HK1216072B - Surgical system and method and operator interface for a surgical system - Google Patents

Description

Surgical system and method and operator interface for surgical system

This application is a divisional application of the invention patent application with application number 201380001235.6 and invention name “Magnetic Anchored Robot System” filed on April 26, 2013.

CROSS-REFERENCE TO RELATED APPLICATIONS : This application claims priority to U.S. Provisional Application Serial No. 61/638,828, filed April 26, 2012, and U.S. Provisional Application Serial No. 61/718,252, filed October 25, 2012, each of which is hereby incorporated by reference herein in its entirety. This application is related to U.S. Application Serial No. 13/835,653, filed March 15, 2013, and U.S. Application Serial No. 13/835,680, filed March 15, 2013.

Background Art

Surgeons traditionally rely on external lighting from operating room lighting and sufficient exposure to obtain a good surgical field of view. This usually requires a large incision (especially if the surgeon's hands are larger) to provide an access path for performing surgery. The introduction of optical fibers in modern endoscopes allows surgeons to clearly view under good lighting inside the body cavity without having to make a large incision. Minimally invasive surgery (MIS) has now replaced most conventional open surgical procedures. Computer-assisted technology or robotics has further promoted the development of MIS, because the computer sensors of the robotic machine can reliably and sensitively convert the motion of the surgeon's fingers and wrists into the motion of the driven laparoscopic instruments inside the body cavity. These developments allow good dexterity and precision control of the surgical instruments used for delicate reconstructive surgery in a small, confined space.

However, the MIS approach requires multiple incisions to insert the camera and the various laparoscopic instruments. In the past few years, single-port laparoscopic (LESS) surgical techniques have become available, but these are greatly hampered by the lack of proper triangulation between the camera and the working instruments, which is important for good surgical ergonomics (and therefore, ease and success of the procedure).

Natural orifice transluminal endoscopic surgery (NOTES) is an alternative to laparotomy that uses endoscopic techniques to completely avoid the need for an external abdominal wall incision. In theory, NOTES offers benefits by minimizing the trauma of entry and various complications associated with external incisions, including wound infection, pain, herniation, unsightly abdominal scars, and adhesions.

However, the NOTES approach suffers from a number of drawbacks, including the lack of proper triangulation of surgical instruments (thus, poor ergonomics in the procedure), the inability to apply off-axis forces, and the difficulty in delivering multiple instruments into the abdominal cavity for proper surgical manipulation.

Summary of the Invention

In an embodiment, a robotic actuator includes an internal anchor and an instrument. The internal anchor is adapted to be inserted into the body via an entry port, positioned within the body, and magnetically coupled to an external anchor positioned outside the body. The instrument is adapted to be inserted into the body via the entry port and secured to the internal anchor. The instrument includes an end effector having multiple degrees of motion through multiple axes and a plurality of actuators providing the multiple degrees of motion.

Wherein the actuators each have an axis of rotation oriented in the same direction.

The actuators are distributed along the rotation axis.

The plurality of actuators include a first actuator adjacent to the internal anchor, a second actuator adjacent to the end effector, and a third actuator disposed between the first and second actuators.

wherein the first actuator provides movement about the axis of the instrument relative to the internal anchor, the second actuator provides movement about the axis of the end effector relative to the body of the instrument, and the third actuator provides movement about the axis of extension/retraction of the body of the instrument.

The robotic actuator also includes a fourth actuator that provides motion about a second axis of the instrument relative to the internal anchor.

The first and fourth actuators are adjacent to each other.

The robotic actuator also includes a fifth actuator that provides motion relative to the body of the instrument about a second axis of the end effector.

The robotic actuator also includes a sixth actuator that provides motion about a third axis of the end effector relative to the body of the instrument.

The second, fifth and sixth actuators are adjacent to each other.

wherein the sixth actuator is coupled to a bevel gear, and the second and fifth actuators are each coupled to a worm gear.

The robotic actuator further includes a mechanical element coupled between the second actuator and the end effector, the mechanical element providing deceleration or force multiplication to the second actuator.

The mechanical element is a planetary gear.

The robotic actuator also includes a pulley coupled between the mechanical element and the end effector.

The robotic actuator also includes a second mechanical element coupled between the pulley and the end effector, the second mechanical element including a gear ratio that increases the torque applied to the end effector by the second actuator.

Wherein the third actuator is coupled to a threaded rod having a bearing engaged thereon, the bearing traveling along the threaded rod when the output of the third actuator rotates.

Wherein the third actuator comprises one or more linear actuators.

Wherein the first actuator is coupled to a worm gear.

wherein the worm gear is coupled to a gear wheel.

The worm gear and the gear are coupled by intersecting at approximately 90 degrees.

Wherein the robotic actuator is substantially cylindrical in shape.

The diameter of the cylinder is 21 mm or less.

The length of the cylinder is 200 mm or less.

wherein the instrument and the internal anchor are adapted to be coupled together prior to insertion into the body through the access port.

wherein the instrument is secured to the internal anchor prior to insertion into the body through the access port.

The robotic actuator also includes a circuit board.

The circuit board includes a driving circuit.

The circuit board includes a network interface.

The circuit board is flexible.

The circuit board is arranged adjacent to the inner wall of the housing of the device.

In an embodiment, a surgical system includes a manipulator, an implantable actuator, and a controller. The manipulator includes a plurality of integrated sensors/actuators. The sensors of the sensors/actuators are adapted to detect motion around a plurality of axes of motion. The actuators of the sensors/actuators are adapted to provide tactile feedback. The implantable actuator includes a plurality of joints providing a plurality of axes of motion. The controller is configured to receive information indicating motion of the manipulator around a plurality of axes from the plurality of sensors/actuators, and is configured to cause the joints of the actuator to move along the corresponding axes of motion. Each sensor/actuator of the manipulator detects motion around a similar axis of motion corresponding to one of the joints of the actuator.

The manipulator includes two manipulator ends, each manipulator end is coupled to a first and a second sensor/actuator of the plurality of sensors/actuators.

Wherein the manipulator ends are arranged adjacent to each other and the first and second sensor/actuators extend away from the manipulator ends.

The first and second sensor/actuators are coupled to the first frame member at portions distal to the manipulator end.

Wherein a third sensor/actuator of the plurality of sensors/actuators is coupled to the first frame member.

Wherein the first frame member comprises a C-shape, the first and second sensors/actuators are respectively coupled to end portions of the C-shape, and the third sensor is coupled to a center portion of the C-shape.

The manipulator includes a second frame member, a third sensor and a fourth sensor/actuator of the plurality of sensors/actuators are respectively coupled to the second frame member, and the second frame member includes a curved portion.

The manipulator includes a third frame member having a first portion coupled to the fourth sensor and a second portion coupled to a fifth sensor/actuator of the plurality of sensors/actuators, the third frame member being extendable and retractable.

The manipulator includes an extendable and retractable frame member, one of the multiple sensors/actuators includes a sensor for detecting extension and retraction of the frame member, the actuator includes extending and retracting joints, and when the sensor/actuator of the manipulator detects extension or retraction of the frame member, the control system causes the extending and retracting joints of the actuator to extend or retract.

The surgical system also includes: a table defining an arm support for use by an operator; and a frame member extending away from the table, wherein a base of the manipulator is coupled to the frame member and a manipulator end of the manipulator distal to the base extends away from the base in a direction toward the table.

The surgical system also includes a display, wherein the table and the manipulator are positioned between the operator and the display, out of sight, so that the operator can see both the manipulator and the display simultaneously when the operator is positioned at the table to manipulate the manipulator.

Wherein the plurality of sensors/actuators includes seven sensors/actuators and the plurality of joints includes seven joints, each of the sensors/actuators corresponds to a respective one of the joints and one of the seven axes of motion.

The axis of motion of each of the plurality of sensors/actuators is directly related to the axis of motion of a corresponding one of the joints.

In another embodiment, an operator interface for a surgical system includes a manipulator and a controller. The manipulator includes a plurality of integrated sensors/actuators that detect motion about a plurality of axes of motion. Each of the axes of motion corresponds to a respective axis of motion of a joint of an implantable actuator. The controller is configured to receive information from the plurality of sensors/actuators indicating motion of the manipulator about the plurality of axes and to cause the joint of the actuator to move along the corresponding axis of motion. Each sensor of the manipulator detects motion about an axis of motion corresponding to a similar one of the joints of the actuator.

The manipulator includes two manipulator ends, each manipulator end is coupled to a first and a second sensor/actuator of the plurality of sensors/actuators.

Wherein the manipulator ends are arranged adjacent to each other and the first and second sensor/actuators extend away from the manipulator ends.

The first and second sensor/actuators are coupled to the first frame member at portions distal to the manipulator end.

Wherein a third sensor/actuator of the plurality of sensors/actuators is coupled to the first frame member.

Wherein the first frame member comprises a C-shape, the first and second sensors/actuators are respectively coupled to end portions of the C-shape, and the third sensor is coupled to a center portion of the C-shape.

The manipulator includes a second frame member, the third sensor and the fourth sensor/actuator of the plurality of sensors/actuators are respectively coupled to the second frame member, and the second frame member includes a curved portion.

The manipulator includes a third frame member having a first portion coupled to the fourth sensor and a second portion coupled to a fifth sensor/actuator of the plurality of sensors/actuators, the third frame member being extendable and retractable.

The actuator of the sensor/actuator provides tactile feedback.

Wherein the manipulator comprises an extendable and retractable frame member, and one of the plurality of sensors/actuators comprises a sensor that detects extension and retraction of the frame member.

The operator interface also includes: a table defining an arm for use by the operator; and a frame member extending away from the table, wherein a base of the manipulator is coupled to the frame member and a manipulator end of the manipulator distal to the base extends away from the base in a direction toward the table.

The operator interface also includes a display, wherein the table and the manipulator are positioned between the operator and the display, out of sight, so that the operator can see both the manipulator and the display simultaneously when the operator is at the table to manipulate the manipulator.

The plurality of sensors/actuators include seven sensors/actuators, each sensor/actuator corresponding to a corresponding one of the joints and one of the seven motion axes.

wherein an axis of motion of each of the plurality of sensors/actuators is directly related to an axis of motion of a corresponding one of the joints.

In another embodiment, a method includes providing a manipulator having a plurality of sensors/actuators that detect motion about a plurality of axes of motion; detecting motion about a corresponding axis of motion using one of the sensors of the sensors/actuators; and moving at least a portion of an implantable actuator about an axis of motion corresponding to the axis of motion detected by the sensor.

Each of the plurality of sensors of the sensor/actuator detects motion about an axis of motion corresponding to a different joint of the implantable actuator.

The axis of motion of each of the plurality of sensor/actuators is directly related to the axis of motion of the corresponding joint of the actuator.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG1 is a general schematic diagram of an exemplary surgical robotic system.

1A and 1B are front views of exemplary human-machine interfaces.

2A and 2B are perspective views of exemplary inlet ports.

3 is a perspective view of an exemplary surgeon's console.

4A is a side view of an exemplary surgeon's console.

4B is a side view of an exemplary surgeon's manipulator.

4C is a side view of an exemplary microrobotic manipulator.

FIG4D is a perspective view of an exemplary surgeon's manipulator.

4E is a perspective view of the exemplary surgeon's manipulator of FIG. 4D in an extended position.

4F is an exploded view of the exemplary surgeon's manipulator of FIG. 4D .

4G is a side view of an exemplary surgeon's console.

FIG5 is a side view of an exemplary patient table.

6A and 6B are side views illustrating 7-axis motion of an exemplary micro-robotic manipulator.

7A and 7B are side views illustrating 7-axis motion of an exemplary microrobotic manipulator.

8A is an end view and FIG. 8B is a side view of an exemplary foldable enclosure of a microrobotic manipulator.

9 is a side view illustrating 2-axis motion of an exemplary 2D micro-robotic camera.

10 is a side view illustrating 2-axis motion of an exemplary 2D microrobotic camera.

11A is an end view of an exemplary foldable enclosure for a microrobotic 2D camera, and FIG. 11B is a side view of the exemplary foldable enclosure.

FIG12 is a side view illustrating 2-axis motion of an exemplary 3D micro-robotic camera.

13 is a side view illustrating 2-axis motion of an exemplary 3D micro-robotic camera.

14A is an end view of an exemplary foldable enclosure of a microrobotic 3D camera, and FIG. 14B is a side view of the exemplary foldable enclosure.

FIG. 15 is a stereoscopic view of an exemplary 3D micro-robotic camera.

16A is an end view of an exemplary microrobotic actuator in a folded configuration.

16B is a side view of an exemplary microrobotic actuator in a folded configuration.

16C is an end view of an exemplary microrobotic actuator in a deployed configuration.

16D is a side view of an exemplary microrobotic actuator in a deployed configuration.

17 is a perspective view of an exemplary microrobotic actuator in a folded state.

18 is a perspective view of an exemplary microrobotic actuator in a folded state with the housing removed.

19 is an exploded view of an exemplary microrobotic actuator.

20 is an exploded view of an exemplary end effector.

21 is a perspective view of an exemplary microrobotic actuator in a deployed state.

22 is a perspective view of an exemplary microrobotic actuator in a deployed state with the housing removed.

23 is a side view of an exemplary microrobotic manipulator in an in vivo environment.

24A and 24B are side views of an exemplary microrobotic manipulator in an in vivo environment.

25 is a schematic diagram of an exemplary surgical robotic system including thin wires.

26A and 26B are front views of exemplary human-machine interfaces.

27 is a side view showing the insertion of an exemplary thin wire.

28 is a side view illustrating securing an exemplary thin wire to a small robot.

FIG. 29 is a side view showing an example of tension of a thin wire.

Figure 30 is a side view showing an exemplary X-Y motion of the microrobotic manipulator to the left with a thin wire.

Figure 31 is a side view showing an exemplary X-Y motion of the microrobotic manipulator to the right with a thin wire.

Figure 32 is a side view showing an exemplary X-Y motion of the microrobotic manipulator to the left without the thin wire.

Figure 33 is a side view showing an exemplary X-Y motion of the microrobotic manipulator to the right without the thin wire.

34 is a side view of an exemplary intra-abdominal mechanical frame.

DETAILED DESCRIPTION

Magnetic anchored robotic systems (MRS) allow computer-assisted minimally invasive surgery using multiple independent intracorporeal miniature robots that can have all seven degrees of freedom of motion in different axes (note that, in addition to the degrees of freedom of motion of the miniature robots discussed below, two more degrees of freedom can be obtained by translating the miniature robots along the abdominal wall). Intra-abdominal surgery can be performed under the remote control of the surgeon through an external computer console and under the monitoring of a rotating camera in the body. Each of the miniature robotic instruments, cameras, and other devices can be inserted into the abdominal cavity via a single incision (e.g., through the umbilicus) or through a natural cavity and can be fixed in place by external electromagnetic anchoring and positioning devices at selected locations outside the abdominal wall to provide surgical ergonomics and triangulation between the camera and the instrument. Depending on the patient's condition and illness, the control of such a miniature robotic system within the abdominal cavity can be, for example, via wired communication or a hybrid combination of wired and wireless communication. In some arrangements, power will be transmitted to the miniature robotic instruments (actuators) via a pair of conductors, and the control signals for the power can be transmitted by wire or wirelessly.

The camera and all laparoscopic instruments can be inserted into the abdominal cavity through a single incision or through a natural orifice. The laparoscopic instruments can then be anchored and positioned by external electromagnets placed outside the abdominal wall. MRS can thus allow MIS to be performed with the benefits of both computer-assisted or robotic surgery and the use of only a single incision or through a natural orifice. Exemplary MRS may include:

(i) one or more externally mounted electromagnetic anchoring and positioning devices;

(ii) a plurality of internal electromagnetic anchoring devices, each of which cooperates with an independent small robotic surgical instrument capable of seven degrees of freedom, e.g., motion via multiple axes; and

(iii) A surgeon's computer console that provides surgical control and manipulation.

Thus, exemplary advantages may be achieved, including minimizing entry trauma, providing unconstrained or less constrained, more dexterous movement of the instrument within the cavity, and enabling proper or improved triangulation of the instrument for optimal or improved operating ergonomics.

Referring to FIG1 , the system may include one or more magnetic or electromagnetic positioning devices (one or more) 1 (hereinafter collectively referred to as electromagnetic positioning devices 1, unless expressly excluded otherwise, including embodiments including permanent magnets and non-electromagnets) placed on the external abdominal wall and associated with remotely controlled robotic manipulators 2 within the body. The electromagnetic positioning devices 1 may include a servomechanism that is remotely controlled to control the position of an internal electromagnetic anchoring device. Thus, the robotic manipulator within the human body can be moved and positioned using an externally applied magnetic field in conjunction with the internal electromagnetic anchoring device, which interacts with one or more permanent magnets or electromagnets included in the electromagnetic positioning devices 1. As shown in FIG24 , such an externally applied magnetic field can be moved to a desired position by an X-Y servomechanism, thereby repositioning the robotic arm 24 to that desired position and then re-secured. As another example, the electromagnetic positioning device 23 shown in FIG23 may be in the form of a linear induction stator external to the abdominal wall, such that when an alternating current of a suitable frequency is applied to the stator external to the abdominal wall, the inner wing 24 will levitate and move forward. When such an alternating current is applied in pulse form, the inner wing 24 will move forward in small steps.Such control can also be provided by a control computer.

For illustration purposes, each positioning device is shown with one robotic manipulator; however, there may be multiple robotic manipulators for one positioning device, or there may be multiple positioning devices for one robotic manipulator. For example, each device may detect the current position of the end effector of a corresponding multi-axis micro-robotic manipulator 2 within the human body. The multi-axis micro-robotic manipulator 2 within the body may detect the current position of the end effector. The micro-robotic manipulator 2 may include various end effectors, such as a grasping device 16 (e.g., as shown in FIG6 ) and an imaging device 3, respectively, for performing a given treatment and visualizing the in vivo environment.

The manipulator 2 can be folded and inserted into a body cavity through an access port 7, which is in the form of a hollow cylinder and is mounted on a minimally invasive opening in the patient, etc. It can be connected to a flexible cable 4 that passes through the access port 7 and is connected to a central control computer 8 via a wire 5 or wirelessly. The diameter of the access port 7 is in some embodiments in the range of 1.5-2 cm, but can vary. The range of 1.5-2 cm is advantageous because it is large enough to allow equipment (manipulator, etc.) to pass through and small enough to be accommodated by most natural cavities.

2A and 2B , the inlet ports 207′ and 207″ may be shaped to accommodate the flexible cables 204′ and 204″ in a manner that allows multiple manipulators 2 to be inserted through the same inlet port 207. The inner walls of the inlet ports 207′ and 207″ (including 207″) include one or more recesses having a shape complementary to the wires 204′ and 204″.

In the embodiment shown in FIG2A , the recesses 208′ in the inner wall of the inlet port 207′ are groove-shaped and include a flat surface for receiving the flat cable 204′. In some embodiments, the cross-section of the inner wall can be in the shape of a polyhedron, with recesses 208′ directly adjoining adjacent recesses 208′. In other embodiments, the recesses 208′ can be distributed circumferentially around the inner surface of the inlet port 207′. The recesses 208′ can be distributed equally or unequally around the inner surface of the inlet port 207′.

In the embodiment shown in Figure 2B, the recesses 208" in the inner wall of the inlet port 207" are rounded to accommodate the round cable 204". In some embodiments, the recesses 208" directly connect to adjacent recesses 208". In other embodiments, the recesses 208" can be distributed circumferentially around the inner surface of the inlet port 207". The recesses 208" can be equally or unequally distributed around the inner surface of the inlet port 207".

It will be appreciated that the above-described shapes are exemplary in nature and that a variety of other shapes may be selected depending on the specific implementation. Providing the recess 208 allows for the use of the same entry port for a number of manipulators 2 by leaving a gap in the opening of the entry port 207 of the cable 204 to allow another manipulator 2 to pass through. In this manner, trauma associated with the insertion of an entry port, trocar, etc. may be minimized by reusing the same entry port for several or all manipulators 2.

Depending on the application, the signal transmission between the remotely controlled microrobotic manipulator 2 and the central control computer 8 can be performed by a wired connection (e.g., by a conductive or optical cable via the access port 7) or a wireless connection (e.g., via inductive coupling with a pickup coil included in the positioning device (such as the device 1a shown). The power for the manipulator 2 can also be supplied wirelessly through the abdominal wall via the positioning device 1. A mixture of wired power supply and wireless control signals can also be used.

Furthermore, in the case where the electromagnetic positioning device 1 is controllable by a central control computer 8, a wired or wireless connection can be provided from the central control computer 8 to the electromagnetic positioning device 1. Alternatively, or in addition, the electromagnetic positioning device 1 can communicate wirelessly with the microrobotic manipulator 2 to provide communication between the electromagnetic positioning device 1 and the central control computer 8, with the microrobotic manipulator 2 being connected to the central control computer 8 via a wired connection (e.g., via the access port 7). The central control computer 8 can control the positioning servo mechanism of the electromagnetic positioning device 1 and activate/deactivate positioning control. Positioning control can be, for example, activating an electromagnet in the electromagnetic positioning device 1. Positioning control does not need to be a discrete on/off control, but can be variable.

The central control computer 8 can independently adjust the position and motion of the manipulator 2 by corresponding movements of trigger units 10b, 11b, which are controlled by an operator via a human-machine interface 9 connected to the controller via a cable 6. The interface 9 may include display screens 10a, 11a and a pair of trigger units 10b, 11b, which may be of different types, such as the remote operation type 10 shown in FIG1A and the multi-axis end effector simulator type 11 shown in FIG1B. In the multi-axis end effector simulator type 11, the trigger unit 11b has a multi-axis robotic joint that can provide fine position control of the end effector of the manipulator 2 with several degrees of freedom. The motion control may also include force feedback.

Furthermore, the number of inserted miniature robots is not limited to the number that one operator can control via the human-machine interface 9. If the surgery requires, a second human-machine interface can be provided to assist the operator in also controlling the miniature robots.

3 , the primary surgeon 100 controls a pair of controls 102, while an assistant 104, working on the same surgeon's console 106 or another surgeon's console, controls additional controls 108. The primary surgeon 100 and/or assistant 104 may also control various cameras. The primary surgeon 100 and assistant 104 may view the same display 110, or they may view separate displays that, for example, show different views of the patient. The display 110 may be a 2D display, a 3D display, a naked eye 3D display, or other types of suitable displays. The assistant 104 may operate and assist in the surgery simultaneously. Two or more operators may advantageously operate on the same patient simultaneously while maintaining a conversation with each other. It will be appreciated that, although a primary surgeon and an assistant surgeon are described, the console 106 may generally be operated by any one or two (or more) operators.

3 and 4A , the surgeon's console 106 can be ergonomically arranged to include one or more of a footrest 114, an armrest 116, and a seat 118. The footrest 114 can include a switch for switching the controls 102 (and/or controls 108) to control the camera instead of the manipulator/robot, or vice versa. The footrest 114 can also include a control for controlling the manual focus of the camera(s). The footrest 114, armrest 116, controls 102, controls 108, and/or any combination thereof can include sensors/actuators for detecting the presence of an operator to enable/disable the robotic system.

The surgeon's console 106 can also be arranged to avoid light reflections. For example, the display 110 can be positioned so that at least a portion is below the height of the table 120 on which the surgeon is seated. The display 110 can also be angled so that reflections are not transmitted to an observer at the table 120 or reflections reaching an observer at the table 120 are reduced. A light shield 122 can also be provided to reduce ambient lighting that could cause reflections.

Tactile feedback can be provided to the primary surgeon 100 and/or the assistant 104. Resistance can be measured by the robotic manipulator 2 in the body, for example, via an onboard sensor (e.g., a load cell). Resistance can also be estimated from the amount of energy (e.g., voltage, current, or power) used by the manipulator 2. Force feedback based on resistance can be provided to the primary surgeon 100 and/or the assistant 104 via the manipulators 102 and 108, respectively.

For example, with reference to Figures 4B and 4D-4F, the surgeon's manipulator 102 can include motors/encoders 402, 404, 406, 408, 410, 412, and 414. Motor/encoder 402 can detect pitch and provide tactile feedback of pitch. For example, motor/encoder 402 can be coupled to joint element 403 with sleeve/pad 405 therebetween. Thus, motor/encoder can detect rotation relative to joint element 403 and provide tactile feedback to the axis of motion. Motor/encoder 404 can detect sway and provide tactile feedback of sway. Motor/encoder 406 can detect wrist yaw and provide tactile feedback of wrist yaw. Motor/encoder 408 can detect extension/retraction and provide tactile feedback of extension/retraction. For example, motor/encoder 408 can be coupled to linear guide 409. As the linear guide is extended/retracted by the surgeon/operator, motor/encoder 408 rotates. Thus, motor/encoder 408 can detect extension/retraction and provide tactile feedback to that axis of motion. Motor/encoders 410 and 412 can detect grasping and provide tactile feedback of grasping. Motor/encoder 414 can detect wrist pitch and provide tactile feedback of wrist pitch. Motors/encoders 404, 406, 410, 412 are arranged in a similar manner as described above in conjunction with motor/encoder 402.

The manipulator ends 420, 422 correspond to the manipulator ends of the robotic actuator. The manipulator ends 420, 422 include contact portions 424, 426 (e.g., cylinders) to provide opposing surfaces through which the movement of the manipulator ends in various directions by the surgeon is facilitated. The manipulators 420, 422 are coupled to motors/encoders 410, 412, respectively. The manipulators 420, 422 can be positioned adjacent to each other, with the motors/encoders 410, 412 extending away from the manipulators 420, 422 in different (in some cases, opposite) directions. The opposing ends of the motors/encoders 410, 412 can be fixed to a frame 428, which can be C-shaped.

Frame 428 can be secured to motor encoder 414 via frame member 430. Frame member 430 can be secured to frame 428 at a central point thereof so that the axis of rotation is centered. Motor/encoder 414 can also be coupled to frame member 432. Thus, motor/encoder 414 can detect rotational movement of frame member 430 relative to frame member 432, thereby detecting rotational movement of the entire assembly including manipulator tips 420, 422 and motor/encoders 410 and 412.

Frame member 432 can be coupled to motor/encoder 406 and can include a bend (eg, approximately 90 degrees) so that motor/encoder 406 can detect rotational motion of the entire assembly including manipulator tips 420 , 422 and motor/encoders 410 , 412 , and 414 .

The motor/encoder 406 can be secured, for example, via a frame member 436, to a first portion 434 of a linear guide 409, which includes the first portion 434, a carriage 435, and a second portion 438. As discussed above, the motor/encoder 408 is coupled to the linear guide 409 via a gear running on a second portion (e.g., a rack) 438 to detect movement of the first portion 434 (e.g., a sliding linear guide) to detect movement of the first portion 434 relative to the carriage 435, which is fixed and mounted to the frame member 441. Thus, the motor/encoder 408 can detect extension/retraction of the entire assembly, including the manipulator tips 420, 422 and the motor/encoders 406, 410, 412, and 414.

Motor/encoder 404 can be coupled to motor/encoder 408 via a curved frame member 441 that can be bent approximately 90 degrees. Thus, motor/encoder 404 can detect rotational motion of the entire assembly, including manipulator ends 420 and 422 and motors/encoders 406, 408, 410, 412, and 414. Motor/encoder 402 can be coupled to motor/encoder 404 via joint element 403. Joint element 403 can be a frame member or block that couples motors/encoders 402 and 404 at different faces thereof. A sleeve/pad (e.g., 405) can be provided between motors/encoders 402 and 404 and joint 403. Motor/encoder 402 can be secured to frame member 442, which can be curved, for example, 90 degrees. Frame member 442 can provide a base 440. Thus, motor/encoder 402 can detect rotational motion of the entire assembly relative to base 440.

As the position of manipulator tips 420, 422 is changed by the surgeon, motors/encoders 402, 404, 406, 408, 410, 412, and 414 can detect movement along the various axes of manipulator 102, as described above. This movement can be directly correlated to movement along corresponding axes of the intracorporeal robotic manipulator. For example, extension of linear guide 409 can directly correspond to extension of the robotic manipulator about axis 308; rotation of motor/encoder 414 can directly correspond to rotation about axis 314; and so on. Specifically, the degree of rotation can be limited in a manner that corresponds to the freedom of motion of the robotic manipulator. Thus, in addition to the relative position of the manipulator tip relative to the base, the surgeon can easily control the precise settings of the entire robotic actuator. This allows for superior control of the robotic manipulator.

The tactile feedback described may be in the form of impedance, vibration, or other forms of feedback. The motor/encoder may also be capable of setting the manipulator 102 to a specified position. For example, at the start of an operation, the manipulator 102 may be driven to a starting position corresponding to the position of the corresponding robotic manipulator. In this regard, the motor/encoder may have the ability to determine an absolute position (e.g., via a potentiometer) or a relative position (e.g., via a digital rotary segment input).

The motors/encoders 402, 404, 406, 408, 410, 412, and 414 can directly correspond to the motion axes 302, 304, 306, 308, 310, 312, and 314 of the microrobotic actuator 350 shown in FIG4C on a one-to-one basis. Thus, the surgeon's manipulator can accurately mimic each axis of the corresponding in-vivo robotic arm. This allows for advantages such as a good feel for control and ergonomics for the surgeon.

4C , the base 340 of the robotic manipulator 350 is typically attached to the inside of the abdominal wall where surgery will typically be performed. This arrangement, with the manipulator tip extending downward from the base of the robotic manipulator, can be simulated by positioning the anchor point 440 of the surgeon's manipulator 102 in a configuration as shown in FIG4G . The anchor point 440 of the surgeon's manipulator can be secured to a frame having vertical members that position the anchor member 442 on the arm 116 . Thus, the surgeon's manipulator is provided in an orientation that corresponds to the orientation of the robotic manipulator 340 during the surgical procedure. This orientation, with a direct correspondence between the surgeon's manipulator and the robotic manipulator, enables direct and precise tactile feedback for the surgeon for each axis of motion.

Referring to FIG5 , an exemplary patient table 130 is shown. Multiple electromagnetic positioning devices 1 can be coupled to an arm 132. Arm 132 can be secured to or coupled to a gantry 134, which in turn is secured to or coupled to the table 130. Thus, the entire system can move simultaneously with the patient. This allows for repositioning of the patient near the table during surgery without requiring the robotic system to detach from the table, and facilitates operations requiring repositioning of the patient during a surgical procedure. Furthermore, arm 132 can be servo-driven to reposition or adjust the orientation of electromagnetic positioning device 1.

6A and 6B , the axes of motion of the microrobotic manipulator 2 can have several different types of structures. In the embodiment shown in FIG6A and 6B , 7-axis motion is shown. The joint 13 can rotate along axes I and II, and the arm 14 can translate along direction III. The wrist 15 can rotate along axis IV, bend along axis V, and bend along axis VI. The gripper/end effector 16 can also open and close along axis VII, which can include rotational and/or translational motion. The portion of the microrobotic manipulator 2 having the following joint is referred to as type A for convenience and is non-limiting, and the joint has an axis of rotation similar to the axis of rotation of the joint 13 and axes I and 2 as shown in FIG6 .

7A and 7B show another structure of 7-axis motion of the manipulator 2, in which the joint 13 rotates in another direction along the axis I. A portion of the microrobotic manipulator 2 having a joint having a rotation axis similar to that of the joint 13 as well as the axes I and II shown in FIG. 7 is referred to as type B for convenience and is not restrictive.

The housing of manipulator 2 can facilitate insertion of the manipulator into the body and protect the robotic arm and end effector within the manipulator during insertion. It can include a base 21 and a pair of foldable wings 17 on either side of the base 21. As a non-limiting example, wings 17 can have a maximum diameter of 18 mm in the folded configuration. An 18 mm maximum diameter is advantageous because it works well with access ports sized to accommodate most natural orifices.

In the initial state or during insertion, the wings 17 are folded as shown in Figure 8. Before deployment of the robotic arm or end effector, the wings 17 can be unfolded by magnetic forces triggered from the corresponding electromagnetic positioning device 1.

The deployment of the wings 17 can be triggered by heat from the abdominal wall, external radiation, or externally supplied electricity. For example, the base 21 can include a heating device that is activated by supplying an electric current or by receiving radiant energy from a transmitter included in the electromagnetic positioning device 1. During removal from the body, the wings 17 can be refolded by cooling. Cooling can be implemented by removing the electric current or the emitted radiation supplied to the heating device and/or separating the manipulator 2 from the abdominal wall. Heating and cooling can also be achieved by other methods (e.g., thermoelectric heaters/coolers, heat pipes, etc.). This operation can be reversed, with folding triggered by heating and deployment triggered by cooling.

Alternatively or additionally, the wings 17 may be a laminate of two materials having different coefficients of thermal expansion. Thus, when the wings 17 are heated and cooled, the materials expand and contract at different rates, causing the wings 17 to fold and unfold. The materials may be metal alloys. The wings 17 may be composed of a shape memory alloy.

Alternatively or additionally, after said operation, the wings 17 may be refolded by manipulating them using another manipulator.

Alternatively or in addition, the wings 17 may have a spring effect that helps open or close the wings and maintain the wings folded. For example, the wings 17 may have a spring effect, wherein the resulting force tends to fold the wings 17. When the positioning device 1 is present, the spring effect is not strong enough to maintain the folded wings 17, and the wings 17 are unfolded by magnetic force. When the positioning device 1 is removed, the spring effect can cause the wings 17 to fold.

Depending on the condition of the abdominal wall, translational movement of the wings 17 may be provided by magnetically switchable or electrically actuatable rollers on the wings 17 (eg, as shown as wings 24 in FIG. 24 ).

The translational motion of the manipulator 2 can be provided by electromagnetic levitation. For example, the attractive force between the manipulator 2 and the electromagnetic positioning device 1 can be weakened or reversed to allow movement relative to the abdominal wall. The electromagnetic positioning device 1 can then be moved on the abdominal wall by a servo-transport device or a magnetic transport device (similar to the electromagnetic positioning device 26 and base 25 shown in FIG24).

In the case of a magnetic transport device, magnets may be provided in the electromagnetic positioning device 1. An externally provided magnetic field is supplied to interact with the magnets of the electromagnetic positioning device 1 or 26 to move the electromagnetic positioning device 1 in the X-Y direction and reposition it relative to the abdominal wall.

According to the purpose of the manipulator during operation, the end effector of the manipulator 2 can be modified into a grasping device 16, an imaging device (such as a 2D camera 18 or a 3D stereo camera 19) or other device. In the case of a 2D camera or a 3D camera, the camera can rotate along two vertical axes to obtain 2D plan views or 3D stereo views of different orientations. An embodiment with two different types of structures is shown in Figures 9 and 12 (type A) and Figures 10 and 13 (type B). The housing of the camera can facilitate the insertion of the manipulator into the body and protect the 2D camera or 3D camera in the manipulator during insertion. In the initial state or during the insertion of the 2D camera or the 3D camera, the wings are folded as shown in Figures 11 and 14 respectively. As a non-limiting embodiment, the wings can have a maximum diameter of 18mm. The maximum diameter of 18mm is advantageous because it works well with the entrance port of the size suitable for most natural cavities. Before the 2D camera is deployed, the wings 17 are unfolded by the magnetic force triggered by the corresponding remote-controlled electromagnetic positioning device 1. As shown in FIG. 14A , for a 3D camera, a spring loaded rotation joint 20 may be included.

FIG15 is a perspective view of an exemplary 3D camera 150. The camera 150 may include three parts: a camera body 152, an extendable link 154, and a foldable magnetic anchoring device 156. The camera body 150 may include a rotating head 158 and two camera lenses 160. The camera lenses 160 may be spaced apart along the main axis of the rotating head 158 and provide a 3D image. The main axis of the rotating head may coincide with the longitudinal axis of the camera 150 in its folded configuration. Spacing the camera lenses along the longitudinal axis, or "sideways," accommodates the two camera lenses 160 within the limited diameter available in the implantable device, thereby providing 3D imaging (which would otherwise be impossible). When a forward-looking view is desired, the rotating head 158 may be swiveled approximately 90 degrees (or more) so that the "side"-looking camera can look forward.

Flexible connector 162, which may be a hinge, is connected to body portion 164, which may be a tube or tubular control unit. Body portion 164 is connected to extendable link 154 via flexible connector 166, which may be a hinge. Extendable link 154 extends and retracts to allow camera body 152 to be positioned near the surgical field. Opposite ends of extendable link 154 are connected to, and in some cases, locked to, foldable magnetic anchoring device 156, for example, via two-axis flexible connectors 168a and 168b. Flexible connectors 162, 166, 168a, and 168b may be servo-driven. Foldable magnetic anchoring device 156 may be secured to the abdominal/body wall, for example, by activating external magnets or positioning permanent magnets external to the abdominal wall.

Flexible connections 162 and 166 allow camera 150 to be bent and positioned in difficult, confined spaces while being secured by anchoring device 156. Collapsible magnetic anchoring device 156 can also be rotated slightly with the center of rotation at the abdominal wall (e.g., by rotating external magnetic anchors) to facilitate slight lateral movement of the camera for more clear visualization of areas of interest.

FIG. 16 shows an exemplary microrobotic actuator 170 having seven degrees of freedom and multiple axes of motion provided by joints 172 , 174 , 178 , and 180 .

Additional anchoring force can be provided to the electromagnetic positioning device 1. For example, for obese patients with thick abdominal walls (e.g., 50 mm thick or more), it may be difficult to adequately secure the electromagnetic positioning device 1 to the manipulator 2 for precise movement during a surgical procedure. It is important to provide a stable platform for securely anchoring a small robot. Furthermore, the space available to accommodate a small-profile manipulator 2 is limited. Thus, providing external actuation may be desirable to provide sufficient torque for all seven axes of motion when grasping and moving organs or tissues during surgery.

FIG17 shows an exemplary microrobotic actuator 1000 including a housing 1002 in a folded state. FIG18 shows an exemplary microrobotic actuator 1000 in a folded state without the housing 1002. FIG19 shows an exploded view of the microrobotic actuator 1000. FIG20 shows an exploded view of the end effector 1004 of the microrobotic actuator 1000. FIG21 shows the microrobotic actuator 1000 in an unfolded state. FIG22 shows the microrobotic actuator 1000 in an unfolded state without the housing 1002. Unless otherwise noted, the following discussion refers substantially to FIG17-22.

The microrobotic actuator 1000 includes actuators/motors 1006, 1008, 1010, 1012, 1014, 1016, and 1018. The actuators/motors 1006, 1008, 1010, 1012, 1014, 1016, and 1018 provide in vivo force generation for seven degrees of freedom in an overall package size that is suitable for easy insertion into the human body through a single entry port. For example, the microrobotic actuator 1000 in the folded configuration can be generally cylindrical, having a diameter of 18 mm or less and a length of 200 mm or less.

In the exemplary microrobotic actuator 1000 and referring also to Figures 16B and 16D, actuator/motor 1006 can provide rotation about axis II at joint 172; actuator/motor 1008 can provide rotation about axis I at joint 174; actuator/motor 1010 can provide rotation about axis IV at joint 177; actuator/motor 1012 can provide extension and retraction along axis III at joint 175; actuator/motor 1014 can provide grasping motion along axis V at joint 180a; actuator/motor 1016 can provide grasping motion along axis VI at joint 180b; and actuator/motor 1018 can provide rotation about axis VII at joint 178.

For example, DC servo motors coupled to planetary gearboxes, spur gears, and 90-degree intersecting worm gears can be mounted near the base of the manipulator at joints 172 and 174. Providing servo motors near the joints allows for greater force generation. For example, two motors can be placed near the base of the microrobotic actuator to provide two degrees of motion around the base, one motor can be positioned at the center of the microrobotic actuator to provide extension/retraction, and three motors can be placed distal to the two base motors and adjacent to the end effector to provide three degrees of motion around the manipulator end of the microrobotic actuator.

In certain embodiments, a 1-2 Nm torque can be generated for loading forces along axes I and II. The gripping forces for forceps and needle drivers are approximately 10 N and 20 N, respectively, and can be generated by a combination of piezoelectric actuators and small DC servomotors mounted near joints 178 and 180. This torque and force are sufficient to perform various manipulations required for surgical procedures. The extension and rotation of the manipulator can be controlled by piezoelectric actuators and DC servomotors mounted at joints 175 and 177, respectively.

Actuator/motor 1006 can be coupled to actuator/motor 1008 via gear assembly 1020. Gear assembly 1020 can include a worm gear 1022 and a gear 1024 coupled to actuator/motor 1006. Rotation output from actuator/motor 1006 can provide rotation about gear 1024, thereby providing rotation about axis II at joint 172. Gear assembly 1020 can also include a worm gear 1028 and a gear 1028 coupled to actuator/motor 1006. Rotation output from actuator/motor 1008 can provide rotation about gear 1026, thereby providing rotation about axis I at joint 174. Gears 1024 and 1028 can be coupled via gear 1030, which can be fixed to housing 1002. The use of 90-degree intersecting gears 1024 and 1030 is a simple, compact, and lightweight way to provide X-Y oscillating motion along axes I and II. The integrated worm gear mechanism can provide increased torque (eg, 1-2 Nm) about axes I and II.

Actuators/motors 1008 and 1010 may be secured together directly or through housing 1002. The output of actuator/motor 1010 may be coupled to gear 1032 (which may be secured to housing 1002) to provide rotation about axis IV at joint 177.

Actuator/motor 1012 can be coupled to threaded rods 1036 and 1038 via gear system 1040. Bearing 1042 can be secured to portion 1003 of housing 1002. When the output of actuator/motor 1012 rotates, bearing 1042, secured to portion 1003, travels along threaded rods 1036 and 1038, thereby causing portions 1003 and 1005 of housing 1002 to extend or retract relative to each other.

In some embodiments, the actuator/motor 1012 may be in the form of a DC servo motor or a plurality of piezoelectric motors along the periphery of the robotic arm. In such embodiments, the threaded rods 1036 and 1038 may not be included.

Actuator/motor 1014 can be coupled to worm gear 1050. Worm gear 1050 can be coupled to gear 1052, which is coupled to manipulator end 1054 via pulley system 1056, which includes a wire or belt 1058. Actuator/motor 1016 can be coupled to worm gear 1060. Worm gear 1060 can be coupled to gear 1062, which is coupled to manipulator end 1064 via pulley system 1066, which includes a wire or belt 1068. The ends of pulley systems 1056 and 1066, located at pulleys 1070 and 1072, respectively, share a common shaft 1074. Pulleys 1070 and 1072 each freely rotate about common shaft 1074. Pulleys 1070 and 1072 may be coupled to manipulator ends 1054 and 1064 via gear teeth that allow the manipulator ends 1054 and 1064 to rotate about a common shaft 1076 to provide grasping motion along axes V and VI at joints 180a and 180b.

Gears 1052 and 1062 can be planetary gearboxes to provide deceleration and force multiplication of the outputs of actuators/motors 1014 and 1016. The flexibility of pulley systems 1056 and 1066 coupled to the planetary gearboxes provides mechanical advantages and freedom of movement. The final connection to manipulator ends 1054 and 1064 can be adjusted to increase the gripping force at the manipulator end. The gear ratios of the planetary gearbox and the gearing at the manipulator end can be different. In addition, the use of dual worm gears (1050 and 1060) and dual actuators/motors (1014 and 1016) allows for increased torque at minimal distance. Thus, increased gripping force (e.g., 10-20N) can be achieved.

Actuator/motor 1018 can be coupled to gear 1080, which is coupled to gear 1082. Gear 1082 can be fixed to portion 1007 of housing 1002 to provide rotation about axis VII at joint 178. Gear 1080 can be beveled and intersect gear 1082 at an angle of approximately ninety degrees.

The microrobotic actuator 1000 may include circuit boards 1090 and 1092. The circuit boards 1090 and 1092 may be flexible (e.g., flexible PCB circuits) to conform to the shape of the housing 1002, such as a cylinder, and may be positioned along the inner wall of the housing 1002. The circuit boards 1090 and 1092 may include electronic drivers and/or integrated networking capabilities. Including electronic drivers and/or integrated networking capabilities in the microrobotic actuator 1000 allows for a reduction in external cabling to fewer conductive members in a wiring harness or fewer wiring harnesses overall.

25-27 , a flexible or semi-flexible magnetic sheet 22 can be inserted into the body cavity through the access port 7. The magnetic sheet 22 can be rolled up or folded when inserted. Once inserted, it can be unfolded or spread out and positioned along the abdominal wall. The magnetic sheet 22 can be unfolded/spread out by a mechanical mechanism, or it can be unfolded/spread out by subjecting it to a magnetic field (which can be provided by an external electromagnet), and/or by being heated or cooled by supplied energy.

The magnetic sheet 22 can be provided as a single large sheet sufficient to cover a large area of the inner abdominal wall. The magnetic sheet can also be provided by one or more small or medium sized sheets to provide coverage of a certain area of the abdominal wall.

An intra-abdominal robotic frame (e.g., intra-abdominal robotic frame 27 shown in FIG. 34 ) can be constructed by connecting individual magnetic sheets to extendable rods to provide a stable platform for small robotic manipulation. This intra-abdominal robotic frame can, in some cases, provide anchoring support similar to that of a large, flexible magnetic sheet covering a large portion of the abdomen without requiring the use of such a large sheet.

The position of the magnetic sheet 22 can be fixed by an external electromagnet 1b. The magnetic sheet 22 provides a stable platform for the microrobotic manipulator 2 to be attached. The magnetic sheet 22 can provide a medium for gathering magnetic flux and provide a secure anchoring of the microrobotic manipulator (e.g., microrobotic manipulator 2). Exemplary materials that provide such a medium for gathering flux include iron-based materials and silicon-iron-based materials. It will be appreciated that this secure anchoring can be provided to any microrobotic manipulator and other related devices (e.g., cameras). It will also be appreciated that the magnetic sheet can be used with any of the described embodiments (including those of Figures 1 and 23-34), but is not required for any of these embodiments.

To provide additional anchoring force, a filament 28 may be included. The filament 28, which may be a metal wire, extends from the external electromagnet 1 b and may be introduced through the abdominal wall via a thin needle or in the form of a thin needle. To facilitate introduction of the thin metal wire 28 via a needle or hypodermic syringe, the wire 28 may have a maximum diameter of 1 mm. A maximum diameter of 1 mm is preferred so that the puncture remains well below the size that would be considered an incision and does not leave a significant visible scar. It will be appreciated that other materials (e.g., flexible or rigid fibers, biocompatible polymers/plastics, and multi-material composites that may or may not include metal) may be used for the wire 28 in place of metal.

As an example, the thin wire 28 may be provided from the outside electromagnet 1 b via a circular through hole, slot or another aperture in the electromagnet 1 b. The hole, slot or other aperture may be provided at the center of the electromagnet 1 b.

A locking mechanism (e.g., a pair of angled metal tongues spaced apart less than the thickness of the filament 28 or its distal end) can be provided to releasably lock the micromanipulator 2 to the distal end of the filament 28. In embodiments where a locking mechanism using metal tongues is employed, the metal tongues can be subjected to a biasing force (e.g., a spring) to keep the filament 28 locked in the microrobotic manipulator 2. Removing the biasing force or providing a counterforce can allow the filament 28 to be released. Release of the filament 28 can be provided by a remotely controlled electrical actuator or by mechanical action within the abdomen, such as an endoscope.

28, the end of the wire 28 can be locked by a releasable anti-return mechanism. The end of the wire 28 can be enlarged to provide a more secure lock.

29 , when the filament 28 is tightened at the base of the external electromagnet 1b, the external electromagnet 1b and the small robot 2 are pressed against the abdominal wall from opposite sides, so that an additional locking force is provided to the microrobotic manipulator 2 to attach to the stable platform, thereby providing reliable and stable movement of the microrobotic manipulator 2 during surgical operations.

An aperture may be provided in the external electromagnet 1b through which the filament 28 passes. The aperture may be in the form of a slot, a cross, a large single opening, or another shape. Providing an aperture allows for repositioning the microrobotic manipulator 2 after the filament 28 is inserted into the abdominal wall without having to reinsert the filament 28. Thus, the filament can be loosened to allow for movement of the external electromagnet 1b and the microrobotic manipulator 2, and then re-tightened to allow for repositioning the microrobotic manipulator 2.

In addition to providing additional anchoring force, the filament 28 can also be used to provide power or provide signals to/from the microrobotic manipulator 2.

30-33, when the small robot is tightly coupled to the electromagnet, the movement of the microrobotic manipulator 2 can be caused by the rotational action of the external electromagnet 1b. For example, the center of motion can be placed at the middle point of the abdominal wall.

External actuation can supplement the X-Y motion of the microactuator on microrobotic manipulator 2. Due to the lever effect, small angular motions of electromagnet 1b will result in large two-dimensional X-Y motions of microrobotic manipulator 2. Without tight coupling, attempts to move microrobotic manipulator 2 in this manner would likely result in separation of microrobotic manipulator 2 and external electromagnet 1b, and no X-Y motion would be achieved.

Although the provision of additional anchoring force described above has been described in the context of a microrobotic manipulator and external magnets, it will be appreciated that this is merely an exemplary application and that the described apparatus and methods may also be applied to any of a variety of other instruments that are desired to be anchored to a stable platform within a body cavity.

Although various embodiments according to the disclosed principles have been described above, it should be understood that these embodiments are presented by way of example only and are not restrictive. Therefore, the breadth and scope of the invention(s) should not be limited by any of the above-described exemplary embodiments, but should only be defined in accordance with the claims published in this disclosure and their equivalents. Moreover, the above advantages and features are provided in the described embodiments, but the application of these published claims should not be limited to any or all of the methods and structures for achieving the above advantages. Specifically, unless otherwise stated, the various features and aspects of the described embodiments can be used separately and/or interchangeably in any combination and are not limited to the above arrangements.

In addition, the paragraph headings of this article are provided to be consistent with the recommendations of 37 CFR 1.77, or to provide structural clues for this article. These titles should not limit or characterize the invention (one or more) that can be set forth in any claim published from this disclosure. Specifically and by way of example, the description of the technology in the "background technology" is not to be interpreted as an admission that this technology is prior art to any invention (one or more) in this disclosure. "Summary of the invention" is also not to be considered as a characterization of the invention (one or more) set forth in the published claims. In addition, any reference to the singular "invention" in this disclosure should not be used to prove that there is only one novel point in this disclosure. Multiple inventions can be set forth according to the limitations of multiple claims published from this disclosure, and these claims accordingly define the invention (one or more) and their equivalents protected by them. In all examples, the scope of these claims is considered in accordance with the essence of these claims themselves according to this disclosure, and should not be limited by the titles stated herein.

Claims (31)

1. A surgical system, the surgical system comprising: A manipulator comprising multiple integrated sensors/actuators, wherein the sensors of the sensors/actuators are adapted to detect motion about multiple axes of motion, and the actuators of the sensors/actuators are adapted to provide tactile feedback; An implantable actuator, located at the distal end of the arm, comprising a plurality of joints providing the plurality of axes of motion; and A controller is configured to receive information from the plurality of sensors/actuators instructing the manipulator to move about the plurality of motion axes, and is configured to cause the joints of the implantable actuator to move along corresponding motion axes. Each sensor/actuator of the manipulator detects motion about a motion axis corresponding to one of the joints of the implantable actuator. At least one of the foldable wings is positioned adjacent to the arm; In the folded position, at least one foldable wing is curved along its length; and In the unfolded position, the at least one foldable wing is planar along its length. 2. The surgical system of claim 1, wherein the manipulator includes two manipulator ends, each manipulator end being coupled to a first and second sensor/actuator among the plurality of sensors/actuators. 3. The surgical system of claim 2, wherein the manipulator ends are arranged adjacent to each other and the first and second sensors/actuators extend away from the manipulator ends. 4. The surgical system of claim 3, wherein the portions of the first and second sensors/actuators distal to the manipulator end are coupled to the first frame member. 5. The surgical system of claim 4, wherein a third sensor/actuator of the plurality of sensors/actuators is coupled to the first frame member. 6. The surgical system of claim 5, wherein... The first frame member includes a C-shape. The first and second sensors/actuators are respectively coupled to the end portions of the C-shape, and The third sensor is coupled to the central portion of the C-shape. 7. The surgical system of claim 5, wherein the manipulator includes a second frame member, a third sensor and a fourth sensor/actuator of the plurality of sensors/actuators are respectively coupled to the second frame member, and the second frame member includes a curved portion. 8. The surgical system of claim 7, wherein the manipulator includes a third frame member having a first portion coupled to the fourth sensor and a second portion coupled to a fifth sensor/actuator among the plurality of sensors/actuators, the third frame member being extendable and retractable. 9. The surgical system of claim 1, wherein... The manipulator includes an extendable and retractable frame member. One of the plurality of sensors/actuators includes a sensor for detecting the extension and retraction of the frame member. The actuator of the manipulator includes an extending and retracting joint, and When the sensor/actuator of the manipulator detects the extension or retraction of the frame member, the controller causes the joint of the actuator of the manipulator to extend or retract. 10. The surgical system of claim 1, further comprising: A table for the boom designed specifically for operator use; and The frame members extending away from the table, wherein The base of the manipulator is coupled to the frame member, and The actuator end of the actuator on the far side of the base extends away from the base in the direction toward the table. 11. The surgical system of claim 10, further comprising a display, wherein the table and the manipulator are positioned between the operator and the display, out of line of sight, such that the operator can see both the manipulator and the display when the operator is positioned at the table to manipulate the manipulator. 12. The surgical system of claim 1, wherein the plurality of sensors/actuators comprises seven sensors/actuators and the plurality of joints comprises seven joints, each of the sensors/actuators corresponding to a specific one of the joints and one of the seven axes of motion. 13. The surgical system of claim 1, wherein the motion axis of each of the plurality of sensors/actuators is directly related to the motion axis of a corresponding one in the joint. 14. The surgical system of claim 1, wherein the at least one foldable wing is operable to be deployed magnetically. 15. The surgical system of claim 1, wherein the at least one foldable wing comprises a shape memory alloy operable to unfold based on temperature conditions. 16. An operator interface for a surgical system, the operator interface comprising: A manipulator comprising a plurality of sensors/actuators that detect movement about a plurality of motion axes, each motion axis corresponding to a corresponding motion axis of a joint into which an actuator can be implanted; and A controller is configured to receive information from the plurality of sensors/actuators instructing the manipulator to move about the plurality of motion axes, and is configured to cause the joints of the implantable actuator to move along corresponding motion axes. The implantable actuator is located at the distal end of the arm. At least one of the foldable wings is positioned adjacent to the arm; and Each sensor/actuator of the manipulator detects motion about a motion axis corresponding to one of the joints of the implantable actuator; In the folded position, at least one foldable wing is curved along its length; and In the unfolded position, the at least one foldable wing is planar along its length. 17. The operator interface of claim 16, wherein the manipulator includes two manipulator ends, each manipulator end being coupled to a first and second sensor/actuator among the plurality of sensors/actuators. 18. The operator interface of claim 17, wherein the manipulator ends are arranged adjacent to each other and the first and second sensors/actuators extend away from the manipulator ends. 19. The operator interface of claim 18, wherein the portions of the first and second sensors/actuators on the distal side of the manipulator end are coupled to the first frame member. 20. The operator interface of claim 19, wherein a third sensor/actuator of the plurality of sensors/actuators is coupled to the first frame member. 21. The operator interface as described in claim 20, wherein... The first frame member includes a C-shape. The first and second sensors/actuators are respectively coupled to the end portion of the C-shape, and The third sensor is coupled to the central portion of the C-shape. 22. The operator interface of claim 20, wherein the manipulator includes a second frame member, the third and fourth sensors/actuators of the plurality of sensors/actuators are respectively coupled to the second frame member, and the second frame member includes a curved portion. 23. The operator interface of claim 22, wherein the manipulator includes a third frame member having a first portion coupled to the fourth sensor and a second portion coupled to a fifth sensor/actuator among the plurality of sensors/actuators, the third frame member being extendable and retractable. 24. The operator interface of claim 16, wherein the actuator of the sensor/actuator provides tactile feedback. 25. The operator interface as described in claim 16, wherein... The manipulator includes an extendable and retractable frame member, and One of the plurality of sensors/actuators includes a sensor that detects the extension and retraction of the frame member. 26. The operator interface as described in claim 16, further comprising: A table for the boom designed specifically for operator use; and The frame members extending away from the table, wherein The base of the manipulator is coupled to the frame member, and The actuator end of the actuator on the far side of the base extends away from the base in the direction toward the table. 27. The operator interface of claim 26, further comprising a display, wherein the table and the manipulator are positioned between the operator and the display, out of line of sight, such that the operator can see both the manipulator and the display while operating the manipulator from the table. 28. The operator interface of claim 16, wherein the plurality of sensors/actuators comprises seven sensors/actuators, each sensor/actuator corresponding to a corresponding one in the joint and one of the seven axes of motion. 29. The operator interface of claim 16, wherein the motion axis of each of the plurality of sensors/actuators is directly related to the motion axis of the corresponding one of the joints. 30. The operator interface of claim 16, wherein the at least one foldable wing is operable to unfold magnetically. 31. The operator interface of claim 16, wherein the at least one foldable wing comprises a shape memory alloy operable to unfold based on temperature conditions.