WO2019096929A1

WO2019096929A1 - Direction adjustable holder for an instrument

Info

Publication number: WO2019096929A1
Application number: PCT/EP2018/081428
Authority: WO
Inventors: Frank Dewaele; Cyriel Mabilde; Lieven MAENE; Bart Blanckaert; Alain Kalmar
Original assignee: Steerable Instruments BVBA
Current assignee: Steerable Instruments BVBA
Priority date: 2017-11-15
Filing date: 2018-11-15
Publication date: 2019-05-23
Anticipated expiration: 2020-05-15
Also published as: EP3709860A1

Abstract

A holder (100) for an instrument (200) having a proximal (20) and distal (40) end comprising: a connector (126) for dismountable attachment to a positioning device, a slidable clamp (140) configured for releasable attachment to the instrument (200) and movement of the instrument (200) in an axial direction, a joint assembly (120) configured 5 for directional movement of the slideable clamp (140) relative to the connector (126), and a locking mechanism (150) configured to lock a direction of the joint assembly (120) around at least one axis, wherein the locking mechanism comprises a lever rod (152) extending from the joint assembly (120) towards a proximal end (20) of the holder (100), wherein manual actuation of the lever rod (151) at the proximal end (20) releases a locked 10 direction of the joint assembly (120)

Description

DIRECTION ADJUSTABLE HOLDER FOR AN INSTRUMENT

Field of the invention

Described herein is a holder for adjusting and fixing a direction of a dismountable instrument, preferably a medical instrument such as an endoscope.

Background to the invention

In procedures where a user manually controls a plurality of tools, the number of tools remaining under full manual control is limited to two, one tool per hand. In manual laparoscopic procedures for instance, a surgeon is able to operate two laparoscopic instruments such as two independent gripper tools, one with each hand, while a third instrument such as an endoscope must be held in a positioning device such as an articulated arm which allows adjustment of the pose (position and orientation) of the endoscope and subsequently locks it. A drawback of the articulated arm is the difficulty of adjusting it during a procedure. Typically an arm comprises a plurality of links

interconnected by joints allowing adjustment of the pose of an effector end in 7 degrees of freedom, which joints can be locked or released upon actuation of a single button. When the joints are released, the arm, without support collapses, requiring the strength of surgeon to support the weight of both the endoscope and arm in order to adjust the pose. Otherwise the instrument will pitch up in the body. The weight of an arm is not

insubstantial, typically being formed of rigid metallic parts for robustness, and the exquisite movements by the surgeon required for delicate procedures such as suturing is problematic.

When working in confined laparoscopic spaces such as a small vessel, the inventors have found that only a sporadic repositioning of an endoscope is required, and then it is within a small angular range. Most of the time a zoom (in/out movement) of the endoscope is required. It is important that the surgeon controls the zoom by himself and not using an assistant as the assistant will not focus on the correct region. Motion stability is also critical when the instrument is a three-dimensional endoscope; unstable images give rise to motion sickness.

Any solution to the problems of control and stability must comply with requirements for compatibility with existing equipment such as trocars in the case of laparoscopy. Any solution must have autoclavable parts for repeated use. The presently described holder aims to overcome the problems of the art. Summary of the invention

Provided is a holder (100) for an instrument (200) having a proximal (20) and distal (40) end comprising:

- a connector (126) for dismountable attachment to a positioning device,

- a longitudinal chassis (110) having a proximal end (20) and distal end (40),

- a slidable clamp (140) configured for releasable attachment to the instrument (200) and movement of the instrument (200) in an axial direction in relation to a longitudinal axis of the chassis (1 10),

- a joint assembly (120) configured for directional movement of the chassis (110) relative to the connector (126), and

- a locking mechanism (150) configured to lock a direction of the joint assembly (120) around at least one axis, wherein the locking mechanism comprises a lever rod (152) extending from the joint assembly (120) towards a proximal end (20) of the chassis

(1 10)holder (100), wherein manual actuation of the lever rod (151 ) at the proximal end

(20) releases a locked direction of the joint assembly (120)

wherein

- the slideable clamp (140) is operatively connected to a linear actuator configured to change the position of the clamp, the holder (100) further comprising a user input unit (300) configured for control of the position of the moveable clamp (140) responsive to a user input, and

the user input unit (300) comprises an attachment element (304) adapted to dismountably attach the user input unit (300) to a proximal end of a manual tool (250, 260) that is other than the instrument (200).

Provided also is a holder (100) for an instrument (200) having a proximal (20) and distal (40) end comprising:

- a connector (126) for dismountable attachment to a positioning device,

- a slidable clamp (140) configured for releasable attachment to the instrument (200) and movement of the instrument (200) in an axial direction,

- a joint assembly (120) configured for directional movement of the slideable clamp (140) relative to the connector (126), and

- a locking mechanism (150) configured to lock a direction of the joint assembly (120) around at least one axis, wherein the locking mechanism comprises a lever rod (152) extending from the joint assembly (120) towards a proximal end (20) of the holder (100), wherein manual actuation of the lever rod (151 ) at the proximal end (20) releases a locked direction of the joint assembly (120).

The holder (100) may further comprise a chassis (110) having a proximal end (20) and distal end (40), wherein the connector (126) is attached via the joint assembly (120) to the chassis (110), and the moveable clamp (140) is provided in slidable relation to a longitudinal axis of the chassis (1 10).

The joint assembly (120) may comprise a first joint body and a second joint body moveable relative to the first joint body, wherein the first joint body is attached to the connector (126) and second joint body is attached to the chassis (110).

The joint assembly (120) may comprise a ball and socket joint, wherein the joint ball (124) is attached in fixed relation to the connector (126), and the joint socket (120) is provided in fixed relationship the chassis (1 10). 6. The number of ball and socket joints may be one.

The joint assembly (120) may comprise a guiderail-and-carriage joint, wherein the carriage (125) is slidably attached to the guiderail (123), guiderail (123) has an arc shape, wherein the guiderail (123) is revolutely attached to the connector (126), and the carriage is provided in fixed relationship the chassis (1 10).

The joint assembly (120) may comprise a parallelogram assembly, comprising at least three revolute joints (402a-d, 412a-c) arranged at the corners of a parallelogram, wherein a lower longitudinal beam (404c, 414a) of the parallelogram is attached to the connector (126), and the chassis (110) forms a crossbeam and is configured to pivot around a point (402i, 412d) disposed on an axis (410) extending from a centre of rotation of the connector (126).

A fulcrum point (152) of the lever rod (151 ) may be maintained in fixed relation to the chassis (110) towards the distal end (40), and is configured to provide a mechanical advantage of 10 to 100.

A proximal end (20) of the chassis (1 10) may be provided with an actuation region (1 12) configured for receiving a manual force to change the direction of the chassis (1 10) around the joint assembly (120), wherein a proximal end (20) of the lever rod (151 ) is disposed adjacent to the actuation region (112) such that the actuation region (1 12) or instrument (200) at the proximal end (20) is graspable simultaneous with activation of the lever rod (151 ).

A proximal (20) part of the lever rod (151 ) may extend in a proximal direction within radial confines of a play zone (170) that is a zone extending radially from a central longitudinal axis of the chassis (B-B’) and beyond an outside surface of the chassis (1 10) by a play width (172) that is up to 2 to 5 cm, preferably up to 2 cm.

The play zone (170) may be preferably bound at the proximal end (20) by the proximal terminal end of the chassis (1 10) and a longitudinal play length (174) of the play zone (170) is 25% or less, preferably 10% or less of the full length (1 16) of the chassis (1 10).

The holder may further comprise an instrument guide (130) configured to receive a shaft of the instrument (200) or a trocar (250) that slidably receives the instrument (200), and to support instrument (200) allowing axial displacements, optionally wherein instrument guide (130) comprises an instrument guide body (132, 132’) provided with a recess (135, 135’) configured for loading of the instrument (200) or trocar (250) by lateral docking.

The holder (100) may further comprise a user input unit (300) configured for control of the position of the moveable clamp (140) responsive to a user input, wherein a slidable clamp (140) moves responsive to an electrical signal.

The user input unit (300) may comprise an attachment element (304) adapted to dismountably attach the user input unit (300) to a proximal end of a manual tool (250, 260).

The slidable clamp (140) may comprise a slidable clamp body (142) provided with a recess (145) configured for loading of the instrument (200) by lateral docking.

The holder (100) may further comprise a tool rest (115) comprising a longitudinal member projecting laterally outwards from the chassis (1 10), configured to support thereon a separate manual tool.

A kit is further provided comprising:

- the holder (100) for an instrument (200) as described herein, and - the manual tool (250, 260) that is other than the instrument (200) to which the slidable clamp (140) can releasably attach.

A medical robot is further provided with a holder (100) as described herein.

Figure Legends

FIG. 1 illustrates a profile/cross-sectional representation of an exemplary holder described herein wherein the joint assembly comprises a ball-and-socket joint.

FIG. 2A and 2B illustrate a detail of a brake of an exemplary locking mechanism.

FIG. 3 illustrates a detail of an exemplary slideable clamp.

FIG. 4 illustrates a detail of an exemplary instrument guide member.

FIG. 5 illustrates a detail of an exemplary alternative instrument guide member.

FIG. 6A & B illustrate different views of a holder described herein wherein the joint assembly comprises a ball-and-socket joint.FIG. 7 illustrates a representation of an exemplary user input unit.

FIG. 8 illustrates a representation of an exemplary holder wherein the joint assembly comprises a guiderail-and-carriage joint.

FIG. 9 illustrates a schematic representation a holder wherein the joint assembly comprises a parallelogram assembly and 4 revolute joints forming a parallelogram core. FIG. 10 illustrates a schematic representation a holder provided wherein the joint assembly comprises a parallelogram assembly and movements of the parallogram are replicated using 3 revolute joints connected by belts.

FIG. 11 illustrates a tool rest as described herein.

FIG. 12 depicts FIG. 1 herein annotated with zones and dimensional markings

Detailed description of invention

Before the present device of the invention is described, it is to be understood that this invention is not limited to particular device or combinations described, since such systems and methods and combinations may, of course, vary. It is also to be understood that the terminology used herein is not intended to be limiting, since the scope of the present invention will be limited only by the appended claims.

As used herein, the singular forms "a", "an", and "the" include both singular and plural referents unless the context clearly dictates otherwise. The terms "comprising", "comprises" and "comprised of" as used herein are synonymous with "including", "includes" or "containing", "contains", and are inclusive or open-ended and do not exclude additional, non-recited members, elements. It will be appreciated that the terms "comprising", "comprises" and "comprised of as used herein comprise the terms "consisting of", "consists" and "consists of".

The recitation of numerical ranges by endpoints includes all numbers and fractions subsumed within the respective ranges, as well as the recited endpoints.

The term "about" or“approximately” as used herein when referring to a measurable value such as a parameter, an amount, a temporal duration, and the like, is meant to

encompass variations of +/- 10% or less, preferably +/- 5% or less, more preferably +/-1% or less, and still more preferably +/-0.1 % or less of and from the specified value, insofar such variations are appropriate to perform in the disclosed invention. It is to be understood that the value to which the modifier "about" or“approximately” refers is itself also specifically, and preferably, disclosed.

Whereas the terms“one or more” or“at least one”, such as one or more or at least one member(s) of a group of members, is clear per se, by means of further exemplification, the term encompasses inter alia a reference to any one of said members, or to any two or more of said members, such as, e.g., any >3, >4, >5, >6 or >7 etc. of said members, and up to all said members.

All references cited in the present specification are hereby incorporated by reference in their entirety. In particular, the teachings of all references herein specifically referred to are incorporated by reference.

Unless otherwise defined, all terms used in disclosing the invention, including technical and scientific terms, have the meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. By means of further guidance, term definitions are included to better appreciate the teaching of the present invention.

In the following passages, different aspects of the invention are defined in more detail. Each aspect so defined may be combined with any other aspect or aspects unless clearly indicated to the contrary. In particular, any feature indicated as being preferred or advantageous may be combined with any other feature or features indicated as being preferred or advantageous.

Reference throughout this specification to“one embodiment” or“an embodiment” means that a particular feature, structure or characteristic described in connection with the embodiment is included in at least one embodiment of the present invention. Thus, appearances of the phrases“in one embodiment” or“in an embodiment” in various places throughout this specification are not necessarily all referring to the same embodiment, but may. Furthermore, the particular features, structures or characteristics may be combined in any suitable manner, as would be apparent to a person skilled in the art from this disclosure, in one or more embodiments. Furthermore, while some embodiments described herein include some but not other features included in other embodiments, combinations of features of different embodiments are meant to be within the scope of the invention, and form different embodiments, as would be understood by those in the art. For example, in the appended claims, any of the claimed embodiments can be used in any combination.

In the present description of the invention, reference is made to the accompanying drawings that form a part hereof, and in which are shown by way of illustration only of specific embodiments in which the invention may be practiced. Parenthesized or emboldened reference numerals affixed to respective elements merely exemplify the elements by way of example, with which it is not intended to limit the respective elements. It is to be understood that other embodiments may be utilised and structural or logical changes may be made without departing from the scope of the present invention. The following detailed description, therefore, is not to be taken in a limiting sense, and the scope of the present invention is defined by the appended claims.

The terms "distal" or“distal to” and "proximal" or“proximal to” are used throughout the specification, and are terms generally understood in the field to mean towards (proximal) or away (distal) from the practitioner's side of an apparatus. Thus, "proximal" or“proximal to” means towards the practitioner's side and, therefore, away from the patient's side. Conversely, "distal" or“distal to” means towards the patient's side and, therefore, away from the practitioner's side.

A holder for an instrument is provided herein. The holder comprises a joint assembly configured to allow directional movement of the instrument relative to a positioning device, and a locking mechanism configured to lock the joint assembly and hence a direction of the instrument. The locking mechanism is released by a lever rod placed for single- handed actuation of the lever and simultaneous adjustment of the instrument direction.

The holder may further comprise a slideable clamp, configured to clamp the instrument which slideable clamp is displaceable in an axial direction upon actuation, typically via an electronic signal. The holder or instrument receives manual forces to control the direction of the instrument around the joint assembly.

The joint assembly allows fine adjustment of the instrument after its pose has been set by the positioning device. As the inventors have found that most adjustments needed in laparoscopy are small and angular, the joint assembly can be positioned remote from the incision without causing displacement of the incision/trocar. The trocar does not need to be integrated into the holder.

The instrument may be a longitudinal instrument. The instrument may be a medical instrument, or useful in other fields of technology such as engineering, chemistry, food science, or biotechnology. The instrument may be an endoscope or videoscope (e.g. 2D or 3D) or ultrasound imaging probe. The instrument may have an instrument shaft. The instrument shaft may occupy a substantial length of the instrument. The instrument may be a laparoscopic instrument such as an endoscope, videoscope (sensor chip on tip or not), gripper, needle holder, retractor, and the like. The instrument may have a longitudinal axial shaft. The holder may be provided devoid of the instrument. The skilled person would be able to implement adjustments to the holder to suit dismountable attachment to a wide variety of instruments, or to one or more particular instruments.

The direction of the instrument refers to its angular placement. Changing the direction of the instrument is typically by a pivoted rotation around a centre of motion. The centre of motion preferably coincides with a central longitudinal axis (A-A’) of the instrument. It may coincide with an axis parallel to a central longitudinal axis (A-A’) of the instrument. Such movements have two degrees of freedom (2-DOF), and may be known as pitch and yaw. When referring to direction, two degrees of freedom is equivalent to a rotation about two axes. The centre of motion is where axes of rotation intersect. Where the instrument is a laparoscopic medical instrument, the centre of motion is placed at or close to (remote from) a bodily incision where the laparoscopic medical instrument is introduced. The joint assembly allows the aforementioned directional movement of the instrument around 2-DOF, preferably around no more than 2-DOF, preferably about the centre of motion. The joint assembly may or may not permit a rotation of the instrument (roll) around its longitudinal axis. The joint assembly typically comprises two joint parts that move relative to each other. The joint assembly may comprise a first joint body and a second joint body that can move relative to the first joint body to move an instrument attached to the second joint body around the 2-DOF relative to the first joint body. The first joint body may be attached to a connector configured for attachment to a positioning device. The second joint body may be attachable to the instrument e.g. via the chassis, the slideable clamp, or guide member.

The joint assembly may prevent, limit or restrict displacement movements of the instrument at a set direction i.e. prevent any non-rotational instrument movements, though the position and direction of the joint assembly itself may be changed by the positioning device.

The joint assembly comprises any mechanical joint configured for directional movement of the instrument around 2-DOF such as a ball and socket joint, an arc-shaped guiderail-and- carriage joint, or parallelogram assembly. The joint may be manually actuated or motorised, preferably manually actuated. A motorised joint may be realised by providing one motor each for controlling an axis of rotation.

The joint assembly may comprise a ball and socket joint, the joint ball may be attached to the connector, and the joint socket attachable to the instrument, via for instance, the slidable clamp (FIGs. 1 to 6A/6B). Alternatively, the joint ball may be attachable to the instrument, and the joint socket attached to the connector. The joint ball may be rigidly attached to the connector. The ball and socket joint may be configured such that the instrument passes through a passage provided in the ball. The centre of motion coincides with the centre of the ball. There may be one (single) ball-and-socket joint.

The joint assembly may comprise a guiderail-and-carriage joint, as exemplified, for instance, in FIG. 8. In such a joint, the carriage is slidably attached to the guiderail. The guiderail may have an arc shape. The arc may be a part of a circumference of a circle.

The arc shaped guiderail rotates the carriage around an axis or area of rotation by displacement of the carriage along the guiderail, providing a first axis or area of rotation. The guiderail or carriage may be revolutely (1-DOF) attached to the connector, thereby providing a second axis of rotation. Alternatively, the guiderail or carriage may be revolutely (1-DOF) attachable to the instrument, thereby providing a second axis of rotation. Where the first and second axes of rotation interact is the centre of motion which is remote from the guiderail-and-carriage elements. The centre of motion coincides with a central longitudinal axis (A-A’) of the instrument.

The joint assembly may comprise a parallelogram assembly, as exemplified, for instance, FIGs. 9 and 10. In one example, a pair of longitudinal beams is mutually connected by a pair of cross-beams, each crossbeam connected to a parallel member using a revolute joint (FIG. 9). The arrangement of longitudinal beams and crossbeams is essentially planar. The axes of rotation of the four revolute joints are parallel. The four revolute joints form the corners of a parallelogram. The longitudinal beams may be positioned essentially horizontally and the crossbeams positioned essentially vertically. The holder chassis may be attached by revolute joints to extensions of the longitudinal beams as a further crossbeam parallel to the pair of cross-struts; the extensions to the longitudinal beams advance in a forward direction. A first angle of the holder is adjustable by adjusting the shape of the parallelogram; the chassis being a crossbeam of the parallelogram can be used to adjust the shape of the parallelogram. A supporting longitudinal beam disposed parallel to the pair of longitudinal beams may be attached by a revolute joint to an extension of each of the pair of crossbeams; the extensions to the crossbeams advance in a downward direction. A first axis of rotation extending from a longitudinal axis of the instrument crosses an axis intersecting the revolute joints of the supporting longitudinal beam. The parallelogram assembly may be revolutely attached to a connector extending in a backward direction from the supporting longitudinal beam. A central axis of the connector provides second axis of rotation and crosses the first axis of rotation. Where the first and second axes of rotation intersect is the centre of motion, which is a remote centre of motion. The centre of motion coincides with a central longitudinal axis (A-A’) of the instrument.

In another example, the four revolute joints defining the parallelogram and as exemplified in FIG. 9 are replaced by three revolute joints as shown in FIG. 10; the lower forward revolute joint is removed; its position is the remote centre of motion. There is a single longitudinal beam connected by a revolute joint to a single crossbeam, the supporting longitudinal beam is attached to the crossbeam by a revolute joint, and movements are synchronised by an arrangement of belts to mimic a parallelogram. The joint assembly components (e.g. first joint body, a second joint body, ball, socket, rail, carriage, longitudinal beam, crossbeam) may be made from any suitable material, preferably suitable for a medical device such as stainless steel, titanium, or composite, or a combination of these. Where necessary one or more of them may be coated with a protective layer, for instance, antibacterial or corrosion resistant.

The holder may be provided with a chassis. The chassis has a proximal and distal end. The chassis may be longitudinal. The chassis may be attached to one of the two joint parts that move relative to each other in the joint assembly. The chassis may be attached preferably at the distal end to the second joint body; the attachment may be rigid i.e. held in non-rotational and non-displaceable relation. The chassis may be attached to the socket of a ball and socket joint. The chassis may be attached to the carriage of a guiderail-and-carriage joint. The chassis is preferably rigid. The chassis may be made from any suitable material, preferably suitable for a medical device such as stainless steel, titanium, or composite. Where necessary the chassis may be coated with a protective layer, for instance, antibacterial or corrosion resistant. The chassis may be provided with an actuation region that is a region at the proximal end of the chassis is graspable or grippable by the user to adjust the direction of the holder. The actuation region may contain a number of serrations, grooves, or other indentations to reduce friction and improve manual grip. The actuation region may be unmarked.

The actuation region (112) occupies the outer surface of the chassis (110) at the proximal end. An exemplary actuation region is shown in FIG. 12. It may have a length (114) that is the 25% or less, preferably 10% or less of the full length (1 16) of the chassis (1 10). The actuation region (1 12) is preferably bound at the proximal end by the proximal terminal end of the chassis (1 10). A gap (176) between the lever rod (151 ) and the chassis (1 10) in the actuation region (1 12) may have a width between 0.5 cm and 2 cm.

The chassis (110) may have any shape, for instance, at least partly cylindrical and/or at least partly cuboid (e.g. rectangular cuboid). The chassis in actuation region (1 12) may be disposed with a collar or one or more protrusions projecting from the outer surface of the chassis (110) in the direction of the lever rod (151 ). The aforementioned gap (176) may hence be measured between the lever rod (151 ) and the collar or protrusion.

The holder is provided with a locking mechanism, configured to lock the direction of at least 1-DOF preferably 2-DOFs of the joint assembly. The locking mechanism comprises a lever rod. Using a lever rod, manual force applied at a proximal end of the rod may be mechanically amplified to release a force maintaining the locked direction of the joint assembly. The locking mechanism typically comprises frictional brake that when applied restricts or prevents movement of the joint assembly, e.g. of a first or second body of the joint assembly. Preferably the locking mechanism is attached to the second body (e.g. to a chassis), and applies a frictional brake to the first body.

The locking mechanism may comprise one or more complaint members such as a helical spring or a disc spring arranged to bias the locking mechanism in locked state, hence to bias the direction of the joint assembly in the locked state. Application of force from the lever rod may act against the one or more complaint members thereby releasing the locking mechanism or direction of the joint assembly from locked state. With release of the lever rod, the locking mechanism or joint assembly revert back to the locked state.

Where the joint assembly comprises a ball and socket joint, the frictional brake is applied to the joint ball, thereby preventing rotation of the ball in 2DOF. Where the joint assembly comprises a guide-rail-and-carriage joint, the frictional brake is applied to the joint guiderail, thereby prevent movement of the carriage in 1 DOF. Where the joint assembly is a parallelogram assembly, the frictional brake is applied to one of the revolute joints.

The lever rod extends from a fulcrum point disposed towards a distal end the holder, towards the proximal end of the holder. The fulcrum point is preferably provided by a revolute joint offering an axis of rotation. The fulcrum point may be disposed on the chassis, or on the joint assembly. Preferably the fulcrum point is positioned to provide a force mechanical advantage of 10 to 100, or more. The proximal end of the lever rod preferably extends axially adjacent to the proximal actuation region on the chassis, or adjacent to a proximal end of instrument. By manually gripping the chassis at the actuation region or the instrument at the proximal end together with the lever rod, the locking mechanism is released and the holder can be freely pivoted about the centre of motion, both actions (release and movement) achieved with a single grip.

At least a proximal part of the lever rod (151 ) may extend in a proximal direction within radial confines of a play zone (170). A play zone (170) is a zone extending radially from a central longitudinal axis of the chassis (B-B’), and beyond the outside surface of the chassis (110), as shown, for example, in FIG. 12. The play zone (170) may extend radially beyond the outside surface of the chassis (1 10) by a play width (172) measured along an axis radially extending from the central longitudinal axis (B-B’) of the chassis (1 10). The play width (172) may be up to 2 to 5 cm, preferably up to 2 cm.

As mentioned elsewhere herein the chassis (110) in actuation region (1 12) may be disposed with a collar or one or more protrusions projecting from the outer surface of the chassis (110) in the direction of the lever rod (151 ). The aforementioned play zone (170) hence may extend beyond the outside surface of said collar or one or more protrusions, and the play width (172) is measured therefrom.

The play zone (170) is preferably bound at the proximal end (20) by the proximal (20) terminal end of the chassis (1 10). A longitudinal play length (174) of the play zone (170) may be 25% or less, preferably 10% or less of the full length (1 16) of the chassis (1 10).

A proximal terminal end of the lever rod (151 ) may be within the longitudinal confines of play zone (170), or may be position in a proximal direction beyond the proximal terminal end of the chassis (1 10).

The lever rod allows the joint direction to be locked with high forces, thereby imparting stability to the holder. For example, using a spring with a force of 1400 N and a frictional brake comprising an annular ring with a bevelled edge for engagement with joint ball, rail or revolute joint, a force of 8000 N can be applied to the joint part that is sufficient to support the weight of a substantial instrument such as an endoscope or videoscope.

Advantageously, the lever rod may be actuated close to the proximal end of the holder or instrument providing a significant longitudinal distance for an amplification of force when the fulcrum point is provided at the distal end of the holder. Achievable mechanical advantage is high; a frictional brake does not need to move a large distance to release locking friction, hence it can be applied with high force and over a small area, thereby allowing a reduction in the size of the joint assembly. The movement of the lever and movement of the holder can be actuated simultaneously with one hand, since the proximal end of the lever coincides with a proximal end of the holder or instrument. Hence the gripping force required to change direction of the holder is utilised also to release the brake in a simultaneous action.

The level rod controls a brake block that can be advanced or withdrawn, thereby applying or releasing friction. The brake block applies friction for instance to the joint ball, to the joint rail or to the revolute joint. The shape of the brake block may be adapted according to the type of joint. For instance, it may comprise an annular ring wherein a circular edge on a first end contacts the joint ball and the second end of the ring receives force from a complant member. The circular edge on a first end may be bevelled or chamfered. The circular edge around its inner circumference couples with the joint ball, and the application of force by the compliant member prevents movement of the ball. The angle of the bevel can amplify the forces of the compliant member. For example, an angle of 60° the force on the ball is 115% of the force of the compliant member, 30° is 200%, 10° is 576%. Using a compliant member with a force of for instance 1400 N, and a frictional brake comprising an annular ring having a chamfered edge with an angle of 10°, a perpendicular force of, for instance, 8000 N can be applied to the relevant part of the joint, e.g. to the ball, to the rail, or to the revolute joint.According to one aspect, the brake block comprises an annular ring having a bevelled edge for slidable advancement towards or withdrawal from an outerface surface of the joint part (e.g. joint ball). An exemplary arrangement is illustrated in FIGs. 2A and 2B.

Preferably the lever is attached at the fulcrum point to the second joint body or to the chassis and releases a frictional brake applied to the first joint body, and not the other way around. Since the brake and the lever for actuation are always in the same relation to its other, it allows a controlled transfer of high forces to release and apply the brake.

The lever rod may be made from any suitable material, preferably suitable for a medical device such as stainless steel, titanium, or composite, or a combination of these. Where necessary one or more of them may be coated with a protective layer, for instance, antibacterial or corrosion resistant.

The holder may be provided with a slideable clamp. The slideable clamp is configured to receive a shaft of the instrument and maintain it in fixed relation thereto, i.e. hold it in non- rotational and non-displaceable relation to the slideable clamp. The slideable clamp is configured to displace the instrument in axial direction e.g. in a direction along its shaft, preferably in response to an electrical signal. The slideable clamp may be slidably attached to the chassis. It may be slidable with respect to the chassis, typically in a longitudinal direction. The slideable clamp preferably travels within a distance between a proximal end of the chassis and the instrument guide element. The slideable clamp may comprise a slideable clamp body provided with a slideable clamp slot or recess to receive the instrument. Preferably, the slideable clamp recess allows loading of the instrument by laterally (sideways) docking e.g. by displacement of the instrument along a plane parallel to or touching an axis of the instrument. Lateral docking prevents contamination of the instrument tip compared with loading by axial sliding of the instrument into the slot or recess. The slideable clamp recess may be provided with a slideable clamp locking assembly comprising one or more elements to lock the position of instrument, such as a threaded bolt, a spring release bolt, or a spring loaded brake - that repeatably and reversibly holds the instrument in fixed relation to the slideable clamp body (see, for instance, FIG. 3). When the slideable clamp locking assembly is open, the instrument may be laterally docked into the recess. The slideable clamp locking assembly is closed, the instrument may be held in fixed position within the recess. The slideable clamp and components thereof may be made from any suitable material, preferably suitable for a medical device such as stainless steel, titanium, or composite, or a combination of these. Where necessary one or more of them may be coated with a protective layer, for instance, antibacterial or corrosion resistant.

The slideable clamp may be operatively connected to a linear actuator, configured to change the position of the clamp. An example of a linear actuator includes a motorised threaded rod. Rotation of the threaded rod results in movement of a travelling nut along an axis of the thread. The nut is attached to the slideable clamp body. The holder may be provided with a motor. The motor may be dismountably attached to the holder or chassis. The motor may be provided, for instance, with a bayonet fitting, screw fitting, twist lock fitting, and the like for dismountable attachment. Dismountable attachment allows convenient cleaning/sterilisation of non-electrical components of the holder. The motor may be a servo motor, a stepper motor, or any type of electrical motor. The motor may be battery powered, or powered from an electrical outlet e.g. via a transformer.

The slideable clamp may be manually controlled, for instance by rotation of a thumb knob. The thumb knob may be provided at a proximal end of the chassis. The thumb knob may be operative attached to a threaded rod. Rotation of the thumb knob leads to rotation of the threaded rod. The thumb knob may directly or indirectly (e.g. via one or more gears) drive the threaded rod. Rotation of the threaded rod results in movement of a travelling nut along an axis of the thread. The nut is attached to the slideable clamp body.

The holder may be provided with an instrument guide. The instrument guide is configured to receive a shaft of the instrument or a trocar into which the instrument can axially slide, and to support instrument (200) allowing axial displacements. The instrument guide may be rigidly attached to the chassis i.e. held in non-rotational and non-displaceable relation. It is preferably attached towards the distal end of the chassis, and proximal of the joint assembly. The instrument guide may comprise an instrument guide body provided with an instrument guide slot or recess to receive the instrument. Preferably, the recess allow loading of the instrument by laterally (sideways) docking i.e. by displacement of the instrument along a plane parallel or perpendicular to an axis of the instrument. Lateral docking prevents contamination of the instrument tip that would otherwise arise if it was loaded by axial sliding of the instrument into a slot.

The instrument guide recess may be provided with an instrument guide locking assembly - comprising one or more elements to lock the trocar, such as a threaded bolt, a spring release bolt, or a spring loaded brake - that repeatably and reversibly holds the trocar in fixed relation to the instrument guide body. When the instrument guide locking assembly is open, the trocar may be laterally docked into the recess. The instrument guide locking assembly is closed, the trocar may be held in fixed position within the recess (see, for instance, FIG. 4). The instrument guide recess may be provided with a lockable gate - such as a threaded bolt, a spring release bolt, or a spring flap - that repeatably and reversibly blocks the open end of the instrument guide recess. When the gate is open, the instrument can be laterally docked. When the gate is closed, the instrument can be held slidably within the instrument guide recess (see, for instance, FIG. 5). The instrument held within the recess is slidable relative to the instrument guide. The instrument guide and components thereof may be made from any suitable material, preferably suitable for a medical device such as stainless steel, titanium, or composite, or a combination of these. Where necessary one or more of them may be coated with a protective layer, for instance, antibacterial or corrosion resistant.

The holder may be provided with a connector. The connector is configured for attachment to a positioning device. It is a mechanical connector. The connector may be of any suitable shape or form. The connector may be rigid. It may comprise a rigid rod that may be clamped by a coupling of the positioning device, or a rigid screw thread that is tightened by rotation into a coupling of the positioning device, or a bayonet-type fitting. Where the joint assembly comprises a ball-and-socket joint, the joint ball may be rigidly attached to the connector i.e. held in non-rotational and non-displaceable relation. Where the joint assembly comprises a guiderail-and-carriage joint, the guiderail may be revolutely attached to the connector i.e. held in rotational and non-displaceable relation therewith. Where the joint assembly comprises a parallelogram assembly, the supporting longitudinal beam revolutely attached or attached in fixed relation to the connector. The connector may be made from any suitable material, preferably suitable for a medical device such as stainless steel, titanium, or composite, or a combination of these. Where necessary one or more of them may be coated with a protective layer, for instance, antibacterial or corrosion resistant.

A positioning device is an apparatus having a base end and an effector end wherein the pose (position and direction) of the effector end can be changed and fixed. A positioning device may be manual or powered e.g. motorised or pneumatic. An example of a positioning device is an articulated arm having a base end and an effector end and a plurality of intervening links connected by joints, whereby the arrangement of links and joints provide a number of degrees of freedom of movement to the effector end, typically at least 6. Examples of positioning devices include articulated holding arms (manual), and articulated robot arms. With a manual arm, the effector end can be manually displaced and/or rotated; the joints can be moved by releasing a clutch or brake. With a robotic arm, the joints are typically motorised or hydraulicly powered. At the effector end is provided a coupling configured for dismountable attachment to the connector.

The holder may further comprise a user input unit (see, for instance, FIG. 7). The user input unit receives an input from the user to control the position of the slideable clamp.

The input may be manual (e.g. from a limb of the user). The input may be from a thumb or finger of the user. The input may be from a foot of the user. The input may be a voice command of the user. The user input unit may comprise a user input sensor such as a momentary on-off-on toggle or rocker switch, a capacitative touch pad, a joystick, a foot pedal, a microphone or a similar component. The user input unit may further comprise an attachment element configured to dismountably attach the user input unit to a manual tool. The manual tool may be other than the instrument held by the holder, for instance, it may be a laparoscopic tool such as a gripper. The manual tool may have an elongated shaft. The attachment element may comprise a spring-clip, or a threaded clamp, or a similar attachment device. In a surgical setting where an endoscope is mounted in a holder described herein and its position adjusted and fixed, and one or two separate surgical laparoscopic instruments e.g. two gripper instruments are being used with each hand of the surgeon, the user input unit allows the surgeon to change the position of the slideable clamp i.e. to zoom in or out without taking his hand off any of the gripper instruments (see, for instance, FIG. 11 ). When a hand is removed, the gripper is not supported and will fall to one side or pitch upwards at the distal end. Such zoom is of assistance, for instance, when performing a laparoscopic suture where a wide field of view is initially needed to position the instruments, needle and suture cord, and an up close image is needed to suture at the tissue interface. The combination of directional control and zoom is important; while orienting, it is necessary to zoom in on a particular spot; the invention allow both, while still giving control of another tool.

The holder may be provided with a controller unit configured to control the position of slideable clamp. The controller unit may output electrical signals e.g. electrical current or a series of control pulses for movement of the slideable clamp. The signals may be sent to the linear actuator e.g. motor, co-operatively attached to the slideable clamp. The controller unit may input receive signal from the user input unit. It may comprise a processor and memory, configured to output electrical signals to the linear actuator responsive to input from the user input unit. It may be powered by a battery (e.g. lithium ion), or received electrical power via a connecting cable. The controller unit may be integrated into a housing of the motor, the user input unit, a wall plug power adaptor, an inline housing, or have a separate housing. The controller unit may be connected to the user input unit using one or more cables or wirelessly. A wireless connection may use a data transmission standard such as Bluetooth.

The holder may be provided with a tool rest configured to support a separate tool, such as a manual tool. The separate tool is different from the instrument mounted in the holder. The tool may be other than the instrument held by the holder, for instance, it may be a laparoscopic tool such as a gripper. The manual tool may have an elongated shaft. The tool rest may comprise a longitudinal member projecting outwards from the chassis in a laterally (sideways) direction. A lateral direction means projecting from the side, left or right when viewed along an axial direction of the holder and the slideable clamp is considered at the front. Where the tool rest is provided on a surgeon’s right side of the holder, a laparoscopic tool such as a gripper can be rested on the tool rest while the surgeon’s right hand changes the direction of the holder (see, for instance, FIG. 8). The tool rest prevents the gripper from pitching upwards. The tool rest may contain a hooked part to prevent the tool from falling to the side. The tool rest may be detachable from the chassis. The tool rest may be attached towards a proximal end of the chassis, preferably within a proximal quarter length of the chassis.

Further provided is a use of holder as described herein for controlling a direction and optionally and axial position of an instrument. Further provided is a use of holder as described herein for controlling the direction and optionally zoom function of a laparoscopic endoscopic.

Further provided is a robotic articulated arm provided with or attached to a holder as described herein.

Further provided is a medical robot provided with or attached to a holder as described herein.

Further provided is a manual articulated arm provided with or attached to a holder as described herein.

Further provided is a kit comprising:

- a holder (100) for an instrument (200), and

- the manual tool (250, 260) that is other than the instrument (200) attached to the slidable clamp (140).

FIG. 1 illustrates a profile/cross-sectional representation of an exemplary holder (100) described herein. The holder (100) has a proximal (20) and distal (40) end. It comprises a joint assembly (120) having a ball-and-socket joint, a joint ball (124) in rigid connection with the connector (126) for attachment to a positioning device, and the joint socket (122) provided in fixed directional relation to a slideable clamp (140). Also illustrated is a chassis (1 10) rigidly attached to the joint socket (122); an instrument guide member (130) is rigidly attached to the chassis (110), and the slideable clamp (140) is slidably attached to the chassis (1 10). The holder is provided with a locking mechanism (150) comprising a lever rod (151 ) attached to the holder (100) at a fulcrum point (152) that transmits and amplifies a manual force applied at a proximal end (20) to release a brake (154) biasedly applied to the joint ball (124). By manually gripping the chassis at a proximal actuation region (112) together with the lever rod (151 ), the instrument (200) mountable in the slideable clamp (140) and instrument guide member (130) can be freely pivoted around the centre of motion corresponding to the centre of the joint ball (124); release of the lever rod (151 ) locks the direction of the instrument (200).

FIG. 2A and 2B illustrate a detail of a brake (154) of the locking mechanism (150). The brake comprises a brake block (156) that applies friction to the joint ball (124). The brake block comprises an annular ring bevelled (157) at one end, which is appliable around the the joint ball (124). The brake block (156) is attached to a transmission rod (158). The transmission rod (158) is provided in slidable relation to the joint socket (122). The transmission rod (158) is in co-operation with a spring (160) that biases the brake block (156) in a brake-on (closed) state as shown in FIG. 2A; the direction of the joint ball (124) is locked and the wedge (157) part of the brake block (156) is disposed between the joint ball (124) and the joint socket (122). In FIG. 2B slidable withdrawal of the transmission rod (158), by application of the lever rod (151 ) releases the brake block (156), allowing directional movement of the joint ball (124).

FIG. 3 illustrates a detail of an exemplary slidable clamp (140) having a slidable clamp body (142) supporting the instrument (200) onto the chassis (not shown). Face (144) adjoins the chassis. The slidable clamp body (142) is provided with a slidable clamp recess (145) through which the instrument (200) can be laterally (sideways) docked so avoiding contamination of the instrument (200) tip. The slidable clamp is provided with a slidable clamp locking assembly (146) comprising a first slidable member (147) and first brake pad (148) attached to the first slidable member (147). The first brake pad (148) is engageable against the instrument (200). The first slidable member (147) is disposed in a channel (seat) in the first body (142). The position and engagement of the first brake pad (148) may be controlled by advancing or withdrawing the first slidable member (147). Engagement of the first brake pad (148) against instrument (200) fixes the position of the instrument (200), allowing it to be axially displaced by the holder (100) relative to the joint assembly (120) by a corresponding displacement of the slidable clamp (140).

FIG. 4 illustrates a detail of an exemplary instrument guide (130) having an instrument guide body (132) that attaches to a trocar (250) slidably supporting the instrument (200) with respect to the chassis (not shown). Face (134) adjoins the chassis. The instrument guide body (132) is provided with a recess (135) through which the trocar (250) can be laterally (sideways) docked so avoiding contamination of the instrument (200) tip. In a typical surgical procedure, the trocar (250) is inserted into a bodily cavity wall,

subsequently, the trocar is fixed to the instrument guide (130), then the instrument inserted through the (sterile) trocar (250). The instrument guide member (130) is provided with an instrument guide locking assembly (146) comprising a second slidable member (137) and a second brake pad (138) attached to the second slidable member (137). The second brake pad (138) is engageable against a trocor (250) into which the instrument (200) can be slidably inserted. A trocar (250) is known in the art as providing a removable bodily entry port for laparoscopic procedures, and typically comprises a longitudinal body and passage therethrough for the instrument. The second slidable member (137) is disposed in a channel (seat) in the instrument guide body (132). The position and engagement of the second brake pad (138) may be controlled by advancing or withdrawing the second slidable member (137). Engagement of the second brake pad (138) against trocar (250) fixes the position of the trocar (250), allowing the instrument (200) to slide axially within the trocar passage.

FIG. 5 illustrates a detail of an exemplary alternative instrument guide (130’) having an instrument guide body (132’) slidably supporting the instrument (200) with respect to the chassis (not shown). Face (134) adjoins the chassis. The instrument guide body (132’) is provided with a recess (135’) through which the instrument (200) can be laterally

(sideways) docked so avoiding contamination of the instrument (200) tip. The instrument guide (130’) is provided with a lockable gate (136’) comprising a third slidable member (137’). The third slidable member (137’) is disposed in a channel (seat) in the instrument guide body (132’). The position and engagement of the lockable gate (136) may be controlled by advancing or withdrawing the third slidable member (137’). Engagement of the lockable gate (136’) across recess (135’) holds instrument (200) in slidable relation to the instrument guide (130).

FIG. 6A and 6B are alternative views of a schematic model representation of an exemplary holder (100) described herein. The holder (100) has a proximal (20) and distal (40) end. It comprises a joint assembly (120) having a ball-and-socket joint, a joint ball (not visible) in rigid connection with the connector (126) for attachment to a positioning device, and the joint socket (not visible) provided in fixed directional relation to a slidable clamp (140). Also illustrated is a chassis (110) rigidly attached to the joint socket (not visible). An instrument guide member (130) is rigidly attached to the chassis (1 10) and is attached to a trocar (270) through which the instrument slides (200). The slidable clamp (140) is slidably attached to the chassis (1 10). The holder is provided with a locking mechanism (150) comprising a lever rod (151 ) attached to the holder (100) at a fulcrum point (not visible) that transmits and amplifies a manual force applied at a proximal end (20) to release a brake (not visible) biasedly applied to the joint ball (not visible). By manually gripping the chassis at a proximal actuation region (112) together with the lever rod (151 ), the instrument (200) mountable in the slidable clamp (140) and instrument guide member (130) can be freely pivoted around the centre of motion corresponding to the centre of the joint ball (not visible); release of the lever rod (151 ) locks the direction of the instrument (200). The proximal actuation region (112) coincides with a motor that drives the slideable clamp (140).

FIG. 7 illustrates a representation of an exemplary user input unit (300), comprising a momentary on-off-on toggle switch (302) for controlling movement of the motorised slideable clamp (140) and an attachment element (304) configured for dismountable attachment of the user input unit to a manual tool.

FIG. 8 illustrates a representation of an exemplary holder (100) described herein, wherein the joint assembly (120) comprises a guiderail-and-carriage joint. The holder (100) has a proximal (20) and distal (40) end. It comprises joint assembly (120) having a guiderail- and-carriage joint, an arc-shaped guiderail (123) in revolute connection with the connector (126) for attachment to a positioning device, and the joint carriage (125) provided in fixed directional relation to a slideable clamp (140). The arc-shaped guiderail (123) revolutely rotates about an axis of rotation (127), relative to the connector, that crosses a central longitudinal axis (A-A’) of the instrument (200). Where the axis of rotation (127) and central longitudinal axis (A-A’) of the instrument (200) intersect is a remote centre of motion (102) about which the instrument (200) pivots. Also illustrated is a chassis (1 10) rigidly attached to the joint carriage (125); an instrument guide member (130) is rigidly attached to the chassis (110), and the slideable clamp (140) is slidably attached to the chassis (110). The holder is provided with a locking mechanism (150) comprising a lever rod (151 ) attached to the holder (100) at a fulcrum point (152’) that transmits and amplifies a manual force applied at a proximal end (20) to release a brake (154’) biasedly applied to the arc-shaped guiderail (123). By manually gripping the chassis at a proximal actuation region (112’) together with the lever rod (151 ), the instrument (200) mountable in the slideable clamp (140) and instrument guide member (130) can be freely pivoted around theremote centre of motion (102); release of the lever rod (151 ) locks the direction of the instrument (200). The use of the arc-shaped guiderail (123) allows placement of the swivel point (102) remote from the holder (100), for instance, so it can coincide with a fascia of the incision of the subject (104).

FIG. 9 illustrates a representation of an exemplary holder (100) described herein, wherein the joint assembly (120) comprises a parallelogram assembly having a parallelogram with 4 revolute joints. A pair of longitudinal beams (404a-b) are mutually connected by a pair of crossbeams (406a-b), each crossbeam connected to a parallel member using a revolute joint (402a-d). The four revolute joints form the corners of a parallelogram (402a-d). The holder chassis (110) is attached by revolute joints (402e-f) to extensions (404ae, 404be) of the longitudinal beams as a further crossbeam parallel to the pair of crossbeams (406a- b); the extensions (404ae, 404be) to the longitudinal beams advance in a forward direction (F). A first angle of the holder is adjustable by adjusting the shape of the parallelogram; the chassis (1 10) being a crossbeam of the parallelogram can be used to adjust the shape of the parallelogram. A supporting longitudinal beam (404c) disposed parallel to the pair of longitudinal beams (404a-b) may be attached by a revolute joint (402g-h) to an extension (406ae, 406be) of each of the pair of crossbeams (406a, 406b); the extensions (406ae, 406be) to the crossbeams advance in a downward (D) direction. The connector (126) having a centre of rotation is attached to the supporting longitudinal beam (404c) such that an axis (410) extending from the centre of rotation of the connector (126) intersects the revolute joints (402g, 402h) of the supporting longitudinal beam (404c). The connector (126) may be attached to the supporting longitudinal beam (404c) extended in a backward (B) direction. The attachment may be revolute, or the connector (126) may attached in fixed relation to the supporting longitudinal beam (404c) and the positioning device may provide an axis of rotation to the connector (126). A first axis of rotation (410) thus corresponds to the axis (410) extending from the centre of rotation of the connector (126) and intersecting the revolute joints (402g, 402h) of the supporting longitudinal beam (404c). A second axis of rotation ( i.e . pivoting rotation) of the instrument (A-A’) or of the chassis (420) intersects the first axis of rotation (410) at a centre of motion of the instrument (102) or the chassis (402i). The centre of motion (102, 402i) is remote. The lever (1 10) is used to release a brake applied to one of the revolute joints (402f) attached to the chassis (1 10).

FIG. 10 illustrates a representation of an exemplary holder (100) described herein, wherein the joint assembly (120) comprises a parallelogram assembly having a

parallelogram behaviour with 3 revolute joints. It comprises a single longitudinal beam (414a) connected by a revolute joint (412a) to a single crossbeam (416a), the supporting longitudinal beam (414b) is attached to the crossbeam by a revolute joint (412c). The revolute joints (412a-c) form 3 corners of a parallelogram geometric shape (420), the forth corner (412d) is absent; movements of the longitudinal beam (414a) and crossbeam (416a) are synchronised by an arrangement of belts (418a-b) and pulleys to mimic a parallelogram. The connector (126) having a centre of rotation is attached to the supporting longitudinal beam (414b) such that an axis (410) extending from the centre of rotation of the connector (126) intersects the revolute joint (412c) of the supporting longitudinal beam (414b). The connector (126) may be attached to the supporting longitudinal beam (414b) extended in a backward (B) direction. The attachment may be revolute, or the connector (126) may attached in fixed relation to the supporting

longitudinal beam (414b) and the positioning device may provide an axis of rotation to the connector (126). A first axis of rotation (410) thus corresponds to the axis (410) extending from the centre of rotation of the connector (126) and intersecting the revolute joint (412c) of the supporting longitudinal beam (414b). A second axis of rotation ( i.e . pivoting rotation) of the instrument (A-A’) or of the chassis (420) intersects the first axis of rotation (410) at a centre of motion of the instrument (102) or the chassis (412d). The centre of motion (102, 402i) is remote. The lever (110) is used to release a brake applied to one of the revolute joints (412b) attached to the chassis (1 10).

FIG. 11 illustrates an exemplary tool rest (1 15) projecting laterally (sideways) right from the chassis (1 10) when viewed axially from the distal end i.e. from the surgeon’s point of view. The slideable clamp (140) and instrument guide member (130) are disposed at the front. The instrument (200) and a separate first tool (250) (e.g. first gripper) share the same incision in the subject (104), and a second tool (260) (e.g. second gripper) is disposed through a separate incision. During laparoscopy, the surgeon operates the first (250) and second (260) tools with separate hands. Typical tasks are a change of direction and actuation of the gripper jaws. An endoscope (200’) maintained by the holder (100) in a fixed direction provides moving images that can be viewed stereoscopically on a screen or through a viewing visor. When the direction of the endoscope (200’) is to be changed by the holder, the surgeon may place the first (250) tool on the tool rest (115), and in its new position (250’) is supported to prevent it pitching upwards within the cavity of the subject (104). Further depicted is a user input unit (300), dismountably attached to a proximal end of the second tool (260). Advantageously, both first tool (250) and second tool (260) can be manually operated the surgeon, and control of the endoscope (200’) zoom that is required most of the time can be achieved simultaneously without removing his hands from the tools (250, 260).

FIG. 12 is similar to FIG. 1 , annotated to indicate a length (114) of the actuation region (1 12), a full length (116) of the chassis (110), a gap (176) between the lever rod (151 ) and the chassis (1 10), a play zone (170), a play width (172), and a longitudinal play length (174).

Claims

1. A holder (100) for an instrument (200) having a proximal (20) and distal (40) end comprising:

- a connector (126) for dismountable attachment to a positioning device,

- a longitudinal chassis (110) having a proximal end (20) and distal end (40),

- a joint assembly (120) configured for directional movement of the chassis (1 10) relative to the connector (126), and

- a locking mechanism (150) configured to lock a direction of the joint assembly (120) around at least one axis, wherein the locking mechanism comprises a lever rod (152) extending from the joint assembly (120) towards a proximal end (20) of the chassis (1 10), wherein manual actuation of the lever rod (151 ) at the proximal end (20) releases a locked direction of the joint assembly (120)

wherein

2. A holder (100) according to claim 1 , wherein

- the proximal end (20) of the chassis (1 10) is provided with an actuation region (1 12) configured for receiving a manual force to change the direction of the chassis (110) around the joint assembly (120), and

- a proximal end (20) of the lever rod (151 ) is disposed adjacent to the actuation region (1 12) such that the actuation region (112) or instrument (200) at the proximal end (20) is graspable simultaneous with activation of the lever rod (151 ),

3. The holder (100) according to claim 2, wherein a proximal (20) part of the lever rod (151 ) extends in a proximal direction within radial confines of a play zone (170) that is a zone extending radially from a central longitudinal axis of the chassis (B-B’) and beyond an outside surface of the chassis (1 10) by a play width (172) that is up to 2 to 5 cm, preferably up to 2 cm.

4. The holder (100) according to claim 3, wherein the play zone (170) is preferably bound at the proximal end (20) by the proximal terminal end of the chassis (1 10) and a longitudinal play length (174) of the play zone (170) is 25% or less, preferably 10% or less of the full length (116) of the chassis (1 10).

5. The holder (100) according to any of claims 1 to 4, wherein the joint assembly (120) comprises a first joint body and a second joint body moveable relative to the first joint body, wherein the first joint body is attached to the connector (126) and second joint body is attached to the chassis (1 10).

6. The holder (100) according to any of claims 1 to 5, wherein the joint assembly (120) comprises a ball and socket joint, wherein the joint ball (124) is attached in fixed relation to the connector (126), and the joint socket (120) is provided in fixed relationship the chassis (1 10).

7. The holder (100) according to claim 6, wherein the number of ball and socket joints is one.

8. The holder (100) according to any of claims 1 to 5, wherein the joint assembly (120) comprises a guiderail-and-carriage joint, wherein the carriage (125) is slidably attached to the guiderail (123), guiderail (123) has an arc shape, wherein the guiderail (123) is revolutely attached to the connector (126), and the carriage is provided in fixed relationship the chassis (1 10).

9. The holder (100) according to any of claims 1 to 5, wherein the joint assembly (120) comprises a parallelogram assembly, comprising at least three revolute joints (402a-d, 412a-c) arranged at the corners of a parallelogram, wherein a lower longitudinal beam (404c, 414a) of the parallelogram is attached to the connector (126), and the chassis (110) forms a crossbeam and is configured to pivot around a point (402i, 412d) disposed on an axis (410) extending from a centre of rotation of the connector (126).

10. The holder (100) according to any of claims 1 to 9, wherein a fulcrum point (152) of the lever rod (151 ) is maintained in fixed relation to the chassis (110) towards the distal end (40), and is configured to provide a mechanical advantage of 10 to 100.

1 1. The holder according to any of the previous claims further comprising an instrument guide (130) configured to receive a shaft of the instrument (200) or a trocar (250) that slidably receives the instrument (200), and to support instrument (200) allowing axial displacements, optionally wherein instrument guide (130) comprises an instrument guide body (132, 132’) provided with a recess (135, 135’) configured for loading of the instrument (200) or trocar (250) by lateral docking.

12. The holder (100) according to any of the previous claims, wherein the slidable clamp (140) comprises a slidable clamp body (142) provided with a recess (145) configured for loading of the instrument (200) by lateral docking.

13. The holder (100) according to any of the previous claims, further comprising a tool rest (1 15) comprising a longitudinal member projecting laterally outwards from the chassis (1 10), configured to support thereon a separate manual tool.

14. A kit comprising:

- a holder (100) for an instrument (200) according to any of the previous claims, and

- the manual tool (250, 260) that is other than the instrument (200) to which the slidable clamp (140) can releasably attach.

15. A medical robot provided with a holder (100) according to any of claims 1 to 13.