Patent Description:
Minimally invasive medical techniques typically reduce the amount of extraneous tissue that is damaged during diagnostic or surgical procedures, thereby reducing patient recovery time, discomfort, and deleterious side effects. Because the average hospital stay for a standard surgery is typically significantly longer than the average stay for an analogous minimally invasive surgery, increased use of minimally invasive techniques can substantially reduce hospital costs each year.

While many of the surgeries performed each year in the United States could potentially be performed in a minimally invasive manner, only a portion of the current surgeries use these advantageous techniques due to limitations in minimally invasive surgical instruments and the additional surgical training involved in mastering them. Thus, there is a need for improved devices, systems and related methods for minimally invasive surgery.

<CIT> discloses a coupler for a robot arm for single port surgery, and a surgical robot comprising the same. The coupler for a robot arm for single port surgery, which is a coupler used in a surgical robot to be operated while surgical instruments are mounted to each of a plurality of robot arms, comprises: a body; coupling portions, which are formed in the body, and are coupled to each end of a plurality of robot arms to enable the plurality of robot arms to be set in a preset state for single port surgery; and a plurality of throughholes for allowing each of a plurality of instruments to be penetrated so as to be inserted into a single port perforated in the surgical site of a patient, perforated in the body. <CIT> discloses a surgical robot system for realizing single-port surgery and multi-port surgery, the system comprising: an operating device; and a controlling device for electro-mechanically controlling the operating device, wherein the operating device includes an alignment section having a plurality of main robot arms, and a plurality of manipulating sections each having a plurality of auxiliary robot arms, and in the multi-port surgery mode, the plurality of main robot arms and at least a portion of the plurality of auxiliary robot arms are operated so that each surgical tool coupled to each of the plurality of manipulating sections can be placed in correspondence with each of a plurality of incisions, and in the single-port surgery mode, the plurality of main robot arms and at least a portion of the plurality of auxiliary robot arms are operated so that each surgical tool coupled to each of the plurality of manipulating sections can be aligned in correspondence with one incision. <CIT> discloses port and port assembly for use with a tool for minimally invasive surgery or a surgical robotic system that adopts the principles of the tool for minimally invasive surgery, and a method of using the same. <CIT> discloses a sterile drape, a surgical system with the drape, and a draping method. The sterile drape may include a plurality of drape pockets, each of the drape pockets including an exterior surface to be adjacent a sterile field for performing a surgical procedure and an interior surface to be adjacent a non-sterile instrument manipulator coupled to a manipulator arm of a robotic surgical system. The drape further includes a plurality of flexible membranes at a distal face of each of the drape pockets for interfacing between outputs of an instrument manipulator and inputs of a respective surgical instrument, and a rotatable seal adapted to couple a proximal opening of each of the drape pockets to a rotatable element at a distal end of the manipulator arm.

The present invention provides a computer-assisted medical system as defined in the appended independent claim <NUM>. Optional features are defined in the appended dependent claims. None of the methods are claimed.

Certain embodiments enable improved operation of surgical tools through a surgical module that is supported by manipulators that are removably attached to the surgical module. The surgical module may enable operation of the surgical tools by providing an integration between actuating mechanisms of the manipulators and actuating mechanisms of the surgical tools. Alternatively or additionally, the surgical module may enable operation of the surgical tools by providing physical access for deploying surgical tools that are operatively connected to the manipulators.

In the invention, a computer-assisted medical system comprises a surgical module, a plurality of manipulator assemblies, and an input controller. The surgical module includes a plurality of actuating mechanisms configured to control one or more surgical tools. The plurality of manipulator assemblies are configured to support and control the surgical module, each manipulator assembly of the plurality of manipulator assemblies being removably attached to the surgical module at a distal portion of that manipulator assembly, and the distal portion of that manipulator assembly including an actuating mechanism configured to interface with one of the plurality of actuating mechanisms of the surgical module. The input controller is operatively coupled to the plurality of manipulator assemblies via a processor and configured to control the manipulator assemblies and the one or more surgical tools through the actuating mechanisms of the plurality of manipulator assemblies.

Another embodiment relates to a method of operating a computer-assisted medical system. A first operation includes using a plurality of manipulator assemblies to support and control a surgical module, the surgical module including a plurality of actuating mechanisms configured to control one or more surgical tools, and each manipulator assembly of the plurality of manipulator assemblies being removably attached to the surgical module at a distal portion of that manipulator assembly, the distal portion of that manipulator assembly including an actuating mechanism configured to interface with one of the plurality of actuating mechanisms of the surgical module. A second operation includes controlling, via a processor, the manipulator assemblies and the one or more surgical tools through the actuating mechanisms of the plurality of manipulator assemblies.

In the invention, a computer-assisted medical system comprises a surgical module, a plurality of manipulator assemblies, and an input controller. The surgical module includes a plurality of channels (e.g., including hollow tubes) configured to deploy a plurality of surgical tools. The plurality of manipulator assemblies are configured to support the surgical module, each manipulator assembly of the plurality of manipulator assemblies being operatively connected to a corresponding surgical tool of the plurality of surgical tools, and each manipulator assembly of the plurality of manipulator assemblies being removably attached to the surgical module at a distal portion of that manipulator assembly. The input controller is operatively coupled to the plurality of manipulator assemblies via a processor and configured to control the manipulator assemblies and the one or more surgical tools through the actuating mechanisms of the plurality of manipulator assemblies.

Another embodiment relates to a method of operating a computer-assisted medical system. A first operation includes using a plurality of manipulator assemblies to support a surgical module, the surgical module including a plurality of channels configured to deploy a plurality of surgical tools, each manipulator assembly of the plurality of manipulator assemblies being operatively connected to a corresponding surgical tool of the plurality of surgical tools, and each manipulator assembly of the plurality of manipulator assemblies being removably attached to the surgical module at a distal portion of that manipulator assembly. A second operation includes controlling, via a processor, the plurality of manipulator assemblies and the plurality of surgical tools through actuating mechanisms of the plurality of manipulator assemblies, the plurality of surgical tools being deployed via the plurality of channels of the surgical module.

Another embodiment relates to an apparatus for carrying out any one of the above-described methods, where the apparatus includes a computer for executing instructions related to the method. For example, the computer may include a processor for executing at least some of the instructions. Additionally or alternatively the computer may include circuitry or other specialized hardware for executing at least some of the instructions. In some operational settings, the apparatus may be configured as a system that includes one or more units, each of which is configured to carry out some aspects of the method either in software, in hardware or in some combination thereof. At least some values for the results of the method can be saved for later use in a computer-readable medium, including memory units and storage devices. Another embodiment relates to a computer-readable medium that stores (e.g., tangibly embodies) a computer program for carrying out the any one of the above-described methods with a computer. In these ways aspects of the disclosed embodiments enable improved integration between actuating mechanisms of manipulators and actuating mechanisms of one or more surgical tools.

Certain embodiments are illustrated by way of example and not limitation in the figures of the accompanying drawings.

The description that follows includes systems, methods, techniques, instruction sequences, and computer-program products that illustrate embodiments of the present disclosure. In the following description, for purposes of explanation, numerous specific details are set forth in order to provide an understanding of various embodiments of the disclosed subject matter. It will be evident, however, to those skilled in the art that embodiments of the disclosed subject matter may be practiced without these specific details. In general, well-known instruction instances, protocols, structures and techniques have not been shown in detail.

Minimally invasive robotically-assisted surgical or telesurgical systems have been developed to increase a surgeon's dexterity and to avoid some of the limitations on manual minimally invasive surgical/interventional techniques. In telesurgery, sitting at a surgeon console/workstation, the surgeon remotely controls and manipulates surgical instrument movements, rather than directly holding and moving the instruments by hand. The surgeon is provided with an image of the surgical site at the surgeon workstation. While viewing a two or three dimensional image of the surgical site on a display, the surgeon performs the surgical procedures on the patient by manipulating master control/input devices (also called the master or input controller), which in turn control motion of the servo-mechanically operated instruments.

The surgeon typically operates the master controller from a location that may be remote from the patient (e.g., across the operating room, in a different room, or a completely different building from the patient). The master controller usually includes one or more hand input devices, such as hand-held wrist gimbals, joy-sticks, exoskeletal gloves, or the like, which are operatively coupled to the surgical instruments that are releasably coupled to a patient side surgical manipulator assembly (also called the the slave(s)). The slave is an electro-mechanical assembly that includes a one or more arms, joints, linkages, servo motors, etc. connected together to support and control one or more surgical instruments. In a surgical procedure, the surgical instruments (including an endoscope) may be introduced directly into an open surgical site or more typically through trocar sleeves into a body cavity. Depending on a surgical procedure, there are available a variety of surgical instruments, such as tissue graspers, needle drivers, electrosurgical cautery probes, etc., to perform various functions for the surgeon, e.g., holding or driving a needle, suturing, grasping a blood vessel, or dissecting, cauterizing or coagulating tissue. The slave may be a multi-port robot as exemplary demonstrated in <CIT>), a single-port robot as exemplary demonstrated in <CIT>), or a flexible robot as exemplary demonstrated in <CIT>).

A surgical manipulator assembly may be said to be divided into three main components that include a non-sterile drive and control component, a sterilizable end effector or surgical tool/instrument, and an interface. The interface includes electro-mechanical as well as required software for coupling the surgical tool with the drive and control component, and for transferring motion from the drive component to the surgical tool. Typically a surgeon will require different surgical instruments/tools during a procedure. As such, these surgical instruments will likely be attached and detached from the manipulator arm a number of times during an operation.

<FIG> illustrates, as an example, components of a multi-port robotic surgical system <NUM> for performing minimally invasive robotic surgery. System <NUM> is similar to that described in more detail in <CIT>). Further related detalils are described in <CIT>) and <CIT>). A system operator <NUM> (generally a surgeon) performs a minimally invasive surgical procedure on a patient <NUM> lying on an operating table <NUM>. The system operator <NUM> sees images presented by display <NUM> and manipulates one or more input devices (or masters) <NUM> at a surgeon's console (or workstation) <NUM>. In response to the surgeon's input commands, a computer processor <NUM> of console <NUM> directs movement of surgical tools <NUM> (also called instruments <NUM>), effecting servo-mechanical movement of the instruments via a robotic patient-side surgical manipulator assembly <NUM> (a cart-based system in this example) including joints, linkages, and manipulator arms each having a telescopic insertion axis. In one embodiment, processor <NUM> correlates the movement of the end effectors of tools <NUM> so that the motions of the end effectors follow the movements of the input devices in the hands of the system operator <NUM>.

Processor <NUM> will typically include data processing hardware and software, with the software typically comprising machine-readable code. The machine-readable code will embody software programming instructions to implement some or all of the methods described herein. While processor <NUM> is shown as a single block in the simplified schematic of <FIG>, the processor may comprise a number of data processing circuits, with at least a portion of the processing optionally being performed adjacent an input device, a portion being performed adjacent a manipulator, and the like. Any of a wide variety of centralized or distributed data processing architectures may be employed. Similarly, the programming code may be implemented as a number of separate programs or subroutines, or may be integrated into a number of other aspects of the robotic systems described herein.

In one example, manipulator assembly <NUM> includes at least four robotic manipulators. Three linkages <NUM> (mounted at the sides of the cart in this example) support and position manipulators <NUM> with linkages <NUM> in general supporting a base of the manipulators <NUM> at a fixed location during at least a portion of the surgical procedure. Manipulators <NUM> move surgical tools <NUM> for robotic manipulation of tissues. One additional linkage <NUM> (mounted at the center of the cart in this example) supports and positions manipulator <NUM> which controls the motion of an endoscope/camera probe <NUM> to capture an image (preferably stereoscopic) of the internal surgical site. The fixable portion of positioning linkages <NUM>, <NUM> of the patient-side system is sometimes referred to herein as a "set-up arm". It should be clear to a person of ordinary skill in the art that linkages <NUM> can also be mounted to operating table <NUM> or to the ceiling.

In one example, the image of the internal surgical site is shown to operator <NUM> by a stereoscopic display <NUM> in surgeon's console <NUM>. The internal surgical site is simultaneously shown to assistant <NUM> by an assistance display <NUM>.

Assistant <NUM> assists in pre-positioning manipulator assemblies <NUM> and <NUM> relative to patient <NUM> using set-up linkage arms <NUM>, <NUM>; in swapping tools <NUM> from one or more of the surgical manipulators for alternative surgical tools or instruments <NUM>; in operating related non-robotic medical instruments and equipment; in manually moving a manipulator assembly so that the associated tool accesses the internal surgical site through a different aperture, and the like.

In general terms, the linkages <NUM>, <NUM> are used primarily during set-up of patient-side system <NUM> (also called manipulator system <NUM>), and typically remain in a fixed configuration during at least a portion of a surgical procedure. Manipulators <NUM>, <NUM> each comprise a driven linkage which is actively articulated under the direction of surgeon's console <NUM>. Although one or more of the joints of the set-up arm may optionally be driven and robotically controlled, at least some of the set-up arm joints may be configured for manual positioning by assistant <NUM>.

For convenience, a manipulator such as manipulator <NUM> that is supporting a surgical tool used to manipulate tissues is sometimes referred to as a patient-side manipulator (PSM), while a manipulator <NUM> which controls an image capture or data acquisition device such as endoscope <NUM> may be referred to as an endoscopic-camera manipulator (ECM). The manipulators may optionally actuate, maneuver, and control a wide variety of instruments or tools, image capture devices, and the like which are useful for surgery.

Tools <NUM> and endoscope <NUM> may be manually positioned when setting up for a surgical procedure, when reconfiguring the manipulator system <NUM> for a different phase of a surgical procedure, when removing and replacing an instrument with an alternate instrument <NUM>, and the like. During such manual reconfiguring of the manipulator assembly by assistant <NUM>, the manipulator assembly may be placed in a different mode than is used during master/slave telesurgery, with the manually repositionable mode sometimes being referred to as a clutch mode. The manipulator assembly may change between the tissue manipulation mode and the clutch mode in response to an input such as pushing a button or switch on manipulator <NUM>, or some other component to the manipulator assembly, thereby allowing assistant <NUM> to change the manipulator mode.

As can be seen in <FIG>, indicators <NUM> may be disposed on a manipulator assembly. In this embodiment, indicators <NUM> are disposed on manipulators <NUM> near the interface between the manipulators and their mounted tools <NUM>. In alternative embodiments, indicators <NUM> may instead be disposed on set-up arms <NUM>, <NUM>, on tools <NUM>, elsewhere on manipulators <NUM>, <NUM>, or the like. An example of an indicator is disclosed in <CIT>).

<FIG> illustrates an embodiment of multi-port robotic patient-side surgical manipulator assembly <NUM> which is commercialized by Intuitive Surgical, Inc. , Sunnyvale, California. As shown, surgical manipulator assembly <NUM> includes four robotic manipulators supported by a mobile cart. Another embodiment of multi-port robotic patient-side surgical manipulator assembly <NUM> may involve four robotic manipulators individually supported by four mobile carts. Yet another embodiment of multi-port robotic patient-side surgical manipulator assembly <NUM> may involve supporting structure for attaching it to an operating bed or ceiling.

Examples of single-port and flexible robotic patient side surgical manipulator assemblies are shown and described in <CIT> and <CIT>, respectively. From these descriptions, the patient-side surgical manipulator assemblies for prior art multi-port robotically assisted systems, single-port robotically assisted systems, and flexible robotically assisted system are substantially different from one another that they require separate designs, developments, and manufacturing lines. In addition to added manufacturing costs and complexities for the manufacturer, hospitals are required to purchase separate patient-side surgical manipulators for multi-port, single-port, and flexible medical procedures, which increases the costs for medical robotic procedures. At a time when health care costs are undergoing strict scrutiny, any added costs are not desirable.

<FIG> shows a surgical tool (or instrument) <NUM> that includes a surgical end effector <NUM> supported relative to a housing <NUM> by an intermediate portion of the instrument, the intermediate portion often comprising of an elongate shaft <NUM>. End effector <NUM> may be supported relative to the shaft by a distal joint or wrist so as to facilitate orienting the end effector within an internal surgical workspace. Proximal housing <NUM> will typically include an interface <NUM> adapted for coupling to a holder of a manipulator <NUM>. As described in more detail in <CIT>), tool <NUM> will often include a memory <NUM>, with the memory typically being electrically coupled to a data interface (the data interface typically forming a portion of interface <NUM>). This allows data communication between memory <NUM> and the robotic surgical processor <NUM> of console <NUM> (see <FIG>) when the instrument is mounted on the manipulator.

A variety of alternative robotic surgical instruments of different types and differing end effectors <NUM> may be used, with the instruments of at least some of the manipulators being removed and replaced during a surgical procedure. Additional details are provided in <CIT>.

In some operational settings, the above-described tools <NUM> and end effectors <NUM> can be combined into combinations with multiple capabilities. Additional details related to these combinations are provided in <CIT>), the disclosure of which is incorporated herein by reference in its entirety. Details related to interfaces between the tools <NUM> and the manipulators <NUM> are provided in <CIT>), <CIT>), and <CIT>.

<FIG> shows a simplified side view of a surgical station <NUM> that is related to the embodiment of <FIG>. Similarly as in the <FIG>, a patient <NUM> is supported by a table <NUM> adjacent to a manipulator system <NUM>, the support for which is not shown. The manipulator system <NUM>, which supports three manipulators <NUM> with associated tools <NUM>, will typically remain in a fixed location over patient <NUM> during at least a portion of a surgical procedure.

In the above-disclosed embodiments, each surgical tool <NUM> is supported by a single manipulator <NUM>. <FIG> disclose aspects of example embodiments of the current invention where a plurality of manipulators of the same type support a single surgical module through which one or more surgical tools are deployed. In an aspect of the current invention, the manipulators <NUM> are configured to be used in multi-port robotically assisted minimally invasive procedures (e.g., where each manipulator supports surgical tool <NUM>), in single-port robotically assisted minimally invasive procedures (e.g., where two or more of the manipulators support a single surgical module for single-port surgery), and in flexible robotically assisted minimally invasive procedures (e.g., where two or more of the manipulators support a single surgical module configured for flexible minimally invasive procedures). In so doing, less design, development, and manufacturing resources, and hence less costs, are needed to design and build manipulators <NUM> because the same manipulators are then configured and used for use in multi-port, single-port, and flexible robotically assisted minimally invasive procedures.

<FIG> shows a perspective view of a portion of a surgical system <NUM> in accordance with an example embodiment. With reference to the system <NUM> of <FIG>, the single manipulator assembly <NUM> that supports multiple manipulators <NUM> has been "separated" into a plurality of four separate manipulators <NUM> (also called manipulator assemblies <NUM>). As shown, the manipulators <NUM> are mounted to the floor at manipulator support structures <NUM>. But, it should be clear to a person of ordinary skill in the art that the manipulators <NUM> may each be mounted on its own cart, to the operating table, or to the ceiling. Although the manipulator support structures <NUM> and manipulators <NUM> are represented as simplified structures, the more detailed representations of the previous figures are fully applicable. The four manipulators <NUM> support a surgical module <NUM> that includes actuating mechanisms that are configured to control one or more surgical tools <NUM>, possibly enclosed by a sheath, through actuating mechanisms of the manipulators <NUM>. In operation, an input controller (e.g., at console <NUM>) is operatively coupled to the manipulators <NUM> and configured to control the manipulators <NUM> and one or more surgical tools <NUM> through the actuating mechanisms of the manipulators <NUM>.

In <FIG>, a distal portion <NUM> of each manipulator <NUM> removably attaches to the surgical module <NUM> so that an actuating mechanism of each manipulator <NUM> interfaces with a corresponding actuating mechanism of the surgical module <NUM>, in accordance with interfaces discussed above with respect to <FIG> and related patents (e.g., <CIT>,<CIT>, <CIT>, <CIT>, and <CIT>). That is, the previously discussed interfaces between the manipulators <NUM> and the surgical tools <NUM> are replaced by equivalent interfaces between the manipulators <NUM> and the surgical module <NUM>, which includes an integration unit <NUM> that combines the contributions of the actuating mechanisms of the manipulators <NUM> for controlling the one or more surgical tools <NUM>. Optionally, other interface designs may be used, such as interfaces that use levers, sliders, gimbals, gears, and the like. In addition to controlling the deployment of the one or more surgical tools <NUM>, the manipulator systems <NUM> provide physical support for the surgical module <NUM> and control the position and orientation of the surgical module <NUM> with respect to a patient <NUM> on a surgical table <NUM>. Although this embodiment includes four manipulators <NUM>, other configurations with a different number of manipulators (e.g., two, three, five, or more) are possible depending on the requirements of the operational setting.

Actuating force or torque from a manipulator is mechanically transmitted through the surgical module to an instrument interface on the integration unit, to which an instrument is mounted, and so the manipulator drives the instrument via the surgical module and its integration unit. Thus if two manipulators support the surgical module, up to two instruments mounted to the integration unit may be driven. Likewise if three manipulators support the surgical module, up to three instruments mounted to the integration unit may be driven, and so on for four, five, or more driving manipulators and corresponding driven instruments. In some implementations, actuating force or torque from two or more manipulators is mechanically transmitted through the surgical module to a single instrument interface on the integration unit, to which a single instrument is mounted, and so the two manipulators drive the single instrument via the surgical module and its integration unit. Likewise, three, four, five, or more manipulators may drive a single instrument. And, a single surgical module may optionally include one or more one-to-one manipulator to instrument drives and one or more plurality-to-one instrument drives. The mechanical coupling to transmit actuating force or torque between the actuation input received at driven interface on the surgical module and the corresponding drive interface on the integration unit is optionally any of various well-known mechanical actuation links, such as rotating or translating rods, gears, universal or constant velocity joints, levers, cables, and the like.

The use of compatible or equivalent interfaces as described above enables a manipulator <NUM> to be used in combination with either an operatively connected surgical tool (e.g., as in <FIG>) or the surgical module <NUM> of <FIG>. Other aspects related to these interfaces may be applied to the surgical modules. For example, the manipulators <NUM> may be draped with a sterile drape or sterilized. Likewise, the surgical module <NUM> may be draped with a sterile drape or sterilized. Sterile adapters may be used between actuation interfaces of the manipulators <NUM> and the surgical module <NUM>. Sterile adapters may be used between actuation interfaces of the surgical module <NUM> and the surgical tools <NUM>. However, if the surgical module <NUM> is sterilizable, then no sterile adapter is generally needed between the surgical module <NUM> and the surgical tools <NUM>. Further related details can be found, for example, in <CIT>, <CIT>, <CIT>, <CIT>, and <CIT>.

<FIG> shows a side view of a surgical system <NUM> for an embodiment with two manipulator systems <NUM> (e.g., a manipulator assembly), each supporting a separate manipulator <NUM>. Similarly as in the system <NUM> of <FIG>, manipulator systems <NUM> and manipulators <NUM> are shown as simplified structures, and the more detailed representations of the previous figures are fully applicable.

Similarly as in the previous figure, <FIG> also shows a surgical module <NUM> that includes actuating mechanisms that are configured to control one or more surgical tools <NUM>, possibly enclosed by a sheath, through actuating mechanisms of the manipulators <NUM>. A distal portion <NUM> of each manipulator <NUM> removably attaches to the surgical module <NUM> so that an actuating mechanism of that manipulator <NUM> interfaces with a corresponding actuating mechanism of the surgical module <NUM> in correspondence to interfaces discussed above with respect to <FIG>. In addition to controlling the deployment of the one or more surgical tools <NUM>, the manipulator systems <NUM> provide physical support for the surgical module <NUM> and control the position and orientation of the surgical module <NUM> with respect to a patient <NUM> on a surgical table <NUM>.

Additional embodiments are discussed below for structural modifications related to the manipulators <NUM> and the tools <NUM> of <FIG> (and corresponding elements of <FIG>).

<FIG> shows a software-center manipulator assembly <NUM>, which may be adapted for one or more of the manipulators <NUM> in accordance with an example embodiment. (With a software-center manipulator, a center of rotational motion (e.g., pitch, yaw, and roll of the instrument shaft) may be defined at a point on the instrument shaft that remains stationary in space under software control. With a software-center manipulator, it is possible to remove the rotational center of motion constraint during operation, and so move the manipulator to various poses in space without constraint. This is in contrast to a hardware-center manipulator in which the center of rotational motion of the instrument shaft is defined by the manipulator's hardware joint axes and cannot be changed. Software- and hardware-center manipulators are known in the art and are illustrated in the various patent references above. ) In operation of the software-center manipulator assembly <NUM>, movement of a pivotal center of motion <NUM> of a robotic instrument <NUM> may be related to an associated port site for minimally invasive surgical access into a patient <NUM>. The manipulator assembly <NUM> may be mounted to a patient side table, ceiling mount or floor mount, and can compensate for port site motion (e.g., patient breathing) by independently controlling the location of the port site. In the exemplary embodiment of <FIG>, the port site location can be controlled in response to Cartesian force information at the cannula pivotal center point as sensed by a force sensing cannula <NUM>.

The coordinate frame attached to the cannula <NUM> is designated as OCAN in <FIG>. This frame is distinct from a base frame, OBASE, at the base of the manipulator assembly <NUM> and the tip frame, OTIP, at the tip of the instrument <NUM>. The Cartesian forces on the cannula <NUM> can be resolved to control the position of the cannula (OCAN). The torques about OCAN are not typically needed for such position control. Some or all of the forces at the port can be resolved using a force sensing system of cannula <NUM>, and optionally at least some of the forces may be resolved using a force sensing system of the instrument <NUM>, the manipulator assembly <NUM> (e.g., joint torque sensors of the manipulator), or the like.

Additional details related to the software center manipulator assembly <NUM> can be found, for example, in <CIT>). In some embodiments, a clutch mode may be enabled so that the surgical module <NUM> of <FIG> can be manually adjusted by a technician with the manipulators <NUM> to technician's manual adjustments. Further details for a clutch mode as applied, for example, to a surgical tool can be found in <CIT>.

Tools <NUM> may be tools used in a single-port procedures or flexible procedures depending on the configuration of surgical module <NUM>. <FIG> illustrates an embodiment of surgical tools 508A for a single-port robotically assisted minimally invasive configuration for the present invention. <FIG> illustrates an embodiment of surgical tools 508B for flexible robotically assisted minimally invasive configuration for the present invention.

The term "flexible" in association with a part, such as a mechanical structure, component, or component assembly, should be broadly construed. In essence, the term means the part can be repeatedly bent and restored to an original shape without harm to the part. Many "rigid" objects have a slight inherent resilient "bendiness" due to material properties, although such objects are not considered "flexible" as the term is used herein. A flexible part may have infinite degrees of freedom (DOFs). Examples of such parts include closed, bendable tubes (made from, e.g., NITINOL, polymer, soft rubber, and the like), helical coil springs, etc. that can be bent into various simple or compound curves, often without significant cross-sectional deformation. Other flexible parts may approximate such an infinite-DOF part by using a series of closely spaced components that are similar to a snake-like arrangement of serial "vertebrae". In such a vertebral arrangement, each component is a short link in a kinematic chain, and movable mechanical constraints (e.g., pin hinge, cup and ball, live hinge, and the like) between each link may allow one (e.g., pitch) or two (e.g., pitch and yaw) DOFs of relative movement between the links. A short, flexible part may serve as, and be modeled as, a single mechanical constraint (joint) that provides one or more DOFs between two links in a kinematic chain, even though the flexible part itself may be a kinematic chain made of several coupled links. Knowledgeable persons will understand that a part's flexibility may be expressed in terms of its stiffness.

Unless otherwise stated in this description, a flexible part, such as a mechanical structure, component, or component assembly, may be either actively or passively flexible. An actively flexible part may be bent by using forces inherently associated with the part itself. For example, one or more tendons may be routed lengthwise along the part and offset from the part's longitudinal axis, so that tension on the one or more tendons causes the part or a portion of the part to bend. Other ways of actively bending an actively flexible part include, without limitation, the use of pneumatic or hydraulic power, gears, electroactive polymer (more generally, "artificial muscle"), and the like. A passively flexible part is bent by using a force external to the part (e.g., an applied mechanical or electromagnetic force). A passively flexible part may remain in its bent shape until bent again, or it may have an inherent characteristic that tends to restore the part to an original shape. An example of a passively flexible part with inherent stiffness is a plastic rod or a resilient rubber tube. An actively flexible part, when not actuated by its inherently associated forces, may be passively flexible. A single part may be made of one or more actively and passively flexible parts in series.

In <FIG>, the tools 508A comprise a surgical instrument assembly that includes multiple surgical instruments. As shown, two independently teleoperated surgical instruments 820A, 820B (each instrument is associated with a separate master <NUM> at the console <NUM>-e.g. one left hand master for the left instrument and one right hand master for the right instrument) run through and emerge at the distal end of a rigid guide tube <NUM> (e.g., a sheath). Each instrument 820A, 820B is a <NUM>-DOF instrument, as described above, and includes a parallel motion mechanism 824A, 824B, with wrists 826A, 826B and end effectors 828A, 828B attached. In addition, an independently teleoperated endoscopic imaging system <NUM> runs through and emerges at the distal end of guide tube <NUM>.

In some embodiments, imaging system <NUM> also includes a parallel motion mechanism <NUM>, a pitch-only wrist mechanism <NUM> at the distal end of the parallel motion mechanism <NUM> (the mechanism may have either one or two DOFs in joint space), and a stereoscopic endoscopic image capture component <NUM> coupled to wrist mechanism <NUM>. Wrist mechanism <NUM> may include a yaw DOF. In yet another aspect, the proximal and distal joints in imaging system <NUM> may be independently controlled. In an illustrative use, parallel motion mechanism <NUM> heaves and sways image capture component <NUM> up and to the side, and wrist mechanism <NUM> orients image capture component <NUM> to place the center of the field of view between the instrument tips if the instruments are working to the side of the guide tube's extended centerline. In another illustrative use, the distal body segment of imaging system is independently pitched up (in some aspects also independently yawed), and image capture component <NUM> is independently pitched down (in some aspects also independently yawed). Imaging system <NUM> may be moved to various places to retract tissue.

<FIG> also shows an optional auxiliary channel <NUM>, through which, for example, irrigation, suction, or other surgical items may be introduced or withdrawn. In some aspects, one or more small, steerable devices may be inserted via auxiliary channel <NUM> to spray a cleaning fluid (e.g., pressurized water, gas) and/or a drying agent (e.g., pressurized air or insufflation gas) on the imaging system's windows to clean them. In another aspect, such a cleaning wand may be a passive device that attaches to the camera before insertion. In yet another aspect, the end of the wand is automatically hooked to the image capture component as the image capture component emerges from the guide tube's distal end. A spring gently pulls on the cleaning wand so that it tends to retract into the guide tube as the imaging system is withdrawn from the guide tube. Additional details related to this embodiment are provided in <CIT>.

In <FIG>, the tools 508B comprise a set of two instruments including a guide instrument <NUM> and a sheath instrument <NUM>, which are coaxially coupled and independently controllable. These instruments <NUM>, <NUM> may be flexible and steerable to facilitate surgical operations in the body cavity of a patient. Although not shown in this figure, the guide instrument <NUM> and the sheath instrument <NUM> may be coupled to an instrument driver at corresponding interfaces (e.g., including mounting pins and sockets). The guide instrument <NUM> includes a guide-instrument lumen (e.g., cavity) and the sheath instrument <NUM> includes a sheath-instrument lumen. The guide instrument <NUM> may be positioned inside the lumen of the sheath instrument <NUM>, and an elongate working instrument may be positioned in the lumen of the guide-instrument <NUM> with actuation robotically controlled by the instrument driver. In operation, the guide instrument <NUM>, the sheath instrument <NUM> and the working instrument may operate as a flexible and steerable instrument assembly. Additional details related to this embodiment are provided in <CIT>.

As illustrated in <FIG>, <FIG> and <FIG>, additional embodiments may include structural elements that enable or accommodate internal articulations in the shaft of a tool (e.g., shaft <NUM> of tool <NUM> of <FIG>).

In correspondence to the tool <NUM> of <FIG>, <FIG> shows an exemplary surgical tool (or instrument) <NUM> including a transmission or backend mechanism <NUM>, a main shaft <NUM> extending from the backend mechanism <NUM>, an optional wrist mechanism <NUM> at the distal end of main shaft <NUM>, and an end effector <NUM> extending from wrist mechanism <NUM> or directly from the shaft <NUM>. Typically, the wrist mechanism <NUM> and end effector <NUM> are the components of surgical instrument <NUM> that generally move extensively during a medical procedure. In the illustrated embodiment, wrist mechanism <NUM> includes a joint <NUM> that connects an extended member <NUM> to main shaft <NUM>, and extended member <NUM> connects to a multimember wrist <NUM> on which end effector <NUM> is mounted. Joint <NUM> can have two angular degrees of freedom for movement of member <NUM>, which, as a result of the extended length of member <NUM>, provides a significant range of spatial motion for wrist <NUM> and end effector <NUM>. Wrist <NUM> includes multiple vertebrae that may be independently controlled to provide multiple degrees of freedom for moving and orienting end effector <NUM> during a medical procedure. <FIG> also illustrates that main shaft <NUM> may include one or more cleaning holes <NUM>, which facilitate cleaning of the interior of instrument <NUM>. Additional details related to this embodiment are provided in <CIT>).

<FIG> shows a distal portion <NUM> of a surgical instrument including a parallel motion mechanism <NUM> connected to an instrument shaft <NUM>. The instrument may be a camera instrument or a surgical instrument with an end effector <NUM> at a distal end <NUM> of the instrument distal portion <NUM>. The instrument distal portion <NUM> may, for example, include a wrist <NUM>, which may be configured in a variety of ways as described in International Application No. <CIT>). A parallel motion mechanism <NUM> may include a straight shaft section <NUM> (with an outer casing <NUM>) that separates a proximal joint mechanism <NUM> from a distal joint mechanism <NUM>. Similarly as in the exemplary embodiments of <CIT>) and <CIT>), joint mechanisms <NUM> and <NUM> and the opposite ends of straight section <NUM> are coupled together so as to operate in cooperation with each other. According to an exemplary embodiment, proximal joint mechanism <NUM> and distal joint mechanism <NUM> may include a plurality of connected disks, similar to a wrist. The disks may include, for example, mechanical stops (not shown) to limit the motion of joint mechanisms <NUM>, <NUM>, such as in pitch and/or yaw directions.

<FIG> shows the instrument distal portion <NUM> of <FIG> in a deflected configuration according to an exemplary embodiment. As shown in <FIG>, parallel motion mechanism <NUM> may control the relative orientations of a distal end portion <NUM> of parallel motion mechanism <NUM> and a proximal end portion <NUM> of parallel motion mechanism <NUM>. As a result, a longitudinal axis <NUM> through distal end portion <NUM> of parallel motion mechanism <NUM> may be substantially parallel to a longitudinal axis <NUM> passing through proximal end <NUM> of parallel motion mechanism <NUM>. Longitudinal axis 1111may also be the longitudinal axis of instrument shaft <NUM>, not shown in <FIG>. Thus, a position of end effector <NUM>, camera device (not shown), or other component at distal end <NUM> of instrument distal portion <NUM> may be changed in X-Y space but the orientation of end effector <NUM> relative to longitudinal axis <NUM> may be maintained (before any motion due to wrist <NUM> is accounted for).

Additional details related to the embodiment of <FIG> are provided in International Application No. <CIT>.

In some embodiments, flexible and steerable tools <NUM> (e.g., <FIG>, <FIG>, <FIG>, <FIG>, <FIG>) may be used with a surgical module <NUM> where the above-described integration unit <NUM> is replaced by a system of channels (e.g., including hollow tubes) for deploying tools <NUM> that are directly controlled by the actuating mechanisms of the manipulators <NUM>. With this interpretation of <FIG>, the distal portion <NUM> of each manipulator <NUM> removably attaches to the surgical module <NUM> to provide support for the surgical module <NUM> (e.g., including control for position and orientation). The broken lines of the surgical module <NUM> in <FIG> then represent channels for deploying the tools <NUM> that are directly controlled by the actuating mechanisms of the manipulators <NUM>. In related embodiments, the surgical module <NUM> operates as an entry guide for the tools <NUM> rather than a transmission mechanism for actuation signals. Certain embodiments may combine these features by employing a transmission mechanism for at least one manipulator and an entry guide for at least one other manipulator.

Additional mechanisms for operating tools <NUM> from the surgical module <NUM> may be employed including manual operation of tools <NUM> from the surgical module <NUM> by a technician (e.g., operating a camera mounted on the surgical module <NUM>). In some embodiments, cables and tubing that are conventionally attached to the tools <NUM> can be attached instead to the surgical module <NUM>, which then relates these connections to the tools <NUM> (e.g., command signals from the cables, fluid flow from the tubing). These connections can be related, for example, from the input controller at the console <NUM> or by a technician from controls at the surgical module <NUM>. <FIG> shows a method <NUM> of operating a computer-assisted medical system (e.g., as in <FIG>). A first operation <NUM> includes using a plurality of manipulator assemblies <NUM> to support and control a surgical module <NUM>, the surgical module including a plurality of actuating mechanisms configured to control one or more surgical tools <NUM>, and each manipulator assembly of the plurality of manipulator assemblies <NUM> being removably attached to the surgical module at a distal portion <NUM> of that manipulator assembly, the distal portion of that manipulator assembly including an actuating mechanism configured to interface with one of the plurality of actuating mechanisms of the surgical module <NUM>. A second operation <NUM> includes controlling the manipulator assemblies <NUM> and the one or more surgical tools <NUM> through the actuating mechanisms of the plurality of manipulator assemblies <NUM>.

Each manipulator assembly of the plurality of manipulator assemblies <NUM> may include a plurality of joints from a proximal portion of that manipulator assembly to the distal portion of that manipulator assembly so that joint ranges of the plurality of joints of the plurality of manipulator assemblies correspond to a range of positions for the surgical module <NUM>. Each manipulator assembly of the plurality of manipulator assemblies <NUM> may include a plurality of joints from a proximal portion of that manipulator assembly to the distal portion of that manipulator assembly so that joint ranges of the plurality of joints of the plurality of manipulator assemblies correspond to a range of positions and orientations for the surgical module <NUM>.

The one or more surgical tools <NUM> may be configured for use in single-port procedures or in flexible instrument procedures where the tools <NUM> may be steerable. The one or more surgical tools <NUM> may include one or more end-effectors and an imaging tool (e.g., a camera). The one or more surgical tools <NUM> may be flexible and steerable (e.g., including a sheath). The surgical module <NUM> may include a sheath for deploying the one or more surgical tools <NUM> at a surgical site of a patient.

Each manipulator assembly of the plurality of manipulator assemblies <NUM> may be a software-center manipulator assembly that includes a plurality of joints and actuators from a proximal portion of that manipulator assembly to the distal portion of that manipulator assembly so that joint ranges of the plurality of joints of the plurality of manipulator assemblies correspond to a range of positions and orientations for the surgical module. The method <NUM> may then further comprise: controlling a position and orientation of the surgical module <NUM> by controlling the plurality of actuators of the plurality of manipulator assemblies <NUM>.

The one or more surgical tools <NUM> may include a first surgical tool, and the method <NUM> may further comprise: deploying the first surgical tool by controlling a tool-actuation unit that is configured to deploy the first surgical tool through an actuator that changes a position relative to the surgical module for the first surgical tool, the tool actuation unit being operatively connected to one or more of the plurality of actuating mechanisms of the surgical module.

The one or more surgical tools <NUM> may include a first surgical tool, and the method <NUM> may further comprise: controlling the first surgical tool through one or more of the actuating mechanisms of the plurality of manipulator assemblies <NUM>. For example, there need not be a one-to-one mapping between manipulator assemblies <NUM> and surgical tools <NUM>. A single tool may be controlled by signals from multiple manipulator assemblies <NUM> (e.g., as specified at the input controller at the console <NUM>). Alternatively, multiple tools may be controlled by signals from a single manipulator assembly <NUM>.

The method <NUM> may further comprise: transmitting a plurality of electrical or mechanical signals from each actuating mechanism of the plurality of manipulator assemblies <NUM> to a corresponding one of the plurality of actuating mechanisms of the surgical module <NUM>.

The method <NUM> may further comprise: transmitting mechanical signals from one or more rotatable elements included in a first actuating mechanism of the plurality of manipulator assemblies <NUM> to one or more corresponding rotatable elements of a first actuating mechanism of the plurality of actuating mechanisms included in the surgical module <NUM>. Additionally or alternatively, prismatic elements can be used to transmit translational mechanical signals.

<FIG> shows a method <NUM> of operating a computer-assisted medical system (e.g., as in <FIG>) when the surgical module includes channels (e.g., including hollow tubes) configured to deploy surgical tools. A first operation <NUM> includes using a plurality of manipulator assemblies <NUM> to support a surgical module <NUM>, the surgical module including a plurality of channels configured to deploy a plurality of surgical tools <NUM>, each manipulator assembly of the plurality of manipulator assemblies <NUM> being operatively connected to a corresponding surgical tool of the plurality of surgical tools <NUM>, and each manipulator assembly of the plurality of manipulator assemblies <NUM> being removably attached to the surgical module at a distal portion of that manipulator assembly. A second operation <NUM> includes controlling the plurality of manipulator assemblies <NUM> and the plurality of surgical tools <NUM> through actuating mechanisms of the plurality of manipulator assemblies <NUM>, the plurality of surgical tools <NUM> being deployed via the plurality of channels of the surgical module <NUM>.

The surgical tools <NUM> may be configured for use in single-port procedures or in flexible procedures where the tools <NUM> may be steerable. The surgical tools <NUM> may include one or more end-effectors and an imaging tool (e.g., a camera). The one or more surgical tools <NUM> may be flexible and steerable (e.g., including a sheath).

A first surgical tool may include a flexible and steerable sheath for deploying the first surgical tool at a surgical site of a patient.

<FIG> shows a machine in the example form of a computer system <NUM> within which instructions for causing the machine to perform any one or more of the methodologies discussed here may be executed. In alternative embodiments, the machine operates as a standalone device or may be connected (e.g., networked) to other machines. In a networked deployment, the machine may operate in the capacity of a server or a client machine in server-client network environment, or as a peer machine in a peer-to-peer (or distributed) network environment. The machine may be a personal computer (PC), a tablet PC, a set-top box (STB), a personal digital assistant (PDA), a cellular telephone, a web appliance, a network router, switch or bridge, or any machine capable of executing instructions (sequential or otherwise) that specify actions to be taken by that machine. Further, while only a single machine is illustrated, the term "machine" shall also be taken to include any collection of machines that individually or jointly execute a set (or multiple sets) of instructions to perform any one or more of the methodologies discussed herein.

The example computer system <NUM> includes a processor <NUM> (e.g., a central processing unit (CPU), a graphics processing unit (GPU) or both), a main memory <NUM>, and a static memory <NUM>, which communicate with each other via a bus <NUM>. The computer system <NUM> may further include a video display unit <NUM> (e.g., a liquid crystal display (LCD) or a cathode ray tube (CRT)). The computer system <NUM> also includes an alphanumeric input device <NUM> (e.g., a keyboard), a user interface (UI) cursor control device <NUM> (e.g., a mouse), a storage unit <NUM> (e.g., a disk drive), a signal generation device <NUM> (e.g., a speaker), and a network interface device <NUM>.

In some contexts, a computer-readable medium may be described as a machine-readable medium. The storage unit <NUM> includes a machine-readable medium <NUM> on which is stored one or more sets of data structures and instructions <NUM> (e.g., software) embodying or utilizing any one or more of the methodologies or functions described herein. The instructions <NUM> may also reside, completely or at least partially, within the static memory <NUM>, within the main memory <NUM>, or within the processor <NUM> during execution thereof by the computer system <NUM>, with the static memory <NUM>, the main memory <NUM>, and the processor <NUM> also constituting machine-readable media.

While the machine-readable medium <NUM> is shown in an example embodiment to be a single medium, the terms "machine-readable medium" and "computer-readable medium" may each refer to a single storage medium or multiple storage media (e.g., a centralized or distributed database, and/or associated caches and servers) that store the one or more sets of data structures and instructions <NUM>. These terms shall also be taken to include any tangible or non-transitory medium that is capable of storing, encoding or carrying instructions for execution by the machine and that cause the machine to perform any one or more of the methodologies disclosed herein, or that is capable of storing, encoding or carrying data structures utilized by or associated with such instructions. These terms shall accordingly be taken to include, but not be limited to, solid-state memories, optical media, and magnetic media. Specific examples of machine-readable or computer-readable media include non-volatile memory, including by way of example semiconductor memory devices, e.g., erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), and flash memory devices; magnetic disks such as internal hard disks and removable disks; magneto-optical disks; compact disc read-only memory (CD-ROM) and digital versatile disc read-only memory (DVD-ROM). However, the terms "machine-readable medium" and "computer-readable medium" are intended to specifically exclude non-statutory signals per se.

The instructions <NUM> may further be transmitted or received over a communications network <NUM> using a transmission medium. The instructions <NUM> may be transmitted using the network interface device <NUM> and any one of a number of well-known transfer protocols (e.g., hypertext transfer protocol (HTTP)). Examples of communication networks include a local area network (LAN), a wide area network (WAN), the Internet, mobile telephone networks, plain old telephone (POTS) networks, and wireless data networks (e.g., WiFi and WiMax networks). The term "transmission medium" shall be taken to include any intangible medium that is capable of storing, encoding or carrying instructions for execution by the machine, and includes digital or analog communications signals or other intangible media to facilitate communication of such software.

Certain embodiments are described herein as including logic or a number of components, modules, or mechanisms. Modules may constitute either software modules or hardware-implemented modules. A hardware-implemented module is a tangible unit capable of performing certain operations and may be configured or arranged in a certain manner. In example embodiments, one or more computer systems (e.g., a standalone, client or server computer system) or one or more processors may be configured by software (e.g., an application or application portion) as a hardware-implemented module that operates to perform certain operations as described herein.

In various embodiments, a hardware-implemented module (e.g., a computer-implemented module) may be implemented mechanically or electronically. For example, a hardware-implemented module may comprise dedicated circuitry or logic that is permanently configured (e.g., as a special-purpose processor, such as a field programmable gate array (FPGA) or an application-specific integrated circuit (ASIC)) to perform certain operations. A hardware-implemented module may also comprise programmable logic or circuitry (e.g., as encompassed within a general-purpose processor or other programmable processor) that is temporarily configured by software to perform certain operations. It will be appreciated that the decision to implement a hardware-implemented module mechanically, in dedicated and permanently configured circuitry, or in temporarily configured circuitry (e.g., configured by software) may be driven by cost and time considerations.

Accordingly, the term "hardware-implemented module" (e.g., a "computer-implemented module") should be understood to encompass a tangible entity, be that an entity that is physically constructed, permanently configured (e.g., hardwired), or temporarily or transitorily configured (e.g., programmed) to operate in a certain manner and/or to perform certain operations described herein. Considering embodiments in which hardware-implemented modules are temporarily configured (e.g., programmed), each of the hardware-implemented modules need not be configured or instantiated at any one instance in time. For example, where the hardware-implemented modules comprise a general-purpose processor configured using software, the general-purpose processor may be configured as respective different hardware-implemented modules at different times. Software may accordingly configure a processor, for example, to constitute a particular hardware-implemented module at one instance of time and to constitute a different hardware-implemented module at a different instance of time.

Hardware-implemented modules can provide information to, and receive information from, other hardware-implemented modules. Accordingly, the described hardware-implemented modules may be regarded as being communicatively coupled. Where multiple of such hardware-implemented modules exist contemporaneously, communications may be achieved through signal transmission (e.g., over appropriate circuits and buses) that connect the hardware-implemented modules. In embodiments in which multiple hardware-implemented modules are configured or instantiated at different times, communications between such hardware-implemented modules may be achieved, for example, through the storage and retrieval of information in memory structures to which the multiple hardware-implemented modules have access. For example, one hardware-implemented module may perform an operation and store the output of that operation in a memory device to which it is communicatively coupled. A further hardware-implemented module may then, at a later time, access the memory device to retrieve and process the stored output. Hardware-implemented modules may also initiate communications with input or output devices and may operate on a resource (e.g., a collection of information).

Similarly, the methods described herein may be at least partially processor-implemented. In some example embodiments, the processor or processors may be located in a single location (e.g., within a home environment, an office environment or as a server farm), while in other embodiments the processors may be distributed across a number of locations.

The one or more processors may also operate to support performance of the relevant operations in a "cloud computing" environment or as a "software as a service" (SaaS). For example, at least some of the operations may be performed by a group of computers (as examples of machines including processors), these operations being accessible via a network (e.g., the Internet) and via one or more appropriate interfaces (e.g., application program interfaces (APIs)).

Claim 1:
A computer-assisted medical system comprising:
a surgical module (<NUM>) including a plurality of channels configured to deploy a plurality of surgical tools (<NUM>);
a plurality of manipulator assemblies (<NUM>) configured to support the surgical module (<NUM>), each manipulator assembly (<NUM>) of the plurality of manipulator assemblies being operatively connected to a corresponding surgical tool of the plurality of surgical tools, and each manipulator assembly (<NUM>) of the plurality of manipulator assemblies being removably attached to the surgical module (<NUM>) at a distal portion (<NUM>) of that manipulator assembly (<NUM>); and
an input controller operatively coupled to the plurality of manipulator assemblies (<NUM>) via a processor and configured to control the plurality of manipulator assemblies (<NUM>) and
the plurality of surgical tools (<NUM>) through actuating mechanisms of the plurality of manipulator assemblies (<NUM>),
the plurality of surgical tools (<NUM>) being deployed via the plurality of channels of the surgical module (<NUM>),
characterized in that
the surgical module (<NUM>) includes actuating mechanisms that are configured to control the plurality of surgical tools (<NUM>) through actuating mechanisms of the plurality of manipulator assemblies (<NUM>), an actuating mechanism of each manipulator assembly (<NUM>) interfaces with a corresponding actuating mechanism of the surgical module (<NUM>).