Minimally invasive laparoscopic surgical pliers

[0001] The present invention finds application in the field of robot surgery, and more particularly relates to forceps suitable for minimally invasive laparoscopic robotic surgery.

[0002] Pliers according to the present invention comprise a kinematic system provided with jaw means which can be opened and closed and which are mounted on a rotating body. The tongs according to the invention further comprise first means for communicating the movement of the jaw means and second means for transmitting the movement of the rotating body.

BACKGROUND OF THE INVENTION [0003] Current techniques used in robotic laparoscopic surgery allow high precision operations, providing significant advantages especially in some complex operations, including those in which there are major difficulties in accessing the surgical site. The present invention is particularly applicable to such a type of laparoscopic robotic surgery, which is a minimally invasive technique because it is performed through small incisions in the patient's body. This technique is widely used, so that in many cases it is used as an alternative to conventional laparoscopic surgery.

[0004] In this type of robot surgery, robotic arms are used as pliers to actuate the ability to hold certain tools and devices. In addition to the surgical precision achieved through the use of computers associated with these operations, the direct contact of the surgeon with the patient can be reduced by such mechanisms, thus leading to a reduction in the number of infections. Through a small incision, cameras and / or pliers are inserted into the patient's body to perform various operations with minimal trauma and minor postoperative pain.

[0005] The term tweezers as used herein in the field of intended use for the subject matter of the present invention should be understood as a tool intended to be coupled to the end of a robotic arm. This robotic arm is usually operated remotely by a surgeon qualified to carry out robotic laparoscopic operations and is adapted to grasp and even hold any useful tools, body or device.

[0006] There are many types of laparoscopic pliers based on their movement and geometry, which aspects depend to a large extent on the type of operation to which the pliers are ultimately intended. In a laparoscopic surgical operation, several pliers are usually used, which usually have a configuration such that their distal end is equipped with jaws of various configurations, as mentioned above, for example, with or without teeth, with a straight or curved shape, etc.

[0007] One example of laparoscopic pliers used in laparoscopic robotic surgery is described in US6969385. This document illustrates the pliers used in a robotic device consisting of jaws mounted on a rotating body. The jaws include fingers that can be rotated relative to each other. The rotation of the jaws is transmitted via cables wound around the grooved pulleys. The pulleys are fastened respectively to the axis of rotation of the fingers and the shaft of said rotary body, which is respectively attached to the end of the robotic arm.

[0008] Another example of the transmission of pliers is the use of gears. In US2009192521, a surgical instrument is described comprising pliers with a fixed finger and a movable finger. The pliers' movable finger is driven by a gear mechanism.

[0009] The use of cables and pulleys or toothed wheels in pliers, as described herein, is necessary for transferring motion from the drive means to the forceps for positioning and transferring the jaws. This causes the pliers mechanism to be much more complex. This complexity is of great importance in the case where the cables for transmitting the movement have to pass through the articulated body, which usually occurs in the above-described pliers. The fact that the transmission cables must pass through the articulated body requires the provision of additional pulleys to allow such transmission of drive from the drive means to the jaws. Document US 2009/0054726 A discloses surgical pliers as defined in the preamble of the appended claim 1.

[0010] The invention provides laparoscopic surgical pliers having a configuration that allows motion to be transmitted through a kinematic system comprising different rotary members from the drive means to the rotating members. This kinematic arrangement of the pliers includes the members enabling the pliers to be arranged and the members allowing the jaws to move. As will be seen later in the description, the laparoscopic surgical pliers according to the present invention can be achieved by means of a simple, compact and reliable configuration, which provides additional benefits, and as will be outlined below.

Description of the Invention [0011] The present invention provides for a pliers suitable for use in a robotic arm. More particularly, the invention relates to pliers intended for performing minimally invasive laparoscopic surgical operations driven by robotic arms.

The invention is defined in the characterizing part of the appended claim 1.

The invention provides pliers for use in laparoscopic laparoscopic surgery, comprising a main body having a proximal end and a distal end. The proximal end of the body is adapted to accept a universal joint with the ability to perform two passive rotary movements. At the end of the distal main body, a kinematic assembly is formed by a rotary body that is rotatably mounted at this end and provided with jaw means. This rotary body can perform many active rotational movements.

[0012] The jaw centers of the forceps according to the present invention comprise at least two movable parts or fingers that can be independently rotatably driven. The movement of the pliers' fingers is carried out by means of the first means to transmit the movement. On the other hand, the rotational movement of the rotary body is performed by the second means for transmitting movement. Said first and second delivery means are driven by means of drive means including, for example, electric motors. The combination of the drive means and the first and second transfer means allows the pliers to be positioned in a suitable manner and allows the jaws to open and close the jaws, to move the fingers towards and away from each other.

[0013] According to the invention, both the first and second means for transmitting the movement comprise tendons extending within and along the main body between the proximal end and the distal end. In use, said ties can be moved along the main body.

[0014] More precisely, the pliers comprise at least one tie associated with the first means for transmitting movement and one tie associated with the second means for transmitting movement. The first means for transmitting the movement may comprise one or two tie rods depending on the embodiment of the pliers, or for controlling one or more fingers of such pliers, depending on the application for which they are intended.

[0015] Each of said rods is formed of several steel cables, preferably three, which are arranged in the center of the sheath that surrounds them. The cables that form each tie preferably have a circular cross-section to obtain greater stiffness, and thus to avoid warping during compression. This cross-section also reduces the friction of the tendons with the cover.

[0016] A bundle of several cables to form each tie to transmit the movement of the pliers provides the necessary stiffness, allowing both compression and drawing, which allows effective transmission of power as if it were transmission via a rod.

[0017] The geometry of the cross-section of each tie rod is determined by the arrangement of the cables forming the tie rod. According to the invention, the arrangement of the cables is such that the rod, close to the distal end of the main body, has a cross section with variable geometry along its length. This is the case for at least the tendons associated with the first means of conveying traffic. Therefore, the change in the shape of the cross-section of the tendon allows very effective action of the jaws.

[0018] In the configuration described in the present invention, the pliers can be rotated about a first axis and the rotating body can be rotated about a second axis. The first axis and the second axis may be arranged substantially perpendicular to each other.

[0019] In one embodiment of the pliers according to the present invention, it is preferred that the change in cross-section geometry of each tie rod is as follows. As stated above, the tendons extend along the interior of the main body, defining the first geometry of the cross-section of the tie rods, in which the individual cables are arranged in a cross-section, their longitudinal axes being arranged radially. Next, the geometry of the cross-section of the tendons changes into a second arrangement in which the respective cables are arranged, in cross-section, with their longitudinal axes in the distribution in the first orientation. Finally, the geometry of the cross-section of the tendons changes into a third arrangement in which the respective cables are located, in cross-section, with their longitudinal axes in a second orientation,

[0020] In other words, in the first geometry of the cross-section of the tendons, the cables of each tendon, most of the length of the main body, are arranged radially such that the cross-section of the tendon is substantially circular in shape. In other words, if the tendon is constituted by three cables, for example as mentioned above, the cables in this case are arranged with respective longitudinal axes in a substantially triangular configuration, in cross-section. In one part corresponding to the vicinity of the end of the distal main body, the cross-section of the same tie rod is changed to said second arrangement in which the cables are arranged with respective longitudinal axes aligned transversely in the first orientation, e.g. horizontally aligned. This provides the necessary flexibility to overcome the bending of the hinge in a direction parallel to its axis of rotation. Finally, the cross section of the tendon changes into a third arrangement in which the cables are arranged with respective longitudinal axes transversely aligned in the second orientation, forming an angle relative to said first orientation, e.g. 90 °, i.e. vertically oriented. In this way, the necessary flexibility is obtained to overcome the bending of the hinge in a direction perpendicular to that obtained in this way. for example, 90 °, i.e. vertical. In this way, the necessary flexibility is obtained to overcome the bending of the hinge in a direction perpendicular to that obtained in this way. for example, 90 °, i.e. vertical. In this way, the necessary flexibility is obtained to overcome the bending of the hinge in a direction perpendicular to that obtained in this way.

[0021] The first and second conveyance means comprising said tendons further comprise rotary drums for tangent winding of the tendons. These drums allow, at said distal end of the system, a longitudinal displacement of the tendons to be turned in two directions, i.e. both for drawing and compression, to rotatably drive the pliers' rotary body and their jaws. The said drums have grooved rims suitable for winding tendons. The pliers rotary body is formed by two of the mentioned drums, which are superimposed on each other. Each of the two reels for winding the rotating body is integral with each jaw.

[0022] A change in the configuration of the cross-section of the tendons (at least those associated with the first transmission means), as it moves along its length towards the distal end of the main body, allows effective winding and twisting of the tie on the respective drums in both directions of travel. [0023] In order to cause the geometry of the cross-section to change, as indicated, at different planes adjacent the distal end of the main body, several modules are provided to change the orientation of the tie rod. Each of the modules changing the orientation of the tendon comprises a block attached to the interior of the elongated body, inside which elongated channels are formed, which are configured to guide the cables of each tendon in one rotation (e.g., at 90 °).

[0024] Two modules for varying the orientation of the tie rod are used for each tendon, which makes it possible to obtain the above mentioned two changes in the shape of the cross-section of the tendon (from circular to straight in the first orientation, and from straight in said first orientation to straight in the other, different orientation) . Each module changing the orientation of the tendon may have a first dimension (width or height) corresponding to, for example, the diameter of the cable used and a second dimension (width or height) corresponding to, for example, three diameters. Between the two modules changing the orientation of the tendon at the same length of the tie rod, their cables are placed inside a flat cover suitable for maintaining their configuration.

[0025] Drive means as mentioned above, such as electric motors, are used to transmit motion by moving the tendons along the elongated body. In one embodiment of the invention, other means may be adapted to rotatably drive internal threaded tubes that are axially mounted in the main body. Inside such internal threaded tubes an appropriate external threaded tube is provided, which is attached to the outer shell in which the cables of the tendons are arranged. The outer threaded tube can be rotated to said internal threaded tube (held axially within the main body) such that its rotation caused by the drive means causes longitudinal movement of the outer threaded tube,

Thanks to the use of the forceps as described in the present invention, the system has been mechanically simplified at the level of the pliers which have been used for this purpose so far, thereby saving costs. With the variable geometry of the configuration of the cross-sectional strands of the pliers' drive means for each orientation change of said section, it is possible, according to the invention, to avoid using pulleys or gears for lateral rotation of the parts in which the tie rods pass. The configuration according to the present invention further enables a very robust system to be obtained with a high durability of the cables and drums around which the cables are to be wound.

[0027] Other objects, advantages and features of minimally invasive laparoscopic surgical pliers according to the present invention will become apparent from the description of a preferred embodiment of the invention. This description is given only as an example and it is shown in the attached drawings.

Brief Description of the Drawings [0028] In the drawings mentioned,

FIG. 1 is a partially perspective partial view of the main body of the minimally invasive laparoscopic surgical pliers according to the present invention; FIG. 2 is a perspective view of one embodiment of one module for changing the orientation of the pincers cable;

FIG. 3 is a perspective view of the minimally invasive laparoscopic surgical pliers according to the present invention, with jaw means and a rotating body mounted at the distal end of the main body of the system;

FIG. 4 is a partial perspective view of a pair of pliers according to the present invention, which schematically shows the configuration of the tendons and their orientation.

Detailed description of a preferred embodiment [0029] In FIG. 1-4 attached to this document shows a preferred embodiment of minimally invasive laparoscopic surgical pliers in robotic arms. The tongs are indicated in the figures as a whole by reference numeral 10.

[0030] The pliers 10 comprise, in the embodiment shown, a main body 20 with an elongated shape having a proximal end 30 (left side in the figures of the drawing) and a distal end 40 (right side in the figures). The main body of the pliers 10 with the proximal end 30 is partially shown in FIG. 1 drawings. The distal end 40 of the main body 20 is shown in FIG. 3 and 4 drawings.

[0031] As shown in FIG. 1, the proximal end 30 of the pliers body 10 can be attached to the robotic arm 50 by means of a universal joint 55. For clarity, the universal joint 55 is shown in said FIG. 1 as separated from the main body 20. The universal joint 55 allows the system to realize two passive rotations GP1, GP2, as shown in FIG. 1, using the appropriate arrows. At the end of the distal body 20, a kinematic assembly is provided, comprising a body 60 pivotally mounted at the distal end 40. The rotatable body 60 has jaw means (jaws 70), which will be described in more detail below.

[0032] Jaws 70 of the embodiment illustrated by way of example in FIG. 3 and 4 include two spoon-shaped fingers 71, 72. In the embodiment of FIG. 3, fingers 71, 72 of the jaws 70 have a flat, rough inner surface. In the embodiment of FIG. 4, fingers 71, 72 of the jaws 70 have a curved, smooth inner surface. However, it should be understood that the fingers 71, 72 of the jaws 70 may have any other configuration as well as an inner surface having different surface finishes, as desired.

[0033] The fingers 71, 72 of the jaws 70 can be rotatably driven in a coordinated and independent manner in accordance with the active turns GA2, GA3 shown in FIG. 3, around the first axis X, to move towards one another and / or from one another. This allows you to grip the pliers 10, and even to maintain a useful tool, body or device (which has not been shown).

[0034] The kinematic system of the forceps 10 can be rotated about a longitudinal axis From the main body 20 according to the passive angular motion GA4 shown in FIG. 1. This passive GA4 rotation is performed at an angle greater than 360 ° and allows for the arrangement of the working plane of the pliers 10.

[0035] Each finger 71, 72 of the jaws 70 is integrally connected to the winding drum 81, 82, which will be described in more detail below.

[0036] At the proximal end 30 of the main body 20, there are drive means M for controlling the guidance of the jaws 70 and their orientation in space. The drive means M will be described in more detail below.

[0037] In cooperation with the drive means M, first movement transmission means 100 are provided, which cause the fingers 71, 72 of the jaws 70 to be turned towards each other and spaced apart as shown in FIG. 3 through GA2 and GA3, respectively, for each finger 71, 72. Second movement means 200 are also provided to rotate the rotating body 60 according to GA1 around the second axis Y, as shown in FIG. 3, for the arrangement of the pliers 10 on the sides in space when they are used in laparoscopic intervention. In one embodiment, preferably the first X axis and the second Y axis form an angle of 90 ° to each other.

The first transmission means 100 comprise tendons 300, 350 and the second transmitting means comprise, respectively, one tie rod 400. The tie 350 is arranged symmetrically with respect to the pull rod 300 and is therefore invisible in FIG. 3 drawings (which is shown with dashed lines). It is evident that in other embodiments of the invention, the jaws 70 may include a single movable finger, the second being fastened such that the first transfer means 100 comprise in this case a single tie (300 or 350).

[0039] The cables 300, 350, 400 extend along the main body 20, from the proximal end 30 to the distal end 40, as can be seen in FIG. 3 and 4 drawings. The cables 300, 350, 400 are adapted to move along the main body 20 to drive the forceps 10, which will be described in detail below.

[0040] In the illustrated embodiment, the cables 300, 350, 400 of the transfer means 100, 200 are formed by three steel cables 500 having a round cross-section, arranged in a jacket that surrounds them (which has not been shown), providing the necessary rigidity to work * for both drawing and compression.

[0041] Several cable systems 500 in one strand 300, 350, 400 are shown in FIG. 2 and 4. In FIG. 4 shows different arrangements A, B, C of the cross-section geometries taken by at least tendons 300, 350 associated with first transmission means 100. This change in the geometry of the cross-section of tendons 300, 350 is determined by the arrangement or orientation of the conductors 500 forming each tension rod. . In the illustrated embodiment, the arrangement of the cables 500 in the tendons 300, 350 is such that near the distal end 40 of the main body 20 the tie rods have their cross-sectional geometry varying with their movement along the length of the distal end 40 of the pliers main body. a change in the geometry of the cross-section of the string 300, 350 allows the rotary movement of GA2, GA3 fingers 71,

[0042] The change in the cross-section geometry of each tie rod 300, 400 will be described below with reference to FIG. 4 drawings. The geometry of the cross-section of each tendon 300, 350 varies twice in its path, and thus there is a first cross-sectional arrangement A 300, 350, a second cross-section geometry B, 300, 350 and a third cross-sectional arrangement C, 300, 350. A, B and C are schematically depicted in FIG. 4.

[0043] According to FIG. 4, at most lengths of the main body 20, the tendons 300, 350 run with respective cables 500 arranged radially from the proximal end 30 to the distal end 40. This radial arrangement of the wires 500 is obtained by a substantially triangular arrangement, as seen in the cross-section, defining substantially the circular shape of the first cross-sectional arrangement A of tendons 300, 350. Near the distal end 40 of the main body 20, the geometry of the cross-section of the same cord 300, 350 changes from the first array 500 (radially) with their longitudinal axes triangularly distributed in the second arrangement B with their longitudinal axes aligned in a first orientation, aligned horizontally as seen in the cross-section as shown in FIG. 4. Finally, the geometry of the cross-section of the tendons 300, 350 changes again from this second arrangement B of the cables 500 (in the first orientation, with their longitudinal axes aligned horizontally) into a system in which said longitudinal axes are aligned in a second orientation, defining in this a third method arrangement C having a cross-sectional geometry of the traction string 300, 350, as shown in FIG. 4. In the case of the disclosed embodiment, the first orientation in the second B-section of the tie rods 300, 350 forms an angle substantially 90 ° to the second orientation of the third C-system with a tie cross section 300, 350. Thus, the third C-section of the tensile cross-section 300, 350 corresponds a shape in which the cables 500 are vertically positioned, as seen in cross-section as shown in FIG. 4. 350 changes again from this second arrangement B of cables 500 (in the first orientation, with their longitudinal axes aligned horizontally) into a system in which said longitudinal axes are aligned in a second orientation, thus defining a third C-system with geometry cross-section of tendon 300, 350, as shown in FIG. 4. In the case of the disclosed embodiment, the first orientation in the second B-section of the tie rods 300, 350 forms an angle substantially 90 ° to the second orientation of the third C-system with a tie cross section 300, 350. Thus, the third C-section of the tensile cross-section 300, 350 corresponds a shape in which the cables 500 are vertically positioned, as seen in cross-section as shown in FIG. 4. 350 changes again from this second arrangement B of cables 500 (in the first orientation, with their longitudinal axes aligned horizontally) into a system in which said longitudinal axes are aligned in a second orientation, thus defining a third C-system with geometry cross-section of tendon 300, 350, as shown in FIG. 4. In the case of the disclosed embodiment, the first orientation in the second B-section of the tie rods 300, 350 forms an angle substantially 90 ° to the second orientation of the third C-system with a tie cross section 300, 350. Thus, the third C-section of the tensile cross-section 300, 350 corresponds a shape in which the cables 500 are vertically positioned, as seen in cross-section as shown in FIG. 4. with their longitudinal axes aligned horizontally) into a system in which said longitudinal axes are aligned in a second orientation, thus defining a third C-system with a cross-sectional geometry of the tensile bars 300, 350, as shown in FIG. 4. In the case of the disclosed embodiment, the first orientation in the second B-section of the tie rods 300, 350 forms an angle substantially 90 ° to the second orientation of the third C-system with a tie cross section 300, 350. Thus, the third C-section of the tensile cross-section 300, 350 corresponds a shape in which the cables 500 are vertically positioned, as seen in cross-section as shown in FIG. 4. with their longitudinal axes aligned horizontally) into a system in which said longitudinal axes are aligned in a second orientation, thus defining a third C-system with a cross-sectional geometry of the tensile bars 300, 350, as shown in FIG. 4. In the case of the disclosed embodiment, the first orientation in the second B-section of the tie rods 300, 350 forms an angle substantially 90 ° to the second orientation of the third C-system with a tie cross section 300, 350. Thus, the third C-section of the tensile cross-section 300, 350 corresponds a shape in which the cables 500 are vertically positioned, as seen in cross-section as shown in FIG. 4. as shown in FIG. 4. In the case of the disclosed embodiment, the first orientation in the second B-section of the tie rods 300, 350 forms an angle substantially 90 ° to the second orientation of the third C-system with a tie cross section 300, 350. Thus, the third C-section of the tensile cross-section 300, 350 corresponds a shape in which the cables 500 are vertically positioned, as seen in cross-section as shown in FIG. 4. as shown in FIG. 4. In the case of the disclosed embodiment, the first orientation in the second B-section of the tie rods 300, 350 forms an angle substantially 90 ° to the second orientation of the third C-system with a tie cross section 300, 350. Thus, the third C-section of the tensile cross-section 300, 350 corresponds a shape in which the cables 500 are vertically positioned, as seen in cross-section as shown in FIG. 4. as shown in FIG. 4. as shown in FIG. 4.

[0044] The cross-section of the ties 300, 350 of the pliers 10 provides the stiffness needed for drawing and compression work, and at the same time allows the tendons to be wound around each drum 81, 82, 83. Changing the orientation of at least tendons 300, 350 in the first transmission means 100 ( it is not needed for the tether 400 associated with the second transmission means 200 in the embodiment shown) permits further passage of the tendons 300 via the joint 350 associated with the axis Y to be adjusted, i.e. enabling rotation of the body 60 according to the rotation GA1.

[0045] As mentioned above, the first and second conveyance means 100, 200 formed by the respective tendons 300, 350, 400 further comprise rotating drums 81, 82, 83 around which the above-mentioned corresponding tie rods 300, 350, 400 are wound. In particular, the drums 81, 82 are arranged coaxially one above the other to form the rotary body 60 of the pliers 10 and are adapted for independent rotary driving by actuating the first transmission means 100, i.e., tendons 300 and tendons 350 (symmetrically invisible to each other). The cable 300, extending along the interior of the main body 20, surrounds the periphery of the drum 81, and the pull 350 extending along the interior of the main body 20 surrounds the periphery of the drum 82. Finally, the cord 400, which also extends along the interior of the main body 20, The displacement of the tendons 300, 350 associated with the first transmission means 100 causes an independent rotation of each drum 81, 82 of the pliers 60, so that the fingers 71, 27 of the jaws 70 can be rotated independently about the X axis according to the respective active the rotation movements GA2, GA3 shown in FIG. 3, when rotated about the X axis in a direction towards itself or from one another, as desired, for gripping, holding, etc. The displacement of the tie 400 associated with the second transfer means 200 rotates the drum 83, thereby rotating the toothed body 60 around the Y axis according to the active GA1 motion shown in FIG. 3, for the correct arrangement of the pliers 10 in space. [0046] For the drums 81, 82, 83 to rotate properly,

[0047] In an embodiment of the minimally invasive laparoscopic surgical pliers 10, which are described herein in accordance with the figures, an additional module 600 is provided to change the orientation of the tendons 300, 350. One example of one of the orientation changing modules 600 is shown in FIG. 2. In said FIG. 2 shows a module 600 changing the orientation of the tendons 300, 350 to cause a change in the geometry of the cross-section geometry A, B, C of each tendon 300, 350 in said first transmission means 100 at different planes adjacent the distal end 40 of the main body 20 pliers 10. Module alternating orientation 600 includes an integrated block mounted inside the main body 20. Inside the orientation-changing module 600, the elongated inner channel 650 is shaped like this,

[0048] For each tendon 300, 350 first transfer means 100 are provided with two orientation-changing modules 600. Modules 600 associated with said first means for transmitting movement 100, i.e. causing a change in the orientation of tendons 300 and 350, when displaced along the main body 20, one of which is positioned just behind the distal end 40 of the main body 20 and the other adjacent to each of the drums 81, 82 of the rotary body 60.

The configuration described for the orientation changer modules 600 allows for two changes in the cross-sectional structure of the tendons, from circular A to straight horizontal B, and from straight horizontal B to straight vertical C, as shown schematically in FIG. 4 and as described above.

[0050] The internal duct 650 of each orientation changer module 600 may have a first dimension d corresponding to the diameter of the cable used (typically 0.3 mm) and the second dimension D corresponding to three of said diameters (0.9 mm). It should be understood that said dimensions d, D in a specific orientation may correspond to the width and height of said channel 650 in the example shown, although the geometry of the module 600 may be determined by other dimensions.

[0051] Between the two orientation-changing modules 600 in the same tendon 300, 350, the cables 500 are arranged inside a flat cover that is suitable to maintain their configuration in this path between the two modules 600.

[0052] Turning now to FIG. 1 of the drawings, the means M for moving the tendons 300, 350, 400 are described in detail.

[0053] In the exemplary embodiment illustrated, the drive means M comprise several electric motors 700 adapted to rotatably drive the outer tubes 800. These outer tubes 800 are provided with an internal thread and are axially held at the proximal end 30 inside the main body 20, as shown in FIG. 1. Inside the outer tubes 800 the corresponding inner tubes are screwed by an external thread 850 cut into the outer portion of the tendons 300, 350, 400. The inner tubes 850 can be rotated relative to the respective outer tubes 800 which, as mentioned above, are held axially in the main body 20. In this way, the rotation of each outer tube 800 by the respective motor 700 causes the longitudinal movement of the inner tube 850, and hence the corresponding longitudinal movement of the tendon 300,

[0054] Although the present invention has been described in the description and illustrated in the attached drawings with reference to a preferred embodiment, the minimally invasive laparoscopic surgical pliers according to the invention are susceptible to various changes not falling outside the scope of protection defined in the appended claims.