HK1211823B

HK1211823B - Active positioning arrangement of a surgical instrument and robotic surgical system comprising same

Info

Publication number: HK1211823B
Application number: HK15112850.7A
Authority: HK
Inventors: 胡伯图斯‧范格林博格
Original assignee: 阿瓦特拉医学有限公司
Priority date: 2012-12-20
Filing date: 2013-12-12
Publication date: 2018-11-09

Abstract

The present invention relates to an active positioning arrangement of a surgical instrument for use on a robotic arm, comprising a support plate (3, 33), which can be connected to a robotic arm (1, 31), a port device (4, 34), which is arranged on the support plate (3, 33) and which is provided for access to the interior of a body, at least one guiding device (6, 36, 59) for guiding a surgical instrument (8, 38, 61) into the body, the shank of the surgical instrument (8, 38, 61) extending through the guiding device (6, 36, 59), and the guiding device (6, 36, 59) being variably connected to the port device (4, 34) via a compensating element (5, 35), and an adjustment device (9, 10, 11, 12, 13, 14, 39, 40, 41, 42, 43, 44, 62, 63, 64, 65, 66, 67) for the guiding device (6, 36, 59) with respect to the port device (4, 34) which is mounted on the support plate (3, 33) and/or the port device (4, 34) and on the other end on the guiding device (6, 36, 59) such that the shank of the surgical instrument (8, 38, 61) can be moved relative to the initial position, in which the longitudinal extent of the surgical instrument runs parallel to the longitudinal extent of the port device (4, 34), in the x direction as well as in the y direction.

Description

Active positioning device for a surgical instrument and surgical robotic system comprising such an active positioning device

Technical Field

The present invention relates to an active positioning device for surgical instruments and to a surgical robotic system or telemanipulator for minimally invasive surgery and in particular laparoscopy.

Background

Robotic systems or telemanipulators for minimally invasive surgery, particularly laparoscopic surgery, replace surgical instruments (e.g., surgical instruments, endoscopes, or cameras) that are typically manually guided by the surgeon by motorized positioning. An alternative surgical instrument is introduced into the patient via one or more trocars. Known as trocars are the following instruments: with the aid of such instruments, the surgeon achieves access to a body cavity (usually the abdominal or thoracic cavity) of a patient in a minimally invasive surgical procedure, wherein the access is kept open by a tube, a so-called cannula. The kinematic mechanics and control logic provided in the robotic system enable movement of the surgical instrument in two degrees of freedom (x, y) about a pivot point and translational movement of the surgical instrument along an instrument axis (z). The motionless point of motion in two degrees of freedom (x, y) is referred to as the pivot point. The pivot point is ideally at the point of penetration of the trocar into the abdominal wall of the patient. The control logic of the robot system must recognize this pivot point or the pivot point must be defined by a structural embodiment of the motion mechanism in order to define the motion of the surgical instrument as follows: so that the biomechanical load on the tissue around the trocar is as low as possible.

The robotic systems known from the prior art are based on a robot arm for passively prepositioning and actively moving the surgical instrument. The prior art-based solutions with a robot arm, which allow passive pre-positioning of the surgical instrument around a pivot point and active movement thereof, require a large installation space on the one hand and the movement process of the robot can lead to collisions on the other hand.

During a minimally invasive surgical intervention, at least two, typically three to four, surgical instruments (e.g., forceps, scissors, needle holders, scalpels) and a camera or endoscope are used, each of which is introduced into the patient via a specialized trocar. This means that: for each surgical instrument used, a robot arm is present, which controls passive pre-positioning and active movement of the instrument.

The drawbacks of the solutions based on the prior art are: the position of the patient must be fixed before the surgery starts and it is almost impossible for the patient to change position during the surgery.

Another disadvantage already mentioned is the large installation space required by the known robot system.

Disclosure of Invention

It is therefore an object of the present invention to provide an active positioning device of a surgical instrument and a surgical robotic system, which are provided with a high degree of variability and require only little construction space, or are smaller and lighter in terms of their embodiments.

Another object of the invention is to provide a robotic system that enables a patient to change positions during surgery, without thereby limiting the freedom of movement of the surgical instrument, in particular after changing positions.

This object is achieved according to the invention by means of an active positioning device for a surgical instrument according to claim 1 and by means of a surgical robotic system according to claim 9.

The subject of the invention relates to an active positioning device for a surgical instrument for use on a robotic arm, comprising:

a support plate connectable with a robot arm,

an implant device disposed on the stent plate and configured for access into a body,

at least one guide device for guiding a surgical instrument into the body, wherein a shaft of the surgical instrument extends through the guide device and the guide device is variably connected to the implant device by means of a compensating element, and

an adjustment device of the guide device relative to the implant device, which is mounted on the carrier plate and/or the implant device on the one hand and on the guide device on the other hand in the following manner: the shaft of the surgical instrument is movable in both the x-direction and the y-direction relative to an initial position, in which the longitudinal extent of the surgical instrument extends parallel to the longitudinal extent of the implant device.

In a preferred embodiment, the balancing element can be varied in its geometry by: the freely selectable angle between the implant device and the guide device in the x-direction and also in the y-direction can be adjusted with the same initial position relative to one another, wherein the balancing element is made of an elastic material in particular.

In a further preferred embodiment, the adjustment device has at least two controllable actuators, in particular in the form of adjustment drives arranged orthogonally to one another, wherein a ball-and-socket lever mechanism between the guide device and the carrier plate or the implant device is provided in the following manner: by means of the ball lever mechanism, the guide device can be positioned independently of one another in the x-direction and in the y-direction relative to the initial position by means of the adjustment drive.

In an equally preferred embodiment, a translational adjustment device is provided on the guide device, which is connected to the surgical instrument in such a way that the rod of the surgical instrument can be moved in the z direction. Preferably, the translational adjustment device moves the shaft of the surgical instrument in the z-direction by means of the retraction system 20 and/or the cable traction system.

In a further preferred embodiment, an instrument drive unit is provided in the surgical instrument, which instrument drive unit comprises a rotary actuator by means of which a lever of the surgical instrument can be changed in rotation about the z direction relative to an initial position. Preferably, the instrument drive unit has three instrument actuators, by means of which the distally arranged active unit of the surgical instrument can be changed in three further degrees of freedom. It is particularly preferred that the instrument drive unit is arranged on the proximal end of the telescopic system by means of a holding device.

Another subject of the invention relates to a surgical robotic system for performing a surgical intervention on a human body, the robotic system comprising:

a control device manipulable by a user to perform a surgical intervention;

a support structure on which two or more robot arms are mounted, the robot arms being movable by a control device,

wherein an active positioning device of the surgical instrument is provided on at least one robot arm, the active positioning device comprising:

a support plate connectable with a robot arm,

an implant device disposed on the stent plate and configured for access into the body,

at least one guide device for introducing the surgical instrument into the body, wherein a shaft of the surgical instrument extends through the guide device and the guide device is variably connected to the implant device by means of a balancing element, and

an adjustment device of the guide device relative to the implant device, which is mounted on the carrier plate and/or the implant device on the one hand and on the guide device on the other hand in the following manner: the shaft of the surgical instrument can be moved in the x-direction and also in the y-direction relative to an initial position in which the longitudinal extent of the surgical instrument extends parallel to the longitudinal extent of the implant device.

In a preferred embodiment of the robot system, the balancing element can be varied in its geometry in such a way that: the freely selectable angle between the implant device and the guide device in the x-direction and also in the y-direction can be adjusted in the same initial position relative to one another, wherein the balancing element is made of an elastic material in particular.

Further advantageous embodiments of the surgical robotic system according to the invention are achieved by the dependent claims analogously to the active positioning device for the surgical instrument. This is achieved in particular in the following manner: the active positioning device according to the invention can be combined with a robot system or subsequently equipped with a robot system.

According to the invention, the robot system and the remote manipulator can be applied synonymously.

Drawings

The invention is realized purely exemplarily by means of the figures. Wherein:

FIG. 1 shows a schematic view of an active positioning device according to the present invention of a surgical instrument, mounted on a robotic arm;

FIG. 2 shows a schematic partial view of an active positioning device according to the invention with a device for introducing an inflation gas (generally CO)₂) The connection feasibility of (c);

FIG. 3 shows a top view of the active positioning device according to FIG. 1;

FIG. 4 shows a schematic view of a portion of a surgical robotic system according to the present invention during surgery on a human body;

figure 5 shows a schematic view of a robot arm according to the invention;

FIG. 6 shows a schematic view of a surgical instrument which may be an integral part of the present invention;

FIG. 7 shows a schematic view of a robotic system having a robotic arm and an active positioning device in accordance with the present invention; and

FIG. 8 shows a schematic view of a robotic system having 4 robotic arms and an active positioning device according to the present invention;

FIG. 9 shows a schematic view of an active positioning device according to the invention for two surgical instruments and one common implant mounted on a robot arm;

fig. 10 shows a top view of the active positioning device according to fig. 9.

Detailed Description

The present invention according to a first aspect relates to a surgical robotic system or telemanipulator wherein passive pre-positioning of a trocar or active positioning device is combined with active control or motorization of the trocar for moving a surgical instrument. Such an "active trocar" according to the present invention enables a medical instrument to be moved about a pivot point with at least 2 degrees of freedom (directions 101 and 102), as shown in figure 6. According to the invention, the surgical instrument has a total of 7 degrees of freedom: 3 degrees of freedom (degrees of freedom 101, 102, 103 according to fig. 6) are achieved by the coupling of the medical instrument inserted into the trocar with the respective drive unit in terms of the motor, and the other 4 degrees of freedom (degrees of freedom 104, 105, 106 and 107 according to fig. 6) are achieved by the drive unit on the end of each used medical instrument.

Since the pivot point is defined by the active trocar itself, the location of the pivot point is determined by means of pre-positioning of the active trocar before the start of the procedure. The patient is thereby able to change position after the surgical intervention has started, because the pivot point is structurally associated with the positioning device or active trocar according to the invention and remains unchanged relative to the active positioning device when changing position, that is to say the pivot point remains unchanged relative to the instrument and the bracket plate and the guide element at all times.

In addition, by eliminating the robot arm for actively positioning the instrument, the system can be made significantly smaller and lighter to implement. As a result, the entire system can be transported more easily, for example, to another operating room, and in turn greater flexibility and use sufficiency are achieved.

The invention is described in detail below with reference to the attached drawing figures:

fig. 1 shows an active positioning device according to the invention of a surgical instrument, which is mounted on a robot arm. During minimally invasive laparoscopic interventions, typically 4 surgical instruments are used, 3 of which are surgical instruments and 1 being a camera or endoscope, which are controlled by the surgeon by means of a telerobotic system. Thus, according to the invention, a 4-fold embodiment of an active trocar or active positioning device is preferably present in the system. It is understood that active trocars having 1 to 3 or more than 4 are also within the scope of the present invention. Each active trocar is supported in a weightless or suspended manner by a robot arm 1 which can be provided with a hinge 2. Thus, a retaining mechanism is provided for each active trocar. All the holding means can be fixed to a common carrier (see fig. 4) or to separate carriers. A fastening solution on a separate holder may be appropriate, for example, in which case the placement solution of the trocar requires this for surgical intervention.

And the bracket plate 3 of the active trocar is fixedly connected with the robot arm 1. The stent plate 3 is in turn fixedly connected with an implantation device 4. The implant device 4 is connected to the guide device 6 by means of the balancing element 5. The movement (tilting) of the guide device 6 relative to the implant device 4 can be achieved by means of the balancing element 5. By this movement, a pivotal movement of the surgical instrument 8 is achieved. The guide 6 receives a surgical instrument 8. The surgical instrument 8 is hermetically sealed with respect to the guide 6 by means of the sealing ring 7. In laparoscopy, the abdominal cavity is treated by introducing a gas (carbon dioxide, CO)₂) Instead of quilt "Inflated "in order for the surgeon to achieve more freedom of movement for the surgical intervention itself. In order to prevent gas from escaping, a seal 7 is required.

The actuators or actuating drives 9, 12 are arranged orthogonally to one another. By means of the ball-end lever mechanisms 10, 11 and 13, 14, a force can be applied to the upper end of the guide device 6, so that the guide device can be moved independently of one another in two axes (x, y) relative to the implant device 4.

A further adjusting drive 15 is mounted on the upper end of the guide 6. By means of an actuating drive formed by the gripper 16, the deflection roller 17, the gripper 18 and the corresponding cable pull 19, a translational movement of the instrument in the z direction is achieved.

The telescopic system 20 is connected to the instrument drive unit 22 by means of the holding device 21 in such a way that a rotational movement α of the surgical instrument 8 about the z-axis is prevented, this rotational movement α of the surgical instrument 8 is effected by means of a rotational actuator 23 which is connected to the shaft of the surgical instrument 8, the instrument actuators 24, 25 and 26 effect a movement of the surgical instrument 8 in degrees of freedom 105, 106 and 107, see fig. 6.

Fig. 2 shows the active positioning device according to the invention as in fig. 1, additionally provided with an inflation connection, which consists of an inlet tube 29 which opens into the cavity of the trocar 6 below the seal 7, and a connection and valve assembly 30. The inflator is selectively connected to the connecting portion and the valve assembly. The inflator device pumps gas (typically CO) via the valve structure assembly 30₂) And the delivery tube 29 connected thereto is introduced into the abdominal cavity of the patient. The seal 7 prevents the undesired escape of gas from the patient's abdominal cavity to the environment. The seal 7 is specifically embodied in such a way that: the seal still hermetically seals the trocar 6 when the instrument 8 is completely removed from the trocar, i.e. no inflation gas is released to the environment even if the instrument is removed.

FIG. 3 shows a top view of the active positioning device according to FIG. 1;

FIG. 4 shows a schematic view of a portion of a surgical robotic system according to the present invention during surgery on a human body; the robot arm described in detail in fig. 5 is held by the basic holders (here exemplary 300a, 300b and 300c) in the following way: the basic holders can be held in connection with 312 and 313, for example in the guide rails 311 shaped like arcs, and are positioned independently of one another. On the coupling surface 310 of the robot arm, the active positioning device according to fig. 1 or 2 is held on the structural component 3. The preferred arcuate configuration of the guide has the advantage that the robotic arm is intended to be positioned over the abdominal wall in an arc according to the typical anatomy of the patient.

Figure 5 shows a schematic view of a robot arm according to the invention; the robot arm is composed of a plurality of segments 303, 306 and 309, which are connected to one another by means of hinges, which enables the arrangement of the coupling surface 310 relative to the active positioning means according to fig. 1 and 2. The robot arm itself is fixed to the basic holder 300 by means of a hinge 301, which allows a pivoting movement of +/-90 deg. about a rotation axis 302. The first subsection 303 of the robot arm leads to a further articulation 304 having a rotation axis 305 which is preferably orthogonal to the rotation axis 302. A further subsection 306 of the robot arm is connected by means of a hinge 304, which further subsection 306 effects a pivoting movement 308, preferably orthogonal to the axis of rotation 302 and to the axis of rotation 305, by means of a further hinge 307. The third subsection 309 of the robot arm has at its distal end a coupling surface 310, by means of which the active positioning device according to fig. 1 or 2 can be fixed on the structural component 3 by establishing a suitable force-locking and preferably form-locking connection. The articulations 301, 304, 307 can be implemented either actively (i.e. with an adjustment drive) or passively. The articulations 301, 304, 307 are provided with absolute position detectors, so that the position or orientation in space of the robot arm and the active positioning device connected thereto respectively is known. The signals of the absolute position detectors can preferably be calculated relative to one another in the control unit 202 in such a way that, knowing the geometry and the current adjustment position of the active positioning device according to fig. 1 or 2, a dangerous collision of different robot arms with one another or with the active positioning device of another robot arm can be detected and a collision warning can be output to the user by means of the operating and display unit 200. In another embodiment, the control unit 202 may actively avoid potential collisions between different robot arms or collisions of a robot arm with active positioning devices of other robot arms by changing the adjustment commands preset by the manipulation and display unit 200. In a passive embodiment, the articulations 301, 304, 307 are preferably in a device to prevent the position of the articulations from being unintentionally adjusted.

Fig. 6 shows a surgical instrument as a possible component of the present invention. The structure has a total of 7 degrees of freedom. These degrees of freedom are achieved by translational movement of the instrument bar 120 in the x-direction 101 and the y-direction 102. The motion effects a tipping of the instrument about the pivot point. Additionally, instrument bar 120 can move along z-direction 103. Instrument rod 120 is rotationally movable about its own instrument axis 110 in direction of motion 104. The instrument tip is made up of at least 3 structural components that can move relative to each other. In this case, the first structural component 121 is arranged so as to be able to pivot about the pivot axis 111 in the pivoting direction 105 and so as to be movable relative to the instrument lever 120. The structural component 121 itself carries two structural components 122, 123 which, independently of one another, are arranged in a reversible manner about the axis of rotation 112 in the direction of rotation 106. By a rotational movement of the structural component 122 relative to the structural component 123, the angle 107 between the two structural components 122, 123 about the rotational axis 112 changes. Thus, the gripping, clamping or shearing movement can be carried out depending on the mechanical configuration of the structural assembly 122, 123.

Fig. 7 and 8 show embodiments of a robot system according to the invention with 1 or 4 robot arms and one (212a) or 4 (212a-d) active positioning device according to the invention. The following explanation relates to an embodiment with a robot arm according to fig. 7. The active positioning device 212a is connected to the arc guide 209 by means of a pre-positioning device consisting of structural components 210 and 211. The pre-positioning means can be realized passively (i.e. by manual adjustment) or preferably actively (i.e. by providing the articulated piece 211 with an active adjustment drive). The pre-positioning means itself is held by means of a suitable holder, for example as an arc-shaped guide 209. The arcuate guide 209 may be positioned relative to the patient by means of a hinge 208. The boom 207 is connected to a movable mounting system 205 and thus enables the positioning of the entire mounting system (consisting of 205, 207..212 a) relative to the operating table 206. By means of the operating and display unit 200, the current state of the pre-positioning devices 210, 211 is output to the operator. By means of the operating and display unit 200, control commands can be input by the operator, which are sent to the control unit 202 by means of a suitable data connection 201 and from the latter to the active positioning device 212a, the pre-positioning devices 210, 211 and the arc guide 209 for further processing. The control unit 202 is connected to the mounting system by means of a suitable data connection 203. The operating table 206 can also be connected to the control unit 202 by means of the data connection 204 according to the control technology, in order to process the position change in the control unit when the operating table position (e.g. height) changes and to achieve an active subsequent guidance of the active positioning device 212a by means of the pre-positioning devices 210, 211 and/or to achieve the position of the arc guide 209. Thus, changes in patient position can be actively compensated for based on changes in the position of the surgical table 206.

Fig. 9 and 10 show the active positioning device according to the invention for two surgical instruments at a common implantation point, which is mounted on a robot arm. During minimally invasive laparoscopic interventions, typically 4 surgical instruments are used, of which 3 are surgical instruments and 1 camera or endoscope, which are controlled by the surgeon by means of a telerobotic system. According to the invention, therefore, two surgical instruments can be introduced into the patient via a common implantation point (single implantation point) by means of two separate guide devices and can be controlled independently of one another by means of one active positioning device per surgical instrument. It is therefore preferred to implement an active trocar or active positioning device in the system in duplicate for one single implantation point entry. It is understood, however, that embodiments having 1 or more than 2 active trocars for a single implantation point entry are also within the scope of the present invention. Each active trocar is suspended by means of a robot arm 31 which may be provided with a hinge 32. Thus, a retaining mechanism is provided for each active trocar. All holding means can be fixed to a common carrier (see fig. 4) or to separate carriers. The fixation on a separate holder is for example reasonable, when the placement of a trocar for surgical intervention needs to be done.

The bracket plate 33 of the active trocar is fixedly connected with the robot arm 31. The stent plate 33 is in turn fixedly connected to an implant device 34. The implant device 34 is connected to the guide devices 36 and 59 by means of the balancing element 35. The guide devices 36 and 59 can be moved (tilted) relative to the implant device 34 by means of the balancing element 35. By this movement, pivotal movement of the surgical instruments 38 and 61 is achieved. Guides 36 and 59 receive surgical instruments 38 and 61. The surgical instruments 38 and 61 are sealed in a gas-tight manner with respect to the guide devices 36 and 59 by means of sealing rings 37 and 60. In laparoscopy, the abdominal wall is treated by introducing gas (carbon dioxide, CO)₂) "inflate" to allow the surgeon more freedom of movement for the surgical access itself. A seal 37 or 60 is required in order to keep gas from escaping.

The actuators or actuating drives 39, 42 and 62, 65 are each arranged orthogonally to one another. Forces are applied to the upper ends of the guides 36 and 59 by means of ball-end lever mechanisms 40, 41, 43, 44 and 63, 64, 66, 67, so that the guides can move independently of one another along 2 axes (x, y) relative to the implant device 34.

Further adjustment drives 45, 68 are mounted on the upper ends of the guides 36 and 59. The translational movement of the instrument 38 in the z-direction is achieved by means of an adjustment drive consisting of a clamp 46, a deflection roller 47, a clamp 48 and a corresponding cable pull 49. The translational movement of the implement 61 in the z direction is achieved by means of an adjustment drive consisting of a clamp 69, a deflection roller 70, a clamp 71 and a corresponding cable pull 72.

Retraction system 50 is connected to instrument drive unit 52 by means of retaining device 51 in such a way that rotational movement β of surgical instrument 38 about the z-axis is prevented rotational movement β of surgical instrument 38 is achieved by means of rotational actuator 53 (which is connected to the shaft of surgical instrument 38). instrument actuators 54, 55 and 56 enable movement of surgical instrument 38 in degrees of freedom 105, 106 and 107, see fig. 6.

The telescopic system 73 is connected to the instrument drive unit 75 by means of a holding device 74 in the following manner: preventing rotational movement gamma of the surgical instrument 61 about the z-axis. The rotary movement γ of the surgical instrument 61 is effected by means of a rotary actuator 76, which is connected to the shaft of the surgical instrument 61. Instrument actuators 77, 78, and 79 enable movement of surgical instrument 61 in degrees of freedom 105, 106, and 107, see fig. 6.

Fig. 10 shows a top view of the active positioning device according to fig. 9, from which it can be seen: the two guide devices 36, 59 extend through the common balancing element 35. As can be seen in particular from fig. 10: the first adjusting means 39, 40, 41, 42, 43, 44 for the first guide means 36 and the second adjusting means 62, 63, 64, 65, 66, 67 for the second guide means 59 are arranged for two surgical instruments in the following manner: so that obstructions or restrictions on the two respective adjusting devices are avoided.

In general, the present invention thus relates to an active positioning device in which one or more surgical instruments can be passed through a trocar for minimally invasive surgery.

Claims

1. An active positioning device for a surgical instrument used on a robotic arm, comprising:

a mounting plate connectable with a robot arm;

an implant device disposed on the stent plate and configured for access into a body;

at least one guide device for guiding a surgical instrument through the body, wherein a shaft of the surgical instrument extends through the guide device, the guide device being variably connected with the implant device by means of a balancing element; and

an adjustment device of the guide device relative to the implant device, which is mounted on the carrier plate and/or the implant device on the one hand and on the guide device on the other hand in the following manner: the rod of the surgical instrument is movable about a pivot point in both x-and y-directions perpendicular to each other relative to an initial position in which the longitudinal extension of the surgical instrument extends parallel to the longitudinal extension of the implant device,

the adjustment device comprises exactly two controllable actuators, which are embodied as adjustment drives arranged orthogonally to one another, wherein a ball-end lever mechanism is provided between the guide device and the carrier plate or the implant device in the following manner: by means of the adjustment drive, the guide device can be positioned in the x-direction independently relative to the implant device by means of a first of the two actuators and in the y-direction independently relative to the implant device by means of a second of the two actuators, by means of the ball-end lever mechanism.

2. Active positioning device according to claim 1, characterized in that the balancing element can be varied in its geometry in the following way: the angle which can be freely selected between the implant device and the guide device in the x-direction and also in the y-direction can be adjusted in the same initial position relative to one another.

3. The active positioning device of claim 2 wherein the balancing element is comprised of an elastic material.

4. Active positioning device according to claim 1 or 2, characterized in that a translational adjustment device is provided on the guide device, which translational adjustment device comprises a further adjustment drive and is connected with the surgical instrument in the following manner: the shaft of the surgical instrument is movable in a z-direction orthogonal to the x-direction and the y-direction by the further adjustment drive.

5. Active positioning device according to claim 4, characterized in that the translational adjustment device enables the movement of the rod of the surgical instrument in the z-direction by means of a telescopic system and/or a cable traction system.

6. Active positioning device according to claim 1 or 2, further comprising a surgical instrument, characterized in that an instrument drive unit is provided on the surgical instrument, which instrument drive unit comprises a rotary actuator by means of which the rod of the surgical instrument is changed in a manner rotatable about the z-direction relative to an initial position.

7. Active positioning device according to claim 6, characterized in that the instrument drive unit has three instrument actuators by means of which the distally mounted active unit of the surgical instrument can be changed with three further degrees of freedom.

8. Active positioning device according to claim 5, characterized in that an instrument drive unit is provided on the surgical instrument, which instrument drive unit comprises a rotary actuator, by means of which the shaft of the surgical instrument is changed in a rotatable manner about the z-direction relative to an initial position, which instrument drive unit is arranged on the proximal end of the telescopic system by means of a holding device.

9. Active positioning device according to claim 1 or 2, characterized in that two guiding devices are provided for guiding two surgical instruments through the balancing element, wherein the adjustment device of a first guiding device is arranged substantially mirror-inverted with respect to the adjustment device of the other guiding device with respect to the longitudinal axis of both said guiding devices.

10. A surgical robotic system for performing a surgical intervention on a human body, comprising:

a control device capable of performing a surgical intervention by a user,

a support structure on which two or more robot arms are mounted, the robot arms being movable by means of the control device,

a mounting plate connectable with a robot arm;

11. A surgical robotic system as claimed in claim 10, wherein the balancing element is variable in its geometry in the following manner: the angle which can be freely selected between the implant device and the guide device in the x-direction and also in the y-direction can be adjusted in the same initial position relative to one another.

12. A surgical robotic system as claimed in claim 11, wherein the balancing element is constructed of an elastic material.

13. A surgical robotic system as claimed in claim 10 or 11, wherein a translational adjustment device is provided on the guide device, the translational adjustment device comprising a further adjustment drive and being connected with the surgical instrument in the following manner: the shaft of the surgical instrument is movable in a z-direction orthogonal to the x-direction and the y-direction by the further adjustment drive.

14. A surgical robotic system as claimed in claim 13, wherein the translational adjustment means enables the rod of the surgical instrument to move in the z direction by means of a telescopic system and/or a cable traction system.

15. A surgical robotic system as claimed in claim 10 or 11, further comprising a surgical instrument, wherein an instrument drive unit is provided on the surgical instrument, the instrument drive unit comprising a rotary actuator by means of which the rod of the surgical instrument is changed in a rotatable manner about the z-direction relative to an initial position.

16. A surgical robotic system as claimed in claim 15, wherein the instrument drive unit has three instrument actuators by means of which a distally mounted action unit of the surgical instrument can be varied in three further degrees of freedom.

17. A surgical robotic system as claimed in claim 14, characterized in that an instrument drive unit is provided on the surgical instrument, the instrument drive unit comprising a rotary actuator by means of which the rod of the surgical instrument is changed in a rotatable manner about the z-direction relative to an initial position, the instrument drive unit being arranged on a proximal end of the telescopic system by means of a holding device.

18. A surgical robotic system as claimed in claim 10 or 11, characterized in that two guide means are provided for guiding two surgical instruments through the balancing element, wherein the adjustment means of a first guide means is arranged substantially mirror-inverted with respect to the adjustment means of the other guide means with respect to the longitudinal axes of the two guide means.