IMPROVED INTERFACE FOR LAPAROSCOPIC SURGERIES - MOVEMENT GESTURES

• US 20180325604A1
• Filed: 07/09/2015
• Published: 11/15/2018
• Est. Priority Date: 07/10/2014
• Status: Active Grant

• Current Assignee: Asensus Surgical Europe SARL (Asensus Surgical, Inc.)
• Original Assignee: M.S.T. Medical Surgery Technologies Ltd (Asensus Surgical, Inc.)
• Inventors: ATAROT, Gal, FRIMER, Motti, NIR, Tal, HAREL, Tami
• Granted Patent: US 10,799,302 B2
• Time in Patent Office: Days
• CPC Class Codes: A61B 1/00147 Holding or positioning arrangements
• CPC Class Codes: A61B 1/3132 for laparoscopy
• CPC Class Codes: A61B 2017/00119 alarm; indicating an abnormal situation
• CPC Class Codes: A61B 2017/00207 with hand gesture control or hand gesture recognition
• CPC Class Codes: A61B 2034/2048 using an accelerometer or inertia sensor
• CPC Class Codes: A61B 2505/05 Surgical care
• CPC Class Codes: A61B 2560/0487 Special user inputs or interfaces
• CPC Class Codes: A61B 2562/0219 Inertial sensors, e.g. accelerometers, gyroscopes, tilt switches
• CPC Class Codes: A61B 2562/028 Microscale sensors, e.g. electromechanical sensors [MEMS]
• CPC Class Codes: A61B 34/25 User interfaces for surgical systems
• CPC Class Codes: A61B 5/0035 adapted for acquisition of images from more than one imaging mode, e.g. combining MRI and optical tomography
• CPC Class Codes: A61B 5/06 Devices, other than using radiation, for detecting or locating foreign bodies for removing same A61B17/50 ; determining position of probes within or on the body of the patient
• CPC Class Codes: A61B 5/1114 Tracking parts of the body
• CPC Class Codes: A61B 5/7425 Displaying combinations of multiple images regardless of image source, e.g. displaying a reference anatomical image with a live image geometric transforms for image registration G06T3/14; enhancement using image fusion G06T5/50; algorithms for registration of images G06T7/30
• CPC Class Codes: A61B 5/7475 User input or interface means, e.g. keyboard, pointing device, joystick

Abstract

The present invention discloses a surgical maneuvering system, in which movement of a moving element is used to control a surgical device such as a surgical tool or an endoscope. The moving element can be a tool or a portion of an operator'"'"'s body. The relationship between the moving element and the surgical device can be any of: motion of a moving element controlling motion of a surgical device, motion of a moving element controlling an action of a surgical device, a command of a moving element controlling motion of a surgical device, or a command of a moving element controlling an action of the device. Commands are typically arbitrary movements such as shaking a tool. Actions are changes in a surgical device that do not change its overall position, such as closing a grasper.

Claims

1-572. -572. (canceled)

573. A maneuvering system, comprising:

a. at least one endoscope adapted to real-time provide at least one image of a field of view;

b. at least one surgical tool;

c. at least one maneuvering mechanism in active communication with at least one selected from a group consisting of said at least one endoscope, said at least one surgical tool and any combination thereof;

said maneuvering mechanism is configured to maneuver at least one selected from a group consisting of said at least one endoscope, said at least one surgical tool and any combination thereof;

in at least two dimensions;

d. a computer program which, when executed by a data processor, is in communication with a member of a group consisting of said at least one endoscope, said at least one surgical tool and any combination thereof;

said program, when executed by a data processor is configured to (i) real-time image process said at least one image;

(ii) detect movement of at least a portion of said at least one surgical tool;

wherein, if said detected movement of at least a portion of said at least one surgical tool is within a predetermined protocol of input movement, then at least one of the following is being held true;

(a) said endoscope is maneuvered by means of said maneuvering mechanism according to a predetermined protocol of output movement;

(b) said at least one surgical tool is maneuvered by means of said maneuvering mechanism according to a predetermined protocol of output movement;

(c) said at least one surgical tool is activated;

(d) a second surgical tool is maneuvered by means of said maneuvering mechanism according to said at least one output movement protocol;

(e) a second surgical tool is activated according to said at least one output movement protocol; and

,

(f) any combination thereof.

574. The system of claim 573, wherein said input movement protocol is selected from a group consisting of:

moving said at least one surgical tool parallel to the X axis;

moving said at least one surgical tool parallel to the Y axis;

moving said at least one surgical tool parallel to the Z-axis;

rotational movement of said at least one surgical tool around an axis parallel to the X axis;

rotational movement of said at least one surgical tool around an axis parallel to the Y axis;

rotational movement of said at least one surgical tool around an axis parallel to the Z axis;

shaking said at least one surgical tool, moving said at least one surgical tool in at least a portion of a circle, moving said at least one surgical tool in at least a portion of an oval, moving said at least one surgical tool in at least a portion of an ellipse, moving said at least one surgical tool in a straight line, moving said at least one surgical tool in a zigzag, moving said at least one endoscope parallel to the X axis;

moving said at least one endoscope parallel to the Y axis;

moving said at least one endoscope parallel to the Z-axis;

rotational movement of said at least one endoscope around an axis parallel to the X axis;

rotational movement of said at least one endoscope around an axis parallel to the Y axis;

rotational movement of said at least one endoscope around an axis parallel to the Z axis;

shaking said surgical tool, moving said at least one endoscope in at least a portion of a circle, moving said at least one endoscope in at least a portion of an oval, moving said at least one endoscope in at least a portion of an ellipse, moving said at least one endoscope in a straight line, moving said at least one endoscope in a zigzag, and any combination thereof.

575. The system of claim 573, additionally comprising an input protocol selected from a group consisting of:

at least a portion of at least one said surgical tool is positioned in a predetermined region of said field of view;

at least a portion of at least one said surgical tool is positioned less than a predetermined distance from an edge of said field of view;

at least a portion of at least one said surgical tool is oriented at a predetermined angle in said field of view;

there exists a predetermined relationship between at least two articles in said field of view and any combination thereof.

577. The system of claim 573, wherein said activation is selected from a group consisting of:

opening said at least one surgical tool, closing said at least one surgical tool, causing said at least one surgical tool to function, stopping said at least one surgical tool from functioning, introducing at least one said surgical tool to the surgical environment, removing at least one said surgical tool from the surgical environment, introducing at least one said endoscope to a surgical environment, removing at least one said endoscope from a surgical environment and any combination thereof.

578. The system of claim 573, wherein said maneuvering mechanism can maneuver said surgical tool in at least three dimensions.

579. The system of claim 573, wherein a relationship between magnitude of an output movement and magnitude of said sensor-indicated movement is selected from a group consisting of:

the magnitude of said output movement is proportional to the magnitude of said detected;

the magnitude of said output movement is substantially identical to the magnitude of said detected movement;

the magnitude of said output movement is independent of the magnitude of said detected movement and any combination thereof.

580. The system of claim 573, wherein at least one said input movement protocol comprises an unwanted movement;

wherein said unwanted movement is selected from a group consisting of;

involuntary movement of a body part, saccadic movement of an eye, winking an eye, blinking an eye, tremor of a body part, a tic in a body part, myoclonus of a body part, dystonia, and any combination thereof.

581. The system of claim 580, wherein said predetermined output protocol, upon detection of at least one said unwanted movement, is that movement of said surgical tool is unaffected by said detection of said at least one unwanted movement.

582. The system of claim 573, additionally comprising either a wired or wireless communicable database for storing at least one selected from a group consisting of said predetermined protocol of input movement;

said predetermined protocol of output movement; and

any combination thereof.

583. The system of claim 573, additionally comprising at least one sensor, configured to indicate at least one movement of at least one moving element.

584. The system of claim 573, wherein said moving element is selected from a group consisting of movement of at least a portion of at least one said surgical tool, of movement of the distal end of at least one said surgical tool, movement of a portion of a body of at least one operator, at least one brain signal indicating a command to move at least a portion of said body of said at least one operator, at least one brain signal indicating future movement of at least a portion of said body of said at least one operator, at least one brain signal of said at least one operator indicating at least one predefined future development, a sound signal, and any combination thereof.

585. The system of claim 573, wherein said sensor indicates movement of said moving element if a current 3D position or current signal, 3D_current is substantially different from a previous 3D position or previous signal of the same, 3D_previous;

further wherein said at least one movement results in an input movement protocol.

586. The system of claim 585, wherein said computer program is configured to instruct said maneuvering mechanism, upon detection of said input movement protocol, to move a member of a group consisting of said at least one endoscope, said at least one surgical tool and any combination thereof according to a predetermined protocol for movement.

587. The system of claim 573, wherein said body portion is selected from a group consisting of:

at least a portion of an arm;

at least a portion of a hand;

at least a portion of a finger;

at least a portion of a wrist;

at least a portion of a forearm;

at least a portion of an elbow;

at least a portion of a shoulder;

at least a portion of a toe;

at least a portion of a foot;

at least a portion of a leg;

at least a portion of a neck;

at least a portion of a chest;

at least a portion of an abdomen;

at least a portion of a trunk;

at least a portion of a head, an eye;

at least a portion of a mouth;

at least a portion of a brain;

at least a portion of a face and any combination thereof.

588. The system of claim 573, wherein said maneuvering mechanism can maneuver a member of a group consisting of said at least one endoscope, said at least one surgical tool and any combination thereof in at least three dimensions.

589. The system of claim 588, wherein each member of a group consisting of an allowed output movement protocol, a restricted output movement protocol and any combination thereof of a member of a maneuverable object group consisting of said at least one endoscope, said at least one surgical tool and any combination thereof is determinable from input movement protocols comprising historical movements of said member of said maneuverable object group according with historical movement patterns of said member of said maneuverable object group in at least one previous surgery.

590. The system of claim 589, wherein each member of a group consisting of an allowed input movement protocol, a restricted input movement protocol and any combination thereof comprises, stored in said communicable database, each 3D spatial position of said member of said maneuverable object group according with at least two 3D spatial positions of said member of said maneuverable object group, such that each movement pattern of said member of said maneuverable object group and each 3D position of said member of said maneuverable object group according with the same is stored;

in said associated allowed output protocol, said allowed movements of said member of said maneuverable object group are movements in which the same is located substantially in at least one of the endoscope 3D spatial positions according with at least one said 3D movement pattern, and said restricted movements are movements in which the location of said member of said maneuverable object group is substantially different from the n 3D spatial positions of the same according with the n movement patterns.

591. The system of claim 589, wherein each member of a group consisting of an allowed output movement protocol, a restricted output movement protocol and any combination thereof comprises at least one rule according to which allowed and restricted movements of said at least one surgical tool are determined, such that each detected movement by said movement detection means of said at least one surgical tool is determined as either an allowed movement or as a restricted movement according to said predetermined set of rules.

592. The system of claim 591, wherein said allowed movement is permitted by said controller and said restricted movement is denied by said controller.

593. The system of claim 591, wherein said predetermined set of rules comprises at least one rule selected from a group consisting of:

most used tool rule, right tool rule, left tool rule, field of view rule, no fly zone rule, a route rule, environmental rule, operator input rule, proximity rule;

collision prevention rule, history-based rule, tool-dependent allowed and restricted movements rule, preferred volume zone rule, preferred tool rule, movement detection rule, tagged tool rule, change of speed rule and any combination thereof.

594. The system of claim 591, wherein at least one of the following is being held true (a) said route rule comprises a communicable database storing predefined route in which said at least one surgical tool is configured to move within said surgical environment;

said predefined route comprises n 3D spatial positions of said at least one surgical tool;

n is an integer greater than or equal to 2;

said allowed movements are movements in which said at least one surgical tool is located substantially in at least one of said n 3D spatial positions of said predefined route, and said restricted movements are movements in which said location of said at least one surgical tool is substantially different from said n 3D spatial positions of said predefined route;

(b) said environmental rule comprises a communicable database;

said communicable database configured to receive at least one real-time image of said surgical environment and is configured to perform real-time image processing of the same and to determine the 3D spatial position of hazards or obstacles in said surgical environment;

said environmental rule is configured to determine said allowed and restricted movements according to said hazards or obstacles in said surgical environment, such that said restricted movements are movements in which said at least one surgical tool is located substantially in at least one of said 3D spatial positions, and said allowed movements are movements in which the location of said at least one surgical tool is substantially different from said 3D spatial positions;

said hazards or obstacles in said surgical environment are selected from a group consisting of tissue, a surgical tool, an organ, an endoscope and any combination thereof;

(c) said operator input rule comprises a communicable database;

said communicable database is configured to receive an input from the operator of said system regarding said allowed and restricted movements of said at least one surgical tool;

(d) said proximity rule is configured to define a predetermined distance between at least two surgical tools;

said allowed movements are movements which are within the range or out of the range of said predetermined distance, and said restricted movements which are out of the range or within the range of said predetermined distance;

(e) said proximity rule is configured to define a predetermined angle between at least three surgical tools;

said allowed movements are movements which are within the range or out of the range of said predetermined angle, and said restricted movements which are out of the range or within the range of said predetermined angle;

(f) said collision prevention rule is configured to define a predetermined distance between said at least one surgical tool and an anatomical element within said surgical environment;

said allowed movements are movements which are in a range that is larger than said predetermined distance, and said restricted movements are movements which is in a range that is smaller than said predetermined distance;

(g) said right tool rule is configured to determine said allowed movement of said endoscope according to the movement of the surgical tool positioned to right of said endoscope;

further wherein said left tool rule is configured to determine said allowed movement of said endoscope according to the movement of the surgical tool positioned to left of said endoscope;

(h) said tagged tool rule comprises means configured to tag at least one surgical tool within said surgical environment and to determine said allowed movement of said endoscope to constantly track the movement of said tagged surgical tool;

(i) said field of view rule comprises a communicable database comprising n 3D spatial positions;

n is an integer greater than or equal to 2;

the combination of all of said n 3D spatial positions provides a predetermined field of view;

said field of view rule is configured to determine said allowed movement of said endoscope within said n 3D spatial positions so as to maintain a constant field of view, such that said allowed movements are movements in which said endoscope is located substantially in at least one of said n 3D spatial positions, and said restricted movements are movements in which the location of said endoscope is substantially different from said n 3D spatial positions;

(j) said preferred volume zone rule comprises a communicable database comprising n 3D spatial positions;

n is an integer greater than or equal to 2;

said n 3D spatial positions provides said preferred volume zone;

said preferred volume zone rule is configured to determine said allowed movement of said endoscope within said n 3D spatial positions and restricted movement of said endoscope outside said n 3D spatial positions, such that said allowed movements are movements in which said endoscope is located substantially in at least one of said n 3D spatial positions, and said restricted movements are movements in which the location of said endoscope is substantially different from said n 3D spatial positions;

(k) preferred tool rule comprises a communicable database, said database stores a preferred tool;

said preferred tool rule is configured to determine said allowed movement of said endoscope to constantly track the movement of said preferred tool;

(l) said no fly zone rule comprises a communicable database comprising n 3D spatial positions;

n is an integer greater than or equal to 2;

said n 3D spatial positions define a predetermined volume within said surgical environment;

said no fly zone rule is configured to determine said restricted movement if said movement is within said no fly zone and allowed movement if said movement is outside said no fly zone, such that said restricted movements are movements in which said at least one of said surgical tool is located substantially in at least one of said n 3D spatial positions, and said allowed movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions;

(m) said most used tool rule comprises a communicable database counting the amount of movement of each of said surgical tools;

said most used tool rule is configured to constantly position said endoscope to track the movement of the most moved surgical tool;

(n) said history-based rule comprises a communicable database storing each 3D spatial position of each of said surgical tool, such that each movement of each surgical tool is stored;

said history-based rule is configured to determine said allowed and restricted movements according to historical movements of said at least one surgical tool, such that said allowed movements are movements in which said at least one surgical tool is located substantially in at least one of said 3D spatial positions, and said restricted movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions;

(o) said tool-dependent allowed and restricted movements rule comprises a communicable database;

said communicable database is configured to store predetermined characteristics of at least one of said surgical tool;

said tool-dependent allowed and restricted movements rule is configured to determine said allowed and restricted movements according to said predetermined characteristics of said surgical tool;

such that allowed movements as movements of said endoscope which tracks said surgical tool having said predetermined characteristics;

(p) said movement detection rule comprises a communicable database comprising the real-time 3D spatial positions of each of said surgical tool;

said movement detection rule is configured to detect movement of said at least one surgical tool when a change in said 3D spatial positions is received, such that said allowed movements are movements in which said endoscope is re-directed to focus on the moving surgical tool; and

any combination thereof.

595. The system of claim 594, wherein said system is configured to provide an alert for said restricted movement of said at least one surgical tool;

wherein said alert is selected from a group consisting of audio signaling, voice signaling, light signaling, flashing signaling and any combination thereof.

596. The system of claim 573, additionally comprising a second imaging modality, configured to generate at least one second modality image.

597. The system of claim 596, wherein said computer program, when executed by said data processor, is configured to generate an augmented reality image comprising a rendered superposition of at least a portion of said image and at least a portion of said at least one second modality image.

598. The system of claim 597, wherein said second imaging modality is selected from a group consisting of:

MRI, CT, PET, ultrasound, IR imaging, heat imaging, a still camera, a videocamera, image-generation software, image-manipulation software, display of stored images and any combination thereof.

599. The system of claim 596, wherein said at least one second modality image is provided in a manner selected from a group consisting of:

said second modality image is real-time generated, said second modality image is a stored image and any combination thereof.

600. The system of claim 596, wherein said second modality image is selected from a group consisting of:

a 2D image, a 3D image and any combination thereof.

601. The system of claim 596, wherein said stored second modality image is storable in a database in communication with said computer program.

602. The system of claim 573, wherein said computer program, when executed by said data processor, is configured to real time generate a display image by at least one of a group consisting of:

(a) generating at least one virtual marker at at least one predetermined position within at least a portion of said image;

(b) rendered superimposing of at least a portion of said image and at least a portion of a second imaging modality.

603. The system of claim 602, wherein said virtual marker provides information selected from a group consisting of:

a distance between predetermined points, an orientation relative to a predetermined direction, an identifier, and any combination thereof.

604. The system of claim 603, wherein said identifier identifies a member of a group consisting of:

at least one portion of tissue of a predetermined type, a predetermined location, a tool, and any combination thereof.

605. The system of claim 602, wherein said tissue of a predetermined type is selected from a group consisting of:

an organ, a blood vessel, a bone, a nerve, a ligament, abnormal tissue and any combination thereof.

606. The system of claim 573, wherein said identifier comprises a mark of predetermined shape.

607. The system of claim 606, wherein said predetermined shape is selected from a group consisting of:

a word, a geometric shape, an outline of a predetermined area, a patch covering said predetermined area, an outline of predetermined shape, a patch of said predetermined shape, and any combination thereof.

608. The system of claim 573, wherein said endoscope further comprises a wide-angle lens at the distal end of the same;

wherein said wide-angle lens is selected from a group consisting of;

a fish-eye lens, an omnidirectional lens, and any combination thereof.

609. The system of claim 608, additionally comprising a light source configured to illuminate at least a portion of said field of view and software which, when executed by said data processor, is configured to control said light source;

further wherein said controlled light source emits a pattern comprising a structured light pattern.

610. The system of claim 609, additionally comprising software which, when executed by said data processor, is configured to generate, real time, a 3D image from at least a portion of at least one camera image generated by said structured light pattern.

611. The system of claim 573, wherein said computer program additionally comprises software which, when executed by said data processor, removes fog from at least a portion of at least one said image.

612. The system of claim 573, wherein said computer program additionally comprises software which, when executed by said data processor, visually enhances at least one of:

at least a portion of a limb, at least a portion of a blood vessel, at least a portion of an organ, at least a portion of a bone, at least a portion of a nerve, at least a portion of a ligament, at least a portion of abnormal tissue and any combination thereof.

613. A system for maneuvering a surgical tool, comprising:

a. at least one surgical tool;

b. at least one endoscope;

c. at least one maneuvering mechanism in active communication with said at least one surgical tool and said at least one endoscope;

said maneuvering mechanism is configured to maneuver at least one selected from a group consisting of said at least one surgical tool, said at least one endoscope and any combination thereof in at least two dimensions;

d. at least one sensor configured to indicate at least one movement of at least one moving element;

said sensor indicates movement of said moving element if a current 3D position or current signal, 3D_current, is substantially different from a previous 3D position or previous signal of the same, 3D_previous;

e. either a wired or wireless communicable database for consecutively storing said 3D_current and said 3D_previous of each of said moving element; and

f. a data processor comprising a computer program in communication with said at least one surgical tool and said at least one maneuvering mechanism;

said program, when executed by said data processor is configured to identify if said movement of said moving element is within a predetermined protocol of input movement;

wherein, if said detected movement of said moving element is within said predetermined protocol of input movement or said detected position of said moving element is within a predetermined protocol of input positions, then at least one of the following is being held true;

(a) said endoscope is maneuvered by means of said maneuvering mechanism according to a predetermined protocol of output movement;

(b) said at least one surgical tool is maneuvered by means of said maneuvering mechanism according to a predetermined protocol of output movement; and

(c) said at least one surgical tool is activated;

(d) a second surgical tool is maneuvered by means of said maneuvering mechanism according to said at least one output protocol;

(e) a second surgical tool is activated according to said at least one output protocol; and

,

(f) any combination thereof.

614. The system of claim 613, wherein at least one of a group consisting of said movement of said moving element, said signal of said moving element and any combination thereof is selected from a group consisting of:

movement of at least a portion of at least one said surgical tool, of movement of the distal end of at least one said surgical tool, movement of a portion of a body of at least one operator, at least one brain signal indicating a command to move at least a portion of said body of said at least one operator, at least one brain signal indicating future movement of at least a portion of said body of said at least one operator, at least one brain signal of said at least one operator indicating at least one predefined future development, a sound signal, and any combination thereof.

615. The system of claim 613, wherein said body portion is selected from a group consisting of:

at least a portion of an arm;

at least a portion of a hand;

at least a portion of a finger;

at least a portion of a wrist;

at least a portion of a forearm;

at least a portion of an elbow;

at least a portion of a shoulder;

at least a portion of a toe;

at least a portion of a foot;

at least a portion of a leg;

at least a portion of a neck;

at least a portion of a chest;

at least a portion of an abdomen;

at least a portion of a trunk;

at least a portion of a head, an eye;

at least a portion of a mouth;

at least a portion of a brain;

at least a portion of a face, and any combination thereof.

616. The system of claim 613, wherein said input movement protocol is selected from a group consisting of:

moving said at least one surgical tool parallel to the X axis;

moving said at least one surgical tool parallel to the Y axis;

moving said at least one surgical tool parallel to the Z-axis;

rotational movement of said at least one surgical tool around an axis parallel to the X axis;

rotational movement of said at least one surgical tool around an axis parallel to the Y axis;

rotational movement of said at least one surgical tool around an axis parallel to the Z axis;

shaking said at least one surgical tool, moving said at least one surgical tool in at least a portion of a circle, moving said at least one surgical tool in at least a portion of an oval, moving said at least one surgical tool in at least a portion of an ellipse, moving said at least one surgical tool in a straight line, moving said at least one surgical tool in a zigzag, moving said at least one endoscope parallel to the X axis;

moving said at least one endoscope parallel to the Y axis;

moving said at least one endoscope parallel to the Z-axis;

rotational movement of said at least one endoscope around an axis parallel to the X axis;

rotational movement of said at least one endoscope around an axis parallel to the Y axis;

rotational movement of said at least one endoscope around an axis parallel to the Z axis;

shaking said at least one endoscope, moving said at least one endoscope in at least a portion of a circle, moving said at least one endoscope in at least a portion of an oval, moving said at least one endoscope in at least a portion of an ellipse, moving said at least one endoscope in a straight line, moving said at least one endoscope in a zigzag, and any combination thereof.

617. The system of claim 613, additionally comprising an input protocol selected from a group consisting of:

at least a portion of at least one said surgical tool is positioned in a predetermined region of said field of view;

at least a portion of at least one said surgical tool is positioned less than a predetermined distance from an edge of said field of view;

at least a portion of at least one said surgical tool is oriented at a predetermined angle in said field of view;

there exists a predetermined relationship between at least two articles in said field of view and any combination thereof.

618. The system of claim 613, additionally comprising an output protocol selected from a group consisting of:

zooming at least one said endoscope inward, zooming at least one said endoscope outward, tagging at least one said tool, activating at least one tagged tool, deactivating at least one tagged tool, rotating a display image, moving a center of a field of view, saving at least one said image, storing at least one said image, augmenting at least one said image, selecting at least one said image with which to augment said display image, establishing a predetermined relationship between at least two articles in said field of view, maneuvering said at least one endoscope such that at least one said surgical tool remains within said field of view, maneuvering said at least one endoscope such that at least one said surgical tool is at a center of said field of view, maneuvering said at least one endoscope such that at least one said surgical tool is more than a predetermined distance from said edge of said field of view, maneuvering said at least one endoscope such that at least one said surgical tool is between said edge of said field of view and said predetermined distance from aid edge of said field of view, altering zoom of said at least one endoscope until said at least one surgical tool at a distance from said edge of said field of view than said predetermined distance from said edge of said field of view and any combination thereof.

619. The system of claim 618, wherein said activation is selected from a group consisting of:

opening said at least one surgical tool, closing said at least one surgical tool, causing said at least one surgical tool to function, stopping said at least one surgical tool from functioning, introducing at least one said surgical tool to the surgical environment, removing at least one said surgical tool from the surgical environment, introducing at least one said endoscope to a surgical environment, removing at least one said endoscope from a surgical environment and any combination thereof.

620. The system of claim 613, wherein said maneuvering mechanism can maneuver said surgical tool in at least three dimensions.

621. The system of claim 613, wherein a relationship between magnitude of an output movement and magnitude of said sensor-indicated movement is selected from a group consisting of:

the magnitude of said output movement is proportional to the magnitude of said detected;

the magnitude of said output movement is substantially identical to the magnitude of said detected movement;

the magnitude of said output movement is independent of the magnitude of said detected movement and any combination thereof.

622. The system of claim 613, wherein at least one said input movement protocol comprises an unwanted movement;

wherein said unwanted movement is selected from a group consisting of;

involuntary movement of a body part, saccadic movement of an eye, winking an eye, blinking an eye, tremor of a body part, a tic in a body part, myoclonus of a body part, dystonia, and any combination thereof.

623. The system of claim 613, wherein said predetermined output protocol, upon detection of at least one said unwanted movement, is that movement of said surgical tool is unaffected by said detection of said at least one unwanted movement.

624. The system of claim 613, wherein said sensor is selected from a group consisting of:

an ultrasound sensor, an IR sensor, a heat sensor, a pressure sensor, a current sensor, an accelerometer, a tilt sensor, a movement sensor, a gyroscope, an inertial sensor, a goniometer, a magnetometer, a thermometer, a humidity sensor, a strain sensor, a position sensor configured to determine position of said at least one portion of said human body;

a speed sensor configured to determine velocity of said at least one portion of said human body;

an accelerometer configured to determine acceleration of said at least one portion of said human body;

a camera and image detection software configured to determine at least one of position, velocity and acceleration of said at least one portion of said human body;

an RF sensor and RF emitter coupleable to said at least one portion of said human body configured to determine at least one of position, velocity and acceleration of said at least one portion of said human body;

a sound sensor and sound emitter coupleable to said at least one portion of said human body configured to determine at least one of position, velocity and acceleration of said at least one portion of said human body;

an electroencephalographic sensor configured to determine, from at least one electroencephalographic pattern, at least one parameter associated with at least one of position, velocity and acceleration of said at least one portion of said human body, a sensor configured to determine, from at least one electrical pattern in at least one muscle, at least one parameter associated with at least one of position, velocity and acceleration of said at least one portion of said human body and any combination thereof.

625. The system of claim 613, wherein said sensor is wearable on said body;

wherein said wearable sensor is worn on a part of the body elected from a group consisting of;

at least a portion of an arm;

at least a portion of a hand;

at least a portion of a finger;

at least a portion of a wrist;

at least a portion of a forearm;

at least a portion of an elbow;

at least a portion of a shoulder;

at least a portion of a toe;

at least a portion of a foot;

at least a portion of a leg;

at least a portion of a neck;

at least a portion of a chest;

at least a portion of an abdomen;

at least a portion of a trunk;

at least a portion of a head, an eye;

at least a portion of a mouth;

at least a portion of a brain;

at least a portion of a face, and any combination thereof.

626. The system of claim 625, wherein the means of wearing said sensor is selected from a group consisting of:

a band, a harness, a ring, a bracelet, a necklace, a belt, an arm ring, a glove, a fingerless glove, a sleeve, a shirt, a vest, a helmet, a collar, a headband and any combination thereof.

627. The system of claim 625, additionally comprising a second imaging modality configured to generate at least one second modality image.

628. The system of claim 627, wherein said computer program, when executed by said data processor, is configured to generate an augmented reality image comprising a rendered superposition of at least a portion of said image and at least a portion of said at least one second imaging modality image.

629. The system of claim 627, wherein said second imaging modality is selected from a group consisting of:

MRI, CT, PET, ultrasound, IR imaging, heat imaging, a still camera, a videocamera, image-generation software, image-manipulation software, display of stored images, and any combination thereof.

630. The system of claim 627, wherein said at least one second modality image is provided in a manner selected from a group consisting of:

said second modality image is real-time generated, said second modality image is a stored image and any combination thereof.

631. The system of claim 627, wherein said at least one second modality image is a 2D image, a 3D image and any combination thereof.

632. The system of claim 627, wherein said computer program, when executed by said data processor, is additionally configured to real time generate a display image by at least one of a group consisting of:

(a) generating at least one virtual marker at at least one predetermined position within at least a portion of said image;

(b) rendered superimposing of at least a portion of said image and at least a portion of a second imaging modality.

633. The system of claim 632, wherein said virtual marker provides information selected from a group consisting of:

a distance between predetermined points, an orientation relative to a predetermined direction, an identifier, and any combination thereof.

634. The system of claim 632, wherein said identifier identifies a member of a group consisting of:

at least one portion of tissue of a predetermined type, a predetermined location, a tool, and any combination thereof.

635. A maneuvering system, comprising:

a. at least one endoscope adapted to real-time provide at least one image of a field of view;

b. at least one surgical tool;

c. at least one maneuvering mechanism in active communication with at least one selected from a group consisting of said at least one endoscope, said at least one surgical tool and any combination thereof;

said maneuvering mechanism is configured to maneuver at least one selected from a group consisting of said at least one endoscope, said at least one surgical tool and any combination thereof;

in at least two dimensions;

d. a computer program which, when executed by a data processor, is in communication with a member of a group consisting of said at least one endoscope, said at least one surgical tool and any combination thereof;

said program, when executed by a data processor is configured to determine, from said image of said field of view, an input protocol;

wherein, if said input protocol is within a predetermined input command, at least one output command is being activated.

636. The system of claim 635, wherein said input command is selected from a group consisting of:

a. at least one said surgical tool is maneuvered according to an input movement protocol;

b. at least a portion of at least one said surgical tool is positioned in a predetermined region of said field of view;

c. at least a portion of at least one said surgical tool is positioned less than a predetermined distance from an edge of said field of view;

d. at least a portion of at least one said surgical tool is oriented at a predetermined angle in said field of view;

e. at least one said surgical tool is activated;

f. at least one said surgical tool is deactivated;

g. at least one said surgical tool is articulated;

h. at least one said endoscope is maneuvered according to an input movement protocol;

i. at least one said endoscope is articulated;

j. at least one said endoscope is zoomed;

k. at least one said endoscope is activated;

l. at least one said endoscope is deactivated;

m. at least a portion of a second endoscope is positioned in a predetermined region of said field of view;

n. at least a portion of a second endoscope is positioned less than a predetermined distance from an edge of said field of view;

o. at least a portion of a second endoscope is oriented at a predetermined angle in said field of view;

p. a relationship between at least two articles; and

q. any combination thereof.

637. The system of claim 636, wherein said input movement protocol is selected from a group consisting of:

moving said at least one surgical tool parallel to the X axis;

moving said at least one surgical tool parallel to the Y axis;

moving said at least one surgical tool parallel to the Z-axis;

rotational movement of said at least one surgical tool around an axis parallel to the X axis;

rotational movement of said at least one surgical tool around an axis parallel to the Y axis;

rotational movement of said at least one surgical tool around an axis parallel to the Z axis;

shaking said at least one surgical tool, moving said at least one surgical tool in at least a portion of a circle, moving said at least one surgical tool in at least a portion of an oval, moving said at least one surgical tool in at least a portion of an ellipse, moving said at least one surgical tool in a straight line, moving said at least one surgical tool in a zigzag, moving said at least one endoscope parallel to the X axis;

moving said at least one endoscope parallel to the Y axis;

moving said at least one endoscope parallel to the Z-axis;

rotational movement of said at least one endoscope around an axis parallel to the X axis;

rotational movement of said at least one endoscope around an axis parallel to the Y axis;

rotational movement of said at least one endoscope around an axis parallel to the Z axis;

shaking said surgical tool, moving said at least one endoscope in at least a portion of a circle, moving said at least one endoscope in at least a portion of an oval, moving said at least one endoscope in at least a portion of an ellipse, moving said at least one endoscope in a straight line, moving said at least one endoscope in a zigzag, and any combination thereof.

638. The system of claim 636, wherein said activation is selected from a group consisting of:

opening said at least one surgical tool, closing said at least one surgical tool, causing said at least one surgical tool to function, stopping said at least one surgical tool from functioning, introducing at least one said surgical tool to the surgical environment, removing at least one said surgical tool from the surgical environment, introducing at least one said endoscope to a surgical environment, removing at least one said endoscope from a surgical environment and any combination thereof.

639. The system of claim 635, wherein said output command is selected from a group consisting of:

a. said at least one surgical tool is maneuvered according to an output movement protocol;

b. at least a portion of at least one said surgical tool is repositioned to a predetermined region of said field of view;

c. at least a portion of at least one said surgical tool is oriented at a predetermined angle in said field of view;

d. said at least one surgical tool is activated;

e. at least one said surgical tool is deactivated;

f. in at least one said surgical tool, at least one of a group consisting of an articulation angle, an articulation length and any combination thereof is altered;

g. at least one said surgical tool is tagged;

h. at least one said surgical tool is tracked;

i. a second surgical tool is maneuvered according to said at least one output protocol;

j. a second surgical tool is activated;

k. a second surgical tool is deactivated;

l. in a second surgical tool, at least one of a group consisting of an articulation angle, an articulation length and any combination thereof is altered;

m. at least one said endoscope is maneuvered according to an output movement protocol;

n. in at least one said endoscope, at least one of a group consisting of an articulation angle, an articulation length and any combination thereof is altered;

o. at least one said endoscope is zoomed;

p. at least one said endoscope is activated;

q. at least one said endoscope is deactivated;

r. at least a portion of a second endoscope is positioned in a predetermined region of said field of view;

s. at least a portion of of a second endoscope is positioned less than a predetermined distance from an edge of said field of view;

t. a second endoscope is tagged;

u. a second endoscope is tracked;

v. at least a portion of an organ is tagged;

w. at least a portion of a body structure is tagged;

x. a relationship between at least two articles; and

y. any combination thereof.

640. The system of claim 639, wherein said output movement protocol is selected from a group consisting of:

moving said at least one surgical tool parallel to the X axis;

moving said at least one surgical tool parallel to the Y axis;

moving said at least one surgical tool parallel to the Z-axis;

rotational movement of said at least one surgical tool around an axis parallel to the X axis;

rotational movement of said at least one surgical tool around an axis parallel to the Y axis;

rotational movement of said at least one surgical tool around an axis parallel to the Z axis;

shaking said at least one surgical tool, moving said at least one surgical tool in at least a portion of a circle, moving said at least one surgical tool in at least a portion of an oval, moving said at least one surgical tool in at least a portion of an ellipse, moving said at least one surgical tool in a straight line, moving said at least one surgical tool in a zigzag, moving said endoscope parallel to the X axis;

moving said endoscope parallel to the Y axis;

moving said endoscope parallel to the Z-axis;

rotational movement of said endoscope around an axis parallel to the X axis;

rotational movement of said endoscope around an axis parallel to the Y axis;

rotational movement of said endoscope around an axis parallel to the Z axis;

shaking said at least one surgical tool, moving said endoscope in at least a portion of a circle, moving said endoscope in at least a portion of an oval, moving said endoscope in at least a portion of an ellipse, moving said endoscope in a straight line, moving said endoscope in a zigzag, an allowed movement, a restricted movement and any combination thereof.

641. The system of claim 639, wherein said output protocol is selected from a group consisting of:

said at least one endoscope is maneuvered such that at least one said surgical tool remains within said field of view, said at least one endoscope is maneuvered such that at least one said surgical tool is at a center of said field of view, said at least one endoscope is maneuvered such that at least one said surgical tool is more than a predetermined distance from said edge of said field of view, said at least one endoscope is maneuvered such that at least one said surgical tool is between said edge of said field of view and said predetermined distance from aid edge of said field of view, zoom of said at least one endoscope is altered until said at least one surgical tool at a distance from said edge of said field of view than said predetermined distance from said edge of said field of view and any combination thereof.

642. The system of claim 641, wherein said activation of said at least one surgical tool is selected from a group consisting of:

opening said at least one surgical tool, closing said at least one surgical tool, causing said at least one surgical tool to said surgical, stopping said at least one surgical tool from functioning and any combination thereof.

643. A system for maneuvering a surgical tool, comprising:

a. at least one surgical tool;

b. at least one endoscope;

c. at least one maneuvering mechanism in active communication with said at least one surgical tool and said at least one endoscope;

said maneuvering mechanism is configured to maneuver said at least one surgical tool in at least two dimensions;

d. at least one sensor configured to indicate a member of a group consisting of;

movement of at least one moving element, position of at least one moving element, and any combination thereof;

said sensor indicates said position of said moving element via a current 3D position or current signal, 3D_current; and

said sensor indicates said movement of said moving element if said current 3D position or current signal, 3D_current, is substantially different from at least one previous 3D position or previous signal of the same, 3D_previous;

e. either a wired or wireless communicable database for storing said 3D_current for each said moving element, and, to indicate movement, consecutively storing said 3D_current and said 3D_previous of each of said moving element; and

f. a data processor comprising a computer program in communication with said at least one surgical tool and said at least one maneuvering mechanism;

said program, when executed by said data processor is configured to identify at least one of a group consisting of;

said movement of said moving element is within a predetermined input protocol;

said position of said moving element is within a predetermined input protocol and any combination thereof;

wherein, if said input command is within a predetermined input protocol, at least one output command is being activated.

644. The system of claim 643, wherein said input command is selected from a group consisting of:

a. at least one said surgical tool is maneuvered according to an input movement protocol;

b. at least a portion of at least one said surgical tool is positioned in a predetermined region of said field of view;

c. at least a portion of at least one said surgical tool is positioned less than a predetermined distance from an edge of said field of view;

d. at least a portion of at least one said surgical tool is oriented at a predetermined angle in said field of view;

e. at least one said surgical tool is activated;

f. at least one said surgical tool is deactivated;

g. at least one said surgical tool is articulated;

h. at least one said endoscope is maneuvered according to an input movement protocol;

i. at least one said endoscope is articulated;

j. at least one said endoscope is zoomed;

k. at least one said endoscope is activated;

l. at least one said endoscope is deactivated;

m. at least a portion of a second endoscope is positioned in a predetermined region of said field of view;

n. at least a portion of a second endoscope is positioned less than a predetermined distance from an edge of said field of view;

o. at least a portion of a second endoscope is oriented at a predetermined angle in said field of view;

p. a relationship between at least two articles; and

q. any combination thereof.

645. The system of claim 644, wherein said input movement protocol is selected from a group consisting of:

moving said at least one surgical tool parallel to the X axis;

moving said at least one surgical tool parallel to the Y axis;

moving said at least one surgical tool parallel to the Z-axis;

rotational movement of said at least one surgical tool around an axis parallel to the X axis;

rotational movement of said at least one surgical tool around an axis parallel to the Y axis;

rotational movement of said at least one surgical tool around an axis parallel to the Z axis;

shaking said at least one surgical tool, moving said at least one surgical tool in at least a portion of a circle, moving said at least one surgical tool in at least a portion of an oval, moving said at least one surgical tool in at least a portion of an ellipse, moving said at least one surgical tool in a straight line, moving said at least one surgical tool in a zigzag, moving said at least one endoscope parallel to the X axis;

moving said at least one endoscope parallel to the Y axis;

moving said at least one endoscope parallel to the Z-axis;

rotational movement of said at least one endoscope around an axis parallel to the X axis;

rotational movement of said at least one endoscope around an axis parallel to the Y axis;

rotational movement of said at least one endoscope around an axis parallel to the Z axis;

shaking said surgical tool, moving said at least one endoscope in at least a portion of a circle, moving said at least one endoscope in at least a portion of an oval, moving said at least one endoscope in at least a portion of an ellipse, moving said at least one endoscope in a straight line, moving said at least one endoscope in a zigzag, and any combination thereof.

646. The system of claim 643, wherein said activation is selected from a group consisting of:

opening said at least one surgical tool, closing said at least one surgical tool, causing said at least one surgical tool to function, stopping said at least one surgical tool from functioning, introducing at least one said surgical tool to the surgical environment, removing at least one said surgical tool from the surgical environment, introducing at least one said endoscope to a surgical environment, removing at least one said endoscope from a surgical environment and any combination thereof.

647. The system of claim 644, wherein said output command is selected from a group consisting of:

a. said at least one surgical tool is maneuvered according to an output movement protocol;

b. at least a portion of at least one said surgical tool is repositioned to a predetermined region of said field of view;

c. at least a portion of at least one said surgical tool is oriented at a predetermined angle in said field of view;

d. said at least one surgical tool is activated;

e. at least one said surgical tool is deactivated;

f. in at least one said surgical tool, at least one of a group consisting of an articulation angle, an articulation length and any combination thereof is altered;

g. at least one said surgical tool is tagged;

h. at least one said surgical tool is tracked;

i. a second surgical tool is maneuvered according to said at least one output protocol;

j. a second surgical tool is activated;

k. a second surgical tool is deactivated;

l. in a second surgical tool, at least one of a group consisting of an articulation angle, an articulation length and any combination thereof is altered;

m. at least one said endoscope is maneuvered according to an output movement protocol;

n. in at least one said endoscope, at least one of a group consisting of an articulation angle, an articulation length and any combination thereof is altered;

o. at least one said endoscope is zoomed;

p. at least one said endoscope is activated;

q. at least one said endoscope is deactivated;

r. at least a portion of a second endoscope is positioned in a predetermined region of said field of view;

s. at least a portion of of a second endoscope is positioned less than a predetermined distance from an edge of said field of view;

t. a second endoscope is tagged;

u. a second endoscope is tracked;

v. at least a portion of an organ is tagged;

w. at least a portion of a body structure is tagged;

x. a relationship between at least two articles; and

y. any combination thereof.

648. The system of claim 647, wherein said output movement protocol is selected from a group consisting of:

moving said at least one surgical tool parallel to the X axis;

moving said at least one surgical tool parallel to the Y axis;

moving said at least one surgical tool parallel to the Z-axis;

rotational movement of said at least one surgical tool around an axis parallel to the X axis;

rotational movement of said at least one surgical tool around an axis parallel to the Y axis;

rotational movement of said at least one surgical tool around an axis parallel to the Z axis;

shaking said at least one surgical tool, moving said at least one surgical tool in at least a portion of a circle, moving said at least one surgical tool in at least a portion of an oval, moving said at least one surgical tool in at least a portion of an ellipse, moving said at least one surgical tool in a straight line, moving said at least one surgical tool in a zigzag, moving said endoscope parallel to the X axis;

moving said endoscope parallel to the Y axis;

moving said endoscope parallel to the Z-axis;

rotational movement of said endoscope around an axis parallel to the X axis;

rotational movement of said endoscope around an axis parallel to the Y axis;

rotational movement of said endoscope around an axis parallel to the Z axis;

shaking said at least one surgical tool, moving said endoscope in at least a portion of a circle, moving said endoscope in at least a portion of an oval, moving said endoscope in at least a portion of an ellipse, moving said endoscope in a straight line, moving said endoscope in a zigzag, an allowed movement, a restricted movement and any combination thereof.

649. The system of claim 648, wherein said output protocol is selected from a group consisting of:

said at least one endoscope is maneuvered such that at least one said surgical tool remains within said field of view, said at least one endoscope is maneuvered such that at least one said surgical tool is at a center of said field of view, said at least one endoscope is maneuvered such that at least one said surgical tool is more than a predetermined distance from said edge of said field of view, said at least one endoscope is maneuvered such that at least one said surgical tool is between said edge of said field of view and said predetermined distance from aid edge of said field of view, zoom of said at least one endoscope is altered until said at least one surgical tool at a distance from said edge of said field of view than said predetermined distance from said edge of said field of view and any combination thereof.

650. The system of claim 647, wherein said activation of said at least one surgical tool is selected from a group consisting of:

opening said at least one surgical tool, closing said at least one surgical tool, causing said at least one surgical tool to said surgical, stopping said at least one surgical tool from functioning and any combination thereof.

651. The system of claim 650, wherein movement of said at least one moving element is indicatable by a member of a group consisting of:

movement of at least a portion of at least one said surgical tool, movement of the distal end of at least one said surgical tool, movement of at least a portion of at least one said endoscope;

movement of a portion of a body of at least one operator, at least one brain signal indicating movement of at least a portion of said body of said at least one operator, at least one brain signal indicating future movement of at least a portion of said body of said at least one operator, at least one brain signal of said at least one operator indicating at least one predefined future development, a sound signal resulting from movement of at least a portion of said body of said at least one operator, and any combination thereof.

652. The system of claim 651, wherein said body portion is selected from a group consisting of:

at least a portion of an arm;

at least a portion of a hand;

at least a portion of a finger;

at least a portion of a wrist;

at least a portion of a forearm;

at least a portion of an elbow;

at least a portion of a shoulder;

at least a portion of a toe;

at least a portion of a foot;

at least a portion of a leg;

at least a portion of a neck;

at least a portion of a chest;

at least a portion of an abdomen;

at least a portion of a trunk;

at least a portion of a head, an eye;

at least a portion of a mouth;

at least a portion of a brain;

at least a portion of a face and any combination thereof.

653. The system of claim 643, additionally comprising a second imaging modality, configured to generate at least one second modality image.

654. The system of claim 653, wherein said computer program, when executed by said data processor, is configured to generate an augmented reality image comprising a rendered superposition of at least a portion of said image and at least a portion of said at least one second modality image.

655. The system of claim 653, wherein said second imaging modality is selected from a group consisting of:

MRI, CT, PET, ultrasound, IR imaging, heat imaging, a still camera, a videocamera, image-generation software, image-manipulation software, display of stored images and any combination thereof.

656. The system of claim 653, wherein said at least one second modality image is provided in a manner selected from a group consisting of:

said second modality image is real-time generated, said second modality image is a stored image and any combination thereof.

657. The system of claim 653, wherein said second modality image is selected from a group consisting of:

a 2D image, a 3D image and any combination thereof.

658. The system of claim 643, wherein said computer program, when executed by said data processor, is configured to real time generate a display image by at least one of a group consisting of:

(a) generating at least one virtual marker at at least one predetermined position within at least a portion of said image;

(b) rendered superimposing of at least a portion of said image and at least a portion of a second imaging modality.

659. The system of claim 658, wherein said virtual marker provides information selected from a group consisting of:

a distance between predetermined points, an orientation relative to a predetermined direction, an identifier, and any combination thereof.

660. The system of claim 659, wherein said identifier identifies a member of a group consisting of:

at least one portion of tissue of a predetermined type, a predetermined location, a tool, and any combination thereof.