Surgical instrument

• US 7,147,650 B2
• Filed: 04/12/2004
• Issued: 12/12/2006
• Est. Priority Date: 10/30/2003
• Status: Expired due to Term

• Current Assignee: Endobotics, LLC
• Original Assignee: Cambridge Endoscopic Devices Inc.
• Inventors: Lee, Woojin
• Primary Examiner(s): Dawson, Glenn K.
• Application Number:
  US10/822,081
• Publication Number:
  US 20050096694A1
• Time in Patent Office: 974 Days
• Field of Search: None
• US Class Current: 606/205
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/062 Needle manipulators
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/32 Surgical cutting instruments A61B18/042 takes precedence; suture cutters A61B17/0467; instruments for ligaturing or cutting A61B17/128; instruments for rupturing the amniotic membrane A61B17/4208; specially adapted knives for eye surgery A61F9/0133
• CPC Class Codes: A61B 17/320016 Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes A61B10/0233, A61B17/29, A61B17/3207 take precedence
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/00327 with actuating members moving in opposite directions
• CPC Class Codes: A61B 2017/00738 part of the tool being offset with respect to a main axis, e.g. for better view for the surgeon
• CPC Class Codes: A61B 2017/2902 characterized by features of the actuating rod
• CPC Class Codes: A61B 2017/2905 flexible
• CPC Class Codes: A61B 2017/291 the position of the handle being adjustable with respect to the shaft
• CPC Class Codes: A61B 2017/2919 details of linkages or pivot points
• CPC Class Codes: A61B 2017/292 connection of actuating rod to handle, e.g. ball end in recess
• CPC Class Codes: A61B 2017/2927 the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61B 2017/2929 with a head rotatable about the longitudinal axis of the shaft
• CPC Class Codes: A61B 2017/2936 Pins in guiding slots
• CPC Class Codes: A61B 2017/294 Connection of actuating rod to jaw, e.g. releasable

Abstract

An endoscopic or laparoscopic instrument includes a distal tool, a rigid or flexible elongated shaft that supports the distal tool, and a proximal handle or control member, where the tool and the handle are coupled to the respective distal and proximal ends of the elongated shaft via bendable motion members. The tool and the tool motion member are coupled to the handle and the handle motion member via cables and a push rod in such a way that the movement of the handle with respect to the elongated shaft in any direction is replicated by the tool at the distal end of the shaft. The magnitude of the tool motion with respect to the handle motion may be scaled depending on the size of the handle motion member with respect to that of the tool motion member.

Claims

1. A surgical instrument comprising:

an elongated instrument shaft having proximal and distal ends;

a tool disposed from the distal end of the instrument shaft; and

a control handle disposed from the proximal end of the instrument shaft;

said tool being coupled to the distal end of said elongated instrument shaft via a first movable member;

said control handle coupled to the proximal end of said elongated instrument shaft via a second movable member;

whereby movement of said control handle with respect to said elongated instrument shaft via said second movable member causes attendant movement of said tool with respect to said elongated instrument shaft via said first movable member;

wherein both of the movable members comprise a bendable motion member, each bendable motion member providing at least one degree of freedom and the bending stiffness of the second movable member is greater than the bending stiffness of the first movable member.

2. The surgical instrument of claim 1 wherein each of the bendable motion members have two degree of freedom to provide motion in all directions.

3. The surgical instrument of claim 1 wherein the control handle comprises a push-pull tool actuation arrangement.

4. A surgical instrument comprising:

an elongated instrument shaft having proximal and distal ends;

a tool disposed from the distal end of the instrument shaft;

a control handle disposed from the proximal end of the instrument shaft; and

said tool being coupled to the distal end of said elongated instrument shaft via a first movable member;

said control handle coupled to the proximal end of said elongated instrument shaft via a second movable member;

whereby movement of said control handle with respect to said elongated instrument shaft via said second movable member causes attendant movement of said tool with respect to said elongated instrument shaft via said first movable member;

wherein at least one of said first and second members comprises a bendable motion member;

wherein the maximum transverse cross-sectional dimension of the second movable member is different than that of the first movable member;

wherein the tool movement with respect to the distal end of the elongated shaft is in the same direction of the control handle movement with respect to the proximal end of the elongated shaft.

5. The surgical instrument of claim 4 wherein both of the movable members comprise a bendable motion member, and the bending stiffness of the second movable member is different than the bending stiffness of the first movable member.

6. The surgical instrument of claim 4 wherein the diameter of the second movable member is greater than the diameter of the first movable member.

7. The surgical instrument of claim 4 wherein the control handle is able to axially rotate relative to at least one of the instrument shaft and second movable member.

8. The surgical instrument of claim 4 including a mechanism for locking the relative orientation between the first and second movable members at a predetermined position.

9. The surgical instrument of claim 4 including a distal axial rotation joint for axially rotating at least one of the first bendable member and tool relative to the instrument shaft.

10. The surgical instrument of claim 4 including a rotation knob adjacent the control handle and rotatable relative to the control handle for causing a corresponding rotation of the tool about a distal tool roll axis.

11. The surgical instrument of claim 4 wherein said second motion member comprises a bendable member and said first motion member comprises a pivotal joint.

12. A surgical instrument comprising:

an elongated instrument shaft having proximal and distal ends;

a tool disposed from the distal end of the instrument shaft; and

a control handle disposed from the proximal end of the instrument shaft;

said tool being coupled to the distal end of said elongated instrument shaft via a distal movable member;

said control handle coupled to the proximal end of said elongated instrument shaft via a proximal movable member;

whereby movement of said control handle with respect to said elongated instrument shaft via said proximal movable member causes attendant movement of said tool with respect to said elongated instrument shaft via said distal movable member;

wherein at least one of said movable members comprises a bendable motion member;

wherein the maximum transverse cross-sectional dimension of the second movable member is different than that of the first movable member;

further including another proximal movable member and another distal movable member for multi-modal controlled movement of the tool.

13. The surgical instrument of claim 12 wherein said elongated instrument shaft is flexible and further including a first shaft section connecting the proximal movable members and a second shaft section connecting the distal movable members.

14. The surgical instrument of claim 12 wherein the maximum transverse cross-sectional dimension of the proximal movable member is different than that of the distal movable member.

15. The surgical instrument of claim 14 wherein both movable members are bendable members, and the diameter and bending stiffness of the proximal bendable member is greater than the diameter and bending stiffness of the distal bendable member.

16. The surgical instrument of claim 12 wherein the control handle is able to axially rotate relative to at least one of the instrument shaft and second movable member.

17. The surgical instrument of claim 12 including a mechanism for locking the relative orientation between the distal and proximal movable members at a predetermined position.

18. The surgical instrument of claim 12 further including distal and proximal axial rotation joints wherein the proximal axial rotation joint actuates the distal axial rotation joint.

19. The surgical instrument of claim 12 including a distal axial rotation joint for axially rotating at least one of the distal movable member and tool relative to the instrument shaft.

20. The surgical instrument of claim 12 including a rolling-motion wheel adjacent the control handle and rotatable relative to the control handle for causing a corresponding rotation of the tool about a distal tool roll axis.

21. The surgical instrument of claim 12 wherein said proximal movable member comprises a bendable member and said distal movable member comprises a pivotal joint.

22. A surgical instrument comprising:

an elongated instrument shaft having proximal and distal ends;

a tool disposed from the distal end of the instrument shaft; and

a control handle disposed from the proximal end of the instrument shaft;

said tool being coupled to the distal end of said elongated instrument shaft via a first movable member;

said control handle coupled to the proximal end of said elongated instrument shaft via a second movable member;

whereby movement of said control handle with respect to said elongated instrument shaft via said second movable member causes attendant movement of said tool with respect to said elongated instrument shaft via said first movable member;

wherein at least one of said first and second members comprises a bendable motion member;

wherein the second movable member is able to axially rotate about the control handle.

23. The surgical instrument of claim 22 including distal and proximal axial rotation joints wherein the proximal axial rotation joint actuates the distal axial rotation joint.

24. The surgical instrument of claim 22 wherein the first movable member is able to axially rotate relative to the tool.

25. The surgical instrument of claim 22 further including a rolling-motion wheel adjacent the control handle and rotatable relative to the control handle for causing a corresponding rotation of the tool about a roll axis.

26. The surgical instrument of claim 22 wherein both movable members are bendable members, and the maximum transverse cross-sectional dimension of the second bendable member is different than that of the first bendable member.

27. The surgical instrument of claim 22 including a mechanism for locking the relative orientation between the first and second movable members at a predetermined position.

28. The surgical instrument of claim 22 wherein the maximum transverse cross-sectional dimension of the second movable member is different than that of the first movable member.

29. The surgical instrument of claim 22 wherein the control handle is able to axially rotate relative to at least one of the instrument shaft and second movable member.

30. The surgical instrument of claim 22 wherein said second movable member comprises a bendable member and said first movable member comprises a pivotal joint.

31. A surgical instrument comprising:

an elongated instrument shaft having proximal and distal ends;

a tool disposed from the distal end of the instrument shaft; and

a control handle disposed from the proximal end of the instrument shaft;

said tool being coupled to the distal end of said elongated instrument shaft via a first movable member;

said control handle coupled to the proximal end of said elongated instrument shaft via a second movable member;

whereby movement of said control handle with respect to said elongated instrument shaft via said second movable member causes attendant movement of said tool with respect to said elongated instrument shaft via said first movable member;

wherein at least one of said first and second members comprises a bendable motion member;

further including a distal axial rotation joint for axially rotating the first movable member about the elongated shaft.

32. The surgical instrument of claim 31 further including a proximal axial rotation joint for axially rotating the second movable member about the elongated shaft.

33. The surgical instrument of claim 32 wherein the proximal axial rotation joint controls the distal axial rotation joint.

34. The surgical instrument of claim 31 wherein the instrument shaft is flexible for passage intraluminally.

35. The surgical instrument of claim 31 wherein both movable members are bendable members, and the maximum transverse cross-sectional dimension of the second bendable member is different than that of the first bendable member.

36. The surgical instrument of claim 31 further including a rolling-motion wheel adjacent the control handle and rotatable relative to the control handle for causing a corresponding rotation of the tool about a distal tool roll axis.

37. The surgical instrument of claim 31 wherein the control handle is able to axially rotate relative to at least one of the instrument shaft and second movable member.

38. The surgical instrument of claim 31 including a mechanism for locking the relative orientation between the distal and proximal movable members at a predetermined position.

39. The surgical instrument of claim 31 wherein said second movable member comprises a bendable member and said first movable member comprises a pivotal joint.

40. The surgical instrument of claim 31 wherein said second movable member comprises a unitary slotted structure including a plurality of separately disposed non-contiguous slots.

41. A surgical instrument comprising:

an elongated instrument shaft having proximal and distal ends;

a tool disposed from the distal end of the instrument shaft; and

a control handle disposed from the proximal end of the instrument shaft;

said tool being coupled to the distal end of said elongated instrument shaft via a first movable member;

said control handle coupled to the proximal end of said elongated instrument shaft via a second movable member;

whereby movement of said control handle with respect to said elongated instrument shaft via said second movable member causes attendant movement of said tool with respect to said elongated instrument shaft via said first movable member;

wherein at least one of said first and second members comprises a bendable motion member;

further including a distal axial rotation joint for axially rotating the tool about the first movable member.

42. The surgical instrument of claim 41 further including a proximal axial rotation joint for axially rotating the handle relative to the second movable member.

43. The surgical instrument of claim 42 wherein the proximal axial rotation joint controls the distal axial rotation joint.

44. The surgical instrument of claim 41 wherein the instrument shaft is flexible for passage intraluminally.

45. The surgical instrument of claim 41 wherein both movable members are bendable members, and the maximum transverse cross-sectional dimension of the second bendable member is different than that of the first bendable member.

46. The surgical instrument of claim 41 further including a rolling-motion wheel adjacent the control handle and rotatable relative to the control handle for causing a corresponding rotation of the tool about a roll axis.

47. The surgical instrument of claim 41 wherein the control handle is able to axially rotate relative to at least one of the instrument shaft and second movable member.

48. The surgical instrument of claim 41 including a mechanism for locking the relative orientation between the distal and proximal movable members at a predetermined position.

49. The surgical instrument of claim 41 wherein said second movable member comprises a bendable member and said first movable member comprises a pivotal joint.

50. The surgical instrument of claim 41 wherein said second movable member comprises a unitary slotted structure including a plurality of separately disposed non-contiguous slots.

51. A surgical instrument comprising:

an elongated instrument shaft having proximal and distal ends;

a tool disposed from the distal end of the instrument shaft; and

a control handle disposed from the proximal end of the instrument shaft;

said tool being coupled to the distal end of said elongated instrument shaft via a first movable member;

said control handle coupled to the proximal end of said elongated instrument shaft via a second movable member;

whereby movement of said control handle with respect to said elongated instrument shaft via said second movable member causes attendant movement of said tool with respect to said elongated instrument shaft via said first movable member;

wherein at least one of said first and second members comprises a bendable motion member;

further including distal and proximal axial rotation joints wherein the proximal axial rotation joint actuates the distal axial rotation joint.

52. The surgical instrument of claim 51 wherein said proximal axial rotation joint is disposed between said second movable member and instrument shaft and said distal axial rotation joint is disposed between said first movable member and instrument shaft.

53. The surgical instrument of claim 51 wherein said proximal axial rotation joint is disposed between said second movable member and said control handle and said distal axial rotation joint is disposed between said first movable member and said tool.

54. The surgical instrument of claim 51 wherein the instrument shaft is flexible for passage intraluminally.

55. The surgical instrument of claim 51 wherein both movable members are bendable members, and the maximum cross-sectional dimension of the second bendable member is different than that of the first bendable member.

56. The surgical instrument of claim 51 wherein the control handle is able to axially rotate relative to at least one of the instrument shaft and second movable member.

57. The surgical instrument of claim 51 including a mechanism for locking the relative orientation between the first and second movable members at a predetermined position.

58. The surgical instrument of claim 51 wherein said second movable member comprises a bendable member and said first movable member comprises a pivotal joint.

59. The surgical instrument of claim 51 wherein said second movable member comprises a unitary slotted structure including a plurality of separately disposed non-contiguous slots.

60. A surgical instrument comprising:

an elongated instrument shaft having proximal and distal ends;

a tool disposed from the distal end of the instrument shaft; and

a control handle disposed from the proximal end of the instrument shaft;

said tool being coupled to the distal end of said elongated instrument shaft via a first movable member;

said control handle coupled to the proximal end of said elongated instrument shaft via a second movable member;

whereby movement of said control handle with respect to said elongated instrument shaft via said second movable member causes attendant movement of said tool with respect to said elongated instrument shaft via said first movable member;

wherein at least one of said first and second members comprises a bendable motion member;

further including a motion member locking mechanism for releasably locking said movable members;

said motion member locking mechanism comprising a locking mechanism for impeding cable means that extend between said movable members.

61. The surgical instrument of claim 60 wherein said motion member locking mechanism is operatively disposed adjacent said handle and in a position for being selectively manipulated by a user.

62. The surgical instrument of claim 60 including a second locking mechanism that releasably retains the position of the second movable member relative to the instrument shaft.

63. The surgical instrument of claim 62 wherein the second locking mechanism includes a locked and unlocked state, in the locked state locking the position of the second movable member relative to the instrument shaft, and in the unlocked state enabling rotation of the second movable member relative to the instrument shaft to change the relative orientation between the proximal and distal movable members.

64. The surgical instrument of claim 63 wherein the second locking mechanism is disposed at the proximal end of the instrument shaft and slides longitudinally between the locked and unlocked states.

65. The surgical instrument of claim 60 wherein the locking mechanism is disposed at the proximal end of the instrument shaft.

66. The surgical instrument of claim 60 wherein the locking mechanism fixes the orientation of the first and second movable members by immobilizing said cable means.

67. The surgical instrument of claim 66 wherein said cable means includes mechanical cabling and said locking mechanism includes a collar and wedge.

68. The surgical instrument of claim 67 wherein said collar slides longitudinally relative to said wedge to pinch the mechanical cabling.

69. The surgical instrument of claim 68 including a cable guide for supporting the mechanical cabling with the mechanical cabling pinched between the guide and one of the collar and wedge.

70. The surgical instrument of claim 60 wherein the maximum transverse cross-sectional dimension of the second movable member is different than that of the first movable member.

71. The surgical instrument of claim 60 wherein the control handle is able to axially rotate relative to at least one of the instrument shaft and second movable member.

72. The surgical instrument of claim 60 including distal and proximal axial rotation joints wherein the proximal axial rotation joint actuates the distal axial rotation joint.

73. The surgical instrument of claim 60 including a distal axial rotation joint for axially rotating at least one of the first bendable member and tool relative to the instrument shaft.

74. The surgical instrument of claim 60 including a rotation knob adjacent the control handle and rotatable relative to the control handle for causing a corresponding rotation of the tool about a distal tool roll axis.

75. The surgical instrument of claim 60 wherein said second movable member comprises a bendable member and said first movable member comprises a pivotal joint.

76. A surgical instrument comprising:

an elongated instrument shaft having proximal and distal ends;

a tool disposed from the distal end of the instrument shaft; and

a control handle disposed from the proximal end of the instrument shaft;

said tool being coupled to the distal end of said elongated instrument shaft via a movable member;

said control handle coupled to the proximal end of said elongated instrument shaft via a torque sensing member;

an electromechanical actuator coupled to said movable member;

wherein torque applied at said torque sensing member by the operator produces a proportional movement of said actuator, which in turn produces a movement of said tool with respect to said elongated instrument shaft via said movable member.

77. The surgical instrument of claim 76 wherein said electromechanical actuator is disposed at said instrument shaft.

78. The surgical instrument of claim 76 wherein said electromechanical, actuator is disposed remote from said instrument shaft.

79. The surgical instrument of claim 76 including cabling interconnecting the electromechanical actuator and said movable member for controlling the movement of said tool.

80. The surgical instrument of claim 76 further including a proximal axial rotation joint for axially rotating the handle relative to the second movable member.

81. The surgical instrument of claim 76 further including a rolling-motion wheel adjacent the control handle and rotatable relative to the control handle for causing a corresponding rotation of the tool about a roll axis.

82. The surgical instrument of claim 76 including a mechanism for locking the relative orientation between the movable member and torque sensing member.

83. The surgical instrument of claim 76 including a distal axial rotation joint for axially rotating at least one of the movable member and tool relative to the instrument shaft.

84. A surgical instrument comprising:

an elongated instrument shaft having proximal and distal ends;

a tool disposed from the distal end of the instrument shaft;

a control handle disposed from the proximal end of the instrument shaft;

a distal bendable member for coupling the distal end of said elongated instrument shaft to said tool;

a proximal bendable member for coupling the proximal end of said elongated instrument shaft to said handle; and

actuation means extending between said distal and proximal bendable members whereby any deflection of said control handle with respect to said elongated instrument shaft causes a corresponding bending of said distal bendable member for control of said tool;

wherein at least one of said bendable members comprise a single unitary slotted structure that is readily capable of bending in any direction;

wherein said slotted structure is comprised of a plurality of separately disposed non-contiguous slots.

85. The surgical instrument of claim 84 wherein said at least one bendable member includes a plurality of separately disposed slots extending transverse to the longitudinal axis of the bendable member to enable lateral bending thereof.

86. The surgical instrument of claim 84 wherein said proximal bendable motion member comprises a unitary non-jointed bendable member.

87. The surgical instrument of claim 84 wherein said slots are defined by a plurality of separate ribs having at least one ridge coupled between adjacent ribs.

88. The surgical instrument of claim 87 including a plurality of ridges between adjacent ribs.

89. The surgical instrument of claim 88 wherein the ridges are disposed in opposite positions.

90. The surgical instrument of claim 84 wherein at least said proximal bendable member comprises a unitary non-jointed bendable member that is supported in-line with and controllable from said handle for bending into a curved configuration without any sharp breaks or angularity, so at to, in turn, control said distal bendable member for corresponding bending.

91. The surgical instrument of claim 84 further including a rotation member adjacent the control handle rotatable relative to the control handle for causing a corresponding rotation of the tool about a distal tool roll axis.

92. The surgical instrument of claim 84 including a mechanism for locking the relative orientation between the distal and proximal bendable members at a predetermined position.

93. The surgical instrument of claim 84 wherein the maximum transverse cross-sectional dimension of the proximal bendable member is different than that of the distal bendable member.

94. The surgical instrument of claim 84 wherein the control handle is able to axially rotate relative to at least one of the instrument shaft and proximal bendable member.

95. The surgical instrument of claim 84 including a distal axial rotation joint for axially rotating at least one of the distal bendable member and tool relative to the instrument shaft.

96. A surgical instrument comprising:

an elongated instrument shaft having proximal and distal ends;

a tool disposed from the distal end of the instrument shaft;

a control handle disposed from the proximal end of the instrument shaft;

a distal motion member for coupling the distal end of said elongated instrument shaft to said tool;

a proximal motion member for coupling the proximal end of said elongated instrument shaft to said handle; and

actuation means extending between said distal and proximal motion members for coupling motion of said proximal motion member to said distal motion member for controlling the positioning of said tool;

at least one of said proximal and distal motion members comprising both a bendable section and a pivot section.

97. The surgical instrument of claim 96 wherein said distal motion member comprising both a bendable section and a pivot section.

98. The surgical instrument of claim 96 wherein said proximal motion member comprising both a bendable section and a pivot section.

99. The surgical instrument of claim 96 wherein both said motion members comprising both a bendable section and a pivot section.

100. The surgical instrument of claim 96 further including a rotation member adjacent the control handle rotatable relative to the control handle for causing a corresponding rotation of the tool about a distal tool roll axis.

101. The surgical instrument of claim 96 further including a motion member locking mechanism.

102. The surgical instrument of claim 96 including a distal axial rotation joint for axially rotating at least one of the distal motion member and tool relative to the instrument shaft.

103. The surgical instrument of claim 96 wherein the maximum transverse cross-sectional dimension of the proximal motion member is different than that of the distal motion member.

104. A surgical instrument comprising:

an elongated instrument shaft having proximal and distal ends;

a tool disposed from the distal end of the instrument shaft;

a control handle disposed from the proximal end of the instrument shaft;

a distal bendable member for coupling the distal end of said elongated instrument shaft to said tool;

a proximal bendable member for coupling the proximal end of said elongated instrument shaft to said handle;

actuation means extending between said distal and proximal bendable members for coupling motion of said proximal bendable member to said distal bendable member for controlling the positioning of said tool;

a distal axial rotation joint at the tool end of the instrument; and

a proximal axial rotation joint;

said distal axial rotation joint responsive to said proximal axial rotation joint so that rotation of said proximal axial rotation joint causes a corresponding rotation of said distal axial rotation joint.

105. The surgical instrument of claim 104 wherein said proximal axial rotation joint is disposed between said proximal bendable member and instrument shaft and said distal axial rotation joint is disposed between said distal bendable member and instrument shaft.

106. The surgical instrument of claim 104 wherein said proximal axial rotation joint is disposed between said proximal bendable member and handle and said distal axial rotation joint is disposed between said distal bendable member and tool.

107. The surgical instrument of claim 104 wherein the instrument shaft is flexible for passage intraluminally.

108. The surgical instrument of claim 104 wherein the maximum transverse cross-sectional dimension of the proximal bendable member is different than that of the distal bendable member.

109. The surgical instrument of claim 104 including a mechanism for locking the relative orientation between the distal and proximal bendable members at a predetermined position.

110. The surgical instrument of claim 104 including a rolling-motion wheel adjacent the control handle and rotatable relative to the control handle for causing a corresponding rotation of the tool about a distal tool roll axis.

111. A surgical instrument comprising:

an elongated instrument shaft having proximal and distal ends;

a tool disposed from the distal end of the instrument shaft;

a control handle disposed from the proximal end of the instrument shaft;

a distal bendable member for coupling the distal end of said elongated instrument shaft to said tool;

a proximal bendable member for coupling the proximal end of said elongated instrument shaft to said handle; and

actuation means extending between said distal and proximal bendable members for coupling motion of said proximal bendable member to said distal bendable member for controlling the positioning of said tool;

said proximal bendable member having a diameter that is different than the diameter of said distal bendable member.

112. The surgical instrument of claim 111 wherein said proximal bendable member has a diameter that is greater than the diameter of said distal bendable member.

113. The surgical instrument of claim 111 wherein the proximal bendable member is able to axially rotate relative to the control handle.

114. The surgical instrument of claim 111 including a mechanism for locking the relative orientation between the proximal and distal bendable members.

115. The surgical instrument of claim 111 including a distal axial rotation joint for axially rotating at least one of the distal bendable member and tool relative to the instrument shaft.

116. The surgical instrument of claim 111 including a rolling-motion wheel adjacent the control handle and rotatable relative to the control handle for causing a corresponding rotation of the tool about a distal tool roll axis.

117. A surgical instrument comprising:

an elongated instrument shaft having proximal and distal ends;

a tool disposed from the distal end of the instrument shaft;

a control handle disposed from the proximal end of the instrument shaft;

a distal bendable member for coupling the distal end of said elongated instrument shaft to said tool;

a proximal bendable member for coupling the proximal end of said elongated instrument shaft to said handle; and

actuation means extending between said distal and proximal bendable members for coupling motion of said proximal bendable member to said distal bendable member for controlling the positioning of said tool;

wherein the instrument shaft is flexible for passage intraluminally;

further including a distal axial rotation joint for axially rotating at least one of the distal bendable member and tool relative to the instrument shaft.

118. The surgical instrument of claim 117 further including a proximal axial rotation joint for axially rotating at least one of the proximal bendable member and handle relative to the instrument shaft.

119. The surgical instrument of claim 117 wherein said distal axial rotation joint is responsive to said proximal axial rotation joint so that rotation of said proximal axial rotation joint causes a corresponding rotation of said distal axial rotation joint.

120. The surgical instrument of claim 117 said proximal bendable member having a maximum transverse cross-sectional dimension that is different than that of said distal bendable member.

121. The surgical instrument of claim 117 wherein the transverse cross-sectional area of the proximal bendable member is greater than that of the distal bendable member.

122. The surgical instrument of claim 117 including a mechanism for locking the relative orientation between the distal and proximal bendable members at a predetermined position.

123. The surgical instrument of claim 117 including a rolling-motion wheel adjacent the control handle and rotatable relative to the control handle for causing a corresponding rotation of the tool about a distal tool roll axis.

124. A surgical instrument comprising:

an elongated instrument shaft having proximal and distal ends;

a tool disposed from the distal end of the instrument shaft;

a control handle disposed from the proximal end of the instrument shaft;

a distal motion member for coupling the distal end of said elongated instrument shaft to said tool;

a proximal motion member for coupling the proximal end of said elongated instrument shaft to said handle;

actuation means extending between said distal and proximal motion members for coupling motion of said proximal motion member to said distal motion member for controlling the positioning of said tool; and

a capstan and cable arrangement connected between said handle and tool and including a pair of handles for control of a corresponding pair of tool jaws;

wherein said actuation means comprises cabling extending between and off-center of said motion members.

125. The surgical instrument of claim 124 including at least one handle end capstan and at least one tool end capstan.

126. The surgical instrument of claim 125 including a pair of handle capstans associated respectively with said pair of handles and a pair of tool capstans associated respectively with said pair of tool jaws.

127. The surgical instrument of claim 124 wherein said proximal motion member comprises a bellows.

128. The surgical instrument of claim 124 wherein said proximal motion member comprises a unitary slotted structure that includes multiple discs that define multiple slots that are separate and non-contiguous.

129. A surgical instrument comprising:

an elongated instrument shaft having proximal and distal ends;

a tool disposed from the distal end of the instrument shaft;

a control handle disposed from the proximal end of the instrument shaft;

a distal motion member for coupling the distal end of said elongated instrument shaft to said tool;

a proximal motion member for coupling the proximal end of said elongated instrument shaft to said handle;

actuation means extending between said distal and proximal motion members for coupling motion of said proximal motion member to said distal motion member for controlling the positioning of said tool; and

wherein said proximal motion member comprises a bendable member and said distal motion member comprises a pivotal joint.

130. The surgical instrument of claim 129 wherein said proximal bendable member comprises a unitary slotted structure that is comprised of multiple discs that define multiple slots that are separate and non-contiguous.

131. The surgical instrument of claim 129 including a rolling-motion wheel adjacent the control handle and rotatable relative to the control handle for causing a corresponding rotation of the tool about a roll axis.

132. The surgical instrument of claim 129 including a distal axial rotation joint for axially rotating at least one of the distal motion member and tool relative to the instrument shaft.

133. The surgical instrument of claim 129 including a mechanism for locking the relative orientation between the proximal and distal motion members.