Medical Intervention Devices

Abstract

There are challenges due to the lack of separation of the tool portion of the device from the handle portion of the device. A medical intervention device may include a handheld device adapted for minimally invasive surgery. The device may include a handle that remains outside of the patient and an extension that extends from the handle into the patient and includes an end effector, such as forceps, at a distal end. The mechanical motion relationship between the extension and the end effector may provide motion about multiple intersecting axes, thereby avoiding the need to compensate for motion. In particular, yaw and pitch motions may be imparted independently of one another, avoiding the need to compensate for motion in one axis relative to another. Additionally, the mechanical motion relationship of the device may be configured to accurately mimic the motion of a surgeon's or other user's hand, including ratioed motions that provide more precise motion in the end effector than the handle and / or tremor control.

Description

Technical Field

[0001] Cross - Reference to Related Applications This application claims priority to U.S. Provisional Patent Application No. 63 / 216,973, entitled "Handheld Telemanipulator for Endoscopic or Laparoscopic Procedures," filed on June 30, 2021, and U.S. Provisional Patent Application No. 63 / 270,684, entitled "Medical Intervention Device," filed on October 22, 2021, the contents of each of which are hereby incorporated by reference in their entirety.

[0002] This application generally relates to Medical data forceps. More specifically, this document generally relates to an operable tool for endoscopy, laparoscopy, and / or electro - surgical procedures having Handheld forceps. Medical data Even more specifically, this application generally relates to a distal portion having movement about multiple intersecting axes, independent and / or constant - speed movement about an axis, proportional movement for accuracy, vibration reduction, battery power, and / or providing four degrees of freedom Handheld forceps. Medical data forceps.

Background Art

[0003] The description of the background art provided herein is for the purpose of generally presenting the context of the present disclosure. The research of the presently named inventors is not admitted as prior art to the present disclosure, either expressly or implicitly, to the extent that it is not described in this background art section as of the filing date of the application, similar to aspects of the specification that are not recognized as prior art at the time of filing.

[0004] Handheld forceps Medical data Forceps may often include a pair of jaws that form a clamp or forceps, or another operable tool may be disposed at the end of a relatively long and thin extension with a handle. This type ofHandheld Medical Medical data The vice can allow an operable tool to be positioned through an access port within a patient and provide operation of the tool in a spaced relationship to the handle. Thus, a surgeon or other user may be able to perform surgery on a patient through a relatively small incision, but may be able to do so using the tool capabilities of open surgery using a much larger incision. As can be appreciated, separating the tool portion of the device from the handle portion of the device can result in less control, a smaller range of motion, fewer degrees of freedom, and / or less tool capability. Additionally, the hand-eye coordination of a surgeon or other user accustomed to open surgery may be affected by separating the tool from the handle. This can occur due to a lack of ability of the device to mimic the performance or movement of a conventional tool that is not separated from the handle. SUMMARY OF THE INVENTION PROBLEMS TO BE SOLVED BY THE INVENTION

[0005] Conventional Handheld Efforts have been made, particularly in the robotic space, to provide tools that properly mimic the movement of conventional tools, but such tools rely on sophisticated computing devices and motors that provide for compensating the movement between several motors and tool characteristics. MEANS FOR SOLVING THE PROBLEMS

[0006] This specification particularly points out and distinctly claims the subject matter that forms various embodiments of the present disclosure, but the invention is considered to be better understood from the following description in conjunction with the accompanying drawings. BRIEF DESCRIPTION OF THE DRAWINGS

[0007]

Figure 1

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Figure 8

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Figure 9A

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Figure 9B

DETAILED DESCRIPTION OF THE INVENTION

[0017] In drawings that are not necessarily drawn to scale, like reference numerals may be used to describe like components in different figures. Like reference numerals with different subscripts may represent different instances of like components. The drawings generally illustrate the various embodiments discussed in this document by way of example, and not by way of limitation.

[0018] In one or more embodiments, the present application relates to a Medical data medical Medical device. The Handheld medical device may be adapted for use in an endoscope, laparoscope, or other minimally invasive surgery. Thus, the Handheld medical device can include a handle that remains outside the patient and an extension that extends from the handle into the patient and includes an end effector, such as forceps, at its distal end. The mechanical operating relationship between the extension and the end effector can provide movement about multiple intersecting axes, thereby avoiding the need for motion compensation and enabling a simpler operation than a computer-controlled motion compensation system. In particular, yaw and pitch motions are imparted independently of each other, avoiding the need to compensate the motion of one axis relative to the other. Further, the mechanical operating relationship between the end effector and the extension and the mechanical operating relationship between the handle and the extension may be configured to accurately mimic the movement of the hand of a surgeon or other user. Still further, the mimicked movement may be a scaled movement that provides a more accurate movement at the end effector than at the handle and may also provide tremor control. Other additional advantages and benefits of the Handheld medical Medical data device will be apparent to those skilled in the art upon review of the following detailed description.

[0019] FIG. 1 shows a partial cutaway isometric schematic view of an example of a portion of a Handheld medical Medical data device 100 according to one or more embodiments. Handheld medicalDevice 100 can be adapted for performing a medical intervention by placing the end effector 110 on the patient's surface through a trocar or other port and by operating the end effector 110 to perform surgery using a handle 106 positioned outside the patient. As shown in FIG. 1, Handheld Doctor Medical data vice 100 has a distal Part 1 02, a central Part 1 03, and a proximal Part 1 04. Each of these parts can be described in turn.

[0020] Proximal Part 1 04 remains outside the patient and Handheld medical can be configured to be operated by a surgeon or other user to control the distal Part 1 02 of the device 100. In one or more embodiments, the proximal Part 1 04 can include a handle 106. The handle 106 may be adapted for gripping and operation by a surgeon or other user and can include a pistol grip handle as shown. Alternatively, the handle 106 can include a rod-shaped handle aligned with the central portion 103 or may be provided with a U-shaped handle, a T-shaped handle, or other types of handles. The handle 106 can include one or more actuators that enable a surgeon or other user to activate one or more features in the distal Part 1 02. For example, an actuator in the form of a plunger, lever, or other trigger may be provided to actuate the jaws of forceps or to advance and retract a blade in the distal Part 1 02. Additionally, buttons, switches, levers, or other triggers may be provided to activate electrodes in the distal Part 1 02. Depending on the nature of the end effector 110 provided in the distal Part 1 02, further other actuators may be provided.

[0021] CentralPart 1 03 may extend proximally Part 1 from 04 distally Part 1 to 02. The central Part 1 03 may be proximally Part 1 offset from 04 and distally Part 1 from 02 to establish an offset distance therebetween and, thus, may be configured to provide operation of one or more end effectors 110 at a distance away from the handle 106. The central Part 1 03 may also be configured to engage a port on the patient to establish a ground point or interface relative to which other components and parts of the device may move. Thus, as shown in FIG. 1, the central Part 1 03 may include a ground element 14 and an extension element 16.

[0022] The ground element 14 may include a relatively wide housing adapted to allow a user to Part 1 handle and / or position the device 100 without imparting motion to the distally Handheld medical 02. The housing may surround a working element extending between the proximally Part 1 04 and the distally Part 1 02 and, thus, may be, for example, generally cylindrical, conical, or nose cone shaped. That is, in one or more embodiments, the relatively wide housing may taper to a smaller size as the housing extends distally, and the taper may be, for example, a curved taper. The housing may include a seating mechanism 105 adapted to engage a trocar or other port on the patient at its distal end. Thus, the distal end of the housing may seat against or within the trocar or other port and Handheld medical establish a pivot point along the device 100 about which Handheld medical the device 100 may be rotated to control the overall orientation of the device 100 relative to the patient. Further, the engagement of the distal end of the housing within the trocar or port may be under movement of the handle 106 relative to the central Handheld medical portion such that the central 103 portion may be rotated about the pivot point established by the engagement of the distal end of the housing within the trocar or port. The central Part 1Resistance to the lateral rocking motion of 03 and central Part 1 Provide resistance to the torsion of 03, and thus distal Part 1 Control the characteristics of 02, central Part 1 Distal to 03 Part 1 A relatively secure anchor point around which the movement of the handle 106 can occur may be provided so as to provide relative movement of 02.

[0023] Central Part 1 The extension element 16 of 03 can extend distally from the grounding element 14. In particular, the extension element 103 can overlap the housing of the grounding element 14, and at the joint between the extension element 16 and the grounding element 14, central Part 1 Resist the bending of 03, relatively rigid and continuous central Part 1 03 can be provided. In one or more embodiments, for example, the housing of the grounding element 14 can include a cylindrical bore at the distal end and have an annular sheet at the proximal end of the bore. As shown, the extension element 16 can extend into the bore and seat against the annular sheet. The extension element 16 may engage the bore of the housing by an interference fit, or an adhesive, welding, or other fixing system may be provided. Extension Element 16 extends distally from the grounding element 14 Part 1 To distally to 02. Extension Element 16 may be sized and shaped for insertion through a trocar or other port on the patient, and thus may have a relatively small diameter and may be substantially elongated. In one or more embodiments, extension Element 16 may be a cylindrical hollow shaft. Extension Element 16 has been described as being relatively firmly fixed to the housing, but in one or more embodiments, extension Element 16 can engage more loosely with the bore of the housing, and thus with respect to the housing of the grounding element 14 Handheld medical It may be possible to rotate about the longitudinal axis of the device 100 or may be configured to rotate.

[0024] DistalPart 1 02 may be disposed distally relative to the center Part 1 03 and may be adapted to move relative to the center Part 1 03 based on the movement of the handle 106 relative to the center Part 1 03. Further, the distal Part 1 02 may be adapted to engage, grip, cut, cauterize, or otherwise interface with patient tissue, blood vessels, organs, or other patient features. For this purpose, the distal Part 1 02 can include a base 19 and one or more end effectors 110 disposed on the base 19. As shown in FIG. 1, for example, the distal Part 1 02 can include a base Part 1 9 having a pair of forks for supporting forceps Part 1 9 can include a generally cylindrical body having a notch cut from its distal end so as to form a pair of forks. An end effector 110 including forceps may be mounted between the forks. The forceps can include a pair of jaws 21, for example, the lower jaw being a fixed jaw and the upper jaw being a hinged jaw. Alternatively, both jaws 21 may be hinged jaws. A pin or other laterally extending element can extend between the forks of the base 19 and, optionally, establish a pivot axis for the upper jaw or both jaws. In one or more embodiments, one or more jaws can include electrodes that can be energized to seal or cauterize tissue, blood vessels, or other patient features. Although an end effector 110 in the form of forceps has been described, a cutting blade may alternatively be provided, or both may be provided. Further other types of end effectors 110 may be provided.

[0025] Using the main structures of the described device, the relative movement of several structures can then be described. That is, for example, the proximal Part 1 04 may be connected to the center Part 1 03 at the actuator interface 112, and the distal Part 1 02 may be connected to the center at the operation interface 108Part 1 It may be connected to 03. Each of these interfaces 112 , 108 can be described in turn.

[0026] The actuator interface 112 is proximal Part 1 04 at the center Part 1 03 and distal Part 1 It may be configured to be operably coupled to 02. In particular, with respect to the center Part 1 03, the actuator interface 112 may be configured to allow rotation of the handle 106 with respect to the center Part 1 03 about each of three orthogonal axes (e.g., pitch, yaw, and roll) that intersect at a common point. In one or more embodiments, the actuator interface 112 can include a ball 2 and a socket 114, the handle 106 being rigidly fixed to the generally spherical ball 2, and the center Part 1 03 is rigidly fixed to a corresponding generally spherical socket 114. The ball 2 is disposed within the socket 114 and may be adapted for rotation within the socket 114. In one or more embodiments, the socket 114 may be disposed at, and / or integrated with, the proximal end of the housing of the ground Element 14, and / or may be integrated with its proximal end. Further, the ball 2 may be disposed at, and / or integrated with, the distal portion of the handle 106, for example, as shown in FIG. 3. In one or more embodiments, the handle 106 may be rigidly fixed to the ball using one or more standoffs or struts. The standoff or strut may be a relatively narrow and / or small element extending from the handle 106 and may be configured to fix the ball 2 to the handle 106 and reduce or minimize interference with the socket 114. That is, the range of motion of the handle 106 about any of the three orthogonal axes can be limited to the extent that the standoff or strut interferes with the socket Torque 1 14.

[0027] As shown by comparing FIGS. 1, 3, and 4, the socket wall may be substantially incomplete to allow the standoff or strut to rotate with the ball 2 without engaging the wall of socket 114. In one or more embodiments, socket 114 can include an open bottom, an open distal side, and an open proximal side. As shown in FIG. 1, with respect to the open proximal side, socket 114 may extend slightly proximally from the vertical centerline of socket 114 so as to prevent the proximal longitudinal movement of ball 2 and maintain ball 2 within socket 114. For example, socket 114 may extend proximally from the vertical centerline by about 20 to 30 degrees. With respect to the open distal side, socket 114 may extend slightly distally from the proximal side. That is, as shown, socket 114 may extend distally from the vertical centerline by about 30 to 45 degrees. With respect to the open bottom, referring to FIG. 4, socket 114 may extend downwardly from the horizontal centerline of socket 114 by about 30 to 45 degrees. Thus, socket 114 is open at the distal side, proximal side, and bottom side, but the socket 114On each of these sides, the ball 2 can be fully surrounded to prevent any disengagement in all longitudinal directions. However, the open bottom and proximal side can provide a path for the standoff or strut of the handle 106 to move about the socket 114 over a substantially large range of motion. For example, with respect to rotation about the longitudinal axis (e.g., torsion or roll rotation), the handle 106 can move freely over a range of motion of about 90 degrees (e.g., 45 degrees on either side of the vertical centerline). With respect to rotation about the lateral horizontal axis (e.g., pitch rotation), the handle 106 can move freely over a range of motion of about 120 degrees (e.g., from the position where the handle 106 is rotated further clockwise compared to the position in FIG. 3 to the counterclockwise position shown in FIG. 3, where the standoff or strut extends proximally from the socket). With respect to rotation about the vertical axis (e.g., yaw rotation), the handle 106 can move freely over a range of motion of about 90 degrees (e.g., 45 degrees on either side of the longitudinal centerline).

[0028] As described above, the actuator interface 112 may be configured to operably couple to the proximal Part 1 04 centrally Part 1 03 and the distal Part 1 02. With respect to the operable coupling to the distal Part 1 02, the movement of the handle 106 is transmitted through the central Part 1 03 to the distal Part 1 02, and one or more working elements 111 may be coupled to the actuator interface 112 to provide a corresponding movement at the distal Part 1 02. One or more working elements 111 may be provided for each type of movement. That is, one or more working elements 111 may be provided for each of pitch, yaw, and roll such that the pitch movement, yaw movement, or roll movement of the handle 106 causes a corresponding pitch movement, yaw movement, and roll movement at the distal Part 1 02.

[0029] Handle 106 and distal Part 1 With respect to the pitch and yaw motion of 02, a plurality of working elements 111 in the form of tension ties or loops are proximal Part 1 Reflecting the rotation at 04, distal Part 1 It may be provided to generate the rotation at 02. In one or more embodiments, as shown in FIGS. 4 and 5, the tie can include a flexible and / or elastic loop such as a belt or chain, for example, and the loop can function as a fixed pulley or sprocket, respectively, on the circular surface 30 of the actuator interface 112 , 31 can engage. As shown in FIG. 4, for example, the actuator interface 112 can include slots leading to the substantially circular or semi-circular surface 30 , 31. The slots may be disposed in a plane having a circular shape defined by the circular or semi-circular surface 30 , 31, and each end of the slot is generally tangential to the circular or semi-circular surface 30 , 31 such that the loop passes through the actuator interface 112, bends across the circular or semi-circular surface 30 , 31, and may be sized to return from the actuator interface 112. In one or more embodiments, the circular or semi-circular shape defined by the surface 30 , 31 may be at the center of the respective axis of motion of ball 2 of the interface 112. That is, for example, the circular or semi-circular surface 30 Actuator 31 may define a circular shape having a center point, and the center point is orthogonal to the circular shape and , May be disposed on an axis passing through the center point of ball 2 of interface 112. The loop may frictionally engage the circular or semi-circular surface 30 Actuator 31, or in the case of a chain, the rotation of ball 2 within the actuator interface 112 causes the circular or semi-circular surface 30 , 31 to rotate, thereby rotating the loop, and its rotation is transmitted distally through the relative translation of each leg of the loop , ​Part 1 It may engage the teeth on the surface so as to transmit to 02. An example of a chain system includes a ball chain 111B having a notched gear 111A, as shown in FIG. 9A. As shown, the working element 111 is disposed on or incorporated in the circular surface 30 , 31 or includes a ball chain 111B extending around the notched gear 111A that provides a non-slip engagement between the working element 111 and the actuator interface 112 and / or the operating interface 108 (for example, the notched gear may also be provided on the operating interface 108). In one or more embodiments such as shown in FIG. 9B, an adjustment link 115 is provided within the length of the ball chain 111B to adjust the overall length of the chain 111B and thus the tension or tightening. As shown, the adjustment link 115 may include a ball seat that allows the chain 111B to be lifted from the adjustment link 115, adjusted (e.g., tightened or loosened), and re-seated within the ball seat of the adjustment link 115. In the case of an elastic tie or loop, the tie or loop can absorb vibrations and avoid transmitting such vibrations to the distal Part 1 02. For example, the tie or loop may be an elastomer or other elastic material that may assist in absorbing vibrations, such as vibrations from tremors induced at the handle 106. Further, the elastic tie or loop can be configured to maintain the tension of the tie or loop, for example, when the rotation of the ball 2 loosens the loop or tie.

[0030] In one or more embodiments, the radius of curvature, and thus the size or width of the circular or semi-circular surface 30 , 31, may be selected relative to the corresponding circular or semi-circular surface at the distal Part 1 02 to magnify or reduce the movement at the distal Part 1 02 in response to the movement of the handle 106. That is, for example, at the distal Part 1If higher precision of movement in 02 is desired, the size or width of the circular or semi-circular surface 30 in the actuator interface 112 , 31 may be selected to be smaller than the size or width of the circular or semi-circular surface 30 in the distal Part 1 02. This is because the angular movement in the actuator interface 112 causes a specific amount of longitudinal movement of each leg of the loop to be converted into the distal , 02, and the longitudinal movement causes a smaller amount of angular movement in the distal Part 1 02 (the same amount of longitudinal movement along a larger circle results in a smaller angular movement in the distal part Part 1 of 02). 102

[0031] The working elements 111 for pitch and yaw are said to include a loop, but instead of looping through the actuator interface 112, the tie may terminate into the actuator interface 112, and the same may apply to the distal Part 1 02. It should be understood that the cam surface may be provided, for example, along the actuator interface 112 on the proximal side of the ball 2 extending from one end to the other. A similar cam surface may be provided on the operating interface 108 near the distal Part 1 02. The spacing between the terminated ties may be adjusted and selected to provide the desired amount of accuracy or magnification of the movement of the handle 106. Furthermore, although a tensile element such as a flexible loop has been described, a more rigid element such as a wire or strut may extend from the actuator interface 112 to the distal Part 1 02 and can transmit tension and compression depending on the position of the wire or strut and the direction of rotation of the actuator interface 112. That is, instead of two tension ties, a single or multiple tension / compression members may be provided.

[0032] ​As described above, one or more working elements 111 may be provided for each type of movement including pitch, yaw, and roll. With respect to roll, referring to FIG. 8, a working element 111 in the form of a torque element 804 may be provided to transmit the roll movement of the handle 106 distally Part 1 to 02. As shown, a flexible torque tube, shaft, spring, coil, braided mesh, or other torque transmission element 804 may extend distally from the actuator interface 112 . In particular, as shown, the torque element 804 may be substantially rigidly fixed to the handle 106 and may extend longitudinally and in a sleeve-like manner through the center of the actuator interface 112. Alternatively, the torque element 804 may be rigidly fixed to the ball 2 of the actuator interface 112. In either case, the twisting or roll movement of the handle 106 can induce a twisting or roll movement of the torque element 804, which can transmit its roll movement distally Part 1 to 02. The torque element 804 may be flexible about an axis orthogonal to the longitudinal axis of the torque element 804, such that the torque element 804 can accommodate yaw or pitch movements of the handle 106 while maintaining its ability to transmit roll movement along its length without twisting or breaking.

[0033] As described above, distally Part 1 02 may be operatively coupled to the center Part 1 03 using the operation interface 108. The operation interface 108 receives movement from one or more working elements 111 extending through the center Part 1 03 and corresponds to the movement at the proximal Part 1 04 with the distal Part 1It may be configured to induce movement in 02. That is, the handle 106 may be operable to rotate with one, two, or three degrees of rotational freedom about an orthogonal axis that intersects at a point such as the center of the actuation interface 112. Similarly, the operation interface 108 corresponds to the orthogonal axis of the handle 106 but intersects at a different point such as the center of the operation interface 108, and provides one, two, or three degrees of rotational freedom of the distal Part 1 02. Thus, the distal end is centered about one, two, or three orthogonal axes that intersect at a point Part 1 The rotation of 02 may be provided by the system, and such rotation may correspond to the rotation of the handle 106. That is, for example, the pitch movement of the handle 106 can cause a corresponding pitch movement of the distal Part 1 02, the yaw movement of the handle 106 can cause a corresponding yaw movement of the distal Part 1 02, and the roll movement of the handle 106 can cause a corresponding roll movement of the distal Part 1 02. Further, the movement may correspond by centering about the corresponding axis, but the ratio of the movements may be different, for example, to provide a higher level of accuracy. This system is advantageous by providing such corresponding movements without the need for computer compensation of the movements. That is, since the movements are centered about axes that intersect at a common point, compensatory movements due to movements about another axis can be avoided, and elaborate robot compensatory movement programming can be avoided as well. Additionally, the operation interface 108At least two of the rotational degrees of freedom centered on the common point in [description] may be independent of each other. That is, as will be described in more detail below, the pitch motion and the yaw motion may be independent of each other, that is, the pitch motion does not adjust the yaw axis, and the yaw motion does not adjust the pitch axis. The pitch and yaw motions also do not adjust the roll axis. On the other hand, the roll motion can affect other axes by rotating the pitch axis and the yaw axis together with the roll axis and maintaining the orthogonal relationship between the pitch axis and the yaw axis. This is in contrast to, for example, a universal joint that may have only one degree of freedom independent of other axes.

[0034] Distal Part 1 Regarding the pitch motion and the yaw motion of 02, refer to FIGS. 6 and 8. As shown, the operation interface 108 is centered Part 1 03 may include a turret, a stand, or other support 18 disposed at the distal end of the extension element 16. Support 18 is distal about a vertical axis Part 1 02 may be configured to support a pulley or a cam surface for interaction with a tension tie or a loop to control the pivotal motion (e.g., yaw) of 02 and the pivotal motion (e.g., pitch) about a laterally extending horizontal axis. In one or more embodiments, Support 18 may be pyramid-shaped such that it tapers slightly as it extends distally. Support 18 may include side walls on each of the four sides that extend distally to respective pivot points. As shown, the distal 102 A gimbal may be provided for each of the yaw motion and the pitch motion of the portion, and the gimbal may be Support Supported at the pivot points of the walls of 18. For example, the pitch gimbal 202 may be Support At the distal end of the wall that extends distally along the side of 18 Support Fixed to the pivot point of 18. The yaw gimbal 204 may be Support At the distal end of the wall that extends distally along the top and bottom of 18 Support Fixed to the pivot point of 18. The gimbal 202 ,204 may be a generally U-shaped element having, for example, a U-shaped bellows, with slots passing through the bellows and extending along the bellows. Beyond the ends of the slots, the gimbal 202 , 204 can include pulleys, sprockets, or other features configured for engagement by a tie or loop, and relative translation of the legs of the tie or loop rotates the pulley or sprocket, and thus the gimbal 202 , enables 204 to rotate about its respective yaw or pitch axis. That is, the pulley or sprocket is the gimbal 202 , may be fixed relative to 204, but the gimbal 202 , 204 and the corresponding pulley or sprocket are Support may be pivotable relative to 18. The pulley / sprocket may be the gimbal 202 , disposed on the outer or inner surface of 204. For example, as shown, the pulley / sprocket is disposed on the outer surface of the yaw gimbal 204 and the inner surface of the pitch gimbal 202. As shown, Support the wall of 18 at the pivot point Support a tie or loop reaches a pulley or sprocket disposed outside 18 Support and can include a window that enables the tie or loop to pass through the wall of 18. Alternatively, Support 18 may be generally rectangular or cylindrical, and the pulley or sprocket may be disposed inside 18 such that a loop or tie Support does not pass through the wall of 18. In either case, movement of the handle 106 about its yaw or pitch axis Actuator can cause a corresponding rotation of the interface 112, which can rotate the respective tie or loop, which can rotate the respective gimbal 202 at the operation interface 108 , 204.

[0035] Distal Part 1 with respect to the rolling motion of 02 Support 18 is central Part 1It may be pivotally coupled to the extension element 16 of 03, or to the central Part 1 The extension element 16 of 03 may be pivotally coupled to the ground element 14. In either case, Support 18 is Handheld medical with respect to the ground element 14 of the device 100 Handheld medical It can rotate freely about the longitudinal axis of the device 100. As described above, the working element 111 in the form of the torque element 804 is such that the rotation of the handle 106 induces the rotation of the torque element 804, Handheld medical It can extend longitudinally along the device 100. The torque element 804 is centered Part 1 It can extend longitudinally through the ground element 14 and the extension element 16 of 03, Support and can engage rotatably with 18. For example, radially extending spokes or struts can Support extend radially away from the torque element 804 so as to engage with 18. Thus, the rotational movement of the handle 106 about the roll axis can cause the rotational movement of Support 18 about the roll axis. Further, the rotation of the handle 106 can cause the loop or tie to Actuator remain aligned with their respective anchor points at the interface 112 and the operating interface 108, and rotate the interface 112 by the same or a similar amount. Actuator

[0036] Referring to FIGS. 2 and 6, the operating interface 108 may also include a distal stem 4. The distal stem 4 may be configured to transmit the yaw and pitch movements of the gimbal 202 , 204 to Handheld medical the distal Part 1 02 of the device 100. That is, the distal stem 4 may be pivotally supported within the distal end of 18 by a core element 208 such as, for example, a stem ball, a spherical bushing, or a hoop. In one or more embodiments, Support SupportThe inner surface of the distal end of the wall 18 can include a cup-shaped sheet 36 adapted to engage each side of the stem ball. The stem ball may be disposed within the cup-shaped sheet 36. The distal stem 4 can be rigidly fixed to the ball and extend generally distally through each slot of the yaw gimbal 204 and the pitch gimbal 202 from the ball. Thus, when either or both of the yaw or pitch gimbals 202 , 204 rotate, the distal stem 4 can be rotated by the same amount while the stem ball remains seated within the cup-shaped sheet 36. Further, Distal the stem 4 can be a hollow element, and the stem ball can include a bore that allows one or more joe-actuating wires or other working elements 111 to pass therethrough. However, the torque element 804 may be fixed to the stem ball such that rotational movement of the handle 106 about the roll axis is transmitted to the distal stem 4 and the stem ball. The distal Part 1 02 may be fixed to the distal stem 4 to track the orientation of the distal stem 4. For example, the distal Part 1 base 19 of the 02 Distal may be rigidly coupled to the stem 4 such that movement of the stem 4 is reflected by the same movement of the distal Part 1 02. Distal

[0037] Additional degrees of freedom may be provided by the present Handheld medical device 100. That is, for example, if forceps are disposed on the distal Part 1 02 and / or a cold cut blade is disposed thereon, one or more longitudinal actuators can extend from the handle 106 to the distal Part 1 02 to control their respective operations. For example, as described above, the handle 106 can include an actuator in the form of a trigger. The trigger passes through Actuator the center of the interface 112, through the central Part 1 03, through the center of the operating interface 108, Distal through the stem 4, and to the distal Part 1 ​It can function to pull a longitudinal actuator or a flexible wire into the 02. The flexible wire may be pivotally coupled to the articulated joint 21 of the forceps, for example, such that actuation of the trigger opens and / or closes the articulated joint 21. A similar system may be used, for example, to operate a cold cut blade. In one or more embodiments, the longitudinal actuator is disposed within the torque element 804 and passes through the stem ball and the Distal stem 4 to the distal Part 1 02 and can extend thereto.

[0038] Torque element 804 It should be understood that the substantially continuous nature of the roll system by fixing the to the stem ball can provide a constant velocity joint. That is, unlike a universal joint, for example, the present design can establish the same amount of rolling rotational displacement at the distal side of the operation interface as is induced at the proximal side of the operation interface. 108 The operation interface 108 at the distal side.

[0039] A mechanical movement mechanism without a powered movement device is described, but it should also be understood that a powered movement device such as a servo or other mechanism may be provided in the present system. For example, as shown in FIG. 7, the handle 106 and Actuator interface 112 may be operably coupled to the operation interface 108 via, for example, an electric servo. That is, a handle the same as or similar to the above-described handle may be provided, and an actuator interface the same as or similar to the above-described handle may also be provided. However, instead of mechanically coupling the actuator interface 106 to the operation interface 106 using the direct working element 111 , a sensor for sensing the movement of the handle 112 may be provided. Further, the operation interface described above 108 to the operation interface 106 The movement of the handle 108A servo may be provided to induce movement in the distal portion via the same or a similar operation interface. That is, as shown in the figure, the servo may be configured to operate a pulley or sprocket similar to the pulley or sprocket illustrated and described with respect to the above actuator interface. Further, the pulley or sprocket may be mechanically coupled to a corresponding pulley or sprocket on the operation interface. Thus, the movement of the handle may be sensed by a computing system, and the corresponding operation of the servo may cause a corresponding movement in each pulley or sprocket, which movement may be transmitted to the corresponding pulley / sprocket in the operation interface to cause movement of the distal portion. Thus, this may function similarly to the yaw and pitch movements of the above device, but may be controlled electromechanically rather than mechanically. With respect to roll movement, a similar arrangement may be provided where a roll servo is connected to a torque element extending to the operation interface to provide roll movement to the stem ball and thus the stem and, in turn, the distal portion. The servo is shown as being coupled to the operation interface using a tension tie or other working element, but it should be noted that the servo may also be directly connected to the operation interface, for example, by directly controlling the position of a yaw and pitch gimbal. 102 A servo may be provided to induce movement in the distal portion via the same or a similar operation interface. That is, as shown, the servo may be configured to operate a pulley or sprocket similar to the pulley or sprocket illustrated and described with respect to the above actuator interface. 112 Further, the pulley or sprocket may be mechanically coupled to a corresponding pulley or sprocket on the operation interface. 108 Thus, the movement of the handle may be sensed by a computing system, and the corresponding operation of the servo may cause a corresponding movement in each pulley or sprocket, which movement may be transmitted to the corresponding pulley / sprocket in the operation interface to cause movement of the distal portion. 106 Thus, this may function similarly to the yaw and pitch movements of the above device, but may be controlled electromechanically rather than mechanically. With respect to roll movement, a similar arrangement may be provided where a roll servo is connected to a torque element extending to the operation interface to provide roll movement to the stem ball and thus the stem and, in turn, the distal portion. 108 The servo is shown as being coupled to the operation interface using a tension tie or other working element, but it should be noted that the servo may also be directly connected to the operation interface, for example, by directly controlling the position of a yaw and pitch gimbal. 102 Handheld medical device 100 108 With respect to roll movement, a similar arrangement may be provided where a roll servo is connected to a torque element extending to the operation interface to provide roll movement to the stem ball and thus the stem and, in turn, the distal portion. 804 The servo is shown as being coupled to the operation interface using a tension tie or other working element, but it should be noted that the servo may also be directly connected to the operation interface, for example, by directly controlling the position of a yaw and pitch gimbal. Distal stem 4 and thus the distal portion 102 111 The servo is shown as being coupled to the operation interface using a tension tie or other working element, but it should be noted that the servo may also be directly connected to the operation interface, for example, by directly controlling the position of a yaw and pitch gimbal. 108 The servo is shown as being coupled to the operation interface using a tension tie or other working element, but it should be noted that the servo may also be directly connected to the operation interface, for example, by directly controlling the position of a yaw and pitch gimbal. 202,204 The servo is shown as being coupled to the operation interface using a tension tie or other working element, but it should be noted that the servo may also be directly connected to the operation interface, for example, by directly controlling the position of a yaw and pitch gimbal. 108 The servo is shown as being coupled to the operation interface using a tension tie or other working element, but it should be noted that the servo may also be directly connected to the operation interface, for example, by directly controlling the position of a yaw and pitch gimbal.

[0040] distal portion 102 ​​​When a servo is provided to generate motion, one or more features may be provided. For example, although the mechanical system described above includes vibration control via elastic elements within the system, the servo system may be configured to control vibration by filtering. That is, for example, sensor data from a handle 106 can be filtered by a computing system to remove motions such as tremors by filtering high-frequency motions that coincide with, for example, hand tremors. Further, accuracy control may be provided by applying a reduction factor to the sensed motion of the handle 106 . In one or more embodiments, such accuracy control may be provided for yaw and pitch, but not for roll. In other examples, accuracy may be provided for yaw, pitch, and roll. Still other approaches and advantages may be provided. For example, Handheld medical Device 100 is Handheld medical described as a device, but a robotic approach may be used, where handle 106 is provided at the user's controller station and the distal portion 102 is provided as part of an operable robot along with an operation interface 108 , a servo, and a working element 111 . Thus, an example of the system may be part of a robotic operating system where a servo, an operation interface 108 , a distal portion 102 , and potentially a central portion 103 are mounted, for example, on a robotic arm. The robot may be operated to insert the distal portion 102 through a port on a patient, and then the handle 106 can be used to operate the distal portion 106 via sensors on the handle 102 and a computing system that interprets and converts those sensor signals to control their respective servos.

[0041] It should be understood that, regardless of whether servo or electromechanical control is provided, a power source for supplying power to the electrodes at the distal end may be provided. In one or more embodiments, the power source may be a corded power source, or a battery power source may be provided. In one or more embodiments, the battery may be located within the handle 106 and may pass through the center of the actuator interface 112 and along the central portion 103 and through the center of the operation interface 108 to the distal portion 102 via an electrical lead that passes through to the distal portion 102 and may be disposed in electrical communication with the distal portion. The electrodes may be present on the distal portion 102 , for example, on the jaws of the forceps, and the electrical conductors can supply power to the electrodes. In one or more embodiments, monopolar electrodes may be provided, or bipolar electrodes may be provided.

[0042] Embodiment As detailed above, this document generally, but not by way of limitation, can include pitch axes, yaw axes, and roll axes that coincide (e.g., intersect) such that three degrees of freedom of articulation can be provided, for endoscopic surgery (which can generally refer to including endoscopy, arthroscopic surgery, laparoscopic surgery, or similar minimally invasive surgery) such as a telemanipulator for Handheld med Medical data vice.

[0043] For comparison, in an approach where the pitch axis, yaw axis, and roll axis do not coincide at a common intersection, the planes corresponding to the individual axes are separated by a distance, which makes the smooth translation of the surgeon's wrist movement much more complex than the present approach that can use a list mechanism that can include coincident (e.g., intersecting) pitch, yaw, and roll axes such that three degrees of freedom of articulation can be provided. For example, in the non - coincident axis approach, rotating about the pitch axis is complex, and instead, the offset distance between the axes results in a rotation about a cone defined by the angle arising from the offset axis.

[0044] As may be apparent from the above - detailed description, this document describes, among other things, endoscopic or laparoscopic devices for, among other things, partial insertion into an opening or incision of a patient, such as for treating a target within a patient. Handheld In one example, the device can include a distal portion that can be sized and shaped for insertion into a patient. Part to The device can also include a proximal portion that can be connected to the distal portion. Part into In one example, the proximal portion can include an external handle for a physician or other user to hold and support during distal insertion of the device into the patient. A mechanical or electromechanical list, such as the described operating interface, can be located distally. The list can be configured to provide yaw, roll, and pitch movements about corresponding yaw, roll, and pitch axes such that each of the yaw axis, roll axis, and pitch axis is arranged to intersect each other at a common point. Actuators, such as the above - described interface, can be located on or near the handle. The actuators can be coupled to the list mechanism for, among other things, operating the list mechanism to provide yaw, roll, and pitch movements. The end effector is at the distal end of the device. Part to In one example, Part is During distal insertion of the device into the patient, Part of The proximal portion can be held and supported by a physician or other user. Part to An external handle can be included for this purpose. Mechanical or electromechanical lists, such as the described operating interface, can be located distally. Part into The list can be configured to provide yaw, roll, and pitch movements about corresponding yaw, roll, and pitch axes such that each of the yaw axis, roll axis, and pitch axis intersects the others at a common point. Actuators, such as the above - described interface, can be located on or near the handle. The actuators can be coupled to the list mechanism to operate the list mechanism, for example, to provide yaw, roll, and pitch movements. The end effector is at the distal end of the device. Actuator Actuators, such as the above - described interface, can be located on or near the handle. The actuators can be coupled to the list mechanism to operate the list mechanism, for example, to provide yaw, roll, and pitch movements. The end effector is at the distal end of the device. Part andIt can be positioned distal to the call list. The end effector can provide at least yaw motion, roll motion, and pitch motion via the list in response to an operation of the actuator by the user.

[0045] This approach can position all of the pitch axis, roll axis, and yaw axis to coincide at a single point. As a result, the extra complexity of non-coincident axes can be avoided, and the problem of compensatory motion can be similarly avoided. For example, the yaw element can be pivotally rotated about the yaw axis without affecting the pitch axis or roll axis. This approach can help enable a significant reduction in complexity in that it does not require a sophisticated motor to control the motion of one axis in consideration of the rotation of different axes. This mechanism can be self-contained in a small 8 mm package having, for example, small pulleys for controlling the pitch axis and yaw axis. For the third degree of freedom of roll, a flexible torque tube can be used. Such a torque tube can manage torque using a spring covered with a flexible elastomer. The flexible elastomer can be easily bent because the spring allows this bending. However, the torque is resisted by the spring encapsulated in the polymer. Next, the roll axis can be driven by either a torque catheter tube or a thin stainless steel tube, and the tube is formed with cuts to allow bending but transmit torque without deforming.

[0046] Thus, a sophisticated bipolar cutting and sealing device having a three-degree-of-freedom wrist can be fabricated using relatively simple and inexpensive components. This allows the device (or a portion thereof) to be discarded after a single use. This can help avoid the approach where the wrist and end effector are multi-use devices that require cleaning and resterilization. This approach can be advantageous for devices used to coagulate or cut tissue since these electrosurgical devices can be covered with a patient's blood. Blood can potentially "bake on" to the cutting surface and be difficult to clean. Electrocautery devices can include small, delicate jaws with teeth that can be difficult to clean and can be covered with carbonization and blood. However, this approach can help provide an electrocautery device where at least a portion of the device that contacts blood can be disposed of after use on a single patient.

[0047] The advantages of such a device for a surgeon are worth considering as either a monopolar or bipolar vessel sealing or other electrosurgical device, or as any device that can be used by a surgeon in a non-dominant hand such that it can incorporate one or more of a J-hook, spatula, forceps, and Lyons dissector non-dominant hand instruments. All of these instruments can be made more useful using a wrist that allows three degrees of freedom. For example, in a colpotomy, a three-dimensional wrist mechanism can be used to manipulate a J-hook to perform a circular cut that would be difficult to perform using a J-hook fixed to a rigid shaft. A Lyons dissector can be used as a needle holder for suturing the colpotomy margin. The device can be used to mimic the motion of a surgeon's hand to suture a wound, which otherwise would be difficult or impossible with a laparoscopic device limited by a pivot point at the trocar entry into the body cavity.

[0048] This approach can solve many technical problems by providing an instrument that has electrosurgical cautery capabilities and incorporates a wrist within a body cavity. This Handheld instrument HandheldAn endoscope or laparoscopic telemanipulator device may be ideal as a non-dominant hand device that enables a surgeon to access surgical tissue that is difficult to reach. This list may be used to drive a needle and sew large incisions. The two instruments can enable a surgeon to tie a knot, and it is very difficult to move using two linear grippers.

[0049] In a possible approach, the surgeon uses a bipolar vessel sealing and cutting instrument in their dominant hand, but this Handheld doctor Medical data will use a vice. This Handheld medical device can be partially or completely discarded after surgery. This instrument does not require expensive major equipment, extensive cleaning and sterilization of instruments after surgery, and since the list mimics the movement of the doctor's wrist, the learning curve should be fairly rapid. This can open the door to advanced surgical procedures in all surgeries, such as helping to avoid securing time on expensive surgical robots.

[0050] As described in detail above, another way to explain the same or similar examples shown in the figures is as follows. Figure 1 is a partial cutaway isometric schematic view of an example of a portion of a Of the form of Handheld doctor Medical data vice 100 for an endoscopic or laparoscopic telemanipulator device, such as for endoscopic or laparoscopic surgery. In the example of Figure 1, Handheld medical device 100 can include portions that can be configured for partial insertion into an opening or incision of a patient, such as for treating a target within the patient. Handheld endoscopic or laparoscopic device To the can be included. Handheld medical Device 100 can include a distal Part 1 02 that can be sized and shaped for insertion into a patient. The proximal Part 1 04 can be connected to the distal Part 1 02. The proximal Part 1 04 is , thecan include the handle 106. The handle 106 is proximal during the insertion of the distal Part 1 02 and can be sized and shaped to be grasped or held by a physician or other user for, among other things, at least one of supporting, orienting, or directing the proximal Part 1 04. Handheld medical The distal Part 1 02 of the device 100 can include a mechanical or electromechanical operation interface 108 or a wrist Structure of and can be configured to provide yaw, roll, and pitch movements, such as of the end effector 110, about corresponding yaw, roll, and pitch axes, each of the yaw, roll, and pitch axes being arranged to intersect one another as described herein. An actuator or Mechanism (operation interface 108) interface 112 can be located on, in, or coupled to the handle 106. The actuator Actuator 112 can be coupled to the Interface 108, and thus to provide, among other things, yaw, roll, and pitch movements of the Operation interface 108 and thus of the end effector 110, for example via one or more cables or pulleys Operation interface to operate the Operation interface 108. The end effector 110 can be located at the distal Operation interface such as of the Handheld medical 108 and at the distal Part 1 02 of the device 100. The end effector 110 can be configured to provide at least yaw, roll, and pitch movements via the Interface 108 in response to operation of the actuator Operation interface 112 by the user, such as by gripping and moving or orienting the handle 106.

[0051] FIG. 1 shows an example of a mechanical version of a handheld medical device 100 that can be configured as a three-dimensional (3D) lions dissector that can include an end effector 110 that can include at least one or both of forceps or one or more electrosurgical electrodes. Operation interface 108 is a ball and socket joint within the handle 106, or at or near the handle 106 Actuator interface 112 or actuator Type of through which it can be driven by one or more pulleys. In the example of FIG. 1, the body of the handle 106 may remain stationary or may be grasped or held by a physician or other user and manipulated within a three-dimensional space similar to that used with laparoscopic instruments. The handle 106 converts the motion of a surgeon or other user (applied to the actuator Interface 112) into small (Handheld medical device 100) motions at the distal Part 1 02 of the telemanipulator device Operation interface 108, etc., so as to be configured to add three degrees of freedom of motion of the end effector 110.

[0052] In FIG. 1, the proximal Part 1 06 can include a ground element 14 or a front housing Group of from which an extension element 16 or tube Block of or other elongated longitudinal member can Handheld medical device extend toward or form the distal Part 1 02 of the 100. The distal Part 1 02 is sized, shaped, or otherwise configured in one example to be insertable into a trocar such as an 8 millimeter trocar that provides a longitudinal lumen having an 8 millimeter inner diameter. The housing at the proximal Part 1 04 (Grounding element 14)can be useful to allow a physician or other user to roughly position the end effector 110 (e.g., positioned near the target location within the patient where grasping of tissue or another target is desired, or may include forceps or other grasping tools 19, 21 that are positioned or located). Proximal Part 1 04 can move toward and away from the trocar, or can move inside and outside of the trocar, and can also sway up and down and / or pivot within the trocar to move left and right. Proximal Part 1 At 04 Grounding element 14 can include an actuator Interface 112. The socket 114 Grounding element 14 and the actuator Interface 112 can be shaped or otherwise formed or configured to be disposed relative to the handle 106 to be useful for providing an additional three degrees of freedom, such as by operating the handle 106 with respect to one or more portions of 14 and the actuator 112

[0053] The actuator Interface 112 Grounding element The actuator within 14 Interface 112 can include a ball 2 sized, shaped, and positioned to fit into the socket 114 of 112. The joint between this ball 2 and the socket 114 can be useful for providing an additional three degrees of freedom. The surgeon or other user Grounding element can grasp 14, the handle 106, or both and move the hand up and down. Thereby, the end effector 110 or the other distal end of the distal Part 1 02 sways pivotably up and down following the movement of the surgeon's or other user's hand. By rotating and moving the handle 106 left and right, the surgeon can pivotably follow the distal end effector 110 in the yaw direction. Further, the surgeon or other user can use an elongate longitudinal tube or member Extension element 16 which isIt is possible to rotate the wrist (of a human user) about the longitudinal axis defined thereby. This induces a roll motion about the longitudinal axis, and the roll motion is transmitted through the ball 2 and socket 114 and mechanically or electromechanically Torque mechanism structure (Operation interface 108) through, the telemanipulator device (Handheld medical device 100) at the distal Part 102 end of the end effector 110 at the distal end is converted into a roll motion.

[0054] FIG. 2 shows an enlarged view of a portion of the mechanical wrist mechanism or operating interface 108, and a common intersection that intersects a central longitudinal roll axis defined to be coaxial with the elongated member (Extension element 16) also shows a pitch axis that intersects the yaw axis at. In the example of FIG. 2, the wrist IN includes a pitch gimbal 202 pivotable about the pitch axis and a yaw gimbal 204 pivotable about the yaw axis, through corresponding pulleys or the like that can be connected to the ball 2 of the actuator (Operation interface 108) 112 via respective cables. The pitch gimbal 202 and the yaw gimbal 204 can cooperate pivotally with each other, such as allowing constrained movement of a tube, rod, or other elongated hitch Interface or stem extending from and attached to a core element IN or ball centered about the common intersection of the pitch axis, yaw axis, and roll axis 208 or bow Loop or The end effector 110 can extend from and be attached to the hitch 206. As shown in FIG. 2, the pitch gimbal 202 and the yaw gimbal 204 can be driven by two wire cables that can be elastic wires or more rigid wires. The motion of these gimbals 202, 204 moves with these gimbals 202, 204 and also returns towards the proximal 206 04 and the actuator Part 1 112 Interface and back towards Handheld medicalThe ball can also be moved through the device 100 by rolling about a roll axis extending longitudinally therethrough, via a mutually constrained cylindrical tube or other hitch 206. (Core element 208) It can be moved.

[0055] Thus, in FIG. 2, Operation interface 108 is governed by three intersecting axes, pitch, roll, and yaw, all intersecting and coinciding. The telemanipulator device Common intersection IN All of these mechanisms at or extending from the distal (Handheld medical device 100) 02 of the Part 1 are sized, shaped, and otherwise configured to fit within a cylinder or similar lumen having an inner diameter of 8 mm to 8.5 mm (or even smaller, e.g., 5 millimeters) that allows insertion into and along the trocar. In FIG. 2, Handheld medical The distal Part 1 02 of the device 100 Operation interface 108 can include a ball and socket joint having, for example, a socket that can be partially provided by the gimbal 202 204 and constrained by 208. Core element 208 can be rigidly attached to the tubular hitch 206, which can then be attached to the base Core element of the end effector 110, such as by attachment to the lower jaw To the of the end effector 110. Having the tubular hitch 206 19 can be attached to the base Core element208 can be positioned in any orientation using two gimbals 202, 204. The yaw gimbal 204 is pivotally rotatable about the yaw axis. The pitch gimbal 202 is pivotally rotatable about the pitch axis. The yaw gimbal 204 and the pitch gimbal 202 can be driven by respective tie or cable 22 that can engage pulleys on their respective gimbals 202, 204. Both gimbals 202, 204 can include a bail that can define respective slots through which a tubular hitch 206 can extend and within which the tubular hitch 206 can slide. For example, when the pitch gimbal 202 rotates about the pitch axis, the slot of the pitch gimbal 202 drives the hitch 206, which in turn moves the distal Part 1 02 and the end effector 110's Base 19. Core element 208 extends between its proximal Part 1 04 and its distal Part 1 02 and can be rotated about a central longitudinal axis that coincides with the main longitudinal shaft of the device 100. This central longitudinal axis is the roll axis and Handheld medical also intersects. The roll can be induced in the gripping jaws of the end effector 110, such as by attaching a flexible torque tube or member that extends proximally from the 208, as more clearly shown as the torque Common intersection IN 804 in FIG. 8. Rotating the flexible torque tube or member causes the Element 208 to roll, which in turn causes the distal portion Core element and the end effector 110's Core element 19 to roll. 102 and the end effector 110's Base 19.

[0056] FIG. 3 shows a side view of a portion of the partially cut-away handheld medical device 100. In FIG. 3 , pi the pitch gimbal 202 and also bi yoThe gimbals 204 can each include pulleys that can be coaxially aligned with their respective pitch and yaw axes. These pulleys can engage a cable 22, which 22 extends Handheld medical longitudinally 100 from the distal Part 1 02 of the device Handheld medical and the proximal Part 1 04 of the device 100, Handheld medical to the proximal Part 1 04 of the device 100 where it joins with the handle 106 Grounding element and the actuator Interface 112 associated with the ball 2. FIG. 3 shows two cross-sections 4-4 (shown in more detail in FIG. 4) and a cross-section 5-5-5 (shown in more detail in FIG. 5).

[0057] FIG. 4 shows a view taken along the cross-section 4-4 of FIG. 3. FIG. 4 shows the actuator Interface 112 including the socket 114 and the ball 2. The pulley (Surfaces 30, 31) can be molded onto the ball 2, which 2 can be connected to the handle 106 via a connecting member 402 or the like. Each cable 22 can Surface be snugly wrapped around , one respective one of 30 Grounding element 31, and this pulley can be molded to the ball features of the ball 2 that mates with the socket 114 of the actuator Interface 112 at the handle 106 or

[0058] FIG. 5 shows Handheld medical a split view taken along the cross-section Part 1 of FIG. 3 to illustrate both the proximal Part 1 04 and the distal 5-5 02 of the device 100. FIG. 5 shows the yaw gimbal pulley 502 of the gimbal 204 via the cable 22, associated with the handle 106 and Grounding element the actuator InterfaceAn example of a pulley system that connects to a corresponding pulley 504 within ball 2 located at 112 is shown. The ball and socket surfaces are shown as 32 and 33 in FIG. 5.

[0059] FIG. 6 shows an exploded view of an example of the distal end Torque machine structure (operating interface 108). The ball (Core element 208) can be captured within a socket element (Support 18) within a longitudinal member connector (Cup-shaped sheet 36) 18 can be connected to the major longitudinal shaft of device 100. The two gimbals 202, 204 can each include a pulley at at least one end of the gimbals 202, 204. It may be desirable to have pulleys at both ends of one or both of the gimbals 202, 204 to help improve the traction force with the corresponding respective drive cables 22. Support 18 is Cup-shaped sheet 36 to Handheld medical can be connected to the major longitudinal shaft of device 100. The two gimbals 202, 204 can each include a pulley at at least one end of the gimbals 202, 204. It may be desirable to have pulleys at both ends of one or both of the gimbals 202, 204 to help improve the traction force with the corresponding respective drive cables 22.

[0060] FIG. 7 shows another example that can include or use one or more sensors or motors to move pitch gimbal 202 and yaw gimbal 204. A gyro PC board 708 including a gyro sensor and an electronic controller circuit can be included in the handle 106. For example, a gyro sensor such as an Adafruit BNO055 can be used. These sensors are relatively inexpensive. The sensors can be monitored by an inexpensive Arduino microcontroller such that the pitch, yaw, and roll of the gyro sensor can be sensed. By mounting the sensor board 708 within the handle 106, the surgeon can grip the handle 106 and the Arduino microcontroller can sense the orientation of the surgeon's wrist. The Arduino microcontroller can be configured to issue one or more pulse width modulation (PWM) signals to respective servo motors 709 and 710 such that the pitch gimbal 202 and yaw gimbal 204 can each be driven.

[0061] In FIG. 7, the servo motors 709, 710 can each include an inexpensive DS3218 20Kg servo motor. The servo motors 709, 710 each drive pulleys 704 and 705 for the yaw gimbal 204 and the pitch gimbal 202, respectively. A thin cable 706 can connect each servo pulley to a pulley on a yaw gimbal and a pitch gimbal concentric with the respective yaw axis 700 and pitch axis 701. These pulleys are included in the respective gimbals that drive the (Core element 208) balls (Hitch 206) and tube hitch. The electromechanical list mechanism of FIG. 7 was fabricated at a 5x scale. The 1x scale components fit within an 8mm trocar. The prototype shown in FIG. 7 provides proof of concept for a list mechanism with (Operation interface 108) matching yaw, pitch, and roll axes.

[0062] FIG. 8 shows Handheld medical an example of a portion of a representative mechanical embodiment of the device 100. In this example, the main longitudinal shaft tube and the pitch and yaw gimbals are 2x size (planned size of 8mm for a 16mm tube diameter). FIG. 8 shows an example that can include a bipolar electrosurgical forceps dissector having 2x scale features at the distal end (except that the forceps jaws themselves are shown at 1x). The ball 2 can drive, via respective cables, Handheld medical respective pitch pulleys and yaw pulleys that can be located on the pitch gimbal and the yaw gimbal, respectively, in a more distal portion of the device 100. Cables connecting the pulleys are omitted from the view of FIG. 8 for clarity, but are understood to be included from other views. A black hypo tube 802 that can extend through the ball 2 rotates freely to allow the handle 806 to drive the ball 2 up and down (pitch) or left and right (yaw). A flexible torque tube (Torque element 804)It can be attached to the handle 106, so that when the surgeon turns the wrist, the jaws of the end effector 110 rotate (roll). Also, the fourth cable can extend between the jaw pulley and the lever pulley caused by compressing together the "scissor handle" portion of the handle 806. This fourth cable can drive the roll Torque element and can extend through 804. The end effector jaw can include an active bipolar coagulation jaw that can be actuated by a coagulation actuation button. A power cord can extend from the bottom of the handle to supply power to the electrosurgical electrode. The example shown in FIG. 8 may be a completely disposable version. Another example can include a partially reusable handle with disposable jaws and major shaft components.

[0063] Supplementary Note The following non-limiting examples detail particular aspects of the subject matter, among other things, to solve problems and provide the benefits described herein.

[0064] Example 1 is a handheld medical intervention device, comprising a central portion for establishing a reference position of the handheld medical intervention device, a handle disposed proximally to the central portion and having at least two rotational degrees of freedom with respect to the central portion, a distal portion disposed distally to the central portion and extending from the central portion, and an operating interface operably coupling the distal portion to the central portion, wherein the distal portion is operable by the handle via the operating interface to provide at least two rotational degrees of freedom of the distal portion with respect to the central portion, and at least two rotational degrees of freedom of the distal portion correspond to two of the at least two rotational degrees of freedom of the handle, and an operating interface including two rotational degrees of freedom centered on a first set of at least two orthogonal axes that intersect at a first point.

[0065] In Example 2, the subject matter of Example 1 optionally includes that the handle includes three rotational degrees of freedom with respect to the central portion.

[0066] In Example 3, the subject matter of Example 2 optionally includes that the three rotational degrees of freedom of the handle are centered about a second set of at least three orthogonal axes that intersect at a second point.

[0067] In Example 4, the subject matter of Example 2 optionally includes that a first set of at least two orthogonal axes includes three orthogonal axes that intersect at a first point, and the distal portion includes three rotational degrees of freedom centered about the first set of three orthogonal axes.

[0068] In Example 5, the subject matter of any one or more of Examples 1 to 4 optionally includes that the movement of the distal portion about one of the two axes of the first set of at least two orthogonal axes is independent of the movement about the other of the two axes.

[0069] In Example 6, the subject matter of any one or more of Examples 1 to 5 optionally includes that the operating interface includes a core element disposed between a pair of gimbals.

[0070] In Example 7, the subject matter of Example 6 optionally includes that the core element is centered about a first point.

[0071] In Example 8, the subject matter of Example 7 optionally includes that the core element includes a spherical bushing.

[0072] In Example 9, the subject matter of Example 7 optionally includes that the core element includes a hoop.

[0073] In Example 10, the subject matter of any one or more of Examples 1 to 9 optionally includes a torque element that extends from the handle to the operating interface and has a longitudinal axis, and a first angular displacement of the torque element about the longitudinal axis is the same as a second angular displacement of the distal portion about each longitudinal axis of the torque element and is independent of the orientation of the distal portion about other axes.

[0074] Example 11 is a handheld medical intervention device, including a central portion for establishing a reference position of the handheld medical device, a handle disposed proximally to the central portion, a distal portion disposed distally to the central portion and extending from the central portion, and an operating interface that couples the distal portion to the central portion and is operable by the handle to control the orientation of the distal portion, wherein a ratio of a first range of motion of the distal portion about a first axis to a second range of motion of the handle about a second axis corresponding to the first axis is less than 1.

[0075] In Example 12, the subject matter of Example 11 optionally includes that the handle is operably coupled to the operating interface using a pair of spaced-apart tension elements that extend along the central portion on both sides of the longitudinal axis, and the distance between the spaced-apart tension elements is smaller at the handle than at the operating interface.

[0076] In Example 13, the subject matter of Example 12 optionally includes that the pair of spaced-apart tension elements includes adjacent segments of the same cord having a first end and a second end, the first end and the second end are fixed to the actuating interface, and the cord wraps around a pulley on the operating interface.

[0077] In Example 14, the subject matter of Example 12 optionally includes that the first end of each tension element is fixed to the actuating interface and the second opposite end is fixed to the operating interface.

[0078] In Example 15, the subject matter of Example 14 optionally includes cam surfaces on each of the actuating interface and the operating interface, and the cam surfaces are defined by a radius equal to half of the distance between the pair of tension elements at each of the respective actuating interface and operating interface.

[0079] In Example 16, the subject of any one or more of Examples 11 to 15 optionally includes that the handle is equipped with a position sensor configured to measure the degree of rotation about the second axis.

[0080] In Example 17, the subject of Example 16 optionally includes that the operating interface is operable by the handle via a servo, and the servo is adapted to control the rotation of the distal portion about the first axis based on the ratio of the degree of rotation of the handle about the second axis.

[0081] Example 18 is a hand-held medical intervention device, including a central portion for establishing a reference position of the hand-held medical device, a handle disposed proximally to the central portion, a distal portion disposed distally to the central portion and extending from the central portion, and an operating interface disposed at the distal end of the central portion, coupling the distal portion to the central portion and being operable by the handle to control the orientation of the distal portion, wherein the handle is operably coupled to the operating interface by a mechanical coupling, and the mechanical coupling is configured to absorb the movement of hand tremors of the handle.

[0082] In Example 19, the subject of Example 18 optionally includes that the mechanical coupling includes an elastic material for absorbing the movement of hand tremors of the handle.

[0083] In Example 20, the subject of any one or more of Examples 18 to 19 optionally includes that the mechanical coupling is controlled by a motor adapted to attenuate the movement of hand tremors of the handle.

[0084] Example 21 is a handheld medical intervention device, comprising a central portion for establishing a reference position of the handheld medical device, a handle disposed proximally to the central portion and having at least two degrees of rotational freedom about respective axes of a first set of orthogonal axes that intersect at a first point with respect to the central portion, a distal portion disposed distally to the central portion and extending from the central portion, and an operating interface operable by the handle to couple the distal portion to the central portion and provide at least two degrees of rotational freedom of the distal portion with respect to the central portion about respective axes of a second set of orthogonal axes that intersect at a second point.

[0085] In Example 22, the subject matter of Example 21 optionally includes that the second set of orthogonal axes corresponds to the first set of orthogonal axes.

[0086] In Example 23, the subject matter of any one or more of Examples 21 and 22 optionally includes that the first set of orthogonal axes and the second set of orthogonal axes each include three orthogonal axes that intersect at respective first and second points.

[0087] In Example 24, the subject matter of any one or more of Examples 21 to 23 optionally includes that the movement of the distal portion corresponds to the movement of the handle.

[0088] In Example 25, the subject matter of Example 24 optionally includes that the movement of the distal portion corresponds to the movement of the handle by a factor of less than 1.

[0089] In Example 26, the subject matter of any one or more of Examples 1 to 25 optionally includes a power source for supplying power to the electrodes.

[0090] In Example 27, the subject matter of Example 26 optionally includes that the power source is a battery.

[0091] In Example 28, the subject matter of Example 27 optionally includes that the battery is disposed on or within the handle.

[0092] In Example 29, the subject matter of Example 27 optionally includes that the electrode is disposed at the distal portion and is selectively in electrical communication with the battery.

[0093] In Example 30, the subject matter of Example 26 regarding Example 17 optionally includes that the servo or motor is in electrical communication with the battery.

[0094] In Example 31, the subject matter of any one or more of Examples 1 to 30 optionally includes that the device is a non-dominant hand instrument.

[0095] In Example 32, the subject matter of any one or more of Examples 1 to 31 optionally includes that the distal portion includes a pair of jaws.

[0096] In Example 33, the subject matter of Example 32 optionally includes that at least one of the pair of jaws includes at least one degree of rotational freedom with respect to the distal portion.

[0097] In Example 34, the subject matter of Example 33 optionally includes that each of the pair of jaws has a degree of rotational freedom with respect to the distal portion.

[0098] Example 35 is a hand-held endoscope or laparoscopic device for partial insertion into an opening or incision of a patient to treat a target within the patient. The device includes a distal portion sized and shaped for insertion into the patient, and a proximal portion connected to the distal portion, the proximal portion including an external handle for a physician or other user to hold and support the proximal portion during insertion of the distal portion into the patient, a mechanical or electromechanical wrist located at the distal portion, the wrist providing yaw, roll, and pitch movements about corresponding yaw, roll, and pitch axes, each of the yaw, roll, and pitch axes being arranged to intersect one another, a mechanical or electromechanical wrist, an actuator located at the handle, the actuator being coupled to the wrist to operate the wrist to provide yaw, roll, and pitch movements, and an end effector at the distal portion of the device and distal to the wrist, the end effector providing at least yaw, roll, and pitch movements via the wrist in response to operation of the actuator by the user.

[0099] In Example 36, the subject matter of Example 35 optionally includes that the wrist includes a first ball at the distal portion of the device that couples the actuator to the end effector.

[0100] In Example 37, the subject matter of any one or more of Examples 35 - 36 optionally includes a second ball at the proximal portion of the device that couples the handle to the wrist.

[0101] In Example 38, the subject matter of Example 37 optionally includes that the second ball is included within a ball and socket at the proximal portion of the device and is coupled to the first ball such that movement of the second ball provides movement of the first ball in response to movement of the second ball.

[0102] In Example 39, the subject matter of Example 38 optionally includes that the second ball is coupled to the first ball such that the second ball provides a reduced movement of the first ball in response to and relative to the movement of the second ball.

[0103] In Example 40, the subject matter of any one or more of Examples 37 - 39 optionally includes that the second ball is larger than the first ball.

[0104] In Example 41, the subject matter of any one or more of Examples 35 - 40 optionally includes at least one filter or damping mechanism between the actuator and at least one of the wrist or end effector to assist in at least one of smoothing or damping tremors or noise in the application of force to the actuator by the user.

[0105] In Example 42, the subject matter of any one or more of Examples 35 - 41 optionally includes that the wrist includes a first gimbal coupled to the actuator and arranged to pivot about a yaw axis, and a second gimbal coupled to the actuator and arranged to pivot about a pitch axis, and the pitch axis intersects the yaw axis.

[0106] In Example 43, the subject matter of Example 42 optionally includes a rod member constrained by the pivoting of each of the first gimbal and the second gimbal and movable therewith, and the rod member couples at least a portion of the end effector to the wrist.

[0107] In Example 44, the subject matter of Example 43 optionally includes that the rod member couples at least a portion of the end effector to a first ball included in the wrist.

[0108] In Example 45, the subject matter of Example 43 optionally includes that the rod member couples the lower jaw of the gripper of the end effector to the wrist.

[0109] In Example 46, any one or more of the subjects of Examples 35 to 44 optionally include that the end effector includes forceps.

[0110] In Example 47, any one or more of the subjects of Examples 35 to 46 optionally include that the end effector includes a bipolar electrosurgical electrode.

[0111] In Example 48, any one or more of the subjects of Examples 42 to 47 optionally include a first cable that couples a first pulley of a first gimbal to a second ball included in an actuator, and a second cable that couples a second pulley of a second gimbal to the second ball included in the actuator.

[0112] In Example 49, any one or more of the subjects of Examples 35 to 48 optionally include a torque transmission member that couples an actuator to a list to manipulate the list for providing a roll motion.

[0113] In Example 50, the subject of Example 49 optionally includes that the torque transmission member is coupled to a first ball portion of the list and defines a coaxial roll axis that intersects a pitch axis and a yaw axis.

[0114] In Example 51, any one or more of the subjects of Examples 35 to 50 optionally include that the actuator includes a servo motor coupled to the list, a gyroscope of another sensor that receives a user input and provides a sensor output, and a controller coupled to the sensor and the servo motor, the controller being configured to operate the servo motor to control at least one movement of the list.

[0115] In Example 52, the subject of Example 51 optionally includes that at least the handle and the actuator are user attachable and user detachable from at least a distal portion of a device that includes the list and the end effector.

[0116] In Example 53, one or more of the subjects of Examples 51-52 optionally include at least one of an electronic filter or a damping mechanism between the actuator and at least one of a list or an end effector to assist in at least one of smoothing or damping tremors or noise in the application of force to the actuator by the user.

[0117] Example 54 is a hand-held endoscope or laparoscopic device for partially inserting into an opening or incision of a patient to treat a target within the patient, the device comprising a distal portion sized and shaped for insertion into the patient, and a proximal portion connected to the distal portion, the proximal portion including an external handle for a physician or other user to hold and support the proximal portion during insertion of the distal portion into the patient, a ball located at the distal portion, the ball being rotatable to provide yaw, roll, and pitch movements about corresponding yaw, roll, and pitch axes, an actuator located at the handle, the actuator being coupled to the ball to operate the ball to provide yaw, roll, and pitch movements, and an end effector at the distal portion of the device and distal to the ball, the end effector providing at least yaw, roll, and pitch movements via a list in response to operation of the actuator by the user.

[0118] Example 55 is a hand-held endoscope or laparoscope device for partial insertion into an opening or incision of a patient to treat a target within the patient. The device includes a distal portion sized and shaped for insertion into the patient, a proximal portion connected to the distal portion, the proximal portion including an external handle for a physician or other user to hold and support the proximal portion during insertion of the distal portion into the patient, a first ball located at the distal portion, the first ball being rotatable to provide movement to a more distal end effector, a second ball located proximal to the first ball, the second ball being coupled to the first ball to provide a reduced rotational movement of the first ball relative to a greater rotational movement of the second ball, and an end effector movable in response to the reduced rotational movement of the first ball in response to the greater rotational movement of the second ball.

[0119] Example 56 is a method of using a hand-held endoscope or laparoscope device for partial insertion into an opening or incision of a patient to treat a target within the patient. The method includes inserting a distal portion of the device into the patient, gripping a handle to support the proximal portion of the device during insertion of the distal portion into the patient, and actuating an end effector at the distal portion of the device via a mechanical or electromechanical wrist at the handle, the wrist providing yaw, roll, and pitch movements about corresponding yaw, roll, and pitch axes, each of the yaw, roll, and pitch axes being arranged to intersect one another.

[0120] Example 57 is a method of using a hand-held endoscope or laparoscope device for partial insertion into an opening or incision of a patient to treat a target within the patient, the method comprising inserting a distal portion of the device into the patient, gripping a handle to support a proximal portion of the device during insertion of the distal portion into the patient, and, at the handle, actuating an end effector at the distal portion of the device via a ball located at the distal portion, the ball providing yaw, roll, and pitch motion about corresponding yaw, roll, and pitch axes, each of the yaw, roll, and pitch axes being arranged to intersect one another.

[0121] In Example 58, the subject matter of Example 57 optionally includes that actuating comprises rotating a second ball located proximal to the first ball, the second ball being coupled to the first ball to provide a reduced rotational movement of the first ball relative to a greater rotational movement of the second ball.

[0122] The above description includes references to the accompanying drawings that form a part of the detailed description. The drawings illustrate, by way of example, specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as "examples." Such examples can include elements in addition to those illustrated or described. However, the inventors contemplate examples in which only the elements illustrated or described are provided. Further, the inventors contemplate examples that use any combination or permutation of the elements (or one or more aspects thereof) illustrated or described with respect to a particular example (or one or more aspects thereof), or any other example (or one or more aspects thereof) illustrated or described herein.

[0123] Where usage is not consistent between this document and any document so incorporated by reference, the usage in this document governs.

[0124] In this document, the term "a" or "an" is used to include one or more, regardless of any other instance or usage of "at least one" or "one or more", as is common in patent documents. In this document, the term "or" is used to indicate non-exclusive, unless otherwise indicated, such that "A or B" includes "A but not B", "B but not A", and "A and B". In this document, the terms "including" and "in which" are used as the plain English equivalents of the respective terms "comprising" and "wherein". Also, in the following claims, the terms "including" and "comprising" are open-ended, i.e., a system, device, article, composition, formulation, or process that includes elements in addition to those recited after such terms in a claim is still considered to fall within the scope of that claim. Further, in the following claims, terms such as "first", "second", and "third" are used merely as labels and are not intended to impose numerical requirements on their subjects.

[0125] Geometric terms such as "parallel", "perpendicular", "circular", or "square" are not intended to require absolute mathematical precision, unless otherwise indicated in the context. Instead, such geometric terms allow for variations due to manufacturing or equivalent functionality. For example, if an element is described as "circular" or "substantially circular", components that are not exactly circular (e.g., slightly elliptical or polygonally multi-sided) are still encompassed by this description.

[0126] As used herein, the terms "substantially" or "generally" refer to the complete or nearly complete scope or degree of an action, characteristic, property, state, structure, item, or result. For example, an object that is "substantially" or "generally" enclosed means that the object is either completely enclosed or nearly completely enclosed. The exact allowable degree of deviation from absolute completeness may, in some cases, depend on the particular circumstances. However, generally speaking, being nearly complete means that the overall result is generally the same as if absolute and total completeness had been achieved. The use of "substantially" or "generally" is equally applicable when used in a negative sense to refer to a complete or nearly complete absence of an action, characteristic, property, state, structure, item, or result. For example, an element, combination, embodiment, or composition that is "substantially free of" or "generally free of" an element may still actually contain such an element, generally speaking, unless its presence has no significant effect.

[0127] Readers of the patent office and any patents issued with respect to this application are hereby put on notice that, to assist in the interpretation of the claims appended hereto, the applicant does not intend to rely on 35 U.S.C. § 112, paragraph (f) for any claim or any element of a claim in which the phrase "means for" or "step for" is not expressly used.

[0128] In addition, as used herein, the phrase "at least one of [X] and [Y]," where X and Y are various components that can be included in embodiments of the present disclosure, means that an embodiment can include component X without component Y, an embodiment can include component Y without component X, or an embodiment can include both components X and Y. Similarly, when used with respect to three or more components, such as "at least one of [X], [Y], and [Z]," this phrase means that an embodiment can include any one of the three or more components, any arbitrary combination or partial combination of the components, or all of the components.

[0129] In the foregoing description, various embodiments of the present disclosure have been presented for purposes of illustration and description. These are not intended to be exhaustive or to limit the invention to the precise forms disclosed. Obvious modifications or variations are possible in light of the above teachings. The various embodiments were chosen and described in order to provide the best illustration of the principles of the present disclosure and their practical application and to enable one of ordinary skill in the art to utilize the various embodiments with various modifications as are suited to the particular use contemplated. All such modifications and variations are within the scope of the present disclosure as determined by the appended claims when they are fairly, legally, and equitably interpreted.

[0130] Examples of the methods described herein may be at least partially machine or computer implemented. Some examples can include a computer-readable or machine-readable medium encoded with instructions operable to configure an electronic device to perform the methods described in the above examples. Implementations of such methods can include code such as microcode, assembly language code, high-level language code, etc. Such code can include computer-readable instructions for performing various methods. The code can form part of a computer program product. Further, in one example, the code can be tangibly stored on one or more volatile, non-transitory, or non-volatile tangible computer-readable media, such as during execution or otherwise. Examples of such tangible computer-readable media can include, but are not limited to, hard disks, removable magnetic disks, removable optical disks (e.g., compact disks and digital video disks), magnetic cassettes, memory cards or sticks, random access memory (RAM), read only memory (ROM), etc.

[0131] The foregoing description is intended to be illustrative and not restrictive. For example, the above-described embodiments (or one or more aspects thereof) may be used in combination with each other. Other embodiments may be utilized by those skilled in the art upon consideration of the foregoing description. The abstract is provided to enable the reader to quickly ascertain the nature of the technical disclosure. The abstract is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above-described modes for carrying out the invention, various features may be grouped together in order to streamline the disclosure. This should not be construed as intending that the disclosed features not claimed are essential to any of the claims. Rather, the subject matter of the present invention may lie in less than all of the features of a particular disclosed embodiment. Accordingly, the following claims are incorporated as examples or modes for carrying out the invention, and each claim stands on its own as a separate embodiment, and it is contemplated that such embodiments may be combined with each other in various combinations or permutations. The scope of the present invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.

Claims

1. A medical device, comprising: a central portion having a first longitudinal axis for establishing a reference position of the medical device; a handle disposed proximally to the central portion and having three rotational degrees of freedom with respect to the central portion; a distal portion disposed distally to the central portion, extending from the central portion, and having a second longitudinal axis; an operating interface operably coupling the distal portion to the central portion, wherein the distal portion is operable by the handle via the operating interface to pivot about a first point disposed on the first and the second longitudinal axes and about a first set of three orthogonal axes, and the second longitudinal axis passes through the first point during pivoting about each of the three orthogonal axes of the first set and all combinations of these orthogonal axes; A medical device comprising the above.

2. The medical device according to claim 1, wherein the three rotational degrees of freedom of the handle are centered about a second set of at least three orthogonal axes intersecting at a second point.

3. The medical device according to claim 1, wherein the movement of the distal portion about one of the three orthogonal axes of the first set is independent of the movement about the other of the three orthogonal axes.

4. The medical device according to claim 1, wherein the operating interface comprises a core element disposed between a pair of gimbals.

5. The medical device according to claim 4, wherein the core element is centered about the second point.

6. The medical device according to claim 5, wherein the core element includes a spherical bushing.

7. The medical device according to claim 5, wherein the core element includes a hoop.

8. The medical device according to claim 1, further comprising a torque element extending from the handle to the operating interface and having a longitudinal axis, wherein a first angular displacement of the torque element about the first longitudinal axis is the same as a second angular displacement of the distal portion about the second longitudinal axis and is independent of the orientation of the distal portion about other axes.

9. The medical device according to claim 1, wherein a ratio of a first movable range of the distal portion about a first axis to a second movable range of the handle about a second axis corresponding to the first axis is less than 1.

10. The handle is operably coupled to the operation interface using a pair of spaced-apart tension elements that extend along the central portion on both sides of the longitudinal axis, and the distance between the spaced-apart tension elements and the handle is shorter than the distance between the spaced-apart tension elements and the operation interface. The medical device according to claim 9.

11. The pair of spaced-apart tension elements comprises adjacent segments of the same cord having a first end and a second end, the first end and the second end being fixed to an actuator interface, and the cord being wound around a pulley on the operation interface. The medical device according to claim 10.

12. The first end of the pair of spaced-apart tension elements is fixed to an actuator interface, and the second opposite end is fixed to the operation interface. The medical device according to claim 10.

13. Each of the actuator interface and the operation interface further comprises a cam surface, the cam surface being defined by a radius equal to half the distance between the pair of tension elements at the respective actuator interface and operation interface. The medical device according to claim 12.

14. The handle is equipped with a position sensor configured to measure the degree of rotation about the second axis. The medical device according to claim 9.

15. The operation interface is operable by the handle via a servo, the servo being adapted to control the rotation of the distal portion about the first axis based on the ratio of the degree of rotation of the handle about the second axis. The medical device according to claim 14.

16. A medical device, a central portion for establishing a reference position of the medical device; a handle disposed proximal to the central portion; a distal portion disposed distal to the central portion and extending from the central portion; an operation interface disposed at the distal end of the central portion, coupling the distal portion to the central portion, and operable by the handle to control the orientation of the distal portion, wherein the handle is operably coupled to the operation interface by a mechanical coupling configured to absorb the movement of hand tremors of the handle, and the mechanical coupling is An elastic material for absorbing the tremor movement of the hand on the handle, or A motor adapted to attenuate the tremor movement of the hand on the handle An operating interface including at least one of them, and A medical device comprising. **Claim 17**: A medical device, comprising: A central portion having a first longitudinal axis for establishing a reference position of the medical device; A handle disposed proximal to the central portion and having at least two degrees of rotational freedom about respective axes of a first set of three orthogonal axes that intersect the central portion at a first point; A distal portion disposed distal to the central portion, extending from the central portion, and having a second longitudinal axis; An operating interface that couples the distal portion to the central portion and is operable by the handle to pivot the distal portion about respective orthogonal axes of a second set of three orthogonal axes that intersect at a second point with three degrees of rotational freedom with respect to the central portion; and The second longitudinal axis passes through the second point during pivoting about each of the three orthogonal axes of the second set and all combinations of these orthogonal axes. A medical device. **Claim 18**: The medical device according to claim 17, wherein the second set corresponds to the first set. **Claim 19**: The medical device according to claim 17, wherein the movement of the distal portion corresponds to the movement of the handle. **Claim 20**: The medical device according to claim 19, wherein the movement of the distal portion corresponds to the movement of the handle with a coefficient less than 1. **Claim 21**: The medical device according to claim 16, further comprising a power source for supplying power to the electrodes. **Claim 22**: The medical device according to claim 21, wherein the power source is a battery. **Claim 23**: The medical device according to claim 22, wherein the battery is disposed on or within the handle. **Claim 24**: The medical device according to claim 22, wherein the electrodes are disposed on the distal portion and are selectively in electrical communication with the battery. **Claim 25**: The medical device according to claim 21, wherein the motor is in electrical communication with the battery. **Claim 26**: The medical device according to claim 1, wherein the medical device is a non-dominant hand instrument. **Claim 27**: The medical device according to claim 1, wherein the distal portion comprises a pair of jaws. **Claim 28**: The medical device according to claim 27, wherein at least one of the pair of jaws includes at least one degree of rotational freedom with respect to the distal portion. **Claim 29** The medical device according to claim 28, wherein each of the pair of jaws has a degree of rotational freedom with respect to the distal portion.

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