Patent Description:
Laparoscopic, endoscopic, and other types of minimally invasive surgical procedures often rely on percutaneous introduction of surgical instruments into an internal region of a patient where the surgical procedure is to be performed. Surgeons continue to find it desirable to utilize smaller and smaller access incisions in order to minimize trauma and reduce patient recovery times. Frequently, surgeons will make additional small incisions through which a viewing scope or other surgical equipment may be passed to assist in the operation. In the case of viewing scopes, an assistant may manipulate and/or hold the scope in a fixed position for the surgeon so that the surgeon may look at images, acquired by the scope, on a monitor screen in order to perform the minimally invasive operation. Holders, such as the one illustrated in <FIG>, may be used in lieu of an assistant to position and hold surgical equipment such as, but not limited to, a viewing scope.

<FIG> is a schematic illustration of a prior art equipment holder <NUM>. The equipment holder <NUM> has a base <NUM>. The base <NUM> is illustrated schematically, but may be an object with substantial mass compared to what it will be holding so that the equipment holder <NUM> is stable. Alternately, the base <NUM> may be a clamp, suction device, magnet, or otherwise have an attachment mechanism for attaching or coupling the equipment holder <NUM> to a surgical operating table or some other equipment in an operating room. Such bases are known to those skilled in the art.

A ball connector <NUM> is coupled to the base <NUM>. A first arm <NUM> is pivotably coupled to the ball connector <NUM> by a socket <NUM> on one end of the first arm <NUM>. The socket <NUM> is sized so that it does not come off the ball connector <NUM>, but otherwise is able to pivot freely in all directions around the ball connector <NUM>. The other end of the first arm <NUM> terminates in a receiver <NUM> which has a threaded opening (not visible in <FIG>) sized to accept a screw (also not visible in <FIG>) which is attached to control knob <NUM>. The screw <NUM> attached to control knob <NUM> can be seen in <FIG> is a partially exploded view of the prior art equipment holder <NUM> of <FIG>. When assembled, the screw <NUM> passes through a clearance hole <NUM> in the first end <NUM> of a second arm <NUM> and is screwed into the threaded opening <NUM> of receiver <NUM>. A rod <NUM> is slideable within the first arm <NUM>. The rod <NUM> may have a cupped end <NUM> which is designed to help create friction against the ball connector <NUM> when the rod <NUM> is pushed towards the ball connector <NUM>. The rod <NUM> also has a tapered end <NUM> opposite the cupped end <NUM>. When the screw <NUM> is not tightened all the way into the threaded opening <NUM> of the receiver <NUM>, the end of the screw <NUM> does not exert enough force on the tapered end <NUM> of the rod <NUM> to push the rod <NUM> against the ball connector <NUM>. Furthermore, when the screw <NUM> is not tightened all the way into the threaded opening <NUM> of the receiver <NUM>, the second arm <NUM> is free to rotate around an axis defined by the screw <NUM>. Thus, while the screw <NUM> is not tightened, a surgeon may use one hand to position the second arm <NUM> as well as the first arm <NUM> coupled to it. Then, while using that one hand to maintain the desired position of the arms, the surgeon may use his/her other hand to tighten the control knob <NUM> to lock the first and second arms of the equipment holder <NUM> in place. As the control knob <NUM> is tightened, the end of the screw <NUM> interferes with the tapered end <NUM> of the rod <NUM>, pushing the rod <NUM> axially against the ball connector <NUM> and fixing the orientation of the first arm <NUM>. Additionally, the tightening of the control knob <NUM> grips the first end <NUM> of the second arm <NUM> between the control knob <NUM> and the receiver <NUM>, thereby fixing the orientation of the second arm <NUM> as illustrated in <FIG>. Unfortunately, this positioning and locking into a desired position takes two hands.

Furthermore, this two-handed adjustment does nothing to adjust an end effector <NUM> coupled to a second end <NUM> of the second arm <NUM>. Many prior art equipment holders <NUM> have an adapter or end effector <NUM> configured to provide an interface with the surgical tool being held. In the case of a viewing scope, the end effector <NUM> would have some type of clamp or set screw, or other attachment features which actually hold the viewing scope. In <FIG> and <FIG>, the end effector <NUM> is simply shown as a generic block, but some end effectors may also have a separate control knob whereby the angle of the device being held by the end effector <NUM> can be changed relative to the second arm <NUM>. Such an adjustment, while providing positioning flexibility, would also require a pair of hands to work and could not be done at the same time as the adjustment of the first and second arm <NUM>, <NUM> positions unless two people were involved at the same time. Therefore, it would be desirable to have an improved surgical equipment holder, especially one which was simpler to adjust.

<CIT> discloses a repositionable, lockable support arm assembly for surgical and other tools, which includes a base arm having a lower end and an upper end, a distal arm having a proximal end and a distal end, and a central joint, typically a rotational joint, directly or indirectly linking the upper end of the base arm to the proximal end of the distal arm. A lower j oint, typically a spherical j oint, is positioned at the lower end of the base arm, and an upper joint, also typically a spherical joint, is located at the distal end of the distal arm, A locking mechanism is coupled to the base arm at a location above the lower joint and is configured to simultaneously deliver locking forces to the lower joint, to the rotational joint, and to the upper joint. The locking mechanism usually includes a powered, bilateral force generator for actuating the locking mechanism.

<CIT> discloses a jointed stand especially for dial gauges, uses a single control element for locking all of the members of the stand in position relative to all other members. The members include at least a pair of arms interconnected at a swivel assembly at which a pair of conical disks engage eccentric rings connected to slide rods which run through the arms and axially displace socket members receiving balls by which a holder and a base are jointed to the arms.

<CIT> discloses a positioning unit having two arms and three joints, whereby a payload carried by the positioning unit at one of the joints can be moved into a desired position. Each joint has locking and releasing means by which the arms can be moved when the locking and releasing means are released and maintained in a desired position when the locking and releasing means are locked. The locking and releasing of the joints is controlled by two controllers both of which can be actuated simultaneously by a single human hand.

A bladeless trocar obturator to separate or divaricate body tissue during insertion through a body wall is disclosed by <CIT>.

The invention is defined by appended independent claim <NUM>, preferred embodiments being defined by appended dependent claims.

A surgical equipment holder according to the invention is disclosed. The surgical equipment holder has a first arm pivotable relative to a base, a second arm pivotably coupled to the first arm, an end effector pivotable relative to the second arm, and a lever movable between a locked position and an unlocked position. The lever is configured such that the first arm does not pivot relative to the base, the second arm does not pivot relative to the first arm, and the end effector does not pivot relative to the second arm when the lever is in the locked position; and the first arm may be pivoted relative to the base, the second arm may be pivoted relative to the first arm, and the end effector may be pivoted relative to the second arm when the lever is in the unlocked position.

Another surgical equipment holder is also disclosed. The surgical equipment holder includes a first arm pivotable relative to a base, a second arm pivotably coupled to the first arm, an end effector pivotable relative to the second arm, and a lever movable between a locked position and an unlocked position. The lever is configured such that the first arm does not pivot relative to the base, the second arm does not pivot relative to the first arm, and the end effector may be pivoted relative to the second arm when the lever is in the locked position. The lever is also configured such that the first arm may be pivoted relative to the base, the second arm may be pivoted relative to the first arm, and the end effector may be pivoted relative to the second arm when the lever is in the unlocked position.

Another surgical equipment holder is also disclosed. The surgical equipment holder has a first arm pivotable relative to a base, a second arm pivotably coupled to the first arm and an end effector pivotable relative to the second arm. The end effector is coupled to one of a group including an endoscope, a rib retractor, an apparatus for suture management as well as combinations thereof. The surgical instrument holder also includes a lever movable between a locked position and an unlocked position and configured such that the first arm does not pivot relative to the base, the second arm does not pivot relative to the first arm, and the end effector does not pivot relative to the second arm when the lever is in the locked position. The lever is also configured such that the first arm may be pivoted relative to the base, the second arm may be pivoted relative to the first arm, and the end effector may be pivoted relative to the second arm when the lever is in the unlocked position. According to the invention, the surgical equipment holder also includes a tension rod having a spherical stop end in communication with the first arm, the second arm and the lever; and a spacing washer having a convex outward surface configured such that the spacing washer shares an assembled center point which is approximately coincident with the center of the spherical stop end of the tension rod. The locking mechanism of the surgical instrument holder includes a latch coupled to the lever and a catch coupled to the second arm, configured such that the locking mechanism is engaged by moving the lever towards the second arm and the locking mechanism is disengaged by moving the lever towards the second arm when in the locked position.

<FIG> illustrates an improved embodiment of a surgical equipment holder <NUM>. Shown is a first arm <NUM> and a second arm <NUM>. The first arm <NUM> has a rod <NUM> slideable therein, the rod <NUM> having a tapered end <NUM> on one end. The other end of rod <NUM> is not visible in this view, but it is configured to interface with a ball connector like the ball connector <NUM> of the device in <FIG>. This ball connector could be coupled to a base. The second arm <NUM> has a rod <NUM> slideable therein, the rod <NUM> having a tapered end <NUM> on one end. The other end of rod <NUM> is not visible in this view, but it is configured to interface with another ball connector. This ball connector could be coupled to an end effector. A lever <NUM> is aligned with one of the arms, in this embodiment, with the second arm <NUM>, with the majority of the lever <NUM> biased away from the arm <NUM> by a spring element <NUM>. Although a specific style of spring is shown in the example of <FIG> for the spring element <NUM>, it should be understood that those skilled in the art are familiar with a wide variety of springs that could be used in place of the illustrated spring element <NUM>.

The lever <NUM> is coupled to a wedge <NUM>. When the lever <NUM> is in the position shown in <FIG>, the wedge <NUM> is pressed against tapered end <NUM> of rod <NUM> in the second arm <NUM>. This will hold the ball connector (not shown) at the other end of the second arm <NUM> in position. When the lever <NUM> is squeezed into the position shown in <FIG>, the wedge <NUM> is pulled away from tapered end <NUM> of rod <NUM> in the second arm <NUM>. This will allow the ball connector (not shown) at the other end of the second arm <NUM> to be moved relative to the second arm <NUM>.

Lever <NUM> is also coupled to a post <NUM> which passes through an opening in wedge <NUM>. A wedge <NUM> is coupled to the post <NUM>. When the lever <NUM> is in the position shown in <FIG> (a locked position), the wedge <NUM> is pulled up against tapered end <NUM> of rod <NUM> in the first arm <NUM>. This will hold the ball connector (not shown) at the other end of the first arm <NUM> in position. When the lever <NUM> is squeezed into the position shown in <FIG> (an unlocked position), the post <NUM> is pushed down with the lever, causing the wedge <NUM> to push away from the tapered end <NUM> of rod <NUM> in the first arm <NUM>. This will allow the ball connector (not shown) at the other end of the first arm <NUM> to be moved relative to the base (also not shown).

Furthermore, when lever <NUM> is in the position shown in <FIG>, a clamping end <NUM> of the lever <NUM> is pressed against the end of the second arm <NUM> while the post <NUM> and wedge <NUM> also help to create a clamping force which holds the position of the first arm <NUM> relative to the second arm <NUM>. When the lever is squeezed into the position shown in <FIG>, the clamping end <NUM> of the lever <NUM> is lifted from the second arm while the post <NUM> and wedge <NUM> release a clamping force, thereby allowing the first and second arms <NUM>, <NUM> to be moved relative to each other. As a result, it can be seen that this one control feature, lever <NUM>, may be squeezed with a single hand to simultaneously defeat three different locking points. This allows the surgeon to hold the lever with one hand (squeezing the lever) while the other hand positions the scope held by the end effector. During positioning, all degrees of freedom are available to the surgeon and the scope should be very easy to position. Once the desired scope position is established, the surgeon simply releases the lever <NUM> and all three locking points are again locked into position (for example: <NUM>) the position of the first arm relative to its ball connector, <NUM>) the position of the first arm relative to the second arm, and <NUM>) the position of the second arm relative to its ball connector. ) In the prior art devices, this would have taken at least two people and four hands to accomplish, so this embodiment offers clear advantages over the prior art.

<FIG> illustrates another embodiment of a surgical equipment holder <NUM>, here shown holding one embodiment of an endoscope <NUM>. The surgical equipment holder <NUM> has a base <NUM> which is configured in this embodiment to clamp onto the side of a surgical table. A removable key <NUM> is provided for adjustment of a screw in the base which raises or lowers one of the clamp arms of the base. Other embodiments may use other kinds of removable keys, bases, and clamp bases are known to those skilled in the art. The base <NUM> has a ball connector <NUM>, similar to the base ball connectors discussed above. Shown is a first arm <NUM> and a second arm <NUM>. The first arm <NUM> has a rod slideable therein having a tapered end (not visible in this view). The slideable rod (not visible in this view) within the first arm <NUM> is configured to interface with the ball connector <NUM>. Similarly, the second arm <NUM> has a rod slideable therein having a tapered end (not visible in this view). The slideable rod (not visible in this view) within the second arm <NUM> is configured to interface with a second ball connector <NUM> which is coupled to an end effector <NUM>. In this embodiment the end effector <NUM> is configured to hold and position the endoscope <NUM>. A lever <NUM> is aligned with one of the arms, in this embodiment, with the second arm <NUM>. The majority of the lever <NUM> is biased away from the second arm <NUM> by a spring element <NUM>. Although a specific style of spring is shown in the example of <FIG>, it should be understood that those skilled in the art are familiar with a wide variety of springs that could be used in place of the illustrated spring element <NUM>.

<FIG> are a series of exploded views which show how the surgical equipment holder <NUM> of <FIG> is put together. For simplicity, only the ball connector <NUM> of the base <NUM> is shown. As mentioned previously, there are a variety of base configurations which could be used and which are known to those skilled in the art. Regardless of the type of base used, the main requirement is that it have a ball connector <NUM>. As shown in <FIG>, wedge <NUM> is placed into a receiver <NUM> in the distal end <NUM> of the first arm <NUM>. A first rod <NUM> is slid into an opening <NUM> in a socket <NUM> and into the hollow interior of the first arm <NUM>. The socket <NUM> is on a proximal end <NUM> of the first arm <NUM>, and the opening <NUM> is aligned with a longitudinal axis <NUM> of the first arm <NUM>. The rod <NUM> has a tapered end 106T which can be pressed against the wedge <NUM> to hold the wedge <NUM> in the receiver <NUM>. The ball connector <NUM> is inserted through a second opening <NUM> in the socket <NUM>. The second opening <NUM> is larger than the first opening <NUM>, and in fact is large enough to allow the entire ball connector <NUM> to pass into the socket <NUM>. An attachment portion <NUM> of the ball connector <NUM> is passed out of the first opening <NUM> as the ball connector <NUM> is inserted through the second opening <NUM>. The first opening <NUM> is sized to prevent the entire portion of the ball connector <NUM> from passing through the first opening <NUM>. The proximal end of the rod 106P rides against the ball connector <NUM> and helps to hold it in the socket <NUM>. A spacer <NUM> has a hole <NUM> which aligns with another hole <NUM> in wedge <NUM>. These two holes <NUM>, <NUM> are not necessarily the same size. The attachment portion <NUM> of ball connector <NUM> may be attached to a base (not shown).

As shown in <FIG>, a second rod <NUM> is slid into an opening <NUM> in a socket <NUM> and into the hollow interior of the second arm <NUM>. The socket <NUM> is on a distal end <NUM> of the second arm <NUM>, and the first opening <NUM> is aligned with a longitudinal axis <NUM> of the second arm <NUM>. The second rod <NUM> has a tapered end 124T which will be accessible in the receiver <NUM>. A ball connector <NUM> is inserted through a second opening <NUM> in the socket <NUM>. The second opening <NUM> is larger than the first opening <NUM>, and in fact is large enough to allow the entire ball connector <NUM> to pass into the socket <NUM>. An attachment portion <NUM> of the ball connector <NUM> is passed out of the first opening <NUM> as the ball connector <NUM> is inserted through the opening <NUM>. The hole of the first opening <NUM> is sized to prevent the entire portion of the ball connector <NUM> from passing through the first opening <NUM>. The distal end of the rod 124D rides against the ball connector <NUM> and helps to hold it in the socket <NUM>. The opening of the receiver <NUM> in the proximal end <NUM> of the second arm <NUM> passes all the way through the second arm <NUM> and may be aligned with the spacer <NUM> and the hole <NUM> therein.

As shown in <FIG>, a hinge acceptor <NUM> is coupled to a post <NUM> which may be passed through a clearance hole <NUM> in a lever block <NUM>. A wedge <NUM> extends outward from the lever block <NUM>, and the lower end of the post <NUM> extends through the clearance hole <NUM> in the lever block <NUM> and through and below the wedge <NUM>. The subassembled hinge acceptor <NUM>, post <NUM>, and lever block <NUM> with wedge <NUM> are moved together and the lower end of the post <NUM> and the wedge <NUM> are inserted into the receiver <NUM> so that the lower end of the post <NUM> is coupled to the hole <NUM> in wedge <NUM> (not visible in this view) and so that the wedge <NUM> sits against the tapered end 124T of the second rod <NUM>.

A spring <NUM> is aligned into a notch <NUM> in the lever block <NUM> and attached to a lever <NUM> by pins <NUM> which are passed through corresponding holes <NUM> in the lever <NUM> and <NUM> in the spring <NUM>. A proximal end <NUM> of the lever <NUM> is placed over the hinge acceptor <NUM> and the lever block <NUM>. A first hole <NUM> in the lever <NUM> is aligned with a tapped hole <NUM> in the hinge acceptor <NUM>. A first pivot screw <NUM> is passed through the first hole <NUM> and threaded into the tapped hole <NUM>. A second pivot screw <NUM> is likewise threaded into similar, mirror-imaged holes on the other side of the lever <NUM> and hinge acceptor <NUM> (those mirrored holes are not visible in this view).

Another hole <NUM> in the lever <NUM> is aligned with a hole <NUM> in the lever block <NUM>, a hole <NUM> in the hinge acceptor <NUM>, a further hole <NUM> in the lever block <NUM>, and a mirrored hole (not visible in this view) in the opposite side of the lever <NUM>. A pin <NUM> is placed through all of these holes to provide another pivot axis.

<FIG> shows an exploded view of the adapter or end effector <NUM> which is then coupled to the second ball connector <NUM> (not shown in this view). A lower yoke <NUM> has a circular post <NUM> that defines an opening <NUM>. There is a recess (not visible in this view) on the outside of the post <NUM> sized to accept a spring latch <NUM>. The spring latch <NUM> has a latch <NUM> which extends past the outer surface of the post <NUM> when the spring latch <NUM> is in its recess. A cannula rotation dial <NUM> is placed over the post <NUM>. A groove runs around the inner circumference of the cannula rotation dial. Only a small portion of this groove is visible in <FIG>. The Latch <NUM> of the spring latch <NUM> engages this groove and helps to hold the cannula rotation dial <NUM> in place. Since the latch <NUM> can ride in the groove <NUM> which passes all the way around the inside of the rotation dial <NUM>, the cannula rotation dial <NUM> may be rotated freely in this position, however axial movement of the dial is resisted by the latch <NUM>. A cannula latch <NUM> is aligned in a slot <NUM> of upper yoke <NUM> such that pivot point <NUM> can be pinned in alignment with hole <NUM> in upper yoke <NUM> by pin <NUM>. The cannula latch <NUM> has a spring <NUM> which pushes the latch <NUM> into an opening <NUM> defined by the upper yoke <NUM>. The cannula latch <NUM> also has a release <NUM> which may be pressed, causing the latch to pivot about pin <NUM> and withdraw from the opening <NUM>. When pressure is removed from release <NUM>, the cannula latch <NUM> pushes back into the opening <NUM>.

An anti-rotation pin <NUM> is inserted into hole <NUM> in the upper yoke <NUM>. The anti-rotation pin <NUM> extends down past the underside of the upper yoke <NUM>. The upper yoke <NUM> is then coupled to the lower yoke <NUM>. While the inner groove <NUM> of the cannula rotation dial <NUM> is pushed towards the lower yoke <NUM> and not engaged with the latch <NUM>, the cannula rotation dial <NUM> may be rotated freely. When it is desired to lock the rotation dial <NUM>, the rotation dial <NUM> may be moved axially towards the upper yoke <NUM>. In so doing, one of a plurality of pin receivers <NUM> positioned around the rotation dial <NUM> will engage the anti-rotation pin <NUM> extending down from the upper yoke <NUM>. At approximately the same time, the latch <NUM> engages the inner groove <NUM> on the inside of the cannula rotation dial <NUM>, helping to prevent axial movement of the dial which would then allow the rotation dial <NUM> to rotate again. As long as the rotation dial <NUM> is left in this position, the rotation dial <NUM> will hold. To rotate the rotation dial <NUM> again, the rotation dial <NUM> would need to be moved axially towards the lower yoke <NUM> so that the anti-rotation pin <NUM> disengages from the pin receiver <NUM>.

A scope port cannula <NUM> is provided. The scope port cannula <NUM> has a proximal opening <NUM> in communication with a distal opening <NUM>. The proximal opening <NUM> may also include a notch <NUM> to accommodate a light source attachment for an endoscope. A retainer ring <NUM> snaps onto a retainer groove <NUM> of the scope port cannula. The retainer ring <NUM> is rotatable from <NUM>) an orientation that would allow the light source attachment <NUM> of an endoscope <NUM> to be placed into the notch <NUM> when the endoscope <NUM> is inserted into the scope port cannula <NUM> to <NUM>) an orientation that would prevent the endoscope <NUM> from being able to be removed from the scope port cannula <NUM>. The notch <NUM> also serves to maintain a known rotational position between the endoscope <NUM> and the scope port cannula <NUM>. The scope port cannula <NUM> also has one or more keyed teeth <NUM> on an outer portion of the cannula <NUM>. In use, the distal end of the scope port cannula <NUM> is inserted into the opening <NUM> of the upper yoke, through the cannula rotation dial <NUM>, and through the opening <NUM> in the lower yoke <NUM> until the one or more keyed teeth <NUM> on the cannula <NUM> engage one or more corresponding key features <NUM> on the inside of the cannula rotation dial <NUM>. The latch <NUM> engages a groove <NUM> on the cannula <NUM>, preventing undesired removal of the scope port cannula <NUM>, but allowing the scope port cannula <NUM> to be rotated as desired by the cannula rotation dial <NUM> (via the intermeshed keys <NUM> and corresponding key features <NUM>) when the cannula rotation dial <NUM> is not engaging the anti-rotation pin <NUM> as described above.

When the upper yoke <NUM> and the lower yoke <NUM> are coupled together, corresponding attachment ends 242A, 242B form a stub which may be coupled to the attachment portion <NUM> of ball connector <NUM> discussed above.

<FIG> illustrates the assembled surgical equipment holder <NUM> from <FIG> with an endoscope installed therein. A base is not shown for the reasons discussed above, but could easily be attached.

<FIG> and <FIG> illustrate operation of the lever <NUM>. Lever <NUM> is coupled via hinge acceptor <NUM> to a post <NUM> which passes through an opening in wedge <NUM>. A wedge <NUM> is also coupled to the post <NUM>. When the lever <NUM> is in the position shown in <FIG> (a locked position), the wedge <NUM> is pulled up against tapered end 106T of rod <NUM> in the first arm <NUM>. This will hold the ball connector (not shown) at the other end of the first arm <NUM> in position. Similarly, in the position of <FIG>, the wedge <NUM> is pressed down against tapered end 124T of rod <NUM> in the second arm <NUM>. This will hold the ball connector (not shown) at the other end of the second arm <NUM> in position. When the lever <NUM> is squeezed into the position shown in <FIG> (a released or unlocked position), the post <NUM> is pushed down with the lever, causing the wedge <NUM> to push away from the tapered end 106T of rod <NUM> in the first arm <NUM>. This will allow the ball connector (not shown) at the other end of the first arm <NUM> to be moved relative to the first arm <NUM>. The squeezed lever of <FIG> also rotates the lever block <NUM> up enough to release the pressure of wedge <NUM> from tapered end 124T. This will allow the ball connector (not shown) at the other end of the second arm <NUM> to be moved relative to the second arm.

Furthermore, when lever <NUM> is in the position shown in <FIG>, a clamping end <NUM> of the lever <NUM> is pressed against the end of the second arm <NUM> while the post <NUM> and wedge <NUM> also help to create a clamping force which holds the position of the first arm <NUM> relative to the second arm <NUM>. When the lever <NUM> is squeezed into the position shown in <FIG>, the clamping end <NUM> of the lever <NUM> is lifted from the second arm while the post <NUM> and wedge <NUM> release a clamping force, thereby allowing the first and second arms <NUM>, <NUM> to be moved relative to each other. As a result, it can be seen that this one control feature (lever <NUM>) may be squeezed with a single hand to simultaneously defeat three different locking points. This allows the surgeon to hold the lever with one hand (squeezing the lever) while the other hand positions the scope held by the end effector. During positioning, all degrees of freedom are available to the surgeon and the scope should be very easy to position. Once the desired scope position is established, the surgeon simply releases the lever <NUM> and all three locking points are again locked into position (for example: <NUM>) the position of the first arm relative to its ball connector, <NUM>) the position of the first arm relative to the second arm, and <NUM>) the position of the second arm relative to its ball connector. ) In devices like the prior art device of <FIG>, this would have taken at least two people and four hands to accomplish simultaneously, so this embodiment offers clear advantages over the prior art.

<FIG> is a perspective view of another embodiment of an arm <NUM> which can be used in a surgical device holder. Arm <NUM> is similar to the arms discussed above, but has the addition of one or more slots <NUM> along the arm. The slots <NUM> will not impact the operation of a rod which needs to slide therein, but they would enable the arm to be cleaned more easily after a surgical procedure has been completed where the surgical device holder was used. Another advantage of a slotted arm would be weight reduction of the assembled arm while retaining its required function and structural integrity.

<FIG> illustrates a further embodiment of a surgical equipment holder <NUM>. Like the embodiment of <FIG>, the surgical equipment holder <NUM> has a base <NUM> configured to receive a removeable key <NUM>, the details of which have been discussed above. A ball connector <NUM> may be coupled to the base <NUM> as described above. Also, like the embodiment of <FIG>, the surgical equipment holder <NUM> has a second ball connector <NUM> which is coupled to an end effector <NUM>, the details of which were also described above. In this embodiment the end effector <NUM> is configured to hold and position the endoscope <NUM>. The ball connectors <NUM> and <NUM> are coupled to adjustable arms <NUM>. The adjustable arms of this embodiment are further detailed in <FIG> and <FIG>.

<FIG> are a series of exploded views which show how the adjustable arms <NUM> are put together. As shown in <FIG>, a tension rod <NUM> having a connection end 264C and a stop end <NUM> is passed with the connection end 264C first through a first wedge <NUM>. The stop end <NUM> of the tension rod <NUM> is sized to prevent the tension rod <NUM> from passing all the way through the wedge <NUM>. In this embodiment, the stop end <NUM> is rounded or even spherical in nature. The assembled tension rod <NUM> and wedge <NUM> may be passed up through a hole (not visible in this view) on the underside of a receiver <NUM> in the first arm <NUM>. The connection end 264C of the tension rod <NUM> will stick up out of the receiver <NUM>. A spacing washer <NUM> may be placed over the connection end 264C protruding from the receiver <NUM>. In this embodiment, the spacing washer <NUM> may have a convex outward surface which ideally shares an assembled center point which is approximately coincident with the center of the spherical stop end <NUM>. The opening in the spacing washer is sized to allow the tension rod <NUM> to pivot and therefore the first arm <NUM> to pivot relative to the second arm in more than a single plane without changing the relative spacing between parts joined by the tension rod. The first rod <NUM> is slid into an opening <NUM> in a socket <NUM> and into the hollow interior of the first arm <NUM>. The socket <NUM> is on a proximal end <NUM> of the first arm <NUM>, and the opening <NUM> is aligned with a longitudinal axis <NUM> of the first arm <NUM>. The rod <NUM> has a tapered end 258T which can be pressed against the wedge <NUM> to hold the wedge <NUM> in the receiver <NUM>. The ball connector <NUM> is placed into the socket <NUM> against the proximal end 258P of the rod <NUM>, and a retainer <NUM> is attached over the ball connector <NUM> to the socket <NUM> in order to hold the ball connector <NUM> in the socket <NUM>. The proximal end 258P of the rod, which rests against the ball connector <NUM>, may be concave so that the circumferential edge of the rod's proximal end 258P is what actually contacts the ball connecter <NUM>. The retainer <NUM> has an opening <NUM> through which the attachment portion <NUM> may protrude. As with previous embodiments, the attachment portion may be attached to a base (not shown).

As shown in <FIG>, the second rod <NUM> is slid into an opening <NUM> in a socket <NUM> and into the hollow interior of the second arm <NUM>. The socket <NUM> is on a distal end <NUM> of the second arm <NUM> and the opening <NUM> is aligned with a longitudinal axis <NUM> of the second arm <NUM>. In this embodiment, the rod <NUM> has some narrower portions 260N which provide weight relieve the overall apparatus. The rod <NUM> also has a tapered end 260T which will be accessible in a receiver <NUM> of the second arm <NUM>. A ball connector <NUM> is inserted through a second opening <NUM> in the socket <NUM>. The second opening <NUM> is larger than the first opening <NUM>, and is large enough to allow the entire ball connector <NUM> to pass into the socket <NUM> while the attachment portion <NUM> passes out of the first opening <NUM>. The first opening <NUM> is sized to prevent the entire portion of the ball connector <NUM> from passing through the first opening <NUM>. The distal end of the rod 260D rides against the ball connector <NUM> and helps to hold it in the socket <NUM>. A lever alignment guide <NUM> may also be coupled to the second arm <NUM>. Further, a lever catch <NUM> may be coupled to the second arm <NUM>, for example, with a pin <NUM> or other attachment technique known to those skilled in the art.

As shown in <FIG>, the receiver opening <NUM> (which goes all the way through the receiver <NUM> of the second arm <NUM>) may be aligned with the tension rod <NUM>. <FIG> illustrates the resultant assembly of items from <FIG>.

<FIG> illustrates another sub-assembly surrounding a lever block <NUM> which has a wedge <NUM>. A lever <NUM> is pivotably coupled to the lever block <NUM> by a lever pivot pin <NUM> inserted through hole <NUM> in the lever block <NUM>, hole <NUM> in the lever <NUM>, and hole <NUM> in the lever block <NUM>. A lever latch <NUM> is coupled to the lever <NUM>, for example by pin <NUM> or by other suitable methods known to those skilled in the art.

As shown in <FIG>, the lever arm assembly of <FIG> can be brought together with the assembly of <FIG>. As can be seen partially in <FIG>, the lever block <NUM> and wedge <NUM> have a channel <NUM> which passes therethrough. Referring to <FIG>, this channel <NUM> allows the wedge <NUM> to be passed over the tension rod <NUM> so that the wedge <NUM> sits against the tapered end 260T (not visible in this view) of the second rod <NUM>. A tension clearance opening <NUM> in the bottom of the lever <NUM> allows the connection end 264C to pass into the lever <NUM>. The lever <NUM> may be aligned so that a tension pivot pin <NUM> may be passed through pass-through hole <NUM> in the lever block <NUM> and into hole <NUM> (visible in <FIG>), through hole <NUM> in the tension rod <NUM>, and into an aligned hole (not visible in this view) in lever <NUM> which corresponds to hole <NUM>. Once installed, the tension pivot pin <NUM> does not interfere with the lever block <NUM>, but it does allow the tension rod <NUM> to pivot with respect to the lever <NUM>.

The assembled adjustable arms <NUM> are shown in <FIG>, coupled to the ball connectors <NUM>, <NUM>. Shown are a first arm <NUM> and a second arm <NUM>. The first arm <NUM> has a rod <NUM> slideable therein having a tapered end (the tapered end is not visible in this view). The slideable first rod <NUM> within the first arm <NUM> is configured to interface with the first ball connector <NUM>. Similarly, the second arm <NUM> has a rod <NUM> slideable therein having a tapered end (the tapered end is not visible in this view). The slideable second rod <NUM> within the second arm <NUM> is configured to interface with the second ball connector <NUM>. A lever <NUM> is aligned with one of the arms, in this embodiment, with the second arm <NUM>.

When installed, the tension rod <NUM> is sized such that the longer portion of lever <NUM> is pivoted up (away from the second arm <NUM>). As illustrated in the partial cross-sectional view of <FIG>, this leaves the lever latch <NUM> separated from the lever catch <NUM> in the unlocked position. As illustrated in <FIG>, the lever <NUM> may be compressed or squeezed towards <NUM> the second arm <NUM> such that the lever latch <NUM> makes contact with the lever catch <NUM>. With just a bit more squeezing, the lever latch <NUM> rides over the lever catch <NUM> and as the compression is released, the latch <NUM> and catch <NUM> are engaged as illustrated in <FIG>. In this state, the lever latch <NUM> and the lever catch <NUM> are slightly deflected from their normal position, and the lever <NUM> is held in a compressed state (locked position), which causes the tension rod (not visible in this view) to be under tension. The differences of what happens when the tension rod <NUM> is not under tension (<FIG>) verses when it is under tension (<FIG>) will be discussed later in this specification. In order to release the tension, the lever <NUM> is further squeezed towards <NUM> the second arm <NUM> as illustrated in <FIG>. This causes the lever latch <NUM> and the lever catch <NUM> to clear each other, allowing them to spring back to a non-deflected position. In this non-deflected position, while the lever catch <NUM> is above the lever latch <NUM>, the latch <NUM> and catch <NUM> will not grab onto each other. Instead, when a squeezing force is released from the lever <NUM>, the tension on the tension rod <NUM> (not visible in this view) will cause the lever <NUM> to return to the unlocked position of <FIG> again. In this way, the latch <NUM> and catch <NUM> mechanism enables the adjustable arms <NUM> to be in an untensioned (unlocked) state (<FIG>) or held in a tensioned (locked) state (<FIG>). The desired positioning and engagement of either the locked or unlocked state can be selected by the operator using only one hand.

<FIG> is a partial cross-sectional view of a portion of the adjustable arms. In the state of <FIG>, the tension rod <NUM> is untensioned. The lever <NUM> is pivotable about lever pivot pin <NUM>, and in the position of <FIG>, lever <NUM> has pushed the attached tension rod <NUM> downward (in the orientation shown). This allows wedge <NUM> to slightly disengage tapered end 258T of rod <NUM>, thereby relaxing the grip of the rod <NUM> on ball connector <NUM> (not shown in this view). In this position, lever <NUM> is not pushing down on wedge <NUM>, so pressure between wedge <NUM> and tapered end 260T is also reduced, thereby relaxing the grip of the rod <NUM> on ball connector <NUM>. There is also less compression of the spacing washer <NUM> between the first and second arms <NUM>, <NUM>, thereby allowing the first arm <NUM> to be pivoted with respect to the second arm <NUM>. In this embodiment, since the spacing washer <NUM> is curved, the arms <NUM>, <NUM> may be pivoted relative to each other in the same plane or in different planes. This provides the ability for an operator to position the arms and an end effector coupled to the ball connector <NUM> easily in any desired position. A more detailed cross-sectional view of the unlocked or open state of this embodiment is shown in <FIG>.

<FIG> shows a further detailed cross-sectional view of the tension rod <NUM>, detailing its position within the receiver <NUM> of the first arm <NUM> and relative to the spacing washer <NUM> as shown in FIG. This view illustrates an aspect of the spatial relationship between the stop end <NUM> of the tension rod <NUM> and the spacing washer <NUM>. The size of the interior concentric circle <NUM> in <FIG> is the same size as a circle corresponding to the spherical portion of the tension rod stop end <NUM>, while the size of the exterior concentric circle 265E matches an arc corresponding to the convex outward surface of the spacing washer <NUM>. Furthermore, the spacing washer shares an assembled center point <NUM> which is approximately coincident with the center of the spherical stop end of the tension rod. The nature of this geometrical and spatial relationship between the tension rod stop end <NUM> and the spacing washer <NUM> allows for a consistent application of force when lever <NUM> is squeezed to engage the locked position of the surgical equipment holder <NUM> (<FIG> and <FIG>) regardless of the relative angle or position of the first arm <NUM> to the second arm <NUM>.

When a desired position is established, the lever <NUM> can be squeezed into the tensioned (locked) state illustrated in the partial cross-sectional view of <FIG>. Again, the lever <NUM> has been pivoted about lever pivot pin <NUM>, and in the position of <FIG>, lever <NUM> has pulled the tension rod <NUM> upward and caused it to be placed under tension. The stop end <NUM> of tension rod <NUM> pulls the wedge <NUM> up against tapered end 258T. This pushes rod <NUM> proximally against the ball connector <NUM>, locking the position of the first arm <NUM> relative to the ball connector <NUM> and ultimately the base (not shown in this view). In the position of <FIG>, lever <NUM> is pushing down on wedge <NUM>, thereby creating pressure between the wedge <NUM> and the tapered end 260T of the second rod <NUM>. This pushes the rod <NUM> against the ball connector <NUM>, thereby fixing the position of any end effector (not shown in this view) coupled to the ball connector <NUM> relative to the second arm <NUM>. In the position of <FIG>, the first and second arms <NUM>, <NUM> clamp onto the spacing washer <NUM>, thereby also locking the first arm <NUM> relative to the second arm <NUM>. A more detailed cross-sectional view of the locked state of this embodiment is shown in <FIG>. This one lever <NUM> can effectively lock the end effector relative to the base with just a single hand squeezing the lever <NUM>. When the lever is squeezed again, with a single hand, three different joints (the ball connector <NUM>, the interface between the first and second arms, and the ball connector <NUM>) are released together, leaving the other hand free to position and end effector. This is a highly efficient improvement over the prior art. It also offers more degrees of freedom compared to the prior art while still only needing a single squeeze to lock or unlock the entire apparatus.

<FIG> illustrates a third embodiment of a surgical equipment holder <NUM>. Like the embodiments of <FIG> and <FIG>, the surgical equipment holder <NUM> has a base <NUM> configured to receive a removable key <NUM>. A ball connector <NUM> may be coupled to the base <NUM> as described previously. The surgical equipment holder <NUM> has a second ball connector <NUM> which is coupled to an end effector <NUM> which is configured to be releasably held onto a quick connect port (not shown in this view) on the end of the ball connector <NUM>. In this embodiment the end effector <NUM> is configured to hold and position a scope port cannula <NUM>, which holds an endoscope <NUM>. The ball connectors <NUM> and <NUM> are coupled to adjustable arms <NUM>. The assembly of the adjustable arms of this embodiment are further detailed in <FIG>.

<FIG> are a series of exploded views which show how the adjustable arms <NUM> shown in <FIG> are put together. As shown in <FIG>, a tension rod <NUM> having a connection end 354C and a stop end <NUM> is passed with the connection end 354C first through a first wedge <NUM>. The stop end <NUM> of the tension rod <NUM> is sized to prevent the tension rod <NUM> from passing all the way through the wedge <NUM>. In this embodiment, the stop end <NUM> is rounded or even spherical in nature. The assembled tension rod <NUM> and wedge <NUM> may be passed up through a hole on the underside of a receiver <NUM> in the first arm <NUM>. The connection end 354C of the tension rod <NUM> will stick up out of the receiver <NUM>. A spacing washer <NUM> may be placed over the connection end 354C protruding from the receiver <NUM>. In this embodiment, and as previously discussed, the spacing washer <NUM> may have a convex outward surface 271which ideally shares an assembled center point which is approximately coincident with the center of the spherical stop end <NUM>. The opening in the spacing washer <NUM> is sized to allow the tension rod <NUM> to pivot and therefore the first arm <NUM> to pivot relative to the second arm 256in more than a single plane without changing the relative spacing between parts joined by the tension rod <NUM>. The first rod <NUM> is slid into an opening <NUM> in a socket <NUM> and into the hollow interior of the first arm <NUM>. The socket <NUM> is on a proximal end <NUM> of the first arm <NUM>, and the opening <NUM> is aligned with a longitudinal axis <NUM> of the first arm <NUM>. The rod <NUM> has a tapered end 355T which can be pressed against the wedge <NUM> to hold the wedge <NUM> in the receiver <NUM>. The rod <NUM> also has a narrow middle section 355N, which is configured to reduce weight and provide spacing between the inner diameter of the first arm <NUM> and outer diameter of the rod <NUM> for improved cleaning and sterilization. The socket stop <NUM> is threaded onto the socket <NUM>, although alternate means of attachment may be used. The ball connector <NUM> is placed into the socket <NUM> against the proximal end 355P of the rod <NUM>, and a retainer <NUM> is attached over the ball connector <NUM> to the socket stop <NUM> in order to hold the ball connector <NUM> in the socket <NUM>. In this embodiment, retainer <NUM> holds the ball connector <NUM> against socket stop <NUM>, so the ball can pivot within socket <NUM>. The socket stop <NUM> is tightened onto the threaded socket <NUM> during assembly and setup of the adjustable arms <NUM> to provide a desired amount of unlocked tension between the ball connector <NUM>, the first rod <NUM>, and the wedge <NUM>. The retainer <NUM> is secured to the socket stop <NUM> with several set screws <NUM> fastened into the threaded holes <NUM> in the socket stop <NUM>. The adjustability of the socket stop <NUM> relative to the socket <NUM> can further provide an adjustable amount of ease of movement between the first arm <NUM> and the second arm <NUM> when the adjustable arms <NUM> are in locked or unlocked position. The retainer <NUM> has an opening <NUM> through which the attachment portion <NUM> may protrude. As with previous embodiments, the attachment portion <NUM> may be attached to a base (not shown).

As shown in <FIG>, a second rod <NUM> is slid into an opening <NUM> in a socket <NUM> and into the hollow interior of the second arm <NUM>. The socket <NUM> is on a distal end <NUM> of the second arm <NUM> and the opening <NUM> is aligned with a longitudinal axis <NUM> of the second arm <NUM>. The rod <NUM> has a tapered end 364T which will be accessible in a receiver <NUM> of the second arm <NUM>. A quick connect port <NUM> having a ball connector <NUM> and attachment portion is provided. The attachment portion <NUM> is configured to have a gap <NUM> along the center and a hole <NUM> though which a pin <NUM> is inserted and fixed via welding, press fitting, or other methods known to those skilled in the art. The pin <NUM> spans the gap <NUM> in the attachment portion <NUM>. The quick connect port <NUM> is inserted through a second opening <NUM> in the socket <NUM>. The second opening <NUM> is larger than the first opening <NUM>, and is large enough to allow the entire ball connector <NUM> to pass into the socket <NUM> while the attachment portion <NUM> passes out of the first opening <NUM>. The first opening <NUM> is sized to prevent the entire portion of the ball connector <NUM> from passing through the first opening <NUM>. The distal end of the rod 364D rides against the ball connector <NUM> and helps to hold it in the socket <NUM>.

A lever alignment guide <NUM> is also coupled to the second arm <NUM>. Further, a lever catch <NUM> is coupled to the second arm <NUM>, within a catch shield <NUM>, by fastening to the second arm <NUM> with screws <NUM>. The catch <NUM> and catch shield <NUM> could be fastened to the second arm <NUM> in other ways, for example, with a pin or other attachment technique known to those skilled in the art. The catch shield <NUM> covers both sides of the catch <NUM> in order to reduce the likelihood that gloves, clothing, or skin could become caught in the catch <NUM> during operation of the surgical equipment holder <NUM>.

As shown in <FIG>, the receiver opening <NUM> (which goes all the way through the receiver <NUM> of the second arm <NUM>) may be aligned with the tension rod <NUM>. <FIG> illustrates the resultant assembly of items from <FIG>. A lever block <NUM> has a wedge <NUM> and a channel <NUM> which passes therethrough. This channel <NUM> allows the wedge <NUM> to be passed over the tension rod <NUM> so that the wedge <NUM> sits against the tapered end 364T (not visible in this view) of the second rod <NUM>. A tension clearance opening <NUM> in the bottom of the proximal end 352P of the lever <NUM> allows the connection end 354C to pass into the lever <NUM>.

<FIG> is an exploded perspective view of a further sub-assembly of the surgical equipment holder <NUM> of <FIG>. A lever latch shield <NUM> and a latch <NUM> are coupled to the lever <NUM> by screws <NUM>, but may be attached by other suitable methods known to those skilled in the art. The lever latch shield <NUM> and the catch shield work in concert to help prevent gloves, clothing, or skin from becoming caught in the latch <NUM> and catch <NUM> mechanism during operation of the surgical equipment holder <NUM>. The latch <NUM> and catch <NUM> mechanism of this embodiment functions similarly to the latch <NUM> and catch <NUM> described with regard to <FIG>. The lever <NUM> of this embodiment further includes a cleaning release <NUM> into which a spring <NUM> is partially inserted. The spring <NUM> followed by the release <NUM> are inserted into a matching slot <NUM> on a proximal end 352P of the lever <NUM>. The cleaning release <NUM> is pressed inward to compress the spring <NUM> so that the proximal end 352P of the lever <NUM> can be set into the lever block <NUM> over the tension rod <NUM>. The cleaning release <NUM> is then released, causing the spring <NUM> to push a post <NUM> on the cleaning release <NUM> into a slot <NUM> on the lever block. While post <NUM> is in slot <NUM>, the lever <NUM> of the assembled device can be moved between unlocked and locked positions and vice versa. To move the lever <NUM> into a cleaning position, the cleaning release <NUM> is pushed to further compress the spring <NUM> and allow post 385to hop from slot <NUM> to recess <NUM>, when the arm is opened farther away from the arm <NUM> than it normally would be in an unlocked position. The operation of the cleaning release <NUM> will be described further in <FIG>.

The lever <NUM> may be aligned so that a tension pivot pin <NUM> may be passed through pass-through hole 372T in the lever block <NUM> and then through hole <NUM> in the lever <NUM>, through hole <NUM> in the tension rod <NUM>, and into a hole mirroring hole <NUM> on the away facing side of the lever <NUM>. When assembled, pin <NUM> does not engage the lever block <NUM>, but it does pivotably couple the proximal end 352P of the lever <NUM> to the tension rod <NUM>. The lever <NUM> is pivotably coupled to the lever block <NUM> by a lever pivot pin <NUM> inserted through hole <NUM> in the lever block <NUM>, hole <NUM> in the lever <NUM>, and hole <NUM> in the lever block <NUM>. This coupling also serves the purpose of coupling the arm subassembly shown in <FIG> to the lever <NUM>.

<FIG> is a fully assembled view of the adjustable arms <NUM> with the lever <NUM> in a locked position.

<FIG> display the lever <NUM> in several operating positions highlighting the enhanced cleanability of the embodiment of the surgical equipment holder <NUM> shown in <FIG>. <FIG> shows the lever <NUM> in the closed or locked position. The mechanism of the locking and unlocking positions and their relative influence on the joint elements of the various equipment holders has been discussed previously, for example in <FIG>, <FIG> and 13A-13B.

<FIG> shows the lever <NUM> in the open or unlocked position. While the lever <NUM> is somewhat open relative to the position of the second arm <NUM>, there may be restricted access to the second arm <NUM> and the second rod <NUM> within for thorough cleaning after a surgical procedure or operation. The post on the cleaning release <NUM> is constrained within slot <NUM> on the lever block <NUM> during the normal locking and unlocking operations of the surgical equipment holder <NUM>. The cleaning release <NUM> located on the proximal end 352P of the lever <NUM> can be moved in direction <NUM> to compress the spring <NUM> and allow post <NUM> on the cleaning release <NUM> to hop from slot <NUM> to recess <NUM> when the lever is lifted farther to a cleaning position shown in <FIG>. This provides improved access and enhanced cleaning of the surgical instrument holder <NUM>. This mechanism has been described relative to the assembly steps detailed with regard to <FIG>. <FIG> is an exploded view showing the assembly of an instrument adapter <NUM> for a scope port cannula <NUM> similar the one described in <FIG>.

A lower yoke <NUM> has a circular post <NUM> that defines an opening <NUM>. There is a recess (not visible in this view) on the outside of the post <NUM> sized to accept a spring latch <NUM>. The spring latch <NUM> has a latch <NUM> which extends past the outer surface of the post <NUM> when the spring latch <NUM> is in its recess. A cannula rotation dial <NUM> is placed over the post <NUM>. A groove <NUM> runs around the inner circumference of the cannula rotation dial <NUM>. The latch <NUM> of the spring latch <NUM> engages this groove and helps to hold the cannula rotation dial <NUM> in place. Since the latch <NUM> can ride in the groove <NUM> which passes all the way around the inside of the rotation dial <NUM>, the cannula rotation dial <NUM> may be rotated freely in this position, however axial movement of the dial is resisted by the latch <NUM>.

An adapter release <NUM> is aligned to a recess <NUM> of lower yoke <NUM> such that pivot point <NUM> can be held in alignment with hole <NUM> in lower yoke <NUM> by screw <NUM> when instrument adapter <NUM> is assembled. A screw <NUM> is passed through a hole <NUM> in the lower yoke <NUM>, through the pivot point <NUM> on the adapter release <NUM>, then into a corresponding threaded hole <NUM> on upper yoke <NUM>. A restrictor pin <NUM> that rides in slot <NUM> on the adapter release <NUM> is placed in a hole <NUM> on the lower yoke <NUM>, passing through slot 418of the adapter release <NUM>, and then is held in a corresponding hole <NUM> on the upper yoke <NUM> when the instrument adapter <NUM> is assembled. The adapter release <NUM> has a spring <NUM> and a latch <NUM> configured to releasably hold the instrument adapter <NUM> onto the attachment portion <NUM> of a surgical equipment holder <NUM>, as will be described later in more detail.

A cannula latch <NUM> is aligned in a slot <NUM> of upper yoke <NUM> such that pivot point <NUM> can be pinned in alignment with hole <NUM> in upper yoke <NUM> by pin <NUM>. The cannula latch <NUM> has a spring <NUM> which pushes the latch <NUM> into an opening <NUM> defined by the upper yoke <NUM>. The cannula latch <NUM> also has a release <NUM> which may be pressed, causing the latch to pivot about pin <NUM> and withdraw from the opening <NUM>. When pressure is removed from release <NUM>, the cannula latch <NUM> pushes back into the opening <NUM>.

An anti-rotation pin <NUM> is inserted into hole <NUM> in the upper yoke <NUM>. The anti-rotation pin <NUM> extends down past the underside of the upper yoke <NUM>. The upper yoke <NUM> is then coupled to the lower yoke <NUM> as described above with screw <NUM>. While the inner groove <NUM> of the cannula rotation dial <NUM> is pushed towards the lower yoke <NUM> and not engaged with the latch <NUM>, the cannula rotation dial <NUM> may be rotated freely. When it is desired to lock the rotation dial <NUM>, the rotation dial <NUM> may be moved axially towards the upper yoke <NUM>. In so doing, one of a plurality of pin receivers <NUM> (not shown in this view, but similar receivers <NUM> are visible in <FIG>) positioned around the rotation dial <NUM> will engage the anti-rotation pin <NUM> extending down from the upper yoke <NUM>. At approximately the same time, the latch <NUM> engages the inner groove <NUM> on the inside of the cannula rotation dial <NUM>, helping to prevent axial movement of the dial which would then allow the rotation dial <NUM> to rotate again. As long as the rotation dial <NUM> is left in this position, the rotation dial <NUM> will hold. To rotate the rotation dial <NUM> again, the rotation dial <NUM> would need to be moved axially towards the lower yoke <NUM> so that the anti-rotation pin <NUM> disengages from the pin receiver <NUM>. This operation is further detailed in <FIG> and <FIG> for another embodiment of a cannula adapter.

<FIG> is a perspective view of the assembled instrument adapter <NUM> of <FIG>. <FIG> is a perspective view of the end of the adjustable arms <NUM> of <FIG>, illustrating instrument adapter <NUM> in alignment for connection with the attachment portion <NUM> of the surgical equipment holder <NUM> of <FIG>. The instrument adapter <NUM> is connected to the surgical equipment holder <NUM> by moving the instrument adapter <NUM> in a direction <NUM> along a longitudinal axis <NUM> towards the adjustable arms <NUM> and aligning the attachment portion <NUM> with the adapter channel <NUM> and inserting the attachment portion <NUM> into the adapter channel <NUM> until the pin <NUM> engages the adapter release latch (not shown in this view, but described previously and also in the following <FIG>). While this embodiment shows an instrument adapter <NUM> for a scope port cannula <NUM>, other instrument adapters may be attached to the surgical equipment holder <NUM> in a similar manner. The components in this embodiment which allow the adapter <NUM> to be removably coupled to the arms <NUM> are a mount. In this example, the mount includes an upper yoke <NUM>, a lower yoke <NUM>, a cannula latch <NUM>, a rotation dial <NUM>, an adapter release <NUM> and a channel <NUM>. It may also include a quick connect port <NUM> having a ball connector <NUM> and an attachment portion <NUM> having a pin <NUM>, a set of adjustable arms <NUM> including a lever <NUM>, and a base <NUM> with a removable key <NUM> if the system is taken as a whole. Other types of mounts are disclosed in this specification, and these embodiments and their equivalents are intended to be covered within the scope of the claims.

<FIG> is a cross-sectional top view of the instrument adapter of <FIG>, showing the mount of the instrument adapter <NUM> to the attachment portion <NUM>. When the attachment portion <NUM>, connected to the second ball connector <NUM>, is inserted into the adapter channel <NUM>, the pin <NUM> engages with a leading edge <NUM> of the adapter release latch <NUM>. The release latch <NUM> rides up the pin <NUM> while pivoting around pivot point <NUM>. As the attachment portion <NUM> is further inserted into the adapter channel <NUM>, the attachment portion pin <NUM> passes beyond the leading edge <NUM> to a notch 420N in the latch <NUM>. The spring <NUM> maintains pressure on the adapter release <NUM> such that the latch's notch 420N continues to engage the pin <NUM>, thereby holding the adapter <NUM> to the attachment portion <NUM>. To remove the attachment portion <NUM> from the adapter channel <NUM> and thus remove the instrument adapter <NUM> from the attachment portion <NUM>, the adapter release <NUM> is depressed, causing the notch 420N of latch <NUM> to pivot clear of attachment portion pin <NUM>. In this state, the adapter <NUM> can be pulled off of the attachment portion <NUM>. After the latch <NUM> is clear of the attachment portion <NUM>, the adapter release <NUM> can be released. Spring <NUM> will pivot the latch <NUM> again, but restrictor pin <NUM> will keep the leading edge <NUM> of latch <NUM> aligned, where it will advantageously contact the attachment portion pin <NUM> on the next insertion.

<FIG> is an exploded view of an improved embodiment of an instrument adapter <NUM>. A lower yoke <NUM> has a circular post <NUM> that defines an opening <NUM>. There is a recess <NUM> on the outside of either side of the post <NUM> sized to accept a spring latch <NUM> in each recess <NUM>. Only one recess is fully visible in this view. Each spring latch <NUM> has a latch <NUM> which extends past the outer surface of the post <NUM> when the spring latch <NUM> is in its recess <NUM>. A cannula rotation dial <NUM> is placed over the post <NUM>. The inner surface of the cannula rotation dial <NUM> has several keyed features <NUM> and a groove <NUM> running around the inner circumference of the cannula rotation dial <NUM>. Only a small portion of the groove <NUM> and the keyed features are visible in <FIG>. The latch <NUM> of each spring latch <NUM> engages this groove <NUM> and helps to resist unintentional movement of the cannula rotation dial <NUM>. Since either latch <NUM> can ride in the groove <NUM> which passes all the way around the inside of the rotation dial <NUM>, the cannula rotation dial <NUM> may be rotated freely in this position, however axial movement of the rotation dial <NUM> is resisted by the latches <NUM>. A cannula latch <NUM> is aligned in a slot <NUM> of upper yoke <NUM> such that pivot point <NUM> can be pinned in alignment with hole <NUM> in upper yoke <NUM> by pin <NUM>. The cannula latch <NUM> has a spring <NUM> which pivots the latch <NUM> into an opening <NUM> defined by the upper yoke <NUM>. The cannula latch <NUM> also has a release <NUM> which may be pressed, causing the latch <NUM> to pivot about pin <NUM> and withdraw from the opening <NUM>. When pressure is removed from release <NUM>, the spring <NUM> pivots the cannula latch <NUM> back into the opening <NUM>. A cam <NUM> having a flat face 520F and a keyway 524A is inserted into a recess 517A in the upper yoke <NUM>. A corresponding key <NUM> on an attachment lever <NUM> is passed through hole <NUM> and into engagement with the keyway 524A. The attachment lever <NUM> can be pivoted to rotate the cam <NUM> inside the adapter <NUM> between locked and unlocked positions. Operation of the attachment lever <NUM> will be discussed later in this specification.

An anti-rotation pin <NUM> is inserted into hole <NUM> in the upper yoke <NUM>. The anti-rotation pin <NUM> extends down past the underside of the upper yoke <NUM>. The upper yoke <NUM> is then coupled to the lower yoke <NUM> with a screw <NUM> passed through a hole <NUM> in the lower yoke <NUM> and into a corresponding threaded hole <NUM> in the upper yoke <NUM>. In other embodiments, the upper yoke <NUM> may be fastened to the lower yoke <NUM> using other techniques, such as, but not limited to welding or press fitting. While the inner groove <NUM> of the cannula rotation dial <NUM> is pushed towards the lower yoke <NUM> and therefore the inner groove <NUM> is not engaged with the latches <NUM>, the cannula rotation dial <NUM> may be rotated freely. When it is desired to lock the rotation dial <NUM>, the rotation dial <NUM> may be moved axially towards the upper yoke <NUM>. In so doing, one of a plurality of pin receivers <NUM> positioned around the rotation dial <NUM> will engage the anti-rotation pin <NUM> extending down from the upper yoke <NUM>. At approximately the same time, the latches <NUM> engage the inner groove <NUM> on the inside of the cannula rotation dial <NUM>, helping to prevent axial movement of the dial which would then allow the rotation dial <NUM> to rotate again. As long as the rotation dial <NUM> is left in this position, the rotation dial <NUM> will hold. To rotate the rotation dial <NUM> again, the rotation dial <NUM> would need to be moved axially towards the lower yoke <NUM> so that the anti-rotation pin <NUM> disengages from the pin receiver <NUM>.

<FIG> is a perspective view of the assembled instrument adapter of <FIG>. When the upper yoke <NUM> and the lower yoke <NUM> are coupled together, an adapter channel <NUM> is formed. An attachment portion of a surgical equipment holder may be configured to fit within the adapter channel <NUM>. One example of a suitable attachment portion <NUM> is shown in <FIG> and the cross-sectional views of <FIG>.

<FIG> are partial cross-sectional views of the instrument adapter of <FIG> in an unlocked and locked state, respectively, relative to an attachment portion <NUM> which has been inserted into the adapter channel <NUM>. In <FIG>, the attachment lever <NUM> is in a position that has rotated the cam <NUM> into a position aligning cam face 520F with channel <NUM> to allow the attachment portion <NUM> of a surgical equipment holder to be inserted into the adapter channel <NUM> of instrument adapter <NUM>. <FIG> shows the lever <NUM> in a position that rotated <NUM> the cam <NUM> into a recess <NUM> on attachment portion <NUM>, thereby causing the adapter <NUM> to be locked onto the attachment portion <NUM>. In this embodiment, the attachment portion <NUM> has a recess <NUM> on opposite sides of the attachment portion <NUM> so that the adapter <NUM> may be attached in more than one orientation.

<FIG> is a perspective view showing the orientation of a cannula <NUM> which can be inserted into the instrument adapter <NUM> of <FIG>. The instrument adapter <NUM> is configured to receive the cannula <NUM> into opening <NUM>. The cannula <NUM> has a proximal opening <NUM> in communication with a distal opening <NUM>. The cannula <NUM> also defines a notch <NUM> in communication with proximal opening <NUM> to accommodate a light source attachment for an endoscope, an obturator depth stop, or features from other instrumentation which may be inserted into the cannula. A retainer ring <NUM> snaps onto a retainer groove <NUM> of the cannula <NUM>. The retainer ring <NUM> is rotatable using a retainer ring handle <NUM> between one position where the notch <NUM> is accessible from the proximal opening <NUM> and another position where the notch <NUM> is not accessible from the proximal opening. The cannula <NUM> also has one or more keyed teeth <NUM> on an outer portion of the cannula <NUM>. In use, the distal end <NUM> of the cannula <NUM> is inserted into the opening <NUM> of the instrument adapter <NUM>, along axis <NUM> through the cannula rotation dial <NUM> until the one or more keyed teeth <NUM> engage one or more corresponding key features <NUM> on the inside of the cannula rotation dial <NUM>. The cannula latch <NUM> (not visible in this view, but discussed with regard to <FIG>) engages a groove <NUM> on the cannula <NUM>, preventing undesired axial movement of the cannula <NUM> relative to the adapter <NUM>, but allowing the cannula <NUM> to be rotated as desired by the cannula rotation dial <NUM> (via the intermeshed keyed teeth <NUM> and corresponding key features <NUM>) when the cannula rotation dial <NUM> is not engaging the restrictor pin <NUM> as will be detailed in regard to <FIG> and <FIG>.

<FIG> is a top elevational view of the cannula <NUM> inserted into the instrument adapter <NUM> and cannula This view illustrates several longitudinal protrusions <NUM> and recesses <NUM> that define a keyed opening 548A that is intended to keep a viewing scope (not shown in this view) that has been passed into the cannula <NUM> from coming into contact with the recesses <NUM>. The recesses <NUM> provide further areas where unwanted fluid may accumulate without contacting or fouling a scope lens when used with an endoscope. In some embodiments, the recesses <NUM> may include a hydrophilic coating to draw fluid away from a scope inserted into the cannula. The protrusions <NUM> may be substantially longitudinal protrusions, but they do not necessarily need to extend all the way through the cannula <NUM>.

<FIG> is a perspective view showing an obturator <NUM> which can be inserted into the cannula <NUM>. and instrument adapter of <FIG>. The distal end 552D of the obturator <NUM> is configured to be inserted into the cannula opening <NUM>. The obturator <NUM> also has a depth stop <NUM> at the proximal end 552P and several keyed features <NUM> at the distal end 552D. The keyed features <NUM> are configured to correspond to the protrusions <NUM> and recesses <NUM> illustrated in <FIG> and align the insertion of the obturator <NUM> into the adapter combination <NUM> such that insertion of the obturator <NUM> along a vertical axis <NUM> aligns the depth stop <NUM> with the notch <NUM> on the cannula <NUM>.

<FIG> is a side view of the top of the obturator <NUM> of <FIG> inserted into the cannula <NUM> and instrument adapter <NUM> of <FIG>. The retainer ring <NUM> has been rotated into a closed position such that when inserted, the depth stop <NUM> on the obturator <NUM> comes to rest on the closed cannula retainer ring <NUM>. This limits the obturator <NUM> to a first insertion depth in the cannula <NUM>. The area near the distal end 552D of the obturator <NUM> which would not extend from the distal opening <NUM> of the cannula <NUM> when the obturator depth stop <NUM> rests against the ring <NUM> may be covered with a cleaning material such as an absorbent lace or cover. If the retainer ring <NUM> is opened, then the obturator depth stop <NUM> can be inserted into the notch <NUM> to a deeper insertion depth, enabling the cleaning material (not shown in this view) to extend out of the distal opening <NUM> of the cannula <NUM> to help wipe away debris and/or fluids which may interfere with a scope that would later be placed into the cannula <NUM> after the obturator <NUM> is removed.

<FIG> is a perspective view showing an endoscope <NUM> having a proximal end 554P and a distal end 554D which is configured to be inserted into cannula opening <NUM>. The endoscope <NUM> also has a light port <NUM> near the proximal end 554P configured to deliver light to the endoscope <NUM>. The scope's light port <NUM> advantageously fits into the notch <NUM> on the cannula <NUM> so that the endoscope <NUM> will rotate with the cannula <NUM> when the adapter's rotation dial <NUM> is rotated.

<FIG> is perspective view of endoscope <NUM> inserted and locked into the cannula <NUM> as held by instrument adapter <NUM>. Several pin receivers 490are visible on the top of the rotation dial <NUM>. These receivers <NUM> will be discussed more with regard to <FIG> and <FIG>, but they may be seen more easily here. This view also demonstrates the assembled endoscope end effector <NUM> having the distal end 554D of the endoscope protruding out from the distal opening <NUM> of the cannula <NUM>. The retainer ring <NUM> is shown in a locked or closed position, which prevents the endoscope from being able to be removed from the cannula <NUM>, as described in regard to <FIG>.

<FIG> are schematic views detailing the rotational dial <NUM> function of the instrument adapter <NUM>. The endoscope <NUM> is inserted in the cannula <NUM> as discussed above. The cannula rotation dial <NUM> as shown in <FIG> has been moved axially towards <NUM> the lower yoke <NUM> of the instrument adapter <NUM>, exposing the anti-rotation pin <NUM> in the instrument adapter <NUM>. In this position, the cannula rotation dial <NUM> may be rotated freely. As shown in <FIG>, when it is desired to lock the rotation dial <NUM>, and therefore prevent the endoscope <NUM> from being rotated, the rotation dial <NUM> may be moved axially towards <NUM> the upper yoke <NUM> of the instrument adapter <NUM>. In so doing, one of a plurality of pin receivers <NUM> (not shown in this view, but visible in <FIG>) positioned around the rotation dial <NUM> will engage the anti-rotation pin <NUM> extending down from the upper yoke <NUM>. At approximately the same time, the latches <NUM> (not visible in this view) engage the inner groove <NUM> (also not visible in this view) on the inside of the cannula rotation dial <NUM>, helping to prevent axial movement of the dial <NUM> so the rotation dial <NUM> is kept from rotating by the pin <NUM>. To rotate the rotation dial <NUM> again, the rotation dial <NUM> would need to be moved axially towards <NUM> the lower yoke <NUM> so that the anti-rotation pin <NUM> disengages from the pin receiver <NUM>.

<FIG> schematically illustrates a further embodiment of a surgical equipment holder <NUM>. Like the embodiments of <FIG>, <FIG> and <FIG>, the surgical equipment holder <NUM> has a base <NUM> configured to receive a removeable key <NUM>. A ball connector <NUM> is coupled to the base <NUM>, forming a base joint 580B between the base <NUM> and a first arm <NUM>. A second arm <NUM> is coupled to the first arm <NUM> and a lever <NUM> at a middle joint <NUM>. As in previous embodiments described, the surgical equipment holder <NUM> has a second ball connector <NUM> coupled to the end of the second arm <NUM>, which is coupled to an adapter <NUM> at an end joint 580E. In this embodiment the adapter <NUM> is configured to hold and position a cannula <NUM> for receiving an endoscope <NUM>. The ball connectors <NUM> and <NUM> are coupled to adjustable arms <NUM> at the ends. The adjustable arms <NUM> of this embodiment are pivotable about the base joint 580B, middle joint <NUM>, and the end joint 580E when the lever <NUM> is in the unlocked or released position. The lever <NUM> as shown in <FIG> is in a locked position. An additional advantage of this embodiment is that while the adjustable arms <NUM> are not pivotable about the base joint 580B and the middle joint <NUM> when the lever <NUM> is in the locked or closed position, the adapter <NUM> is tightened yet still pivotable for fine-tune adjustment of the adapter <NUM> about the end joint 580E. The adjustable arms <NUM> of this embodiment and their assembly and operation are further detailed in <FIG> AND <FIG>, <FIG>, and <FIG>.

<FIG> are a series of exploded perspective views which show how the adjustable arms <NUM> are put together. As shown in <FIG>, a tension rod <NUM> having a connection end 608C and a stop end <NUM> is passed with the connection end 608C first through a wedge <NUM>. The stop end <NUM> of the tension rod <NUM> is sized to prevent the tension rod <NUM> from passing all the way through the wedge <NUM>. In this embodiment, the stop end <NUM> is rounded or even spherical in nature. The assembled tension rod <NUM> and wedge <NUM> may be passed up through a hole <NUM> on a receiver <NUM> at the distal end 598D of the first arm <NUM>. The connection end 608C of the tension rod <NUM> will protrude from the receiver <NUM>. A spacing washer <NUM> is placed over the connection end 608C protruding from the receiver <NUM>. In this embodiment, the spacing washer <NUM> has a convex outward surface <NUM> which ideally shares an assembled center point that is approximately coincident with the center of the spherical stop end <NUM>. The opening in the spacing washer <NUM> is sized to allow the tension rod <NUM> to pivot and therefore the first arm <NUM> to pivot relative to the second arm <NUM> in more than a single plane without changing the relative spacing between parts joined by the tension rod <NUM>. A first rod <NUM> is slid into an opening <NUM> in a socket <NUM> and into the hollow interior of the first arm <NUM>. The socket <NUM> is threaded and is on a proximal end 598P of the first arm <NUM>, and the opening <NUM> is aligned with a longitudinal axis <NUM> of the first arm <NUM>. The rod <NUM> has a tapered end 594T which can be pressed against the wedge <NUM> to hold the wedge <NUM> in the receiver <NUM>. There is a flange <NUM> at the proximal end 594P of the first rod. The rod <NUM> also has a narrower portion 594N which provides weight relief and improved cleaning capability for the overall apparatus. The threaded socket <NUM> is configured to receive a ring nut <NUM>, a ball connector <NUM> and a retainer <NUM>. The jam nut <NUM> is threaded onto the socket <NUM>, which limits the extent to which the retainer <NUM> can be tightened. The ball connector <NUM> is placed into the socket <NUM> against the flange <NUM> fixed to the proximal end 594P of the rod <NUM>, and the retainer <NUM> is attached over the ball connector <NUM> to the socket <NUM> in order to hold the ball connector <NUM> in the socket <NUM>. The ring nut <NUM> and retainer <NUM> are counter rotated against each other to hold the ball connector <NUM> against the flange <NUM>, so that the ball can pivot within socket <NUM> with a desired amount of pressure of the ball connector <NUM> against the rod <NUM>. The adjustability of the jam nut <NUM> and the retainer <NUM> provide an adjustable amount of ease of movement between the first arm <NUM> and the second arm <NUM> when the adjustable arms <NUM> are in the unlocked position. The retainer <NUM> has an opening <NUM> through which an attachment portion <NUM> may protrude. As with previous embodiments, the attachment portion <NUM> may be attached to a base (not shown in this view).

<FIG> shows a second rod <NUM> and a preassembly step before it is inserted into the second arm <NUM> (described in regard to <FIG>). The second rod <NUM> has a tapered end 612T which is configured with a hole <NUM> to receive a limiter pin <NUM>, shown later in <FIG>. The second rod <NUM> is configured on the distal end 612D to receive along a longitudinal axis <NUM> a stack of disc springs <NUM>, a stack of shims <NUM>, and a rodcap <NUM> before the final assembly of the second arm <NUM>. The stack of disc springs <NUM>, stack of shims <NUM>, and rodcap <NUM> are loosely held in place during the subsequent assembly steps shown in <FIG>, but may be fastened to the second rod <NUM> by other methods, such as, but not limited to staking or welding.

As shown in <FIG>, the fully assembled second rod <NUM> of <FIG> is slid into opening <NUM> located at the distal end <NUM> of the second arm <NUM>, and into the hollow interior of the second arm <NUM>. The opening <NUM> is aligned with a longitudinal axis <NUM> of the second arm <NUM>. The tapered end 612T of the second rod <NUM> slides far enough into the second arm <NUM> such that a quick connect port 625having a ball connector <NUM> and an attachment portion <NUM>, can be placed into hole <NUM> in the bottom of the distal end <NUM> of the second arm <NUM> and out of opening <NUM>. While hole <NUM> is large enough to allow the ball connector <NUM> portion to pass through, opening <NUM> is small enough to restrict the second ball connector <NUM> from passing completely through. The distal end 612D of the tapered rod <NUM> is now moved towards the distal end <NUM> of the second arm <NUM> to align a hole <NUM> on the arm 654with the hole <NUM> in the tapered end 612T of the second rod <NUM>. Pin <NUM> is then inserted into hole <NUM> and then through to hole <NUM> in the tapered end 612T of the second rod <NUM>. Hole <NUM> holds the pin <NUM> in the arm <NUM>, however, the diameter of hole <NUM> is larger than the diameter of pin <NUM>, such that movement of the tapered rod <NUM> relative to longitudinal axis <NUM> is possible within the constraints of hole <NUM>. This will be further described in more detail with regard to <FIG>. As shown in <FIG>, the distal end 612D of the second rod <NUM> rides against the ball connector <NUM> and helps to hold it in the distal end <NUM>. A lever alignment guide <NUM> is coupled to the second arm using a screw <NUM> to fasten the lever alignment guide <NUM> through hole <NUM> in the second arm <NUM>. A catch <NUM>, coupled to a catch shield <NUM> is also attached to the second arm <NUM> using another screw <NUM> to fasten the catch shield <NUM> through hole <NUM>. While screws are used in this embodiment, other fastening methods may be used. A lever block <NUM> having a wedge <NUM> is placed into a hole <NUM> in the second arm <NUM> along axis <NUM>, where the wedge <NUM> is configured to ride against the tapered end 612T of the second rod <NUM>. The lever block <NUM> also has a channel <NUM> configured to receive the connection end 608C of the tension rod <NUM>, which will protrude above the lever block <NUM> prior to final assembly of the adjustable arms <NUM>, as shown in <FIG>.

<FIG> illustrates the further subassembly step of how the lever <NUM> is attached to the adjustable arms <NUM> of the surgical equipment holder <NUM> of <FIG>. A latch <NUM> is attached to the lever <NUM> with a screw <NUM>. A ball-spring element <NUM> is inserted into hole <NUM> in the lever <NUM>. The lever <NUM> will be pivotably coupled to the lever block <NUM> by a lever pivot pin <NUM> and its mirrored pin on the side facing away. The lever <NUM> is then placed over the connection end 608C of the tension rod <NUM> protruding from the channel <NUM> in the lever block <NUM>. The mirror of lever pivot pin <NUM> on the opposite side is held in a recess <NUM> in the lever block <NUM> and the visible pin <NUM> will be held in a corresponding recess in a lever block plate <NUM> (not shown in this view). An opening <NUM> located on the underside of lever <NUM> near hole <NUM> and hole <NUM> is configured to fit the connection end 608C of the tension rod <NUM>. The tension pivot pin <NUM> is inserted through hole <NUM> in lever <NUM>, through a hole <NUM> in the connection end 608C in the tension rod <NUM> and held against a back <NUM> of the lever block plate <NUM>. Once installed, the tension pivot pin <NUM> allows the tension rod <NUM> to pivot with respect to the lever <NUM>.

<FIG> is a perspective view showing the final assembly step of the lever <NUM>. A lever block plate <NUM> is attached with screws <NUM> to hold the lever <NUM> in place and cover the lever pivot pin <NUM>, the tension pivot pin <NUM>, and the ball-spring element <NUM>. The lever block <NUM> and the inside of the block plate <NUM> has a guide slot <NUM> configured to allow the ends of the ball-spring element <NUM> to freely travel in guide slot <NUM> during locking and unlocking of the lever <NUM>. To move the lever <NUM> further away from the second arm <NUM> to a cleaning position, a minimal force set by the ball-spring element <NUM> must be overcome to cause the ball spring element <NUM> to compress and to hop to a cleaning position recess <NUM> located on the back plate <NUM> and on the inside of block plate <NUM> of the lever block <NUM>. While ball spring element is in cleaning position recess <NUM>, the lever <NUM> is opened farther away from the second arm <NUM> than it normally would be in an unlocked position.

<FIG> illustrates the resultant arm assembly <NUM> of items from <FIG> with the lever <NUM> in the locked position. The mechanism of the locking and unlocking positions and their relative influence on the joint elements of the various equipment holders has been discussed previously, for example in <FIG>, <FIG> and <FIG>. The embodiment of <FIG> works similarly. <FIG> are cross-sectional views of a portion of the middle joint <NUM> from <FIG> comparing the position of the lever <NUM>, the tension rod <NUM> and the tapered end 612T of the second rod <NUM> when the locking mechanism between the lever <NUM> and the second arm <NUM> is in both the unlocked and locked positions, respectively.

<FIG> is a cross-sectional view of the middle joint <NUM> of adjustable arms <NUM> when the position of the lever <NUM> relative to the second arm <NUM> is in the unlocked or released position. In the state of <FIG>, the tension rod <NUM> is untensioned. The lever <NUM> pivots about lever pivot pin <NUM>, and in the position of <FIG>, tension pivot pin <NUM> is pushing tension rod <NUM> downward. This allows wedge <NUM> to slightly disengage tapered end 594T of rod <NUM>, thereby relaxing the grip of the rod <NUM> on ball connector <NUM> (not shown in this view). In this position, lever <NUM> is not pushing down on wedge <NUM>, so pressure between wedge <NUM> and tapered end 612T is also reduced, thereby relaxing the grip of the rod <NUM> on ball connector <NUM>. There is also less compression of the spacing washer <NUM> between the first and second arms <NUM>, <NUM>, thereby allowing the first arm <NUM> to be pivoted with respect to the second arm <NUM>. In this embodiment, since the spacing washer <NUM> is curved, the arms <NUM>, <NUM> may be pivoted relative to each other in the same plane or in different planes. This provides the ability for an operator to position the arms and an end effector coupled to the ball connector <NUM> easily in any desired position. In this unlocked position, the second rod <NUM> moves in a direction <NUM> such that the limiter pin <NUM> is against the distal end 612D side of hole <NUM> in the second rod <NUM> and reduces the compressive force of the stack of disc springs <NUM> from the end of rod <NUM> (not shown in this view, but described further in regard to <FIG>).

<FIG> is a cross-sectional view of the middle joint <NUM> of adjustable arms <NUM> when the position of the lever <NUM> relative to the second arm <NUM> is in the locked or closed position. When a desired position for the adapter <NUM> and adjustable arms <NUM> is established, the lever <NUM> can be squeezed into the locked state illustrated in the partial cross-sectional view of <FIG>. Again, the lever <NUM> pivots about lever pivot pin <NUM> and in the position of <FIG>, the tension pivot pin <NUM> pulls the tension rod <NUM> upward causing the tension rod <NUM> to be placed under tension. The stop end <NUM> of tension rod <NUM> pulls the wedge <NUM> up against tapered end 594T. This pushes rod <NUM> proximally against the ball connector <NUM>, locking the position of the first arm <NUM> relative to the ball connector <NUM> and ultimately the base <NUM> (not shown in this view). In the position of <FIG>, lever <NUM> is pushing down on wedge <NUM>, thereby creating pressure between the wedge <NUM> and the tapered end 612T of the second rod <NUM>. In this locked position, the second rod <NUM> is pushed against the ball connector <NUM> in direction <NUM>, and the limiting pin <NUM> is against the tapered end 612T side of the rod <NUM>. The second rod <NUM> is also pushed towards the second ball connector <NUM> to fix the position of the adapter <NUM> (not shown in this view) relative to the second arm <NUM>, but movement is not restricted with the same amount of force as in previous embodiments. This restricting function of the limiting pin <NUM>, in combination with the stack of disc springs <NUM> on the opposite end of the second rod <NUM> (shown in <FIG> and <FIG>) results in a reduced amount of pressure on the second arm <NUM> components relative to the pressure on the first arm <NUM> components and allows some fine adjustment of the adapter <NUM> (not shown in <FIG>) when the first and second arms <NUM>, <NUM> are locked relative to one another,. This one lever <NUM> can effectively lock the adapter <NUM> relative to the base with just a single hand squeezing the lever <NUM>, while still allowing for some fine adjustment of the adapter <NUM> relative to the second arm. When the lever is squeezed again, with a single hand, three different joints (the base joint 580B, the middle joint <NUM> interface between the first and second arms, and the end joint 580E) are released together, leaving the other hand free to position and adapter <NUM>. This is a highly efficient improvement over the prior art. It also offers more degrees of freedom compared to the prior art while still only needing a single squeeze to lock or unlock the entire apparatus.

<FIG> illustrate the position of the stack of disc springs <NUM> when the lever <NUM> is in the unlocked position. <FIG> is a partial cross-sectional side view of adjustable arms <NUM> showing the lever <NUM> in the open or unlocked position. In <FIG>, an enlarged partial cross-sectional side view of the state of the stack of disc springs <NUM> is shown for the unlocked position. When the lever <NUM> is in the unlocked position, the second rod <NUM> is not pressed towards the end joint 580E, and therefore the rodcap <NUM> and distal end 612D of the second rod <NUM> is not pressing the disc springs <NUM> towards the rodcap <NUM>, which allows the stack of disc springs <NUM> to freely rest in a relaxed state. This allows a free movement of second ball connector <NUM>, and the adapter <NUM> attached to surgical equipment holder <NUM> to be freely movable relative to the second arm <NUM>.

<FIG> illustrate the position of the stack of disc springs <NUM> when the lever <NUM> is in the locked position. <FIG> is a partial cross-sectional side view of adjustable arms <NUM> showing the lever <NUM> in the closed or locked position. In <FIG>, an enlarged partial cross-sectional sideview of the state of the stack of disc springs <NUM> is shown. When the lever <NUM> is in the locked position, the second rod <NUM> is pressed towards the end joint 580E, and therefore the rod <NUM> pushes distally in direction <NUM> against the disc springs <NUM>. The disc springs <NUM> press against the rodcap <NUM>, pushing the rodcap <NUM> against the ball connector <NUM>. In this state, the stack of disc springs <NUM> are in a compressed state. This compressed state of the disc spring washers restricts movement of the second ball connector <NUM>, but the movement of the second ball connector <NUM> is not as restricted as in embodiments that do not include a stack of disc springs <NUM>. This provides the advantage of allowing some finely adjustable movement of any adapter <NUM> attached to the second ball connector <NUM> relative to the second arm <NUM> while the surgical equipment holder <NUM> is in the locked state. The ease of fine adjustment can be determined by the disc springs <NUM>. Stiffer springs will require more force for fine adjustment, while softer springs <NUM> allow for a fine adjustment with less force. Once moved, the adapter <NUM> will remain in the position desired by the operator. The stiffness of the individual disc spring washers in the stack of disc springs <NUM> may be configured to provide the desired amount of force in this locked position and allow limited relative movement between the adapter <NUM> and the base <NUM> when the lever <NUM> on the adjustable arms <NUM> are in the locked position.

<FIG> is a right side view of an embodiment of a base for use with the surgical equipment holders of <FIG>, <FIG>, <FIG>, <FIG>, and <FIG>. The base <NUM> has a base body <NUM> and a removable key <NUM>. The removable key has gears <NUM> that interface with a screw drive <NUM> in the base body <NUM> which actuate a screw thread within an upper clamp shaft <NUM> (not shown in this view) to raise and lower an upper clamp jaw <NUM> relative to a pair of lower clamp jaws <NUM>, which are coupled to the base body <NUM>. A stop pin <NUM> is attached to the upper clamp jaw <NUM> such that the stop pin <NUM> interacts with an interference feature (shown in <FIG>) to limit the travel of the screw drive <NUM> along the base body <NUM>.

<FIG> show front, right side, left side, rear, top, and bottom views, respectively, of the base of <FIG>. As illustrated in the top view of <FIG>, the base <NUM> has an upper jaw shaft <NUM> which is coupled to the upper clamp jaw <NUM> and mounted onto the screw thread (not shown in this view). The upper clamp jaw <NUM> and upper jaw shaft <NUM> are configured to slidably travel towards and away from the lower clamp jaws <NUM>. The gears <NUM> of the removable key <NUM>, shown in <FIG>, are inserted into the screw drive <NUM> (shown in <FIG>) to turn the screw thread thereby raising and lowering the upper clamp jaw <NUM> relative to the lower clamp jaws <NUM> coupled to the base body <NUM>. The base has an interference feature <NUM> that limits the travel of the upper jaw <NUM> thereby limiting the extent the jaws <NUM>, <NUM> can open. The interference feature also contacts the stop pin <NUM>, limiting the extent to which the jaws <NUM>, <NUM> can be closed. <FIG> illustrate an arm mount <NUM> on both the right and left side of the base body <NUM>, respectively, where a set of adjustable arms <NUM> are attached. The base <NUM> is clamped to an accessory rail of a surgical table. t While a screw type clamp is used in this embodiment, other methods of clamping or attaching of a base may be used with the surgical equipment holders described herein.

<FIG> are perspective views of the surgical equipment holder <NUM> of <FIG> coupled to base <NUM> shown in <FIG> and <FIG> being attached to a surgical table <NUM>. <FIG> illustrates how the base <NUM> for the surgical equipment holder <NUM> as described in regard to <FIG> is attached to an accessory rail <NUM> of a surgical table <NUM>, which is covered in a surgical drape <NUM>. The lower clamp jaw <NUM> is hooked under the accessory rail <NUM> and pivoted in a direction towards <NUM> the surgical table <NUM> until the upper clamp jaw <NUM> is aligned vertically with the lower clamp jaw <NUM> and is also in a position to hook onto the accessory rail <NUM>. The embodiment shown in <FIG> has adjustable arms <NUM> as described in regard to <FIG>, having a first arm <NUM>, a second arm <NUM>, a lever <NUM> and an attachment portion <NUM> or adapter <NUM> (not shown in this view) for the connection and positioning of various adapters and surgical equipment useful in surgical procedures. An advantage of utilizing this base <NUM> with this surgical equipment holder <NUM> is that it can be clamped directly over the surgical drape <NUM> and onto the accessory rail <NUM> without having to remove or reposition the drape <NUM>. This is an improvement over other methods of instrument holders and similar devices. Once the upper clamp jaw <NUM> and lower clamp jaws <NUM> are placed in the desired horizontal location on the accessory rail <NUM>, the removable key <NUM> is turned in a clockwise direction <NUM> to engage a screw thread <NUM> to move the upper clamp jaw <NUM> closer to the lower clamp jaw <NUM> such that the base <NUM> and therefore the entire surgical equipment holder <NUM> is firmly attached to the accessory rail as shown in <FIG>. Once base is clamped, the knob or key <NUM> can be set aside in a sterile location until needed for removal of the surgical instrument holder <NUM>. While this embodiment of a clamping base is shown in the preceding figures, other methods for clamping or attaching a base <NUM> to an accessory rail <NUM> on a surgical table <NUM>.

<FIG> are perspective views of other embodiments of instrument adapters <NUM>, <NUM> for use with the surgical equipment holder of <FIG>. <FIG> shows an adapter <NUM> comprised of a body <NUM> having a channel (not shown in this view) which can be slidably engaged onto a quick connect port <NUM> (not shown here) and locked with a lever <NUM> similar to the instrument adapter <NUM> described with regard to <FIG>. Further positional adjustment can be achieved using such an adapter <NUM> by using a knob <NUM> to tighten an articulating hinge <NUM> once an upper arm <NUM> and lower arm <NUM> are adjusted to a desired position. An upper accessory attachment point <NUM> is located at the end of the upper arm <NUM> and a lower accessory attachment point <NUM> is located at the end of the lower arm <NUM>. This type of adapter may be arranged with alternative arrangements of the upper arm <NUM> and lower arm <NUM>, for example, as shown in the mirror image <NUM> as illustrated later in <FIG>. <FIG> is an adapter <NUM> similar to the adapter <NUM> shown in <FIG>. The adapter <NUM> has a body <NUM> with a locking lever <NUM> at a distal end 766D of the adapter <NUM> and a single accessory attachment point <NUM> at a proximal end 766P of the adapter <NUM>.

<FIG> is a perspective view of a suture management system <NUM> and a rib retractor <NUM> for use with the surgical equipment holder <NUM> of <FIG>. A suitable suture management system could be the RAM® Ring from LSI Solutions, Inc. of Victor, NY (lsisolutions. Adapter <NUM>, as shown in mirror image as adapter <NUM> in FIG. 27A, is configured to be connected to a surgical equipment holder <NUM>. A surgical rib retractor <NUM> is attached to the upper accessory attachment point <NUM> of adapter <NUM>. A suitable rib retractor could be the 3D™ Retractor from LSI Solutions, Inc. of Victor, NY (lsisolutions. The surgical rib retractor <NUM> has two adjustable arm units <NUM> each configured to receive a rib and spread the ribs apart to provide more access to a patient's thoracic cavity during a minimally invasive surgical procedure. An apparatus for suture management <NUM> is attached by a bolt <NUM> to the lower accessory attachment point <NUM> (not visible in this view) of adapter <NUM>. This apparatus for suture management <NUM> includes three segments <NUM> configured to hold and manage sutures (not shown here) during surgical procedures. A support <NUM> is connected to each of the segments <NUM> and are configured to help support the apparatus for suture management <NUM> during a minimally invasive surgical procedure. The pivotable articulation of the surgical instrument holders described herein combined with the adapters <NUM>, <NUM> provide a surgical team with a finely adjustable positioning system for precise location of surgical instrumentation around an incision site during a minimally invasive surgical procedure. While mechanical hinges and bolted mechanical connections are shown in these adapters, other types of hinges, fasteners, or attachment methods may be used.

<FIG> is a perspective view of a display mount adapter <NUM> for use with the surgical equipment holder <NUM> of <FIG>. The display mount adapter <NUM> has an upper yoke <NUM> and lower yoke <NUM> fastened together using a screw (not shown here). The display mount adapter <NUM> can be slidably engaged onto a quick connect port <NUM> (not shown here) and locked with a lever <NUM> similar to the instrument adapter <NUM> described with regard to <FIG>. The upper yoke <NUM> and lower yoke <NUM> define a channel <NUM> configured to receive a quick connect port <NUM> connected to a surgical equipment holder <NUM>. A display ball connector <NUM> having a threaded post (not shown here) is attached to the display mount adapter <NUM> and tightened using a nut <NUM>, although other methods of fastening such as welding, staking, and others may be used.

<FIG> are perspective views of a display attached to the display mount adapter of <FIG>. A display adapter <NUM> has a pivot nut <NUM> pre-assembled onto the display ball connector <NUM>. This pivot nut <NUM> is then fastened onto a threaded member (not shown in this view) located on the back of a mount plate and configured to allow the mount plate <NUM> and thus the entire display <NUM> to pivot freely on the display ball connector <NUM> until the pivot nut <NUM> is tightened. The mount plate <NUM> is attached to a display mount <NUM> utilizing several mount bolts <NUM>. The display mount <NUM> has a display holder <NUM> having two adjustable display arms <NUM> terminated in two display grips <NUM> configured to reliably hold a display <NUM>. The adjustable display arms <NUM> are also configured to be movable and lockable in opposition to one another to reliably hold a mounted display <NUM> such as a tablet, device, or monitor. The mounted display <NUM> is used for viewing the output from an endoscope or other video capture device during a surgical procedure. The use of this display adapter <NUM> and display <NUM> with a surgical equipment holder <NUM> can provide many degrees of freedom for positioning the display <NUM> in a convenient and desirable location during a minimally invasive surgical procedure.

<FIG> is a perspective view of three surgical equipment holders <NUM> of <FIG> attached to a surgical table <NUM> with different adapters and equipment attached thereto for use during a minimally invasive surgical procedure on a patient <NUM>. One is configured to hold a cannula <NUM> and endoscope similar to the one described in regard to <FIG>. Another is configured to hold an apparatus for suture management <NUM> and surgical rib retractor <NUM> as illustrated in <FIG>. The third is configured to hold a display mount adapter <NUM> and a display <NUM> as described in regard to <FIG>. The three surgical equipment holders <NUM> are attached to the accessory rail <NUM> of a surgical table <NUM>, where the base <NUM> of each surgical equipment holder <NUM> clamps each respective equipment holder <NUM> over the surgical drapes <NUM>.

Claim 1:
A surgical equipment holder (<NUM>; <NUM>; <NUM>; <NUM>; <NUM>), comprising:
a first arm (<NUM>; <NUM>; <NUM>; <NUM> ) pivotable relative to a base (<NUM>; <NUM>);
a second arm (<NUM>; <NUM>; <NUM>; <NUM>) pivotably coupled to the first arm (<NUM>; <NUM>; <NUM>; <NUM>);
an end effector (<NUM>; <NUM>; <NUM>) pivotable relative to the second arm (<NUM>; <NUM>; <NUM>; <NUM>); and
a lever (<NUM>; <NUM>, <NUM>; <NUM>, <NUM>; <NUM>) movable between a locked position and an unlocked position;
wherein the lever (<NUM>, <NUM>; <NUM>) is configured such that:
a) the first arm (<NUM>; <NUM>; <NUM>; <NUM>) does not pivot relative to the base (<NUM>; <NUM>), the second arm (<NUM>; <NUM>; <NUM>; <NUM>) does not pivot relative to the first arm (<NUM>; <NUM>; <NUM>; <NUM>) when the lever (<NUM>; <NUM>, <NUM>; <NUM>, <NUM>; <NUM>) is in the locked position; and
b) the first arm (<NUM>; <NUM>; <NUM>; <NUM>) may be pivoted relative to the base (<NUM>; <NUM>), the second arm (<NUM>; <NUM>; <NUM>; <NUM>) may be pivoted relative to the first arm (<NUM>; <NUM>; <NUM>; <NUM>), and the end effector (<NUM>; <NUM>; <NUM>) may be pivoted relative to the second arm (<NUM>; <NUM>; <NUM>; <NUM>) when the lever (<NUM>; <NUM>, <NUM>; <NUM>, <NUM>; <NUM>) is in the unlocked position,
characterised by
the surgical equipment holder further comprises a tension rod (<NUM>; <NUM>; <NUM>) in communication with the first arm (<NUM>; <NUM>), the second arm (<NUM>; <NUM>) and the lever (<NUM>, <NUM>; <NUM>); and
a spacing washer (<NUM>; <NUM>) comprised of a convex outward surface (<NUM>; <NUM>) and having an opening;
wherein the opening in the spacing washer (<NUM>; <NUM>) is sized to allow the tension rod (<NUM>; <NUM>; <NUM>) to pivot such that the first arm (<NUM>; <NUM>; <NUM>; <NUM> ) is allowed to pivot relative to the second arm (<NUM>; <NUM>; <NUM>; <NUM>) in more than a single plane; and