Multiport surgical robot system structure

Abstract

A surgical system is provided. The surgical system includes an orienting platform, a support linkage that movably supports the orienting platform, a plurality of surgical instrument manipulators, and a plurality of setup linkages. Each of the manipulators includes an instrument holder and is operable to rotate the instrument holder about a remote center of operation (RC). At least one of the manipulators includes a reorientation mechanism that, when actuated, moves the attached manipulator through motion that holds the associated remote center in a fixed position.

Description

[Technical Field]

[0001] This application claims priority to U.S. Patent Application No. 61 / 654,367, filed June 1, 2012, the entire contents of which are incorporated herein by reference. [Background technology]

[0002] Minimally invasive medical techniques aim to reduce the amount of extraneous tissue damaged during diagnostic or surgical procedures, thereby reducing patient recovery time, discomfort, and adverse side effects. For example, one benefit of minimally invasive surgery is reduced post-operative hospital recovery time. Because the average length of hospital stay for standard surgical procedures is longer than the average length of stay for comparable minimally invasive procedures, increased use of minimally invasive techniques could save millions of dollars in annual hospital costs. Although many of the surgeries performed each year in the United States could potentially be performed minimally invasively, only a fraction of current surgeries utilize these advantageous techniques due to limitations in minimally invasive surgical instruments and the additional surgical training involved in using them.

[0003] Minimally invasive robotic surgery or telesurgery systems are being developed to increase the surgeon's dexterity and avoid some of the limitations of traditional minimally invasive techniques. In telesurgery, the surgeon uses some form of remote control (e.g., servomechanisms, etc.) to manipulate the movement of surgical instruments rather than directly grasping and moving them with their hands. In telesurgery, the surgeon may be provided with an image of the surgical site at a surgical workstation. While viewing a two- or three-dimensional image of the surgical site on a display, the surgeon performs surgery on the patient by manipulating a master control device, which controls the movement of servomechanically manipulated instruments.

[0004] Servo mechanisms used in telesurgery often receive input from two master controllers (one for each of the surgeon's hands) and may include two or more robotic arms to which surgical instruments are attached. Operational communication between the master controller and associated robotic arm and instrument assemblies is typically accomplished by a control system. The control system typically includes at least one processor that relays input commands from the master controller to the associated robotic arm and instrument assemblies, and from the instrument and arm assemblies back to the associated master controller, such as in the case of force feedback. One example of a robotic surgical system is the DA VINCI® system, commercially available from Intuitive Surgical, Inc. of Sunnyvale, California.

[0005] Various structural arrangements can be used to support surgical instruments at a surgical site during robotic surgery. Driven linkages, or "slaves," are often referred to as robotic surgical manipulators, and exemplary linkage arrangements for use as robotic surgical manipulators during minimally invasive robotic surgery are described in U.S. Patent Nos. 5,629,999; 5,729,929; 5,729,929; and 5,729,929, the entire disclosures of which are incorporated herein by reference. These linkages often use parallelogram devices to hold instruments with shafts. Such manipulator structures can constrain the motion of the instruments so that they pivot about a remote center of operation positioned in space along the length of a rigid shaft. By aligning the remote center of operation with an incision point into an internal surgical site (e.g., using a trocar or cannula in the abdominal wall during laparoscopic surgery), the end effector of the surgical instrument can be safely positioned by moving the proximal end of the shaft with the manipulator linkage without exerting potentially dangerous forces against the abdominal wall. Alternative manipulator structures are described, for example, in U.S. Patent Nos. 5,629,999; 5,729,949; 5,829,093; 5,929,093 ...929,093; and 5,929,093, the entire disclosures of which are incorporated by reference into this application.

[0006] Various structural arrangements can also be used to support and position robotic surgical manipulators and surgical instruments at a surgical site during robotic surgery. Support linkages, sometimes referred to as setup joints or setup joint arms, are often used to position and align each manipulator with its respective incision point on the patient's body. The support linkages facilitate alignment of the surgical manipulators with the desired surgical incision point and targeted anatomical structure. Exemplary support linkages are described in U.S. Patent Nos. 5,629,999 and 5,729,999, the entire disclosures of which are incorporated herein by reference. [Prior art documents] [Patent documents]

[0007] [Patent Document 1] U.S. Patent No. 7,594,912 [Patent Document 2] U.S. Patent No. 6,758,843 [Patent Document 3] U.S. Patent No. 6,246,200 [Patent Document 4] U.S. Patent No. 5,800,423 [Patent Document 5] U.S. Patent No. 7,763,015 [Patent Document 6] U.S. Patent No. 6,702,805 [Patent Document 7] U.S. Patent No. 6,676,669 [Patent Document 8] U.S. Patent No. 5,855,583 [Patent Document 9] U.S. Patent No. 5,808,665 [Patent Document 10] U.S. Patent No. 5,445,166 [Patent Document 11] U.S. Patent No. 5,184,601 [Patent Document 12] U.S. Patent No. 6,788,018 Summary of the Invention [Problem to be solved by the invention]

[0008] While new telesurgery systems and devices have proven highly effective and advantageous, further improvements are still desired. Improved minimally invasive robotic surgical systems are generally desirable. It would be particularly beneficial if these improved technologies increased the efficiency and ease of use of robotic surgical systems. For example, it would be particularly beneficial to increase maneuverability, improve operating room space utilization, provide faster and easier setup, prevent collisions between robotic devices during use, and / or reduce the mechanical complexity and size of these new surgical systems. [Means for solving the problem]

[0009] The following presents a simplified summary of some embodiments of the invention in order to provide a basic understanding of the invention. This summary is not an extensive overview of the invention. It is not intended to identify key / critical elements of the invention or to delineate the scope of the invention. Its sole purpose is to present some embodiments of the invention in a simplified form as a prelude to the more detailed description that is presented later.

[0010] An improved robotic surgical system and a modular manipulator support for use in the robotic surgical system are disclosed. The improved robotic surgical system includes an orienting platform used to support multiple setup linkages, each of which supports an associated surgical instrument manipulator or manipulators. The support linkages are used to movably support the orienting platform. One or more of the support linkages can include a reorienting mechanism operable to reposition the manipulator by movement that holds an associated remote center of operation (RC) in a fixed position, thereby allowing the supported manipulator to be repositioned without causing potentially dangerous forces to the patient at the incision site. One or more of the support linkages can also include a first link rotationally coupled to the reorienting platform, a second link slidably attached to the first link to slide horizontally relative to the first link, a third link slidably attached to the second link to slide vertically relative to the second link, and a fourth link rotationally coupled to the third link to rotate about an axis perpendicular to the third link. The support linkage can include a movable, floor-supported mounting base and an adjustable linkage coupled to the mounting base and movably supporting the orienting platform. The mounting base can also be immobile, for example, by being mounted directly to the floor or other fixed structure. The disclosed robotic surgical systems and modular manipulator supports enhance maneuverability, improve operating room space utilization, provide faster and easier setup, prevent collisions between robotic devices during use, and have reduced mechanical complexity relative to existing systems and supports of comparable capabilities.

[0011] Thus, in one aspect, a robotic surgical system is disclosed that includes an orienting platform, a support linkage that movably supports the orienting platform, a plurality of manipulators, and a plurality of setup linkages. Each of the manipulators can include an instrument holder. Each of the manipulators can be configured to support an associated surgical instrument attached to the instrument holder, insert the associated surgical instrument into a patient along an insertion axis through an associated remote center of operations (RC), rotate the instrument holder about a first manipulator axis that intersects the associated RC, and rotate the instrument holder about a second manipulator axis that intersects the associated RC. Each of the first and second manipulator axes is perpendicular to the insertion axis. The second manipulator axis is perpendicular to the first manipulator axis. Each of the setup linkages couples one of the manipulators to the orienting platform and is operable to reorient the associated manipulator relative to the orienting platform and to fixedly support the associated manipulator at a selected position relative to the orienting platform. Each of the setup linkages includes a proximal link coupled to the orienting platform and a distal link coupled to an associated manipulator, and at least one of the setup linkages includes a reorientation mechanism that, when actuated, moves the distal link relative to the proximal link through a motion that holds the associated RC in a fixed position relative to the proximal link.

[0012] In many embodiments, the reorientation mechanism includes a tornado revolute joint and a tornado link. The tornado link has a proximal end coupled to the tornado revolute joint and a distal end coupled to an associated manipulator. Actuation of the tornado revolute joint rotates the tornado link about a tornado axis that intersects the RC and is not coincident with either the first or second manipulator axis. The tornado link is configured to hold the associated RC in a fixed position relative to the proximal link for all orientations of the tornado link about the tornado axis.

[0013] In many embodiments, at least one of the manipulators is mechanically constrained to maintain a fixed position of the associated RC relative to the distal link during rotation of the instrument holder about a first manipulator axis and during rotation of the instrument holder about a second manipulator axis. For example, at least one of the manipulators can be mechanically configured to move the instrument holder in response to actuation of a first joint of the manipulator through a first motion mechanically limited to rotation about the first manipulator axis and to move the instrument holder in response to actuation of a second joint of the manipulator through a second motion mechanically limited to rotation about the second manipulator axis.

[0014] In many embodiments, the support linkage includes a movably floor-supported mounting base, a column slidably mounted to the mounting base, a boom base member rotatably coupled to the column through a shoulder joint, and an extendable boom member slidably coupled to the boom base member through a boom joint. The column is selectively positionable relative to the mounting base along a vertically oriented first support axis. The shoulder joint is operable to selectively orient the boom base member relative to the column about a vertically oriented second support axis. The boom joint is operable to selectively position the extendable boom member relative to the boom base member along a horizontally oriented third support axis. An orienting platform is rotatably coupled to the extendable boom member.

[0015] In another aspect, a robotic surgical system is disclosed that includes an orienting platform, a support linkage that movably supports the orienting platform, a plurality of manipulators, and a plurality of setup linkages. Each of the manipulators movably supports an associated surgical instrument that is insertable into a patient. Each of the setup linkages couples one of the manipulators to the orienting platform and is operable to reposition the associated linkage relative to the orienting platform and to fixedly support the associated manipulator relative to the orienting platform. At least one of the setup linkages includes a first link, a second link, a third link, and a fourth link. The first link has a first link proximal end that is rotationally coupled to the orienting platform through a first setup linkage joint that is operable to selectively orient the first link about a first setup linkage axis relative to the orienting platform. The second link is slidably attached to the first link through a second setup linkage joint that is operable to selectively reposition the second link along a second setup linkage axis that is oriented horizontally relative to the first link. The third link is slidably attached to the second link through a third set-up linkage joint operable to selectively reposition the third link along a third set-up linkage axis oriented perpendicular to the second link, the fourth link is rotationally coupled to the third link through a fourth set-up linkage joint operable to selectively orient the fourth link about a fourth set-up linkage axis oriented substantially perpendicular to the third link, and an associated manipulator is distal to and supported by the fourth link.

[0016] In many embodiments, at least one of the manipulators can include an instrument holder configured to support an associated surgical instrument. At least one of the manipulators can be configured to insert the associated surgical instrument into a patient through an associated remote center of operations (RC), rotate the instrument holder about a first manipulator axis that intersects the associated RC, and rotate the instrument holder about a second manipulator axis that intersects the associated RC. The second manipulator axis is orthogonal to the first manipulator axis.

[0017] In many embodiments, at least one of the setup linkages includes a reorientation mechanism coupled to the fourth link, actuation of which moves the associated manipulator relative to the fourth link through a motion that holds the associated RC in a fixed position relative to the fourth link.

[0018] In many embodiments, the reorientation mechanism includes a tornado revolute joint and a tornado link. The tornado link has a proximal end coupled to the tornado revolute joint and a distal end coupled to an associated manipulator. Actuation of the tornado revolute joint rotates the tornado link about a tornado axis that intersects the RC and is not coincident with either the first or second manipulator axes. The tornado link is configured to hold the associated RC in a fixed position relative to the fourth link for all orientations of the tornado link about the tornado axis.

[0019] In another aspect, a modular manipulator support for use in a robotic surgical system is disclosed. The robotic surgical system includes a plurality of manipulators, each including a driven link and a joint for moving an associated surgical instrument. The modular manipulator support includes a movably floor-supported mounting base, a column slidably mounted to the mounting base, a boom base member rotatably coupled to the column through a shoulder joint, an extendable boom member slidably coupled to the boom base member through a boom joint, an orienting platform rotatably coupled to the extendable boom member through a wrist joint, and a plurality of setup linkages. The column is selectively positionable relative to the mounting base along a vertically oriented first support axis. The shoulder joint is operable to selectively orient the boom base member about a second support axis oriented perpendicular to the column. The boom joint is operable to selectively position the extendable boom member along a third support axis oriented horizontally relative to the boom base member. The wrist joint is operable to selectively orient the orienting platform about a fourth support axis oriented perpendicular to the extendable boom member. Each of the setup linkages couples one of the manipulators to the orienting platform and is operable to selectively position and fixedly support the associated manipulator relative to the orienting platform. In many embodiments, the angular orientation of the shoulder joint is limited to prevent it from exceeding a predetermined stability limit of the mounting base.

[0020] In many embodiments, at least one of the set-up linkages includes a first link, a second link, a third link, and a fourth link. The first link has a first link proximal end rotationally coupled to the orienting platform through a first set-up linkage joint operable to selectively orient the first link about a first set-up linkage axis relative to the orienting platform. The second link is slidably attached to the first link through a second set-up linkage joint operable to selectively reposition the second link along a second set-up linkage axis oriented horizontally relative to the first link. The third link is slidably attached to the second link through a third set-up linkage joint operable to selectively reposition the third link along a third set-up linkage axis oriented perpendicularly relative to the second link. The fourth link is rotationally coupled to the third link through a fourth set-up linkage joint operable to selectively orient the fourth link about a fourth set-up linkage axis oriented perpendicularly relative to the third link. The associated manipulator is distal to and supported by the fourth link. In many embodiments, the first link is cantilevered horizontally from the first setup linkage joint.

[0021] In many embodiments, at least one of the setup linkages includes a reorientation mechanism coupled between the fourth link and an associated manipulator, actuation of the reorientation mechanism moving the associated manipulator relative to the fourth link through a motion that holds the associated remote center (RC) of operation in a fixed position relative to the fourth link.

[0022] In many embodiments, the reorientation mechanism includes a tornado revolute joint and a tornado link. The tornado link has a proximal end coupled to the tornado revolute joint and a distal end coupled to an associated manipulator. Actuation of the tornado revolute joint rotates the tornado link about a tornado axis that intersects the RC and is not coincident with either the first or second manipulator axes. The tornado link is configured to hold the associated RC in a fixed position relative to the fourth link for all orientations of the tornado link about the tornado axis.

[0023] For a more complete understanding of the nature and advantages of the present invention, reference should be made to the following description and accompanying drawings. Other aspects, objects and advantages of the present invention will become apparent from the following drawings and detailed description. [Brief explanation of the drawings]

[0024] [Figure 1] FIG. 1 is a plan view of a minimally invasive robotic surgical system used to perform surgery, according to many embodiments. [Figure 2] FIG. 1 is a perspective view of a surgeon's control console for a robotic surgical system, according to many embodiments. [Figure 3] FIG. 1 is a perspective view of a robotic surgical system electronics cart, according to many embodiments. [Figure 4] 1 schematically illustrates a robotic surgical system, according to many embodiments. [Figure 5A] FIG. 1 illustrates a partial view of a patient side cart (surgical robot) of a robotic surgical system, according to many embodiments. [Figure 5B] FIG. 1 is a front view of a robotic surgical tool, according to many embodiments. [Figure 6] FIG. 1 is a perspective schematic diagram of a robotic surgical system, according to many embodiments. [Figure 7] FIG. 1 is a perspective schematic view of another robotic surgical system, according to many embodiments. [Figure 8]8 illustrates a robotic surgical system, according to many embodiments, consistent with the schematic diagram of FIG. 7. [Figure 9] 10 illustrates the rotational orientation limits of the setup linkage relative to the orienting platform of the robotic surgical system of FIG. 8. [Figure 10] 1 illustrates a center of gravity diagram associated with rotation limits of a boom assembly for a robotic surgical system, according to many embodiments. DETAILED DESCRIPTION OF THE INVENTION

[0025] In the following description, various embodiments of the present invention are described. For purposes of explanation, specific configurations and details are set forth in order to provide a thorough understanding of the embodiments. However, it will also be apparent to those skilled in the art that the present invention may be practiced without the specific details. Additionally, well-known features may be omitted or simplified so as not to obscure the described embodiments.

[0026] Minimally Invasive Robotic Surgery Referring now to the drawings, FIG. 1 is a plan view of a minimally invasive robotic surgery (MIRS) system 10, typically used to perform minimally invasive diagnostic or surgical procedures on a patient 12 reclining on an operating table 14. Like reference numerals represent like parts throughout the drawings. The system includes a surgeon's console 16 for use by a surgeon 18 during surgery. One or more assistants 20 may also participate in the procedure. The MIRS system 10 may further include a patient side cart 22 (surgical robot) and an electronics cart 24. The patient side cart 22 can manipulate at least one detachably coupled tool assembly 26 (hereinafter simply referred to as "tool") through a minimally invasive incision in the body of the patient 12 while the surgeon 18 visualizes the surgical site through the console 16. Images of the surgical site can be acquired by an endoscope 28, such as a stereo endoscope, which can be manipulated by the patient side cart 22 to position and orient the endoscope 28. The electronics cart 24 may be used to process images of the surgical site for subsequent display to the surgeon 18 through the surgeon's console 16. The number of surgical tools 26 used at one time generally depends on the diagnostic or surgical procedure and the space constraints within the operating room, among other factors. If it becomes necessary to replace one or more of the tools 26 being used during a procedure, the assistant 20 may remove a tool 26 from the patient side cart 22 and replace it with another tool 26 from a tray 30 in the operating room.

[0027] FIG. 2 is a perspective view of the surgeon's console 16. The surgeon's console 16 includes a left-eye display 32 and a right-eye display 34 to present the surgeon 18 with a coordinated stereoscopic view of the surgical site, enabling depth perception. The console 16 further includes one or more input controllers 36, which operate one or more tools on the patient side cart 22 (shown in FIG. 1). The input controllers 36 can provide the same degrees of freedom as their associated tools 26 (shown in FIG. 1) to provide telepresence to the surgeon, or they can provide a sense of unity with the tools 26 so that the surgeon has a strong sense of direct control over the tools 26. To this end, position, force, and tactile feedback sensors (not shown) can be used to transmit position, force, and tactile sensations from the tools 26 back to the surgeon's hands through the input controllers 36.

[0028] The surgeon's console 16 is typically located in the same room as the patient so that the surgeon can directly monitor the procedure, be physically present if necessary, and speak to the assistant directly rather than by telephone or other communication medium, but the surgeon can be in a different room from the patient, in a different building entirely, or in other locations remote from the patient allowing for remote surgery.

[0029] FIG. 3 is a perspective view of the electronics cart 24. The electronics cart 24 can be coupled to an endoscope 28 and can include a processor for processing captured images for subsequent display to the surgeon, such as at the surgeon's console or on another suitable display located locally and / or remotely. For example, if a stereoscopic endoscope is used, the electronics cart 24 can process the captured images to present a coordinated stereoscopic image of the surgical site to the surgeon. Such coordination can include alignment between opposing images and adjusting the stereoscopic working distance of the stereoscopic endoscope. As another example, image processing can include the use of previously determined camera calibration parameters to compensate for imaging errors of the image capture device, such as optical aberrations.

[0030] FIG. 4 diagrammatically illustrates a robotic surgery system 50 (such as the MIRS system 10 of FIG. 1). As mentioned above, a surgeon's console 52 (such as the surgeon's console 16 of FIG. 1) can be used by a surgeon to control a patient side cart (surgical robot) 54 (such as the patient side cart 22 of FIG. 1) during minimally invasive surgery. The patient side cart 54 can use an imaging device, such as a stereoscopic endoscope, to capture images of the surgical site and output the captured images to an electronics cart 56 (such as the electronics cart 24 of FIG. 1). As mentioned above, the electronics cart 56 can process the captured images in various ways before subsequent display. For example, the electronics cart 56 can overlay the captured images with a virtual control interface before displaying the combined image to the surgeon via the surgeon's console 52. The patient side cart 54 can output the captured images for processing outside of the electronics cart 56. For example, the patient side cart 54 can output the captured images to a processor 58, which can be used to process the captured images. The images may also be processed by a combination of the electronics cart 56 and processor 58, which may be coupled together to process the captured images jointly, sequentially, and / or combinations thereof. One or more separate displays 60 may also be coupled with the processor 58 and / or the electronics cart 56 for local and / or remote display of images, such as images of the surgical site or other related images.

[0031] 5A and 5B show the patient side cart 22 and surgical tools 26, respectively. The surgical tools 26 are examples of surgical tools 26. The illustrated patient side cart 22 provides for manipulation of three surgical tools 26 and an imaging device 28, such as a stereo endoscope, used to acquire images of the surgical field. Manipulation is provided by a robotic mechanism having several robotic joints. The imaging device 28 and surgical tools 26 can be positioned and manipulated within the patient through an incision such that a kinematic remote center is held at the incision to minimize the size of the incision. The image of the surgical field can include an image of the distal end of the surgical tool 26 when the surgical tool 26 is positioned within the field of view of the imaging device 28.

[0032] Robotic surgery system and modular manipulator support FIG. 6 is a perspective schematic diagram of a robotic surgical system 70, according to many embodiments. The surgical system 70 includes a mounting base 72, a support linkage 74, an orienting platform 76, a plurality of outer setup linkages 78 (two shown), a plurality of inner setup linkages 80 (two shown), and a plurality of surgical instrument manipulators 82. Each of the manipulators 82 is operable to selectively articulate a surgical instrument attached to the manipulator 82 and insertable into a patient along an insertion axis. Each of the manipulators 82 is mounted to and supported by one of the setup linkages 78, 80. Each of the outer setup linkages 78 is rotationally coupled to and supported by the orienting platform 76 by a first setup linkage joint 84. Each of the inner setup linkages 80 is fixedly coupled to and supported by the orienting platform 76. The orienting platform 76 is rotationally coupled to and supported by the support linkage 74, which in turn is fixedly mounted to and supported by the mounting base 72.

[0033] In many embodiments, the mounting base 72 is movable and floor-supported, thereby allowing for selective repositioning of the entire surgical system 70, for example, within an operating room. The mounting base 72 can include a steerable wheel assembly and / or any other suitable feature that provides both selective repositioning and selectively preventing movement of the mounting base 72 from a selected position. The mounting base 72 can also have any other suitable configuration, such as, for example, a ceiling mount, a fixed floor / pedestal mount, a wall mount, or any other suitable mounting surface.

[0034] The support linkage 74 is operable to selectively position and / or orient the orienting platform 76 relative to the mounting base 72. The support linkage 74 includes a column base 86, a translatable column member 88, a shoulder joint 90, a boom base member 92, a boom first stage member 94, a boom second stage member 96, and a wrist joint 98. The column base 86 is fixedly mounted to the mounting base 72. The translatable column member 88 is slidably coupled to the column base 86 for translational movement relative to the column base 86. In many embodiments, the translatable column member 88 translates along an axis oriented perpendicular to the column base 86. The boom base member 92 is rotationally coupled to the translatable column member 88 by the shoulder joint 90. The shoulder joint 90 is operable to selectively orient the boom base member 92 relative to the translatable column member 88 in a horizontal plane, which translatable column member 88 has a fixed angular orientation relative to the column base 86 and the mounting base 72. The boom first stage member 94 is selectively translatable horizontally relative to the boom base member 92, which in many embodiments is aligned with both the boom base member 92 and the boom first stage member 94. The boom second stage member 96 is similarly selectively translatable horizontally relative to the boom first stage member 94, which in many embodiments is aligned with both the boom first stage member 94 and the boom second stage member 96. Thus, the support linkage 74 is operable to selectively set the distance between the shoulder joint 90 and the distal end of the boom second stage member 96. A wrist joint 98 rotationally couples the distal end of the boom second stage member 96 to the orienting platform 76. Wrist joint 98 is operable to selectively set the angular orientation of orienting platform 76 relative to mounting base 72 .

[0035] Each of the setup linkages 78, 80 is operable to selectively position and / or orient an associated manipulator 82 relative to the orienting platform 76. Each of the setup linkages 78, 80 includes a setup linkage base link 100, a setup linkage extension link 102, a setup linkage parallelogram linkage section 104, a setup linkage vertical link 106, a second setup linkage joint 108, and a manipulator support link 110. Each of the setup linkage base links 100 of the outer setup linkage 78 can be selectively oriented relative to the orienting platform 76 via operation of the first setup linkage joint 84. In the illustrated embodiment, each of the setup linkage base links 100 of the inner setup linkage 80 is fixedly attached to the orienting platform 76. Each of the inner setup linkages 80, like the outer setup linkages, can also be rotationally attached to the orienting platform 76 via an additional first setup linkage joint 84. Each of the setup linkage extension links 102 is translatable horizontally relative to the associated setup linkage base link 100, which in many embodiments is aligned with the associated setup linkage base link and setup linkage extension link 102. Each of the setup linkage parallelogram linkage sections 104 is configured and operable to selectively translate the setup linkage vertical link 106 vertically while maintaining the setup linkage vertical link 106 in a vertical orientation. In the exemplary embodiment, each of the setup linkage parallelogram linkage sections 104 includes a first parallelogram joint 112, a connecting link 114, and a second parallelogram joint 116. The first parallelogram joint 112 rotationally couples the connecting link 114 to the setup linkage extension link 102. The second parallelogram joint 116 rotationally couples the setup linkage vertical link 106 to the connecting link 114.The first parallelogram joint 112 is rotationally coupled to the second parallelogram joint 116 such that rotation of the connecting link 114 relative to the setup linkage extension link 102 is matched by a counteracting rotation of the setup linkage vertical link 106 relative to the connecting link 114 such that the setup linkage vertical link 106 is maintained vertically oriented while the setup linkage vertical link 106 is selectively translated vertically. The second setup linkage joint 108 is operable to selectively orient the manipulator support link 110 relative to the setup linkage vertical link 106, thereby selectively orienting the associated attached manipulator 82 relative to the setup linkage vertical link 106.

[0036] FIG. 7 is a perspective schematic diagram of a robotic surgical system 120, according to many embodiments. Because the surgical system 120 includes similar components to those of the surgical system 70 of FIG. 6, the same reference numerals are used for similar components, and corresponding descriptions of the similar components described above are applicable to the surgical system 120 and will be omitted here to avoid repetition. The surgical system 120 includes a mounting base 72, a support linkage 122, an orienting platform 124, a plurality of setup linkages 126 (four shown), and a plurality of surgical instrument manipulators 82. Each of the manipulators 82 is operable to selectively articulate a surgical instrument attached to the manipulator 82 and insertable into a patient along an insertion axis. Each of the manipulators 82 is attached to and supported by one of the setup linkages 126. Each of the setup linkages 126 is rotationally coupled to and supported by the orienting platform 124 by a first setup linkage joint 84. The orienting platform 124 is rotationally coupled to and supported by the support linkage 122. The support link mechanism 122 is fixedly attached to and supported by the mounting base 72 .

[0037] The support linkage 122 is operable to selectively position and / or orient the orienting platform 124 relative to the mounting base 72. The support linkage 122 includes the column base 86, the translatable column member 88, the shoulder joint 90, the boom base member 92, the boom first stage member 94, and the wrist joint 98. The support linkage 122 is operable to selectively set the distance between the shoulder joint 90 and the distal end of the boom first stage member 94. The wrist joint 98 rotationally couples the distal end of the boom first stage member 94 to the orienting platform 124. The wrist joint 98 is operable to selectively set the angular orientation of the orienting platform 124 relative to the mounting base 72.

[0038] Each of the setup linkages 126 is operable to selectively position and / or orient an associated manipulator 82 relative to the orienting platform 124. Each of the setup linkages 126 includes a setup linkage base link 100, a setup linkage extension link 102, a setup linkage vertical link 106, a second setup linkage joint 108, a tornado mechanism support link 128, and a tornado mechanism 130. Each of the setup linkage base links 100 of a setup linkage 126 can be selectively oriented relative to the orienting platform 124 via operation of the associated first setup linkage joint 84. Each of the setup linkage vertical links 106 is selectively translatable vertically relative to the associated setup linkage extension link 102. The second setup linkage joint 108 is operable to selectively orient the tornado mechanism support link 128 relative to the setup linkage vertical link 106.

[0039] Each tornado mechanism 130 includes a tornado joint 132, a connecting link 134, and a manipulator support 136. The connecting link 134 fixedly connects the manipulator support 136 to the tornado joint 132. The tornado joint 132 is operable to rotate the manipulator support 136 about a tornado axis 138 relative to the tornado mechanism support link 128. The tornado mechanisms 130 are configured to position and orient the manipulator support 134 so that a remote center of operation (RC) of the manipulator 82 intersects the tornado axis 136. Thus, operation of the tornado joint 132 can be used to reorient the associated manipulator 82 relative to the patient without moving the associated remote center of operation (RC) relative to the patient.

[0040] Figure 8 is a simplified diagram of a robotic surgical system 140, according to many embodiments, that corresponds to the schematic diagram of robotic surgical system 120 of Figure 7. Because surgical system 140 corresponds to robotic surgical system 120 of Figure 7, the same reference numbers are used for similar components, and the corresponding descriptions of similar components described above are applicable to surgical system 140 and are omitted here to avoid repetition.

[0041] The support linkage 122 is configured to selectively position and orient the orienting platform 124 relative to the mounting base 72 via relative movement between the links of the support linkage 122 along multiple setup structure axes. The translatable column member 88 is selectively repositionable relative to the column base 86 along a first setup structure (SUS) axis 142, which in many embodiments is oriented vertically. The shoulder joint 90 is operable to selectively orient the boom base member 92 relative to the translatable column member 88 about a second SUS axis 144, which in many embodiments is oriented vertically. The boom first stage member 94 is selectively repositionable relative to the boom base member 92 along a third SUS axis 146, which in many embodiments is oriented horizontally. The wrist joint 98 is then operable to selectively orient the boom first stage member 94 orienting platform 124 along a fourth SUS axis 148, which in many embodiments is oriented vertically.

[0042] Each setup linkage 126 is configured to selectively position and orient an associated manipulator 82 relative to the orienting platform 124 via relative movement between the links of the setup linkage 126 along multiple setup joint (SUJ) axes. Each first setup linkage joint 84 is operable to selectively orient a setup linkage base link 100 associated with the orienting platform 124 about a first SUJ axis 150, which in many embodiments is oriented vertically. Each setup linkage extension link 102 is selectively repositionable relative to the associated setup base link 100 along a second SUJ axis 152, which in many embodiments is oriented horizontally. Each setup linkage vertical link 106 is selectively repositionable relative to the associated setup linkage extension link 102 along a third SUJ axis 154, which in many embodiments is oriented vertically. Each of the second setup linkage joints 108 is operable to selectively orient the tornado mechanism support link 128 relative to the setup linkage vertical link 106 about the third SUJ axis 154. Each of the tornado joints 132 is operable to rotate the associated manipulator 82 about the associated tornado axis 138.

[0043] FIG. 9 illustrates the rotational orientation limits of the setup linkages 126 relative to the orienting platform 124, according to many embodiments. Each of the setup linkages 126 is shown at its clockwise limit orientation relative to the orienting platform 124. The corresponding counterclockwise limit orientation is shown by mirroring FIG. 9 relative to a vertically oriented mirror plane. As shown, each of the two inner setup linkages 126 can be oriented from 5 degrees in one direction from a vertical reference 156 to 75 degrees in the opposite direction from the vertical reference 156. Also shown, each of the two outer setup linkages can be oriented from 15 degrees to 95 degrees in the corresponding direction from the vertical reference 156.

[0044] 10 illustrates a center of gravity diagram associated with the rotation limits of a support linkage for a robotic surgical system 160, according to many embodiments. With the components of the robotic surgical system 160 positioned and oriented to move the center of gravity 162 of the robotic surgical system 160 to a maximum extent to one side relative to the support linkage 164 of the surgical system 160, the shoulder joint of the support linkage 164 can be configured to limit rotation of the support structure 164 about the setup structure (SUS) shoulder joint axis 166 to prevent exceeding a predetermined stability limit of the mounting base.

[0045] Other variations are within the spirit of the invention. Accordingly, while the invention is susceptible to various modifications and alternative constructions, certain illustrated embodiments have been shown in the drawings and have been described in detail. It is to be understood, however, that it is not intended to limit the invention to the particular forms or forms disclosed, but rather, it is intended to cover all modifications, alternative constructions, and equivalents which fall within the spirit and scope of the invention as defined by the appended claims.

[0046] Use of the terms "a," "an," "the," and similar referents in the context of describing the present invention (particularly in the context of the claims below) should be interpreted to encompass both the singular and the plural unless otherwise indicated herein or clearly contradicted by context. The terms "comprising," "having," "including," and "containing" should be interpreted as open-ended terms (i.e., meaning "including, but not limited to") unless otherwise indicated. The term "connected" should be interpreted as partially or completely contained within, attached to, or joined together, even if there is something intervening. Recitations of ranges of values ​​herein are merely intended to serve as a shorthand method of individually referencing each individual value falling within the range, unless expressly stated herein, and each individual value is incorporated into the specification as if it were individually referenced herein. All methods described herein can be performed in any suitable order unless otherwise stated herein or clearly contradicted by context. The use of any and all examples, or exemplary language (e.g., "etc.") used herein is intended merely to better clarify embodiments of the invention and does not pose a limitation on the scope of the invention unless recited in the claims. No language in the specification should be construed as indicating any non-claimed element as essential to the practice of the invention.

[0047] Preferred embodiments of the present invention are described herein, including the best mode known to the inventors for carrying out the invention. Variations of these preferred embodiments may become apparent to those of ordinary skill in the art upon reading the foregoing description. The inventors anticipate that skilled artisans will employ such variations as they see fit, and the inventors intend the invention to be practiced otherwise than as specifically described herein. Accordingly, this invention includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Furthermore, any combination of the above-described elements in all possible variations thereof is encompassed by the invention unless otherwise expressly stated herein or otherwise clearly contradicted by context.

[0048] All references cited in this application, including publications, patent applications, and patents, are hereby incorporated by reference to the same extent as if each reference was individually and specifically indicated to be incorporated by reference and as if fully set forth in this application.

[0049] The following additional note is added: (Appendix 1) Supports and; a manipulator to which a surgical instrument is attachable, the manipulator configured to rotate the surgical instrument about a first manipulator axis intersecting a remote center of operation (RC) and to rotate the surgical instrument about a second manipulator axis intersecting the RC to insert the surgical instrument into a patient along an insertion axis through the RC, the second manipulator axis intersecting the first manipulator axis, and each of the first manipulator axis and the second manipulator axis intersecting the insertion axis; a setup linkage configured to reorient the manipulator relative to the support and to fixedly support the manipulator at a selected position relative to the support, the setup linkage including a proximal link coupled to the support, a distal link coupled to the manipulator, and a reorientation mechanism configured to move the distal link relative to the proximal link in a motion that maintains the RC in a fixed position relative to the proximal link; Surgical system. (Appendix 2) the reorientation mechanism includes a reorientation rotary joint and a reorientation link; the reorientation link has a proximal end coupled to the reorientation rotation joint and a distal end coupled to the manipulator; actuation of the reorientation rotary joint rotates the reorientation link about a reorientation axis that intersects the RC and is not aligned with either the manipulator first axis or the manipulator second axis; the reorienting link is configured to hold the RC in a fixed position relative to the proximal link in response to actuation of the reorienting rotary joint. 10. The surgical system of claim 1. (Appendix 3) the manipulator is mechanically constrained to maintain a fixed position of the RC relative to the distal link when the manipulator rotates the surgical instrument about the manipulator first axis and when the manipulator rotates the surgical instrument about the manipulator second axis. 10. The surgical system of claim 1. (Appendix 4) the manipulator is mechanically configured to move the surgical instrument through a first motion mechanically limited to rotation about the manipulator first axis in response to actuation of a first joint of the manipulator, and to move the surgical instrument through a second motion mechanically limited to rotation about the manipulator second axis in response to actuation of a second joint of the manipulator. 4. The surgical system of claim 3. (Appendix 5) the proximal link has a proximal end coupled to the support through a proximal setup linkage joint configured to selectively orient the proximal link relative to the support about a first setup linkage axis; the distal link has a distal end coupled to the manipulator and repositionable relative to the proximal link in at least two directions; 10. The surgical system of claim 1. (Appendix 6) a second manipulator to which a second surgical instrument is attachable, the second manipulator configured to rotate the second surgical instrument about a second manipulator first axis intersecting a second remote center of operation (second RC) and to rotate the second surgical instrument about a second manipulator second axis intersecting the second RC to insert the second surgical instrument into the patient through the second RC along a second insertion axis, the second manipulator second axis intersecting the second manipulator first axis, and each of the second manipulator first axis and the second manipulator second axis intersecting the second insertion axis; a second setup linkage configured to reorient the second manipulator relative to the support and to fixedly support the second manipulator at a selected position relative to the support, the second setup linkage including a second proximal link coupled to the support, a second distal link coupled to the second manipulator, and a second reorientation mechanism configured to move the second distal link relative to the second proximal link in a motion that maintains the second RC in a fixed position relative to the second proximal link. 10. The surgical system of claim 1. (Appendix 7) the second reorienting mechanism includes a second reorienting rotary joint and a second reorienting link; the second reorienting link having a proximal end coupled to the second reorienting rotary joint and a distal end coupled to the second manipulator; actuation of the second reorientation rotary joint rotates the second reorientation link about a second reorientation axis that intersects the second RC and is not aligned with either the second manipulator first axis or the second manipulator second axis; the second reorienting link is configured to hold the second RC in a fixed position relative to the second proximal link in response to actuation of the second reorienting rotary joint. 7. The surgical system of claim 6. (Appendix 8) the second manipulator is mechanically constrained to maintain a fixed position of the second RC relative to the second distal link when the second manipulator rotates the second surgical instrument about the second manipulator first axis and when the second manipulator rotates the second surgical instrument about the second manipulator second axis. 7. The surgical system of claim 6. (Appendix 9) the second manipulator is mechanically configured to move the second surgical instrument through a first motion mechanically limited to rotation about a first axis of the second manipulator in response to actuation of a first joint of the second manipulator, and to move the second surgical instrument through a second motion mechanically limited to rotation about a second axis of the second manipulator in response to actuation of a second joint of the second manipulator. 9. The surgical system of claim 8. (Appendix 10) the second proximal link has a proximal end coupled to the support through a proximal second setup linkage joint configured to selectively orient the second proximal link relative to the support about a second setup linkage axis; the second distal link has a distal end coupled to the second manipulator and repositionable relative to the second proximal link in at least two directions; 7. The surgical system of claim 6. (Appendix 11) Supports and; a surgical instrument manipulator configured to movably support a surgical instrument insertable into a patient; a setup linkage coupling the surgical instrument manipulator to the support; the set-up linkage is operable to reposition the surgical instrument manipulator relative to the support and to fixedly support the surgical instrument manipulator relative to the support; The setup linkage comprises: Base link and; a first joint rotatably coupling the base link to the support and operable to selectively orient the base link relative to the support; an extension link slidably coupled to the base link for horizontal translational movement relative to the base link; Vertical links and; a parallelogram linkage portion connecting the vertical link and the extension link, the parallelogram linkage portion configured and operable to move the vertical link relative to the extension link while maintaining the vertical link oriented; a manipulator support link to which the surgical instrument manipulator is attached; a second joint rotatably coupling the manipulator support link to the vertical link and operable to selectively orient the manipulator support link relative to the vertical link; having Robotic surgery system. (Appendix 12) a second surgical instrument manipulator configured to movably support a second surgical instrument insertable into the patient; a second setup linkage coupling the second surgical instrument manipulator to the support; the second set-up linkage is operable to reposition the second surgical instrument manipulator relative to the support and to fixedly support the second surgical instrument manipulator relative to the support. 12. The robotic surgery system of claim 11. (Appendix 13) a third surgical instrument manipulator configured to movably support a third surgical instrument insertable into the patient; a third set-up linkage coupling the third surgical instrument manipulator to the support and operable to reposition and fixedly support the third surgical instrument manipulator relative to the support. 13. The robotic surgery system of claim 12. (Appendix 14) Mounting base and; a support linkage connecting the support to the mounting base; the support linkage is operable to reposition the support relative to the mounting base and to fixedly support the support relative to the mounting base. 14. A robotic surgery system according to any one of claims 11 to 13. (Appendix 15) the support link mechanism includes a column base, a translationally movable column member, a shoulder joint, a boom base member, a boom first stage member, a boom second stage member, and a wrist joint; the column base is fixedly attached to the mounting base; the translatable column member slidably coupled to the column base for translational movement along an axis oriented perpendicular to the column base; the boom base member is rotatably coupled to the translatable column member by the shoulder joint; the shoulder joint is operable to selectively orient the boom base member in a horizontal plane relative to the translatable column member; the boom first stage member is selectively translatably movable in a horizontal direction relative to the boom base member; the boom second stage member is selectively translatable in a horizontal direction relative to the boom first stage member; The wrist joint rotatably connects the boom second stage member to the support portion. 15. The robotic surgery system of claim 14. (Appendix 16) Orientation platform and; a support linkage that movably supports the orienting platform; A plurality of manipulators, each of the manipulators includes an instrument holder; each of the manipulators is configured to support an associated surgical instrument attached to the instrument holder, to rotate the instrument holder about a first manipulator axis intersecting an associated remote center of operations (RC) for inserting the associated surgical instrument into a patient along an insertion axis through the associated RC, and to rotate the instrument holder about a second manipulator axis intersecting the associated RC; each of the first manipulator axis and the second manipulator axis transverses the insertion axis, and the second manipulator axis transverses the first manipulator axis; with multiple manipulators; A plurality of setup linkages, each of the set-up linkages couples an associated manipulator of the plurality of manipulators to the orienting platform; each of the set-up linkages is operable to reposition the associated manipulator relative to the orienting platform; each of the set-up linkages is operable to fixedly support the associated manipulator at a selected position relative to the orienting platform; each of the set-up linkages includes a proximal link coupled to the orienting platform and a distal link coupled to the associated manipulator; At least one of the setup linkages has a reorientation mechanism that, when actuated, moves the distal link relative to the proximal link through a movement that holds the RC of the associated manipulator in a fixed position relative to the proximal link. With multiple setup linkages; having Robotic surgery system. (Appendix 17) the reorientation mechanism includes a tornado revolute joint and a tornado link, the tornado link having a tornado link proximal end coupled to the tornado revolute joint and a tornado link distal end coupled to the associated manipulator; Actuation of the tornado revolute joint rotates the tornado link about a tornado axis that intersects the RC of the associated manipulator and is not aligned with either the first manipulator axis or the second manipulator axis; The tornado link is configured to hold the RC of the associated manipulator in a fixed position relative to the proximal link in response to actuation of the tornado revolute joint. 17. The robotic surgery system of claim 16. (Appendix 18) at least one of the manipulators is mechanically constrained to maintain a fixed position of the RC of the associated manipulator relative to the distal link during rotation of the instrument holder about the first manipulator axis and during rotation of the instrument holder about the second manipulator axis; 17. The robotic surgery system of claim 16. (Appendix 19) each of the manipulators is mechanically constrained to maintain a fixed position of the RC of the associated manipulator relative to the distal link during rotation of the instrument holder about the first manipulator axis and during rotation of the instrument holder about the second manipulator axis; 17. The robotic surgery system of claim 16. (Appendix 20) at least one of the manipulators is mechanically configured to move the instrument holder in response to actuation of a first joint of the manipulator through a first motion mechanically limited to rotation about the first manipulator axis and to move the instrument holder in response to actuation of a second joint of the manipulator through a second motion mechanically limited to rotation about the second manipulator axis; 19. The robotic surgery system of claim 16 or 18. (Appendix 21) each of the manipulators is mechanically configured to move the instrument holder in response to actuation of a first joint of the manipulator through a first motion mechanically limited to rotation about the first manipulator axis, and to move the instrument holder in response to actuation of a second joint of the manipulator through a second motion mechanically limited to rotation about the second manipulator axis; 20. The robotic surgery system of claim 16 or 19. (Appendix 22) The support linkage comprises: Mounting base and; a column slidably mounted to the mounting base and selectively positionable relative to the mounting base along a vertically oriented first support axis; a boom base member rotatably coupled to the column through a shoulder joint operable to selectively orient the boom base member relative to the column about a vertically oriented second support axis; an extendable boom member slidably coupled to the boom base member through a boom joint operable to selectively position the extendable boom member relative to the boom base member along a horizontally oriented third support axis; the orienting platform is rotationally coupled to the extendable boom member; 22. A robotic surgery system according to any one of claims 16 to 21. (Appendix 23) Orientation platform and; a support linkage that movably supports the orienting platform; a plurality of manipulators, each manipulator movably supporting an associated surgical instrument insertable into a patient; a plurality of setup linkages, each of the setup linkages coupling an associated manipulator of the plurality of manipulators to the orienting platform, each of the setup linkages operable to reposition the associated manipulator relative to the orienting platform, and each of the setup linkages operable to fixedly support the associated manipulator relative to the orienting platform; and At least a first setup linkage of the plurality of setup linkages: a first link having a first link proximal end rotationally coupled to the orienting platform through a first set-up linkage joint operable to selectively orient the first link relative to the orienting platform about a first set-up linkage axis; a second link slidably attached to the first link through a second set-up linkage joint operable to selectively reposition the second link along a second set-up linkage axis oriented horizontally relative to the first link; a third link slidably attached to the second link through a third set-up linkage joint operable to selectively reposition the third link along a third set-up linkage axis oriented perpendicular to the second link; a fourth link rotationally coupled to the third link through a fourth set-up linkage joint operable to selectively orient the fourth link about a fourth set-up linkage axis oriented perpendicular to the third link; and a corresponding one or more manipulators of the plurality of manipulators coupled to the orienting platform by one or more of the plurality of setup linkages are distal to and supported by the fourth link; Robotic surgery system. (Appendix 24) each manipulator of the plurality of manipulators has an instrument holder configured to support the associated surgical instrument; each manipulator of the plurality of manipulators is configured to rotate the instrument holder about a first manipulator axis intersecting an associated remote center of operations (RC) and to rotate the instrument holder about a second manipulator axis intersecting the associated RC, the second manipulator axis transverse to the first manipulator axis, to insert the associated surgical instrument into a patient through the associated RC; 24. The robotic surgery system of claim 23. (Appendix 25) at least a first one of the set-up linkages includes a reorientation mechanism coupled to the fourth link; Actuation of the reorientation mechanism moves the associated manipulator relative to the fourth link through a motion that holds the associated RC in a fixed position relative to the fourth link. 25. The robotic surgery system of claim 24.

Claims

1. an orientation platform; a first manipulator having a first manipulator instrument holder; a first setup linkage having a support for the first manipulator; the first setup linkage is attached to the orienting platform; the first manipulator is attached to the support for the first manipulator; the first manipulator is configured to support a first surgical instrument attached to the instrument holder of the first manipulator, insert the first surgical instrument along an insertion axis of the first manipulator through a remote center (RC) of first manipulator operation and into a patient, rotate the instrument holder of the first manipulator relative to the support for the first manipulator about a first axis of the first manipulator, and rotate the instrument holder of the first manipulator relative to the support for the first manipulator about a second axis of the first manipulator; the first axis of the first manipulator and the second axis of the first manipulator each transverse the insertion axis of the first manipulator; the second axis of the first manipulator transverses the first axis of the first manipulator; the first set-up linkage is operable to reposition the support for the first manipulator RC relative to the orienting platform with a movement that maintains the first manipulator RC in a first fixed position relative to the orienting platform; Surgical system.

2. the first setup linkage having a first setup linkage tornado mechanism operable to rotate the support for the first manipulator about a first setup linkage tornado axis that is not aligned with the first axis of the first manipulator. The surgical system of claim 1 .

3. the first set-up linkage is operable to maintain the first manipulator RC at the first fixed position relative to the orienting platform during operation of the first set-up linkage tornado mechanism to rotate the support for the first manipulator about the first set-up linkage tornado axis. The surgical system of claim 2 .

4. the first setup linkage tornado axis intersects with the first axis of the first manipulator; The surgical system of claim 3 .

5. The first axis of the first manipulator intersects with the first manipulator RC, The surgical system of claim 3 .

6. the first setup linkage further includes a first setup linkage first link and a first setup linkage first joint; the first set-up linkage first joint is operable to selectively reorient the first set-up linkage first link relative to the orienting platform about a first set-up linkage first axis; The surgical system of claim 2 .

7. the first setup linkage further includes a first setup linkage second link and a first setup linkage second joint; the first set-up linkage second joint is operable to selectively reposition the first set-up linkage second link along a first set-up linkage second axis that is oriented horizontally relative to the first set-up linkage first link; The surgical system of claim 6 .

8. the first setup link mechanism further includes a first setup link mechanism third link and a first setup link mechanism third joint; the first set-up linkage third joint is operable to selectively reposition the first set-up linkage third link along a first set-up linkage third axis oriented perpendicular to the first set-up linkage second link; The surgical system of claim 7 .

9. the first setup linkage further includes a first setup linkage fourth link and a first setup linkage fourth joint; the first setup linkage fourth joint is operable to selectively rotate the first setup linkage fourth link about a first setup linkage fourth axis oriented perpendicular to the first setup linkage third link; the first manipulator is distal to and supported by the first setup linkage fourth link; The surgical system of claim 8 .

10. the first setup linkage tornado axis intersects the insertion axis of the first manipulator; The surgical system of claim 2 .

11. The first axis of the first manipulator is perpendicular to the second axis of the first manipulator. The surgical system of claim 1 .

12. A second manipulator, the second manipulator having an instrument holder for the second manipulator; a second setup linkage having a support for the second manipulator; the second manipulator is configured to support a second surgical instrument attached to the instrument holder of the second manipulator, insert the second surgical instrument through the second manipulator RC and into the patient along an insertion axis of the second manipulator, rotate the instrument holder of the second manipulator relative to the support for the second manipulator about a first axis of the second manipulator, and rotate the instrument holder of the second manipulator relative to the support for the second manipulator about a second axis of the second manipulator; the first axis of the second manipulator and the second axis of the second manipulator each transverse the insertion axis of the second manipulator; the second axis of the second manipulator transverses the first axis of the second manipulator; the second set-up linkage is operable to reposition the support for the second manipulator RC relative to the orienting platform with a second movement that maintains the second manipulator RC at a second fixed position relative to the orienting platform. The surgical system of claim 1 .

13. the second setup linkage having a second setup linkage tornado mechanism operable to rotate the support for the second manipulator about a second setup linkage tornado axis that is not parallel to the first axis of the second manipulator. The surgical system of claim 12.

14. the second set-up linkage is operable to maintain the second manipulator RC at the second fixed position relative to the orienting platform during operation of the second set-up linkage tornado mechanism to rotate the support for the second manipulator RC about the second set-up linkage tornado axis. The surgical system of claim 13.

15. the second setup linkage tornado axis intersects with the first axis of the second manipulator; The surgical system of claim 14.

16. the second setup linkage tornado axis intersects the insertion axis of the second manipulator; The surgical system of claim 13.

17. the first axis of the second manipulator is perpendicular to the second axis of the second manipulator; The surgical system of claim 12.

18. The first axis of the second manipulator intersects with the second manipulator RC. The surgical system of claim 17.

19. A second manipulator, the second manipulator having an instrument holder for the second manipulator; a second setup linkage having a support for the second manipulator; the second manipulator is configured to support a second surgical instrument attached to the instrument holder of the second manipulator, insert the second surgical instrument through the second manipulator RC and into the patient along an insertion axis of the second manipulator, rotate the instrument holder of the second manipulator relative to the support for the second manipulator about a first axis of the second manipulator, and rotate the instrument holder of the second manipulator relative to the support for the second manipulator about a second axis of the second manipulator; the first axis of the second manipulator and the second axis of the second manipulator each transverse the insertion axis of the second manipulator; the second axis of the second manipulator transverses the first axis of the second manipulator; the second set-up linkage is operable to reposition the support for the second manipulator RC relative to the orienting platform with a second movement that maintains the second manipulator RC at a second fixed position relative to the orienting platform. The surgical system of claim 5 .

20. the second setup linkage having a second setup linkage tornado mechanism operable to rotate the support for the second manipulator about a second setup linkage tornado axis that is not aligned with the first axis of the second manipulator.

20. The surgical system of claim 19.

21. the second set-up linkage is operable to maintain the second manipulator RC at the second fixed position relative to the orienting platform during operation of the second set-up linkage tornado mechanism to rotate the support for the second manipulator RC about the second set-up linkage tornado axis. The surgical system of claim 20.

22. The first axis of the second manipulator intersects with the second manipulator RC. The surgical system of claim 21.

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