar to that shown for  FIG. 25   b , however in  FIG. 25   c , the wire  826  sits partially above the wire guide channel  827  profile.  
       FIGS. 25   d  and  25   e  depict a cross-sectional view of the needle  816   f  with a slidable plate-type bevel lock. As may be appreciated from the drawings, different types of slidable plates  829   a  and  829   b  may be used to lock the bevel on the needle  816   f . These needles are preferably provided with a channel in which the slidable plate  829   a  and  829   b  may slide.  FIGS. 25   d  and  25   e  show this channel at the intersection of the slidable plate  829   a  or  829   b  and the needle  816   f.    
       FIGS. 25   f  and  25   g  depict a cross sectional view of the bevel portion of the needle  831 . In  FIGS. 25   f  and  25   g , the cross section is taken at the bevel, and the remaining raised portion of the needle  831  is not shown, thus the view is only a cross section of the bevel portion of the needle  831 . The bevel portion may a variety of sizes, as is useful for the particular application. By way of example,  FIG. 25   f  depicts a bevel portion with approximately 50% of the needle  831  cut away,  FIG. 25   g  depicts a bevel portion with approximately 20% of the needle  831  cut away.  
      Thus, it may be appreciated that the needle may be fixed relative to the device, and the needle bevel is opened or closed by a mobile lock such as the sheath, plate or wire lock described above. Alternatively, the needle may be mobile and the needle bevel lock mechanism, such as the sheath, plate or wire described above, may be in a fixed position relative to the device. The needle bevel is constructed so that it may hold a suture or be empty or release a suture.  
       FIG. 26  depicts a pistol-style ligation device  828 . The device  828  includes a handle  830  associated with an extended shaft  832 . Certain control elements  834   a - f  are provided to allow a user control over the operation of the device  828 . In one embodiment, the device  828  has at least one of four distinct features. First, the device  828  may grasp two sutures to be joined as is commonly done with an open instrument. Second, the user may position the device  828  and choose the desired tension of the sutures and the actual site of the binding of the suture material. Third, the equivalent of a knot may be formed by fusion of the suture material either thermally or through adhesive fusion. Finally, the device  828  may provide the option of cutting off the sutures above the fusion or adhesive knot. Alternatively, the cutting may be performed by a separate scissor device (not shown).  
      One of two types of adhesive ligatures are preferably used in accordance with certain embodiments of the present invention such as that depicted in  FIG. 26 . One type involves the injection of liquid adhesive into a ligature forming mold (not shown) which may be heat sensitive. Upon application of heat, the liquid adhesive hardens to form a permanent to semi-permanent ligature, depending upon the material being used. The adhesion may be accomplished with a variety of suitable agents, including mixtures of multiple agents. Alternatively, mixtures of reactive agents may be formed which undergo a chemical reaction, either in the presence of heat energy or not, resulting in a permanent or semi-permanent solid with the sutures bound together therein. Ligatures may also be formed using an adhesive that hardens upon contact with some third substance, which third substance may act as catalyst. In one embodiment, the adhesive hardens upon contact with a mold frame. Suitable adhesives include plastic, polymeric silicon (available from Dow Chemicals under the tradename SILASTIC), polypropylene, polyglycolic, polyvicryl, GORTEX, cellulose, a chromic material, polyethylene, ceramic, glass, and stainless steel. In another embodiment, sutures are bound using a staple configuration  
      Control element  834   d  is a trigger that activates a scissor or blade to cut the suture material above the fusion site. In one embodiment, the suture material is cut 0.05 cm-1.0 cm above the fusion site. Preferably, control element  834   d  causes the blade or microscissor or regular scissor to advance to a position just above the suture so that the excess suture material may be cut away. Preferably the blade or scissors is advanced and then automatically retracted as a result of the single trigger pull.  
      The ligation device  828  may also include one or more rods  836  which are useful for manipulating the sutures. For instance, the rods  836  may be used to push or grasp or pull the sutures so that they may be ligated together. These rods  836  enable the ligation device  828  to be used to securely grasp the suture material the user desires to ligate, tie, or fuse together. The rods  836  may be integrated with the extended shaft  832 . In one embodiment (not shown) there are three rods  836  provided with the ligation device  828 . One rod is for grasping two sutures, one rod is for fusing or adhesive ligation stapling, and the third rod may be used for cutting the suture after ligation. Alternatively, a combination of a lesser number of the aforementioned rods may be provided.  
       FIG. 27   a  depicts one embodiment of a grasping rod  838  for use in accordance with one embodiment of the invention. The grasping rod  838  includes two elongated grasping elements  840   a  and  840   b , each of which are configured to close about a suture or other material and grasp it for manipulation by a user. In this embodiment, an adhesive substance is loaded in to a ligation device such as ligation device  828  depicted in  FIG. 26 . The adhesive substance may be provided in a particular shape or configuration, for instance in the configuration of a staple. The adhesive substance is applied or compressed on to the suture material which needs to be bound and the adhesive substance fuses together with the suture material. The adhesive substance may be fused by the activation of a fusion switch. The fusion switch activates a temperature controller which heats a heating element to cause fusion of a temperature sensitive adhesive.  
       FIG. 27   b  depicts a stapler  842  for use in accordance with an embodiment of the invention. This stapler  842  may be used to staple two sutures together instead of using a knot to tying them together. The stapler includes elongated grasping elements  844   a  and  844   b , similar to that depicted in  FIG. 27   a . Each of the elongated grasping elements  844   a  and  844   b  is also provided with a thermal element  846   a  and  846   b  which may be used to induce melting of suture material together. In one embodiment, the thermal element is switched on by the touching of the thermal elements  846   a  and  846   b  together which closes an electrical circuit. This may then either melt the suture material or initiate a heat sensitive reaction with some other binding compound (as described below). Preferably this heat need only be applied for a few seconds, after which the thermal element  846   a  and  846   b  may be released Alternatively, the thermal elements  846   a  and  846   b  may be replaced with binding compound. The binding compound may take on any suitable form. In one arrangement, the binding compound is a non-metallic material which is pressed onto the sutures to be joined and the non-metallic material adheres to the sutures, creating a bond which is the functional equivalent of a knot tying the sutures together. The bond may be formed as a result of chemical reactivity between different binding compounds being brought together, or it may be spontaneous, as in the case of cyanoacrylate based glues, or a heat sensitive material such as chromic, plastic, nylon. The material may or may not be absorbable. Thus, the grasping rod  842  may be used to grab the sutures that are to be fastened together and then secure them through a thermal fusion action by use of the thermal elements or with binding compound.  
       FIG. 27   c  depicts a manipulation rod  848  for use in accordance with an embodiment of the invention. This rod  848  is configured to grasp the sutures together, and then apply an injectable adhesive which binds the sutures together. A variety of suitable configurations may be used in order to apply the adhesive to the sutures. In the embodiment depicted in  FIG. 27   c , the adhesive  850  is encased within an injectable mold  852 . In use, the mold  852  is compressed by lateral movement of the rod housing  854 , or alternatively movement of the rod  848  within the rod housing  854 , which compresses the mold  852 , forcing the adhesive  850  out each end of the adhesive housing  856   a  and  856   b  so that the adhesive  850  is applied to the sutures. Alternatively, the mold  852  may be opened to grasp the sutures to be bound together. At the desired position, the adhesive is injected and the sutures become bound. Preferably, the glue or adhesive bonds almost instantly so that after application of the glue or adhesive to the already-present sutures, they may be released from the grasp of the device and they are bound together. Further, a container  853  may be provided to hold and dispense the glue or adhesive for the stapler. The container  853  may be replaceable and tube-shaped and preferably dispenses the glue or adhesive as a result of pressure applied to the outer surfaces thereof.  
       FIG. 27   d  depicts an adhesive ligation staple rod  860  similar to that shown in  FIG. 27   c , but without the injector components. This staple rod  860  can be used to secure sutures together with an adhesive staple. In use, the staple rod  860  can be pushed into an open position followed by closure around the sutures which are to be secured together. An adhesive may then be applied and the sutures thereby secured together.  
       FIG. 27   e  depicts an adhesive stapler loading device  862 . The adhesive stapler loading device  862  is configured to accept multiple staples  864   a - 864   d  of different types. In on embodiment, two types of staples are provided, either hot or cold staples. The cold staples are compressed around the sutures to be fastened together, and no thermal energy is required to secure the ligation. The hot, or thermal staples, are configured to be compressed around the suture and thermal energy is applied to precipitate a chemical reaction to secure a bond between the sutures being fastened together. Preferably, the staples are nonmetallic, for instance they may be configured from nylon, polypropylene, polyethylene, or another plastic or other suitable material which may be used to bind the sutures together with either or both of compressive force and heat.  
       FIG. 27   f  depicts an injector  866  which injects an adhesive substance into a compressor mold  868 . The compressor mold  868  may be either spherical, or rectangular, or box shaped. A suture guard  870  is provided to capture the suture material in an adhesive compression chamber  872  within the compressor mold  868 . Once the suture material  874  is captured within the compression mold  868 , two sides of the compression mold  868   a  and  868   b  are approximated, or closed together, and the adhesive is injected. In this way, the suture material is glued or bound together.  
       FIG. 27   g  depicts an injector  866  similar to that shown in  FIG. 27   f . The injector  866  of  FIG. 27   g  includes a compressor mold  868 . However, this compressor mold  868  includes rectangular or box shaped compression features  876   a  and  876   b . The compression features  876  and  876   b  may be provided in any of a variety of shapes or configurations. For instance, the circular spheres depicted in  FIG. 27   f  or elliptical shapes or the rectangular shape shown in  FIG. 27   g . The spherical delivery of the adhesive results, from the device shown in  FIG. 27   f , results in a generally spherical shape of adhesive. The cube shaped delivery of the adhesive results, from the device shown in  FIG. 27   g , in a generally cube-shape of adhesive.  
       FIG. 28   a  depicts a tie clasp  878  which may be used to secure or bind sutures. The tie clasp  878  is configured from two semicircular shaped elements  878   a  and  878   b  which are pivotally attached to rotate about axis  880 .  
       FIG. 28   b  depicts the tie clasp  878  of  FIG. 28   a  in a closed position. In the position shown in  FIG. 28   b , semicircular elements  878   a  and  878   b  are closed so as to form a single circular, elliptical, or oval-shaped unit.  
       FIG. 28   c  depicts another drawing of the tie clasp  878  of  FIG. 28   a . In  FIG. 28   c  the tie clasp  878  is closed tightly. As can be seen in the drawing, the semicircular elements  878   a  and  878   b  are closed so as to tightly bind any suture material that might be on the interior of the closed shape formed by the two circular elements  878   a  and  878   b.    
       FIG. 29   a  depicts a clip  880  similar to that depicted in  FIG. 28   a . However, the clip  880  of  FIG. 29   a  more closely resembles a staple than a device with two elongated semicircular rounded elements which pivot about an axis. The clip  880  of  FIG. 29   a  may be constructed from a single length of wire, flat metal, or other suitable material  882 . This single length of material  882  may be bent into what is generally a “U” shape with an opening  884  at one end.  
       FIG. 29   b  depicts the clip  880  of  FIG. 29   a  in a closed position. The single length of material  882  is pressed together so that the opening  884  (depicted in  FIG. 29   a ) is closed. Preferably the single length of material  882  is closed about one or more sutures so as to bind them together.  
       FIG. 29   c  depicts the clip  880  of  FIG. 29   a  in another closed position. In  FIG. 29   c  the clip  880  is closed tightly so that the single length of material  882  forms a loop with an interior area which is smaller than that depicted in  FIG. 29   b . This may be useful in order to bind one or more sutures together tightly.  
      Referring to  FIGS. 28   a - 28   c  and  29   a - 29   c  certain clasps  878  and  880  are shown which may be used with certain embodiments of the present invention. These clasps  878  and  880  are configured to have an opening which may accept the one or more sutures to be bound. The clasps  878  and  880  are then closed about the sutures so as to bind them together. The clasps  878  and  880  may be closed in either loose or tight positions depending on the wishes of the user and upon the tissue response. Alternatively, the clasps  878  and  880  may be useful for binding multiple tissues or closing off openings in tissue, as in the case of closing a severed bowel, vessel, or other tubular-shaped tissue, or tissue with an opening.  
       FIG. 30   a  depicts a circular stapler device  884  in accordance with an embodiment of the invention. The circular stapler device  884  is configured to staple pieces of bowel (stomach, colon, intestine, esophagus, or other tubular tissue) together. The circular stapler device  884  is useful to anastomose, or interjoin multiple tissues, such as tubular vessels. The circular stapler device  884  may be configured in a specific inner anastomosis diameter with a minimum of from a minimum of about 1 cm to about 3 cm. The circular stapler device  884  is configured to collapse into a smaller diameter when necessary to enter a laparoscopic port, or the bowel, prior to closure for stapling. The circular stapler  884  includes an anvil  886  which is attached to an elongated portion  888  and is operated by a handle configuration  890 . The handle configuration  890  is similar to that provided with respect to other embodiments of the invention (as previously described). The stapler head  890  is configured so that it may be angled in relation to the elongated shaft  888  as desired by the user. Angling the circular staple head  890  provides significantly improved positioning in a constricted space, as is commonly encountered during minimally invasive medical procedures.  
       FIG. 30   b  shows the circular stapler device  884  of  FIG. 30   a . However, the elongated shaft  888  is in an angled position. As described previously, when angled, the extended shaft  888  may facilitate better positioning of the stapler head  890 . Also visible in  FIG. 30   b  is the anvil  886  which has been positioned more closely to the extended shaft  888  than is shown in  FIG. 30   a.    
       FIG. 31   a  depicts an anvil  887   a  for a circular stapling device such as that shown in  FIG. 30   a . The anvil  887   a  of  FIG. 31   a  is hinged so that it may fold into a smaller size. In its folded form the it resembles anvil  887   b .  FIG. 31   b  depicts an anvil  886  and a base  889  connected by a rod  891 .  FIG. 31   c  shows an anvil  893   a  with a quartered “pie” construction which allows for a size reduction (anvil  893   b ). The anvils shown in  FIGS. 31   a - 31   c  represent methods of anvil construction that facilitate temporarily reducing the profile or size of the anvil so that it may be passed through skin or fascia through an entry port and for small enterotomy in gastric tissue, the small bowel or colon.  
      Referring to  FIGS. 32   a  and  32   b , the circular staple head  890  is depicted along with the extended shaft  888 . In  FIG. 32   a  the circular staple head  890  is shown essentially as a linear extension of the extended shaft  888  such that the circular staple head  890  is in line with the extended shaft  888 . In  FIG. 32   b  the circular staple head  890  is shown at an angle of approximately 45° with respect to the extended shaft  888 . As discussed previously, this movement of the circular staple head  890  from a straight to an angled position at the desire of the user is useful in positioning and articulating the circular staple head  890  to anastomose tissues or other internal materials.  
       FIG. 33  depicts an anchor face with a staple ring and anchor stud needles. The needles pass through the tissue and enter the hollow needle pockets prior to stapling.  FIG. 33  shows the stapler guide receptacle to close the staples after they penetrate the tissue being anastomosed. Both the anvil  895  and the base  897  are shown “flat faced”, that is, in line with the connecting rod  899 , so as to facilitate passage of the device through a laparoscopic port.  
       FIG. 34  depicts a side view of a portion of anchor  900  showing the anchor stud needles  902   a  and the hollow needle pockets  902   b . The needles  902   a  pass through tissue and enter the hollow needle pockets  902   b  so as to ensure the tissue is grasped by the device and properly held in place. The needles  902   a  may also help to ensure proper position of the tissue for adequate stapling. The extended shaft  888  of the device is also shown in  FIG. 34 .  
       FIG. 35  depicts an aspiration or injection device  910 . The aspiration or injection device  910  includes a handle portion  912  similar to that described with respect to other embodiments of the invention, see, for instance,  FIGS. 10   b ,  23   a ,  24   a , and  26 , among others. The aspiration or injection device  910  may be provided with a needle  914  that may be manipulated, and/or operated by one or more of the numerous control devices provided with the handle  912 . The needle  914  may operate in connection with a syringe  916  which is preferably removable. In this way, material in the syringe  916  may be injected through the needle  914  into a patient. Alternatively, material from the patient may be withdrawn through the needle  914  and into the syringe  916 . In one embodiment the needle  914  is removable and may be replaced by any one of a variety of different tools, including needles of varying sizes and/or materials. In one embodiment, the needle may be manipulated by the trigger. For instance, the needle  914  may be advanced and/or retracted by operation of one or more trigger pulls.  
       FIG. 36   a  depicts a biopsy device  920 . The biopsy device  920  is provided with a handle  912  configured like the handles of the previous embodiments, for instance, like the handle of  FIG. 35 . The biopsy device  920  is provided with a biopsy needle  922  which is arranged so that it may be advanced and/or withdrawn as required by a user. A protective sheath  924  is also provided. The protective sheath  924  serves to seal off the sample containing portion of the biopsy needle  992 . The biopsy device  920  is configured to safely obtain a biopsy sample with a needle and at the same time avoid the risks associated with obtaining biopsy samples via transcutaneous needles, which are known to leave a needle track that may be at least partially filled with biopsy material in the subcutaneous tissue or skin. In certain instances, this may result in cancer and/or infection or the subcutaneous tissue or skin.  
      In operation, the sheath  924  is retracted so that the needle  922  is outside of the biopsy device  920  and the needle  992  is inserted into the tissue to be sampled. At this point, the needle  922  is beyond the sheath  924  as is shown in  FIG. 36   b . Subsequently, the sheath  924  is advanced to cover the needle  922  and effectively protect the biopsy material collected within the needle  922  from all other tissues. The entire biopsy device  920  may then be withdrawn from the patient, thereby safely removing the biopsy material.  
       FIG. 37   a  depicts an external radiation machine  930  with a flexible connective elbow  932 . The external radiation device  930  is useful for internal delivery of radiation therapy, especially gamma radiation.  FIGS. 37   b - 37   e  depict various radiation delivery scopes  934   b - 934   e  for use in combination with the radiation machine  930  of  FIG. 37   a . The radiation scopes  934   b - 934   e  all include an elongated shaft  936  which is adapted for internal use on a patient. The radiation scopes  934   b - 934   e  vary in the type of radiation that they deliver and the way that that radiation is delivered.  
       FIG. 37   b  depicts a radiation scope  934   b  with an elongated shaft  936 , which includes a window  938  for the delivery of radiation. Preferably the radiation scope  934   b  of  FIG. 37   b  is configured to deliver gamma radiation.  
      The radiation scope  934   c  of  FIG. 37   c  includes an elongated shaft  936  with an open end  940 . The open end  940  is configured to deliver radiation from the radiation scope  934 . Preferably, the radiation scope  934   c  of  FIG. 37   c  is configured to deliver gamma radiation.  
      The radiation scope  934   d  of  FIG. 37   d  includes an elongated shaft  936  with an open end  942  which is configured to allows for the emission of radiation. The radiation scope  934   d  of  FIG. 37   c  is preferably configured for use with beta radiation.  
      The radiation scope  934   e  of  FIG. 37   e  includes an elongated shaft  936  and also includes an enhanced tip  944 , which allows for positioning. This is useful, for instance, when the radiation scope  934   e  is being employed for work on an inner-organ tumor. The radiation scope  934   e  may be used in conjunction with a separate imaging device which provides a visual field either through the use of visual image capture configuration or an ultrasonic image capture device. In the embodiment depicted in  FIG. 37   e , an ultrasonic tip  946  is provided in conjunction with the radiation scope  934   e  so that a single device may be used to both deliver a radiation treatment to a patient and to image the area of treatment. This may make the use of the radiation scope  934  easier, and lessens the invasiveness of the procedure for the patient. Alternately, the ultrasonic tip  946  may be associated with the radiation device  934   e  in another way. For instance, the ultrasonic tip  946  may be placed inside or on one end of the elongated shaft  936  of the radiation device  934   e.    
       FIG. 37   f  depicts a radiation tool  934   f  in accordance with the invention. The radiation tool  934   f  includes an extended shaft  936  and a boring tip  950 . The boring tip  950  allows placement of the tool into a patient&#39;s organ by boring through the surrounding tissue. Once in position, the boring tip  950  retracts to expose radioactive material  952  which is positioned near one end of the radiation tool  934   f  so as to enable radiation therapy for the patient.  
       FIG. 38  depicts an radiation delivery device  954  which is loaded with a radioactive emitter  956 . The radioactive emitter may be a gamma or a beta emitter. The total dose for use in a given therapy is determined by the user, typically a radio-oncologist, or a radiation scientist prior to loading of the radioactive emitter  956 . The radioactive emitter may be loaded within its own case  958 , which is located within the scope  960  itself. The case  958  for the radioactive emitter  956  may be a lead shield. Preferably the radiation scope  960  is placed in a proper position within the patient prior to beginning the radiation therapy and all personnel in the room are evacuated. Once radiation therapy is to begin, the shield or case  958  is opened or moved so as to expose the radioactive emitter  956 . The patient may be irradiated through either the window  962  or an end opening in the radiation scope  960 . Once therapy is complete, the shield  954  is replaced to avoid irradiation of health care personnel.  
       FIG. 39  depicts a medical device  970  which includes a glove handle  972  similar to that depicted in  FIG. 6 . The glove handle is connected to a tool  974  which includes an elongated shaft  976 . At one end of the elongated shaft  976  are three elongated finger members  978   a ,  978   b  and  978   c . Each of the finger members  978   a ,  978   b , and  978   c  are configured to mimic the motion and responsiveness of human fingers. In particular, finger member  978   a  replicates a thumb. Finger member  978   b  replicates an index finger. Finger member  978   c  replicates a middle finger. Each of the finger members  978   a ,  978   b  and  978   c  are provided with a pressure sensor  980   a ,  980   b  and  980   c . The pressure sensors  980   a - 980   c  operate similarly to those previously described.  
      The glove handle  972  includes an opening  980  that allows a user to place his or her hand inside of the glove handle  972 . Separate pockets may be provided for one or more of the fingers. In particular, a thumb pocket  982   a , an index pocket  982   b , and a middle finger pocket  982   c  may be provided as part of the glove handle  972 . The fourth and fifth digits of a user&#39;s hand may be used to wrap around a grip rod  984  provided within the glove handle  972 . Pressure sensors may also be provided as part of the finger pockets  982   a ,  982   b  and  982   c . Pressure sensors  9862 ,  986   b  and  986   c  operate in a manner similar to that previously described. The glove handle  972  may be provided in either a left or a right-handed version for the respective hands of a user. Accordingly, the tool  974  is configured to mimic the hand configuration provided in the glove handle  972 .  
      The medical device  970  as shown in  FIG. 39  effectively extends the function of the right or left hand of a user from outside the patient to inside the patient. The finger members  978   a ,  978   b  and  978   c  are flexible and include pressure sensitive pads  980   a ,  980   b  and  980   c  to communicate, among other things, the tissue density and firmness of the grip by the tool  974 . In one embodiment, the tool  974  is passable through an port of approximately 2 cm in diameter. Once inside the patient the tool  974  may open so that the finger members  978   a ,  978   b  and  978   c  are of a size of up to about the size of three average adult human fingers. In one embodiment, the finger members  978   a ,  978   b , and  978   c  are configured not only to grasp or release an object but also to move up and down or laterally right to left. Further, the finger members  978   a ,  978   b  and  978   c  may be configured to rotate either individually or as a unit and also to move forward and backward.  
       FIG. 40   a  depicts another embodiment of the present invention. In the embodiment depicted in  40   a , a robotic console  988  is provided along with a manual driving stick  990 . The manual driving stick  990  operates in conjunction with certain other control features  992   a - e . The control features  992   a - e  may be used to control one or more robotic limbs  994  which are in communication with the robotic console  988 . In the embodiment depicted in  FIG. 40   a , control features  992   a ,  992   b  and  992   c  may be used to pick which robotic limb  994  is currently being manipulated by the robotic console  988 . Control feature  992   d  allows a user to control the height of the robotic console  988  relative to a patient. Control feature  992   e  is a microphone which may be configured with suitable electronics (including any necessary software in addition to required hardware) to facilitate auditory control of the device.  
       FIG. 40   b  depicts a robotic limb  994  for use in accordance with the robotic console  988 , such as that depicted in  FIG. 40   a . The robotic limb  994  may be provided with one or more telescoping sections  996   a ,  996   b  and  996   c  which enable the retraction or extension of the robotic hand  998  attached to the robotic limb  994 . Robotic hand  998  may be configured in a similar fashion as robotic tool  974  described in  FIG. 39 . As described with respect to the tool  974  of  FIG. 39 , the robotic hand  998  may move in a variety of directions including up and down, laterally right to left or backwards and forwards with further refined movements, including rotation, of one or all of the finger members  1000   a ,  1000   b , and  1000   c.    
       FIG. 40   c  depicts the finger members  1000   a ,  1000   b , and  1000   c  of the robotic hand in an open position.  
       FIG. 40   d  depicts the finger members  1000   a ,  1000   b  and  1000   c  of the robotic hand in a closed position. Referring to  FIGS. 40   c  and  40   d , it may be appreciated how finger members  1000   a ,  1000   b  and  1000   c  may be moved between an open positions, such as that shown in  FIG. 40   c  and a closed position, such as that shown in  FIG. 40   d , so as to grasp and/or release an object, material or tissue.  
       FIG. 41  depicts the robotic console  988  as previously described. However, the robotic console  988  is used in conjunction with an operating table  1002 . In certain embodiments, the robotic consol  988  may be installed as part of the operating table  1002 .  
       FIG. 42  shows a movable pedestal  1004  in accordance with one embodiment of the invention. The movable pedestal  1004  may be configured with one or more caster wheels  1006  attached thereto for ease of movement in and around the surgical area. A power cord  1008  may also be provided as part of the pedestal  1004 . The robotic console  988  may be position at multiple places on the movable pedestal  1004  as shown by mounting features  1010   a ,  1010   b , and  1010   b . The movable pedestal  1004  is configured so that multiple robotic consoles  988  may be installed thereupon. The preferable orientation for the multiple robotic consoles  988  is such that one robotic console is provided on either side of the patient and a third robotic console is provided between the legs of a positioned patient.  
      Alternatively, one or more robotic limbs  994 , as shown in  FIG. 40   b , may be mounted to the movable pedestal  1004 . These separately mounted robotic limbs may be controlled by one or more robotic consoles  988 , such as that depicted in  FIG. 40   a . The moveable pedestal  1004  is preferably configured so that it will fit around an operating table  1006 .  
      The foregoing description and examples have been set forth merely to illustrate the invention and are not intended to be limiting. Since modifications of the described embodiments incorporating the spirit and substance of the invention may occur to persons skilled in the art, the invention should be construed broadly to include all variations within the scope of the appended claims and equivalents thereof.