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A minimally invasive surgical instrument having an elongate stem extending between a proximal end which in use is located externally of an operating space and a distal end which in use is located within an operating space. At least a portion of the stem is malleable to facilitate manipulation of the

A minimally invasive surgical instrument having an elongate stem extending between a proximal end which in use is located externally of an operating space and a distal end which in use is located within an operating space. At least a portion of the stem is malleable to facilitate manipulation of the stem in the operating space and then to maintain the stem in the manipulated position and/or orientation within the operating space. The instrument has an end effector at the distal end of the stem, the end effector having a proximal main body and distal operating means, such as graspers or cutters. The instrument has at least one joint for independent movement of the end effector main body in at least one direction relative to the distal end of the stem for enhanced degrees of freedom of the instrument.

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1. A surgical instrument, comprising: a handle portion;a stem including a proximal portion coupled to the handle portion, and a distal portion having a bend; andan end effector coupled to a distal end of the bent stem by both a hinge joint and a rotational joint to allow pivoting and rotational move

1. A surgical instrument, comprising: a handle portion;a stem including a proximal portion coupled to the handle portion, and a distal portion having a bend; andan end effector coupled to a distal end of the bent stem by both a hinge joint and a rotational joint to allow pivoting and rotational movement of the end effector relative to the bent stem, the hinge joint and rotational joint being located proximal the end effector,wherein the rotational joint is distal of the hinge joint. 2. The surgical instrument of claim 1, wherein control of the hinge joint, rotational joint, and end effector, is provided at the handle portion. 3. The surgical instrument of claim 2, further comprising an actuator on the handle portion configured to control the hinge joint and the rotational joint. 4. The surgical instrument of claim 3, wherein the actuator includes a control dial configured to control the hinge joint and the rotational joint. 5. The surgical instrument of claim 3, wherein the actuator includes a switch member moveable between a first position for control of the rotational joint and a second position for control of the hinge joint. 6. The surgical instrument of claim 1, wherein the end effector includes a pair of grasping fingers or cutting fingers, and the handle portion affects movement of the grasping fingers or cutting fingers. 7. The surgical instrument of claim 1, wherein the proximal portion of the stem includes a straight portion. 8. The surgical instrument of claim 1, wherein the stem is configured to maintain a plurality of different desired bend orientations. 9. A surgical instrument, comprising: a handle portion;a stem including a proximal portion coupled to the handle portion, and a distal portion having a bend; andan end effector coupled to a distal end of the bent stem,the stem further comprising a hinge joint and a rotational joint being located proximal the end effector, and wherein the hinge joint is separate from the end effector, andwherein the hinge joint is configured to allow pivoting movement of a portion of the stem distal portion containing the rotational joint. 10. The surgical instrument of claim 9, wherein control of the hinge joint, rotational joint, and end effector, is provided at the handle portion. 11. The surgical instrument of claim 10, further comprising an actuator on the handle portion configured to control the hinge joint and the rotational joint. 12. The surgical instrument of claim 11, wherein the actuator includes a control dial configured to control the hinge joint and the rotational joint. 13. The surgical instrument of claim 11, wherein the actuator comprises a switch member moveable between a first position for control of the rotational joint and a second position for control of the hinge joint. 14. The surgical instrument of claim 9, wherein the end effector includes a pair of grasping fingers or cutting fingers. 15. The surgical instrument of claim 9, wherein the proximal portion of the stem includes a straight portion. 16. A surgical instrument, comprising: a handle portion;a stem including a proximal portion coupled to the handle portion, and a distal portion having a bend;an end effector coupled to a distal end of the bent stem;a first hinge joint configured to allow pivoting movement of the stem distal portion proximal the end effector; anda second joint separate from the first hinge joint and configured to allow pivoting movement of the end effector. 17. The surgical instrument of claim 16, further comprising a rotational joint configured to allow rotational movement of the end effector. 18. The surgical instrument of claim 16, further comprising an actuator on the handle portion configured to control the first hinge joint. 19. The surgical instrument of claim 16, wherein the end effector includes a pair of grasping fingers or cutting fingers. 20. The surgical instrument of claim 16, wherein the proximal portion of the stem includes a straight portion.