Method for abdominal surgery

Abstract

A method of performing an abdominal surgery within a surgical zone. The method includes creating an incision in the subumbilical region of the abdomen. A mechanical limb is inserted through the incision into the body of the subject, where the mechanical limb comprises a linear portion at least a part of which extends outside the body, and a tool coupled to the distal end of the mechanical limb. The mechanical limb is manipulated within the body such that the tool comes into contact with an abdominal target site. The manipulation of the mechanical limb does not affect any part of the mechanical limb disposed outside the body of the subject. An abdominal surgery is performed within the surgical zone by using the tool.

Description

Technical Field

[0001] This application claims priority to U.S. Provisional Patent Application No. 63 / 357,274, titled "METHODS FOR ABDOMINAL SURGERY," filed on June 30, 2022, which is incorporated herein by reference in its entirety as if fully set forth herein.

[0002] In some embodiments of the present invention, the present invention relates to a method of key-hole abdominal surgery, and more particularly, to a method of key-hole abdominal surgery using a multi-joint robotic arm, which is performed through a Pfannenstiel incision, a sub-Pfannenstiel incision, or an umbilical incision.

Background Art

[0003] For many years, surgeons have sought techniques to reduce the level of invasiveness, reduce scarring, and shorten recovery time associated with surgical procedures. Over the past few decades, various robotic and laparoscopic surgical systems have been developed that enable surgeons to perform surgeries using robotic arms and catheters, among other things. By using such robotic and laparoscopic surgical systems, the size of the incisions required to perform the surgery is reduced, and thus, scarring is reduced and recovery time is shortened. Some examples of such robotic surgical systems are described, for example, in U.S. Patent No. 9,788,911 (Patent Document 1) and U.S. Patent Application Publication No. 2016 / 0184033 (Patent Document 2).

[0004] Regarding abdominal surgery, it is known in the medical art that incisions within the abdomen can lead to the formation of hernias or become infected. Therefore, it is desirable to reduce the number of incisions within the abdomen and / or reduce their dimensions. Further, there are specific locations within the abdomen that are more suitable for making incisions due to being less susceptible to infection and / or the development of hernias. These include incisions along the Pfannenstiel line, also known as the bikini line, or incisions within the umbilicus.

[0005] Some prior art robotic systems use stick arms that terminate within a suitable surgical tool. These arms have minimal flexibility and thus must be inserted into the body at specific angles suitable for performing the surgery. When multiple stick arms are used, multiple incisions are required to enable each stick arm to function at the desired position and angle. Therefore, although the incisions used for such robotic surgery are small, using multiple such incisions can be problematic due to the increased risk of infection and / or the development of hernias.

[0006] It may have been attempted to perform robotic surgery using stick arms as known in the art through a Pfannenstiel incision or an umbilical incision for the purpose of reducing the risk of infection. However, due to the flexibility limitations of the stick arms, there are also specific types of surgeries that may not be possible with such an approach.

[0007] Therefore, there is a need in the art for a robotic system or laparoscopic system that can perform an abdominal surgical process across the entire abdominal cavity while reducing the risk of hernias or infection by using a single small Pfannenstiel incision, sub-Pfannenstiel incision, or umbilical incision to insert the mechanical limb used for performing the surgical procedure.

Prior Art Documents

Patent Documents

[0008]

Patent Document 1

Patent Document 2

Patent Document 3

Summary of the Invention

Means for Solving the Problems

[0009] In some embodiments of the present invention, it relates to a method of keyhole abdominal surgery, and more specifically, to a method of keyhole abdominal surgery using a multi-joint robotic arm, which is performed through a Pfannenstiel incision, a sub-Pfannenstiel incision, or an umbilical incision.

[0010] In the following description and claims, any example referring to performing surgery through a Pfannenstiel is considered to also refer to performing surgery through a sub-Pfannenstiel incision.

[0011] In the context of the following description and claims, a "sub-Pfannenstiel incision" relates to an incision located below the Pfannenstiel line at any location between the Pfannenstiel line and the pubis.

[0012] An incision is considered to be "proximate" to another body part if the shortest distance from the incision, measured along the outer contour of the body, to the body part is at most the width of one finger.

[0013] According to some embodiments, a method of repairing a hernia is provided, the method comprising: inserting a multi-joint robotic arm into the body through an abdominal incision, the multi-joint robotic arm comprising: A linear portion at least a part of which extends outside the body, the linear portion being connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and, A tool connected to the at least one flexible portion, Inserting a multi-joint robotic limb into the body through an abdominal incision, including; Curving the multi-joint robotic limb within the body at the at least one flexible portion such that the tool contacts the hernia, the step of curving the multi-joint robotic limb where the sum of the angles between the longitudinal axes of adjacent effective line segments in at least one three-dimensional plane exceeds 90°; Repairing the hernia using the tool of the multi-joint robotic limb, the step of repairing the hernia including covering the site of the hernia with a mesh, Including.

[0014] According to some embodiments, a method of performing an abdominal surgery within a surgical zone of the body is provided, the method comprising: Inserting two robotic limbs into the body through a single abdominal incision, each of the robotic limbs terminating within a tool, at least one of the two robotic limbs being a multi-joint robotic limb, the multi-joint robotic limb comprising: A linear portion at least a part of which extends outside the body, the linear portion being connected to a mount disposed outside the body; and, At least one flexible portion connected to the linear portion Including, The tool being connected to a second flexible portion, Inserting two robotic limbs into the body through a single abdominal incision; and, The step of transferring the tool of the robotic arm to the surgical area, including curving at least one multi-joint robotic arm within the body at at least one flexible portion so that the tool of the multi-joint robotic arm enters the surgical area, wherein the sum of the angles between the longitudinal axes of adjacent effective line segments in at least one three-dimensional plane exceeds 90°, the step of transferring the tool of the robotic arm to the surgical area; The step of performing surgery within the surgical area using two tools of the robotic arm; Including.

[0015] According to some embodiments, a method of performing an abdominal surgery is provided, the method comprising: The step of inserting a multi-joint robotic arm through a Pfannenstiel incision or through a sub-Pfannenstiel incision into the body, the multi-joint robotic arm comprising: A linear portion at least a part of which extends outside the body, the linear portion being connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and, A tool connected to at least one flexible portion, The step of inserting a multi-joint robotic arm through a Pfannenstiel incision or through a sub-Pfannenstiel incision into the body, including; Curving the robotic arm within the body at at least one flexible portion so that the tool of the robotic arm enters the abdominal surgical area, wherein the abdominal surgical area is the lower quadrant of the abdomen, the step of curving the robotic arm; The step of performing surgery within the abdominal surgical area using the tool; Including.

[0016] According to some embodiments, a method of performing an abdominal surgery within the surgical area of the body is provided, the method comprising: The step of inserting a multi-joint robotic arm through an abdominal incision into the body, the abdominal incision being outside the surgical area, the multi-joint robotic arm comprising: A linear portion at least a part of which extends outside the body, the linear portion being connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and, A tool connected to at least one flexible portion, Inserting a multi-joint robotic limb through an abdominal incision into the body, including: Bending the multi-joint robotic limb within the body at at least one flexible portion such that the tool of the multi-joint robotic limb enters the surgical zone; Using the tool to perform surgery within the surgical zone; and, Including, The shortest distance between the surgical zone and the abdominal incision measured along the body wall is less than 10 cm, less than 8 cm, less than 5 cm, less than 4 cm, less than 3 cm, less than 2 cm, or less than 1 cm.

[0017] According to some embodiments, a method of performing abdominal surgery within a surgical zone of the body is provided, the method comprising: Inserting a multi-joint robotic limb through an abdominal incision into the body, the abdominal incision being outside the surgical zone, the multi-joint robotic limb comprising: A linear portion at least a part of which extends outside the body, the linear portion being connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and, A tool connected to at least one flexible portion; Inserting the multi-joint robotic limb along through the abdominal incision into the body, including: Bending the multi-joint robotic limb within the body at at least one flexible portion such that the tool of the multi-joint robotic limb enters the surgical zone; Performing surgery within the surgical zone using the tool; and, Including, The ratio of the length of the multi-articular robotic limb inside the body, measured as the sum of the lengths of the longitudinal axes of a part of the multi-articular robotic limb inside the body, to the distance between the abdominal incision and the surgical zone when measured along the body wall is at least 2:1.

[0018] According to some embodiments, a method for performing an abdominal surgery within a surgical zone of a body is provided, the method comprising: Inserting a multi-articular robotic limb through an abdominal incision into the body, the multi-articular robotic limb comprising: A linear portion at least a part of which extends outside the body and is connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and, A tool connected to the at least one flexible portion, Inserting the multi-articular robotic limb through the abdominal incision into the body, the multi-articular robotic limb comprising the above; Bending the multi-articular robotic limb within the body at at least one flexible portion such that the tool of the multi-articular robotic limb enters the surgical zone, and after bending, the tool is disposed above the horizontal line with respect to the linear portion entering the abdominal incision, bending the multi-articular robotic limb within the body; Performing a surgery within the surgical zone using the tool; And the like.

[0019] According to some embodiments, a method for performing an abdominal surgery within a surgical zone of a body is provided, the method comprising: Inserting a multi-articular robotic limb through an abdominal incision into the body, the multi-articular robotic limb comprising: A linear portion at least a part of which extends outside the body and is connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and, A tool connected to the at least one flexible portion, Inserting the multi-articular robotic limb through the abdominal incision into the body, the multi-articular robotic limb comprising the above; Curving the multi-joint robotic arm within the body at at least one flexible portion so that the tool of the multi-joint robotic arm enters the surgical zone, and after curving, the tool is disposed within a tool plane that is above the incision plane formed by the abdominal incision and the linear portion with respect to a reference plane; the step of curving the multi-joint robotic arm within the body, The step of performing surgery within the surgical zone using the tool, Including.

[0020] According to some embodiments, a method for performing an abdominal surgery within a surgical zone of a body is provided, the method comprising: Inserting a multi-joint robotic arm through an abdominal incision into the body, the multi-joint robotic arm comprising: A linear portion at least a part of which extends outside the body and is connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and, A tool connected to at least one flexible portion, The step of inserting a multi-joint robotic arm through an abdominal incision into the body, including, Curving the multi-joint robotic arm within the body at at least one flexible portion so that the tool of the multi-joint robotic arm enters the surgical zone, The step of performing surgery within the surgical zone using the tool, Including, The inserting step includes inserting the first and second flexible portions into the body while maintaining at least a majority of the linear portion outside the body.

[0021] In some embodiments, the inserting step includes inserting the first and second flexible portions into the body while maintaining the entire linear portion outside the body.

[0022] According to some embodiments, a method for performing an abdominal surgery within a surgical zone of a body is provided, the method comprising: Inserting a multi-joint robotic limb through an abdominal incision into the body, the multi-joint robotic limb comprising: A linear portion at least a part of which extends outside the body and is connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and A tool connected to at least one flexible portion, comprising the step of inserting a multi-joint robotic limb through an abdominal incision into the body; Bending the multi-joint robotic limb within the body at at least one flexible portion so that the tool of the multi-joint robotic limb enters the surgical zone; Performing a surgery within the surgical zone using the tool; and The ratio of the length of the multi-joint robotic limb disposed outside the body to the length of the portion of the multi-joint robotic limb disposed inside the body, measured as the sum of the length of the multi-joint robotic limb disposed outside the body and the length of the longitudinal axis of a part of the multi-joint robotic limb inside the body, is in the range of 1:2 to 1:4.

[0023] According to some embodiments, a method for performing an abdominal surgery within a surgical zone of the body is provided, the method comprising: Inserting a multi-joint robotic limb through an abdominal incision into the body, the multi-joint robotic limb comprising: A linear portion at least a part of which extends outside the body and is connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and A tool connected to at least one flexible portion, comprising the step of inserting a multi-joint robotic limb through an abdominal incision into the body; Bending the multi-joint robotic limb within the body at at least one flexible portion so that the tool of the multi-joint robotic limb enters the surgical zone; Performing a surgery within the surgical zone using the tool; and The ratio of the length of a portion of the multi-joint robotic limb disposed outside the body to the length of a portion of the multi-joint robotic limb disposed inside the body, measured as the sum of the length of a portion of the multi-joint robotic limb disposed outside the body and the length of the longitudinal axis of a portion of the multi-joint robotic limb disposed inside the body, is at least 1:2 or at least 1:3.

[0024] According to some embodiments, a method of performing an abdominal surgery within a surgical zone of the body is provided, the method comprising: Inserting a multi-joint robotic limb through an abdominal incision into the body, the multi-joint robotic limb comprising: A linear portion at least a portion of which extends outside the body and is connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and, A tool connected to at least one flexible portion, Inserting the multi-joint robotic limb through the abdominal incision into the body; Bending the multi-joint robotic limb within the body at at least one flexible portion such that the tool of the multi-joint robotic limb enters the surgical zone; Performing a surgery within the surgical zone using the tool; And, When the mount outside the body is stationary, the ratio of the length of the multi-joint robotic limb disposed inside the body that is stationary with respect to the abdominal incision to the length of the multi-joint robotic limb disposed inside the body that is movable with respect to the abdominal incision is at least 1:5, at least 1:8, at least 1:10, or at least 1:15.

[0025] According to some embodiments, a method of performing an abdominal surgery using a robotic limb is provided, the robotic limb comprising (i) a linear portion, (ii) at least one flexible portion connected to the linear portion, and (iii) a tool connected to at least one flexible portion, the method comprising: Placing a trocar within an abdominal incision while the trocar is at a first angular direction with respect to abdominal tissue including the incision; Inserting the mechanical limb through the trocar into the body to a first extent while the trocar is in a first angular direction such that a first segment of the mechanical limb is disposed inside the body; Changing the angular direction of the trocar relative to the abdominal tissue together with the first segment of the mechanical limb; Inserting the mechanical limb through the trocar to a second extent while the trocar is in a second angular direction such that the first segment of the mechanical limb and an additional second segment are disposed inside the body; Bending the mechanical limb within the body with the first and second flexible portions such that the tool of the mechanical limb enters the abdominal surgery zone; Performing surgery within the abdominal surgery zone using the tool; Including.

[0026] According to some embodiments, a method of performing abdominal surgery within a surgical zone is provided, the method comprising: Creating an incision in the subumbilical fan retractor region of the abdomen; Inserting a mechanical limb through the incision into the body of the subject, the mechanical limb including a linear portion at least a part of which extends outside the body and a tool coupled to the distal end of the mechanical limb, inserting the mechanical limb through the incision into the body of the subject; Manipulating the mechanical limb within the body such that the tool contacts the abdominal target site, the step of manipulating the mechanical limb not affecting any portion of the mechanical limb disposed outside the body of the subject, manipulating the mechanical limb within the body; Performing abdominal surgery within the surgical zone using the tool; Including.

[0027] According to some embodiments, the step of creating the incision includes creating an incision below the fan retractor line and proximate to the pubis.

[0028] Unless otherwise specified, all technical and / or scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention pertains. Although methods and materials similar or equivalent to those described herein can be used in the practice or testing of embodiments of the present invention, the following describes exemplary methods and / or materials. In case of conflict, the present specification, including definitions, will control. In addition, these materials, methods, and examples are illustrative only and not intended to be limiting in any way.

[0029] The above considerations will be more readily understood from the following detailed description of the invention in conjunction with the accompanying drawings (FIGS. 1A - 11).

Brief Description of the Drawings

[0030]

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DETAILED DESCRIPTION OF THE INVENTION

[0031] By referring to the drawings and the accompanying description, the principle of the method of the robot and / or laparoscopic abdominal surgery of the present invention can be better understood.

[0032] Before describing in detail at least one embodiment of the present invention, it will be understood that the present invention is not limited only to the details of the configuration and arrangement of the components described in the following description or shown in the drawings in its application. The present invention is capable of other embodiments or can be implemented or carried out in various ways. Further, it will be understood that the terms and technical terms employed herein are for the purpose of description and should not be regarded as limiting.

[0033] In this application, the terms "subject" and "patient" are used interchangeably and relate to humans.

[0034] In this application, the term "retroflex" relates to curving the mechanical limb to an angle greater than 90 degrees such that the vector of the tip of the mechanical limb has a component that at least points towards the base of the mechanical limb. An example of curving the mechanical limb in retroflex is presented in FIG. 1A.

[0035] In this application, the term "antigrade" relates to curving the mechanical limb such that the vector representing the direction of the tip of the mechanical limb has a component that at least points away from the base of the mechanical limb. Examples of curving the mechanical limb in antigrade are presented in FIGS. 1B and 1C.

[0036] FIGS. 1A, 1B, and 1C are simplified schematic views of a multi-joint mechanical arm of a surgical device in various orientations according to some embodiments of the present invention.

[0037] As shown, the device 100 (e.g., a surgical device) in FIGS. 1A to 1C includes at least one multi-joint mechanical limb 101 or arm according to some embodiments of the present invention. In some embodiments, the device includes a first arm and a second arm. However, the device can also include three or more arms. In the context of this application, a multi-joint mechanical arm or limb is a flexible arm made of two or more links that can be manipulated to change the shape, form, or geometry of the arm.

[0038] In some embodiments, each arm 101 includes a support segment 102 connected to a first segment 112 by a first connection section 108. The first segment 112 can be connected to a second segment 116 by a second connection section 120, and a third segment 124 can be connected to the second segment 116 by a third connection section 128.

[0039] In some embodiments, the support segment 102 is rigid. In some embodiments, the support segment 102 can be flexible or can include a flexible portion. In some embodiments, the support segment 102 is linear.

[0040] In some embodiments, the articulated robotic limb can include a humanoid-like structure. For clarity, in this application, some device segments and connection sections can be referred to by anatomical names: The support segment 102 is also referred to as the torso 102; The first connection section 108 is also referred to as the shoulder joint 108; The first segment 112 is also referred to as the upper arm 112; The second connection section 120 is also referred to as the elbow joint 120; The second segment 116 is also referred to as the radius 116; The third segment 124 is also referred to as the hand tool 124.

[0041] In some embodiments, one or more connection sections include a hinge. In some embodiments, one or more connection sections are flexible and / or include a flexible portion. In an exemplary embodiment, for example, the articulated robotic arm of the device includes an elbow joint and a shoulder joint. Curving each joint can be distributed along the joint in the direction of the longitudinal axis of the joint.

[0042] In some embodiments, one or more device segments have a substantially cylindrical outer shape (e.g., radius, upper arm). In some embodiments, the joint can have a circular cross-section that is perpendicular to the longitudinal axis of the joint. Alternatively, in some embodiments, one or more device segments and / or joints have a non-circular cross-section or non-circular outer shape, such as an elliptical, square, rectangular, or irregular shape.

[0043] In some embodiments, the articulated robotic arm includes one or more short and / or adjustable segments. In some embodiments, the flexible portion is directly connected.

[0044] In some embodiments, the articulated robotic arm 101 of device 100 has at least the degrees of freedom of movement of a human arm. Generally, the segments of a human limb (e.g., arm, leg) move to bend and extend from the proximal segment joint and to rotate about the proximal segment joint. For example, the human radius bends and extends at the elbow and rotates around the elbow.

[0045] As used herein, the term proximal joint means a joint that is at least removed from the torso to which the segment is connected. For example, the proximal joint of the hand is the wrist, the proximal joint of the radius is the elbow joint, and the proximal joint of the upper arm is the shoulder joint.

[0046] As used herein, the term proximal segment means a segment that is at least removed from the torso to which the segment is connected (e.g., by the proximal segment joint). For example, the proximal segment of the hand is the radius, the proximal segment of the radius is the upper arm, and the proximal segment of the upper arm is the torso.

[0047] In some embodiments, one or more joints are bendable and extendable in a certain direction. In some embodiments, the rotation of the segment about the proximal joint of the segment is achieved by the rotation of the proximal segment about the longitudinal axis of the proximal segment. For example, the rotation of the hand about the wrist joint is by the rotation of the radius about the longitudinal axis of the radius.

[0048] Generally, the degrees of freedom of movement of a human arm include the limit points of the rotation angle and the bending angle. Optionally, in some embodiments, the device is limited to the degrees of freedom of movement of a human, for example, during one or more control modes.

[0049] In some embodiments, the upper arm 112 is adapted to flex or extend at the shoulder joint 108 by at least 45°, at least 90°, at least 120°, or at least 180° (referred to herein as shoulder flexion). In some embodiments, the shoulder flexion exceeds 180°. In some embodiments, the shoulder flexion is up to 250° or up to 300°. In an exemplary embodiment, the shoulder flexion is about 200°.

[0050] In some embodiments, the radius 116 is adapted to flex or extend from the elbow joint 120 by at least 45°, at least 90°, or at least 180° (also referred to herein as elbow flexion). In some embodiments, the elbow flexion exceeds 180°. In some embodiments, the elbow flexion is up to 250° or up to 300°. In an exemplary embodiment, the elbow flexion is about 200°.

[0051] Typically, during a surgical procedure, the multi-joint robotic arm 101 enters the body 160 through a body cavity or incision. Typically, the torso 102 extends through the entry point and the remainder of the arm 101 is disposed inside the body.

[0052] In some embodiments, the arm 101 inside the body curves such that the tool 124 faces towards the torso 102, as shown in FIG. 1A. This type of curvature is referred to as "retroflexion curvature". The arm 101 is considered to be curved in retroflexion when the vector in the direction pointed by the arm has a component towards the torso 102, although it will be recognized that the tool 124 is not oriented in a direction parallel to the torso 102.

[0053] In some embodiments, the in-body arm 101 curves, as shown in FIGS. 1B and 1C, such that the tool 124 faces away from the torso 102. This type of curvature is referred to herein as "antegrade motion curvature". The arm 101 is considered to curve in antegrade motion if the vector in the direction indicated by the arm has a component that faces away from the torso 102, although it will be recognized that the tool 124 does not face in a direction parallel to the torso 102.

[0054] FIG. 1A schematically shows two types of retrograde motion curvature that can be achieved by the arm 101. In the version shown as arm 101a, the flexible portion of the arm and in particular the tool 124a curves upward to the tool line 130 with respect to the torso 102 extending through the entry point and with respect to the bed 135 on which the body is placed. As indicated by reference numeral 140 in FIG. 1A, one can imagine that the horizontal line of the arm 101 is a plane that extends through the incision or entry point where the arm enters the body and through the torso 102 of the arm. In this case, the tool line 130 is disposed "above the horizontal line" with respect to the bed 135 and functions as a reference plane. Thus, the tool 124a of the arm 101a is said to be disposed "above the horizontal line", and the arm 101a is said to "retrograde above the horizontal line".

[0055] Conversely, in the version shown as arm 101b, the flexible portion of the arm and in particular the tool 124b curves downward to the tool line 150 with respect to the horizontal line 140 and with respect to the bed 135. In this case, the tool line 150 is disposed "below the horizontal line" with respect to the reference plane of the bed 135. Thus, the tool 124b of the arm 101b is said to be disposed "below the horizontal line", and the arm 101b is said to "retrograde below the horizontal line".

[0056] Figures 1B and 1C schematically show two types of forward movement curvatures achievable by the arm 101. As can be seen in Figure 1B, the flexible portion of the arm 101 or particularly the tool 124 curves upward to the tool line 160 with respect to the body 102 extending through the entry point and with respect to the bed 135. In Figure 1B, the horizontal line is indicated by reference numeral 165. In this case, the tool line 160 is disposed "above the horizontal line" with respect to the reference plane of the bed 135. Accordingly, the tool 124 of the arm 101 is said to be disposed "above the horizontal line", and the arm 101 is said to "perform forward movement above the horizontal line". The curvature of the arm shown in Figure 1B is also known as an S-shaped curvature above the horizontal line.

[0057] Conversely, as can be seen in Figure 1C, the flexible portion of the arm 101 or particularly the tool 124 curves upward to the tool line 170 with respect to the body 102 extending through the entry point and with respect to the bed 135. In Figure 1C, the horizontal line is indicated by reference numeral 175. In this case, the tool line 170 is disposed "below the horizontal line" with respect to the reference plane of the bed 135. Accordingly, the tool 124 of the arm 101 is said to be disposed "below the horizontal line", and the arm 101 is said to "perform forward movement below the horizontal line". The curvature of the arm shown in Figure 1C is also known as an S-shaped curvature below the horizontal line.

[0058] In some embodiments, the device is self-standing, e.g., it does not require the support of a user or another support structure. In some embodiments, one or more parts of the device are at least partially supported by a support structure. In some embodiments, the user does not interact directly with the device. In some embodiments, the movement of the device is substantially automated.

[0059] FIG. 2 is a simplified schematic view of a system 550 according to some embodiments of the present invention, where the device 500 is held by a support structure 552 in a position suitable for a transfan nenstiel surgery. FIGS. 3A and 3B are simplified schematic views of a system 550 according to some embodiments of the present invention, where the device 500 is held by a support structure 552 in a position suitable for a transumbilical surgery.

[0060] In some embodiments, the device 500 is coupled to a bed 580. In some embodiments, the patient 560 lies laterally on the bed 580 during a surgical procedure using the device 500. In some embodiments, one or more components of the device, such as one or more components of a device control device (e.g., a motor), are located under the bed. In some embodiments, the support structure 552 connects the device 500 to the bed 580. Optionally, connections to other components, such as other components such as a transformer, other components such as a display, may be located within a housing 554 that may be under the bed.

[0061] In an exemplary embodiment, a main motor unit for controlling the movement of the device is located within the housing, where, for example, in some embodiments, a torque transmission element transmits torque from the motor within the housing to the device 500, and / or an elongate element for achieving flexion of a device joint is coupled to the motor within the housing.

[0062] In some embodiments, the control of the movement of the device above the bed using a motor unit under the bed is via an orientation control device, such as using parallel links, as described, for example, in International Publication No. WO 2011 / 036626 (Patent Document 3), which is hereby incorporated by reference in its entirety.

[0063] One or more components located under the bed (e.g., inside the housing) can reduce the footprint of the system in the operating room. Additionally, this configuration can potentially improve access to the patient (e.g., in an emergency situation).

[0064] A device coupled to the bed can be capable of moving the bed and / or changing the angle of the bed while the device remains in the same position relative to the bed and / or the patient, for example, during surgery. In some embodiments, the position of the device relative to the patient and / or the bed is adjustable, for example, before and / or during a treatment using the device.

[0065] Optionally, in some embodiments, the support device 552 is adapted to move the device 500 to a position for surgery. In some embodiments, the support device 552 is adapted to move the device 500 to a desired position for inserting the arm of the device into the patient 560. In some embodiments, the support device 552 is adapted to move the device vertically, horizontally, and / or laterally. In some embodiments, the support device 552 is adapted to insert the device 500 into the patient 1160 and / or to withdraw the device 500 from the patient.

[0066] In the embodiment shown in FIG. 2, the support device 552 and the device 500 are configured to insert the device into the patient's body through a Pfannenstiel incision. However, the support device and the device of FIG. 2 can similarly be used to perform surgery through a sub-Pfannenstiel incision.

[0067] Specifically, in this arrangement, the support structure 552 is located at the leg end of the bed 580 such that the device 500 extends over the patient's pubic area towards the patient's bikini line. In FIG. 2, the patient 560 is shown in a position suitable for inserting the device 500 through a small Pfannenstiel incision, where the patient's legs are lifted and separated (e.g., held by a stirrup strap not shown). In some embodiments, when the device 500 enters the body through the Pfannenstiel incision, a camera functionally associated with the device enters the body through a small umbilical incision, as will be described in more detail later.

[0068] In the embodiments shown in FIGS. 3A and 3B, the support device 552 and the device 500 are arranged to insert the device into the patient's body through a small umbilical incision. Specifically, in this arrangement, the support structure 552 is located approximately at the center of the longitudinal axis of the side edge along the side edge of the bed 580 such that the device 500 extends over the patient's umbilical area. In FIGS. 3A and 3B, the patient 560 is shown with the patient's legs lifted and separated (e.g., held by a stirrup strap not shown). However, in the case of transumbilical access of the device 500, the patient can also assume other postures, such as lying on their side with the entire spine on the bed 580. In some embodiments, when the device 500 enters the body through the umbilical incision, a camera functionally associated with the device also enters the body through the umbilical incision.

[0069] FIGS. 4A and 4B are schematic views of the position of a system 650 including a device 600, according to some embodiments, as described above in connection with FIGS. 1A and 1C, where a surgery for the treatment of an inguinal hernia is being performed through a small Pfannenstiel incision. However, in some embodiments, the surgery can be performed similarly through a sub-Pfannenstiel incision.

[0070] As shown, the system 650 includes a device 600 that enters the patient's body 660 through a Pfannenstiel incision and an imaging assembly 670 that enters the body 660 through an umbilical incision.

[0071] As shown, the device 600 includes one or more articulated robotic arms 620 that pass through a first trocar 622 disposed within the Pfannenstiel incision. The articulated robotic arms 620 can be controlled by a remote-control unit (RCU) 624 disposed external to the patient's body. In some embodiments, the robotic arm 620 can be further associated with a laparoscopic grasper 626. As discussed above in connection with FIGS. 1A through 1C, the robotic arm includes segments connected by joints that can rotate independently about the longitudinal axis of the segment and can bend independently within a single plane of curvature.

[0072] The imaging assembly 670 includes a camera 672 disposed on a laparoscope 674, and the laparoscope 674 enters the body through a second trocar 676 disposed within the umbilical incision. In some embodiments, the imaging assembly 670 can further include a light source 678 and / or a carbon dioxide insufflation assembly 680, both of which are functionally associated with the laparoscope 674 for use during the surgical procedure.

[0073] For comparison, FIG. 4A additionally shows what occurs when using a prior art "stick arm" 690, as described in the prior art, to repair an inguinal hernia through a Pfannenstiel incision. As shown, the prior art arm 690 is to be inserted through the Pfannenstiel incision and will be guided towards the inguinal triangle as far as possible given the anatomical structure. However, since the prior art arm 690 has a maximum curvature range of 45 degrees (or less than 45 degrees), it is mechanically impossible to transfer the prior art arm 690 through the Pfannenstiel incision to reach the inguinal triangle. This angular difference is simply too large to be covered using an arm that has such a limited curvature range.

[0074] In contrast, the robotic arm 620 according to an embodiment of the present invention curves around the pubis of the patient 660, thereby making it possible to reach the inguinal hernia for the treatment of the inguinal hernia. For the treatment of the inguinal hernia, the robotic arm 620 must flex posteriorly at an angle greater than 90 degrees below the horizontal line (as described above in relation to FIG. 1A) to assist in the surgery within the inguinal triangle (e.g., as the surgical zone), as clearly illustrated in FIGS. 4A and 4B. In some embodiments, the curvature of the arm 620 is such that the hernia will be contacted from the access direction, which is at least 90 degrees different from the direction in which the arm 620 enters the incision.

[0075] As will be described in more detail later, for the treatment of the hernia, the displaced tissue can be returned to its intended position and the hernia site can be covered with a mesh. In some embodiments, the mesh can be inserted through the Pfannenstiel incision, as will be described in more detail later.

[0076] In some embodiments, multiple robotic arms 620 can be inserted through an incision for the treatment of a hernia. For example, this can be useful when the hernia has to be treated from multiple different angles, such as when holding a mesh from various angles. As another example, multiple different tools can be used at the ends of different robotic arms.

[0077] As will be described in more detail later in connection with FIG. 6, the surgical zone is very close to the incision, and the distance between them or the distance between the surgical zone and the first trocar 622 can be less than 10 cm. In some embodiments, the ratio of the length of the robotic arm 620 disposed inside the body (i.e., the total length of the longitudinal axis of the segments of the arm disposed inside the body) to the distance between the incision / trocar and the surgical zone is at least 2:1, at least 3:1, at least 4:1, at least 5:1, at least 8:1, or at least 10:1. This distance can be measured along the body wall such as the pubic wall, and can be measured from the center of the incision to the center of the surgical zone or from the edge of the incision to the edge of the surgical zone.

[0078] As will be described in more detail later in connection with FIG. 7, at least most of the linear portion of the robotic arm (the torso 102 shown in FIG. 1A), and in some embodiments, the entire linear portion, is maintained outside the body during the hernia repair surgery, and the distance between them or the distance between the surgical zone and the first trocar 622 is less than 10 cm.

[0079] In some embodiments, the inguinal hernia can be an indirect inguinal hernia, where the tissue is trapped within the inguinal triangle (Hesselbach triangle). In some embodiments, the inguinal hernia can be a direct inguinal hernia, where the tissue (e.g., of the intestine) extends through the inguinal triangle and outside the inguinal triangle.

[0080] Next, refer to FIGS. 5A and 5B, which are schematic views of the positions of device 600 and system 650 during surgery for treating abdominal wall hernias through a small Pfannenstiel incision according to some embodiments. However, in some embodiments, the surgery can also be performed through a sub-Pfannenstiel incision.

[0081] As shown, the abdominal wall hernia is disposed between the Pfannenstiel incision and the umbilicus along the abdominal wall of the patient's body. The systems and devices shown in FIGS. 5A and 5B are substantially the same as the systems and devices shown in FIGS. 4A and 4B, and for the sake of brevity, the descriptions of the systems and devices shown in FIGS. 5A and 5B are not repeated herein.

[0082] For comparison, FIG. 5A additionally shows what occurs when using a prior art "stick arm" 690 to repair an abdominal wall hernia through a Pfannenstiel incision, as described in the prior art. As shown, the prior art arm 690 is to be inserted through the Pfannenstiel incision and will be guided towards the abdominal wall hernia as far as possible given the anatomical structure. However, since the prior art arm 690 has a maximum bending range of 45 degrees (or less than 45 degrees), it is mechanically impossible to transfer the prior art arm 690 through the Pfannenstiel incision to reach an abdominal wall hernia disposed on the abdominal wall below the umbilicus. This angular difference is simply too large to be covered using an arm that has such a limited bending range.

[0083] In contrast, the robotic arm 620 according to an embodiment of the present invention can reach the abdominal wall hernia for the treatment of the abdominal wall hernia. For the treatment of the abdominal wall hernia along the abdominal wall, the robotic arm 620 must bend backward at an angle exceeding 90 degrees above the horizontal line, as described above in connection with FIG. 1A and as can be clearly seen in FIGS. 5A and 5B. In some embodiments, the curvature of the arm 620 is such that the hernia will be contacted from the access direction, which is at least 90 degrees different from the direction in which the arm 620 enters the incision.

[0084] The treatment of abdominal wall hernias is substantially the same as the treatment of inguinal hernias as described herein and can include the use of multiple robotic arms, placement of the mesh, and working within the surgical zone very close to the incision.

[0085] Next, refer to FIG. 6, which is a schematic view of the system 700 of the system 750 during an abdominal surgery according to some embodiments. The device 700 includes one or more robotic arms 710 as described above in connection with FIGS. 1A through 1C.

[0086] As discussed above in connection with FIGS. 4A through 5B, the robotic arm 710 enters the body through the incision zone 720 and performs surgery within the surgical zone 730. As can be clearly seen in FIG. 9, there may be a very small distance D between the incision zone 720 and the surgical zone 730. For example, the distance D may be less than 10 cm, less than 8 cm, less than 5 cm, less than 4 cm, less than 3 cm, less than 2 cm, or less than 1 cm.

[0087] In some embodiments, the distance D can be measured between the center of the incision and the center of the surgical zone. In some embodiments, the distance D can be the shortest distance measured between any point within the incision and any point within the surgical zone. The distance D can be measured along a body wall such as the abdominal wall, or can be measured along the shortest possible route including passing through the abdominal cavity. In some embodiments, the distance D can be measured between the base of the trocar disposed within the incision and the point within the surgical zone closest to the trocar.

[0088] In some embodiments, the ratio of the length of the arm 710 disposed inside the body to the distance D is at least 1.5:1, at least 2:1, at least 3:1, at least 4:1, at least 5:1, at least 8:1, or at least 10:1. The length of the arm 710 disposed inside the body can be measured as the sum of the lengths of the longitudinal axes of portions of the arm disposed inside the body. This sum typically includes the longitudinal length of the joints, but is not necessarily required.

[0089] FIG. 7 is a schematic view of the device 800 of the system 850 during an abdominal surgery according to some embodiments. The device 800 includes one or more robotic arms 810 as described above in connection with FIGS. 1A - 1C. Each of the robotic arms 810 includes a linear portion 812 (similar to the torso 102 of FIG. 1A), a tool 814 disposed at the end of the robotic arm, and a flexible portion 816 extending between the end of the linear portion 812 and the tool 814. The flexible portion 816 typically includes a first joint 817 (similar to the shoulder joint 108 of FIG. 1A) and a second joint 818 (similar to the elbow joint 120 of FIG. 1A).

[0090] As discussed above with reference to FIGS. 4A - 5B, the robotic arm 810 enters the body through a small incision 820 that can be a Fannensteel incision, a sub - Fannensteel incision, or an umbilical incision for performing surgery within the surgical zone 830.

[0091] In abdominal surgeries such as surgeries for treating hernias, most of the linear portion 812 of the arm is disposed outside the body, and only a small portion of the linear portion of the arm enters the body through the incision. In some embodiments, the entire linear portion 812 can be retained outside the body such that the most proximal point of the arm 810 entering the body is the first joint 817.

[0092] In some embodiments, the ratio of the length of the section of the linear portion 812 disposed inside the body, indicated by "l" in FIG. 7, to the length of the section of the linear portion 812 disposed outside the body, indicated by "L" in FIG. 7, is at least 1:3, at least 1:5, at least 1:8, or at least 1:10.

[0093] In some embodiments, when the arm 810 is inserted into the body through the incision 820 and the remote control unit outside the body remains in a fixed position, the linear arm portion 812 also maintains a non-movable state with respect to the incision and the tissue surrounding the incision. In some embodiments, the ratio of the length of the movable portion of the arm 810 disposed inside the body (i.e., the total length of the flexible portion 816) to the length of the portion of the arm 810 at a fixed position within the body (i.e., the length "l" of the section of the linear portion 812 disposed inside the body) is at least 3:1, at least 5:1, at least 8:1, or at least 10:1.

[0094] FIGS. 8A, 8B, and 8C are schematic diagrams of steps of inserting the device 900 of the system 950 into the abdomen during surgery, according to some embodiments. The device 900 includes one or more robotic arms 910, as described above in connection with FIGS. 1A through 1C. Each of the robotic arms 910 includes a linear portion 912 (similar to the torso 102 of FIG. 1A), a tool 914 disposed at the end of the robotic arm, and a flexible portion 916 extending between the end of the linear portion 912 and the tool 914. The flexible portion 916 typically includes a first joint (similar to the shoulder joint 108 of FIG. 1A) and a second joint (similar to the elbow joint 120 of FIG. 1A).

[0095] As can be seen in FIG. 8A, to perform surgery within abdominal tissue 920 having an incision 922 therein, a trocar 924, which may also be referred to as a cannula or port, can be inserted into the incision in a first angular direction that is shown here as being substantially perpendicular to tissue 920. Arm 910 can be inserted into the body to a first extent in a first orientation that is in the direction of arrow 926 through incision 922 and trocar 924. Typically, some of tool 914 and flexible portion 916 will be inserted through trocar 924 during this initial penetration stage. In some embodiments, the penetration of arm 910 into the body in the angular direction of FIG. 8A is limited by the presence of anatomical structures or formations that block the path for further insertion of arm 910. For example, if incision 922 is a Pfannenstiel incision into the abdomen, the pubis and / or uterus may prevent the arm from further entering the body in the direction of arrow 926.

[0096] As can be seen in FIG. 8B, trocar 924 is pivoted in the direction of arrow 928 together with arm 910, such that the angular direction between the longitudinal axes of trocar 924 and arm 910 with respect to tissue 920 changes to a second angular direction. In the illustrated embodiment, at the second angular direction, an acute angle α is formed between tissue 920 and the longitudinal axis of arm 910. It will be appreciated that during the pivoting shown in FIG. 8B, the longitudinal axes of arm 910 and trocar 924 remain substantially parallel to each other, and arm 910 pivots minimally or not at all with respect to the trocar.

[0097] Arm 910 is then continuously inserted into the body through trocar 924 in its new orientation in the direction of arrow 930. When a sufficient length of arm 910 has entered the body, arm 910 can be curved, for example, by performing a posterior flexion movement in the direction of arrow 932 as can be seen in FIG. 8C, for the purpose of accessing surgical zone 940.

[0098] After the arm 910 is inserted into the body to the extent necessary, the surgery continues with the trocar 924 in the position shown in FIGS. 8B and 8C, and it will be appreciated that the movements necessary to perform the surgery are effected by curving and rotating the arm 910 or segments of the arm 910 in various directions to various orientations.

[0099] FIGS. 9A, 9B, 9C, 9D, and 9E are schematic views of a system 1150 including a device 1100 and a camera 1120 when performing abdominal surgery through a transfascial stab incision according to some embodiments. The device 1100 includes one or more robotic arms 1110 as described above in connection with FIGS. 1A - 1C. As can be seen in FIG. 9A, during surgery through a transfascial stab incision, the arm 1110 enters the body through the transfascial stab incision in the direction of arrow 1122, while the camera 1120 enters the body through a transumbilical incision in the direction of arrow 1124.

[0100] As shown, for example, for the purpose of reducing the occlusion of the images captured by the camera 1120 caused by an arm 1100 that curves in a retroflexion movement below the horizontal line and blocks the camera's line of sight, the direction in which the arm enters the body is determined to be at an angle with respect to the direction in which the camera enters the body and not along the midline of the body. This aspect is more clearly shown in FIG. 9B, which shows an obtuse angle formed between the direction in which the arm 1110 enters the body and the direction in which the camera 1120 enters the body. FIG. 9B further shows the curvature of the arm 1110 below the horizontal line for treating the pubic region.

[0101] FIG. 9C shows that, regardless of the relative angular direction of the arm 1110 and the camera 1120, the line of sight of the camera may be blocked by the arm as indicated by arrow 1130. Further, in some embodiments, the camera will view the arm from above the height of the arm or from below the arm, which can be very disorienting for a surgeon accustomed to viewing the surgical zone from above the tools of the arm.

[0102] One possible solution for preventing or reducing the blocking of the camera's field of view in this way is shown in FIGS. 9D and 9E. As shown, rather than having arms disposed parallel to each other as shown in FIGS. 9B and 9C, the arms are curved such that they come to either side of the surgical zone 1140, thereby enabling visual access to the surgical zone. Specifically, in FIG. 9D, while the arm 1110b is being moved from its previous position indicated by the dashed line 1142 to the opposite side of the surgical zone 1140, the arm 1110a remains in its position as discussed above. This forms a shape similar to that of a "frog's leg", defining a window having, for example, a rhombic cross-section, thereby enabling the camera to have an unobstructed line of sight to the surgical zone 140.

[0103] FIG. 9E shows a surgical procedure from the perspective of a camera entering through a transumbilical incision. As shown, the camera visually recognizes the tools of the arm 1110 from above in a convenient manner for the surgeon, and the surgical zone 1140 is not blocked. In some embodiments, the arm may be traversed as can be seen in FIG. 9E to make the orientation of the surgeon with respect to the arm easier.

[0104] Next, refer to FIGS. 10A, 10B, 10C, 10D, and 10E, which are schematic diagrams of a method for performing an abdominal surgery according to some embodiments.

[0105] As can be seen in FIG. 10A, for example, a scope 1200 including a light source, a camera, and a gas source is inserted into the body 1202 of a subject through an umbilical incision and is used to inflate the subject's stomach. As described in detail above herein, an incision zone 1204 in which an incision for performing an abdominal surgery is made can be within the Pfannenstiel line, also known as the bikini line. The Pfannenstiel region is typically two finger breadths (i.e., 2 - 5 cm) above the pubis 1206 and is disposed higher than the gallbladder 1208 and the uterus 1210. FIG. 10B shows the abdominal surgery described above, where the subject's stomach 1212 is inflated, the scope 1200 has entered the body through the umbilical incision, and the multi-joint robotic arm 1214 has entered the body through the Pfannenstiel incision.

[0106] FIG. 10C is a view similar to FIG. 10A and includes a different incision zone 1216 in the sub-Pfannenstiel region. As shown, the different incision zone 1216 is close to the pubis 1206, such as within a range of, for example, 1 cm from the pubis. The second incision zone 1216 remains above the gallbladder 1208 but is often disposed below the highest point of the uterus 1210, as shown. For clarity, if an incision is made within the sub-Pfannenstiel region, this incision replaces the Pfannenstiel incision described above.

[0107] FIG. 10D shows an abdominal surgery, where the subject's stomach 1212 is inflated, the scope 1200 has entered the body through the umbilical incision, and the multi-joint robotic arm 1218 has entered the body through the sub-Pfannenstiel incision within the second incision zone 1216. As shown, the multi-joint robotic arm 1218 enters the body very close to the pubis 1206 and can be in a state of almost leaning on the pubis. In some embodiments, as shown, all the joint parts of the robotic arm are within the body, and at least all the parts of the robotic arm disposed outside the body remain linear.

[0108] In some embodiments, the procedure of FIG. 10D can be performed using any of the systems, tools, or methods described above, and as detailed above herein, performing the procedure through a trocar or another access kit, modifying the angle of the robotic arm with respect to the stomach after partially inserting the robotic arm into the incision, and using various lengths, distances, and ratios.

[0109] FIG. 10D shows an abdominal procedure through a sub-umbilical incision performed using a multi-jointed arm substantially as described above, although it will be appreciated that a sub-umbilical incision can also be suitable for performing the procedure using a robotic arm of a linear stick that includes a linear portion that does not have the ability to terminate with a tool and articulate within the body.

[0110] FIG. 10E shows the body of FIGS. 10C and 10D after surgery, after the stomach 1212 has stopped expanding further. As shown, the second incision zone 1216 has been moved and is located above the pubis 1206 here due to the change in the inflation level of the stomach 1212. Thus, after the procedure of FIG. 10D, the incision (and resulting scar tissue) is not located on the patient's abdominal section, and thus, even when compared to an incision within the sub-umbilical region, which is considered a safer location to make an abdominal incision as described above, the risk of incisional hernia is significantly reduced. Additionally, scar tissue located more inferiorly on the patient's body provides some aesthetic benefit as it is easier to conceal.

[0111] It will be appreciated that any type of abdominal procedure can be performed through the sub-umbilical incision shown in FIGS. 10C through 10E, including, for example, procedures for repairing hernias, hysterectomies, colectomies, appendectomies, Nissen fundoplications, cholecystectomies, sleeve gastrectomies, and gastric bypass surgeries, as described above.

[0112] FIG. 11 is a flowchart of an exemplary method of performing a surgery within an abdominal surgery zone according to some embodiments. In some embodiments, the system and / or device used to perform hernia treatment includes a robotic arm as described herein. Alternatively, in some embodiments, other devices in the art that have the ability to curve within the body, for example, may also be used.

[0113] In an initial step S1300, an abdominal incision is made into the body. In some embodiments, the incision can be an umbilical incision, a Pfannenstiel incision, or a sub-Pfannenstiel incision. In some embodiments, the length of the abdominal incision is in the range of 1 cm to 5 cm, 2 cm to 5 cm, 1 cm to 4 cm, 2 cm to 4 cm, 1 cm to 3 cm, 2 cm to 3 cm, or 1 cm to 2 cm.

[0114] In step S1302, at least one multi-articulated or jointed robotic arm of a device as described herein is inserted into the body through the abdominal incision. The arm includes a linear or rigid portion that remains at least partially (and in some embodiments, entirely) outside the body. Thus, the flexible portion of the arm is inserted into the body as described above.

[0115] In some embodiments, the incision made in step S1300 is made using the device that enters the body in step S1302. In other embodiments, the incision can be made using a dedicated device or a surgical scalpel.

[0116] Optionally, in some embodiments, the device includes two or more multi-articulated robotic arms as described, for example, elsewhere in this document. In an exemplary embodiment, the device includes two such arms. Optionally, in some embodiments, the device includes one or more additional tools.

[0117] In some embodiments, the device arm is selected to be suitable for a particular patient and / or treatment. For example, in some embodiments, the user selects a device arm with a long upper arm portion when performing surgery on an obese patient. For example, in some embodiments, the user selects a device arm with a short upper arm portion when performing surgery on a child. In some embodiments, the length of one or more portions of the arm can be changed during the surgical treatment.

[0118] In some embodiments, at step S1304, in addition to this device, one or more laparoscopic tools or other devices are inserted through one or more additional incisions in the abdomen so as to be used in the surgical treatment. For example, in a transfascial stapling technique or a subfascial stapling technique, in addition to the incision through which the device enters the body, a camera can be inserted into the body through a transumbilical incision. However, it will be appreciated that all the multi-joint arms involved in this surgery enter the body through a single incision.

[0119] At step S1306, one or more portions (e.g., rim, arm) of the device are curved within the body to access the surgical zone.

[0120] In some embodiments, the surgery is a hernia repair surgery and the surgical zone is the site of the hernia. In some embodiments where the hernia is an inguinal hernia, the surgical zone may be present within or near the inguinal triangle, also known as the Hasselbach triangle. In some embodiments where the hernia is an abdominal wall hernia, the surgical zone can be along the abdominal wall.

[0121] In some embodiments, the surgery is a cholecystectomy and the surgical zone is present within or near the gallbladder and / or along the abdominal wall.

[0122] In some embodiments, the surgery is a colectomy and the surgical zone is present within or near a portion of the colon.

[0123] The direction in which the arm curves is determined by the position of the incision and the spatial relationship of the surgical zone. As discussed above in connection with FIGS. 4A through 5B, the arm can be curved to flex posteriorly either above or below the horizontal line as needed. In some embodiments, the arm may be curved in another direction, such as curved in an S shape, as shown in FIGS. 1B and 1C.

[0124] In some embodiments where the device includes two or more arms, such as shown by FIGS. 9B and 9C, the arms of the device curve in the same direction within the body, such as approaching the target from the same direction. In some embodiments, the arms curve along substantially the same trajectory at one or more segments and / or joints, where for example pairs of joints and / or segments are in contact and / or have the same orientation. In other embodiments, the arms can curve in different directions or along different trajectories, such as to access the surgical zone from two different directions. Examples of arm curving in two different directions are shown and discussed in connection with FIGS. 9D and 9E above.

[0125] In the following discussion, again in connection with FIG. 1A and specifically in connection with its arm 101, angle A is defined as the angle between the longitudinal axis of the first torso 102 and the longitudinal axis of the first upper arm 112; angle B is defined as the angle between the longitudinal axis of the first upper arm 112 and the longitudinal axis of the first radius 116; and angle C is defined as the angle between the longitudinal axis of the first radius 116 and the longitudinal axis of the first hand tool 124. Angles A, B, and C can each correspond to the angles of the shoulder, elbow, and wrist joints, respectively.

[0126] In some embodiments, the curvature of the device within the body means the sum of angles A, B, and C that is at least 90°, at least 120°, at least 180°, at least 240°, or at least 360°, where at least two of the angles A, B, and C are greater than zero. In some embodiments, one or more of the angles A, B, or C are adjustable up to 180°, for example, it is possible to curve the device up to 540°. In an exemplary embodiment, angles A and B are adjustable up to 180°, and angle C is adjustable up to 90°. In some embodiments, one or more of the angles A, B, and C are three-dimensionally adjustable such that the angles can also have a z-axis component in addition to the x-axis and y-axis components.

[0127] In some embodiments, the curvature of the device within the body means the sum of angles A, B, and C that is at least 90°, at least 120°, at least 180° in at least one robotic arm in the x-y plane, the x-z plane, and / or the z-y plane, where in the x-y plane, the x-z plane, and / or the z-y plane, at least two of the angles A, B, and C are greater than zero.

[0128] In some embodiments, curving the device within the body results in the access direction to the surgical zone being at an angle of at least 90°, at least 120°, or at least 180° with respect to the insertion direction of the arm entering the incision in at least one dimension. In some embodiments, the difference between the insertion direction and the access direction is defined by angle D = A + B + C.

[0129] In some embodiments where the number of segments within the robotic arm of the device is different from the number of segments shown in FIGS. 1A through 1C (e.g., more segments or fewer segments), the sum of the angles means the sum of all the relative angles of this number of segments, which can be a larger or smaller angle.

[0130] In step S1308, the device performs a surgical procedure within the surgical zone.

[0131] In some embodiments where the surgical procedure is a hernia repair, the procedure includes covering the hernia site with a mesh. In some embodiments, the hernia repair includes moving the displaced tissue so that the hernia passes through a second tissue, prior to covering. For example, this can include moving the intestinal tissue so that it passes through the inguinal tissue or through the abdominal wall tissue and back into the abdominal cavity.

[0132] In some embodiments, the first arm of the device is used to separate (e.g., by pushing) the hernia tissue from the surrounding tissue, and the second arm is used to apply the mesh. In some embodiments, the mesh is inserted into the body through an abdominal incision while being held, for example, within a gripping tool of the arm. In some embodiments, the device can include a tissue manipulation device that can be placed on the arm of the device to move interfering tissue out of the way, for the purpose of reducing the risk of damaging interfering tissue during the surgical procedure.

[0133] In embodiments where the surgical procedure is the treatment of an inguinal hernia, the procedure is performed within the inguinal triangle having a planar area of about 10 cm after curving, whereas the tool used for the surgical procedure enters the body from a single abdominal incision, as discussed herein. 2 In some embodiments where the surgical procedure is a colectomy or cholecystectomy, the procedure can include separating or excising tissue from the surrounding tissue that is to be removed from the body. In some embodiments, the tissue to be removed is moved through a second tissue.

[0134]

[0135] ​Optionally, in some embodiments, at an optional step S1310, the abdomen is inflated (e.g., using CO2) before the start of treatment and / or surgery. In some embodiments, the abdomen is inflated through an incision that is different from the incision used to insert the device, for example, an incision through which a camera is inserted when inserted, i.e., an additional incision (not the incision for device insertion). In some embodiments, the abdomen is inflated through the incision used for device insertion.

[0136] Exemplary embodiments of the present invention are presented below.

[0137] "Example 1" A method of repairing a hernia, comprising: Inserting a multi-joint robotic arm into the body through an abdominal incision, the multi-joint robotic arm comprising: A linear portion at least a part of which extends outside the body and is connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and, A tool connected to at least one flexible portion, Inserting a multi-joint robotic arm into the body through an abdominal incision; Bending the multi-joint robotic arm within the body at at least one flexible portion such that the tool contacts the hernia, the step of bending the multi-joint robotic arm wherein the sum of the angles between the longitudinal axes of adjacent effective line segments in at least one three-dimensional plane exceeds 90°; Repairing the hernia using the tool of the multi-joint robotic arm, the step of repairing the hernia including covering the site of the hernia with a mesh, Including.

[0138] "Example 2" The method of Example 1, wherein the step of repairing the hernia includes moving the displaced tissue of the hernia body through a second tissue.

[0139] "Example 3" The method of Example 1 or Example 2, wherein the hernia is an inguinal hernia and the surgical area is the inguinal triangle.

[0140] "Example 4" The method of Example 3, wherein the bending step includes a step of bending around the pubis of the body.

[0141] "Example 5" The method of Example 3 or Example 4, wherein the abdominal incision is outside the surgical area including the hernia, and the length of the multi-articular mechanical limb inside the body, measured as the sum of the lengths of the longitudinal axes of a part of the multi-articular mechanical limb inside the body, is at least 1.5 times, at least 2 times, at least 3 times, or at least 4 times the distance between the abdominal incision and the inguinal hernia, and the distance is the shortest distance between the abdominal incision and the inguinal hernia when measured along the lower pelvic wall.

[0142] "Example 6" The method of Example 1 or Example 2, wherein the hernia is an abdominal wall hernia and the surgical area is the surface of the abdominal wall.

[0143] "Example 7" The method of Example 6, wherein the bending step includes a step of bending at least one flexible portion so that the tool is disposed above the horizontal line with respect to the linear portion entering the abdominal incision.

[0144] "Example 8" The method of Example 6, wherein the bending step includes a step of bending at least one flexible portion so that the tool is disposed within a tool plane above the incision plane formed by the abdominal incision and the linear portion with respect to a reference plane.

[0145] "Example 9" The method of any one of Examples 6 to 8, wherein the abdominal incision is outside the surgical area including the hernia, and the step of bending the multi-joint mechanical limb is measured as the total length of the longitudinal axis of a part of the multi-joint mechanical limb inside the body. The length of the multi-joint mechanical limb inside the body is at least 1.5 times, at least 2 times, at least 3 times, or at least 4 times the distance between the abdominal incision and the abdominal wall hernia, and the distance is the shortest distance between the abdominal incision and the abdominal wall hernia when measured along the abdominal wall.

[0146] "Example 10" The method of any one of Examples 1 to 9, wherein the abdominal incision is a Pfannenstiel incision or a sub-Pfannenstiel incision.

[0147] "Example 11" The method of any one of Examples 1 to 9, wherein the abdominal incision is an umbilical incision.

[0148] "Example 12" The method of any one of Examples 1 to 11, wherein the length of the abdominal incision is in the range of 1 cm to 5 cm, 2 cm to 5 cm, 1 cm to 4 cm, 2 cm to 4 cm, 1 cm to 3 cm, or 2 cm to 3 cm.

[0149] "Example 13" The method of any one of Examples 1 to 12, wherein the step of bending the multi-joint mechanical limb is to contact the hernia from the access direction, and the access direction is at least 90° different from the direction of inserting the multi-joint mechanical limb into the body.

[0150] "Example 14" The method of any one of Examples 1 to 13, further including the step of inserting a mesh into the body through the abdominal incision.

[0151] "Example 15" The method of any one of Examples 1 to 14, wherein at least one flexible portion of the multi-joint mechanical limb includes a first flexible portion connected to a linear portion, and a second flexible portion connected to the first flexible portion at one end and connected to a tool at the opposite end.

[0152] "Example 16" The method of Example 15, wherein each of the first and second flexible portions is rotatable independently about its respective longitudinal axis and bendable independently within a single bending plane.

[0153] "Example 17" The method of any one of Examples 15 to 16, wherein each of the first and second flexible portions is bendable in one rotational direction about the circumference of its respective corresponding bending plane.

[0154] "Example 18" The method of any one of Examples 1 to 17, wherein the repairing step includes the step of holding a portion of the body tissue away from the surgical zone.

[0155] "Example 19" The method of any one of Examples 1 to 18, wherein the inserting step includes the step of inserting a plurality of multi-joint mechanical limbs into the body through an abdominal incision, and the repairing step includes the step of repairing a hernia using the tools of the plurality of multi-joint mechanical limbs.

[0156] "Example 20" The method of any one of Examples 1 to 19, further including the step of inflating the abdominal cavity before or during the repair.

[0157] "Example 21" The method according to any one of Examples 1 to 20, wherein the abdominal incision is outside the surgical area including the hernia, and the shortest distance between the abdominal incision and the surgical area measured along the body wall is less than 10 cm, less than 8 cm, less than 5 cm, less than 4 cm, less than 3 cm, less than 2 cm, or less than 1 cm.

[0158] "Example 22" The method according to any one of Examples 1 to 20, wherein the inserting step includes inserting a multi-joint mechanical limb through a trocar located within the abdominal incision, the abdominal incision is outside the surgical area including the hernia, and the shortest distance between the base of the trocar and the surgical area measured along the body wall is less than 10 cm, less than 8 cm, less than 5 cm, less than 4 cm, less than 3 cm, less than 2 cm, or less than 1 cm.

[0159] "Example 23" The method according to any one of Examples 1 to 22, wherein the inserting step includes inserting at least one flexible portion into the body while maintaining at least a majority of the linear portion outside the body.

[0160] "Example 24" The method according to any one of Examples 1 to 22, wherein the inserting step includes inserting at least one flexible portion into the body while maintaining the entire linear portion outside the body.

[0161] "Example 25" The method according to any one of Examples 1 to 22, wherein the ratio of the length of the multi-joint mechanical limb disposed inside the body, measured as the sum of the length of the multi-joint mechanical limb disposed outside the body and the length of the longitudinal axis of a portion of the multi-joint mechanical limb inside the body, is in the range of 1:2 to 1:4.

[0162] "Example 26" The method according to any one of Examples 1 to 22, wherein the ratio of the length of a part of the multi-joint mechanical limb disposed outside the body to the length of the longitudinal axis of a part of the multi-joint mechanical limb disposed inside the body, measured as the sum of the two, is at least 1:2 or at least 1:3.

[0163] "Example 27" The method according to any one of Examples 1 to 22, wherein when the mount outside the body is stationary, the ratio of the length of the multi-joint mechanical limb disposed inside the body that is stationary with respect to the abdominal incision to the length of the multi-joint mechanical limb disposed inside the body that is movable with respect to the abdominal incision is at least 1:5, at least 1:8, at least 1:10, or at least 1:15.

[0164] "Example 28" The method according to any one of Examples 1 to 27, wherein the inserting step comprises: placing the trocar into the abdominal incision while the trocar is at a first angular direction with respect to the abdominal tissue including the incision; inserting the multi-joint mechanical limb through the trocar to a first extent while the trocar is at the first angular direction so that a first segment of the multi-joint mechanical limb is disposed inside the body; changing the angular direction of the trocar with respect to the abdominal tissue together with the multi-joint mechanical limb; inserting the multi-joint mechanical limb through the trocar to a second extent while the trocar is at a second angular direction so that the first segment and an additional second segment of the multi-joint mechanical limb are disposed inside the body, in this order.

[0165] "Example 29" The method according to Example 28, wherein the first angular direction is substantially perpendicular to the abdominal tissue, and the second angular direction is an acute angle with respect to the abdominal tissue.

[0166] "Example 30" A method of performing abdominal surgery within a surgical zone of the body, comprising: Inserting two robotic arms into the body through a single abdominal incision, each of the robotic arms terminating within a tool, at least one of the two robotic arms being a multi-joint robotic arm, the multi-joint robotic arm comprising: A linear portion at least a part of which extends outside the body and is connected to a mount disposed outside the body; and At least one flexible portion connected to the linear portion Including, The tool is connected to the second flexible portion, Inserting two robotic arms into the body through a single abdominal incision; and Transferring the tool of the robotic arm to the surgical zone, including curving at least one multi-joint robotic arm within the body at at least one flexible portion such that the tool of the at least one multi-joint robotic arm enters the surgical zone, the sum of the angles between the longitudinal axes of adjacent effective line segments in at least one three-dimensional plane exceeding 90°, transferring the tool of the robotic arm to the surgical zone; and Performing surgery within the surgical zone using the tools of the two robotic arms; and Including.

[0167] "Example 31" The method of Example 30, wherein the surgical zone has an area of at most 10 cm 2 Having.

[0168] "Example 32" The method of Example 31, wherein the curving step is performed within a size range having a cross-sectional area exceeding 10 cm 2 Having.

[0169] "Example 33" The method of any one of Examples 30 to 32, wherein the abdominal surgery includes hernia surgery, and the step of performing the surgery includes repairing a hernia within the surgical zone using the tool of the robotic arm.

[0170] "Example 34" The method of Example 33, wherein the step of repairing includes the step of covering the hernia site with a mesh.

[0171] "Example 35" The method of Example 34, further including the step of inserting the mesh into the body through an abdominal incision.

[0172] "Example 36" The method of any one of Examples 33 to 35, wherein the step of repairing the hernia includes the step of moving the displaced tissue of the hernia body through a second tissue.

[0173] "Example 37" The method of any one of Examples 33 to 36, wherein the hernia is an inguinal hernia and the surgical zone is the inguinal triangle.

[0174] "Example 38" The method of Example 37, wherein the step of curving includes curving around the pubis of the body.

[0175] "Example 39" The method of any one of Examples 31 to 38, wherein the abdominal incision is outside the surgical zone, and the step of curving at least one multi-joint mechanical limb, as measured by the total length of the longitudinal axis of a portion of at least one multi-joint mechanical limb inside the body, the length of at least one multi-joint mechanical limb inside the body is at least 1.5 times, at least 2 times, at least 3 times, or at least 4 times the distance between the abdominal incision and the surgical zone, and the distance is the shortest distance between the abdominal incision and the surgical zone when measured along the body wall.

[0176] "Example 40" The method of any one of Examples 30 to 39, wherein the abdominal incision is a fanenstiel incision or a sub-fanenstiel incision.

[0177] "Example 41" The method of any one of Examples 30 to 39, wherein the abdominal incision is an umbilical incision.

[0178] "Example 42" The method of any one of Examples 30 to 41, wherein the length of the abdominal incision is in the range of 1 cm to 5 cm, 2 cm to 5 cm, 1 cm to 4 cm, 2 cm to 4 cm, 1 cm to 3 cm, or 2 cm to 3 cm.

[0179] "Example 43" The method of any one of Examples 30 to 42, wherein the step of bending at least one multi-joint robotic arm is a step of contacting the surgical zone from the access direction, and the access direction is at least 90° different from the direction of inserting at least one multi-joint robotic arm into the body.

[0180] "Example 44" The method of any one of Examples 30 to 43, wherein at least one flexible portion of the multi-joint robotic arm includes a first flexible portion connected to a linear portion and a second flexible portion connected to the first flexible portion at one end and connected to a tool at the opposite end.

[0181] "Example 45" The method of Example 45, wherein each of the first and second flexible portions is independently rotatable about its respective longitudinal axis and independently bendable within a single bending plane.

[0182] "Example 46" The method of Example 45 or Example 46, wherein each of the first and second flexible portions is bendable in one rotational direction around its respective corresponding bending plane.

[0183] "Example 47" The method of any one of Examples 30 to 46, wherein the step of performing the operation includes the step of separating and holding a part of the body tissue away from the surgical zone.

[0184] "Example 48" The method of any one of Examples 30 to 47, further including the step of inflating the abdominal cavity before or during the operation.

[0185] "Example 49" The method of any one of Examples 30 to 48, wherein the abdominal incision is outside the surgical zone, and the shortest distance between the abdominal incision and the surgical zone, measured along the body wall, is less than 10 cm, less than 8 cm, less than 5 cm, less than 4 cm, less than 3 cm, less than 2 cm, or less than 1 cm.

[0186] "Example 50" The method of any one of Examples 30 to 49, wherein the abdominal incision is outside the surgical zone, and the step of insertion includes the step of inserting a mechanical limb through a trocar located within the abdominal incision, and the shortest distance between the base of the trocar and the surgical zone, measured along the body wall, is less than 10 cm, less than 8 cm, less than 5 cm, less than 4 cm, less than 3 cm, less than 2 cm, or less than 1 cm.

[0187] "Example 51" The method of any one of Examples 30 to 50, wherein the step of insertion is: The step of placing the trocar within the abdominal incision while the trocar is in a first angular direction with respect to the abdominal tissue including the incision; The step of inserting the mechanical limb through the trocar to a first extent while the trocar is in the first angular direction so that the first segment of the multi-joint mechanical limb is disposed inside the body; The step of changing the angular direction of the trocar with respect to the abdominal tissue together with the mechanical limb; Inserting the robotic limb through the trocar to a second degree while the trocar is in a second angular direction such that a first segment of the robotic limb and an additional second segment are disposed inside the body; Including them in order.

[0188] "Example 52" The method of Example 51, wherein the first angular direction is substantially perpendicular to the abdominal tissue and the second angular direction is an acute angle with respect to the abdominal tissue.

[0189] "Example 53" The method of any one of Examples 30 to 52, wherein the bending step includes bending at least one flexible portion such that the tool is disposed above the horizontal line with respect to the linear portion entering the abdominal incision.

[0190] "Example 54" The method of any one of Examples 30 to 52, wherein the bending step includes bending at least one flexible portion such that the tool is disposed within a tool plane above the incision plane formed by the abdominal incision and the linear portion with respect to a reference plane.

[0191] "Example 55" A method of performing abdominal surgery comprising: Inserting a multi-joint robotic limb into the body through a Pfannenstiel incision or a sub-Pfannenstiel incision, the multi-joint robotic limb comprising: A linear portion at least a part of which extends outside the body and is connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and A tool connected to at least one flexible portion, Inserting the multi-joint robotic limb into the body through a Pfannenstiel incision or a sub-Pfannenstiel incision, including; Curving the robotic limb within the body at at least one flexible portion so that the tool of the robotic limb enters the abdominal surgery zone, wherein the abdominal surgery zone is the lower quadrant of the abdomen; Performing surgery within the abdominal surgery zone using the tool; comprising.

[0192] "Example 56" The method of Example 55, wherein when curving, the sum of the angles between the longitudinal axes of adjacent effective line segments of the multi-joint robotic limb exceeds 90° in at least one three-dimensional plane

[0193] "Example 57" The method of Example 55 or Example 56, further comprising moving the tool between at least two quadrants of the abdomen without moving the linear portion of the robotic limb or the mount disposed outside the body when performing surgery.

[0194] "Example 58" The method of any one of Examples 55 to 57, wherein the abdominal surgery includes hernia surgery, and the step of performing surgery includes repairing the hernia within the surgery zone using the tool of the multi-joint robotic limb.

[0195] "Example 59" The method of Example 58, wherein the step of repairing includes covering the hernia site with a mesh.

[0196] "Example 60" The method of Example 59, further comprising inserting the mesh into the body through the incision.

[0197] "Example 61" The method of any one of Examples 58 to 60, wherein the step of repairing the hernia includes moving the displaced tissue of the hernia body through a second tissue.

[0198] "Example 62" The method of any one of Examples 58 to 61, wherein the hernia is an inguinal hernia and the surgical area is the inguinal triangle.

[0199] "Example 63" The method of Example 62, wherein the bending step includes bending around the pubis of the body.

[0200] "Example 64" The method of any one of Examples 58 to 61, wherein the hernia is an abdominal wall hernia and the surgical area is the abdominal wall within the lower quadrant of the abdomen.

[0201] "Example 65" The method of any one of Examples 55 to 64, wherein the bending step includes bending at least one flexible portion such that the tool is disposed above the horizontal line with respect to the linear portion entering the abdominal incision.

[0202] "Example 66" The method of any one of Examples 55 to 65, wherein the bending step includes bending at least one flexible portion such that the tool is disposed within a tool plane above the incision plane formed by the abdominal incision and the linear portion with respect to a reference plane.

[0203] "Example 67" The method of any one of Examples 55 to 66, wherein the abdominal incision is outside the abdominal surgical area, and the length of the poly-articular robotic limb inside the body, measured as the sum of the lengths of the longitudinal axes of a part of the poly-articular robotic limb inside the body, is at least 1.5 times, at least 2 times, at least 3 times, or at least 4 times the distance between the incision and the surgical area, and the distance is the shortest distance between the incision and the surgical area when measured along the body wall.

[0204] "Example 68" The method according to any one of Examples 55 to 67, wherein the length of the incision is in the range of 1 cm to 5 cm, 2 cm to 5 cm, 1 cm to 4 cm, 2 cm to 4 cm, 1 cm to 3 cm, or 2 cm to 3 cm.

[0205] "Example 69" The method according to any one of Examples 55 to 68, wherein the step of bending the multi-joint mechanical limb is to contact the surgical area from the access direction, and the access direction is at least 90° different from the direction of inserting the multi-joint mechanical limb into the body.

[0206] "Example 70" The method according to any one of Examples 55 to 69, wherein at least one flexible portion of the multi-joint mechanical limb includes a first flexible portion connected to a linear portion, and a second flexible portion connected to the first flexible portion at one end and connected to a tool at the opposite end.

[0207] "Example 71" The method according to Example 70, wherein each of the first and second flexible portions is rotatable independently about its respective longitudinal axis and bendable independently within a single bending plane.

[0208] "Example 72" The method according to Example 70 or Example 71, wherein each of the first and second flexible portions is bendable in one rotational direction around its respective corresponding bending plane.

[0209] "Example 73" The method according to any one of Examples 55 to 72, wherein the step of performing the surgery includes the step of separating and holding a part of the body tissue from the surgical area.

[0210] "Example 74" The method according to any one of Examples 55 to 73, further including the step of inflating the abdominal cavity before or during the surgery.

[0211] "Example 75" The method of any one of Examples 55 to 74, wherein the abdominal incision is outside the surgical zone, and the shortest distance between the incision and the surgical zone, measured along the body wall, is less than 10 cm, less than 8 cm, less than 5 cm, less than 4 cm, less than 3 cm, less than 2 cm, or less than 1 cm.

[0212] "Example 76" The method of any one of Examples 55 to 74, wherein the abdominal incision is outside the surgical zone, and the insertion step includes inserting a mechanical limb through a trocar located within the incision, and the shortest distance between the base of the trocar and the surgical zone, measured along the body wall, is less than 10 cm, less than 8 cm, less than 5 cm, less than 4 cm, less than 3 cm, less than 2 cm, or less than 1 cm.

[0213] "Example 77" The method of any one of Examples 55 to 76, wherein the insertion step is: placing the trocar within the incision while the trocar is in a first angular direction with respect to the abdominal tissue including the incision; inserting the mechanical limb through the trocar to a first extent while the trocar is in the first angular direction so that a first segment of the multi-joint mechanical limb is disposed inside the body; changing the angular direction of the trocar with respect to the abdominal tissue together with the mechanical limb; inserting the mechanical limb through the trocar to a second extent while the trocar is in a second angular direction so that the first segment and an additional second segment of the mechanical limb are disposed inside the body, including them in order.

[0214] "Example 78" The method of Example 77, wherein the first angular direction is substantially perpendicular to the abdominal tissue, and the second angular direction is an acute angle with respect to the abdominal tissue.

[0215] "Example 79" The method of any one of Examples 55 to 78, wherein the inserting step includes inserting a plurality of multi-joint robotic limbs into the body through an incision, and the abdominal surgery step includes performing abdominal surgery using tools of the plurality of multi-joint robotic limbs.

[0216] "Example 80" The method of any one of Examples 55 to 79, wherein the inserting step includes inserting at least one flexible portion into the body while maintaining at least a majority of the linear portion outside the body.

[0217] "Example 81" The method of any one of Examples 55 to 79, wherein the inserting step includes inserting at least one flexible portion into the body while maintaining the entire linear portion outside the body.

[0218] "Example 82" The method of any one of Examples 55 to 79, wherein the ratio of the length of the multi-joint robotic limb disposed outside the body to the length of the multi-joint robotic limb disposed inside the body, measured as the sum of the length of a portion of the multi-joint robotic limb disposed inside the body along the longitudinal axis, is in the range of 1:2 to 1:4.

[0219] "Example 83" The method of any one of Examples 55 to 79, wherein the ratio of the length of a portion of the multi-joint robotic limb disposed outside the body to the length of a portion of the multi-joint robotic limb disposed inside the body, measured as the sum of the length of a portion of the multi-joint robotic limb disposed inside the body along the longitudinal axis, is at least 1:2 or at least 1:3.

[0220] "Example 84" The method according to any one of Examples 55 to 79, when the mount outside the body is stationary, the ratio of the length of the multi-joint robotic limb disposed inside the body and stationary with respect to the abdominal incision to the length of the multi-joint robotic limb disposed inside the body and movable with respect to the abdominal incision is at least 1:5, at least 1:8, at least 1:10, or at least 1:15.

[0221] "Example 85" A method of performing an abdominal surgery within the surgical zone of the body, comprising: Inserting a multi-joint robotic limb into the body through an abdominal incision, wherein the abdominal incision is outside the surgical zone and the multi-joint robotic limb comprises: A linear portion at least partially extending outside the body and connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and A tool connected to at least one flexible portion, Inserting the multi-joint robotic limb into the body through the abdominal incision; Bending the multi-joint robotic limb within the body at at least one flexible portion so that the tool of the multi-joint robotic limb enters the surgical zone; Performing a surgery within the surgical zone using the tool; Including The shortest distance between the surgical zone and the abdominal incision measured along the body wall is less than 10 cm, less than 8 cm, less than 5 cm, less than 4 cm, less than 3 cm, less than 2 cm, or less than 1 cm.

[0222] "Example 86" The method according to Example 85, wherein when bending, the sum of the angles between the longitudinal axes of adjacent effective line segments of the robotic limb in at least one three-dimensional plane exceeds 90°.

[0223] "Example 87" The method of any one of Examples 85 to 86, wherein the abdominal surgery includes hernia surgery, and the step of performing the surgery includes the step of repairing the hernia within the surgical area using a tool of a multi-joint robotic arm.

[0224] "Example 88" The method of Example 87, wherein the step of repairing includes the step of covering the site of the hernia with a mesh.

[0225] "Example 89" The method of Example 88, further including the step of inserting the mesh into the body through the incision.

[0226] "Example 90" The method of any one of Examples 87 to 89, wherein the step of repairing the hernia includes the step of moving the displaced tissue of the hernia body through a second tissue.

[0227] "Example 91" The method of any one of Examples 87 to 90, wherein the hernia is an inguinal hernia and the surgical area is the inguinal triangle.

[0228] "Example 92" The method of Example 91, wherein the step of curving includes the step of curving around the pubis of the body.

[0229] "Example 93" The method of any one of Examples 87 to 90, wherein the hernia is an abdominal wall hernia and the surgical area is the abdominal wall of the abdomen.

[0230] "Example 94" The method of any one of Examples 85 to 93, wherein the step of curving includes the step of curving at least one flexible portion such that the tool is disposed above the horizontal line with respect to the linear portion entering the abdominal incision.

[0231] "Example 95" The method of any one of Examples 85 to 94, wherein the bending step includes bending at least one flexible portion such that the tool is disposed within the tool plane, and the tool plane is above the incision plane formed by the laparotomy and the linear portion, with reference to the reference plane.

[0232] "Example 96" The method of any one of Examples 85 to 95, wherein the length of the multi-joint robotic limb inside the body, measured as the sum of the lengths of the longitudinal axes of a part of the multi-joint robotic limb inside the body, is at least 1.5 times, at least 2 times, at least 3 times, or at least 4 times the distance between the incision and the surgical zone, and the distance is the shortest distance between the incision and the surgical zone when measured along the body wall.

[0233] "Example 97" The method of any one of Examples 85 to 96, wherein the length of the incision is in the range of 1 cm to 5 cm, 2 cm to 5 cm, 1 cm to 4 cm, 2 cm to 4 cm, 1 cm to 3 cm, or 2 cm to 3 cm.

[0234] "Example 98" The method of any one of Examples 85 to 97, wherein the laparotomy is a Pfannenstiel incision or a sub-Pfannenstiel incision.

[0235] "Example 99" The method of any one of Examples 85 to 97, wherein the laparotomy is an umbilical incision.

[0236] "Example 100" The method of any one of Examples 85 to 99, wherein the step of bending the multi-joint robotic limb is to contact the surgical zone from the access direction, and the access direction is at least 90° different from the direction of inserting the multi-joint robotic limb into the body.

[0237] "Example 101" A method according to any one of Examples 85 to 100, wherein at least one flexible portion of the multi-joint mechanical limb comprises a first flexible portion connected to a linear portion and a second flexible portion connected to the first flexible portion at one end and to a tool at the opposite end.

[0238] "Example 102" A method according to Example 101, wherein each of the first and second flexible portions is rotatable independently about its respective longitudinal axis and bendable independently within a single bending plane.

[0239] "Example 103" A method according to Example 101 or Example 102, wherein each of the first and second flexible portions is bendable in one rotational direction about the circumference of its respective bending plane.

[0240] "Example 104" A method according to any one of Examples 85 to 103, wherein the step of performing the surgery includes the step of holding a portion of the body tissue away from the surgical zone.

[0241] "Example 105" A method according to any one of Examples 85 to 104, further including the step of inflating the abdominal cavity before or during the surgery.

[0242] "Example 106" A method according to any one of Examples 85 to 105, wherein the step of inserting comprises: placing the trocar into the incision while the trocar is at a first angular direction with respect to the abdominal tissue including the incision; inserting the mechanical limb through the trocar to a first extent while the trocar is at the first angular direction so that a first segment of the multi-joint mechanical limb is disposed inside the body; varying the angular direction of the trocar with respect to the abdominal tissue together with the mechanical rim; inserting the mechanical rim through the trocar to a second extent while the trocar is in a second angular direction such that a first segment of the mechanical rim and an additional second segment are disposed inside the body; including in order.

[0243] "Example 107" The method of Example 106, wherein the first angular direction is substantially perpendicular to the abdominal tissue and the second angular direction is an acute angle with respect to the abdominal tissue.

[0244] "Example 108" The method of any one of Examples 85 to 107, wherein the inserting step includes inserting a plurality of multi-articulated mechanical rims into the body through an incision, and the step of performing an abdominal operation includes performing an abdominal operation using tools of the plurality of multi-articulated mechanical rims.

[0245] "Example 109" The method of any one of Examples 85 to 108, wherein the inserting step includes inserting at least one flexible portion into the body while maintaining at least a majority of the linear portion outside the body.

[0246] "Example 110" The method of any one of Examples 85 to 108, wherein the inserting step includes inserting at least one flexible portion into the body while maintaining the entire linear portion outside the body.

[0247] "Example 111" The method of any one of Examples 85 to 108, wherein the ratio of the length of the multi-articulated mechanical rim disposed outside the body to the length of the multi-articulated mechanical rim disposed inside the body, measured as the sum of the length of the multi-articulated mechanical rim disposed outside the body and the length of the longitudinal axis of a portion of the multi-articulated mechanical rim inside the body, is in the range of 1:2 to 1:4.

[0248] "Example 112" The method of any one of Examples 85 to 108, wherein the ratio of the length of a part of the multi-joint mechanical limb disposed outside the body to the length of the longitudinal axis of a part of the multi-joint mechanical limb disposed inside the body, measured as the sum of the length of a part of the multi-joint mechanical limb disposed outside the body and the length of a part of the multi-joint mechanical limb disposed inside the body, is at least 1:2 or at least 1:3.

[0249] "Example 113" The method of any one of Examples 85 to 108, wherein when the mount outside the body is stationary, the ratio of the length of the multi-joint mechanical limb disposed inside the body that is stationary with respect to the abdominal incision to the length of the multi-joint mechanical limb disposed inside the body that is movable with respect to the abdominal incision is at least 1:5, at least 1:8, at least 1:10, or at least 1:15.

[0250] "Example 114" A method of performing abdominal surgery within the surgical zone of the body, comprising: Inserting a multi-joint mechanical limb into the body through an abdominal incision, wherein the abdominal incision is outside the surgical zone and the multi-joint mechanical limb comprises: A linear portion at least partially extending outside the body and connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and A tool connected to the at least one flexible portion, Inserting the multi-joint mechanical limb into the body through the abdominal incision; Bending the multi-joint mechanical limb within the body at at least one flexible portion so that the tool of the multi-joint mechanical limb enters the surgical zone; Performing surgery within the surgical zone using the tool; Including The ratio of the length of the multi-articular mechanical limb inside the body, measured as the sum of the lengths of the longitudinal axes of a part of the multi-articular mechanical limb inside the body, to the distance between the abdominal incision and the surgical zone is at least 2:1, and the distance is the shortest distance between the abdominal incision and the surgical zone when measured along the body wall.

[0251] "Example 115" The method of Example 114, wherein the abdominal incision is a fanenstiel incision or a sub-fanenstiel incision.

[0252] "Example 116" The method of the example of Example 114, wherein the abdominal incision is an umbilical incision.

[0253] "Example 117" The method of any one of Examples 114 to 116, wherein when bending, the sum of the angles between the longitudinal axes of adjacent effective line segments of the multi-articular mechanical limb in at least one three-dimensional plane exceeds 90°.

[0254] "Example 118" The method of any one of Examples 114 to 117, wherein the abdominal surgery includes a hernia surgery, and the step of performing the surgery includes the step of repairing the hernia within the surgical zone using the tool of the multi-articular mechanical limb.

[0255] "Example 119" The method of Example 118, wherein the step of repairing includes the step of covering the site of the hernia with a mesh.

[0256] "Example 120" The method of Example 119, further including the step of inserting the mesh into the body through the incision.

[0257] "Example 121" A method according to any one of Examples 118 to 120, wherein the step of repairing a hernia includes the step of moving the displaced tissue of the hernia body through a second tissue.

[0258] "Example 122" A method according to any one of Examples 118 to 121, wherein the hernia is an inguinal hernia and the surgical zone is the inguinal triangle.

[0259] "Example 123" A method according to Example 122, wherein the step of curving includes the step of curving around the pubis of the body.

[0260] "Example 124" A method according to any one of Examples 118 to 121, wherein the hernia is an abdominal wall hernia and the surgical zone is the abdominal wall of the abdomen.

[0261] "Example 125" A method according to any one of Examples 114 to 124, wherein the step of curving includes the step of curving at least one flexible portion such that the tool is disposed above the horizontal line with respect to the linear portion entering the abdominal incision.

[0262] "Example 126" A method according to any one of Examples 114 to 125, wherein the step of curving includes the step of curving at least one flexible portion such that the tool is disposed within a tool plane above the incision plane formed by the abdominal incision and the linear portion with respect to a reference plane.

[0263] "Example 127" A method according to any one of Examples 55 to 66, wherein the ratio of the length of the multi-joint robotic arm in the body to the distance between the abdominal incision and the surgical zone is at least 3:1 or at least 4:1.

[0264] "Example 128" The method of any one of Examples 114 to 127, wherein the length of the incision is in the range of 1 cm to 5 cm, 2 cm to 5 cm, 1 cm to 4 cm, 2 cm to 4 cm, 1 cm to 3 cm, or 2 cm to 3 cm.

[0265] "Example 129" The method of any one of Examples 114 to 128, wherein the step of bending the multi-articular mechanical limb is to contact the surgical zone from the access direction, and the access direction is at least 90° different from the direction of inserting the multi-articular mechanical limb into the body.

[0266] "Example 130" The method of any one of Examples 114 to 129, wherein at least one flexible portion of the multi-articular mechanical limb includes a first flexible portion connected to a linear portion, and a second flexible portion connected to the first flexible portion at one end and connected to a tool at the opposite end.

[0267] "Example 131" The method of Example 130, wherein each of the first and second flexible portions is rotatable independently about its respective longitudinal axis and bendable independently within a single bending plane.

[0268] "Example 132" The method of Example 130 or Example 131, wherein each of the first and second flexible portions is bendable in one rotational direction around its respective corresponding bending plane.

[0269] "Example 133" The method of any one of Examples 114 to 132, wherein the step of performing the surgery includes the step of holding a portion of the body tissue away from the surgical zone.

[0270] "Example 134" The method of any one of Examples 114 to 133, further comprising the step of expanding the abdominal cavity before or during the surgery.

[0271] "Example 135" The method of any one of Examples 114 to 134, wherein the distance between the abdominal incision and the surgical zone is less than 10 cm, less than 8 cm, less than 5 cm, less than 4 cm, less than 3 cm, less than 2 cm, or less than 1 cm.

[0272] "Example 136" The method of any one of Examples 114 to 135, wherein the inserting step is: Placing the trocar into the incision while the trocar is in a first angular direction with respect to the abdominal tissue including the incision; Inserting the robotic limb through the trocar to a first extent while the trocar is in the first angular direction so that the first segment of the multi-joint robotic limb is disposed inside the body; Changing the angular direction of the trocar with respect to the abdominal tissue together with the robotic limb; Inserting the robotic limb through the trocar to a second extent while the trocar is in a second angular direction so that the first segment and an additional second segment of the robotic limb are disposed inside the body, Including in order.

[0273] "Example 137" The method of Example 136, wherein the first angular direction is substantially perpendicular to the abdominal tissue, and the second angular direction is an acute angle with respect to the abdominal tissue.

[0274] "Example 138" The method of any one of Examples 114 to 137, wherein the inserting step includes inserting a plurality of multi-joint robotic limbs into the body through the incision, and the step of performing the abdominal surgery includes performing the abdominal surgery using the tools of the plurality of multi-joint robotic limbs.

[0275] "Example 139" The method of any one of Examples 114 to 137, wherein the inserting step includes inserting at least one flexible portion into the body while maintaining at least a majority of the linear portion outside the body.

[0276] "Example 140" The method of any one of Examples 114 to 137, wherein the inserting step includes inserting at least one flexible portion into the body while maintaining the entire linear portion outside the body.

[0277] "Example 141" The method of any one of Examples 114 to 137, wherein the ratio of the length of the multi-joint mechanical limb disposed inside the body, measured as the sum of the length of the multi-joint mechanical limb disposed outside the body and the length of the longitudinal axis of a portion of the multi-joint mechanical limb inside the body, is in the range of 1:2 to 1:4.

[0278] "Example 142" The method of any one of Examples 114 to 137, wherein the ratio of the length of a portion of the multi-joint mechanical limb disposed inside the body, measured as the sum of the length of a portion of the multi-joint mechanical limb disposed outside the body and the length of the longitudinal axis of a portion of the multi-joint mechanical limb inside the body, is at least 1:2 or at least 1:3.

[0279] "Example 143" The method of any one of Examples 114 to 137, wherein when the mount outside the body is stationary, the ratio of the length of the multi-joint mechanical limb disposed inside the body that is stationary with respect to the abdominal incision to the length of the multi-joint mechanical limb disposed inside the body that is movable with respect to the abdominal incision is at least 1:5, at least 1:8, at least 1:10, or at least 1:15.

[0280] "Example 144" A method of performing an abdominal surgery within a surgical zone of a body, comprising: Inserting a multi-joint robotic limb through an abdominal incision into the body, the multi-joint robotic limb comprising: A linear portion at least a part of which extends outside the body and is connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and A tool connected to the at least one flexible portion, Inserting the multi-joint robotic limb through the abdominal incision into the body; Bending the multi-joint robotic limb within the body at at least one flexible portion so that the tool of the multi-joint robotic limb enters the surgical zone, and after bending, the tool is disposed above a horizontal line with respect to the linear portion entering the abdominal incision, bending the multi-joint robotic limb within the body; Performing a surgery within the surgical zone using the tool; and Including.

[0281] "Example 145" A method of performing an abdominal surgery within a surgical zone of a body, comprising: Inserting a multi-joint robotic limb through an abdominal incision into the body, the multi-joint robotic limb comprising: A linear portion at least a part of which extends outside the body and is connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and A tool connected to the at least one flexible portion, Inserting the multi-joint robotic limb through the abdominal incision into the body; Bending the multi-joint robotic limb within the body at at least one flexible portion so that the tool of the multi-joint robotic limb enters the surgical zone, and after bending, the tool is disposed within a tool plane above a plane of the incision formed by the abdominal incision and the linear portion with respect to a reference plane, bending the multi-joint robotic limb within the body; Steps of performing surgery within the surgical field using the tool, including.

[0282] "Example 146" The method of Example 144 or Example 145, wherein the abdominal incision is a Fannennsteil incision or a sub-Fannennsteil incision.

[0283] "Example 147" The method of Example 144 or Example 145, wherein the abdominal incision is an umbilical incision.

[0284] "Example 148" The method of any one of Examples 144 to 147, wherein when bending, the sum of the angles between the longitudinal axes of adjacent effective line segments of the multi-joint mechanical limb in at least one three-dimensional plane exceeds 90°.

[0285] "Example 149" The method of any one of Examples 144 to 148, wherein the abdominal surgery includes a hernia surgery, and the step of performing the surgery includes the step of repairing a hernia within the surgical field using the tool of the multi-joint mechanical limb.

[0286] "Example 150" The method of Example 149, wherein the step of repairing includes the step of covering the hernia site with a mesh.

[0287] "Example 151" The method of Example 150, further including the step of inserting the mesh into the body through the incision.

[0288] "Example 152" The method of any one of Examples 149 to 151, wherein the step of repairing the hernia includes the step of moving the displaced tissue of the hernia body through a second tissue.

[0289] "Example 153" The method of any one of Examples 144 to 152, wherein the abdominal incision is outside the abdominal surgical zone, and the step of bending the multi-joint mechanical limb is measured as the total length of the longitudinal axis of a part of the multi-joint mechanical limb inside the body, and the length of the multi-joint mechanical limb inside the body is at least 1.5 times, at least 2 times, at least 3 times, or at least 4 times the distance between the incision and the surgical zone, and the distance is the shortest distance between the incision and the surgical zone when measured along the body wall.

[0290] "Example 154" The method of any one of Examples 144 to 153, wherein the length of the incision is in the range of 1 cm to 5 cm, 2 cm to 5 cm, 1 cm to 4 cm, 2 cm to 4 cm, 1 cm to 3 cm, or 2 cm to 3 cm.

[0291] "Example 155" The method of any one of Examples 144 to 154, wherein the step of bending the multi-joint mechanical limb is to contact the surgical zone from the access direction, and the access direction is at least 90° different from the direction of inserting the multi-joint mechanical limb into the body.

[0292] "Example 156" The method of any one of Examples 144 to 155, wherein at least one flexible portion of the multi-joint mechanical limb includes a first flexible portion connected to a linear portion, and a second flexible portion connected to the first flexible portion at one end and connected to a tool at the opposite end.

[0293] "Example 157" The method of Example 156, wherein each of the first and second flexible portions is rotatable independently about its respective longitudinal axis and bendable independently within a single bending plane.

[0294] "Example 158" The method of Example 156 or Example 157, wherein each of the first and second flexible portions is bendable in one rotational direction around its respective corresponding bending plane.

[0295] "Example 159" The method of any one of Examples 144 to 158, wherein the step of performing the surgery includes the step of holding a part of the body tissue away from the surgical zone.

[0296] "Example 160" The method of any one of Examples 144 to 159, further including the step of inflating the abdominal cavity before or during the surgery.

[0297] "Example 161" The method of any one of Examples 144 to 160, wherein the abdominal incision is outside the surgical zone, and the shortest distance between the incision and the surgical zone, measured along the body wall, is less than 10 cm, less than 8 cm, less than 5 cm, less than 4 cm, less than 3 cm, less than 2 cm, or less than 1 cm.

[0298] "Example 162" The method of any one of Examples 144 to 160, wherein the abdominal incision is outside the surgical zone, and the step of inserting includes the step of inserting the mechanical rim through a trocar located within the incision, and the shortest distance between the base of the trocar and the surgical zone, measured along the body wall, is less than 10 cm, less than 8 cm, less than 5 cm, less than 4 cm, less than 3 cm, less than 2 cm, or less than 1 cm.

[0299] "Example 163" The method of any one of Examples 144 to 162, wherein the step of inserting is: placing the trocar within the incision while the trocar is at a first angular direction with respect to the abdominal tissue including the incision; Inserting the robotic limb through the trocar to a first extent while the trocar is in a first angular direction such that a first segment of the multi-joint robotic limb is disposed inside the body; Changing the angular direction of the trocar relative to the abdominal tissue together with the robotic limb; Inserting the robotic limb through the trocar to a second extent while the trocar is in a second angular direction such that the first segment and an additional second segment of the robotic limb are disposed inside the body; Including in sequence.

[0300] "Example 164" The method of Example 163, wherein the first angular direction is substantially perpendicular to the abdominal tissue and the second angular direction is an acute angle with respect to the abdominal tissue.

[0301] "Example 165" The method of any one of Examples 144 to 164, wherein the inserting step includes inserting a plurality of multi-joint robotic limbs into the body through an incision, and the step of performing abdominal surgery includes performing abdominal surgery using tools of the plurality of multi-joint robotic limbs.

[0302] "Example 166" The method of any one of Examples 144 to 165, wherein the inserting step includes inserting at least one flexible portion into the body while maintaining at least a majority of the linear portion outside the body.

[0303] "Example 167" The method of any one of Examples 144 to 165, wherein the inserting step includes inserting at least one flexible portion into the body while maintaining the entire linear portion outside the body.

[0304] "Example 168" The method of any one of Examples 144 to 165, wherein the ratio of the length of the multi-joint mechanical limb disposed outside the body to the length of the multi-joint mechanical limb disposed inside the body, measured as the sum of the length of the multi-joint mechanical limb disposed outside the body and the length of the longitudinal axis of a part of the multi-joint mechanical limb inside the body, is in the range of 1:2 to 1:4.

[0305] "Example 169" The method of any one of Examples 144 to 165, wherein the ratio of the length of a part of the multi-joint mechanical limb disposed outside the body to the length of a part of the multi-joint mechanical limb disposed inside the body, measured as the sum of the length of a part of the multi-joint mechanical limb disposed outside the body and the length of the longitudinal axis of a part of the multi-joint mechanical limb inside the body, is at least 1:2 or at least 1:3.

[0306] "Example 170" The method of any one of Examples 144 to 165, wherein when the mount outside the body is stationary, the ratio of the length of the multi-joint mechanical limb disposed inside the body that is stationary with respect to the abdominal incision to the length of the multi-joint mechanical limb disposed inside the body that is movable with respect to the abdominal incision is at least 1:5, at least 1:8, at least 1:10, or at least 1:15.

[0307] "Example 171" A method of performing an abdominal surgery within the surgical zone of the body, comprising: Inserting a multi-joint mechanical limb through an abdominal incision into the body, wherein the multi-joint mechanical limb comprises: A linear portion at least a part of which extends outside the body and is connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and A tool connected to at least one flexible portion, Inserting the multi-joint mechanical limb through the abdominal incision into the body; and Bending the multi-joint mechanical limb within the body at at least one flexible portion so that the tool of the multi-joint mechanical limb enters the surgical zone. The step of using a tool to perform surgery within the surgical zone, and including The inserting step includes inserting the first and second flexible portions into the body while maintaining at least a majority of the linear portion outside the body.

[0308] "Example 172" The method of Example 171, wherein the inserting step includes inserting the first and second flexible portions into the body while maintaining the entire linear portion outside the body.

[0309] "Example 173" A method of performing abdominal surgery within the surgical zone of the body, comprising: Inserting a multi-joint robotic limb through an abdominal incision into the body, the multi-joint robotic limb comprising: A linear portion at least a part of which extends outside the body, the linear portion being connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and A tool connected to at least one flexible portion, Including the step of inserting a multi-joint robotic limb through an abdominal incision into the body, The step of curving the multi-joint robotic limb within the body at at least one flexible portion so that the tool of the multi-joint robotic limb enters the surgical zone, and The step of performing surgery within the surgical zone using the tool, and including The ratio of the length of the multi-joint robotic limb disposed outside the body to the length of the multi-joint robotic limb disposed inside the body, measured as the sum of the length of the multi-joint robotic limb disposed outside the body and the length of the longitudinal axis of a portion of the multi-joint robotic limb inside the body, is in the range of 1:2 to 1:4.

[0310] "Example 174" A method of performing abdominal surgery within the surgical zone of the body, comprising: Inserting a multi-joint robotic limb through an abdominal incision into the body, the multi-joint robotic limb comprising: A linear portion at least a part of which extends outside the body, the linear portion being connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and, A tool connected to at least one flexible portion, Including inserting a multi-joint robotic limb through an abdominal incision into the body, Curving the multi-joint robotic limb within the body at at least one flexible portion so that the tool of the multi-joint robotic limb enters the surgical area; Performing a surgery within the surgical area using the tool; Including, The ratio of the length of a portion of the multi-joint robotic limb disposed inside the body, measured as the sum of the length of a portion of the multi-joint robotic limb disposed outside the body and the length of the longitudinal axis of a portion of the multi-joint robotic limb disposed inside the body, is at least 1:2 or at least 1:3.

[0311] "Example 175" A method for performing an abdominal surgery within a surgical area of the body is provided, the method comprising: Inserting a multi-joint robotic limb through an abdominal incision into the body, the multi-joint robotic limb comprising: A linear portion at least a part of which extends outside the body, the linear portion being connected to a mount disposed outside the body; At least one flexible portion connected to the linear portion; and, A tool connected to at least one flexible portion, Including inserting a multi-joint robotic limb through an abdominal incision into the body; Curving the multi-joint robotic limb within the body at at least one flexible portion so that the tool of the multi-joint robotic limb enters the surgical area; Performing a surgery within the surgical area using the tool; Including, When the mount outside the body is stationary, the ratio of the length of the multi-joint robotic limb disposed inside the body that is stationary with respect to the abdominal incision to the length of the multi-joint robotic limb disposed inside the body that is movable with respect to the abdominal incision is at least 1:5, at least 1:8, at least 1:10, or at least 1:15.

[0312] "Example 176" A method according to any one of Examples 171 to 175, wherein the abdominal incision is a Pfannenstiel incision or a sub-Pfannenstiel incision.

[0313] "Example 177" A method according to any one of Examples 171 to 175, wherein the abdominal incision is an umbilical incision.

[0314] "Example 178" A method according to any one of Examples 171 to 177, wherein when bending, the sum of the angles between the longitudinal axes of adjacent effective line segments of the multi-joint robotic limb in at least one three-dimensional plane exceeds 90°.

[0315] "Example 179" A method according to any one of Examples 171 to 178, wherein the abdominal surgery includes a hernia surgery, and the step of performing the surgery includes the step of repairing the hernia within the surgical zone using a tool of the multi-joint robotic limb.

[0316] "Example 180" A method according to Example 179, wherein the step of repairing includes the step of covering the site of the hernia with a mesh.

[0317] "Example 181" A method according to Example 180, further including the step of inserting the mesh into the body through the incision.

[0318] "Example 182" The method of any one of Examples 179 to 181, wherein the step of repairing the hernia includes moving the displaced tissue of the hernia body through the second tissue.

[0319] "Example 183" The method of any one of Examples 179 to 182, wherein the hernia is an inguinal hernia and the surgical zone is the inguinal triangle.

[0320] "Example 184" The method of Example 183, wherein the step of bending includes bending around the pubis of the body.

[0321] "Example 185" The method of any one of Examples 179 to 182, wherein the hernia is an abdominal wall hernia and the surgical zone is the abdominal wall of the abdomen.

[0322] "Example 186" The method of any one of Examples 171 to 185, wherein the step of bending includes bending at least one flexible portion such that the tool is disposed above the horizontal line with respect to the linear portion entering the abdominal incision.

[0323] "Example 187" The method of any one of Examples 171 to 186, wherein the step of bending includes bending at least one flexible portion such that the tool is disposed within a tool plane above the incision plane formed by the abdominal incision and the linear portion with respect to a reference plane.

[0324] "Example 188" The method according to any one of Examples 171 to 187, wherein the abdominal incision is outside the abdominal surgery zone, and the step of bending the multi-joint robotic limb is measured as the total length of the longitudinal axis of a part of the multi-joint robotic limb inside the body, and the length of the multi-joint robotic limb inside the body is at least 1.5 times, at least 2 times, at least 3 times, or at least 4 times the distance between the incision and the surgery zone, and the distance is the shortest distance between the incision and the surgery zone when measured along the body wall.

[0325] "Example 189" The method according to any one of Examples 171 to 188, wherein the length of the incision is in the range of 1 cm to 5 cm, 2 cm to 5 cm, 1 cm to 4 cm, 2 cm to 4 cm, 1 cm to 3 cm, or 2 cm to 3 cm.

[0326] "Example 190" The method according to any one of Examples 171 to 189, wherein the step of bending the multi-joint robotic limb is to contact the surgery zone from the access direction, and the access direction is at least 90° different from the direction of inserting the multi-joint robotic limb into the body.

[0327] "Example 191" The method according to any one of Examples 171 to 190, wherein at least one flexible part of the multi-joint robotic limb includes a first flexible part connected to a linear part, and a second flexible part connected to the first flexible part at one end and connected to a tool at the opposite end.

[0328] "Example 192" The method of Example 191, wherein each of the first and second flexible parts is rotatable independently about its respective longitudinal axis and bendable independently within a single bending plane.

[0329] "Example 193" The method of Example 191 or Example 192, wherein each of the first and second flexible portions is bendable in one rotational direction around its respective corresponding bending plane.

[0330] "Example 194" The method of any one of Examples 171 to 193, wherein the step of performing the surgery includes the step of separating and holding a part of the body tissue away from the surgical zone.

[0331] "Example 195" The method of any one of Examples 171 to 194, further including the step of inflating the abdominal cavity before or during the surgery.

[0332] "Example 196" The method of any one of Examples 171 to 195, wherein the abdominal incision is outside the surgical zone, and the shortest distance between the incision and the surgical zone, measured along the body wall, is less than 10 cm, less than 8 cm, less than 5 cm, less than 4 cm, less than 3 cm, less than 2 cm, or less than 1 cm.

[0333] "Example 197" The method of any one of Examples 171 to 195, wherein the abdominal incision is outside the surgical zone, and the step of inserting includes the step of inserting a mechanical rim through a trocar located within the incision, and the shortest distance between the base of the trocar and the surgical zone, measured along the body wall, is less than 10 cm, less than 8 cm, less than 5 cm, less than 4 cm, less than 3 cm, less than 2 cm, or less than 1 cm.

[0334] "Example 198" The method of any one of Examples 171 to 197, wherein the step of inserting is: the step of disposing the trocar within the incision while the trocar is in a first angular direction with respect to the abdominal tissue including the incision; Inserting the robotic limb through the trocar to a first extent while the trocar is in a first angular direction such that a first segment of the multi-articulated robotic limb is disposed inside the body; Changing the angular direction of the trocar with respect to the abdominal tissue along with the robotic limb; Inserting the robotic limb through the trocar to a second extent while the trocar is in a second angular direction such that the first segment of the robotic limb and an additional second segment are disposed inside the body; Including the steps in sequence.

[0335] "Example 199" The method of Example 198, wherein the first angular direction is substantially perpendicular to the abdominal tissue and the second angular direction is an acute angle with respect to the abdominal tissue.

[0336] "Example 200" The method of any one of Examples 171 to 199, wherein the inserting step includes inserting a plurality of multi-articulated robotic limbs into the body through an incision, and the step of performing an abdominal surgery includes performing an abdominal surgery using tools of the plurality of multi-articulated robotic limbs.

[0337] "Example 201" A method of performing an abdominal surgery using a robotic limb, the robotic limb including (i) a linear portion, (ii) at least one flexible portion coupled to the linear portion, and (iii) a tool coupled to the second flexible portion, the method comprising: Placing the trocar within an abdominal incision while the trocar is in a first angular direction with respect to the abdominal tissue including the incision; Inserting the robotic limb into the body through the trocar to a first extent while the trocar is in the first angular direction such that a first segment of the robotic limb is disposed inside the body; Changing the angular direction of the trocar with respect to the abdominal tissue along with the first segment of the robotic limb; Inserting the mechanical limb through the trocar to a second degree while the trocar is in a second angular direction such that a first segment of the mechanical limb and an additional second segment are disposed inside the body; Bending the mechanical limb within the body with the first and second flexible portions such that a tool of the mechanical limb enters the abdominal surgical zone; Performing a surgery within the abdominal surgical zone using the tool, and including.

[0338] "Example 202" A method of performing an abdominal surgery within a surgical zone, comprising: Creating an incision in the subumbilical region of the abdomen; Inserting a mechanical limb through the incision into the body of the subject, the mechanical limb including a linear portion at least a part of which extends outside the body and a tool connected to the distal end of the mechanical limb; Manipulating the mechanical limb within the body such that the tool contacts the abdominal target site; Performing an abdominal surgery within the surgical zone using the tool; and including.

[0339] "Example 203" The method of Example 202, wherein the step of creating the incision includes creating an incision below the umbilical line and close to the pubis (e.g., up to the width of one finger).

[0340] "Example 204" The method of Example 202, wherein the mechanical limb includes a straight mechanical limb such that the tool is connected to the distal end of the linear portion.

[0341] "Example 205" The method of Example 202, wherein the mechanical limb includes a multi-joint mechanical limb further including at least one flexible portion disposed between the linear portion and the tool.

[0342] "Example 206" The method of Example 205, wherein the operating step includes bending the multi-joint mechanical limb within the body in at least one flexible region such that the tool contacts the surgical zone.

[0343] "Example 207" The method of Example 206, wherein the bending step includes bending the multi-joint mechanical limb such that the sum of the angles between the longitudinal axes of adjacent effective line segments in at least one three-dimensional plane exceeds 90°.

[0344] "Example 208" The method of Example 206 or Example 207, wherein the bending step includes bending around the pubis of the body.

[0345] "Example 209" The method of Example 206 or Example 207, wherein the bending step includes bending at least one flexible portion such that the tool is disposed above the horizontal line with respect to the linear portion entering the incision.

[0346] "Example 210" The method of Example 209, wherein the bending step includes bending at least one flexible portion such that the tool is disposed within a tool plane above the incision plane formed by the incision and the linear portion with respect to a reference plane.

[0347] "Example 211" The method of any one of Examples 206 to 210, wherein the step of bending the multi-joint mechanical limb is to contact the surgical zone from the access direction, and the access direction is at least 90° different from the direction of inserting the multi-joint mechanical limb into the body.

[0348] "Example 212" The method according to any one of Examples 205 to 211, wherein at least one flexible portion of the multi-articular mechanical limb includes a first flexible portion connected to a linear portion, and a second flexible portion connected to the first flexible portion at one end and connected to a tool at the opposite end.

[0349] "Example 213" The method according to Example 212, wherein each of the first and second flexible portions is rotatable independently about its respective longitudinal axis and bendable independently within a single curved plane.

[0350] "Example 214" The method according to any one of Examples 212 to 213, wherein each of the first and second flexible portions is bendable in one rotational direction about the circumference of its respective corresponding curved plane.

[0351] "Example 215" The method according to any one of Examples 205 to 214, wherein the inserting step includes inserting at least one flexible portion into the body while maintaining at least a majority of the linear portion outside the body.

[0352] "Example 216" The method according to any one of Examples 205 to 214, wherein the inserting step includes inserting at least one flexible portion into the body while maintaining the entire linear portion outside the body.

[0353] "Example 217" The method according to any one of Examples 202 to 216, wherein the operating step includes repairing a hernia using a tool of the mechanical limb.

[0354] "Example 218" The method according to Example 217, wherein the step of repairing a hernia includes moving the displaced tissue of the hernia body through a second tissue.

[0355] "Example 219" The method of Example 217 or Example 218, wherein the step of repairing the hernia includes covering the site of the hernia with a mesh.

[0356] "Example 220" The method of Example 219, further including the step of inserting a mesh into the body through an incision.

[0357] "Example 221" The method of any one of Examples 217 to 220, wherein the hernia is an inguinal hernia and the surgical zone is the inguinal triangle.

[0358] "Example 222" The method of any one of Examples 217 to 220, wherein the hernia is an abdominal wall hernia and the surgical zone is the surface of the abdominal wall.

[0359] "Example 223" The method of any one of Examples 202 to 216, wherein the step of operating includes performing a hysterectomy using a tool with a mechanical rim.

[0360] "Example 224" The method of any one of Examples 202 to 216, wherein the step of operating includes performing a colectomy using a tool with a mechanical rim.

[0361] "Example 225" The method of any one of Examples 202 to 216, wherein the step of operating includes performing a sleeve gastrectomy using a tool with a mechanical rim.

[0362] "Example 226" The method of any one of Examples 202 to 216, wherein the step of operating includes performing a cholecystectomy using a tool with a mechanical rim.

[0363] "Example 227" A method according to any one of Examples 202 to 216, wherein the operating step includes performing an appendectomy using a tool of a mechanical rim.

[0364] "Example 228" A method according to any one of Examples 202 to 216, wherein the operating step includes performing a Nissen fundoplication using a tool of a mechanical rim.

[0365] "Example 229" A method according to any one of Examples 202 to 216, wherein the operating step includes performing a gastric bypass using a tool of a mechanical rim.

[0366] "Example 230" A method according to any one of Examples 202 to 229, wherein the length of the incision is in the range of 1 cm to 5 cm, 2 cm to 5 cm, 1 cm to 4 cm, 2 cm to 4 cm, 1 cm to 3 cm, or 2 cm to 3 cm.

[0367] "Example 231" A method according to any one of Examples 202 to 230, wherein the repairing step includes holding a part of the body tissue away from the surgical zone.

[0368] "Example 232" A method according to any one of Examples 202 to 231, wherein the inserting step includes inserting a plurality of mechanical rims into the body through the incision, and the operating step includes operating a tool of the plurality of mechanical rims to perform the surgery.

[0369] "Example 233" A method according to any one of Examples 202 to 232, further including the step of inflating the abdominal cavity before or during the operation.

[0370] "Example 234" The method of any one of Examples 202 to 233, wherein the incision is outside the surgical zone, and the shortest distance between the incision and the surgical zone, measured along the body wall, is less than 10 cm.

[0371] "Example 235" The method of any one of Examples 202 to 234, wherein the ratio of the length of the mechanical limb disposed inside the body, measured as the sum of the length of the mechanical limb disposed outside the body and the length of the longitudinal axis of a part of the mechanical limb inside the body, is in the range of 1:2 to 1:4.

[0372] "Example 236" The method of any one of Examples 202 to 234, wherein the ratio of the length of a part of the mechanical limb disposed inside the body, measured as the sum of the length of a part of the mechanical limb disposed outside the body and the length of the longitudinal axis of a part of the mechanical limb inside the body, is at least 1:2 or at least 1:3.

[0373] "Example 237" The method of any one of Examples 202 to 236, wherein the inserting step comprises placing a trocar into the incision while the trocar is in a first angular direction with respect to the abdominal tissue including the incision; inserting the mechanical limb through the trocar to a first extent while the trocar is in the first angular direction so that a first segment of the mechanical limb is disposed inside the body; changing the angular direction of the trocar with respect to the abdominal tissue together with the mechanical limb; and inserting the mechanical limb through the trocar to a second extent while the trocar is in a second angular direction so that the first segment and an additional second segment of the mechanical limb are disposed inside the body, in this order.

[0374] "Example 238" The method of Example 237, wherein the first angular direction is substantially perpendicular to the abdominal tissue and the second angular direction is an acute angle with respect to the abdominal tissue.

[0375] "Example 239" The method of any one of Examples 202 to 238, wherein the step of operating the mechanical rim does not affect the shape or extension of a portion of the mechanical rim disposed outside the body of the subject.

[0376] It will be recognized that the specific features of the invention described in the context of separate embodiments for clarity may be provided in combination in a single embodiment. Conversely, the various features of the invention described in the context of a single embodiment for brevity may be provided separately or in any suitable subcombination.

[0377] Although the invention has been described in connection with specific embodiments thereof, it will be apparent to those skilled in the art that many alternative forms, modifications, and variations are possible. Accordingly, it is intended to embrace all such alternative forms, modifications, and variations that fall within the spirit and broad scope of the appended claims. All published documents, patents, and patent applications mentioned herein are hereby incorporated by reference in their entirety to the same extent as if each individual published document, patent, or patent application was specifically and individually indicated to be incorporated by reference herein. In addition, any reference citation or identification in this application is not to be construed as an admission that these references are available as prior art to the present invention.

Claims

1. A surgical mechanical rim, The device comprises a linear portion configured to extend at least a portion outside the body, and a tool connected to the distal end of the surgical instrument rim and configured to operate on an abdominal target site, The surgical instrument rim is, The surgical instrument rim is inserted, at least partially, into the patient's body through an incision made in the subfangenstein region of the abdomen. The tool is manipulated within the body to reach the abdominal target site, and The tool is operated to activate in order to perform abdominal surgery within the aforementioned abdominal target site. A surgical instrument rim that can perform this procedure.

2. The surgical mechanical rim according to claim 1, wherein the surgical mechanical rim allows the method to be performed with the incision located below the vannensteel line and close to the pubic bone.

3. The surgical mechanical rim according to claim 1, wherein the mechanical rim includes a linear mechanical rim such that the tool is connected to the distal end of the linear portion.

4. The surgical mechanical rim according to claim 1, wherein the mechanical rim further includes an articulated mechanical rim comprising at least one flexible portion disposed between the linear portion and the tool.

5. The surgical mechanical rim according to claim 4, wherein the operation includes bending the articulated mechanical rim in the body in the at least one flexible region so that the tool contacts the surgical zone.

6. The surgical mechanical rim according to claim 5, wherein the curving includes curving the articulated mechanical rim such that the sum of the angles between the longitudinal axes of adjacent effective line segments in at least one three-dimensionally oriented plane exceeds 90°.

7. The surgical mechanical rim according to claim 5, wherein the curving includes curving around the pubic bone of the body.

8. The surgical instrument rim according to claim 5, wherein the curving includes curving the at least one flexible portion such that the tool is positioned above the horizontal line with respect to the linear portion that enters the incision.

9. The surgical mechanical rim according to claim 5, wherein the articulated mechanical rim is curved to allow contact with the surgical zone from the access direction, and the access direction is at least 90° different from the direction in which the articulated mechanical rim is inserted into the body.

10. The surgical mechanical rim according to claim 4, wherein the at least one flexible portion of the articulated mechanical rim comprises a first flexible portion connected to the linear portion and a second flexible portion connected to the first flexible portion at one end and connected to the tool at the opposite end.

11. The surgical mechanical rim according to claim 4, wherein the insertion includes inserting the at least one flexible portion into the body while maintaining at least the majority of the linear portion outside the body.

12. The surgical mechanical rim according to claim 1, wherein the tool of the surgical mechanical rim is configured to repair a hernia.

13. The surgical mechanical rim according to claim 12, wherein repairing the hernia involves moving the displaced tissue of the hernia body through a second tissue.

14. The aforementioned hernia, Inguinal hernia, wherein the surgical zone is the inguinal triangle, and Abdominal wall hernia, wherein the surgical zone is the surface of the abdominal wall, One of them is the surgical mechanical rim according to claim 12.

15. The surgical mechanical rim according to any one of claims 1 to 11, wherein the surgical mechanical rim is configured to perform one or more of the following: hysterectomy, colectomy, sleeve gastrectomy, cholecystectomy, appendectomy, Nissen fundoplication, and gastric bypass surgery.

16. The surgical instrument rim according to claim 1, wherein the surgical instrument rim is insertable into the incision having a length in the range of 1 cm to 5 cm, 2 cm to 5 cm, 1 cm to 4 cm, 2 cm to 4 cm, 1 cm to 3 cm, or 2 cm to 3 cm.

17. The surgical instrument rim according to claim 1, wherein two or more surgical instrument rims are configured to be simultaneously inserted into the body through the incision and manipulated within the body to perform the surgery.

18. The surgical instrument rim according to claim 1, wherein the surgical instrument rim is configured to perform surgery through an incision located outside the surgical zone, and the shortest distance between the incision and the surgical zone, measured along the wall of the body, is less than 10 cm.

19. The surgical instrument rim according to claim 1, wherein the ratio of the length of the surgical instrument rim disposed on the outside of the body to the length of the surgical instrument rim disposed inside the body, measured as the sum of the lengths of the longitudinal axes of a portion of the surgical instrument rim inside the body, is within the range of 1:2 to 1:

4.

20. The surgical mechanical rim, The trocar is positioned within the incision while it is in a first angular direction relative to the abdominal tissue including the incision. Inserting the surgical instrument rim to a first extent through the trocar while the trocar is in the first angular direction, such that the first segment of the surgical instrument rim is positioned inside the body, Together with the surgical instrument rim, the angle direction of the trocar is changed with respect to the abdominal tissue, Inserting the surgical instrument rim through the trocar to a second degree while the trocar is in a second angular direction, such that the first segment and an additional second segment of the surgical instrument rim are arranged inside the body, Configured to be inserted through a trocar in a manner that enables this, The surgical instrument rim according to claim 1.

21. The surgical instrument rim according to claim 20, wherein the first angular direction is substantially perpendicular to the abdominal tissue and the second angular direction is acute to the abdominal tissue.

22. The surgical mechanical rim according to claim 1, wherein the surgical mechanical arm is configured such that operating the mechanical rim does not affect the shape or extension of a portion of the mechanical rim that is located outside the body of the patient.

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