Roll-pitch-roll surgical tool

CROSS-REFERENCES TO RELATED APPLICATIONS

0001This application is related to the following patents and patent applications, the full disclosures of which are incorporated herein by reference: PCT International Application No. PCT/US98/19508, entitled “Robotic Apparatus”, filed on Sep. 18, 1998, U.S. application Ser. No. 09/418,726, entitled “Surgical Robotic Tools, Data Architecture, and Use”, filed on Oct. 15, 1999; U.S. Application Ser. No. 60/111,711, entitled “Image Shifting for a Telerobotic System”, filed on Dec. 8, 1998; U.S. application Ser. No. 09/378,173, entitled “Stereo Imaging System for Use in Telerobotic System”, filed on Aug. 20, 1999; U.S. application Ser. No. 09/398,507, entitled “Master Having Redundant Degrees of Freedom”, filed on Sep. 17, 1999, U.S. application Ser. No. 09/399,457, entitled “Cooperative Minimally Invasive Telesurgery System”, filed on Sep. 17, 1999; U.S. application Ser. No. 09/373,678, entitled “Camera Referenced Control in a Minimally Invasive Surgical Apparatus”, filed on Aug. 13, 1999; U.S. Provisional application Ser. No. 09/398,958, entitled “Surgical Tools for Use in Minimally Invasive Telesurgical Applications”, filed on Sep. 17, 1999; and U.S. Pat. No. 5,808,665, entitled “Endoscopic Surgical Instrument and Method for Use”, issued on Sep. 15, 1998.

BACKGROUND OF THE INVENTION

0002Advances in minimally invasive surgical technology could dramatically increase the number of surgeries performed in a minimally invasive manner. Minimally invasive medical techniques are aimed at reducing the amount of extraneous tissue that is damaged during diagnostic or surgical procedures, thereby reducing patient recovery time, discomfort, and deleterious side effects. The average length of a hospital stay for a standard surgery may also be shortened significantly using minimally invasive surgical techniques. Thus, an increased adoption of minimally invasive techniques could save millions of hospital days, and millions of dollars annually in hospital residency costs alone. Patient recovery times, patient discomfort, surgical side effects, and time away from work also be reduced with minimally invasive surgery.

0003The most common form of minimally invasive surgery may be endoscopy. Probably the most common form of endoscopy is laparoscopy, which is minimally invasive inspection and surgery inside the abdominal cavity. In standard laparoscopic surgery, a patient's abdomen is insufflated with gas, and cannula sleeves are passed through small (approximately ½ inch) incisions to provide entry ports for laparoscopic surgical instruments. The laparoscopic surgical instruments generally include a laparoscope (for viewing the surgical field) and working tools. The working tools are similar to those used in conventional (open) surgery, except that the working end or end effector of each tool is separated from its handle by an extension tube. As used herein, the term “end effector” means the actual working part of the surgical instrument and can include clamps, graspers, scissors, staplers, and needle holders, for example. To perform surgical procedures, the surgeon passes these working tools or instruments through the cannula sleeves to an internal surgical site and manipulates them from outside the abdomen. The surgeon monitors the procedure by means of a monitor that displays an image of the surgical site taken from the laparoscope. Similar endoscopic techniques are employed in, e.g., arthroscopy, retroperitoneoscopy, pelviscopy, nephroscopy, cystoscopy, cisternoscopy, sinoscopy, hysteroscopy, urethroscopy and the like.

0004There are many disadvantages relating to current minimally invasive surgical (MIS) technology. For example, existing MIS instruments deny the surgeon the flexibility of tool placement found in open surgery. Most current laparoscopic tools have rigid shafts, so that it can be difficult to approach the worksite through the small incision. Additionally, the length and construction of many endoscopic instruments reduces the surgeon's ability to feel forces exerted by tissues and organs on the end effector of the associated tool. The lack of dexterity and sensitivity of endoscopic tools is a major impediment to the expansion of minimally invasive surgery.

0005Minimally invasive telesurgical robotic systems are being developed to increase a surgeon's dexterity when working within an internal surgical site, as well as to allow a surgeon to operate on a patient from a remote location. In a telesurgery system, the surgeon is often provided with an image of the surgical site at a computer workstation. While viewing a three-dimensional image of the surgical site on a suitable viewer or display, the surgeon performs the surgical procedures on the patient by manipulating master input or control devices of the workstation. The master controls the motion of a servomechanically operated surgical instrument. During the surgical procedure, the telesurgical system can provide mechanical actuation and control of a variety of surgical instruments or tools having end effectors such as, e.g., tissue graspers, needle drivers, or the like, that perform various functions for the surgeon, e.g., holding or driving a needle, grasping a blood vessel, or dissecting tissue, or the like, in response to manipulation of the master control devices.

0006Some surgical tools employ a roll-pitch-yaw mechanism for providing three degrees of rotational movement to an end effector around three perpendicular axes. At about 90° pitch, the yaw and roll rotational movements overlap, resulting in the loss of one degree of rotational movement.

SUMMARY OF THE INVENTION

0007The present invention is generally directed to robotic surgery methods, devices, and systems. The invention provides a minimally invasive surgical tool which operates with three degrees of rotational movement at about 90° pitch. In particular, the surgical tool employs a roll-pitch-roll configuration in which an elongate shaft is rotatable in proximal roll, a wrist member is pivotally mounted on the working end of the elongate shaft to rotate in pitch, and an end effector is pivotally mounted on the wrist member to rotate in distal roll around the wrist axis of the wrist member. At about 90° pitch, the wrist axis is generally perpendicular to the shaft axis of the elongate shaft. The proximal roll around the shaft axis and the distal roll around the wrist axis do not overlap. In some embodiments, a pulley and cable mechanism is used to rotate and actuate the end effector.

0008In some embodiments, the end effector can be bent back beyond 90° pitch. The mechanism coupling the end effector to the working end of the elongate shaft allows the wrist member and end effector to bend back by an angle θ of more than about 90° from the forward position, desirably by more than about 120°, and more desirably by more than about 135°. The ability to operate the end effector at about 90° pitch and to bend back the end effector renders the wrist mechanism more versatile and adaptable to accessing hard to reach locations, particularly with small entry points such as those involving spinal, neural, or rectal surgical sites. In specific embodiments, a pair of linking arms are pivotally connected between the working end and the wrist member to facilitate bend back pitching while maintaining the size of the tool to a sufficiently small size for minimally invasive surgical applications.

0009In accordance to an aspect of the present invention, a minimally invasive surgical instrument comprises an elongate shaft having a working end and a shaft axis, and at least one linking arm having a proximal end and a distal end. The proximal end is pivotally mounted on the working end of the shaft to rotate around a first pitch axis which is nonparallel to the shaft axis. A wrist member has a proximal portion pivotally connected to the distal end of the linking arm to rotate around a second pitch axis which is nonparallel to the shaft axis. An end effector is pivotally mounted on a distal portion of the wrist member to rotate around a wrist axis of the wrist member. The wrist axis extends between the proximal portion and the distal portion of the wrist member. The elongate shaft is rotatable around the shaft axis.

0010In some embodiments, the first pitch axis and the second pitch axis are parallel, and are perpendicular to the shaft axis. A pair of linking arms are connected between the working end and the wrist member. The end effector includes an end effector support pivotally mounted on the distal portion of the wrist member to rotate around the wrist axis. The end effector includes at least one end effector link pivotally mounted on the end effector support to rotate around a pivot axis which is nonparallel to the wrist axis. The pivot axis may be perpendicular to the wrist axis. The end effector may include a pair of end effector links. The end effector links may be rotatable around the pivot axis to move toward and away from one another. The end effector links may be rotatable around the pivot axis to move together in the same direction. One of the end effector links may be fixed relative to the end effector support.

0011In accordance with another aspect of the invention, a minimally invasive surgical instrument comprises an elongate shaft having a working end and a proximal end. The elongate shaft has a shaft axis between the proximal end and the working end. A wrist member includes a wrist axis between a proximal portion and a distal portion. An end effector is pivotally mounted on the distal portion of the wrist member to rotate around the wrist axis. At least one linking member is rotatably coupled between the working end and the wrist member to permit rotation of the wrist member relative to the working end, from a forward position in which the wrist axis is oriented with the end effector at the distal portion pointing generally away from the proximal end of the elongate shaft, to a backward position in which the wrist axis is oriented with the end effector at the distal portion pointing generally toward the proximal end of the elongate shaft.

0012In accordance with another aspect of the present invention, a method of performing minimally invasive surgery in a body cavity of a patient comprises introducing an elongate shaft having a working end into the cavity. The elongate shaft has a proximal end and a shaft axis between the working end and the proximal end. A wrist member which is pivotally coupled with the working end is rotated relative to the working end. The wrist member having a wrist axis. The method further comprises rotating at least one of the elongate shaft around the shaft axis and an end effector pivotally mounted on the wrist member around the wrist axis to position the end effector at a desired location inside the cavity.

0013In some embodiments, the wrist member is rotated around a pitch axis which is perpendicular to at least one of the shaft axis and the wrist axis to change an angle between the wrist axis and the shaft axis. The wrist member is rotated relative to the working end until the wrist axis is approximately perpendicular to the shaft axis. The wrist member may be rotated relative to the working end from a forward position in which the wrist axis is oriented with the end effector pointing generally away from the proximal end of the elongate shaft, to a backward position in which the wrist axis is oriented with the end effector pointing generally toward the proximal end of the elongate shaft.

BRIEF DESCRIPTION OF THE DRAWINGS

0014<figref idref="DRAWINGS">FIG. 1</figref> is a side view of a robotic arm and surgical instrument assembly according to a preferred embodiment of the invention;

0015<figref idref="DRAWINGS">FIG. 2</figref> is a perspective view of the robotic arm and surgical instrument assembly of <figref idref="DRAWINGS">FIG. 1</figref>;

0016<figref idref="DRAWINGS">FIG. 3</figref> is a perspective view of a surgical instrument according to a preferred embodiment of the invention;

0017<figref idref="DRAWINGS">FIG. 4</figref> is a schematic kinematic diagram corresponding to the side view of the robotic arm shown in <figref idref="DRAWINGS">FIG. 1</figref>, and indicates the arm having been displaced from one position into another position;

0018<figref idref="DRAWINGS">FIG. 5</figref> is a perspective view of a roll-pitch-yaw wrist mechanism;

0019<figref idref="DRAWINGS">FIG. 6</figref> is a front view of the wrist mechanism of <figref idref="DRAWINGS">FIG. 5</figref> along arrow VI;

0020<figref idref="DRAWINGS">FIG. 7</figref> is a side view of the wrist mechanism of <figref idref="DRAWINGS">FIG. 5</figref> along arrow VII;

0021<figref idref="DRAWINGS">FIG. 8</figref> is a perspective view of the wrist mechanism of <figref idref="DRAWINGS">FIG. 5</figref> schematically illustrating the singularity at the 90° pitch position;

0022<figref idref="DRAWINGS">FIG. 9</figref> is a perspective view of a roll-pitch-roll wrist mechanism according to a preferred embodiment of the present invention;

0023<figref idref="DRAWINGS">FIG. 10</figref> is a front view of the wrist mechanism of <figref idref="DRAWINGS">FIG. 9</figref> along arrow X;

0024<figref idref="DRAWINGS">FIG. 11</figref> is a side view of the wrist mechanism of <figref idref="DRAWINGS">FIG. 9</figref> along arrow XI;

0025<figref idref="DRAWINGS">FIG. 12</figref> is a perspective view of the wrist mechanism of <figref idref="DRAWINGS">FIG. 9</figref> at the 90° pitch position;

0026<figref idref="DRAWINGS">FIG. 13</figref> is a perspective view of a roll-pitch-roll wrist mechanism according to another preferred embodiment of the present invention;

0027<figref idref="DRAWINGS">FIG. 14</figref> is a sectional view of the wrist mechanism of <figref idref="DRAWINGS">FIG. 13</figref> along XIV-XIV;

0028<figref idref="DRAWINGS">FIG. 15</figref> is another perspective view of the wrist mechanism of <figref idref="DRAWINGS">FIG. 13</figref>;

0029<figref idref="DRAWINGS">FIG. 16</figref> is another perspective view of the wrist mechanism of <figref idref="DRAWINGS">FIG. 13</figref>; and

0030<figref idref="DRAWINGS">FIG. 17</figref> is a perspective view of the Wrist mechanism of <figref idref="DRAWINGS">FIG. 13</figref> schematically illustrating the bend back feature of the end effector.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

0031<figref idref="DRAWINGS">FIGS. 1 and 2</figref> illustrate a robotic arm and surgical instrument assembly <b>10</b>. The assembly <b>10</b> includes a robotic arm <b>12</b> and a surgical instrument <b>14</b>. <figref idref="DRAWINGS">FIG. 3</figref> indicates the general appearance of the surgical instrument <b>14</b>.

0032The surgical instrument <b>14</b> includes an elongate shaft <b>14</b>.<b>1</b>. A wrist-like mechanism <b>50</b> is located at a working end of the shaft <b>14</b>.<b>1</b>. A housing <b>53</b> arranged releasably to couple the instrument <b>14</b> to the robotic aim <b>12</b> is located at an opposed end of the shaft <b>14</b>.<b>1</b>. In <figref idref="DRAWINGS">FIG. 1</figref>, and when the instrument <b>14</b> is coupled or mounted on the robotic arm <b>12</b>, the shaft <b>14</b>.<b>1</b> extends along an axis indicated at <b>14</b>.<b>2</b>. The instrument <b>14</b> is typically releasably mounted on a carriage <b>11</b> which is driven to translate along a linear guide formation <b>24</b> in the direction of arrows P. The surgical instrument <b>14</b> is described in greater detail herein below.

0033The robotic aim <b>12</b> is typically mounted on a base (not shown) by a bracket or mounting plate <b>16</b>. The base is typically in the form of a mobile cart or trolley (not shown) which is retained in a stationary position during a surgical procedure.

0034The robotic arm <b>12</b> includes a cradle <b>18</b>, an upper arm portion <b>20</b>, a forearm portion <b>22</b>, and the guide formation <b>24</b>. The cradle <b>18</b> is pivotally mounted on the plate <b>16</b> in a gimbaled fashion to permit rocking movement of the cradle in the direction of arrows <b>26</b> about a pivot axis <b>28</b>, as shown in <figref idref="DRAWINGS">FIG. 2</figref>. The upper arm portion <b>20</b> includes link members <b>30</b>, <b>32</b> and the forearm portion <b>22</b> includes link members <b>34</b>, <b>36</b>. The link members <b>30</b>, <b>32</b> are pivotally mounted on the cradle <b>18</b> and are pivotally connected to the link members <b>34</b>, <b>36</b>. The link members <b>34</b>, <b>36</b> are pivotally connected to the guide formation <b>24</b>. The pivotal connections between the link members <b>30</b>, <b>32</b>, <b>34</b>, <b>36</b>, the cradle <b>18</b>, and the guide formation <b>24</b> are arranged to enable the robotic arm to move in a specific manner.

0035The movements of the robotic arm <b>12</b> is illustrated schematically in <figref idref="DRAWINGS">FIG. 4</figref>. The solid lines schematically indicate one position of the robotic arm and the dashed lines indicate another possible position into which the arm can be displaced from the position indicated in solid lines.

0036It will be understood that in a preferred embodiment, the axis <b>14</b>.<b>2</b> along which the shaft <b>14</b>.<b>1</b> of the instrument <b>14</b> extends when mounted on the robotic arm <b>12</b> pivots about a pivot center or fulcrum <b>49</b>. Thus, irrespective of the movement of the robotic arm <b>12</b>, the pivot center <b>49</b> normally remains in substantially the same position relative to the stationary cart <b>300</b> on which the arm <b>12</b> is mounted. In use, the pivot center <b>49</b> is typically positioned at a port of entry into a patient's body during an endoscopic procedure when an internal surgical procedure is to be performed. It will be appreciated that the shaft <b>14</b>.<b>1</b> extends through such a port of entry, the wrist-like mechanism <b>50</b> then being positioned inside the patient's body. Thus, the general position of the mechanism <b>50</b> relative to the surgical site in a patient's body can be changed by movement of the arm <b>12</b>. Since the pivot center <b>49</b> is coincident with the port of entry, such movement of the arm does not excessively effect the surrounding tissue at the port of entry. It is to be appreciated that the field of application of the invention is not limited to surgical procedures at internal surgical sites only, but can be used on open surgical sites as well.

0037As can best be seen in <figref idref="DRAWINGS">FIG. 4</figref>, the robotic arm <b>12</b> provides three degrees of freedom of movement to the surgical instrument <b>14</b> when mounted thereon. These degrees of freedom of movement are firstly the gimbaled motion indicated by arrows <b>26</b>, pivoting or pitching movement as indicated by arrows <b>27</b>, and the linear displacement in the direction of arrows P. Movement of the arm as indicated by arrows <b>26</b>, <b>27</b> and P is controlled by appropriately positioned actuators, e.g., electrical motors or the like, which respond to inputs from its associated master control to drive the arm <b>12</b> to a desired position as dictated by movement of the master control.

0000Roll-Pitch-Yaw Mechanism

0038<figref idref="DRAWINGS">FIGS. 5, 6</figref> and <b>7</b> show a roll-pitch-yaw wrist-like mechanism <b>50</b>. In <figref idref="DRAWINGS">FIG. 5</figref>, the working end of the shaft <b>14</b>.<b>1</b> is indicated at <b>14</b>.<b>3</b>. The wrist-like mechanism <b>50</b> includes a rigid wrist member <b>52</b>. One end portion of the wrist member <b>52</b> is pivotally mounted in a clevis <b>17</b> on the end <b>14</b>.<b>3</b> of the shaft <b>14</b>.<b>1</b> by means of a pivotal connection <b>54</b>. As best seen in <figref idref="DRAWINGS">FIG. 7</figref>, the wrist member <b>52</b> can pitch in the direction of arrows <b>56</b> about the pivotal connection <b>54</b>. This rotation around the pivotal connection <b>54</b> in the direction <b>56</b> is referred to as the pivot or pitch of the wrist member <b>52</b>. The end <b>14</b>.<b>3</b> is rotatable with the shaft <b>14</b>.<b>1</b> around the axis <b>14</b>.<b>2</b> in the direction H, as shown in <figref idref="DRAWINGS">FIGS. 3 and 5</figref>. This rotation around the axis <b>14</b>.<b>2</b> in the direction H is referred to as the roll of the working end <b>14</b>.<b>3</b>.

0039An end effector, generally indicated by reference numeral <b>58</b>, is pivotally mounted on an opposed end of the wrist member <b>52</b>. The end effector <b>58</b> is in the form of forceps or graspers for grasping tissue or the like during a surgical procedure. Accordingly, the end effector <b>58</b> has two parts <b>58</b>.<b>1</b>, <b>58</b>.<b>2</b> together defining a jaw-like arrangement. The end effector <b>58</b> is pivotally mounted in a clevis <b>19</b> on an opposed end of the wrist member <b>52</b>, by means of a pivotal connection <b>60</b>. Free ends <b>11</b>, <b>13</b> of the parts <b>58</b>.<b>1</b>, <b>58</b>.<b>2</b> are angularly displaceable about the pivotal connection <b>60</b> toward and away from each other as indicated by arrows <b>62</b>, <b>63</b> in <figref idref="DRAWINGS">FIG. 6</figref>. This movement of the parts <b>58</b>.<b>1</b>, <b>58</b>.<b>2</b> is referred to as the grip of the end effector <b>58</b>. The members <b>58</b>.<b>1</b>, <b>58</b>.<b>2</b> can be displaced angularly about the pivotal connection <b>60</b> to change the orientation of the end effector <b>58</b> as a whole, relative to the wrist member <b>52</b>. Thus, each part <b>58</b>.<b>1</b>, <b>58</b>.<b>2</b> is angularly displaceable about the pivotal connection <b>60</b> independently of the other, so that the end effector <b>58</b> is, as a whole, angularly displaceable about the pivotal connection <b>60</b> in the direction <b>61</b>, as indicated in dashed lines in <figref idref="DRAWINGS">FIG. 6</figref>. This rotation around the pivotal connection <b>60</b> in the direction <b>61</b> is referred to the yaw of the end effector <b>58</b>. The wrist mechanism <b>50</b> as illustrated in <figref idref="DRAWINGS">FIGS. 5-7</figref> is referred to as a roll-pitch-yaw mechanism having roll in the direction H, pitch in the direction <b>56</b>, and yaw in the direction <b>61</b>.

0040The parts <b>58</b>.<b>1</b>, <b>58</b>.<b>2</b> each include an elongate finger portion or end effector element <b>58</b>.<b>3</b> and an end effector mounting formation in the form of, e.g., a pulley portion <b>58</b>.<b>5</b>. In a preferred embodiment, the finger portion <b>58</b>.<b>3</b> is integrally formed with the pulley portion <b>58</b>.<b>5</b>. The pulley portion <b>58</b>.<b>5</b> defines a circumferentially extending channel <b>58</b>.<b>6</b> in which an elongate element in the form of, e.g., an activation cable, is carried. A generally circumferentially directed hole <b>58</b>.<b>8</b> extends through a nape region of the finger portion <b>58</b>.<b>3</b> and generally in register with the circumferentially extending channel <b>58</b>.<b>6</b>. The hole <b>58</b>.<b>8</b> has a first portion <b>58</b>.<b>9</b> and a second portion <b>58</b>.<b>10</b> having a diameter greater than the first portion <b>58</b>.<b>9</b>. In use, the activation cable has a thickened portion along its length which seats in the hole portion <b>58</b>.<b>10</b>, the rest of the activation cable then extending along the channel <b>58</b>.<b>6</b> in opposed directions. The thickened portion is crimped in its seated position in the hole portion <b>58</b>.<b>10</b> so as to anchor the cable in the hole <b>58</b>.<b>8</b>. It will be appreciated that a greater force is necessary to clamp the free ends together when gripping an object therebetween, than that which is required to open the free ends <b>11</b>, <b>13</b>. Thus, the thickened portion of the cable is urged against an annular stepped surface between the hole portion <b>58</b>.<b>9</b> and the hole portion <b>58</b>.<b>10</b>, when the free ends <b>11</b>, <b>13</b> are urged into a closed condition.

0041As best seen in <figref idref="DRAWINGS">FIG. 6</figref>, the wrist member <b>52</b> is flanked by two sets of pulleys <b>64</b>, <b>66</b> which are coaxially positioned on the pivotal connection <b>54</b> and in the clevis <b>17</b> at the end <b>14</b>.<b>3</b> of the shaft <b>14</b>.<b>1</b>. Two further sets of pulleys <b>68</b>, <b>70</b> are rotatably mounted on opposed sides of the wrist member <b>52</b>. Each pulley of the set of pulleys <b>68</b> on the one side of the wrist member <b>52</b> is generally co-planar with an associated pulley of the pulley set <b>66</b>. Furthermore, each of the pulleys <b>68</b> is positioned such that its circumference is in close proximity to the circumference of its associated pulley of the pulley set <b>66</b>. A similar arrangement exists for each pulley of the pulley set <b>70</b> on the other side of the wrist member and its associated pulley of the pulley set <b>64</b>. Thus, the circumferentially extending channel formation of each pulley of the pulley sets <b>68</b>, <b>70</b> and their associated pulleys of the pulley sets <b>64</b>, <b>66</b> define between each of them a space <b>72</b> through which an activation cable can snugly pass.

0042A plurality of elongate elements, e.g., cables, are used to effect movement of the wrist mechanism <b>50</b> and end effector <b>58</b>. As seen in <figref idref="DRAWINGS">FIG. 7</figref>, two cables C<b>1</b>, C<b>2</b> are anchored on the parts <b>58</b>.<b>1</b>, <b>58</b>.<b>2</b>, respectively, to effect movement of the parts <b>58</b>.<b>1</b>, <b>58</b>.<b>2</b> independently in directions <b>62</b>, <b>63</b> or as a whole (<figref idref="DRAWINGS">FIG. 6</figref>).

0043Cable C<b>1</b> rides over an outer pulley of the pulley set <b>64</b>, an outer pulley of the pulley set <b>70</b>, over part of circumferential channel <b>58</b>.<b>6</b> of the pulley portion <b>58</b>.<b>5</b> of the part <b>58</b>.<b>2</b> of the end effector <b>58</b>, through the hole <b>58</b>.<b>8</b>, again along part of the circumferential channel <b>58</b>.<b>6</b> of the pulley portion <b>58</b>.<b>5</b>, over an outer pulley of the pulley set <b>68</b> and over an outer pulley of the pulley set <b>66</b>. Similarly, cable C<b>2</b> rides over an inner pulley of the pulley set <b>64</b>, over an inner pulley of the pulley set <b>70</b>, along the circumferential channel <b>58</b>.<b>6</b> of the part <b>58</b>.<b>1</b> of the end effector <b>58</b>, through the hole <b>58</b>.<b>8</b> of the part <b>58</b>.<b>1</b>, again along the circumferential channel <b>58</b>.<b>6</b> of the pulley portion <b>58</b>.<b>5</b>, over an inner pulley of the pulley set <b>68</b> and over an inner pulley of the pulley set <b>66</b>. The cables C<b>1</b>, C<b>2</b> pass from the wrist mechanism <b>50</b> through appropriately positioned holes <b>47</b> in the base region of the clevis <b>17</b> (<figref idref="DRAWINGS">FIG. 5</figref>), and internally along the shaft, toward the housing <b>53</b> (<figref idref="DRAWINGS">FIG. 3</figref>). The housing <b>53</b> includes driving members, e.g., in the form of spool assemblies for manipulating the cables. Additional details of the spool assemblies and the grip mechanism for manipulating the finger portions <b>58</b>.<b>1</b>, <b>58</b>.<b>2</b> to achieve gripping as well as description of various surgical tools can be found in U.S. application Ser. No. 09/398,958, entitled “Surgical Tools for Use in Minimally Invasive Telesurgical Applications”, filed on Sep. 17, 1999.

0044When the end effector <b>58</b> is oriented forward, the roll, pitch, and yaw provide rotational movements relative to three generally perpendicular axes. <figref idref="DRAWINGS">FIG. 8</figref> shows the position of the end effector <b>58</b> after rotation in pitch in the direction <b>56</b> of the wrist member <b>52</b> around the pivotal connection <b>54</b> by about 90°. In this position, the yaw in the direction <b>61</b> around the pivotal connection <b>60</b> overlaps with the roll H of the working end <b>14</b>.<b>3</b>. The overlap or redundancy results in the loss of one degree of freedom of movement of the end effector <b>58</b> at or near this position of singularity. In some applications, the end effector <b>58</b> may be used primarily at this position of about 90° pitch. It is desirable to provide a wrist mechanism that does not operate at a singularity in this position.

0000Roll-Pitch-Roll Mechanism

0045<figref idref="DRAWINGS">FIGS. 9-11</figref> show a roll-pitch-roll wrist-like mechanism <b>500</b>. In <figref idref="DRAWINGS">FIG. 9</figref>, the working end of the tool shaft is indicated at <b>502</b>, and includes a pair of extensions <b>506</b>. The wrist-like mechanism <b>500</b> includes a rigid wrist member <b>504</b>. One end portion of the wrist member <b>504</b> forms a clevis <b>508</b> in which the extensions <b>506</b> of the working end <b>502</b> of the tool shaft is pivotally mounted by means of a pivotal connection <b>510</b>. As best seen in <figref idref="DRAWINGS">FIG. 10</figref>, the wrist member <b>504</b> can pitch in the direction of arrows <b>512</b> about the pivotal connection <b>510</b>. This rotation around the pivotal connection <b>510</b> in the direction <b>512</b> is referred to as the pivot or pitch of the wrist member <b>504</b>. The end <b>502</b> is rotatable with the tool shaft around the shaft axis in the direction <b>516</b>. This rotation around the shaft axis in the direction <b>516</b> is referred to as the roll of the working end <b>502</b>.

0046An end effector, generally indicated by reference numeral <b>514</b>, is supported on an end effector support base <b>518</b> which is pivotally mounted on an opposed end of the wrist member <b>504</b> to rotate around its axis in the direction <b>520</b> as shown in <figref idref="DRAWINGS">FIG. 9</figref>. In the embodiment shown, the axis of the base <b>518</b> coincides with the axis of the wrist member <b>504</b>. The rotation in the direction <b>520</b> is referred to the distal roll of the end effector <b>514</b>. This distal roll of the end effector <b>514</b> in the direction <b>520</b> is differentiated from the proximal roll of the working end <b>502</b> in the direction <b>516</b>. In the position of the wrist mechanism <b>500</b> as shown in <figref idref="DRAWINGS">FIGS. 9-11</figref>, the distal roll <b>520</b> of the end effector <b>514</b> overlaps with the proximal roll <b>516</b> of the working end <b>502</b>. Because the rotation of the wrist member <b>504</b> around the pivotal connection <b>510</b> provides pitch <b>512</b> of the end effector <b>514</b>, the distal roll <b>520</b> generally will not coincide with the proximal roll <b>516</b>. The wrist mechanism <b>500</b> as illustrated in <figref idref="DRAWINGS">FIGS. 9-11</figref> is referred to as a roll-pitch-roll mechanism.

0047The end effector <b>514</b> is in the form of forceps or graspers for grasping tissue or the like during a surgical procedure. Accordingly, the end effector <b>514</b> has two parts <b>522</b>.<b>1</b>, <b>522</b>.<b>2</b> together defining a jaw-like arrangement. The two parts <b>522</b>.<b>1</b>, <b>522</b>.<b>2</b> are pivotally mounted in a clevis <b>524</b> on the base <b>518</b>, by means of a pivotal connection <b>526</b>. Free ends <b>528</b>.<b>1</b>, <b>528</b>.<b>2</b> of the parts <b>522</b>.<b>1</b>, <b>522</b>.<b>2</b> are angularly displaceable about the pivotal connection <b>526</b> toward and away from each other as indicated by arrows <b>530</b>, <b>532</b> in <figref idref="DRAWINGS">FIG. 10</figref>. This movement is referred to as the grip of the end effector <b>514</b>. The members <b>522</b>.<b>1</b>, <b>522</b>.<b>2</b> can be displaced angularly about the pivotal connection <b>526</b> to change the orientation of the end effector <b>514</b> as a whole, relative to the wrist member <b>504</b>. Thus, each part <b>522</b>.<b>1</b>, <b>522</b>.<b>2</b> is angularly displaceable about the pivotal connection <b>526</b> independently of the other, so that the end effector <b>514</b> is, as a whole, angularly displaceable about the pivotal connection <b>526</b> in the direction <b>534</b>, as shown in <figref idref="DRAWINGS">FIG. 10</figref>. This rotation around the pivotal connection <b>526</b> is referred to the yaw of the end effector <b>514</b>. In the position of the wrist mechanism <b>500</b> as shown in <figref idref="DRAWINGS">FIGS. 9-11</figref>, the yaw <b>534</b> of the end effector <b>514</b> overlaps with the pitch <b>512</b> of the wrist member <b>504</b>. Because the rotation of the base <b>518</b> provides distal roll <b>520</b> of the end effector <b>514</b>, the yaw <b>534</b> generally will not coincide with the pitch <b>512</b>. With the additional degree of freedom in yaw in the specific embodiment shown, the wrist mechanism <b>500</b> as illustrated in <figref idref="DRAWINGS">FIGS. 9-11</figref> may be referred to as a roll-pitch-roll-yaw mechanism.

0048The parts <b>522</b>.<b>1</b>, <b>522</b>.<b>2</b> each include an elongate finger portion or end effector element <b>536</b> and an end effector mounting formation in the form of, e.g., a pulley portion <b>538</b>. The finger portion <b>536</b> may be integrally formed with the pulley portion <b>538</b>. The pulley portion <b>538</b> defines a circumferentially extending channel for receiving an activation cable in a manner similar to the pulley portion <b>58</b>.<b>5</b> in the end effector <b>58</b> of <figref idref="DRAWINGS">FIGS. 5-7</figref>. Two elongate members such as cables C<b>1</b>, C<b>2</b> are used to effect movement of the parts <b>522</b>.<b>1</b>, <b>522</b>.<b>2</b> in yaw <b>534</b> and grip <b>530</b>, <b>532</b>. The cables C<b>1</b>, C<b>2</b> pass from the wrist mechanism <b>500</b> internally through the shaft toward the housing <b>53</b> (<figref idref="DRAWINGS">FIG. 3</figref>). For simplicity, details of the pulley portion <b>538</b> in the end effector <b>514</b> of <figref idref="DRAWINGS">FIGS. 9-11</figref> are omitted. The configuration and operation of the parts <b>522</b>.<b>1</b>, <b>522</b>.<b>2</b> are similar to those of the parts <b>58</b>.<b>1</b>, <b>58</b>.<b>2</b> in <figref idref="DRAWINGS">FIGS. 5-7</figref>.

0049In an alternate embodiment, the end effector <b>514</b> does not include the additional degree of freedom in yaw <b>534</b> but is still configured to perform the grip function. The parts <b>522</b>.<b>1</b>, <b>522</b>.<b>2</b> perform gripping and does not move as a whole in yaw. For example, one part <b>522</b>.<b>1</b> may be substantially fixed with respect to the support base <b>518</b>, while the other part <b>522</b>.<b>2</b> is rotatable relative to the pivotal connection <b>526</b> to move away from and toward the fixed part <b>522</b>.<b>1</b> in grip <b>530</b>, <b>532</b>. In that case, only one cable C<b>2</b> is needed to manipulate the part <b>522</b>.<b>2</b> to effect the grip movement thereof (C<b>1</b> is no longer needed). This alternate roll-pitch-roll mechanism with grip capability is simpler in structure and operation than the roll-pitch-roll-yaw mechanism with grip.

0050As best seen in <figref idref="DRAWINGS">FIG. 11</figref>, the pair of working end extensions <b>506</b> are flanked by two pulleys <b>540</b>, <b>542</b> which are, coaxially positioned on the pivotal connection <b>510</b> and in the clevis <b>508</b> at the proximal end of the wrist member <b>504</b>. A tangent pulley <b>544</b> which is associated with the pulley <b>540</b> is attached to the bottom of the end effector support base <b>518</b>. Another tangent pulley <b>546</b> which is associated with the pulley <b>542</b> is also attached to the bottom of the base <b>518</b>. The tangent pulleys <b>544</b>, <b>546</b> in the specific embodiment shown are generally perpendicular to the pair of pulleys <b>540</b>, <b>542</b>, and move together with the base <b>518</b>. The circumference of each tangent pulley <b>544</b> or <b>546</b> is in close proximity to the circumference of its associated pulley <b>540</b> or <b>542</b>. In a specific embodiment, the tangent pulleys are integrally formed with the bottom of the base <b>518</b>.

0051Two elongate elements such as cables C<b>3</b>, C<b>4</b> are used to effect movement of the end effector <b>514</b> and support base <b>518</b> in distal roll <b>520</b>. As best seen in <figref idref="DRAWINGS">FIG. 11</figref>, two cables C<b>3</b>, C<b>4</b> are anchored on the tangent pulleys <b>544</b>, <b>546</b>, respectively, to effect distal roll <b>520</b> of the base <b>518</b> attached to the tangent pulleys <b>544</b>, <b>546</b>. Cable C<b>3</b> wraps around a portion of the tangent pulley <b>544</b>, rides over the pulley <b>540</b> and extends through the shaft <b>14</b>.<b>1</b> to the housing <b>53</b>, while cable C<b>4</b> wraps around a portion of the tangent pulley <b>546</b>, rides over the pulley <b>542</b> and extends through the shaft <b>14</b>.<b>1</b> to the housing <b>53</b> (<figref idref="DRAWINGS">FIG. 3</figref>). The circumference of each tangent pulley <b>544</b> or <b>546</b> is in sufficiently close proximity to the circumference of its associated pulley <b>540</b> or <b>542</b> to allow the corresponding cable C<b>3</b> or C<b>4</b> to slide in the pulley channels securely through the approximately 90° change in orientation from one pulley to the other. In a preferred embodiment, cables C<b>3</b>, C<b>4</b> are connected in the housing <b>53</b> and form a single cable. The single cable substantially does not change in length during distal roll <b>520</b> so that no tensioning spring or similar member is needed.

0052Another pulley <b>550</b> is disposed adjacent the pulley <b>540</b> and is coaxially positioned with the pulleys <b>540</b>, <b>542</b> on the pivotal connection <b>510</b> and in the clevis <b>508</b> at the proximal end of the wrist member <b>504</b>. An elongate element such as cable C<b>5</b> is used to effect movement of the wrist member <b>504</b> in pitch <b>512</b>. As seen in <figref idref="DRAWINGS">FIGS. 9-11</figref>, cable C<b>5</b> is anchored on the pulley <b>550</b>, rides over the pulley <b>540</b>, and extends through the shaft <b>14</b>.<b>1</b> to the housing <b>53</b> (<figref idref="DRAWINGS">FIG. 3</figref>). In an alternate embodiment, another pulley is coaxially positioned adjacent the pulley <b>542</b> opposite from the pulley <b>550</b> on the other side of the pair of working end extensions <b>506</b>, and the opposite end of cable C<b>5</b> is anchored on that pulley. In the alternate embodiment, cable C<b>5</b> substantially does not change in length during pitch <b>512</b> of the wrist member <b>504</b> so that no tensioning spring or similar member is needed.

0053<figref idref="DRAWINGS">FIG. 12</figref> shows the position of the end effector <b>514</b> after rotation in pitch <b>512</b> of the wrist member <b>504</b> around the pivotal connection <b>510</b> by about 90°. In this position, there is no overlap among the proximal roll <b>516</b>, pitch <b>512</b>, and distal roll <b>520</b>, which are oriented around axes that are generally perpendicular to each other, making the wrist mechanism <b>500</b> more suitable to operate in the 90° pitch position than the wrist mechanism <b>50</b> of <figref idref="DRAWINGS">FIGS. 5-8</figref>. In addition, the two parts <b>522</b>.<b>1</b>, <b>522</b>.<b>2</b> of the end effector <b>514</b> are movable in yaw <b>524</b> and in grip <b>530</b>, <b>532</b> in the specific embodiment shown. In the forward position of the end effector <b>514</b> as shown in <figref idref="DRAWINGS">FIGS. 9-11</figref>, the distal roll <b>520</b> coincides with the proximal roll <b>516</b>, which presents a singularity. The addition of the yaw <b>524</b> of the end effector <b>514</b> in conjunction with the distal roll <b>520</b> in a preferred embodiment essentially eliminates the singularity by providing roll <b>516</b>, pitch <b>512</b>, and yaw <b>534</b> oriented around axes that are nonparallel and may be generally perpendicular to each other.

0000Bend Back Roll-Pitch-Roll Mechanism

0054<figref idref="DRAWINGS">FIGS. 13-17</figref> show a roll-pitch-roll wrist-like mechanism <b>560</b> including a bend back feature in the pitch direction to increase the versatility of the mechanism <b>560</b>. In <figref idref="DRAWINGS">FIG. 13</figref>, the working end of the tool shaft is indicated at <b>562</b>. The end <b>562</b> is rotatable with the tool shaft around the shaft axis in the proximal roll <b>563</b>. The wrist-like mechanism <b>560</b> includes a rigid wrist member <b>564</b>. The working end <b>562</b> forms a working end clevis <b>566</b>, and one end portion of the wrist member <b>564</b> forms a wrist member clevis <b>568</b> facing the clevis <b>566</b>. The working end <b>562</b> includes a central extension <b>570</b>. Disposed in the working end clevis <b>566</b> are a first pair of pitch or knee pulleys <b>572</b>, <b>574</b> on opposite sides of the central extension <b>570</b>. The pulleys <b>572</b>, <b>574</b> are coaxially positioned on a pivotal connection <b>575</b>. A central extension <b>576</b> is located in the wrist member clevis <b>568</b>. Disposed in the wrist member clevis <b>568</b> are a second pair of pitch or knee pulleys <b>578</b>, <b>580</b> on opposite sides of the central extension <b>576</b>. The pulleys <b>578</b>, <b>580</b> are coaxially positioned on a pivotal connection <b>581</b>. The second pair of pitch pulleys <b>578</b>, <b>580</b> in the wrist member clevis <b>568</b> are coplanar with the first pair of pitch pulleys <b>572</b>, <b>574</b> in the working end clevis <b>566</b>, respectively.

0055As best seen in <figref idref="DRAWINGS">FIGS. 13 and 14</figref>, a first pair of distal roll pulleys <b>584</b>, <b>586</b> are disposed in the working end clevis <b>566</b>, on opposite sides of the central extension <b>570</b>. The pulleys <b>584</b>, <b>586</b> are coaxially positioned on the pivotal connection <b>575</b>. A second pair of distal roll pulleys <b>588</b>, <b>590</b> are disposed in the wrist member clevis <b>568</b> on opposite sides of the central extension <b>576</b>. The pulleys <b>588</b>, <b>590</b> are coaxially positioned on the pivotal connection <b>581</b>. The second pair of distal roll pulleys <b>588</b>, <b>590</b> in the wrist member clevis <b>568</b> are coplanar with the first pair of distal roll pulleys <b>584</b>, <b>586</b> in the working end clevis <b>566</b>, respectively.

0056A pair of bend back pulley arms or lining arms <b>592</b>, <b>594</b> extend between the working end clevis <b>566</b> and the wrist member clevis <b>568</b>, and are disposed on opposite sides of the central extensions <b>570</b>, <b>576</b>. Each pulley arm <b>592</b>, <b>594</b> has an end coaxially positioned on the pivotal connection <b>575</b> of the working end <b>562</b> and another end coaxially positioned on the pivotal connection <b>581</b> of the wrist member <b>564</b>. Rotation of the bend back pulley arms <b>592</b>, <b>594</b> relative to the working end <b>562</b> around the pivotal connection <b>575</b> in the direction <b>596</b> provides proximal pitch, while rotation of the wrist member <b>564</b> relative to the bend back pulley arms <b>592</b>, <b>594</b> around the pivotal connection <b>581</b> in the direction <b>598</b> provides distal pitch. The proximal pitch <b>596</b> and distal pitch <b>598</b> allow the wrist member <b>564</b> to be bent back in pitch by more than 90° as discussed in more detail below.

0057The central extension <b>576</b> in the wrist member clevis <b>568</b> is connected to a support base <b>602</b> for an end effector, generally indicated by reference numeral <b>600</b>. The central extension <b>576</b> may be integrally formed with the base <b>602</b>. The support base <b>602</b> is pivotally mounted on an opposed end of the wrist member <b>564</b> to rotate around its axis in the direction <b>604</b>, as shown in <figref idref="DRAWINGS">FIG. 13</figref>. In the embodiment shown, the axis of the base <b>602</b> coincides with the wrist axis of the wrist member <b>564</b>. The rotation in the direction <b>604</b> is referred to the distal roll of the end effector <b>600</b>. This distal roll of the end effector <b>600</b> in the direction <b>604</b> is differentiated from the proximal roll of the working end <b>562</b> in the direction <b>563</b>. In the position of the wrist mechanism <b>560</b> as shown in <figref idref="DRAWINGS">FIGS. 13-16</figref>, the distal roll <b>604</b>; of the end effector <b>600</b> coincides with the proximal roll <b>563</b> of the working end <b>562</b>. Because the rotation of the wrist member <b>564</b> around the pivotal connections <b>575</b>, <b>581</b> provides compound pitch <b>596</b>, <b>598</b> of the end effector <b>600</b>, the distal roll <b>604</b> generally will not coincide with the proximal roll <b>563</b>. The wrist mechanism <b>560</b> as illustrated in <figref idref="DRAWINGS">FIGS. 13-17</figref> is referred to as a bend back roll-pitch-roll mechanism.

0058The end effector <b>600</b> is in the form of forceps or graspers for grasping tissue or the like during a surgical procedure. Accordingly, the end effector <b>600</b> has two parts <b>608</b>.<b>1</b>, <b>608</b>.<b>2</b> together defining a jaw-like arrangement. The two parts <b>608</b>.<b>1</b>, <b>608</b>.<b>2</b> are pivotally mounted in a clevis <b>610</b> on the base <b>602</b>, by means of a pivotal connection <b>612</b>. Although free ends <b>614</b>.<b>1</b>, <b>614</b>.<b>2</b> of the parts <b>608</b>.<b>1</b>, <b>608</b>.<b>2</b> may be angularly displaceable about the pivotal connection <b>612</b> toward and away from each other in some embodiments, the specific embodiment shown in <figref idref="DRAWINGS">FIGS. 13-17</figref> permits rotation of only the part <b>608</b>.<b>2</b> relative to the pivotal connection <b>612</b>. The other part <b>608</b>.<b>1</b> is fixed relative to the base <b>602</b>. The movable part <b>608</b>.<b>2</b> is movable toward and away from the fixed part <b>608</b>.<b>1</b> as indicated by arrows <b>616</b>, <b>618</b> in <figref idref="DRAWINGS">FIG. 16</figref>. This movement is referred to as the grip of the end effector <b>600</b>.

0059The movable part <b>608</b>.<b>2</b> includes a mounting formation in the form of, e.g., a pulley portion <b>620</b>. The pulley portion <b>620</b> defines a circumferentially extending channel for receiving an elongate member such as an activation cable C<b>1</b> which is anchored to the pulley portion <b>620</b>, as best seen in <figref idref="DRAWINGS">FIGS. 13 and 14</figref>. The cable C<b>1</b> pass through the central extensions <b>576</b>, <b>570</b> and the shaft toward the housing <b>53</b> (<figref idref="DRAWINGS">FIG. 3</figref>). In a preferred embodiment, the cable C<b>1</b> forms a continuous loop between the pulley portion <b>620</b> and the housing <b>53</b> and does not change in length during grip <b>616</b>, <b>618</b> of the end effector <b>600</b>, so that no tensioning spring is needed.

0060Two elongate elements such as cables C<b>3</b>, C<b>4</b> are used to effect movement of the end effector <b>600</b> and support base <b>602</b> in distal roll <b>604</b>. As best seen in <figref idref="DRAWINGS">FIG. 14</figref>, two cables C<b>3</b>, C<b>4</b> are anchored on the tangent surface <b>624</b> of the central extension <b>576</b> of the base <b>602</b> to effect distal roll <b>604</b> of the base <b>602</b> (<figref idref="DRAWINGS">FIG. 13</figref>). Cable C<b>3</b> wraps around a portion of the tangent surface <b>624</b>, while cable C<b>4</b> wraps around another portion of the tangent surface <b>624</b>. Cable C<b>3</b> rides over the roll pulleys <b>588</b>, <b>584</b> and extends through the shaft <b>14</b>.<b>1</b> to the housing <b>53</b>, while cable C<b>4</b> rides over the roll pulleys <b>590</b>, <b>586</b> and extends through the shaft <b>14</b>.<b>1</b> to the housing <b>53</b> (<figref idref="DRAWINGS">FIG. 3</figref>). The circumference of the tangent surface <b>624</b> is in sufficiently close proximity to the circumferences of the two roll pulleys <b>588</b>, <b>590</b> to allow the corresponding cables C<b>3</b>, C<b>4</b>, respectively, to slide in the pulley channels securely through the approximately 90° change in orientation from the roll pulleys <b>588</b>, <b>590</b> to the tangent surface <b>624</b>. In a preferred embodiment, cables C<b>3</b>, C<b>4</b> are connected in the housing <b>53</b> and form a single cable. The single cable substantially does not change in length during distal roll <b>604</b> so that no tensioning spring or similar member is needed. For clarity, cables C<b>3</b>, C<b>4</b> are not shown in <figref idref="DRAWINGS">FIGS. 13 and 15</figref>-<b>17</b>. In an alternate embodiment, the tangent surface <b>624</b> may include a pair of circumferential channels for receiving the cables C<b>3</b>, C<b>4</b> such as those for the tangent pulleys <b>544</b>, <b>546</b> shown in <figref idref="DRAWINGS">FIG. 11</figref> for the wrist mechanism <b>500</b>.

0061As best seen in <figref idref="DRAWINGS">FIG. 14</figref>, two cables C<b>5</b>, C<b>6</b> are provided for activating roll <b>596</b>, <b>598</b> of the wrist member <b>564</b>. Cable C<b>5</b> is anchored on the pulley <b>578</b>, rides over the pulleys <b>578</b>, <b>572</b>, and extends through the shaft <b>14</b>.<b>1</b> to the housing <b>53</b> (<figref idref="DRAWINGS">FIG. 3</figref>). Cable C<b>6</b> is anchored on the pulley <b>580</b>, rides over the pulleys <b>580</b>, <b>574</b>, and extends through the shaft <b>14</b>.<b>1</b> to the housing <b>53</b>. In a preferred embodiment, the two cables C<b>5</b>, C<b>6</b> are connected to form a single cable that substantially does not change in length during pitch <b>596</b>, <b>598</b> of the wrist member <b>564</b> so that no tensioning spring is needed.

0062<figref idref="DRAWINGS">FIG. 17</figref> illustrates the bend back feature of the wrist mechanism <b>560</b>. The compound pitch <b>596</b>, <b>598</b> around pivotal connections <b>575</b>, <b>581</b> allows the wrist member <b>564</b> and end effector <b>600</b> to bend back by an angle θ of more than about 90° from the forward position of <figref idref="DRAWINGS">FIGS. 13-16</figref>, desirably by more than about 120°, and more desirably by more than about 135°. Thus, the angle between the shaft axis and the wrist axis is about 180° when the end effector <b>600</b> is in the forward position, and is less than 90° in the bent back position, and may be down to less than about 60° or less than about 45°. The ability to bend back the end effector <b>600</b> renders the wrist mechanism <b>560</b> more versatile and adaptable to accessing hard to reach locations, particularly with small entry points such as those involving spinal, neural, or rectal surgical sites. The use of the linking arms <b>592</b>, <b>594</b> provides this capability while maintaining the size of the tool <b>560</b> to a sufficiently small size for minimally invasive surgical applications.

0063The above-described arrangements of apparatus and methods are merely illustrative of applications of the principles of this invention and many other embodiments and modifications may be made without departing from the spirit and scope of the invention as defined in the claims. For instance, the linking arms may have other configurations. Different actuation mechanisms other than activating cables may be used to manipulate the wrist member and end effector. The scope of the invention should, therefore, be determined not with reference to the above description, but instead should be determined with reference to the appended claims along with their full scope of equivalents.