System for performing a minimally invasive surgical procedure

[0001] Surgical procedures are often used to treat and cure a wide range of diseases, conditions, and injuries. Surgery often requires access to internal tissue through open surgical procedures or endoscopic surgical procedures. The term “endoscopic” refers to all types of minimally invasive surgical procedures including laparoscopic, arthroscopic, natural orifice intraluminal, and natural orifice transluminal procedures. Endoscopic surgery has numerous advantages compared to traditional open surgical procedures, including reduced trauma, faster recovery, reduced risk of infection, and reduced scarring. Endoscopic surgery is often performed with an insufflatory fluid present within the body cavity, such as carbon dioxide or saline, to provide adequate space to perform the intended surgical procedures. The insufflated cavity is generally under pressure and is sometimes referred to as being in a state of pneumoperitoneum. Surgical access devices are often used to facilitate surgical manipulation of internal tissue while maintaining pneumoperitoneum. For example, trocars are often used to provide a port through which endoscopic surgical instruments are passed. Trocars generally have an instrument seal, which prevents the insufflatory fluid from escaping while an instrument is positioned in the trocar.

[0002] Other camera and surgical tool guiding systems have been disclosed. For example, Magnetic anchoring and guidance systems (MAGS) have been developed for use in minimally invasive procedures. MAGS include an internal device attached in some manner to a surgical instrument, or camera or other viewing device, and an external hand held device or external control unit (“ECU”) for controlling the movement of the internal device. Each of the external and internal devices has magnets, which are magnetically coupled to each other across, for example, a patient's abdominal wall. In the current systems, the external magnet may be adjusted by varying the height of the external magnet.

[0003] While surgical access devices are known, no one has previously made or used the surgical devices and methods in accordance with the present invention.

[0015] Numerous specific details are set forth to provide a thorough understanding of the overall structure, function, manufacture, and use of the embodiments as described in the specification and illustrated in the accompanying drawings. It will be understood by those skilled in the art, however, that the embodiments may be practiced without such specific details. In other instances, well-known operations, components, and elements have not been described in detail so as not to obscure the embodiments described in the specification. Those of ordinary skill in the art will understand that the embodiments described and illustrated herein are non-limiting examples, and thus it can be appreciated that the specific structural and functional details disclosed herein may be representative and do not necessarily limit the scope of the embodiments, the scope of which is defined solely by the appended claims.

[0016] Reference throughout the specification to “various embodiments or forms,” “some embodiments or forms,” “one embodiment or form,” or “an embodiment”, or the like, means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment or form. Thus, appearances of the phrases “in various embodiments,” “in some embodiments,” “in one embodiment,” or “in an embodiment”, or the like, in places throughout the specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, the particular features, structures, or characteristics illustrated or described in connection with one embodiment may be combined, in whole or in part, with the features structures, or characteristics of one or more other embodiments without limitation.

[0017] It will be appreciated that the terms “proximal” and “distal” may be used throughout the specification with reference to a clinician manipulating one end of an instrument used to treat a patient. The term “proximal” refers to the portion of the instrument closest to the clinician and the term “distal” refers to the portion located farthest from the clinician. It will be further appreciated that for conciseness and clarity, spatial terms such as “vertical,” “horizontal,” “up,” and “down” may be used herein with respect to the illustrated embodiments. However, surgical instruments may be used in many orientations and positions, and these terms are not intended to be limiting and absolute.

[0018] The term “coupled” is defined as connected, although not necessarily directly, and not necessarily mechanically; two items that are “coupled” may be integral with each other. The terms “a” and “an” are defined as one or more unless this disclosure explicitly requires otherwise.

[0019] The terms “comprise” (and any form of comprise, such as “comprises” and “comprising”), “have” (and any form of have, such as “has” and “having”), “include” (and any form of include, such as “includes” and “including”) and “contain” (and any form of contain, such as “contains” and “containing”) are open-ended linking verbs. As a result, a surgical system, device, or apparatus that “comprises,” “has,” “includes” or “contains” one or more elements possesses those one or more elements, but is not limited to possessing only those one or more elements. Likewise, an element of a system, device, or apparatus that “comprises,” “has,” “includes” or “contains” one or more features possesses those one or more features, but is not limited to possessing only those one or more features.

[0020] As used herein, the term “percutaneous” refers to any medical procedure where access to inner organs or other tissue is done via a puncture of the skin, rather than by using an “open” approach where inner organs or tissue are exposed.

[0021] Referring primarily to FIG. 1, a surgical device 100 is shown in conjunction with a patient 14, and more particularly relative to a longitudinal cross-sectional view of the ventral cavity of the patient. For brevity, cavity 18 is shown in a simplified conceptual form without organs and the like. Cavity 18 is at least partially defined by a wall 22, such as the abdominal wall, that includes an interior surface 26 and an exterior surface 30. The exterior surface 30 of wall 22 can also be an exterior surface of the patient 14.

[0022] Further to the above, although surgical device 100 is depicted relative to ventral cavity 18, surgical device 100 and various other embodiments of the present disclosure can be utilized in other body cavities of a patient, human or animal, such as, for example, the thoracic cavity, the abdominopelvic cavity, the abdominal cavity, the pelvic cavity, and other cavities (e.g., lumens of organs such as the stomach, colon, or bladder of a patient). In some embodiments of the present methods, and when using embodiments or forms of the present devices and systems, a pneumoperitoneum may be created in the cavity of interest to yield a relatively open space within the cavity.

[0023] The surgical device 100 may comprise an in-vivo instrument 138 and a percutaneous member 136. The in-vivo instrument 138 can be inserted or introduced into cavity 18 through an access port (not shown) having a suitable internal diameter. Such access ports include those created using a conventional laparoscopic trocar, gel ports, and those created by incision (e.g., abdominal incision). In-vivo instrument 138 can be pushed through the access port with any elongated instrument such as, for example, a surgical instrument such as a laparoscopic grasper. If the cavity 18 is pressurized, in-vivo instrument 138 can be inserted or introduced into the cavity 18 before or after the cavity is pressurized. The in-vivo instrument 138 may also be inserted into the cavity 18 via an introducer tool. Several types of introducers that may be utilized, for example, are described in U.S. application Ser. No. 13/325,791, entitled INTRODUCER FOR AN INTERNAL MAGNETIC CAMERA, filed Dec. 14, 2011, the entire disclosure of which is incorporated herein by reference.

[0024] Referring to FIG. 2, the in-vivo instrument 138 may include a housing 40 which may include a central longitudinal axis 62 through the length of the housing 40, a body portion 60, shown as generally tubular in shape, a leading head portion 46, and a trailing end portion 48. Housing 40 may include at least one camera and at least one light emitting diode (LED). In the embodiment of housing 40 shown in FIG. 2, there are two LEDs 52 for each of the two cameras 54 and 56 on head portion 46.

[0025] For purposes of orientation, Referring again to FIG. 2, there is a plane P perpendicular to the longitudinal axis 62, between the body portion 60 and the head portion 46 of the housing 40. For purposes of orientation, the orientation of the lens of each of the cameras 54 and 56 is described herein as being directed or directed at angles relative to the axis 62 and plane P.

[0026] Referring still to FIG. 2, the camera 56 may have a lens that is directed at an angle greater than 0° and less than 90° and preferably between 10° to 60°, more preferably between 10° to 45°, measured downwardly, or distally, from the longitudinal axis 62 for viewing tissue under the axis 62 of the housing 40. For example, the angle of the camera 56 lens relative to the central axis 62 is directed between 20° and 40°, and more preferably between about 25° and 35°, and most preferably at or about 30°. The housing 40 may have in addition, a camera 54 having a lens aligned with the axis 62 or with a line parallel to it, at or about 0 degrees along the axis 62 for viewing sites directly in front of the housing 40. Those skilled in the art will appreciate that the cameras 54, 56 as used in the housing 40 may be any known optical viewing systems, such as, without limitation, standard cameras and lights, or fiber optic systems, or CCD systems, for example.

[0027] Referring still to FIG. 2, a tether 50 may extend from the trailing end 48 of the housing 40. The tether 50 may be, for example, an energy tether, such as an insulated electrical wire that extends from the trailing end 48 of the housing 40 for connection with an energy source (not shown). Tether 50 may also carry video images to a video screen outside of the patient. In use, when the housing 40 is deployed in a patient during a minimally invasive surgical or diagnostic procedure, the tether 50 would typically pass through a port (not shown) from the inside to the outside of a patient's body directly, or indirectly through an intermediate instrument, to an energy source or a receiver or processor for receiving video signals from the one or more cameras. Alternatively, the camera may be powered wirelessly or by internal batteries. Furthermore, the camera feed may be transmitted wirelessly to a receiver outside the patient where the signal can be viewed on an external monitor.

[0028] Referring again to FIG. 2, the housing 40 may include a cleaning apparatus to clean a dirty or obstructed lens as needed. A cleaning apparatus that may be utilized is described in U.S. patent application Ser. No. 13/399,358, entitled APPARATUS AND METHODS FOR CLEANING THE LENS OF AN ENDOSCOPE, filed Feb. 17, 2012, the entire disclosure of which is incorporated herein by reference. The cleaning apparatus may comprise a conduit having a lumen through which fluid flows. The conduit may extend through housing 40 and may comprise a distal tip, which may have a delivery port (not shown) such as an opening or a slot through which cleaning fluid may be directed toward camera 54 and/or camera 56.

[0029] Referring primarily to FIG. 1, the percutaneous member 136 may include an elongate body 140 which may have a distal portion 142 insertable into the cavity 18 through the wall 22 and a proximal portion 144 connected to a handle 146. The percutaneous member 136 may be releasably coupled to the in-vivo instrument 138, within the cavity 18, by operating the handle 146 as will be explained in more detail.

[0030] Referring again to FIG. 1, the percutaneous member 136 may be inserted into the cavity 18 by puncturing through wall 22. The elongate body 140 of the percutaneous member 136 may include an external needle with a piercing tip at a distal portion thereof for puncturing the wall 22 into the cavity 18. The elongate body 140 may be slidably disposed in the needle such that the piercing tip may be alternated between exposed and unexposed positions by sliding the elongate body 140 relative to the needle. For example, the piercing tip may be exposed by sliding the elongate body proximally relative to the needle. The piercing tip may then be utilized to puncture wall 22 into cavity 18. Once the distal portion 142 of the elongate body 140 passes into cavity 18, the piercing tip can be unexposed by sliding the elongate body 140 distally beyond the piercing tip thereby avoiding injury to surrounding internal tissue within the cavity 18.

[0031] Referring primarily to FIG. 3, the elongate body 140 of the percutaneous member 136 may include a hollow tubular member 150 and a connector 148 that is slidably movable relative to the hollow tubular member 150. For example, the hollow tubular member 150 may include a lumen that extends therethrough and terminates at an opening 152 at a distal end thereof. In addition, the connector 148 may include an elongate shaft 154 such as, for example, a rod that is at least partially slidably disposed through the lumen of the hollow tubular member 150. Furthermore, the connector 148 may comprise an enlarged portion 156 at a distal end of the elongate shaft 154, as illustrated in FIG. 3.

[0032] Under certain circumstances, the enlarged portion 156 can be sized and shaped such that it cannot pass through the opening 152 of the hollow tubular member 150 when the connector 148 is slidably retracted relative to the hollow tubular member 150. In other words, the connector 148 may be retracted relative to the hollow tubular member 148 until the enlarged portion 156 is abutted against a distal end of the hollow tubular member 150. In one example, as illustrated in FIG. 3, the elongate shaft 154 may comprise a cylindrical, or substantially cylindrical, shape having a first diameter that is sized to allow the elongate shaft 154 to be slidably movable relative to the hollow tubular member 150. In addition, the enlarged portion 156 may comprise a spherical, or substantially spherical, shape that has a second diameter that is greater than the first diameter of the elongate shaft 154, such that the enlarged portion 156 is unable to be retracted through the opening 152 of the hollow tubular member 150.

[0033] Referring primarily to FIG. 2, the in-vivo instrument 138 may comprise a connection portion 158, which may include a track 160 that is, for example, substantially parallel to the axis 62 on a lateral section of body portion 60 of the in-vivo instrument 138. The track 160 may include an opening 162 at a distal portion thereof for entry into the track 160. The opening 162 may be sized to receive the enlarged portion 156 of the connector 148.

[0034] Further to the above, referring to FIGS. 3-5, the enlarged portion 156 of the connector 148 may be operatively coupled to the track 160 through complementary contours, for example. A first contour of enlarged portion 156 can have a substantially matching shape to a second contour of track 160, such that the enlarged portion 156 may be inserted into and slid within track 160. For example, as illustrated in FIG. 4, the track 160 may comprise a generally “C-shaped” channel body that defines a semicircular channel when viewed in cross section. The channel body can include floor 164, upstanding sidewalls 166, and inwardly extending prongs 168. As described above, the enlarged portion 156 may have a spherical shape disposed at a distal end of the elongate shaft 154, which may have a cylindrical shape with a smaller diameter than the diameter of the enlarged portion 156. The enlarged portion 156 can be brought into sliding engagement with the C-shaped channel of the track 160 by inserting the enlarged portion 156 into the opening 162 of the track 160 while allowing the elongate shaft 154 to pass between prongs 168, as illustrated in FIG. 5. Once the enlarged portion 156 is received in the track 160, the in-vivo instrument 138 can be secured onto the percutaneous member 136 by retracting the elongate shaft 154 relative to the hollow tubular member 150 until the housing 40 of the in-vivo instrument 138 is abutted against the distal end of the hollow tubular member 150 to thereby lock a corresponding portion of the housing 40 between the enlarged portion 156 and the distal end of the hollow tubular member 150. Alternatively, the hollow tubular member 150 can be extended relative to the elongate shaft 154 until the in-vivo instrument 138 is abutted against the distal end of the hollow tubular member 150.

[0035] Referring primarily to FIG. 1, the handle 146 of the percutaneous member 136 may include a trigger 145 for retracting and/or extending the connector 148 relative to the hollow tubular member 150. A trigger lock 147 can be configured to selectively lock/unlock the trigger 145. For example, the trigger 145 of the handle 146 can be coupled to the elongate shaft 154 such that an operator may retract the elongate shaft 154 relative to the hollow tubular member 150 by moving the trigger 145. For example, the elongate shaft 154 can be retracted relative to the hollow tubular member 150 until the in-vivo instrument 138 is abutted against the distal end of the hollow tubular member 150. The operator may then lock the trigger 145 by pressing the trigger lock 147.

[0036] Further to the above, referring again to FIGS. 3-5, the connector 148 can be selectively locked to the in-vivo instrument 138 at a plurality of positions along a length of the track 160. For example, the connector 148 can be locked at a first position along the track 160 by guiding the enlarged portion 156 into the track 160, as described above, and advancing the enlarged portion 156 through the track 160 until the enlarged portion 156 reaches a desired first position. To lock connector 148 in the first position, the trigger 145 can be moved to retract the elongate shaft 154 relative to the hollow tubular member 150 until the in-vivo instrument 138 is abutted against the distal end of the hollow tubular member 150. The trigger lock 147 can then be pressed to lock the trigger 145 to prevent further movement of the connector 148 relative to the housing 40 of the in-vivo instrument 138.

[0037] To transition the enlarged portion 156 from the first position to another desired position or a “second” position along track 160, the trigger 145 may be unlocked by repressing the trigger lock 147. The trigger 145 may then be moved to advance the elongate shaft 154 relative to the hollow tubular member 150 thereby loosening the enlarged portion 156 in the track 160. The enlarged portion 156 can then be slidably moved to the second position, for example, by pushing the in-vivo instrument 138 against surrounding tissue of the patient. Upon reaching the second position, the trigger 145 can be moved again to retract the elongate shaft 154 relative to the hollow tubular member 150 to lock another corresponding portion of the housing 40 between the enlarged portion 156 and the distal end of the hollow tubular member 150. The trigger lock 147 can then be pressed to relock the trigger 145 to prevent further movement of the connector 148 relative to the housing 40 of the in-vivo instrument 138.

[0038] Referring to FIG. 3, the enlarged portion 156 can be selectively locked, for example, in a partially extended position (on the left) or in a partially retracted position (on the right). The elongate shaft 154 can be advanced or retracted relative to the hollow tubular member 150 by moving trigger 145 until a desired position is reached. The trigger lock 147 can then be pressed to lock the enlarged portion 156 in the desired position. The handle 146 may include visual indicators that may aid an operator in determining the position of the enlarged portion 156 relative to a distal end of the hollow tubular member 150, for example.

[0039] In various forms, one or both of track 160 and enlarged portion 156 can be made from a low friction, plastic material, such as polyethylene, Teflon®, or polypropylene to provide a low coefficient of friction between the members as they slide relative to one another. Furthermore, it will be understood that the track 160 and the enlarged portion 156 may be provided in various shapes and configurations that are complementary to the shape of track 160 to facilitate selective movement of the enlarged portion 156 and the locking of the connector 148 to the housing 40 when the connector 148 has been moved to the desired position.

[0040] Referring again to FIGS. 1 and 2, the connector 148 of the percutaneous member 136 can be coupled with the connection portion 158 of the in-vivo instrument 138 inside cavity 18. In some instances, to minimize the number of access ports in the wall 22, an operator may need to rely on the cameras 54 and 56 of the in-vivo instrument 138 to facilitate coupling of the connector 148 to the connection portion 158. For example, the camera 56 may be positioned adjacent the opening 162 of the track 160, as illustrated in FIG. 2, to allow the operator to view the approach of connector 148 and its subsequent coupling with the track 160. Relying on cameras 54 and/or 56 to couple the in-vivo instrument 138 to the percutaneous member 136 may result in the ability to reduce the number of access ports in the wall 22.

[0041] Referring now to FIG. 6, a surgical system 200 for surgical procedures is shown in conjunction with a patient, and more particularly relative to a longitudinal cross-sectional view of the ventral cavity of the patient. As described above, the cavity 18 is shown in simplified conceptual form without organs and the like. Furthermore, the cavity 18 is at least partially defined by wall 22. The exterior surface of wall 22 can also be an exterior surface of the patient.

[0042] Referring primarily to FIG. 6, the surgical system 200, in at least one form, comprises an ex-vivo positioning mechanism 234, an in-vivo instrument 238, and a percutaneous member 136. The ex-vivo positioning mechanism 234 is configured to magnetically position in-vivo instrument 238 within the cavity 18. As illustrated in FIG. 6, the ex-vivo positioning mechanism 234 can be positioned outside the cavity 18 near, adjacent to, and/or in contact with the exterior surface of the wall 22.

[0043] Referring Primarily to FIGS. 6A and 7, the in-vivo instrument 238 is substantially similar in many respects to the in-vivo instrument 138. The in-vivo instrument 238 can be introduced into the cavity 18 via an introducer 270, as illustrated in FIG. 6. Several types of introducers that may be utilized, for example, are described in U.S. application Ser. No. 13/325,791, entitled INTRODUCER FOR AN INTERNAL MAGNETIC CAMERA, filed Dec. 14, 2011, the entire disclosure of which is incorporated herein by reference. Furthermore, the in-vivo instrument 238 is positionable (can be positioned), and is shown positioned, within the cavity 18 and near, adjacent to, and/or in contact with the interior surface of wall 22, as illustrated in FIG. 7.

[0044] Referring again to FIG. 6A, the in-vivo instrument 238 may be magnetically couplable to the ex-vivo positioning mechanism 234. For example, ex-vivo positioning mechanism 234 can comprise one or more magnets (e.g., permanent magnets, electromagnets, or the like) and in-vivo instrument 238 can comprise a ferromagnetic material. Alternatively, ex-vivo positioning mechanism 234 can comprise one or more magnets, and in-vivo instrument 238 can comprise a ferromagnetic material, such that ex-vivo positioning mechanism 234 attracts in-vivo instrument 238 and in-vivo instrument 238 is attracted to ex-vivo positioning mechanism 234. In yet another example, both ex-vivo positioning mechanism 234 and in-vivo instrument 238 can comprise one or more magnets such that ex-vivo positioning mechanism 234 and in-vivo instrument 238 attract each other. In the example illustrated in FIG. 7, the ex-vivo positioning mechanism comprises magnets 235 and 237, and the in-vivo instrument 238 comprises magnets 239 and 241 which are attracted to magnets 235 and 237, respectively.

[0045] Further to the above, the ex-vivo positioning mechanism 234, the in-vivo instrument 238, or both may comprise a sensing mechanism to measure the magnitude of the magnetic force that the ex-vivo positioning mechanism 234 exerts on in-vivo instrument 238 or vice versa. Ex-vivo positioning mechanism 234, in-vivo instrument 238, or both may be further configured to modulate the strength of the magnetic field therebetween as described in U.S. patent application Ser. No. 12/783,449 filed on May 19, 2010, now U.S. Patent Publication No. US 2011/0285488, entitled MAGNETIC THROTTLING AND CONTROL: MAGNETIC CONTROL, the entire disclosure of which is incorporated herein by reference.

[0046] Referring primarily to FIGS. 6-7, an operator of the surgical system 200 may introduce the in-vivo instrument 238 into the cavity 18 through an access port in the wall 22, for example, by using the introducer 270. The operator may then magnetically engage the ex-vivo positioning system 234 with the in-vivo instrument 238 through the wall 22, as illustrated in FIG. 8. In addition, the operator may use the ex-vivo positioning mechanism 234 to navigate the in-vivo instrument 234 within cavity 18, for example, to view surrounding tissue via the camera 54 and/or camera 56.

[0047] Referring now to FIGS. 8 and 9, during the surgical procedure, the operator may choose to navigate another instrument using the ex-vivo positioning mechanism 234. In such a case, the operator may choose to separate the in-vivo instrument 238 from its magnetic coupling to the ex-vivo positioning mechanism 234 and to couple the in-vivo instrument 238 to the percutaneous member 136 in order to free the ex-vivo positioning mechanism 234 for the other instrument. The operator may navigate the ex-vivo positioning mechanism 234 to view another portion of wall 22 via the camera 54, for example, and pierce through that portion of the wall 22 using the needle of the percutaneous member 136. Furthermore, the operator may extend the distal portion 142 of the elongate body 140 into the cavity 18 in view of camera 54, for example. To separate the in-vivo instrument 238 from magnetic coupling with the ex-vivo positioning mechanism 234, the operator may couple the in-vivo instrument 238 to connector 148, as described above, and move the in-vivo instrument 234 in a direction away from the ex-vivo positioning mechanism 234 in order to overcome the attractive forces therebetween. In addition, the operator may selectively lock the connector 148 to the in-vivo instrument 238 by, for example, retracting the elongate shaft 152 relative to the hollow tubular member 150 until the in-vivo instrument 138 is abutted against the distal end of the hollow tubular member 150. The ex-vivo positioning mechanism can then be removed, as illustrated in FIG. 9, or magnetically coupled to the other instrument.

[0048] The reader will appreciate that the in-vivo instrument 238 can be toggled within the cavity 18 between being coupled to the ex-vivo positioning mechanism 234 and being coupled to the percutaneous member 138. For example, the in-vivo instrument 238 can be re-coupled to the ex-vivo positioning mechanism 234 by, for example, moving the in-vivo instrument 238 sufficiently close to re-established magnetic coupling with the ex-vivo positioning mechanism 234. The connector 148 can then be released from its locked position, for example, by advancing the elongate shaft 154 relative to the hollow tubular member 152. The enlarged portion 156 can then be retracted from the track 160 through the opening 162 thereby releasing the in-vivo instrument 238 from the coupling engagement with the percutaneous member 136.

[0049] The toggling of the in-vivo instrument 238 between the ex-vivo positioning mechanism 234 and the percutaneous member 138 may give the surgical operator freedom to view the surgical site from different angles. For example, a surgical operator performing a surgical procedure such as, for example, removing a gall bladder may elect to transition the in-vivo instrument 238 from the ex-vivo positioning mechanism 234 to the percutaneous member 236 to introduce, for example, grasper into the surgical site via the ex-vivo positioning mechanism.

[0050] The reader will appreciate that the in-vivo instrument 238 may include surgical end effectors other than or in addition to a camera. For example, in-vivo surgical instrument 238 may include a grasper, a harmonic blade, and/or a surgical stapler. Other surgical end effectors are also contemplated within the scope of the present disclosure.

[0051] A surgical device comprises a percutaneous member which comprises an elongate body including a first distal end portion configured for insertion into a body cavity and a connector at the distal end portion of the elongate body, wherein the connector is selectively movable relative to the distal end portion between locked and unlocked orientations. In addition, the surgical device comprises an in-vivo instrument configured for use within the body cavity, wherein the in-vivo instrument defines a longitudinal axis, wherein the connector is selectively coupled to the in-vivo instrument, and wherein the connector is selectively lockable to the in-vivo instrument at multiple positions along the longitudinal axis.

[0052] A surgical system comprises an ex-vivo positioning mechanism, an in-vivo instrument magnetically attracted to the ex-vivo positioning mechanism, whereby the in-vivo instrument can be positioned within a patient by moving the ex-vivo positioning mechanism, and a percutaneous member introducible into the patient independent from the ex-vivo positioning mechanism, the percutaneous member comprising a connector at a distal portion thereof, wherein the connector is selectively couplable to the in-vivo instrument within the patient.

[0053] A surgical method comprises passing a camera into a body cavity through an incision in a first portion of a body wall, the camera comprising a lens and a connection portion, magnetically coupling the camera to an ex-vivo positioning mechanism, positioning the camera in the body cavity by operating the ex-vivo positioning mechanism, operating the camera to visualize the body cavity on an external monitor, directing the camera lens toward a second portion of the body wall, passing a distal portion of a percutaneous member into the body cavity through the second portion of the body wall, guiding a connector at the distal portion of the percutaneous member toward the connection portion of the camera, and coupling the connector with the connection portion of the camera.

[0054] Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated materials does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.

[0055] While this invention has been described as having exemplary designs, the present invention may be further modified within the spirit and scope of the disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the invention using its general principles. Further, this application is intended to cover such departures from the present disclosure as come within known or customary practice in the art to which this invention pertains.