Abstract:
A surgical utility tube, comprising a plurality of members, wherein the plurality of members are joined together to form a continuous first tube, wherein the first tube is bendable to a plurality of angles along a length of the first tube, and wherein the first tube locks at each of the plurality of angles, and a second tube positioned in the first tube.

Description:
CROSS-REFERENCE TO RELATED APPLICATION  
       [0001]     This application claims the benefit of Provisional Application Ser. No. 60//834,967, filed on Aug. 1, 2006, the contents of which are herein incorporated by reference in their entirety. 
     
    
     BACKGROUND OF THE INVENTION  
       [0002]     1. Technical Field  
         [0003]     The present disclosure relates to surgical equipment supporting frames and attachments for same.  
         [0004]     2. Discussion of the Related Art  
         [0005]     Devices to support surgical instruments, which attach to, for example, an operating table, are known. These devices are positioned on or near an operating table to allow an operating physician or assistant access to surgical tools and utilities, such as, for example, suction tubes, irrigation tubes, scopes, smoke exhaust ducts, cautery, pens, common hand tools and auxiliary lights. Such devices also enable the operator or assistant to use the surgical tools and utilities when needed, and retain them in a position of access when not in use.  
         [0006]     However, the known devices have limited ranges of motion, may not be suitable for more than one type of surgery, and may not be equipped to hold multiple surgical tools or utilities. For example, a known device may be designed for a specific type of surgical procedure, such as laparoscopic surgery, and is not useful for other surgeries. In addition, a known device mounted to an operating table can have a limited range of motion, and while useful for a surgery at one part of the body, for example, the head, is not useful for a surgery at another part body, such as the legs, which are outside of the device&#39;s range of motion.  
         [0007]     Known devices are also designed for specific purposes, such as retraction, and are limited to such functions. Such devices are not equipped to handle multiple functions that may be needed for different surgeries.  
         [0008]     Accordingly, there is need for a device to support surgical tools, which has an increased range of motion, is universal to multiple types of surgical procedures, and is capable of supporting a variety of surgical tools for multiple procedures.  
       SUMMARY OF THE INVENTION  
       [0009]     Embodiments of the present invention provide medical practitioners, such as surgeons, with facilitated access to tools and other utilities to improve operating room efficiency by reducing labor requirements or by reducing the time to perform various procedures. Tools and utilities such as suction tubes, irrigation tubes, scopes, smoke exhaust ducts, cautery pens, common hand tools and auxiliary lights are examples of the types of tools and utilities that can be supported.  
         [0010]     A surgical utility tube, in accordance with an embodiment of the present invention, comprises an outer surface, an inner surface, a wall formed between the inner and outer surfaces, and a plurality of wires formed in the wall between the outer and inner surfaces.  
         [0011]     The wires may be spaced apart at predetermined intervals around the wall of the tube. The tube may be used for at least one of suction and irrigation. The tube may be used as a smoke duct or to support a light.  
         [0012]     The wires at a first end of the tube may have less rigidity than the wires at a second end of the tube. The wires at an end of the tube may have less rigidity than the wires at a portion of the tube between ends of the tube.  
         [0013]     The first end of the tube may be attached to a frame positioned at a side of an operating table and a second free end of the tube may be self-suspended over the operating table.  
         [0014]     The surgical utility tube may further comprise a pig tail wire attached to the tube, and a surgical tool attached to the pig tail wire.  
         [0015]     The surgical utility tube may further comprise a recoiling spool attached to the tube, and a surgical tool attached to the recoiling spool.  
         [0016]     A surgical utility tube, in accordance with an embodiment of the present invention, comprises a plurality of members, wherein the plurality of members are joined together to form a continuous first tube, wherein the first tube is bendable to a plurality of angles along a length of the first tube, and wherein the first tube locks at each of the plurality of angles, and a second tube positioned in the first tube.  
         [0017]     The second tube may be flexible and may be used for at least one of suction and irrigation, or as a smoke duct.  
         [0018]     The plurality of members may comprise a plurality of interlocking knuckles or adjacent sections of a helix.  
         [0019]     The first end of the first tube may be attached to a frame positioned it a side of an operating table and a second free end of the first tube may be self-suspended over the operating table.  
         [0020]     The surgical utility tube may further comprise a pig tail wire attached to the first tube, and a surgical tool attached to the pig tail wire.  
         [0021]     The surgical utility tube may further comprise a recoiling spool attached to the first tube, and a surgical tool attached to the recoiling spool. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0022]     Exemplary embodiments of the present invention will be described below in more detail, with reference to the accompanying drawings, of which:  
         [0023]      FIG. 1  is a perspective view of a surgical equipment supporting frame in an extended position, according to an embodiment of the present invention;  
         [0024]      FIG. 2  is a perspective view of a surgical equipment supporting frame in a partially extended position, according to an embodiment of the present invention;  
         [0025]      FIG. 3  is a perspective view of a surgical equipment supporting frame in a retracted position, according to an embodiment of the present invention;  
         [0026]      FIG. 4  is a perspective view of a surgical equipment supporting frame in a partially extended position and with a patient on the operating table, according to an embodiment of the present invention;  
         [0027]      FIG. 5  is a perspective view of a surgical equipment supporting frame in a retracted position and with a patient on the operating table, according to an embodiment of the present invention;  
         [0028]      FIG. 6  is an overhead perspective view of a surgical equipment supporting frame in an extended position, according to an embodiment of the present invention;  
         [0029]      FIGS. 7-10  are perspective views of an interface for consumable tools, according to an embodiment of the present invention;  
         [0030]      FIG. 11  is a perspective view of a surgical equipment supporting frame in an extended position, according to an embodiment of the present invention;  
         [0031]      FIG. 12  is a perspective view of a surgical equipment supporting frame, according to an embodiment of the present invention;  
         [0032]      FIG. 13  is a perspective view of a surgical equipment supporting frame, according to embodiment of the present invention;  
         [0033]      FIG. 14  is a perspective view of a surgical equipment supporting frame, according to an embodiment of the present invention;  
         [0034]      FIG. 15  is a perspective view of a surgical equipment supporting frame, according to an embodiment of the present invention;  
         [0035]      FIG. 16  is a cross-sectional view of a co-extruded tube, according to an embodiment of the present invention;  
         [0036]      FIG. 17  shows a helix tube in snapped and unsnapped configurations, according to an embodiment of the present invention;  
         [0037]      FIG. 18  shows a tube including interlocking knuckles, according to an embodiment of the present invention;  
         [0038]      FIG. 19  shows a tube including interlocking knuckles and a co-extruded tube at an end thereof, according to an embodiment of the present invention;  
         [0039]      FIG. 20  shows a tube including interlocking knuckles including a standard tube therein, according to an embodiment of the present invention;  
         [0040]      FIG. 21  shows a surgical tool attached to a pig tail wire, according to an embodiment of the present invention; and  
         [0041]      FIG. 22  shows a surgical toot attached to a recoiling spool, according to an embodiment of the present invention. 
     
    
     DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS  
       [0042]     Exemplary embodiments of the present invention now will be described more fully hereinafter with reference to the accompanying drawings. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiments set forth herein.  
         [0043]     Referring to  FIGS. 1-6 , a surgical equipment supporting frame  10  is shown attached to an operating table  5 . The frame  10  is attached to the operating table  5  using fixing devices, such as, for example, screws, bolts, and the like. For example, as shown in  FIGS. 1-5 , screws  11  having a gripping handle, which can be hand tightened, are used. The screws  11  allow for easy installation and removal of the frame  10  from the operating table  5 . The frame  10  includes a plurality of branches forming the structure of the frame. For example, the frame includes branches  12 ,  13 ,  14 ,  15  and  16 . The branches  12 - 16  can be molded as a single piece, and/or formed in separate parts and subsequently joined by, for example, welding, press fitting, and/or snap fitting, using, for example, spring-biased balls snapped into recesses.  
         [0044]     Referring to  FIGS. 4 and 5 , the branches  13  each include a curved portion  13 A, which is curved around the shoulders and/or arms of a patient  7 , so as not to obstruct access to these parts of the body. Branches  13  also include a lower portion  13 B substantially parallel to a side of the operating table  5  and an upper portion  13 C oblique to the operating table  5 . The curved portion  13 A is positioned between the upper and lower portions  13 C and  13 B. The branch  12  extends between the upper and lower portions  13 C and  13 B behind the curved portion  13 A. The fixing devices  11  are attached to the frame via, for example, holes in the lower portion  13 B or loops  17  extending from the lower portion  13 B.  
         [0045]     Branch  14  extends substantially perpendicular to and between branches  13 C. Branches  15  extend in-line from respective branches  13 C, and U-shaped branch  16  attaches to branches  15  and oblique to branches  15 . The branches  14  and  16  are sufficiently high above the patient  7  so as to provide an operator with required clearance for unobstructed access to the body. Some of the branches may be removed depending on the use of the frame  10 . For example, if the operation is on the head portion of the body, branch  12  may be removed to provide the operator with increased access to the head. In addition, if branch  16  must be positioned closer to the patient  7 , branches  15  could be removed to reduce the height of branch  16 .  
         [0046]     As shown in  FIGS. 1-6 , the frame  10  includes an arm portion  20 . The arm portion  20  includes a plurality of limbs  21 ,  22 ,  23 ,  24  connected to base portions  25 ,  26  and  27 . For example, base portion  25  is connected to branch  16  by, for example, molding, welding, adhesive, or a mechanical fixing device, and limbs  21  and  22  extend from base portion  25 . The limbs  21  and  22  extend from upper and lower sides of the base portion  25  respectively. The limbs  21  and  22  are connected to the base portion  25  at rotatable joints  28 . The limbs  21  and  22  end at base portion  26 , and are connected to base portion  26  at respective upper and lower sides of the base portion  26  using the rotatable joints  28 . Similarly, limbs  23  and  24  extend from upper and lower sides of base portion  26  to upper and lower sides of base portion  27 , respectively. The limbs  23  and  24  are connected to the base portions  26  and  27  using the rotatable joints  28 .  
         [0047]     The arm portion  20 , like a human arm attached to a shoulder (e.g., base portion  25 ) and having an elbow (e.g., base portion  26 ) and a wrist (e.g., base portion  27 ), can be fully extended, as shown in  FIGS. 1 and 6 , partially extended, as shown in  FIGS. 2 and 4 , and folded, as shown in  FIGS. 3 and 5 . The arm portion  20  can be extended and fixed at a plurality of positions between the non-extended and fully extended positions. As shown in  FIGS. 4 and 5 , the plurality of positions enable an operator to reach the surgical tools to different parts of the body of the patient  7 . For example, referring to  FIGS. 4 and 5 , when in a partially extended position, the surgical tool  50  can reach portions of the body closer to the feet than when in the folded position.  
         [0048]     The rotatable joints  28  include a fixing device  30 , such as a screw or a bolt, penetrating a sleeve  31  into which the end of a limb  21 - 24  is inserted and fixed. The sleeve  31  may form part of the limb  21 - 24 . Alternatively, the sleeve  31  can be omitted and the limb  21 - 24  can include a hole through which the fixing device  30  passes. The base portions  25 - 27  include holes  32  for receiving the fixing devices  30 . The arrangement of the fixing device  30  permits side to side movement of the limbs  21 - 24  about the joints  28 . A limb may rotate approximately 180 degrees to form an arc, wherein the rotatable joint  28  forms the center of the arc, and the length of the limb is the radius of the arc. For example, the limb  21  may form an arc from a right side of the operating table  5  to a left side of the operating table  5  across the width of the operating table  5 .  
         [0049]     According to an embodiment of the present invention, upon locating the arm portion  20  in a desired position, the fixing devices  30  may be adjustable to be tightened and lock the arm portion  20  in the desired position. Alternatively, the arm portion  20  and the fixing devices  30  may be readily moved from side to side to change the location of the arm portion  20 . According to an embodiment, the rotatable joints  28  may rotate around multiple axes, so as to permit, for example, side to side and up and down movement. To permit rotation around multiple axes, a ball and socket joint may be used.  
         [0050]     The base portion  27  includes an interface  40  at the end of the base portion  27  opposite the end where the limbs  23  and  24  are attached. The interface  40  is used to mount surgical tools  50 , such as, for example, suction tubes, irrigation tubes, scopes, smoke exhaust ducts, cautery pens, common hand tools and auxiliary lights, on the frame  10 . Depending on the type of surgery, a kit of one or more tools  50  can be attached to the frame  10  via the interface  40 . For example, a kit may include a plurality of consumable tubes used for suction, smoke exhaust, and irrigation, and be designated according to the type of surgery, for example, as an orthopedic kit or a cardiac kit. Further, each kit can be discarded after the surgery is completed. According to an embodiment, each kit includes a sterile sheath (not shown) running therefrom, which covers the arm portion  20  after the kit and tools  50  are mounted to the frame  10  via the interface  40 . For example, the sterile sheath may be attached to the mating cover portion  43 , and extended therefrom to cover the arm portion  20 .  
         [0051]     Referring to  FIGS. 7-10 , the interface  40  includes a floor having portions  41  and  42  at different heights, with a step between portions  41  and  42 . The interface  40  receives a cover portion  43 , which sits on the stepped floor and functions as a mating interface portion. The cover portion  43  includes portions  45  and  46 , which correspond to portions  41  and  42 , respectively. Like the portions  41  and  42 , the portions  45  and  46  are at different heights, and include a step between them. Portion  46  overlaps portion  45 , and part of portion  45  extends through an opening at the back  47  of the interface  40  to lock the cover portion  43  in place. Alternatively, other types of interfaces are contemplated, including, for example, snap-in or press-fit tabs, adhesives, latches, button or switch operated quick release mechanisms, and VELCRO type fasteners.  
         [0052]     The cover portion  43  may have one or more surgical tools  50  attached thereto. Further, multiple interfaces  40  may be positioned on base portion  27  to mate with corresponding cover portions  43  including one or more surgical tools  50  attached thereto. The respective sizes of the interface and cover portions  40 ,  43  may be reduced to accommodate multiple interfaces on the base portion  27 .  
         [0053]     Tubes or wires providing conduits for or power to the surgical tools can be attached to the surgical tools  50  at, for example, portion  46 . The tubes or wires can be extended to be dressed along and adjacent any or all of the limbs  21 - 24  of the arm portion  20 , and any or all of the branches  12 - 16  of the frame  10  to their respective deposit tanks, and/or power sources.  
         [0054]     Referring to  FIG. 11 , a surgical equipment supporting frame  100  is shown. The frame is mounted to the operating table  105  at a head or foot portion thereof in mount  111 . The mount  111  may also be located on a left or right side of the operating table  105 . The mount  111  is attached to the operating table  105  using for example, a fixing device, such as a clamp, screw, bolt or the like, and includes an opening into which a branch  112  of the frame  100  is inserted. The mount  111  may also be molded or adhered to the operating table  105 . The mount  111  snugly holds the branch  112  therein, and may also permit the branch to rotate around the vertical axis, so that the frame  100  can be moved from side to side. The frame  100  also includes an arm portion including branches  113  and  114  substantially perpendicular to branch  112 . Like the frame  10 , the branches of frame  100  can be molded as a single piece, and/or formed in separate parts and subsequently joined. The branch  114  telescopes into and out of branch  113  to increase or decrease the size of the horizontal portion of the frame  100 , so as to extend a surgical tool  150  to different portions of the body of a patient on the operating table  105 . One or more surgical tools  150  as described above may be attached to the frame  100  using any of the interfaces, kits and methods for tube or wire dressing described above in connection with frame  10 .  
         [0055]     Referring to  FIG. 12 , a surgical equipment supporting frame  200  is shown. The frame  200  is free standing on the floor of the operating room, and may be moved to different points along a length of the operating table  205  depending on the part of the body that is the focus of the operation. The frame  200  may be braced to the operating table, using for example, a clamp, at a point where branches  212  are in contact with or close to the operating table  205 . The frame  200  includes branches  212 ,  214 ,  215 , and  2 l 6 . Like the frame  10 , the branches of frame  200  can be molded as a single piece, and/or formed in separate parts and subsequently joined. One or more surgical tools  250  as described above may be attached to the frame  200  at an arm portion including branch  216  using any of the interfaces, kits and methods for tube or wire dressing described above in connection with frame  10 .  
         [0056]      FIGS. 13 and 14  show surgical equipment supporting frames  300  and  400  positioned at a side of an operating table  305 ,  405 .  
         [0057]     The frame  300  is free standing on a floor of the operating room, and, like the frame  200 , and may be moved to different points along a length of the operating table  305  depending on the part of the body that is the focus of the operation. Further, if necessary, the frame may also be moved to a head or foot of the operating table as needed. The frame  300  includes a base  311 , and a vertical branch  312  to which surgical tools  350  as described above are attached. Alternatively, the branch  312  may be attached to a side of the operating table, or to a wall, and the base  311  can be omitted.  
         [0058]     The frame  400  includes a U-shaped member  412  attached to a side of the operating table  405  using, for example a clamp or fixing devices, such as screws or bolts. Alternatively, the U-shaped member  412  may be attached to a wall. The U-shaped member  412  may also be molded or adhered to the operating table  405 . The U-shaped member  412  may be positioned at different points along a length of the operating table  405  depending on the part of the body that is the focus of the operation. Further, if necessary, the member  412  may also be moved to a head or foot of the operating table as needed. Surgical tools  450  as described above are attached to the U-shaped member  412 .  
         [0059]     One or more of the surgical tools  350 ,  450  may be attached to the frame  300 ,  400  using any of the interfaces, kits and methods for tube or wire dressing described above in connection with frame  10 . Since the surgical tools  350 ,  450  are not suspended from a point above the patient  307 ,  407 , the surgical tools  350 ,  450  can be used in conjunction with self-supporting tubes as described below in connection with  FIGS. 16-20 . The self-supporting tubes have the necessary rigidity to support themselves over the body without the need of an overhead frame suspending the tubes therefrom.  
         [0060]     Referring to  FIG. 15 , a surgical equipment supporting frame  500  is shown. The frame  500  is positioned over and to the side of a patient  507  and the operating table  505 . The frame  500  includes branches  511 ,  512 ,  513 ,  514  and  515 . Like the frame  10 , the branches of frame  500  can be molded as a single piece, and/or formed in separate parts and subsequently joined. In addition, the L-shaped branch  514  and branch  516  are sufficiently high above the patient  507  so as to provide an operator with required clearance for unobstructed access to the body. The branches  512 ,  512  can be located on both left and right sides of the operating table  505 .  
         [0061]     One or more surgical tools  550  as described above may be attached to the frame  500  using any of the interfaces, kits and methods for tube or wire dressing described above in connection with frame  10 . Further, the tools  550  are attached to the frame  500  via an arm portion including telescoping supports  520 . The telescoping supports  520  telescope into and out of base  521  to increase or decrease the size of the telescoping supports  520 , so as to extend the surgical tools  550  to different portions of the body of a patient  507  on the operating table  505 . The frame  500  includes IV bag supports  517 , which may be used support IV bags during an operation. The frame  500  also includes casters or wheels  518  so that the frame  500  may be easily moved into position for an operation, and out of position when the operation is finished. The frame  500  also includes conduit channels  516  through which wires or tubes may pass to their source or deposit points. The conduit channels  516  include holes  526  on sides thereof, which may serve as mounting locations for devices, such as, for example, patient monitors. As is the case with each of the frames  10  and  100 - 400 , the frame  500  may be used in conjunction with self supporting tubes as described below in connection with  FIGS. 16-20 , or tubes which are not self-supporting.  
         [0062]     In some embodiments, the frames  10  and  100 - 500 , in addition to supporting surgical tools, may also support IV bags, sterile curtains or various patient monitors.  
         [0063]     The frames  10  and  100 - 500  are made from, for example, plastic, PVC or metal and can be autoclavable. The arm portions of the frames  10 ,  100 ,  200  and  500  are positioned to extend substantially over and/or parallel to a longitudinal (lengthwise) centerline of the operating table to permit delivery of the surgical tools to and along, a centerline of the operating table.  
         [0064]     Referring to  FIGS. 16-20 , self-supporting tubes  600 ,  700  and  800  are shown. The self-supporting tubes  600 ,  700 , and  800  have the necessary rigidity to support themselves over the body, or within reach of the surgeon, without the need of a frame suspending the tubes therefrom. For example, the self-supporting tubes  600 ,  700  and  800  are cantilevered from a point of origin, and have enough rigidity so that the cantilevered self-supporting tubes are taut and do not sag.  
         [0065]      FIG. 16  is a cross-sectional view of co-extruded tubing  600 . The co-extruded tubing includes, for example, PVC tubing  601  with, for example, about 0.4″ OD and about 0.3″ ID. Wires  602  made from, for example, metal or other rigid or semi-rigid material, are co-extruded into the wall  603  of the tube  600  so that the tube can be self supporting and used for functions, such as suction and irrigation. The co-extruded tube  600  can be used in place of a PVC tube that is not co-extruded and not self supporting. There could be one or more support wires  602  that are co-extruded. The cross section of the wire could be various shapes, including for example, circular, square, or oval.  
         [0066]     Versions of the tube  600 , for example, up to about 3″ in diameter or more, can be used as smoke ducts to convey cautery smoke, laser smoke or other kinds of undesirable airborne particles away from the operating table. The co-extruded tube  600  can also be used to support lights and other tools and utilities.  
         [0067]      FIG. 17  shows a helix tube  700  in snapped and unsnapped configurations. The helix tube  700  is flexible and hollow, and includes a snap together helix  701 , which when snapped together, forms a continuous flexible tube  702  that may range in diameter from, for example, about 0.5″ to about 3″. The material of the helix tube  700  can be, for example, metal or plastic, and is rigid or semi-rigid so that the tube can be self supporting.  
         [0068]      FIG. 18  shows a tube  800  including interlocking knuckles  801  having axial flexibility that permits a self supporting flexible characteristic. Each interlocking knuckle  801  includes top and bottom portions  802  and  803 , which fit into respective bottom and top portions of adjacent interlocking knuckles  801 . The size of the resulting tube  800  can be in a range of, for example, about 0.5″ to bout 3″ in diameter. The tube material can be, for example, plastic or metal, and the tube  800  is rigid or semi-rigid so that the tube can be self-supporting.  
         [0069]      FIG. 19  shows a tube including an interlocking knuckle tube  800  and a co-extruded tube  600  at an end thereof. The tube shown in  FIG. 19  is a staged design including a combination of the interlocking and co-extruded designs. Other combinations are also contemplated. For example, it is possible to have a co-extruded tube  600  at the end of a flexible hollow helix tube  700 . A combination may also include a co-extruded tube  600  with weaker support wires  602  at the end of a co-extruded tube  600  having stronger wires  602 , so as to enable greater flexibility of a tube at the end of the tube. Any combination of the above supports is envisioned and the staged design could consist of more than two stages. At the joints that transition from one stage to another, the tubes, for example tubes  600  and  800  shown in  FIG. 19 , can be fused together in numerous ways, such as heat welding, ultrasonic welding or with adhesives.  
         [0070]      FIG. 20  shows an interlocking knuckle tube  800  including a standard tube  575  therein. For example, standard tubes and/or wires, such as, for example, PVC tubing used for suction or irrigation, can be placed within one of the self supporting structures  600 - 800  described and shown above. This would enable standard, inexpensive tubes and wires to be used, while providing, for example, the self-supporting features. Alternatively, tubes and wires can also run on the outside of the self-supporting structures  600 - 800  with clips or other supports holding the tubes and wires to the self supporting structure  600 - 800 .  
         [0071]     Each of the tubes  600 - 800 , when used for passing materials directly therethrough, are designed to be leak resistant. In order prevent leakage, tubes  700  and  800 , for example, may include a leak proof coating, such as, for example, silicone material, or the like, applied to the tubes  700  and  800 .  
         [0072]     Another type of self-supporting structure includes a support wire with end clamp connectors. The support wire could be flexible, but also include sufficient rigidity to be self-supporting. The support wire structure utilizes unsupported tubes, wires, smoke ducts and other tools and utilities that clamp to the end of a support wire. The support wire furnishes the self-supporting function for the tubes, wires, etc. attached at an end thereof, and can be, for example, an annealed metal wire with a diameter between, for example, about 0.1″ to about 0.5″.  
         [0073]     In addition to tubes to convey fluids and air, such as smoke, and wires to power devices such as a cautery pen, fiber optic cables could also run through the self-supporting structures.  
         [0074]     In an alternative embodiment, a supported holder could be mounted to any of the frames  10  and  100 - 500 , and/or attached at an end of any of the self-supporting structures, for example, tubes  600 - 800 , described above. The supported holder includes a tray, a hook, a holster or another holder that allows tools that require very sensitive positioning to be unsecured, yet remain in easy reach for the surgeon. Tethered tools, such as laser cutting hand tools and cautery pens, are examples of tools that may require very sensitive positioning. Other non-tethered tools, including simple tools like scalpels, could also be positioned on the supported holder for easy access.  
         [0075]     According to an embodiment, a self supporting smoke exhaust duct formed of the co-extruded tube  600  could have a supported holder mounted to it to support a cautery pen or a laser hand tool. Other self supporting structures, for example tubes  700 - 800 , could also include supported holders mounted thereto.  
         [0076]     According to an embodiment, a coupling that allows very controlled motions or high flex life performance could be added to a tube, such as a non-supported tube, anywhere along the tube. This coupling could be a “snap-in” tube holder that snaps onto a tube, receives the tube therethrough, and has a mechanical joint. The coupling could also be an in-line tube of a different construction and/or material that allows improved bending performance. In an embodiment, the in-line tube could be a mostly metal constructed tube that is similar to goose neck type tubing.  
         [0077]     Referring to  FIGS. 21 and 22 , surgical tools  950 ,  1050  attached to a pig tail wire support  900  and a recoiling spool support  1000  are shown. These designs allow tools, such as a cautery pen, to hang in place in easy reach of the surgeon. The surgeon can extend the tool support  900 ,  1000  by simply extending the tool to the desired position. Upon completion of a task, the tool support  900 ,  1000  retracts and the tool returns to the initial position. The pig tail wire support  900  includes, for example, spiraled wire  901  attached to the tool  950 , which can be extended by a pulling force, and returns to its original position when the pulling force is decreased or ceases. The recoiling spool support  1000  is attached to a tool  1050 , and includes, for example, wire  1001  which winds around a spring loaded rotating spool  1002 . Upon application of a pulling force, the wire  1001  is unwound and can be extended from the spool  1002 , and upon completion of a task, the pulling force is decreased to allow spring force to rotate the spool  1002  and retract the wire  1001  around the spool  1002 . The spool support  1000  may lock at different positions corresponding to different lengths of the wire  1001 . The pig tail wire and recoiling spool supports may be attached to a frame  10  or  100 - 500 , any one of the self-supporting structures  600 - 800 , or attached to a wall, ceiling, or other structure in an operating room. In an embodiment where the pig tail wire and recoiling spool supports are attached to a self-supporting structure, such as structures  600 - 800 , the self-supporting structure will have sufficient rigidity to maintain a substantially stationary position when a pulling force is applied to the pig tail wire and/or recoiling spool support.  
         [0078]     In an alternative embodiment, robotic positioning, controlled by, for example, retinal positioning and a confirmation/initiate button controlled by the eye, tongue, hand or foot, can be used by the surgeon to position various devices.  
         [0079]     Although exemplary embodiments of the present invention have been described hereinabove, it should be understood that the present invention is not limited to these embodiments, but may be modified by those skilled in the art without departing from the spirit and scope of the present invention, as defined in the appended claims.