MINIMALLY INVASIVE SURGICAL APPARATUS WITH SIDE EXIT INSTRUMENTS

1 . A surgical instrument assembly comprising:

a secondary guide tube having at least two side exit ports;

a first primary guide tube that extends through the secondary guide tube and exits via a first one of the side exit ports;

a second primary guide tube that extends through the secondary guide tube and exits via a second one of the side exit ports;

a first surgical instrument that extends through and exits a distal end of the first primary guide tube; and

a second surgical instrument that extends through and exits a distal end of the second primary guide tube.

2 . The assembly of claim 1:

wherein the first side exit port is directly opposite the second side exit port.

3 . (canceled)

4 . The assembly of claim 1:

wherein the first primary guide tube comprises a bend sensor.

5 . (canceled)

6 . The assembly of claim 1:

wherein the first instrument comprises a bend sensor.

7 . The assembly of claim 1:

wherein at least a portion of the first primary guide tube that extends from the first one of the side exit ports comprises an actively controllable flexible segment.

8 . The assembly of claim 7:

wherein the actively controllable flexible segment of the first primary guide tube is the most distal segment of the first primary guide tube; and

wherein the actively controllable flexible segment of the first primary guide tube moves an end effector of the first surgical instrument.

9 . The assembly of claim 1:

wherein the first surgical instrument can be removed and replaced with a third surgical instrument during a surgical procedure.

10 . The assembly of claim 1:

wherein the first primary guide tube can be removed and replaced with a third primary guide tube during a surgical procedure.

11 . The assembly of claim 1 , further comprising:

a third surgical instrument that extends through and exits the distal end of the secondary guide tube.

12 . (canceled)

13 . The assembly of claim 1:

wherein the secondary guide tube comprises an actively controllable flexible portion.

14 . The assembly of claim 1:

wherein the secondary guide tube comprises an actively controllable retroflexive portion.

15 . The assembly of claim 1:

wherein the retroflexive portion retroflexes in a pitch degree of freedom, in a yaw degree of freedom, or in both pitch and yaw degrees of freedom.

16 . The assembly of claim 1:

wherein a portion of the secondary guide tube between the side exit ports and the distal end is flexible; and

wherein the portion of the secondary guide tube between the side exit ports and the distal end is movable while the positions of the side exit ports remain unchanged.

17 . The assembly of claim 1:

wherein a cross sectional shape of the secondary guide tube comprises an oblong shape;

wherein the first primary guide tube extends through a first end of the oblong shape; and

wherein the second primary guide tube extends through a second end of the oblong shape.

18 . The assembly of claim 1 , further comprising:

a telemanipulative control system that controls movement of the secondary guide tube, the first and second primary guide tubes, and the first and second surgical instruments.

19 . (canceled)

20 . A method comprising:

extending a first primary guide tube through a first side exit port in a secondary guide tube;

extending a second primary guide tube through a second side exit port in the secondary guide tube;

extending a first surgical instrument through the first primary guide tube;

extending a second surgical instrument through the second primary guide tube; and

positioning a distal end of the first surgical instrument and a distal end of the second surgical instruments in a field of view of a stereoscopic image capture component.

21 . The method of claim 20 , further comprising:

automatically extending a distal end of the first primary guide tube into the field of view of the image capture component as the first primary guide tube is extended from the first side exit port.

22 . The method of claim 20 , further comprising:

replacing the first primary guide tube with a third primary guide tube during a surgical procedure; and

positioning a distal end of the third primary guide tube within the field of view of the image capture component.

23 . The method of claim 20 , further comprising:

extending a third surgical instrument through an exit port at the distal end of the guide tube.

24 . The method of claim 20 , further comprising:

retroflexing the secondary guide tube.

25 . The method of claim 20 , further comprising:

retroflexing the secondary guide tube in a pitch degree of freedom, in a yaw degree of freedom, or in both Ditch and yaw degrees of freedom.

26 . The method of claim 20 , further comprising:

moving a segment of the secondary guide tube that is between the side exit ports and the distal end of the secondary guide tube while the side exit ports remain stationary.

27 . The method of claim 20 , further comprising:

telemanipulatively controlling the secondary guide tube, the first primary guide tube, the secondary guide tube, the first surgical instrument, and the second surgical instrument.

28 . A method comprising:

automatically guiding a distal portion of a primary guide tube as the distal portion extends through a side exit port of a secondary guide tube so that a distal end of the primary guide tube is automatically moved into a field of view of an endoscopic vision system; and

inserting a surgical instrument through the extended primary guide tube so that a distal end of the surgical instrument is within the field of view of the endoscopic vision system.

29 . The method of claim 28 further comprising:

moving the distal portion of the primary guide tube so as to apply a working force by the distal end of the surgical instrument against tissue.