This paper deals with the design process adapted to medical robots. The large diversity of kinematic architectures that can be encountered in medical robotics leads us to seek a robust method dedicated to tool-guidance medical robot design. First, we detail a proposed design process adapted especially for handling the inherent needs in tool-guidance in medical robotics. This proposed method ties together the phases of the design process with their respective tools. We describe the spectrum of medical robots and particularly the variety of kinematic architectures used. Each phase of the design process is detailed through application examples in the domains of tele-echography and minimally invasive surgery, which exhibit a number of commonalities. The use of tools for accomplishing the various steps of the design process is detailed, with emphasis on medical gesture analysis. This is followed by topological and dimensional synthesis. This study illustrates how the type of medical robot can impose specific requirements and a particular approach in the design process. We expect through this paper to bring a significant contribution to the design of medical tool-guidance robots and to facilitate their integration in the clinical environment. The main contribution of this work is to propose a design process method for robotic medical tool-guidance manipulators.