Automatic tool adjustment for robot-assisted surgical platforms

Abstract

The present invention provides a robotic surgical system, the robotic surgical system comprising: a control unit; a robot, the robot comprising a tool mount; a tool comprising an energy delivery surface, wherein the tool is releasably mounted to the tool mount; and a sensor system, the sensor system being configured to detect at least one condition at a surgical site. The control unit comprises a processor and a memory communicatively coupled to the processor. The sensor system is in signal communication with the processor. The memory stores instructions executable by the processor to determine use of the tool based on input from the sensor system, and automatically energize the energy delivery surface when the use is determined.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This patent application claims the benefit of priority under 35 U.S.C. 119(e) to U.S. Provisional Patent Application Serial No. 62 / 649,307, filed on March 28, 2018, entitled “AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS,” the disclosure of which is incorporated herein by reference in its entirety.

[0003] This patent application also claims the benefit of priority, pursuant to 35 U.S.C. § 119(e), to U.S. Provisional Patent Application Serial No. 62 / 611,341, filed on December 28, 2017, entitled “INTERACTIVE SURGICAL PLATFORM,” U.S. Provisional Patent Application Serial No. 62 / 611,340, filed on December 28, 2017, entitled “CLOUD-BASEDMEDICAL ANALYTICS,” and U.S. Provisional Patent Application Serial No. 62 / 611,339, filed on December 28, 2017, entitled “ROBOT ASSISTED SURGICAL PLATFORM,” the disclosure of each of which is incorporated herein by reference in its entirety. Background Art

[0004] The present disclosure relates to a robotic surgical system. The robotic surgical system may include a central control unit, a surgeon's command console, and a robot having one or more robotic arms. The robotic surgical tools may be releasably mounted to the robotic arms. The number and type of robotic surgical tools may depend on the type of surgical procedure. The robotic surgical system may be used in conjunction with one or more displays and / or one or more handheld surgical instruments during a surgical procedure. Summary of the invention

[0005] In one general aspect, a robotic surgical system is provided. The robotic surgical system includes: a control unit; a robot including a tool mount; a tool including an energy delivery surface, wherein the tool is releasably mounted to the tool mount. The robotic surgical system also includes a sensor system configured to detect at least one condition at a surgical site. The control unit includes a processor and a memory communicatively coupled to the processor. The sensor system is in signal communication with the processor. The memory stores instructions executable by the processor to determine use of the tool based on input from the sensor system, and automatically energize the energy delivery surface when the use is determined.

[0006] In another general aspect, a robotic surgical system is provided. The robotic surgical system includes: a control unit; a robot including a tool mount; and a tool including an energy delivery surface, wherein the tool is releasably mounted to the tool mount. The robotic surgical system also includes a sensor system configured to detect at least one condition at a surgical site. The sensor system is in signal communication with the control unit. The control unit is configured to determine use of the tool based on input from the sensor system, and automatically energize the energy delivery surface upon determining the use.

[0007] In yet another general aspect, a non-transitory computer-readable medium is provided that stores instructions that, when executed, cause a machine to determine usage of a surgical tool based on input from a sensor system and, when usage is determined, automatically energize an energy delivery surface of the surgical tool. BRIEF DESCRIPTION OF THE DRAWINGS

[0008] The features of the various aspects are particularly described in the appended claims. However, the various aspects (relating to surgical organizations and methods) and further objects and advantages thereof may best be understood by reference to the following description taken in conjunction with the following drawings.

[0009] Figure 1 is a block diagram of a computer-implemented interactive surgical system according to at least one aspect of the present disclosure.

[0010] Figure 2 A surgical system for performing surgical procedures in an operating room according to at least one aspect of the present disclosure.

[0011] Figure 3 A surgical hub is paired with a visualization system, a robotic system, and a smart instrument according to at least one aspect of the present disclosure.

[0012] Figure 4A partial perspective view of a surgical hub housing and a combination generator module slidably received in a drawer of the surgical hub housing according to at least one aspect of the present disclosure.

[0013] Figure 5 is a perspective view of a combination generator module having bipolar, ultrasonic and monopolar contacts and smoke evacuation components according to at least one aspect of the present disclosure.

[0014] Figure 6 A single power bus attachment for multiple lateral docking ports of a lateral modular housing configured to accommodate a plurality of modules is shown in accordance with at least one aspect of the present disclosure.

[0015] Figure 7 A vertical modular housing configured to house a plurality of modules according to at least one aspect of the present disclosure is shown.

[0016] Figure 8 A surgical data network including a modular communication hub configured to connect modular devices located in one or more operating rooms of a medical facility or any room in a medical facility dedicated to surgical procedures to a cloud is shown in accordance with at least one aspect of the present disclosure.

[0017] Fig. 9 A computer-implemented interactive surgical system according to at least one aspect of the present disclosure.

[0018] Fig.10 A surgical hub comprising multiple modules coupled to a modular control tower is shown in accordance with at least one aspect of the present disclosure.

[0019] Fig.11 An aspect of a universal serial bus (USB) hub device in accordance with at least one aspect of the present disclosure is shown.

[0020] Fig.12 A logic diagram of a control system for a surgical instrument or tool according to at least one aspect of the present disclosure is shown.

[0021] Fig.13 Control circuitry configured to control various aspects of a surgical instrument or tool in accordance with at least one aspect of the present disclosure is shown.

[0022] Fig.14 Combinatorial logic circuits configured to control various aspects of a surgical instrument or tool in accordance with at least one aspect of the present disclosure are shown.

[0023] Fig.15 A sequential logic circuit configured to control various aspects of a surgical instrument or tool according to at least one aspect of the present disclosure is shown.

[0024] Fig.16 A surgical instrument or tool including multiple motors that can be activated to perform various functions in accordance with at least one aspect of the present disclosure is shown.

[0025] Fig.17 is a schematic diagram of a robotic surgical instrument configured to operate the surgical tools described herein according to at least one aspect of the present disclosure.

[0026] Fig.18 A block diagram of a surgical instrument programmed to control distal translation of a displacement member in accordance with at least one aspect of the present disclosure is shown.

[0027] Fig.19 is a schematic diagram of a surgical instrument configured to control various functions according to at least one aspect of the present disclosure.

[0028] Fig. 20 is a simplified block diagram of a generator configured to provide, among other benefits, inductorless tuning in accordance with at least one aspect of the present disclosure.

[0029] Fig.21 An example of a generator according to at least one aspect of the present disclosure is shown. Fig. 20 A form of generator.

[0030] Fig. 22 is a schematic diagram of a robotic surgical system according to one aspect of the present disclosure.

[0031] Fig.23 is a schematic diagram of a robotic surgical system according to at least one aspect of the present disclosure.

[0032] Fig.24 According to at least one aspect of the present disclosure Fig.23 Block diagram of the control components of a robotic surgical system.

[0033] Fig.25A is a front view of an ultrasonic surgical tool positioned out of contact with tissue according to at least one aspect of the present disclosure.

[0034] Fig.25B A device according to at least one aspect of the present disclosure positioned in abutting contact with tissue Fig.25A Front view of an ultrasonic surgical tool.

[0035] Fig.26A is a front view of a monopolar cautery pencil positioned out of contact with tissue according to at least one aspect of the present disclosure.

[0036] Fig.26B A device according to at least one aspect of the present disclosure positioned in abutting contact with tissue Fig.26A Front view of the monopolar cautery pencil.

[0037] Fig. 27 According to at least one aspect of the present disclosure Fig.25A and Fig.25B Graphical display of continuity and current of ultrasonic surgical tools over time.

[0038] Fig.28 An end effector including a radio frequency (RF) data sensor located on a jaw member is shown in accordance with at least one aspect of the present disclosure.

[0039] Fig.29 According to at least one aspect of the present disclosure, Fig.28 The sensor shown is mounted on a flexible circuit or formed integrally with a flexible circuit.

[0040] Fig.30 A flow chart depicting an automatic activation mode of a surgical instrument according to at least one aspect of the present disclosure.

[0041] Fig.31 is a perspective view of an end effector of a bipolar radiofrequency (RF) surgical tool having a smoke evacuation pump for use with a robotic surgical system, depicting the surgical tool gripping and manipulating tissue, in accordance with at least one aspect of the present disclosure.

[0042] Fig.32 1 is a block diagram of a surgical system including a robotic surgical system, a handheld surgical instrument, and a surgical hub according to at least one aspect of the present disclosure.

[0043] Fig.33 is a perspective view of a handle portion of a handheld surgical instrument including a display according to at least one aspect of the present disclosure, and further depicts a detailed view of the display depicting information from the instrument itself.

[0044] Fig.34 According to at least one aspect of the present disclosure Fig.33 A perspective view of the handle portion of a handheld surgical instrument depicting the instrument paired with a surgical hub and also includes a detailed view of a display depicting information from the surgical hub.

[0045] Fig.35 is a schematic diagram of a colon resection procedure according to at least one aspect of the present disclosure.

[0046] Fig.36 According to at least one aspect of the present disclosure, Fig.35 Graphical display of forces over time for a colon resection procedure on an instrument display.

[0047] Fig.37 is a schematic diagram of a robotic surgical system during a surgical procedure according to at least one aspect of the present disclosure, the robotic surgical system including a plurality of hubs and an interactive auxiliary display.

[0048] Fig.38 According to at least one aspect of the present disclosure Fig.37 Detailed view of the interactive auxiliary display.

[0049] Fig.39 is a block diagram of a robotic surgical system including more than one robotic arm according to at least one aspect of the present disclosure.

[0050] Fig.40 For use according to at least one aspect of the present disclosure Fig.39 Schematic illustration of a surgical procedure with a robotic surgical system.

[0051] Fig.41 According to at least one aspect of the present disclosure, Fig.39 A graphical representation of the forces and position displacements experienced by the robotic arm.

[0052] Fig.42 A flow chart depicting an algorithm for controlling the position of a robotic arm of a robotic surgical system according to at least one aspect of the present disclosure.

[0053] Fig.43 A flow chart depicting an algorithm for controlling forces applied by a robotic arm of a robotic surgical system in accordance with at least one aspect of the present disclosure.

[0054] Fig.44 A flow chart depicting an algorithm for monitoring position and force applied by a robotic arm of a robotic surgical system in accordance with at least one aspect of the present disclosure.

[0055] Fig.45 1 is a block diagram of a surgical system including a robotic surgical system, a powered handheld surgical instrument, and a surgical hub according to at least one aspect of the present disclosure.

[0056] Fig.46 is a perspective view of a robotic tool and a handheld surgical instrument during a surgical procedure according to at least one aspect of the present disclosure.

[0057] Fig.47 A schematic diagram depicting a communication link between a surgical hub and a host server according to at least one aspect of the present disclosure.

[0058] Fig.48 To describe at least one aspect of the present disclosure, Fig.47 Flowchart of the queues for external outputs of data received by each surgical hub.

[0059] Fig.49 A timeline depicting situational awareness of a surgical hub according to one aspect of the present disclosure. DETAILED DESCRIPTION

[0060] The applicant of the present application owns the following U.S. provisional patent applications filed on March 28, 2018, each of which is incorporated herein by reference in its entirety:

[0061] U.S. Provisional Patent Application Serial No. 62 / 649,302, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES;

[0062] U.S. Provisional Patent Application Serial No. 62 / 649,294, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD;

[0063] U.S. Patent Application Serial No. 62 / 649,300, entitled SURGICALHUB SITUATIONAL AWARENESS;

[0064] U.S. Provisional Patent Application Serial No. 62 / 649,309, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES INOPERATING THEATER;

[0065] U.S. Patent Application Serial No. 62 / 649,310, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;

[0066] U.S. Provisional Patent Application Serial No. 62 / 649,291, entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT;

[0067] U.S. Patent Application Serial No. 62 / 649,296, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES;

[0068] U.S. Provisional Patent Application Serial No. 62 / 649,333, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER;

[0069] U.S. Provisional Patent Application Serial No. 62 / 649,327, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES;

[0070] U.S. Provisional Patent Application Serial No. 62 / 649,315, entitled DATA HANDLING AND PRIORITIZATION IN ACLOUD ANALYTICS NETWORK;

[0071] U.S. Patent Application Serial No. 62 / 649,313, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES;

[0072] U.S. Provisional Patent Application Serial No. 62 / 649,320, entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;

[0073] U.S. Provisional Patent Application Serial No. 62 / 649,307, entitled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and

[0074] • U.S. Provisional Patent Application Serial No. 62 / 649,323, entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.

[0075] The applicant of the present patent application owns the following U.S. patent applications filed on March 29, 2018, each of which is incorporated herein by reference in its entirety:

[0076] U.S. Patent Application Serial No. ____________, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES; Attorney Docket No. END8499USNP / 170766;

[0077] U.S. Patent Application Serial No. ____________, entitled INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICES AND DATA CAPABILITIES; Attorney Docket No. END8499USNP1 / 170766-1;

[0078] U.S. Patent Application Serial No. ____________, entitled SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATINGROOM DEVICES; Attorney Docket No. END8499USNP2 / 170766-2;

[0079] U.S. Patent Application Serial No. ____________, entitled SPATIAL AWARENESS OF SURGICAL HUBS IN OPERATING ROOMS; Attorney Docket No. END8499USNP3 / 170766-3;

[0080] U.S. Patent Application Serial No. ____________, entitled COOPERATIVE UTILISATION OF DATA DERIVED FROM SECONDARY SOURCES BY INTELLIGENT SURGICAL HUBS; Attorney Docket No. END8499USNP4 / 170766-4;

[0081] U.S. Patent Application Serial No. ____________, entitled SURGICAL HUB CONTROL ARRANGEMENTS; Attorney Docket No. END8499USNP5 / 170766-5;

[0082] U.S. Patent Application Serial No. ____________, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD; Attorney Docket No. END8500USNP / 170767;

[0083] U.S. Patent Application Serial No. ____________, entitled COMMUNICATION HUB AND STORAGE DEVICE FOR STORING PARAMETERS AND STATUS OF A SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED ANALYTICS SYSTEMS; Attorney Docket No. END8500USNP1 / 170767-1;

[0084] U.S. Patent Application Serial No. ____________, entitled SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT; Attorney Docket No. END8500USNP2 / 170767-2;

[0085] U.S. Patent Application Serial No. ____________, entitled DATA PAIRING TO INTERCONNECT ADEVICE MEASURED PARAMETER WITH AN OUTCOME; Attorney Docket No. END8500USNP3 / 170767-3;

[0086] U.S. Patent Application Serial No. ____________, entitled SURGICALHUB SITUATIONAL AWARENESS; Attorney Docket No. END8501USNP / 170768;

[0087] U.S. Patent Application Serial No. ____________, entitled SURGICAL SYSTEM DISTRIBUTED PROCESSING; Attorney Docket No. END8501USNP1 / 170768-1;

[0088] U.S. Patent Application Serial No. ____________, entitled AGGREGATION AND REPORTING OF SURGICAL HUB DATA; Attorney Docket No. END8501USNP2 / 170768-2;

[0089] U.S. Patent Application Serial No. ____________, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES INOPERATING THEATER; Attorney Docket No. END8502USNP / 170769;

[0090] U.S. Patent Application Serial No. ____________, entitled DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE; Attorney Docket No. END8502USNP1 / 170769-1;

[0091] U.S. Patent Application Serial No. ____________, entitled STERILEFIELD INTERACTIVE CONTROL DISPLAYS; Attorney Docket No. END8502USNP2 / 170769-2;

[0092] U.S. Patent Application Serial No. ____________, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS; Attorney Docket No. END8503USNP / 170770;

[0093] U.S. Patent Application Serial No. ____________, entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT; Attorney Docket No. END8504USNP / 170771;

[0094] U.S. Patent Application Serial No. ____________, entitled CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY; Attorney Docket No. END8504USNP1 / 170771-1; and

[0095] U.S. Patent Application Serial No. ____________, entitled DUAL CMOS ARRAY IMAGING; Attorney Docket No. END8504USNP2 / 170771-2.

[0096] The applicant of the present patent application owns the following U.S. patent applications filed on March 29, 2018, each of which is incorporated herein by reference in its entirety:

[0097] U.S. Patent Application Serial No. ____________, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES; Attorney Docket No. END8506USNP / 170773;

[0098] U.S. Patent Application Serial No. ____________, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS; Attorney Docket No. END8506USNP1 / 170773-1;

[0099] U.S. Patent Application Serial No. ____________, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER; Attorney Docket No. END8507USNP / 170774;

[0100] U.S. Patent Application Serial No. ____________, entitled CLOUD-BASED MEDICAL ANALYTICS FOR LINKING OF LOCAL USAGE TRENDS WITH THE RESOURCE ACQUISITION BEHAVIORS OF LARGER DATA SET; Attorney Docket No. END8507USNP1 / 170774-1;

[0101] U.S. Patent Application Serial No. ____________, entitled CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTED INDIVIDUALIZATION OF INSTRUMENT FUNCTION; Attorney Docket No. END8507USNP2 / 170774-2;

[0102] U.S. Patent Application Serial No. ____________, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES; Attorney Docket No. END8508USNP / 170775;

[0103] U.S. Patent Application Serial No. ____________, entitled DATA HANDLING AND PRIORITIZATION IN ACLOUD ANALYTICS NETWORK; Attorney Docket No. END8509USNP / 170776; and

[0104] U.S. Patent Application Serial No. ____________, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES; Attorney Docket No. END8510USNP / 170777.

[0105] The applicant of the present patent application owns the following U.S. patent applications filed on March 29, 2018, each of which is incorporated herein by reference in its entirety:

[0106] U.S. Patent Application Serial No. ____________, entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney Docket No. END8511USNP / 170778;

[0107] U.S. Patent Application Serial No. ____________, entitled COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney Docket No. END8511USNP1 / 170778-1;

[0108] U.S. Patent Application Serial No. ____________, entitled CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney Docket No. END8511USNP2 / 170778-2;

[0109] U.S. Patent Application Serial No. ____________, entitled CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney Docket No. END8512USNP1 / 170779-1;

[0110] U.S. Patent Application Serial No. ____________, entitled COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney Docket No. END8512USNP2 / 170779-2;

[0111] U.S. Patent Application Serial No. ____________, entitled DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney Docket No. END8512USNP3 / 170779-3; and

[0112] U.S. Patent Application Serial No. ____________, entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney Docket No. END8513USNP / 170780.

[0113] Before describing in detail various aspects of the surgical device and generator, it should be noted that the application or use of the illustrative examples is not limited to the details of the configuration and arrangement of the components shown in the drawings and detailed description. The illustrative examples may be implemented alone or in combination with other aspects, variations and modifications, and may be practiced or performed in a variety of ways. In addition, unless otherwise indicated, the terms and expressions used herein are selected for the convenience of the reader to describe the exemplary embodiments and are not for limiting purposes. Moreover, it should be understood that one or more of the aspects, expressions of aspects and / or examples described below may be combined with any one or more of the other aspects, expressions of aspects and / or examples described below.

[0114] See also Figure 1 , the computer-implemented interactive surgical system 100 includes one or more surgical systems 102 and a cloud-based system (e.g., a cloud 104 that may include a remote server 113 coupled to a storage device 105). Each surgical system 102 includes at least one surgical hub 106 in communication with the cloud 104 that may include the remote server 113. In one example, as Figure 1 As shown in , the surgical system 102 includes a visualization system 108, a robotic system 110, and a handheld intelligent surgical instrument 112, which are configured to communicate with each other and / or with the hub 106. In some aspects, the surgical system 102 may include M number of hubs 106, N number of visualization systems 108, O number of robotic systems 110, and P number of handheld intelligent surgical instruments 112, where M, N, O, and P are integers greater than or equal to one.

[0115] Figure 3 An example of a surgical system 102 is shown for performing a surgical procedure on a patient lying flat on an operating table 114 in a surgical operating room 116. A robotic system 110 is used as part of the surgical system 102 during a surgical procedure. The robotic system 110 includes a surgeon's console 118, a patient side cart 120 (surgical robot), and a surgical robotic hub 122. While the surgeon views the surgical site through the surgeon's console 120, the patient side cart 117 can manipulate at least one removably coupled surgical tool 118 through a minimally invasive incision in the patient. Images of the surgical site can be obtained through a medical imaging device 124, which can be manipulated by the patient side cart 120 to orient the imaging device 124. The robotic hub 122 can be used to process images of the surgical site for subsequent display to the surgeon through the surgeon's console 118.

[0116] Other types of robotic systems may be readily adapted for use with the surgical system 102. Various examples of robotic systems and surgical tools suitable for use with the present disclosure are described in U.S. Provisional Patent Application Serial No. 62 / 611,339, filed on December 28, 2017, entitled ROBOT ASSISTED SURGICAL PLATFORM, the disclosure of which is incorporated herein by reference in its entirety.

[0117] Various examples of cloud-based analytics performed by cloud 104 and suitable for use in the present disclosure are described in U.S. Provisional Patent Application Serial No. 62 / 611,340, filed on December 28, 2017, entitled “CLOUD-BASED MEDICAL ANALYTICS,” the disclosure of which is incorporated herein by reference in its entirety.

[0118] In various aspects, imaging device 124 includes at least one image sensor and one or more optical components. Suitable image sensors include, but are not limited to, charge coupled device (CCD) sensors and complementary metal oxide semiconductor (CMOS) sensors.

[0119] The optical components of the imaging device 124 may include one or more illumination sources and / or one or more lenses. The one or more illumination sources may be directed to illuminate multiple portions of the surgical field. The one or more image sensors may receive light reflected or refracted from the surgical field, including light reflected or refracted from tissue and / or surgical instruments.

[0120] One or more illumination sources may be configured to radiate electromagnetic energy in the visible spectrum as well as in the invisible spectrum. The visible spectrum (sometimes referred to as the optical spectrum or the luminescence spectrum) is that portion of the electromagnetic spectrum that is visible to (i.e., detectable by) the human eye and may be referred to as visible light or simply light. A typical human eye will respond to wavelengths in the range of about 380 nm to about 750 nm in air.

[0121] The invisible spectrum (i.e., non-luminescent spectrum) is the portion of the electromagnetic spectrum below and above the visible spectrum (i.e., wavelengths below about 380 nm and above about 750 nm). The invisible spectrum is not detectable by the human eye. Wavelengths greater than about 750 nm are longer than the red visible spectrum, and they become invisible infrared (IR), microwaves, and radio electromagnetic radiation. Wavelengths less than about 380 nm are shorter than the violet spectrum, and they become invisible ultraviolet, x-ray, and gamma-ray electromagnetic radiation.

[0122] In various aspects, the imaging device 124 is configured for use in minimally invasive procedures. Examples of imaging devices suitable for use in the present disclosure include, but are not limited to, arthroscopes, angioscopes, bronchoscopes, choledochoscopes, colonoscopes, cytoscopes, duodenoscopes, enteroscopes, esophago-duodenoscopes (gastroscopes), endoscopes, laryngoscopes, nasopharyngeal-renal endoscopes, sigmoidoscopes, thoracoscopes, and hysteroscopes.

[0123] In one aspect, the imaging device uses multispectral monitoring to distinguish topography and underlying structure. Multispectral images are images that capture image data within a specific wavelength range across the electromagnetic spectrum. The wavelengths can be separated by filters or by using instruments that are sensitive to specific wavelengths, including light from frequencies outside the visible light range, such as IR and ultraviolet. Spectral imaging allows the extraction of additional information that the human eye fails to capture with its red, green, and blue receptors. The use of multispectral imaging is described in more detail under the title "Advanced Imaging Acquisition Module" of U.S. Provisional Patent Application Serial No. 62 / 611,341, entitled "INTERACTIVE SURGICALPLATFORM", filed on December 28, 2017, the disclosure of which is incorporated herein by reference in its entirety. After completing the surgical task to perform one or more of the previously described tests on the treated tissue, multispectral monitoring can be a useful tool for repositioning the surgical site.

[0124] It is self-evident that during any surgical procedure, the operating room and surgical equipment need to be strictly sterilized. The strict sanitary and sterile conditions required in a "surgical room" (i.e., an operating room or treatment room) require the highest possible sterility of all medical devices and equipment. Part of this sterilization process is the need to sterilize any material that contacts the patient or penetrates the sterile field, including the imaging device 124 and its attachments and components. It should be understood that the sterile field can be considered to be a designated area that is considered to be free of microorganisms, such as within a tray or sterile towels, or the sterile field can be considered to be an area around a patient that has been prepared for a surgical procedure. The sterile field can include a scrubbed team member that is appropriately dressed, as well as all furniture and fixtures in the area.

[0125] In various aspects, the visualization system 108 includes one or more imaging sensors, one or more image processing units, one or more storage arrays, and one or more displays that are strategically arranged relative to the sterile field, such as Figure 2. In one aspect, the visualization system 108 includes interfaces for HL7, PACS, and EMR. Various components of the visualization system 108 are described under the title “Advanced Imaging Acquisition Module” in U.S. Provisional Patent Application Serial No. 62 / 611,341, filed on December 28, 2017, entitled “INTERACTIVE SURGICAL PLATFORM,” the disclosure of which is incorporated herein by reference in its entirety.

[0126] like Figure 2 , the main display 119 is positioned in the sterile field to be visible to the operator at the operating table 114. In addition, the visualization tower 111 is positioned outside the sterile field. The visualization tower 111 includes a first non-sterile display 107 and a second non-sterile display 109 that are separated from each other. The visualization system 108 guided by the hub 106 is configured to coordinate the flow of information to the operators inside and outside the sterile field using the displays 107, 109 and 119. For example, the hub 106 can cause the visualization system 108 to display a snapshot of the surgical site recorded by the imaging device 124 on the non-sterile display 107 or 109, while maintaining a real-time feed of the surgical site on the main display 119. The snapshot on the non-sterile display 107 or 109 can allow the non-sterile operator to perform diagnostic steps related to the surgical procedure, for example.

[0127] In one aspect, the hub 106 is also configured to route diagnostic input or feedback entered by a non-sterile operator at the visualization tower 111 to a primary display 119 within the sterile field, where it can be viewed by a sterile operator at the operating table. In one example, the input can be a modified form of a snapshot displayed on a non-sterile display 107 or 109, which can be routed to the primary display 119 via the hub 106.

[0128] See also Figure 2, the surgical instrument 112 is used in a surgical procedure as part of the surgical system 102. The hub 106 is also configured to coordinate the flow of information to the display of the surgical instrument 112. For example, U.S. Provisional Patent Application Serial No. 62 / 611,341, entitled "INTERACTIVE SURGICAL PLATFORM," filed on December 28, 2017, the disclosure of which is incorporated herein by reference in its entirety. Diagnostic input or feedback entered by a non-sterile operator at the visualization tower 111 can be routed by the hub 106 to the surgical instrument display 115 within the sterile field, where the operator of the surgical instrument 112 can observe the input or feedback. Exemplary surgical instruments suitable for use with surgical system 102 are described under the title “Surgical Instrument Hardware” in U.S. provisional patent application serial number 62 / 611,341, entitled “INTERACTIVE SURGICAL PLATFORM,” filed on December 28, 2017, the disclosure of which is incorporated herein by reference in its entirety.

[0129] See now Figure 3 , the hub 106 is depicted as communicating with the visualization system 108, the robotic system 110, and the handheld intelligent surgical instrument 112. The hub 106 includes a hub display 135, an imaging module 138, a generator module 140, a communication module 130, a processor module 132, and a storage array 134. In certain aspects, as Figure 3 As shown in , the hub 106 also includes a smoke evacuation module 126 and / or a suction / rinsing module 128.

[0130] During surgical procedures, energy application to tissue for sealing and / or cutting is often associated with smoke evacuation, suction of excess fluid, and / or flushing of tissue. Fluid lines, power lines, and / or data lines from different sources often become tangled during surgical procedures. Valuable time can be lost in solving this problem during surgical procedures. Disconnecting a line may require disconnecting the line from its corresponding module, which may require resetting the module. The hub modular housing 136 provides a unified environment for managing power lines, data lines, and fluid lines, which reduces the frequency of tangling between such lines.

[0131] Aspects of the present disclosure provide a surgical hub for surgical procedures involving application of energy to tissue at a surgical site. The surgical hub includes a hub housing and a combination generator module slidably accommodated in a docking base of the hub housing. The docking base includes data contacts and power contacts. The combination generator module includes two or more of an ultrasonic energy generator component, a bipolar RF energy generator component, and a monopolar RF energy generator component seated in a single unit. In one aspect, the combination generator module also includes a smoke exhaust component for connecting the combination generator module to at least one energy delivery cable of a surgical instrument, at least one smoke exhaust component configured to exhaust smoke, fluid, and / or particles generated by applying therapeutic energy to tissue, and a fluid line extending from a remote surgical site to the smoke exhaust component.

[0132] In one aspect, the fluid line is a first fluid line and the second fluid line extends from the remote surgical site to an aspiration and irrigation module slidably received in the hub housing. In one aspect, the hub housing includes a fluid interface.

[0133] Certain surgical procedures may require more than one energy type to be applied to tissue. One energy type may be more conducive to cutting tissue, while another different energy type may be more conducive to sealing tissue. For example, a bipolar generator may be used to seal tissue, while an ultrasonic generator may be used to cut sealed tissue. Aspects of the present disclosure provide a solution in which a hub modular housing 136 is configured to accommodate different generators and facilitate interactive communication between them. One of the advantages of the hub modular housing 136 is the ability to quickly remove and / or replace various modules.

[0134] Aspects of the present disclosure provide a modular surgical housing for use in a surgical procedure involving application of energy to tissue. The modular surgical housing includes a first energy generator module configured to generate a first energy for application to tissue, and a first docking base including a first docking port including first data and power contacts, wherein the first energy generator module is slidably movable into electrical engagement with the power and data contacts, and wherein the first energy generator module is slidably movable out of electrical engagement with the first power and data contacts.

[0135] Further describing the above, the modular surgical shell also includes a second energy generator module, which is configured to generate a second energy different from the first energy for application to tissue, and a second docking base, which includes a second docking port, the second docking port including second data and power contacts, wherein the second energy generator module is slidably movable into electrical engagement with the power and data contacts, and wherein the second energy generator is slidably movable out of electrical engagement with the second power and data contacts.

[0136] In addition, the modular surgical shell also includes a communication bus between the first docking port and the second docking port, which is configured to facilitate communication between the first energy generator module and the second energy generator module.

[0137] See also Figure 3-7 , aspects of the present disclosure are presented as a hub modular housing 136 that allows modular integration of the generator module 140, the smoke evacuation module 126, and the suction / irrigation module 128. The hub modular housing 136 also facilitates interactive communication between the modules 140, 126, 128. Figure 5 As shown in , the generator module 140 may be a generator module having integrated monopolar components, bipolar components, and ultrasonic components supported in a single housing unit 139 that is slidably inserted into the hub modular housing 136. Figure 5 As shown in , the generator module 140 may be configured to connect to a monopolar device 146, a bipolar device 147, and an ultrasonic device 148. Alternatively, the generator module 140 may include a series of monopolar generator modules, bipolar generator modules, and / or ultrasonic generator modules that interact through the hub modular housing 136. The hub modular housing 136 may be configured to facilitate insertion of multiple generators and interactive communication between the generators docked into the hub modular housing 136 so that the generators will act as a single generator.

[0138] In one aspect, the hub modular housing 136 includes a modular power and communications backplane 149 with external and wireless communications connectors to enable removable attachment of the modules 140, 126, 128 and interactive communications therebetween.

[0139] In one aspect, the hub modular housing 136 includes a docking base or drawer 151 (also referred to herein as a drawer) that is configured to slidably accommodate the modules 140, 126, 128. Figure 4A partial perspective view of a surgical hub housing 136 and a combination generator module 145 slidably received in a docking station 151 of the surgical hub housing 136 is shown. A docking port 152 having power and data contacts on a back side of the combination generator module 145 is configured to engage a corresponding docking port 150 with the power and data contacts of a corresponding docking station 151 of the hub modular housing 136 when the combination generator module 145 is slid into place within the corresponding docking station 151 of the hub modular housing 136. In one aspect, the combination generator module 145 includes bipolar, ultrasonic and monopolar modules and a smoke evacuation module integrated together into a single housing unit 139, such as Figure 5 as shown in .

[0140] In various aspects, the smoke evacuation module 126 includes a fluid line 154 that delivers captured / collected smoke and / or fluid from the surgical site to, for example, the smoke evacuation module 126. Vacuum suction from the smoke evacuation module 126 can draw smoke into an opening of a common conduit at the surgical site. The common conduit coupled to the fluid line can be in the form of a flexible tube that terminates at the smoke evacuation module 126. The common conduit and the fluid line define a fluid path that extends toward the smoke evacuation module 126 housed in the hub housing 136.

[0141] In various aspects, the suction / irrigation module 128 is coupled to a surgical tool including an aspiration fluid line and a suction fluid line. In one example, the aspiration fluid line and the suction fluid line are in the form of flexible tubes extending from the surgical site toward the suction / irrigation module 128. One or more drive systems can be configured to flush fluid to the surgical site and to aspirate fluid from the surgical site.

[0142] In one aspect, the surgical tool comprises a shaft having an end effector at its distal end and at least one energy treatment associated with the end effector, a suction tube, and a flushing tube. The suction tube may have an inlet at its distal end, and the suction tube extends through the shaft. Similarly, the suction tube may extend through the shaft and may have an inlet adjacent to an energy delivery tool. The energy delivery tool is configured to deliver ultrasonic energy and / or RF energy to a surgical site and is coupled to a generator module 140 by a cable initially extending through the shaft.

[0143] The irrigation tube may be in fluid communication with a fluid source, and the aspiration tube may be in fluid communication with a vacuum source. The fluid source and / or vacuum source may be seated in the suction / irrigation module 128. In one example, the fluid source and / or vacuum source may be seated in the hub housing 136 independently of the suction / irrigation module 128. In such examples, a fluid interface is capable of connecting the suction / irrigation module 128 to the fluid source and / or vacuum source.

[0144] In one aspect, the modules 140, 126, 128 and / or their corresponding docking stations on the hub modular housing 136 may include alignment features configured to align the docking ports of the modules to engage with their corresponding ports in the docking stations of the hub modular housing 136. For example, Figure 4 As shown in , the combination generator module 145 includes a side bracket 155, which is configured to slidably engage with a corresponding bracket 156 of a corresponding docking base 151 of the hub modular housing 136. The bracket cooperates to guide the docking port contacts of the combination generator module 145 to electrically engage with the docking port contacts of the hub modular housing 136.

[0145] In some aspects, the drawers 151 of the hub modular housing 136 are the same or substantially the same size, and the size of the module is adjusted to be accommodated in the drawer 151. For example, the side brackets 155 and / or 156 can be larger or smaller depending on the size of the module. In other aspects, the drawers 151 are different sizes and each is designed to accommodate a specific module.

[0146] Additionally, the contacts of a particular module may be keyed to engage the contacts of a particular drawer to avoid inserting a module into a drawer with mismatched contacts.

[0147] like Figure 4 As shown in , the docking port 150 of one drawer 151 can be coupled to the docking port 150 of another drawer 151 via a communication link 157 to facilitate interactive communication between modules seated in the hub modular housing 136. Alternatively or additionally, the docking port 150 of the hub modular housing 136 can facilitate wireless interactive communication between modules seated in the hub modular housing 136. Any suitable wireless communication can be employed, such as, for example, Air Titan-Bluetooth.

[0148] Figure 6 A single power bus attachment is shown for multiple lateral docking ports of a lateral modular housing 160 configured to accommodate multiple modules of a surgical hub 206. The lateral modular housing 160 is configured to laterally accommodate and interconnect modules 161. The modules 161 are slidably inserted into docking bases 162 of the lateral modular housing 160, which includes a bottom plate for interconnecting the modules 161. Figure 6 As shown in FIG, the modules 161 are arranged transversely in the transverse modular housing 160. Alternatively, the modules 161 may be arranged vertically in the transverse modular housing.

[0149] Figure 7A vertical modular housing 164 is shown that is configured to accommodate a plurality of modules 165 of a surgical hub 106. The modules 165 are slidably inserted into a docking station or drawer 167 of the vertical modular housing 164, which includes a bottom plate for interconnecting the modules 165. Although the drawers 167 of the vertical modular housing 164 are arranged vertically, in some cases, the vertical modular housing 164 may include drawers arranged horizontally. In addition, the modules 165 can interact with each other through the docking ports of the vertical modular housing 164. Figure 7 In the example of FIG. 1 , a display 177 is provided for displaying data related to the operation of the module 165. In addition, the vertical modular housing 164 includes a main module 178 that seats a plurality of sub-modules that are slidably received in the main module 178.

[0150] In various aspects, the imaging module 138 includes an integrated video processor and a modular light source, and is suitable for use with various imaging devices. In one aspect, the imaging device is composed of a modular housing that can be equipped with a light source module and a camera module. The housing can be a disposable housing. In at least one example, the disposable housing is removably coupled to a reusable controller, light source module, and camera module. The light source module and / or camera module can be selectively selected according to the type of surgical procedure. In one aspect, the camera module includes a CCD sensor. On the other hand, the camera module includes a CMOS sensor. On the other hand, the camera module is configured for scanning beam imaging. Similarly, the light source module can be configured to deliver white light or different light, depending on the surgical procedure.

[0151] During a surgical procedure, it may be inefficient to remove a surgical device from the surgical field and replace the surgical device with another surgical device that includes a different camera or a different light source. Temporarily losing sight of the surgical field may lead to undesirable consequences. The modular imaging device of the present disclosure is configured to allow mid-stream replacement of a light source module or a camera module during a surgical procedure without having to remove the imaging device from the surgical field.

[0152] In one aspect, an imaging device includes a tubular housing including a plurality of channels. A first channel is configured to slidably receive a camera module, which can be configured to snap-fit ​​into engagement with the first channel. A second channel is configured to slidably receive a light source module, which can be configured to snap-fit ​​into engagement with the second channel. In another example, the camera module and / or the light source module can be rotated into a final position within their respective channels. A threaded engagement can be used in place of a snap-fit ​​engagement.

[0153] In various examples, multiple imaging devices are placed at different locations in the surgical field to provide multiple views. The imaging module 138 can be configured to switch between imaging devices to provide the best view. In various aspects, the imaging module 138 can be configured to integrate images from different imaging devices.

[0154] Various image processors and imaging devices suitable for use with the present disclosure are described in U.S. Pat. No. 7,995,045, entitled COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR, issued on August 9, 2011, which is incorporated herein by reference in its entirety. In addition, U.S. Pat. No. 7,982,776, entitled SBI MOTION ARTIFACT REMOVAL APPARATUS AND METHOD, issued on July 19, 2011, describes various systems for removing motion artifacts from image data, which is incorporated herein by reference in its entirety. Such systems may be integrated with imaging module 138. In addition, U.S. patent application publication 2011 / 0306840, entitled CONTROLLABLE MAGNETIC SOURCE TO FIXTUREINTRACORPOREAL APPARATUS, published on December 15, 2011, and U.S. patent application publication 2014 / 0243597, entitled SYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCEDURE, published on August 28, 2014, each of the above patents is incorporated herein by reference in its entirety.

[0155] Figure 8A surgical data network 201 is shown that includes a modular communication hub 203 configured to connect modular devices located in one or more operating rooms of a medical facility or any room in a medical facility that is specifically equipped for surgical operations to a cloud-based system (e.g., a cloud 204 that may include a remote server 213 coupled to a storage device 205). In one aspect, the modular communication hub 203 includes a network hub 207 and / or a network switch 209 that communicates with a network router. The modular communication hub 203 may also be coupled to a local computer system 210 to provide local computer processing and data manipulation. The surgical data network 201 may be configured as passive, intelligent, or switched. A passive surgical data network acts as a conduit for data, enabling it to be transferred from one device (or segment) to another device (or segment) and to cloud computing resources. An intelligent surgical data network includes additional features to enable monitoring of traffic through the surgical data network and configuration of each port in the network hub 207 or network switch 209. The intelligent surgical data network may be referred to as a manageable hub or switch. The switching hub reads the destination address of each packet and then forwards the packet to the correct port.

[0156] Modular devices 1a-1n located in an operating room may be coupled to a modular communication hub 203. A network hub 207 and / or a network switch 209 may be coupled to a network router 211 to connect devices 1a-1n to a cloud 204 or a local computer system 210. Data associated with devices 1a-1n may be transmitted to a cloud-based computer via a router for remote data processing and manipulation. Data associated with devices 1a-1n may also be transmitted to a local computer system 210 for local data processing and manipulation. Modular devices 2a-2m located in the same operating room may also be coupled to a network switch 209. A network switch 209 may be coupled to a network hub 207 and / or a network router 211 to connect devices 2a-2m to a cloud 204. Data associated with devices 2a-2n may be transmitted to a cloud 204 via a network router 211 for data processing and manipulation. Data associated with devices 2a-2m may also be transmitted to a local computer system 210 for local data processing and manipulation.

[0157] It should be understood that the surgical data network 201 can be expanded by interconnecting multiple network hubs 207 and / or multiple network switches 209 with multiple network routers 211. The modular communication hub 203 can be included in a modular control tower that is configured to accommodate multiple devices 1a-1n / 2a-2m. A local computer system 210 can also be included in the modular control tower. The modular communication hub 203 is connected to a display 212 to display images obtained by some of the devices 1a-1n / 2a-2m during a surgical procedure, for example. In various aspects, devices 1a-1n / 2a-2m may include, for example, various modules, such as an imaging module 138 coupled to an endoscope, a generator module 140 coupled to an energy-based surgical device, a smoke evacuation module 126, a suction / irrigation module 128, a communication module 130, a processor module 132, a storage array 134, a surgical device connected to a display, and / or a non-contact sensor module in other modular devices that can be connected to a modular communication hub 203 of a surgical data network 201.

[0158] In one aspect, the surgical data network 201 may include a combination of (one or more) network hubs, (one or more) network switches, and (one or more) network routers that connect the devices 1a-1n / 2a-2m to the cloud. Any or all of the devices 1a-1n / 2a-2m coupled to the network hub or network switch can collect data in real time and transmit the data to the cloud computer for data processing and manipulation. It should be understood that cloud computing relies on shared computing resources rather than using local servers or personal devices to process software applications. The term "cloud" can be used as a metaphor for "Internet", although the term is not limited to this. Therefore, the term "cloud computing" can be used herein to refer to "a type of Internet-based computing", in which different services (such as servers, storage, and applications) are delivered to a modular communication hub 203 and / or a computer system 210 located in a surgical room (e.g., a fixed, mobile, temporary, or on-site operating room or space) and a device connected to the modular communication hub 203 and / or the computer system 210 via the Internet. The cloud infrastructure can be maintained by a cloud service provider. In this case, the cloud service provider may be an entity that coordinates the use and control of devices 1a-1n / 2a-2m located in one or more operating rooms. Cloud computing services may perform a large number of calculations based on data collected by smart surgical instruments, robots, and other computerized devices located in the operating room. Hub hardware enables multiple devices or connections to connect to a computer that communicates with cloud computing resources and storage.

[0159] Applying cloud computer data processing technology to the data collected by the devices 1a-1n / 2a-2m, the surgical data network provides improved surgical results, reduced costs and improved patient satisfaction. At least some of the devices 1a-1n / 2a-2m can be used to observe tissue status to evaluate leakage or perfusion of sealed tissue after tissue sealing and cutting procedures. At least some of the devices 1a-1n / 2a-2m can be used to identify pathology, such as the effects of disease, using cloud-based computing to examine data including images of body tissue samples for diagnostic purposes. This includes positioning and edge confirmation of tissue and phenotype. At least some of the devices 1a-1n / 2a-2m can be used to identify the anatomical structure of the body using various sensors integrated with imaging devices and technologies (such as overlapping images captured by multiple imaging devices). The data collected by the devices 1a-1n / 2a-2m (including image data) can be transmitted to the cloud 204 or the local computer system 210 or both for data processing and manipulation, including image processing and manipulation. The data can be analyzed to improve surgical procedure outcomes by determining whether further treatment can be pursued, such as endoscopic interventions, emerging technologies, targeted radiation, targeted interventions, and precision robotic applications to tissue-specific sites and conditions. Such data analysis can be further processed using outcome analysis, and using standardized methods can provide helpful feedback to confirm surgical treatments and surgeon behavior, or suggest modifications to surgical treatments and surgeon behavior.

[0160] In one specific implementation, operating room devices 1a-1n may be connected to the modular communication hub 203 via a wired channel or a wireless channel, depending on the configuration of the devices 1a-1n to the network hub. In one aspect, the network hub 207 may be implemented as a local network broadcast device that operates on the physical layer of the open system interconnection (OSI) model. The network hub provides connections to devices 1a-1n located in the same operating room network. The network hub 207 collects data in the form of packets and sends it to a router in half-duplex mode. The network hub 207 does not store any media access control / internet protocol (MAC / IP) for transmitting device data. Only one of the devices 1a-1n can send data through the network hub 207 at a time. The network hub 207 has no knowledge of where to send information and broadcasts all network data on each connection and to the remote server 213 ( Fig. 9 ) Routing tables or intelligence that broadcasts all network data. The network hub 207 can detect basic network errors such as collisions, but broadcasting all information to multiple ports can pose security risks and cause bottlenecks.

[0161] In another specific implementation, the operating room devices 2a-2m can be connected to the network switch 209 through a wired channel or a wireless channel. The network switch 209 operates in the data link layer of the OSI model. The network switch 209 is a multicast device for connecting the devices 2a-2m located in the same operating room to the network. The network switch 209 sends data to the network router 211 in the form of a frame and operates in full-duplex mode. Multiple devices 2a-2m can send data simultaneously through the network switch 209. The network switch 209 stores and uses the MAC addresses of the devices 2a-2m to transmit data.

[0162] The network hub 207 and / or the network switch 209 are coupled to a network router 211 to connect to the cloud 204. The network router 211 operates in the network layer of the OSI model. The network router 211 creates a route for transmitting data packets received from the network hub 207 and / or the network switch 211 to cloud-based computer resources to further process and manipulate data collected by any or all of the devices 1a-1n / 2a-2m. The network router 211 can be used to connect two or more different networks located in different locations, such as, for example, different operating rooms in the same medical facility or different networks located in different operating rooms in different medical facilities. The network router 211 sends data to the cloud 204 in the form of packets and operates in full-duplex mode. Multiple devices can send data simultaneously. The network router 211 uses IP addresses to transmit data.

[0163] In one example, the network hub 207 may be implemented as a USB hub that allows multiple USB devices to be connected to a host computer. The USB hub may expand a single USB port to multiple levels so that more ports are available to connect devices to a host system computer. The network hub 207 may include wired or wireless capabilities for receiving information through a wired channel or a wireless channel. In one aspect, a wireless USB short-range, high-bandwidth wireless radio communication protocol may be used for communication between devices 1a-1n and devices 2a-2m located in an operating room.

[0164] In other examples, the operating room devices 1a-1n / 2a-2m can communicate with the modular communication hub 203 via the Bluetooth wireless technology standard for exchanging data from fixed and mobile devices over short distances (using short wavelength UHF radio waves in the ISM band of 2.4 to 2.485 GHz) and building a personal area network (PAN). In other aspects, the operating room devices 1a-1n / 2a-2m can communicate with the modular communication hub 203 via a variety of wireless or wired communication standards or protocols, including but not limited to Wi-Fi (IEEE 802.11 series), WiMAX (IEEE 802.16 series), IEEE 802.20, Long Term Evolution (LTE) and Ev-DO, HSPA+, HSDPA+, HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT, and Ethernet derivatives thereof, and any other wireless and wired protocols designated as 3G, 4G, 5G and above. The computing module may include multiple communication modules. For example, the first communication module may be dedicated to shorter-range wireless communications such as Wi-Fi and Bluetooth, and the second communication module may be dedicated to longer-range wireless communications such as GPS, EDGE, GPRS, CDMA, WiMAX, LTE, Ev-DO, etc.

[0165] The modular communication hub 203 can serve as a central connection for one or all of the operating room devices 1a-1n / 2a-2m and handles data types called frames. The frames carry data generated by the devices 1a-1n / 2a-2m. When the modular communication hub 203 receives a frame, it is amplified and transmitted to the network router 211, which transmits the data to the cloud computing resources using multiple wireless or wired communication standards or protocols as described herein.

[0166] Modular communication hub 203 can be used as a standalone device or connected to compatible network hubs and network switches to form a larger network. Modular communication hub 203 is generally easy to install, configure and maintain, making it a good option for networking operating room devices 1a-1n / 2a-2m.

[0167] Fig. 9A computer-implemented interactive surgical system 200 is shown. The computer-implemented interactive surgical system 200 is similar in many respects to the computer-implemented interactive surgical system 100. For example, the computer-implemented interactive surgical system 200 includes one or more surgical systems 202 that are similar in many respects to the surgical system 102. Each surgical system 202 includes at least one surgical hub 206 in communication with a cloud 204, which may include a remote server 213. In one aspect, the computer-implemented interactive surgical system 200 includes a modular control tower 236 that is connected to a plurality of operating room devices, such as, for example, smart surgical instruments, robots, and other computerized devices located in the operating room. Fig.10 As shown in FIG, modular control tower 236 includes modular communication hub 203 coupled to computer system 210. Fig. 9 As shown in the example of , the modular control tower 236 is coupled to an imaging module 238 coupled to an endoscope 239, a generator module 240 coupled to an energy device 241, a smoke evacuator module 226, a suction / irrigation module 228, a communication module 230, a processor module 232, a storage array 234, a smart device / instrument 235 optionally coupled to a display 237, and a non-contact sensor module 242. The operating room devices are coupled to cloud computing resources and data storage via the modular control tower 236. The robotic hub 222 can also be connected to the modular control tower 236 and cloud computing resources. The devices / instruments 235, the visualization system 208, etc. can be coupled to the modular control tower 236 via wired or wireless communication standards or protocols, as described herein. The modular control tower 236 can be coupled to a hub display 215 (e.g., monitor, screen) to display and overlay images received from the imaging module, device / instrument display, and / or other visualization system 208. The hub display may also combine graphics and overlay images to display data received from devices connected to the modular control tower.

[0168] Fig.10 A surgical hub 206 is shown comprising a plurality of modules coupled to a modular control tower 236. The modular control tower 236 comprises a modular communication hub 203 (e.g., network connectivity means) and a computer system 210 to provide, for example, local processing, visualization, and imaging. Fig.10 As shown in , the modular communication hub 203 can be hierarchically configured to expand the number of modules (e.g., devices) that can be connected to the modular communication hub 203 and transmit data associated with the modules to the computer system 210, cloud computing resources, or both. Fig.10As shown in , each of the network hubs / switches in the modular communication hub 203 includes three downstream ports and one upstream port. The upstream network hub / switch is connected to the processor to provide communication connections with cloud computing resources and local display 217. Communication with the cloud 204 can be carried out through wired or wireless communication channels.

[0169] The surgical hub 206 employs a non-contact sensor module 242 to measure the size of the operating room and generates a map of the surgical room using an ultrasound or laser-based non-contact measurement device. The ultrasound-based non-contact sensor module scans the operating room by emitting a burst of ultrasound waves and receiving the echoes as they bounce off the walls of the operating room, as described in U.S. Provisional Patent Application Serial No. 62 / 611,341, filed on December 28, 2017, entitled INTERACTIVE SURGICAL PLATFORM, under the title "Surgical Hub Spatial Awareness Within an Operating Room," the disclosure of which is incorporated herein by reference in its entirety, wherein the sensor module is configured to determine the size of the operating room and adjust the Bluetooth pairing distance limit. The laser-based non-contact sensor module scans the operating room by emitting laser pulses, receiving laser pulses that bounce off the walls of the operating room, and comparing the phase of the emitted pulses with the received pulses to determine the size of the operating room and adjust the Bluetooth pairing distance limit.

[0170] The computer system 210 includes a processor 244 and a network interface 245. The processor 244 is coupled to a communication module 247, a storage device 248, a memory 249, a non-volatile memory 250, and an input / output interface 251 via a system bus. The system bus may be any of several types of bus structures including a memory bus or memory controller, a peripheral bus or external bus, and / or a local bus using any of a variety of available bus architectures including, but not limited to, a 9-bit bus, Industry Standard Architecture (ISA), Micro Charmel Architecture (MSA), Extended ISA (EISA), Intelligent Drive Electronics (IDE), VESA Local Bus (VLB), Peripheral Component Interconnect (PCI), USB, Advanced Graphics Port (AGP), Personal Computer Memory Card International Association bus (PCMCIA), Small Computer System Interface (SCSI), or any other peripheral bus.

[0171] Controller 244 may be any single-core or multi-core processor, such as those offered by Texas Instruments under the trade name ARM Cortex. In one aspect, the processor may be a commercially available ARM Cortex-M4F processor core, such as the Texas Instruments LM4F230H5QR, which includes 256KB of single-cycle flash or other non-volatile memory (up to 40 MHz) on-chip memory, a pre-fetch buffer for improved performance above 40 MHz, 32KB of single-cycle sequential random access memory (SRAM), a Stellaris Internal read-only memory (ROM) for software, 2KB electrically erasable programmable read-only memory (EEPROM), and / or one or more pulse width modulation (PWM) modules, one or more quadrature encoder input (QEI) simulations, one or more 12-bit analog-to-digital converters (ADCs) with 12 analog input channels, details of which can be found in the product data sheet.

[0172] In one aspect, the processor 244 may include a safety controller including two families based on controllers such as TMS570 and RM4x, known under the trade name Hercules ARM Cortex R4, also produced by Texas Instruments. The safety controller may be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide an advanced integrated safety feature architecture while delivering scalable performance, connectivity, and memory options.

[0173] System memory includes volatile memory and non-volatile memory. The basic input / output system (BIOS), which contains basic routines such as transferring information between elements within the computer system during startup, is stored in non-volatile memory. For example, non-volatile memory may include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), EEPROM, or flash memory. Volatile memory includes random access memory (RAM) that acts as external cache memory. In addition, RAM is available in a variety of forms, such as SRAM, dynamic RAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDRSDRAM) enhanced SDRAM (ESDRAM), synchronous link DRAM (SLDRAM), and direct Rambus RAM (DRRAM).

[0174] Computer system 210 also includes removable / non-removable, volatile / non-volatile computer storage media, such as, for example, disk storage. Disk storage includes, but is not limited to, devices such as disk drives, floppy disk drives, tape drives, Jaz drives, Zip drives, LS-60 drives, flash memory cards, or memory sticks. In addition, disk storage may include storage media individually or in combination with other storage media, including but not limited to optical disk drives such as optical disk ROM devices (CD-ROM), optical disk recordable drives (CD-R drives), optical disk rewritable drives (CD-RW drives), or digital universal disk ROM drives (DVD-ROM). In order to facilitate the connection of the disk storage device to the system bus, a removable or non-removable interface may be used.

[0175] It should be understood that the computer system 210 includes software that acts as an intermediary between a user and the basic computer resources described in a suitable operating environment. Such software includes an operating system. An operating system that can be stored on a disk storage device is used to control and allocate the resources of the computer system. System applications utilize the operating system to manage resources through program modules and program data stored in system memory or disk storage devices. It should be understood that the various components described herein can be implemented with various operating systems or combinations of operating systems.

[0176] The user inputs commands or information into the computer system 210 through (one or more) input devices coupled to the I / O interface 251. Input devices include, but are not limited to, pointing devices such as a mouse, a touch ball, a stylus, a touch pad, a keyboard, a microphone, a joystick, a game pad, a satellite dish, a scanner, a TV tuner card, a digital camera, a digital video camera, a web camera, etc. These and other input devices are connected to the processor through the system bus via (one or more) interface ports. (One or more) interface ports include, for example, serial ports, parallel ports, game ports, and USB. (One or more) output devices use the same type of port as (one or more) input devices. Thus, for example, a USB port can be used to provide input to the computer system and output information from the computer system to an output device. Output adapters are provided to illustrate that there are some output devices (such as monitors, displays, speakers, and printers) that require special adapters among other output devices. Output adapters include, by way of example, but are not limited to, video and sound cards that provide connection means between output devices and the system bus. It should be noted that other devices or systems of devices such as (one or more) remote computers provide both input capabilities and output capabilities.

[0177] The computer system 210 can operate in a networked environment using a logical connection with one or more remote computers (such as (one or more) cloud computers) or local computers. (One or more) remote cloud computers can be personal computers, servers, routers, network PCs, workstations, microprocessor-based appliances, peer devices or other public network nodes, etc., and generally include many or all of the elements described relative to the computer system. For simplicity, only a memory storage device with (one or more) remote computers is shown. (One or more) remote computers are logically connected to the computer system through a network interface, and then physically connected via a communication connection. The network interface covers communication networks such as local area networks (LANs) and wide area networks (WANs). LAN technologies include fiber distributed data interface (FDDI), copper distributed data interface (CDDI), Ethernet / IEEE 802.3, token ring / IEEE 802.5, etc. WAN technologies include, but are not limited to, point-to-point links, circuit switching networks such as integrated services digital networks (ISDN) and their variants, packet switching networks, and digital subscriber lines (DSL).

[0178] In every aspect, Fig.10 computer system 210, imaging module 238 and / or visualization system 208, and / or Figure 9-10 The processor module 232 may include an image processor, an image processing engine, a media processor, or any dedicated digital signal processor (DSP) for processing digital images. The image processor may employ parallel computing with single instruction, multiple data (SIMD) or multiple instructions, multiple data (MIMD) techniques to improve speed and efficiency. The digital image processing engine may perform a range of tasks. The image processor may be a system on a chip with a multi-core processor architecture.

[0179] The communication connection(s) refers to the hardware / software used to connect the network interface to the bus. Although the communication connections are shown for exemplary clarification within the computer system, they may also be located external to the computer system 210. The hardware / software necessary to connect to the network interface includes internal and external technologies such as modems, including conventional telephone grade modems, cable modems and DSL modems, ISDN adapters, and Ethernet cards for exemplary purposes only.

[0180] Fig.11A functional block diagram of one aspect of a USB network hub 300 device according to one aspect of the present disclosure is shown. In the illustrated aspect, the USB network hub device 300 employs a TUSB2036 integrated circuit hub from Texas Instruments. The USB network hub 300 is a CMOS device that provides an upstream USB transceiver port 302 and up to three downstream USB transceiver ports 304, 306, 308 according to the USB 2.0 specification. The upstream USB transceiver port 302 is a differential root data port that includes a differential data negative (DP0) input paired with a differential data positive (DM0) input. The three downstream USB transceiver ports 304, 306, 308 are differential data ports, each of which includes a differential data positive (DP1-DP3) output paired with a differential data negative (DM1-DM3) output.

[0181] The USB network hub 300 device is implemented with a digital state machine rather than a microcontroller, and does not require firmware programming. A fully compatible USB transceiver is integrated into the circuit for the upstream USB transceiver port 302 and all downstream USB transceiver ports 304, 306, 308. The downstream USB transceiver ports 304, 306, 308 support both full-speed devices and low-speed devices by automatically setting the conversion rate according to the speed of the device attached to the port. The USB network hub 300 device can be configured to be in bus-powered mode or self-powered mode, and includes a hub power logic 312 for managing power.

[0182] The USB network hub 300 device includes a serial interface engine 310 (SIE). The SIE 310 is the front end of the USB network hub 300 hardware and handles most of the protocols described in Chapter 8 of the USB specification. The SIE 310 generally includes up to transaction-level signaling. The functions it handles may include: packet identification, transaction ordering, SOP, EOP, RESET and RESUME signal detection / generation, clock / data separation, non-return to zero inversion (NRZI) data encoding / decoding and digit filling, CRC generation and verification (token and data), packet ID (PID) generation and verification / decoding, and / or serial-to-parallel / parallel-to-serial conversion. The 310 receives a clock input 314 and is coupled to a pause / resume logic and frame timer 316 circuit and a hub repeater circuit 318 to control the communication between the upstream USB transceiver port 302 and the downstream USB transceiver port 304, 306, 308 through the port logic circuit 320, 322, 324. SIE 310 is coupled to command decoder 326 via interface logic to control commands from the serial EEPROM via serial EEPROM interface 330 .

[0183] In various aspects, the USB network hub 300 can connect 127 functions configured in up to six logical layers (hierarchies) to a single computer. In addition, the USB network hub 300 can be connected to all external devices using a standardized four-wire cable that provides both communication and power distribution. The power is configured as a bus-powered mode and a self-powered mode. The USB network hub 300 can be configured to support four power management modes: a bus-powered hub with individual port power management or a complete set of port power management, and a self-powered hub with individual port power management or a complete set of port power management. In one aspect, the USB network hub 300, the upstream USB transceiver port 302 is inserted into the USB host controller using a USB cable, and the downstream USB transceiver ports 304, 306, 308 are exposed for connecting USB compatible devices, etc.

[0184] Surgical Instrument Hardware

[0185] Fig.12 A logic diagram of a control system 470 of a surgical instrument or tool according to one or more aspects of the present disclosure is shown. The system 470 includes a control circuit. The control circuit includes a microcontroller 461, which includes a processor 462 and a memory 468. For example, one or more of the sensors 472, 474, 476 provide real-time feedback to the processor 462. A motor 482 driven by a motor driver 492 is operably coupled to a longitudinally movable displacement member to drive an I-beam blade element. The tracking system 480 is configured to determine the position of the longitudinally movable displacement member. The position information is provided to the processor 462, which can be programmed or configured to determine the position of the longitudinally movable drive member and the position of the firing member, the firing rod, and the I-beam blade element. Additional motors can be provided at the tool driver interface to control I-beam firing, closure tube travel, shaft rotation, and joint movement. The display 473 displays a variety of operating conditions of the instrument and can include a touch screen function for data input. The information displayed on the display 473 can be superimposed with an image acquired via an endoscopic imaging module.

[0186] In one aspect, microprocessor 461 can be any single-core or multi-core processor, such as those known under the trade name ARM Cortex manufactured by Texas Instruments. In one aspect, microcontroller 461 can be a LM4F230H5QR ARM Cortex-M4F processor core available from, for example, Texas Instruments, which includes 256KB of single-cycle flash or other non-volatile memory (up to 40 MHz) on-chip memory, a pre-fetch buffer for improved performance above 40 MHz, 32KB of single-cycle SRAM, a Stellaris Internal ROM for software, 2KB electrical EEPROM, one or more PWM modules, one or more QEI analog, one or more 12-bit ADC with 12 analog input channels, details of which can be found in the product data sheet.

[0187] In one aspect, the microcontroller 461 may include a safety controller including two families based on controllers such as TMS570 and RM4x, known under the trade name Hercules ARM Cortex R4 also produced by Texas Instruments. The safety controller may be configured specifically for IEC 61508 and ISO26262 safety critical applications, among others, to provide an advanced integrated safety feature architecture while delivering scalable performance, connectivity, and memory options.

[0188] The microcontroller 461 can be programmed to perform various functions, such as precise control of the speed and position of the knife and articulation system. In one aspect, the microcontroller 461 includes a processor 462 and a memory 468. The electric motor 482 can be a brushed DC (DC) motor having a gearbox and a mechanical link to the articulation or knife system. In one aspect, the motor driver 492 can be an A3941 available from Allegro Microsystems, Inc. Other motor drivers can be easily replaced for use in the tracking system 480 including an absolute positioning system. A detailed description of the absolute positioning system is described in U.S. Patent Application Publication 2017 / 0296213 entitled SYSTEMS AND METHODS FOR CONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT published on October 19, 2017, which is incorporated herein by reference in its entirety.

[0189] The microcontroller 461 can be programmed to provide precise control of the speed and position of the displacement member and articulation system. The microcontroller 461 can be configured to calculate the response in the software of the microcontroller 461. The calculated response is compared to the measured response of the actual system to obtain the "observed" response, which is used for actual feedback decisions. The observed response is a favorable tuning value that balances the smooth continuous nature of the simulated response with the measured response, which can detect external influences on the system.

[0190] In one aspect, the motor 482 can be controlled by a motor driver 492 and can be adopted by the firing system of a surgical instrument or tool. In various forms, the motor 482 can be a brushed DC drive motor with a maximum rotation speed of about 25,000 RPM. In other arrangements, the motor 482 may include a brushless motor, a cordless motor, a synchronous motor, a stepper motor, or any other suitable electric motor. The motor driver 492 may include, for example, an H-bridge driver including a field effect transistor (FET). The motor 482 can be powered by a power assembly that can be releasably mounted to a handle assembly or a tool housing for supplying control power to a surgical instrument or tool. The power assembly may include a battery that may include a plurality of battery cells connected in series that can be used as a power source to provide power to a surgical instrument or tool. In some cases, the battery cells of the power assembly may be replaceable and / or rechargeable. In at least one example, the battery cell may be a lithium-ion battery that can be coupled to the power assembly and can be separated from the power assembly.

[0191] Driver 492 may be an A3941 available from Allegro Microsystems, Inc. A3941 492 is a full-bridge controller for use with external N-channel power metal oxide semiconductor field effect transistors (MOSFETs) specifically designed for inductive loads such as brushed DC motors. Driver 492 includes a unique charge pump regulator that provides full (>10V) gate drive for battery voltages as low as 7V and allows the A3941 to operate at reduced gate drive as low as 5.5V. A bootstrap capacitor may be used to provide the above-mentioned battery supply voltage required for the N-channel MOSFET. The internal charge pump of the high-side driver allows DC (100% duty cycle) operation. The full bridge may be driven in fast decay mode or slow decay mode using diodes or synchronous rectification. In slow decay mode, current recirculation may pass through the high-side or low-side FETs. The power FETs are protected from breakdown by resistor-adjustable dead time. The integral diagnostics provide indications of undervoltage, overtemperature, and power bridge faults, and can be configured to protect the power MOSFETs under most short circuit conditions.Other motor drivers can be easily substituted for use in the tracking system 480 including the absolute positioning system.

[0192] Tracking system 480 includes a controlled motor drive circuit arrangement including position sensor 472 according to one aspect of the present disclosure. Position sensor 472 for absolute positioning system provides a unique position signal corresponding to the position of displacement member. In one aspect, displacement member represents a longitudinally movable drive member, which includes a rack of drive teeth for meshing engagement with a corresponding drive gear of a gear reducer assembly. In other aspects, displacement member represents a firing member, which can be adapted and configured to include a rack of drive teeth. In another aspect, displacement member represents a firing rod of an I-beam, each of which can be adapted and configured to include a rack of drive teeth. Therefore, as used herein, the term displacement member is generally used to refer to any movable member of a surgical instrument such as a drive member, a firing member, a firing rod, an I-beam, or any element that can be displaced. In one aspect, a longitudinally movable drive member is coupled to the firing member, the firing rod, and the I-beam. Therefore, the absolute positioning system can actually track the linear displacement of the I-beam by tracking the linear displacement of the longitudinally movable drive member. In various other aspects, the displacement member may be coupled to any position sensor 472 suitable for measuring linear displacement. Thus, the longitudinally movable drive member, firing member, firing rod or I-beam or a combination thereof may be coupled to any suitable linear displacement sensor. The linear displacement sensor may include a contact displacement sensor or a non-contact displacement sensor. The linear displacement sensor may include a linear variable differential transformer (LVDT), a differential variable reluctance transducer (DVRT), a slide potentiometer, a magnetic sensing system including a movable magnet and a series of linearly arranged Hall effect sensors, a magnetic sensing system including a fixed magnet and a series of movable linearly arranged Hall effect sensors, an optical sensing system including a movable light source and a series of linearly arranged photodiodes or photodetectors, an optical sensing system including a fixed light source and a series of movable linearly arranged photodiodes or photodetectors, or any combination thereof.

[0193] The electric motor 482 may include a rotatable shaft operably interfacing with a gear assembly that is mounted on the displacement member in meshing engagement with a group or rack of drive teeth. The sensor element may be operably coupled to the gear assembly so that a single rotation of the position sensor 472 element corresponds to some linear longitudinal translation of the displacement member. The arrangement of the transmission and the sensor may be connected to a linear actuator via a rack and pinion arrangement, or to a rotary actuator via a spur gear or other connection. The power source supplies power to the absolute positioning system, and the output indicator may display the output of the absolute positioning system. The displacement member represents a longitudinally movable drive member that includes a rack of drive teeth formed thereon for meshing engagement with a corresponding drive gear of a gear reducer assembly. The displacement member represents a longitudinally movable firing member, a firing rod, an I-beam, or a combination thereof.

[0194] A single rotation of the sensor element associated with the position sensor 472 is equivalent to a longitudinal linear displacement of the displacement member, d1, where d1 is the longitudinal linear distance the displacement member moves from point "a" to point "b" after a single rotation of the sensor element coupled to the displacement member. The sensor arrangement may be connected via a gear reduction that enables the position sensor 472 to complete only one or more rotations for a full stroke of the displacement member. The position sensor 472 may complete multiple rotations for a full stroke of the displacement member.

[0195] A series of switches (where n is an integer greater than one) may be employed alone or in combination with gear reduction to provide unique position signals for more than one rotation of the position sensor 472. The state of the switches is fed back to the microcontroller 461, which applies logic to determine a unique position signal corresponding to the longitudinal linear displacement d1+d2+...dn of the displacement member. The output of the position sensor 472 is provided to the microcontroller 461. The position sensor 472 of this sensor arrangement may include a magnetic sensor, an analog rotation sensor (such as a potentiometer), an array of analog Hall effect elements that output a unique combination of position signals or values.

[0196] Position sensor 472 may include any number of magnetic sensing elements, such as, for example, magnetic sensors classified according to whether they measure the total magnetic field or the vector component of the magnetic field. The technologies used to produce the above two types of magnetic sensors cover many aspects of physics and electronics. Technologies for magnetic field sensing include probe coils, fluxgates, optical pumps, nuclear spins, superconducting quantum interference devices (SQUIDs), Hall effects, anisotropic magnetoresistance, giant magnetoresistance, magnetic tunnel junctions, giant magnetoimpedance, magnetostrictive / piezoelectric composites, magnetosensitive diodes, magnetosensitive transistors, optical fibers, magneto-optics, and magnetic sensors based on micro-electromechanical systems, among others.

[0197] In one aspect, the position sensor 472 for the tracking system 480 including the absolute positioning system includes a magnetic rotation absolute positioning system. The position sensor 472 can be implemented as an AS5055EQFT monolithic magnetic rotation position sensor, which can be purchased from Austria Microsystems, AG. The position sensor 472 interfaces with the microcontroller 461 to provide an absolute positioning system. The position sensor 472 is a low voltage and low power component and includes four Hall effect elements in the area of ​​the position sensor 472 located on the magnet. A high resolution ADC and an intelligent power management controller are also provided on the chip. A coordinate rotation digital computer (CORDIC) processor (also known as the bitwise method and Volder algorithm) is provided to perform a simple and efficient algorithm to calculate hyperbolic and trigonometric functions, which only requires addition, subtraction, digit shift and table lookup operations. The angular position, alarm bit and magnetic field information are transmitted to the microcontroller 461 via a standard serial communication interface (such as a serial peripheral interface (SPI) interface). The position sensor 472 provides 12 or 14 bit resolution. The position sensor 472 may be an AS5055 chip provided in a small QFN 16-pin 4×4×0.85 mm package.

[0198] The tracking system 480 including the absolute positioning system may include and / or may be programmed to implement a feedback controller such as a PID, state feedback, and an adaptive controller. The power source converts the signal from the feedback controller into a physical input to the system: in this case, a voltage. Other examples include PWM of voltage, current, and force. In addition to the position measured by the position sensor 472, other sensor(s) may be provided to measure physical parameters of the physical system. In some aspects, the other sensor(s) may include sensor arrangements such as those described in U.S. Patent 9,345,481, entitled STAPLE CARTRIDGE TISSUE THICKNESS, issued on May 24, 2016, which is incorporated herein by reference in its entirety; U.S. Patent Application Publication 2014 / 0263552, entitled STAPLE CARTRIDGE TISSUE THICKNESS, issued on September 18, 2014, which is incorporated herein by reference in its entirety; and U.S. Patent Application Serial No. 15 / 628,175, entitled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT, filed on June 20, 2017, which is incorporated herein by reference in its entirety. In a digital signal processing system, the absolute positioning system is coupled to a digital data acquisition system, where the output of the absolute positioning system will have a finite resolution and sampling frequency. The absolute positioning system may include comparison and combination circuits to combine the calculated response with the measured response using an algorithm (such as weighted average and theoretical control loop) that drives the calculated response toward the measured response. The calculated response of the physical system takes into account characteristics such as mass, inertia, viscous friction, inductance and resistance to predict the state and output of the physical system by knowing the input.

[0199] Thus, the absolute positioning system provides the absolute position of the displacement member when the instrument is powered on, and does not retract or advance the displacement member to a reset (zero or home) position as may be required with conventional rotary encoders, which simply count the number of forward or backward steps taken by the motor 482 to infer the position of the device actuator, drive rod, knife, etc.

[0200] The sensor 474 (such as, for example, a strain gauge or a micro strain gauge) is configured to measure one or more parameters of the end effector, such as, for example, the amplitude of the strain applied to the anvil during the clamping operation, which can indicate the closing force applied to the anvil. The measured strain is converted into a digital signal and provided to the processor 462. Alternatively or in addition to the sensor 474, the sensor 476 (such as, for example, a load sensor) can measure the closing force applied to the anvil by the closed drive system. The sensor 476 such as, for example, a load sensor can measure the firing force applied to the I-beam in the firing stroke of the surgical system instrument or tool. The I-beam is configured to engage a wedge-shaped sliding member, which is configured to enable the nail driver to cam upward to push the nail out to contact with the deformation of the anvil. The I-beam also includes a sharp cutting edge, which can be used to cut off tissue when the I-beam is pushed distally by the firing rod. Alternatively, a current sensor 478 can be used to measure the current consumed by the motor 482. The force required to advance the firing member may correspond to, for example, the current consumed by the motor 482. The measured force is converted into a digital signal and provided to the processor 462.

[0201] In one form, a strain gauge sensor 474 can be used to measure the force applied to the tissue by the end effector. A strain gauge can be coupled to the end effector to measure the force on the tissue processed by the end effector. A system for measuring the force applied to the tissue grasped by the end effector includes a strain gauge sensor 474, such as, for example, a micro strain gauge, which is configured to measure, for example, one or more parameters of the end effector. In one aspect, the strain gauge sensor 474 can measure the amplitude or magnitude of the strain applied to the jaw member of the end effector during the clamping operation, which can indicate tissue compression. The measured strain is converted into a digital signal and provided to the processor 462 of the microcontroller 461. The load sensor 476 can measure the force used to operate the knife element, for example, to cut the tissue captured between the anvil and the nail magazine. A magnetic field sensor can be used to measure the thickness of the captured tissue. The measurement value of the magnetic field sensor can also be converted into a digital signal and provided to the processor 462.

[0202] The microcontroller 461 can characterize the corresponding values ​​of the selected position of the firing member and / or the velocity of the firing member using the measurements of tissue compression, tissue thickness, and / or the force required to close the end effector measured by the sensors 474, 476, respectively. In one example, the memory 468 can store techniques, formulas, and / or lookup tables that can be used by the microcontroller 461 in the evaluation.

[0203] The control system 470 of the surgical instrument or tool may also include wired or wireless communication circuitry to communicate with the modular communication hub, such as Figure 8-11 as shown in .

[0204] Fig.13A control circuit 500 is shown, which is configured to control various aspects of a surgical instrument or tool according to one aspect of the present disclosure. The control circuit 500 may be configured to implement various processes described herein. The control circuit 500 may include a microcontroller, which includes one or more processors 502 (e.g., microprocessors, microcontrollers) coupled to at least one memory circuit 504. The memory circuit 504 stores machine executable instructions that cause the processor 502 to execute machine instructions to implement various processes described herein when executed by the processor 502. The processor 502 may be any of a variety of single-core or multi-core processors known in the art. The memory circuit 504 may include a volatile storage medium and a non-volatile storage medium. The processor 502 may include an instruction processing unit 506 and an operation unit 508. The instruction processing unit may be configured to receive instructions from the memory circuit 504 of the present disclosure.

[0205] Fig.14 Combinatorial logic circuit 510 is shown, which is configured to control various aspects of a surgical instrument or tool according to one aspect of the present disclosure. Combinatorial logic circuit 510 can be configured to implement various processes described herein. Combinatorial logic circuit 510 may include a finite state machine that includes combinatorial logic 512 that is configured to receive data associated with a surgical instrument or tool at input 514, process the data through combinatorial logic 512, and provide output 516.

[0206] Fig.15 A sequential logic circuit 520 configured to control various aspects of a surgical instrument or tool is shown according to one aspect of the present disclosure. The sequential logic circuit 520 or the combinatorial logic 522 may be configured to implement the various processes described herein. The sequential logic circuit 520 may include a finite state machine. The sequential logic circuit 520 may include, for example, the combinatorial logic 522, at least one memory circuit 524, and a clock 529. The at least one memory circuit 524 may store the current state of the finite state machine. In some cases, the sequential logic circuit 520 may be synchronous or asynchronous. The combinatorial logic 522 is configured to receive data associated with a surgical instrument or tool from an input 526, process the data through the combinatorial logic 522, and provide an output 528. In other aspects, the circuit may include a processor (e.g., the processor 502, Fig.13 ) and a finite state machine to implement the various processes herein. In other embodiments, the finite state machine may include a combinational logic circuit (e.g., combinational logic circuit 510, Fig.14 ) and a sequential logic circuit 520.

[0207] Fig.16A surgical instrument or tool is shown that includes multiple motors that can be activated to perform various functions. In some cases, a first motor can be activated to perform a first function, a second motor can be activated to perform a second function, and a third motor can be activated to perform a third function. In some cases, multiple motors of the robotic surgical instrument 600 can be individually activated to cause a firing motion, a closing motion, and / or an articulation motion in an end effector. The firing motion, the closing motion, and / or the articulation motion can be transmitted to the end effector, for example, via a shaft assembly.

[0208] In some cases, the surgical instrument system or tool may include a firing motor 602. The firing motor 602 may be operably coupled to a firing motor drive assembly 604, which may be configured to transmit the firing motion generated by the motor 602 to the end effector, specifically for displacing the I-beam element. In some cases, the firing motion generated by the motor 602 may cause, for example, a staple to be deployed from a staple cartridge into tissue captured by the end effector and / or cause the cutting edge of the I-beam element to be advanced to cut the captured tissue. The I-beam element may be retracted by reversing the direction of the motor 602.

[0209] In some cases, the surgical instrument or tool may include a closing motor 603. The closing motor 603 may be operably coupled to a closing motor drive assembly 605, which is configured to transmit the closing motion generated by the motor 603 to the end effector, specifically for displacing the closing tube to close the anvil and compress the tissue between the anvil and the staple cartridge. The closing motion may cause, for example, the end effector to transition from an open configuration to a close configuration to capture tissue. The end effector may be transitioned to an open position by reversing the direction of the motor 603.

[0210] In some cases, the surgical instrument or tool may include, for example, one or more articulation motors 606a, 606b. The motors 606a, 606b may be operably coupled to respective articulation motor drive assemblies 608a, 608b, which may be configured to transmit the articulation generated by the motors 606a, 606b to the end effector. In some cases, the articulation may cause the end effector to articulate relative to an axis, for example.

[0211] As described above, surgical instruments or tools may include multiple motors that may be configured to perform various independent functions. In some cases, multiple motors of surgical instruments or tools may be individually or independently activated to perform one or more functions, while other motors remain inactive. For example, articulation motors 606a, 606b may be activated to articulate the end effector, while firing motor 602 remains inactive. Alternatively, firing motor 602 may be activated to fire multiple nails and / or advance the cutting edge, while articulation motor 606 remains inactive. In addition, closing motor 603 may be started simultaneously with firing motor 602 to advance the closing tube and I-beam element toward the distal side, as described in more detail below.

[0212] In some cases, a surgical instrument or tool may include a common control module 610 that can be used with multiple motors of the surgical instrument or tool. In some cases, the common control module 610 can adjust one of the multiple motors at a time. For example, the common control module 610 can be individually coupled to multiple motors of the surgical instrument and can be separated from the multiple motors of the surgical instrument. In some cases, multiple motors of the surgical instrument or tool can share one or more common control modules such as the common control module 610. In some cases, multiple motors of the surgical instrument or tool can independently and selectively engage the common control module 610. In some cases, the common control module 610 can switch from interfacing with one of the multiple motors of the surgical instrument or tool to interfacing with another of the multiple motors of the surgical instrument or tool.

[0213] In at least one example, the common control module 610 can selectively switch between operably engaging the articulation motors 606a, 606b and operably engaging the firing motor 602 or the closing motor 603. Fig.16 As shown in , the switch 614 can move or change between multiple positions and / or states. In the first position 616, the switch 614 can electrically couple the common control module 610 to the firing motor 602; in the second position 617, the switch 614 can electrically couple the common control module 610 to the closing motor 603; in the third position 618a, the switch 614 can electrically couple the common control module 610 to the first joint motion motor 606a; and in the fourth position 618b, the switch 614 can electrically couple the common control module 610 to, for example, the second joint motion motor 606b. In some cases, a separate common control module 610 can be electrically coupled to the firing motor 602, the closing motor 603, and the joint motion motors 606a, 606b at the same time. In some cases, the switch 614 can be a mechanical switch, an electromechanical switch, a solid-state switch, or any suitable switch mechanism.

[0214] Each of the motors 602, 603, 606a, 606b may include a torque sensor to measure the output torque on the shaft of the motor. The force on the end effector may be sensed in any conventional manner, such as by a force sensor on the outside of the jaws or by a torque sensor of the motor used to actuate the jaws.

[0215] In various cases, such as Fig.16 As shown in , the common control module 610 may include a motor driver 626, which may include one or more H-bridge field effect FETs. The motor driver 626 may regulate the power transmitted from a power source 628 to a motor coupled to the common control module 610, for example, based on input from a microcontroller 620 ("controller"). In some cases, when a motor is coupled to the common control module 610, the microcontroller 620 may be used, for example, to determine the current consumed by the motor, as described above.

[0216] In some cases, microcontroller 620 may include a microprocessor 622 ("processor") and one or more non-transitory computer-readable media or storage units 624 ("memory"). In some cases, memory 624 may store various program instructions that, when executed, may cause processor 622 to perform a number of functions and / or calculations described herein. In some cases, one or more of memory units 624 may be coupled to processor 622, for example.

[0217] In some cases, the power source 628 can be used, for example, to power the microcontroller 620. In some cases, the power source 628 can include a battery (or "battery pack" or "power pack"), such as a lithium-ion battery, for example. In some cases, the battery pack can be configured to be releasably mounted to the handle for powering the surgical instrument 600. A plurality of battery cells connected in series can be used as the power source 628. In some cases, the power source 628 can be, for example, replaceable and / or rechargeable.

[0218] In various cases, the processor 622 may control the motor driver 626 to control the position, rotation direction, and / or speed of the motor coupled to the common controller 610. In some cases, the processor 622 may signal the motor driver 626 to stop and / or deactivate the motor coupled to the common controller 610. It should be understood that the term "processor" as used herein includes any suitable microprocessor, microcontroller, or other basic computing device that combines the functions of the central processing unit (CPU) of a computer on one integrated circuit or at most several integrated circuits. A processor is a multi-purpose programmable device that receives digital data as input, processes the input according to instructions stored in its memory, and then provides a result as output. Because the processor has internal memory, it is an example of sequential digital logic. The operating objects of the processor are numbers and symbols represented in the binary number system.

[0219] In one example, processor 622 may be any single-core or multi-core processor, such as those known under the trade name ARM Cortex produced by Texas Instruments. In some cases, microcontroller 620 may be, for example, LM 4F230H5QR available from Texas Instruments. In at least one example, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4F processor core that includes: 256KB of single-cycle flash or other non-volatile memory (up to 40MHz) on-chip memory, a pre-fetch buffer for improved performance above 40MHz, 32KB of single-cycle SRAM, a Stellaris Internal ROM for software, 2KB of EEPROM, one or more PWM modules, one or more QEI simulations, one or more 12-bit ADCs with 12 analog input channels, and other features readily available. Other microcontrollers can be easily substituted for use with module 4410. Therefore, the present disclosure should not be limited to this context.

[0220] In some cases, the memory 624 may include program instructions for controlling each of the motors of the surgical instrument 600 that may be coupled to the common controller 610. For example, the memory 624 may include program instructions for controlling the firing motor 602, the closing motor 603, and the articulation motors 606a, 606b. Such program instructions may cause the processor 622 to control the firing, closing, and articulation functions based on input from an algorithm or control program of the surgical instrument or tool.

[0221] In some cases, one or more mechanisms and / or sensors (such as, for example, sensor 630) can be used to alert the processor 622 to program instructions that should be used in a particular setting. For example, the sensor 630 can alert the processor 622 to use program instructions associated with firing, closing, and articulating the end effector. In some cases, the sensor 630 can include, for example, a position sensor that can be used to sense the position of the switch 614. Thus, the processor 622 can use program instructions associated with firing the I-beam of the end effector when, for example, the sensor 630 detects that the switch 614 is in the first position 616; the processor 622 can use program instructions associated with closing the anvil when, for example, the sensor 630 detects that the switch 614 is in the second position 617; and the processor 622 can use program instructions associated with articulating the end effector when, for example, the sensor 630 detects that the switch 614 is in the third position 618a or the fourth position 618b.

[0222] Fig.17 7 is a schematic diagram of a robotic surgical instrument 700 configured to operate the surgical tools described herein according to one aspect of the present disclosure. The robotic surgical instrument 700 can be programmed or configured to control distal / proximal translation of a displacement member, distal / proximal displacement of a closure tube, shaft rotation, and articulation with a single or multiple articulation drive links. In one aspect, the surgical instrument 700 can be programmed or configured to individually control a firing member, a closing member, an axis member, and / or one or more articulation members. The surgical instrument 700 includes a control circuit 710 configured to control a motor-driven firing member, a closing member, an axis member, and / or one or more articulation members.

[0223] In one aspect, the robotic surgical instrument 700 includes a control circuit 710 configured to control the anvil 716 and I-beam 714 (including sharp cutting edges) portions of the end effector 702 via a plurality of motors 704a-704e, a removable staple cartridge 718, an axis 740, and one or more articulation members 742a, 742b. A position sensor 734 may be configured to provide position feedback of the I-beam 714 to the control circuit 710. Other sensors 738 may be configured to provide feedback to the control circuit 710. A timer / counter 731 provides timing and counting information to the control circuit 710. An energy source 712 may be provided to operate the motors 704a-704e, and a current sensor 736 provides motor current feedback to the control circuit 710. The motors 704a-704e may be operated individually by the control circuit 710 in open-loop or closed-loop feedback control.

[0224] In one aspect, the control circuit 710 may include one or more microcontrollers, microprocessors, or other suitable processors for executing instructions that cause the one or more processors to perform one or more tasks. In one aspect, the timer / counter 731 provides an output signal, such as an elapsed time or a digital count, to the control circuit 710 to correlate the position of the I-beam 714 as determined by the position sensor 734 with the output of the timer / counter 731 so that the control circuit 710 can determine the position of the I-beam 714 at a particular time (t) relative to a starting position or a time (t) when the I-beam 714 is at a particular position relative to a starting position. The timer / counter 731 can be configured to measure elapsed time, count external events, or time external events.

[0225] In one aspect, the control circuit 710 can be programmed to control the function of the end effector 702 based on one or more tissue conditions. The control circuit 710 can be programmed to sense tissue conditions, such as thickness, directly or indirectly, as described herein. The control circuit 710 can be programmed to select a firing control program or a closing control program based on the tissue conditions. The firing control program can describe the distal movement of the displacement member. Different firing control programs can be selected to better handle different tissue conditions. For example, when thicker tissue is present, the control circuit 710 can be programmed to translate the displacement member at a lower speed and / or at a lower power. When thinner tissue is present, the control circuit 710 can be programmed to translate the displacement member at a higher speed and / or at a higher power. The closing control program can control the closing force applied to the tissue by the anvil 716. Other control programs control the rotation of the shaft 740 and the articulation members 742a, 742b.

[0226] In one aspect, the control circuit 710 may generate a motor set point signal. The motor set point signal may be provided to various motor controllers 708a-708e. The motor controllers 708a-708e may include one or more circuits configured to provide motor drive signals to the motors 704a-704e to drive the motors 704a-704e as described herein. In some examples, the motors 704a-704e may be brushed DC electric motors. For example, the speed of the motors 704a-704e may be proportional to the corresponding motor drive signals. In some examples, the motors 704a-704e may be brushless DC motors, and the corresponding motor drive signals may include PWM signals provided to one or more stator windings of the motors 704a-704e. Moreover, in some examples, the motor controllers 708a-708e may be omitted, and the control circuit 710 may directly generate the motor drive signals.

[0227] In some examples, the control circuit 710 may initially operate each of the motors 704a-704e in an open-loop configuration for a first open-loop portion of the travel of the displacement member. Based on the response of the robotic surgical instrument 700 during the open-loop portion of the travel, the control circuit 710 may select a firing control program in a closed-loop configuration. The response of the instrument may include the translation distance of the displacement member during the open-loop portion, the time consumed during the open-loop portion, the energy provided to one of the motors 704a-704e during the open-loop portion, the sum of the pulse widths of the motor drive signal, etc. After the open-loop portion, the control circuit 710 may implement the selected firing control program for a second portion of the travel of the displacement member. For example, during the closed-loop portion of the travel, the control circuit 710 may modulate one of the motors 704a-704e based on the translation data describing the position of the displacement member in a closed-loop manner to cause the displacement member to translate at a constant speed.

[0228] In one aspect, the motors 704a-704e may receive power from the energy source 712. The energy source 712 may be a DC power source driven by a main AC power source, a battery, a supercapacitor, or any other suitable energy source. The motors 704a-704e may be mechanically coupled to various movable mechanical elements, such as the I-beam 714, the anvil 716, the shaft 740, the articulation 742a, and the articulation 742b, via corresponding transmissions 706a-706e. The transmissions 706a-706e may include one or more gears or other connecting rod components to couple the motors 704a-704e to the movable mechanical elements. The position sensor 734 may sense the position of the I-beam 714. The position sensor 734 may be or include any type of sensor capable of generating position data indicating the position of the I-beam 714. In some examples, the position sensor 734 may include an encoder configured to provide a series of pulses to the control circuit 710 when the I-beam 714 is translated toward the distal side and toward the proximal side. The control circuit 710 can track the pulses to determine the position of the I-beam 714. Other suitable position sensors can be used, including, for example, proximity sensors. Other types of position sensors can provide other signals indicating the movement of the I-beam 714. Moreover, in some examples, the position sensor 734 can be omitted. In the case where any of the motors 704a-704e is a stepper motor, the control circuit 710 can track the position of the I-beam 714 by aggregating the number and direction of steps that the motor 704 has been instructed to perform. The position sensor 734 can be located in the end effector 702 or at any other part of the instrument. The output of each of the motors 704a-704e includes a torque sensor 744a-744e for sensing force, and has an encoder for sensing the rotation of the drive shaft.

[0229] In one aspect, the control circuit 710 is configured to drive a firing member such as an I-beam 714 portion of the end effector 702. The control circuit 710 provides a motor set point to a motor control 708a, which provides a drive signal to the motor 704a. The output shaft of the motor 704a is coupled to a torque sensor 744a. The torque sensor 744a is coupled to a transmission 706a, which is coupled to the I-beam 714. The transmission 706a includes a movable mechanical element such as a rotating element and a firing member to control the movement of the I-beam 714 along the longitudinal axis of the end effector 702 toward the distal and proximal sides. In one aspect, the motor 704a can be coupled to a knife gear assembly, which includes a knife gear reduction group, and the knife gear reduction group includes a first knife drive gear and a second knife drive gear. The torque sensor 744a provides a firing force feedback signal to the control circuit 710. The firing force signal represents the force required to fire or displace the I-beam 714. The position sensor 734 can be configured to provide the position of the I-beam 714 along the firing stroke or the position of the firing member as a feedback signal to the control circuit 710. The end effector 702 may include an additional sensor 738 configured to provide a feedback signal to the control circuit 710. When ready for use, the control circuit 710 can provide a firing signal to the motor control 708a. In response to the firing signal, the motor 704a can drive the firing member from the proximal stroke start position to the distal end of the stroke start position along the longitudinal axis of the end effector 702. When the firing member is translated toward the distal side, the I-beam 714 having a cutting element positioned at the distal end is advanced toward the distal side to cut the tissue between the staple cartridge 718 and the anvil 716.

[0230] In one aspect, the control circuit 710 is configured to drive a closing member, such as the anvil 716 portion of the end effector 702. The control circuit 710 provides a motor set point to the motor control 708b, which provides a drive signal to the motor 704b. The output shaft of the motor 704b is coupled to the torque sensor 744b. The torque sensor 744b is coupled to the transmission 706b, which is coupled to the anvil 716. The transmission 706b includes a movable mechanical element such as a rotating element and a closing member to control the movement of the anvil 716 from an open position and a closed position. In one aspect, the motor 704b is coupled to a closing gear assembly, which includes a closing reduction gear set supported to mesh with a closing spur gear. The torque sensor 744b provides a closing force feedback signal to the control circuit 710. The closing force feedback signal represents the closing force applied to the anvil 716. The position sensor 734 can be configured to provide the position of the closing member as a feedback signal to the control circuit 710. The additional sensor 738 in the end effector 702 can provide a closing force feedback signal to the control circuit 710. The pivotable anvil 716 is positioned opposite to the staple cartridge 718. When ready for use, the control circuit 710 can provide a closing signal to the motor control 708b. In response to the closing signal, the motor 704b advances the closing member to grasp the tissue between the anvil 716 and the staple cartridge 718.

[0231] In one aspect, the control circuit 710 is configured to rotate an axis member such as the axis 740 to rotate the end effector 702. The control circuit 710 provides a motor set point to the motor control 708c, which provides a drive signal to the motor 704c. The output shaft of the motor 704c is coupled to a torque sensor 744c. The torque sensor 744c is coupled to a transmission 706c coupled to the axis 740. The transmission 706c includes a movable mechanical element such as a rotating element to control the axis 740 to rotate clockwise or counterclockwise more than 360°. In one aspect, the motor 704c is coupled to a rotation transmission assembly, which includes a tube gear section formed on (or attached to) the proximal end of the proximal closure tube to be operably engaged by a rotation gear assembly operably supported on the tool mounting plate. The torque sensor 744c provides a rotational force feedback signal to the control circuit 710. The rotational force feedback signal represents the rotational force applied to the axis 740. The position sensor 734 may be configured to provide the position of the closing member as a feedback signal to the control circuit 710. An additional sensor 738 such as a shaft encoder may provide the rotational position of the shaft 740 to the control circuit 710.

[0232] In one aspect, the control circuit 710 is configured to articulate the end effector 702. The control circuit 710 provides a motor set point to a motor control 708d, which provides a drive signal to a motor 704d. The output of the motor 704d is coupled to a torque sensor 744d. The torque sensor 744d is coupled to a transmission 706d coupled to the articulation member 742a. ​​The transmission 706d includes a movable mechanical element such as an articulation element to control the articulation of the end effector 702 ± 65°. In one aspect, the motor 704d is coupled to an articulation nut that is rotatably journaled on a proximal end portion of the distal spine and rotatably driven thereon by an articulation gear assembly. The torque sensor 744d provides an articulation force feedback signal to the control circuit 710. The articulation force feedback signal represents the articulation force applied to the end effector 702. A sensor 738 , such as an articulation encoder, may provide the articulation position of the end effector 702 to the control circuit 710 .

[0233] On the other hand, the joint motion function of the robotic surgical system 700 may include two joint motion components or connecting rods 742a, 742b. These articulated components 742a, 742b are driven by a separate disk on the robot interface (rack) driven by two motors 708d, 708e. When a separate firing motor 704a is provided, each of the joint motion connecting rods 742a, 742b can be driven in an antagonistic manner relative to another connecting rod so as to provide resistance to the head to maintain motion and load when the head is not moving, and to provide joint motion when the head is articulated. When the head rotates, the joint motion components 742a, 742b are attached to the head with a fixed radius. Therefore, when the head rotates, the mechanical advantage of the push-pull connecting rod changes. This change in mechanical advantage can be more obvious for other joint motion connecting rod drive systems.

[0234] In one aspect, one or more motors 704a-704e may include a brushed DC motor with a gearbox and a mechanical link with a firing member, a closing member, or an articulation member. Another example includes an electric motor 704a-704e that operates a movable mechanical element such as a displacement member, an articulation link, a closing tube, and an axis. External influences are unmeasured, unpredictable effects of things such as tissue, surrounding body, and friction on a physical system. Such external influences may be referred to as drag, which acts relative to one of the electric motors 704a-704e. External influences such as drag may cause the operation of a physical system to deviate from the desired operation of the physical system.

[0235] In one aspect, the position sensor 734 can be implemented as an absolute positioning system. In one aspect, the position sensor 734 can include a magnetic rotation absolute positioning system implemented as an AS5055EQFT monolithic magnetic rotation position sensor purchased from Austria Microsystems, AG. The position sensor 734 can interface with the control circuit 710 to provide an absolute positioning system. The position can include a Hall effect element located above the magnet and coupled to a CORDIC processor, which is also known as a bitwise method and Volder algorithm, which is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions, which only require addition operations, subtraction operations, digit shift operations, and table lookup operations.

[0236] In one aspect, the control circuit 710 may communicate with one or more sensors 738. The sensor 738 may be positioned on the end effector 702 and adapted to operate with the robotic surgical instrument 700 to measure various derived parameters, such as gap distance versus time, tissue compression versus time, and anvil strain versus time. The sensor 738 may include a magnetic sensor, a magnetic field sensor, a strain gauge, a load sensor, a pressure sensor, a force sensor, a torque sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor, and / or any other suitable sensor for measuring one or more parameters of the end effector 702. The sensor 738 may include one or more sensors. The sensor 738 may be located on the nail magazine 718 platform to determine tissue position using segmented electrodes. The torque sensors 744a-744e may be configured to sense forces such as firing forces, closing forces, and / or joint motion forces, etc. Thus, the control circuit 710 can sense (1) the closure load experienced by the distal closure tube and its position, (2) the firing member at the rack and its position, (3) the portion of the staple cartridge 718 having tissue thereon, and (4) the loads and positions on the two articulation rods.

[0237] In one aspect, one or more sensors 738 may include a strain gauge, such as a micro strain gauge, configured to measure the magnitude of the strain in the anvil 716 during the clamping condition. The strain gauge provides an electrical signal whose amplitude varies with the magnitude of the strain. The sensor 738 may include a pressure sensor configured to detect the pressure generated by the presence of compressed tissue between the anvil 716 and the staple cartridge 718. The sensor 738 may be configured to detect the impedance of the tissue section between the anvil 716 and the staple cartridge 718, which indicates the thickness and / or integrity of the tissue located therebetween.

[0238] In one aspect, the sensor 738 may be implemented as one or more limit switches, electromechanical devices, solid-state switches, Hall effect devices, magnetoresistive (MR) devices, giant magnetoresistive (GMR) devices, magnetometers, and the like. In other implementations, the sensor 738 may be implemented as a solid-state switch that operates under the influence of light, such as an optical sensor, an IR sensor, an ultraviolet sensor, and the like. Likewise, the switch may be a solid-state device, such as a transistor (e.g., a FET, a junction FET, a MOSFET, a bipolar transistor, and the like). In other implementations, the sensor 738 may include a non-electrical conductor switch, an ultrasonic switch, an accelerometer, an inertial sensor, and the like.

[0239] In one aspect, the sensor 738 may be configured to measure the force applied by the closure drive system to the anvil 716. For example, one or more sensors 738 may be located at the interaction point between the closure tube and the anvil 716 to detect the closing force applied by the closure tube to the anvil 716. The force applied to the anvil 716 may represent the tissue compression experienced by the tissue segment captured between the anvil 716 and the staple cartridge 718. One or more sensors 738 may be positioned at various interaction points along the closure drive system to detect the closing force applied by the closure drive system to the anvil 716. One or more sensors 738 may be sampled in real time by the processor of the control circuit 710 during the clamping operation. The control circuit 710 receives real-time sample measurements to provide and analyze time-based information and evaluate the closing force applied to the anvil 716 in real time.

[0240] In one aspect, the current sensor 736 can be used to measure the current consumed by each of the motors 704a-704e. The force required to propel any of the movable mechanical elements, such as the I-beam 714, corresponds to the current consumed by one of the motors 704a-704e. The force is converted into a digital signal and provided to the control circuit 710. The control circuit 710 can be configured to simulate the response of the actual system of the instrument in the software of the controller. The displacement member can be actuated to move the I-beam 714 in the end effector 702 at a target speed or close to the target speed. The robotic surgical system 700 may include a feedback controller, which may be one of any feedback controllers, including but not limited to, for example, PID, state feedback, linear square (LQR) and / or adaptive controllers. The robotic surgical instrument 700 may include a power source to, for example, convert a signal from the feedback controller into a physical input, such as a housing voltage, a PWM voltage, a frequency modulated voltage, a current, a torque and / or a force. Additional details are disclosed in U.S. patent application serial number 15 / 636,829, filed on June 29, 2017, entitled CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT, which is incorporated herein by reference in its entirety.

[0241] Fig.18 A block diagram of a surgical instrument 750 programmed to control distal translation of a displacement member is shown according to one aspect of the present disclosure. In one aspect, the surgical instrument 750 is programmed to control distal translation of a displacement member such as an I-beam 764. The surgical instrument 750 includes an end effector 752, which may include an anvil 766, an I-beam 764 (including a sharp cutting edge), and a removable staple cartridge 768.

[0242] The position, movement, displacement and / or translation of a linear displacement member such as the I-beam 764 may be measured by an absolute positioning system, a sensor arrangement and a position sensor 784. Since the I-beam 764 is coupled to a longitudinally movable drive member, the position of the I-beam 764 may be determined by measuring the position of the longitudinally movable drive member using the position sensor 784. Thus, in the following description, the position, displacement and / or translation of the I-beam 764 may be achieved by the position sensor 784 as described herein. The control circuit 760 may be programmed to control the translation of a displacement member such as the I-beam 764. In some examples, the control circuit 760 may include one or more microcontrollers, microprocessors or other suitable processors for executing instructions that cause the one or more processors to control the displacement member (e.g., the I-beam 764) in the manner described. In one aspect, the timer / counter 781 provides an output signal, such as an elapsed time or a digital count, to the control circuit 760 to correlate the position of the I-beam 764 as determined by the position sensor 784 with the output of the timer / counter 781 so that the control circuit 760 can determine the position of the I-beam 764 at a particular time (t) relative to a starting position. The timer / counter 781 can be configured to measure elapsed time, count external events, or time external events.

[0243] The control circuit 760 may generate a motor set point signal 772. The motor set point signal 772 may be provided to the motor controller 758. The motor controller 758 may include one or more circuits configured to provide a motor drive signal 774 to the motor 754 to drive the motor 754 as described herein. In some examples, the motor 754 may be a brushed DC electric motor. For example, the speed of the motor 754 may be proportional to the motor drive signal 774. In some examples, the motor 754 may be a brushless DC electric motor, and the motor drive signal 774 may include a PWM signal provided to one or more stator windings of the motor 754. Moreover, in some examples, the motor controller 758 may be omitted, and the control circuit 760 may directly generate the motor drive signal 774.

[0244] The motor 754 may receive power from the energy source 762. The energy source 762 may be or include a battery, a supercapacitor, or any other suitable energy source. The motor 754 may be mechanically coupled to the I-beam 764 via the transmission 756. The transmission 756 may include one or more gears or other connecting rod components to couple the motor 754 to the I-beam 764. The position sensor 784 may sense the position of the I-beam 764. The position sensor 784 may be or include any type of sensor capable of generating position data indicating the position of the I-beam 764. In some examples, the position sensor 784 may include an encoder configured to provide a series of pulses to the control circuit 760 when the I-beam 764 is translated toward the distal side and toward the proximal side. The control circuit 760 may track the pulses to determine the position of the I-beam 764. Other suitable position sensors may be used, including, for example, proximity sensors. Other types of position sensors may provide other signals indicating the movement of the I-beam 764. Moreover, in some examples, the position sensor 784 may be omitted. Where motor 754 is a stepper motor, control circuit 760 can track the position of I-beam 764 by aggregating the number and direction of steps motor 754 has been instructed to perform. Position sensor 784 may be located in end effector 752 or at any other portion of the instrument.

[0245] The control circuit 760 may communicate with one or more sensors 788. The sensor 788 may be positioned on the end effector 752 and adapted to operate with the surgical instrument 750 to measure various derived parameters, such as gap distance versus time, tissue compression versus time, and anvil strain versus time. The sensor 788 may include, for example, a magnetic sensor, a magnetic field sensor, a strain gauge, a pressure sensor, a force sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor, and / or any other suitable sensor for measuring one or more parameters of the end effector 752. The sensor 788 may include one or more sensors.

[0246] One or more sensors 788 may include a strain gauge, such as a micro strain gauge, which is configured to measure the magnitude of the strain in the anvil 766 during the clamping condition. The strain gauge provides an electrical signal whose amplitude varies with the magnitude of the strain. The sensor 788 may include a pressure sensor configured to detect the pressure generated by the presence of compressed tissue between the anvil 766 and the staple cartridge 768. The sensor 788 may be configured to detect the impedance of the tissue section between the anvil 766 and the staple cartridge 768, which indicates the thickness and / or integrity of the tissue located therebetween.

[0247] The sensor 788 may be configured to measure the force applied to the anvil 766 by the closure drive system. For example, one or more sensors 788 may be located at the interaction point between the closure tube and the anvil 766 to detect the closing force applied to the anvil 766 by the closure tube. The force applied to the anvil 766 may represent the tissue compression experienced by the tissue segment captured between the anvil 766 and the staple cartridge 768. One or more sensors 788 may be positioned at various interaction points along the closure drive system to detect the closing force applied to the anvil 766 by the closure drive system. One or more sensors 788 may be sampled in real time by the processor of the control circuit 760 during the clamping operation. The control circuit 760 receives real-time sample measurements to provide and analyze time-based information and evaluate the closing force applied to the anvil 766 in real time.

[0248] The current sensor 786 may be used to measure the current consumed by the motor 754. The force required to advance the I-beam 764 corresponds to, for example, the current consumed by the motor 754. The force is converted into a digital signal and provided to the control circuit 760.

[0249] The control circuit 760 may be configured to simulate the response of the actual system of the instrument in the software of the controller. The displacement member may be actuated to move the I-beam 764 in the end effector 752 at a target speed or close to the target speed. The surgical instrument 750 may include a feedback controller, which may be one of any feedback controllers, including but not limited to, for example, PID, state feedback, LQR, and / or adaptive controllers. The surgical instrument 750 may include a power source to, for example, convert a signal from the feedback controller into a physical input, such as a housing voltage, a PWM voltage, a frequency modulated voltage, a current, a torque, and / or a force.

[0250] The actual drive system of the surgical instrument 750 is configured to drive the displacement member, cutting member or I-beam 764 through a brushed DC motor with a gear box and a mechanical link to the articulation and / or knife system. Another example is an electric motor 754 that operates the displacement member and articulation drive of, for example, an interchangeable shaft assembly. External influences are the unmeasured, unpredictable effects of things such as tissue, surrounding body, and friction on the physical system. Such external influences may be referred to as drag, which acts against the electric motor 754. External influences such as drag may cause the operation of the physical system to deviate from the desired operation of the physical system.

[0251] Various exemplary aspects relate to a surgical instrument 750 that includes an end effector 752 having a motor-driven surgical stapling and cutting tool. For example, a motor 754 can drive a displacement member distally and proximally along a longitudinal axis of the end effector 752. The end effector 752 can include a pivotable anvil 766, and when configured for use, a staple cartridge 768 is positioned relative to the anvil 766. A clinician can grasp tissue between the anvil 766 and the staple cartridge 768, as described herein. When the instrument 750 is ready to be used, the clinician can provide a firing signal, for example, by depressing a trigger of the instrument 750. In response to the firing signal, the motor 754 can drive the displacement member distally from a proximal stroke start position to a stroke end position distal to the stroke start position along the longitudinal axis of the end effector 752. When the displacement member translates distally, an I-beam 764 having a cutting element positioned at a distal end can cut tissue between the staple cartridge 768 and the anvil 766.

[0252] In various examples, the surgical instrument 750 may include a control circuit 760 that is programmed to control the distal translation of a displacement member, such as an I-beam 764, based on one or more tissue conditions, for example. The control circuit 760 may be programmed to sense tissue conditions, such as thickness, directly or indirectly, as described herein. The control circuit 760 may be programmed to select a firing control program based on the tissue conditions. The firing control program may describe the distal movement of the displacement member. Different firing control programs may be selected to better handle different tissue conditions. For example, when thicker tissue is present, the control circuit 760 may be programmed to translate the displacement member at a lower speed and / or at a lower power. When thinner tissue is present, the control circuit 760 may be programmed to translate the displacement member at a higher speed and / or at a higher power.

[0253] In some examples, the control circuit 760 can initially operate the motor 754 in an open-loop configuration for a first open-loop portion of the displacement member's travel. Based on the response of the instrument 750 during the open-loop portion of the travel, the control circuit 760 can select a firing control program. The response of the instrument can include the distance the displacement member is translated during the open-loop portion, the time elapsed during the open-loop portion, the energy provided to the motor 754 during the open-loop portion, the sum of the pulse widths of the motor drive signal, etc. After the open-loop portion, the control circuit 760 can implement the selected firing control program for a second portion of the displacement member's travel. For example, during the closed-loop portion of the travel, the control circuit 760 can modulate the motor 754 based on the translation data describing the position of the displacement member in a closed-loop manner to cause the displacement member to translate at a constant speed. Additional details are disclosed in U.S. patent application serial number 15 / 720,852, filed on September 29, 2017, entitled SYSTEM AND METHODS FOR CONTROLLING A DISPLAY OF A SURGICAL INSTRUMENT, which is incorporated herein by reference in its entirety.

[0254] Fig.19 is a schematic diagram of a surgical instrument 790 configured to control various functions according to one aspect of the present disclosure. In one aspect, the surgical instrument 790 is programmed to control the distal translation of a displacement member such as an I-beam 764. The surgical instrument 790 includes an end effector 792, which may include an anvil 766, an I-beam 764, and a removable staple cartridge 768 that may be interchangeable with an RF cartridge 796 (shown in phantom).

[0255] In one aspect, the sensor 788 may be implemented as a limit switch, an electromechanical device, a solid-state switch, a Hall effect device, an MR device, a GMR device, a magnetometer, and the like. In other implementations, the sensor 638 may be implemented as a solid-state switch that operates under the influence of light, such as an optical sensor, an IR sensor, an ultraviolet sensor, and the like. Likewise, the switch may be a solid-state device, such as a transistor (e.g., a FET, a junction FET, a MOSFET, a bipolar transistor, and the like). In other implementations, the sensor 788 may include a non-electrical conductor switch, an ultrasonic switch, an accelerometer, an inertial sensor, and the like.

[0256] In one aspect, the position sensor 784 can be implemented as an absolute positioning system, including a magnetic rotary absolute positioning system implemented as an AS5055EQFT monolithic magnetic rotary position sensor available from Austria Microsystems, AG. The position sensor 784 can interface with the control circuit 760 to provide an absolute positioning system. The position can include a Hall effect element located above a magnet and coupled to a CORDIC processor, which is also known as a bitwise method and Volder algorithm, which is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions, which only require addition operations, subtraction operations, bit shift operations, and table lookup operations.

[0257] In one aspect, the I-beam 764 can be implemented as a knife member including a knife body that operably supports the tissue cutting blade thereon, and the I-beam can also include an anvil engagement tab or feature and a channel engagement feature or base. In one aspect, the staple cartridge 768 can be implemented as a standard (mechanical) surgical fastener cartridge. In one aspect, the RF cartridge 796 can be implemented as an RF cartridge. These and other sensor arrangements are described in co-owned U.S. patent application serial number 15 / 628,175, entitled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTORVELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT, filed on June 20, 2017, which is incorporated herein by reference in its entirety.

[0258] The position, movement, displacement and / or translation of a linear displacement member such as the I-beam 764 can be measured by an absolute positioning system, a sensor arrangement, and a position sensor, represented as position sensor 784. Since the I-beam 764 is coupled to a longitudinally movable drive member, the position of the I-beam 764 can be determined by measuring the position of the longitudinally movable drive member using the position sensor 784. Therefore, in the following description, the position, displacement and / or translation of the I-beam 764 can be achieved by the position sensor 784 as described herein. The control circuit 760 can be programmed to control the translation of the displacement member such as the I-beam 764, as described herein. In some examples, the control circuit 760 may include one or more microcontrollers, microprocessors, or other suitable processors for executing instructions that cause the one or more processors to control the displacement member (e.g., the I-beam 764) in the manner described. In one aspect, the timer / counter 781 provides an output signal, such as an elapsed time or a digital count, to the control circuit 760 to correlate the position of the I-beam 764 as determined by the position sensor 784 with the output of the timer / counter 781 so that the control circuit 760 can determine the position of the I-beam 764 at a particular time (t) relative to a starting position. The timer / counter 781 can be configured to measure elapsed time, count external events, or time external events.

[0259] The control circuit 760 may generate a motor set point signal 772. The motor set point signal 772 may be provided to the motor controller 758. The motor controller 758 may include one or more circuits configured to provide a motor drive signal 774 to the motor 754 to drive the motor 754 as described herein. In some examples, the motor 754 may be a brushed DC electric motor. For example, the speed of the motor 754 may be proportional to the motor drive signal 774. In some examples, the motor 754 may be a brushless DC electric motor, and the motor drive signal 774 may include a PWM signal provided to one or more stator windings of the motor 754. Moreover, in some examples, the motor controller 758 may be omitted, and the control circuit 760 may directly generate the motor drive signal 774.

[0260] The motor 754 may receive power from the energy source 762. The energy source 762 may be or include a battery, a supercapacitor, or any other suitable energy source. The motor 754 may be mechanically coupled to the I-beam 764 via the transmission 756. The transmission 756 may include one or more gears or other connecting rod components to couple the motor 754 to the I-beam 764. The position sensor 784 may sense the position of the I-beam 764. The position sensor 784 may be or include any type of sensor capable of generating position data indicating the position of the I-beam 764. In some examples, the position sensor 784 may include an encoder configured to provide a series of pulses to the control circuit 760 when the I-beam 764 is translated toward the distal side and toward the proximal side. The control circuit 760 may track the pulses to determine the position of the I-beam 764. Other suitable position sensors may be used, including, for example, proximity sensors. Other types of position sensors may provide other signals indicating the movement of the I-beam 764. Moreover, in some examples, the position sensor 784 may be omitted. Where motor 754 is a stepper motor, control circuit 760 can track the position of I-beam 764 by aggregating the number and direction of steps the motor has been instructed to perform. Position sensor 784 may be located in end effector 792 or at any other portion of the instrument.

[0261] The control circuit 760 may communicate with one or more sensors 788. The sensor 788 may be positioned on the end effector 792 and adapted to operate with the surgical instrument 790 to measure various derived parameters, such as gap distance versus time, tissue compression versus time, and anvil strain versus time. The sensor 788 may include, for example, a magnetic sensor, a magnetic field sensor, a strain gauge, a pressure sensor, a force sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor, and / or any other suitable sensor for measuring one or more parameters of the end effector 792. The sensor 788 may include one or more sensors.

[0262] One or more sensors 788 may include a strain gauge, such as a micro strain gauge, which is configured to measure the magnitude of the strain in the anvil 766 during the clamping condition. The strain gauge provides an electrical signal whose amplitude varies with the magnitude of the strain. The sensor 788 may include a pressure sensor configured to detect the pressure generated by the presence of compressed tissue between the anvil 766 and the staple cartridge 768. The sensor 788 may be configured to detect the impedance of the tissue section between the anvil 766 and the staple cartridge 768, which indicates the thickness and / or integrity of the tissue located therebetween.

[0263] The sensor 788 may be configured to measure the force applied by the closure drive system to the anvil 766. For example, one or more sensors 788 may be located at the interaction point between the closure tube and the anvil 766 to detect the closing force applied by the closure tube to the anvil 766. The force applied to the anvil 766 may represent the tissue compression experienced by the tissue segment captured between the anvil 766 and the staple cartridge 768. One or more sensors 788 may be positioned at various interaction points along the closure drive system to detect the closing force applied by the closure drive system to the anvil 766. One or more sensors 788 may be sampled in real time by the processor portion of the control circuit 760 during the clamping operation. The control circuit 760 receives real-time sample measurements to provide and analyze time-based information and evaluate the closing force applied to the anvil 766 in real time.

[0264] The current sensor 786 may be used to measure the current consumed by the motor 754. The force required to advance the I-beam 764 corresponds to, for example, the current consumed by the motor 754. The force is converted into a digital signal and provided to the control circuit 760.

[0265] When the RF cartridge 796 is loaded in the end effector 792 in place of the staple cartridge 768, the RF energy source 794 is coupled to the end effector 792 and applied to the RF cartridge 796. The control circuit 760 controls the delivery of RF energy to the RF cartridge 796.

[0266] Additional details are disclosed in U.S. patent application serial number 15 / 636,096 filed on June 28, 2017, entitled SURGICAL SYSTEM COUPLABLE WITH STAPLE CARTRIDGE AND RADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME, which is incorporated herein by reference in its entirety.

[0267] Generator Hardware

[0268] Fig. 20800 is a simplified block diagram of a generator 800 configured to provide, among other benefits, inductor-free tuning. Further details of the generator 800 are described in U.S. Pat. No. 9,060,775, issued Jun. 23, 2015, entitled SURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES, which is incorporated herein by reference in its entirety. The generator 800 may include a patient-isolated stage 802 that communicates with a non-isolated stage 804 via a power transformer 806. The secondary winding 808 of the power transformer 806 is included in the isolation stage 802 and may include a tap configuration (e.g., a center tap or a non-center tap configuration) to define drive signal outputs 810a, 810b, 810c for delivering drive signals to different surgical instruments, such as, for example, ultrasonic surgical instruments, RF electrosurgical instruments, and multi-function surgical instruments including ultrasonic energy modes and RF energy modes that can be delivered separately or simultaneously. Specifically, the drive signal outputs 810a, 810c can output ultrasonic drive signals (e.g., 420V root mean square (RMS) drive signals) to ultrasonic surgical devices, and the drive signal outputs 810b, 810c can output RF electrosurgical drive signals (e.g., 100V RMS drive signals) to RF electrosurgical instruments, wherein the drive signal output 810b corresponds to the center tap of the power transformer 806.

[0269] In some forms, the ultrasonic drive signal and the electrosurgical drive signal can be provided simultaneously to different surgical instruments and / or a single surgical instrument having the ability to transmit both ultrasonic energy and electrosurgical energy to tissue, such as a multifunctional surgical instrument. It should be understood that the electrosurgical signal provided to a dedicated electrosurgical instrument and / or a combined multifunctional ultrasonic / electrosurgical instrument can be a therapeutic level or sub-therapeutic level signal, wherein the sub-therapeutic signal can be used, for example, to monitor tissue or instrument conditions and provide feedback to the generator. For example, an ultrasonic signal and an RF signal can be delivered separately or simultaneously from a generator having a single output port to provide a desired output signal to the surgical instrument, as will be discussed in more detail below. Therefore, the generator can combine ultrasonic energy and electrosurgical RF energy and deliver the combined energy to the multifunctional ultrasonic / electrosurgical instrument. A bipolar electrode can be placed on one or both jaws of the end effector. In addition to electrosurgical RF energy, one jaw can be driven simultaneously by ultrasonic energy. Ultrasonic energy can be used to dissect tissue, while electrosurgical RF energy can be used for vessel sealing.

[0270] The non-isolated stage 804 may include a power amplifier 812 having an output connected to a primary winding 814 of a power transformer 806. In some forms, the power amplifier 812 may include a push-pull amplifier. For example, the non-isolated stage 804 may also include a logic device 816 for supplying a digital output to a digital-to-analog converter (DAC) circuit 818, which in turn supplies a corresponding analog signal to an input of the power amplifier 812. In some forms, the logic device 816 may include, for example, a programmable gate array (PGA), an FPGA, a programmable logic device (PLD), among other logic circuits. Thus, by controlling the input of the power amplifier 812 through the DAC circuit 818, the logic device 816 may control any one of a plurality of parameters (e.g., frequency, waveform shape, waveform amplitude) of the drive signal appearing at the drive signal outputs 810a, 810b, 810c. In certain forms, as described below, the logic device 816 in conjunction with a processor (e.g., a DSP described below) may implement a plurality of DSP-based algorithms and / or other control algorithms to control parameters of the drive signal output by the generator 800.

[0271] Power may be supplied to the power rail of the power amplifier 812 by a switch-mode regulator 820, such as a power converter. In certain forms, the switch-mode regulator 820 may include, for example, an adjustable buck regulator. For example, the non-isolated stage 804 may also include a first processor 822, which in one form may include a DSP processor, such as an Analog Devices ADSP-21469 SHARC DSP available from Analog Devices, Norwood, MA, USA, but any suitable processor may be used in various forms. In certain forms, the DSP processor 822 may control the operation of the switch-mode regulator 820 in response to voltage feedback data received by the DSP processor 822 from the power amplifier 812 via an ADC circuit 824. In one form, for example, the DSP processor 822 may receive as input a waveform envelope of a signal (e.g., an RF signal) amplified by the power amplifier 812 via the ADC circuit 824. The DSP processor 822 can then control the switch mode regulator 820 (e.g., via a PWM output) so that the rail voltage provided to the power amplifier 812 tracks the waveform envelope of the amplified signal. By dynamically modulating the rail voltage of the power amplifier 812 based on the waveform envelope, the efficiency of the power amplifier 812 can be significantly improved relative to a fixed rail voltage amplifier solution.

[0272] In certain forms, the logic device 816 in conjunction with the DSP processor 822 may implement a digital synthesis circuit such as a direct digital synthesizer control scheme to control the waveform shape, frequency and / or amplitude of the drive signal output by the generator 800. In one form, for example, the logic device 816 may implement a DDS control algorithm by recalling waveform samples stored in a dynamically updated lookup table (LUT) (such as a RAM LUT), which may be embedded in an FPGA. The control algorithm is particularly useful in ultrasound applications where an ultrasonic transducer such as an ultrasonic transducer may be driven by a pure sinusoidal current at its resonant frequency. Because other frequencies may excite parasitic resonances, minimizing or reducing the overall distortion of the motional branch current may correspondingly minimize or reduce adverse resonance effects. Because the waveform shape of the drive signal output by the generator 800 is affected by various sources of distortion present in the output drive circuit (e.g., power transformer 806, power amplifier 812), voltage and current feedback data based on the drive signal can be input into an algorithm (such as an error control algorithm implemented by the DSP processor 822) that compensates for distortion by appropriately pre-distorting or modifying the waveform samples stored in the LUT in a dynamic and ongoing manner (e.g., in real time). In one form, the amount or degree of pre-distortion applied to the LUT samples can be based on the error between the calculated motional branch current and the desired current waveform shape, where the error can be determined on a sample-by-sample basis. In this way, the pre-distorted LUT samples, when processed by the drive circuit, can cause the motional branch drive signal to have a desired waveform shape (e.g., a sinusoidal shape) to optimally drive the ultrasonic transducer. Therefore, in such forms, when the distortion effects are taken into account, the LUT waveform samples will not exhibit the desired waveform shape of the drive signal, but rather will exhibit the waveform shape required to ultimately produce the desired waveform shape of the motional branch drive signal.

[0273] The non-isolated stage 804 may also include a first ADC circuit 826 and a second ADC circuit 828 coupled to the output of the power transformer 806 via respective isolation transformers 830, 832 for respectively sampling the voltage and current of the drive signal output by the generator 800. In certain forms, the ADC circuits 826, 828 may be configured to sample at a high speed (e.g., 80 megasamples / second (MSPS)) to enable oversampling of the drive signal. In one form, for example, the sampling speed of the ADC circuits 826, 828 may enable oversampling of the drive signal by approximately 200x (depending on the frequency). In certain forms, the sampling operation of the ADC circuits 826, 828 may be performed by having a single ADC circuit receive the input voltage and current signals via a two-way multiplexer. By using high speed sampling in forms of the generator 800, calculations of complex currents flowing through the dynamical branches (which in some forms can be used to implement the DDS-based waveform shape control described above), accurate digital filtering of the sampled signals, and calculation of actual power consumption with high accuracy can be achieved, among other things. The voltage and current feedback data output by the ADC circuits 826, 828 can be received and processed by the logic device 816 (e.g., first-in, first-out (FIFO) buffer, multiplexer) and stored in a data memory for subsequent retrieval by, for example, the DSP processor 822. As described above, the voltage and current feedback data can be used as input to an algorithm for pre-distorting or modifying LUT waveform samples in a dynamic, ongoing manner. In some forms, when voltage and current feedback data pairs are acquired, it may be necessary to index each stored voltage and current feedback data pair based on or otherwise associated with the corresponding LUT sample output by the logic device 816. Synchronizing the LUT samples and the voltage and current feedback data in this manner facilitates accurate timing and stability of the pre-distortion algorithm.

[0274] In certain forms, the voltage and current feedback data may be used to control the frequency and / or amplitude (e.g., current amplitude) of the drive signal. In one form, for example, the voltage and current feedback data may be used to determine the impedance phase. The frequency of the drive signal may then be controlled to minimize or reduce the difference between the determined impedance phase and the impedance phase set point (e.g., 0°), thereby minimizing or reducing the effects of harmonic distortion and correspondingly improving the impedance phase measurement accuracy. The determination of the phase impedance and frequency control signal may be implemented in the DSP processor 822, for example, where the frequency control signal is provided as an input to a DDS control algorithm implemented by the logic device 816.

[0275] In another form, for example, current feedback data may be monitored in order to maintain the current amplitude of the drive signal at a current amplitude set point. The current amplitude set point may be specified directly or determined indirectly based on a particular voltage amplitude and power set point. In certain aspects, control of the current amplitude may be achieved by a control algorithm in the DSP processor 822, such as, for example, a proportional integral derivative (PID) control algorithm. The variables controlled by the control algorithm in order to properly control the current amplitude of the drive signal may include, for example, scaling of the LUT waveform samples stored in the logic device 816 and / or the full-scale output voltage of the DAC circuit 818 (which provides input to the power amplifier 812) via the DAC circuit 834.

[0276] The non-isolated stage 804 may also include a second processor 836 for providing user interface (UI) functions and the like. In one form, the UI processor 836 may include, for example, an Atmel AT91SAM9263 processor with an ARM 926EJ-S core purchased from Atmel Corporation, San Jose, California, USA. Examples of UI functions supported by the UI processor 836 may include audible and visual user feedback, communication with peripheral devices (e.g., via a USB interface), communication with a foot switch, communication with an input device (e.g., a touch screen display), and communication with an output device (e.g., a speaker). The UI processor 836 may communicate with the DSP processor 822 and the logic device 816 (e.g., via an SPI bus). Although the UI processor 836 may primarily support UI functions, in some forms, it may also cooperate with the DSP processor 822 to mitigate risks. For example, the UI processor 836 may be programmed to monitor various aspects of user input and / or other input (e.g., touch screen input, foot switch input, temperature sensor input) and disable the drive output of the generator 800 when an error condition is detected.

[0277] In certain forms, both the DSP processor 822 and the UI processor 836 may, for example, determine and monitor the operating state of the generator 800. For the DSP processor 822, the operating state of the generator 800 may indicate, for example, which control and / or diagnostic processes the DSP processor 822 implements. For the UI processor 836, the operating state of the generator 800 may indicate, for example, which elements of the UI (e.g., display screen, sound) may be presented to the user. The respective DSP processor 822 and UI processor 836 may independently maintain the current operating state of the generator 800 and identify and evaluate possible transitions of the current operating state. The DSP processor 822 may serve as the principal in this relationship and determine when a transition between operating states will occur. The UI processor 836 may note valid transitions between operating states and may verify whether a particular transition is appropriate. For example, when the DSP processor 822 commands the UI processor 836 to transition to a particular state, the UI processor 836 may verify that the requested transition is valid. If the UI processor 836 determines that the requested transition between states is invalid, the UI processor 836 may cause the generator 800 to enter a fault mode.

[0278] The non-isolated stage 804 may also include a controller 838 for monitoring input devices (e.g., capacitive touch sensors, capacitive touch screens for turning the generator 800 on and off). In certain forms, the controller 838 may include at least one processor and / or other control device in communication with the UI processor 836. In one form, for example, the controller 838 may include a processor (e.g., a Meg168 8-bit controller available from Atmel) configured to monitor user input provided via one or more capacitive touch sensors. In one form, the controller 838 may include a touch screen controller (e.g., a QT5480 touch screen controller available from Atmel) to control and manage the collection of touch data from the capacitive touch screen.

[0279] In certain forms, when the generator 800 is in the "power off" state, the controller 838 may continue to receive operating power (e.g., via a line from a power source of the generator 800, such as the power source 854 described below). In this manner, the controller 838 may continue to monitor an input device (e.g., a capacitive touch sensor located on a front panel of the generator 800) to turn the generator 800 on and off. When the generator 800 is in the power off state, if user activation of the "on / off" input device is detected, the controller 838 may cycle the power source (e.g., enable operation of one or more DC / DC voltage converters 856 of the power source 854). The controller 838 may thus initiate a sequence that causes the generator 800 to transition to the "power on" state. Conversely, when the generator 800 is in the power on state, if activation of the "on / off" input device is detected, the controller 838 may initiate a sequence that causes the generator 800 to transition to the power off state. In certain forms, for example, the controller 838 may report activation of an "on / off" input device to the UI processor 836, which in turn implements the required sequence of processes to transition the generator 800 to the power-off state. In such forms, the controller 838 may not have an independent ability to remove power from the generator 800 after the power-on state is established.

[0280] In some forms, the controller 838 may cause the generator 800 to provide audible or other sensory feedback to alert the user that a power-on or power-off sequence has begun. Such an alert may be provided when a power-on or power-off sequence begins and before other processes associated with the sequence begin.

[0281] In certain forms, the isolation stage 802 may include an instrument interface circuit 840, e.g., to provide a communication interface between the control circuitry of the surgical instrument (e.g., control circuitry including a handpiece switch) and components of the non-isolated stage 804, such as, for example, the logic device 816, the DSP processor 822, and / or the UI processor 836. The instrument interface circuit 840 may exchange information with components of the non-isolated stage 804 via a communication link (such as, for example, an IR-based communication link) that maintains a suitable degree of electrical isolation between the isolation stage 802 and the non-isolated stage 804. Power may be supplied to the instrument interface circuit 840 using, for example, a low dropout voltage regulator powered by an isolation transformer, which is driven from the non-isolated stage 804.

[0282] In one form, the instrument interface circuit 840 may include a logic circuit 842 (e.g., a logic circuit, a programmable logic circuit, a PGA, an FPGA, a PLD) in communication with a signal conditioning circuit 844. The signal conditioning circuit 844 may be configured to receive a periodic signal (e.g., a 2kHz square wave) from the logic circuit 842 to generate a bipolar interrogation signal having the same frequency. For example, the interrogation signal may be generated using a bipolar current source fed by a differential amplifier. The interrogation signal may be transmitted to a surgical instrument control circuit (e.g., by using a conductive pair in a cable connecting the generator 800 to the surgical instrument) and monitored to determine the state or configuration of the control circuit. The control circuit may include a plurality of switches, resistors, and / or diodes to modify one or more characteristics of the interrogation signal (e.g., amplitude, rectification) so that the state or configuration of the control circuit can be uniquely discerned based on the one or more characteristics. In one form, for example, the signal conditioning circuit 844 may include an ADC circuit for generating a sample of a voltage signal appearing at the input of the control circuit due to the interrogation signal passing through the control circuit. Subsequently, logic circuit 842 (or a component of non-isolated stage 804) may determine a state or configuration of the control circuit based on the ADC circuit samples.

[0283] In one form, the instrument interface circuit 840 may include a first data circuit interface 846 to enable information exchange between the logic circuit 842 (or other elements of the instrument interface circuit 840) and the first data circuit disposed in the surgical instrument or otherwise associated with the surgical instrument. In some forms, for example, the first data circuit may be disposed in a cable integrally attached to the surgical instrument handpiece, or in an adapter for interfacing a specific surgical instrument type or model with the generator 800. The first data circuit may be implemented in any suitable manner and may communicate with the generator according to any suitable protocol including, for example, those described herein with respect to the first data circuit. In some forms, the first data circuit may include a non-volatile storage device, such as an EEPROM device. In some forms, the first data circuit interface 846 may be implemented independently of the logic circuit 842 and include a suitable circuit system (e.g., a discrete logic device, a processor) to enable communication between the logic circuit 842 and the first data circuit. In other forms, the first data circuit interface 846 may be integrated with the logic device 842.

[0284] In some forms, the first data circuit may store information related to the associated specific surgical instrument. Such information may include, for example, a model number, a serial number, a number of operations in which the surgical instrument has been used, and / or any other type of information. Such information may be read by the instrument interface circuit 840 (e.g., via the logic circuit 842), transmitted to the components of the non-isolated stage 804 (e.g., transmitted to the logic device 816, the DSP processor 822 and / or the UI processor 836) to be presented to the user via the output device and / or control the function or operation of the generator 800. In addition, any type of information may be transmitted to the first data circuit via the first data circuit interface 846 (e.g., using the logic circuit 842) for storage therein. Such information may include, for example, an updated number of operations in which the surgical instrument has been used and / or the date and / or time of its use.

[0285] As previously discussed, surgical instruments may be detachable from handpieces (e.g., multifunctional surgical instruments may be detachable from handpieces) to facilitate instrument interchangeability and / or disposability. In such cases, the ability of conventional generators to identify the specific instrument configuration being used and to optimize control and diagnostic processes accordingly may be limited. However, addressing this by adding readable data circuits to surgical instruments is problematic from a compatibility perspective. For example, designing a surgical instrument to maintain backward compatibility with a generator that lacks the requisite data reading functionality may be impractical due to, for example, different signaling schemes, design complexity, and cost. The form of the instrument described herein addresses these issues by using a data circuit that can be economically implemented in existing surgical instruments with minimal design changes to maintain compatibility of the surgical instrument with the current generator platform.

[0286] In addition, the form of the generator 800 can realize communication with the data circuit based on the instrument. For example, the generator 800 can be configured to communicate with the second data circuit contained in the instrument (e.g., a multifunctional surgical instrument). In some forms, the second data circuit can be implemented in a manner similar to the first data circuit described herein. The instrument interface circuit 840 may include a second data circuit interface 848 for realizing the communication. In one form, the second data circuit interface 848 may include a tri-state digital interface, but other interfaces may also be used. In some forms, the second data circuit may generally be any circuit for transmitting and / or receiving data. In one form, for example, the second data circuit may store information related to the associated specific surgical instrument. Such information may include, for example, a model number, a serial number, a plurality of operations in which the surgical instrument has been used, and / or any other type of information.

[0287] In some forms, the second data circuit may store information about the electrical and / or ultrasonic performance of the associated ultrasonic transducer, end effector, or ultrasonic drive system. For example, the first data circuit may indicate an aging frequency slope, as described herein. In addition or alternatively, any type of information may be transmitted to the second data circuit via the second data circuit interface 848 (e.g., using the logic circuit 842) for storage therein. Such information may, for example, include an updated number of operations in which a surgical instrument is used and / or the date and / or time of its use. In certain forms, the second data circuit may transmit data collected by one or more sensors (e.g., an instrument-based temperature sensor). In certain forms, the second data circuit may receive data from the generator 800 and provide an indication to the user based on the received data (e.g., an LED indication or other visual indication).

[0288] In certain forms, the second data circuit and the second data circuit interface 848 may be configured such that communication between the logic circuit 842 and the second data circuit may be achieved without providing additional conductors for this purpose (e.g., dedicated conductors of a cable connecting the hand piece to the generator 800). In one form, for example, a single bus communication scheme implemented on an existing cable (such as one of the conductors used to transmit an interrogation signal from the signal conditioning circuit 844 to the control circuit in the hand piece) may be used to transmit information to and from the second data circuit. In this manner, design changes or modifications to the surgical instrument that may otherwise be necessary may be minimized or reduced. Furthermore, because the different types of communications implemented on a common physical channel may be frequency-band separated, the presence of the second data circuit may be "invisible" to generators that do not have the requisite data reading functionality, thereby enabling backward compatibility of surgical instruments.

[0289] In some forms, the isolation stage 802 may include at least one blocking capacitor 850-1, which is connected to the drive signal output 810b to prevent DC current from flowing to the patient. For example, the signal blocking capacitor may be required to comply with medical regulations or standards. Although errors are relatively rare in single capacitor designs, such errors may have adverse consequences. In one form, a second blocking capacitor 850-2 may be provided in series with the blocking capacitor 850-1, wherein current leakage from a point between the blocking capacitors 850-1 and 850-2 is monitored, for example, by an ADC circuit 852 to sample the voltage induced by the leakage current. These samples may be received by, for example, a logic circuit 842. Based on changes in the leakage current (as shown in the voltage samples), the generator 800 can determine when at least one of the blocking capacitors 850-1, 850-2 fails, thereby having an advantage over a single capacitor design with a single failure point.

[0290] In certain forms, the non-isolated stage 804 may include a power source 854 for delivering DC power at a suitable voltage and current. The power source may include, for example, a 400W power source for delivering a system voltage of 48VDC. The power source 854 may also include one or more DC / DC voltage converters 856 for receiving the output of the power source to generate a DC output at the voltage and current required by the various components of the generator 800. As described above in conjunction with the controller 838, one or more of the DC / DC voltage converters 856 may receive input from the controller 838 when the controller 838 detects that a user activates an "on / off" input device to enable operation of the DC / DC voltage converter 856 or wake up the DC / DC voltage converter.

[0291] Fig.21 An example of a generator 900 is shown, which is a generator 800 ( Fig. 20 ) is a form of a surgical instrument. Generator 900 is configured to deliver multiple energy modalities to a surgical instrument. Generator 900 provides RF signals and ultrasonic signals for independently or simultaneously delivering energy to a surgical instrument. The RF signal and the ultrasonic signal may be provided separately or in combination, and may be provided simultaneously. As described above, at least one generator output may deliver multiple energy modalities (e.g., ultrasound, bipolar or monopolar RF, irreversible and / or reversible electroporation and / or microwave energy, etc.) through a single port, and these signals may be delivered separately or simultaneously to an end effector to treat tissue.

[0292] The generator 900 includes a processor 902 coupled to a waveform generator 904. The processor 902 and the waveform generator 904 are configured to generate various signal waveforms based on information stored in a memory coupled to the processor 902, which is not shown for clarity of the present disclosure. Digital information associated with the waveform is provided to the waveform generator 904, which includes one or more DAC circuits to convert digital inputs into analog outputs. The analog output is fed to the amplifier 1106 for signal conditioning and amplification. The conditioned and amplified output of the amplifier 906 is coupled to the power transformer 908. The signal is coupled to the secondary side in the patient isolation side through the power transformer 908. The first signal of the first energy mode is provided to the surgical instrument between the terminals marked as ENERGY1 and RETURN. The second signal of the second energy mode is coupled across the capacitor 910 and provided to the surgical instrument between the terminals marked as ENERGY2 and RETURN. It should be understood that more than two energy modes may be output, and thus the subscript "n" may be used to specify that up to n ENERGYn terminals may be provided, where n is a positive integer greater than 1. It should also be understood that up to "n" return paths RETURNn may be provided without departing from the scope of the present disclosure.

[0293] The first voltage sensing circuit 912 is coupled to both ends of the terminals marked as ENERGY1 and RETURN paths to measure the output voltage therebetween. The second voltage sensing circuit 924 is coupled to both ends of the terminals marked as ENERGY2 and RETURN paths to measure the output voltage therebetween. As shown, the current sensing circuit 914 is arranged in series with the RETURN branch on the secondary side of the power transformer 908 to measure the output current of any energy mode. If a different return path is provided for each energy mode, a separate current sensing circuit should be provided in each return branch. The outputs of the first voltage sensing circuit 912 and the second voltage sensing circuit 924 are provided to the corresponding isolation transformers 916, 922, and the output of the current sensing circuit 914 is provided to another isolation transformer 918. The outputs of the isolation transformers 916, 928, 922 on the primary side of the power transformer 908 (non-patient isolation side) are provided to one or more ADC circuits 926. The digitized output of the ADC circuit 926 is provided to the processor 902 for further processing and calculation. The output voltage and output current feedback information can be used to adjust the output voltage and current provided to the surgical instrument and calculate parameters such as output impedance. Input / output communication between the processor 902 and the patient isolation circuit is provided through the interface circuit 920. The sensor can also be in electrical communication with the processor 902 through the interface 920.

[0294] In one aspect, the impedance may be determined by the processor 902 by dividing the output of a first voltage sensing circuit 912 coupled across terminals labeled ENERGY1 / RETURN or a second voltage sensing circuit 924 coupled across terminals labeled ENERGY2 / RETURN by the output of a current sensing circuit 914 arranged in series with the RETURN branch on the secondary side of the power transformer 908. The outputs of the first voltage sensing circuit 912 and the second voltage sensing circuit 924 are provided to separate isolation transformers 916, 922, and the output of the current sensing circuit 914 is provided to another isolation transformer 916. The digitized voltage and current sense measurements from the ADC circuit 926 are provided to the processor 902 for calculating the impedance. For example, the first energy modality ENERGY1 may be ultrasonic energy, and the second energy modality ENERGY2 may be RF energy. However, in addition to ultrasonic and bipolar or monopolar RF energy modalities, other energy modalities include irreversible and / or reversible electroporation and / or microwave energy, etc. Moreover, although Fig.21The illustrated example shows that a single return path RETURN may be provided for two or more energy modalities, but in other aspects, multiple return paths RETURNn may be provided for each energy modality ENERGYn. Thus, as described herein, the ultrasonic transducer impedance may be measured by dividing the output of the first voltage sensing circuit 912 by the output of the current sensing circuit 914, and the tissue impedance may be measured by dividing the output of the second voltage sensing circuit 924 by the output of the current sensing circuit 914.

[0295] like Fig.21 As shown in , a generator 900 including at least one output port may include a power transformer 908 having a single output and multiple taps to provide power to an end effector in the form of one or more energy modalities (such as ultrasound, bipolar or monopolar RF, irreversible and / or reversible electroporation, and / or microwave energy, etc.), for example, depending on the type of tissue treatment being performed. For example, the generator 900 may deliver energy with a higher voltage and lower current to drive an ultrasonic transducer, deliver energy with a lower voltage and higher current to drive an RF electrode for sealing tissue, or deliver energy with a coagulation waveform for use with monopolar or bipolar RF electrosurgical electrodes. The output waveform from the generator 900 may be manipulated, switched, or filtered to provide a frequency to the end effector of the surgical instrument. The connection of the ultrasonic transducer to the output of the generator 900 will preferably be located between the outputs labeled ENERGY1 and RETURN, as shown in FIG. Fig.21 In one example, the connection of the RF bipolar electrode to the generator 900 output will preferably be between the outputs labeled ENERGY2 and RETURN. In the case of a monopolar output, the preferred connection would be an active electrode (e.g., a pen or other probe) at the ENERGY2 output and a suitable return pad connected to the RETURN output.

[0296] Additional details are disclosed in U.S. patent application publication 2017 / 0086914, entitled TECHNIQUES FOR OPERATING GENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICAL INSTRUMENTS, published on March 30, 2017, which is incorporated herein by reference in its entirety.

[0297] As used throughout this specification, the term "wireless" and its derivatives may be used to describe circuits, devices, systems, methods, techniques, communication channels, etc. that can transmit data through a non-solid medium using modulated electromagnetic radiation. The term does not mean that the associated organization does not contain any wires, although in some aspects they may not. The communication module may implement any of a variety of wireless or wired communication standards or protocols, including but not limited to Wi-Fi (IEEE 802.11 series), WiMAX (IEEE 802.16 series), IEEE 802.20, Long Term Evolution (LTE), Ev-DO, HSPA+, HSDPA+, HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT, Bluetooth, and its Ethernet derivatives, and any other wireless and wired protocols designated as 3G, 4G, 5G and above. The computing module may include multiple communication modules. For example, the first communication module may be dedicated to shorter-range wireless communications such as Wi-Fi and Bluetooth, and the second communication module may be dedicated to longer-range wireless communications such as GPS, EDGE, GPRS, CDMA, WiMAX, LTE, Ev-DO, etc.

[0298] As used herein, a processor or processing unit is an electronic circuit that performs operations on some external data source (usually a memory or some other data stream). The term is used herein to refer to a central processing unit (Central Processing Unit) in one or more systems (especially System on Chip (SoC)) that combine multiple specialized "processors".

[0299] As used herein, a system on a chip or system on a chip (SoC or SOC) is an integrated circuit (also referred to as an "IC" or "chip") that integrates all the components of a computer or other electronic system. It can contain digital, analog, mixed signal, and often radio frequency functions - all on a single substrate. A SoC integrates a microcontroller (or microprocessor) with advanced peripherals such as a graphics processing unit (GPU), a Wi-Fi module, or a coprocessor. A SoC may or may not include built-in memory.

[0300] As used herein, a microcontroller or controller is a system that integrates a microprocessor with peripheral circuits and memory. A microcontroller (or MCU for a microcontroller unit) can be implemented as a small computer on a single integrated circuit. It can be similar to a SoC; an SoC may include a microcontroller as one of its components. A microcontroller may include one or more core processing units (CPUs) as well as memory and programmable input / output peripherals. Program memory in the form of ferroelectric RAM, NOR flash memory, or OTP ROM, as well as a small amount of RAM, is also often included on the chip. Compared to microprocessors used in personal computers or other general-purpose applications consisting of various discrete chips, microcontrollers can be used for embedded applications.

[0301] As used herein, the term controller or microcontroller may be a stand-alone IC or chip device that interfaces with peripheral devices. This may be a link between the two components of a computer or a controller on an external device that manages the operation of the device (and the connection to the device).

[0302] Any of the processors or microcontrollers described herein may be any single-core or multi-core processor, such as those offered by Texas Instruments under the trade name ARM Cortex. In one aspect, the processor may be, for example, the LM4F230H5QR ARMCortex-M4F processor core available from Texas Instruments, which includes: 256KB of single-cycle flash or other non-volatile memory (up to 40 MHz) on-chip memory, a pre-fetch buffer for improving performance beyond 40 MHz, 32KB of single-cycle serial random access memory (SRAM), a Stellaris Internal read-only memory (ROM) for software, 2KB of electrically erasable programmable read-only memory (EEPROM), one or more pulse width modulation (PWM) modules, one or more quadrature encoder input (QEI) simulations, one or more 12-bit analog-to-digital converters (ADCs) with 12 analog input channels, and other features that are readily available.

[0303] In one example, the processor may include a safety controller including two families based on controllers such as the TMS570 and RM4x also offered by Texas Instruments under the trade name Hercules ARMCortex R4. The safety controller may be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide an advanced integrated safety feature structure while delivering scalable performance, connectivity, and memory options.

[0304] The modular device includes a module that can be accommodated in a surgical hub (such as a combination of Figure 3 and Fig. 9The invention relates to a surgical device or instrument that can be connected to various modules so as to be connected or paired with a corresponding surgical hub. The modular device includes, for example, intelligent surgical instruments, medical imaging devices, suction / irrigation devices, smoke evacuators, energy generators, ventilators, insufflators, and displays. The modular device described herein can be controlled by a control algorithm. The control algorithm can be executed on the modular device itself, on a surgical hub paired with a specific modular device, or on both the modular device and the surgical hub (e.g., via a distributed computing architecture). In some examples, the control algorithm of the modular device controls the device based on data sensed by the modular device itself (i.e., by sensors in, on, or connected to the modular device through the modular device). The data can be related to the patient being operated on (e.g., tissue properties or insufflation pressure) or the modular device itself (e.g., the rate at which the knife is advanced, the motor current, or the energy level). For example, the control algorithm of a surgical suturing and cutting instrument can control the rate at which the motor of the instrument drives its knife through the tissue according to the resistance encountered by the knife as it advances.

[0305] Situational Awareness

[0306] Situational awareness is the ability of some aspects of a surgical system to determine or infer information related to a surgical procedure from data received from a database and / or instrument. The information may include the type of procedure being performed, the type of tissue being operated on, or the body cavity that is the subject of the procedure. Using contextual information related to a surgical procedure, a surgical system can, for example, improve the way it controls modular devices connected thereto (e.g., robotic arms and / or robotic surgical tools) and provide contextual information or suggestions to a surgeon during a surgical procedure.

[0307] See now Fig.49 , which shows a timeline 5200 depicting the situational awareness of a hub, such as a surgical hub 106 or 206. The timeline 5200 is an illustrative surgical procedure and background information that the surgical hub 106, 206 can derive from data received from data sources at each step in the surgical procedure. The timeline 5200 depicts typical steps that nurses, surgeons, and other medical personnel will take during a segmentectomy procedure, starting with setting up the operating room and ending with transferring the patient to a postoperative recovery room.

[0308] The situational awareness surgical hub 106, 206 receives data from data sources throughout the surgical procedure, including data generated each time a medical professional utilizes a modular device paired with the surgical hub 106, 206. The surgical hub 106, 206 may receive this data from paired modular devices and other data sources, and continually derive inferences (i.e., contextual information) about the ongoing procedure as new data is received, such as which step of the procedure is being performed at any given time. The situational awareness system of the surgical hub 106, 206 is capable of, for example, recording data related to the procedure for generating a report, verifying the steps being taken by the medical professional, providing data or prompts that may be related to a particular procedure step (e.g., via a display screen), adjusting a modular device based on the context (e.g., activating a monitor, adjusting the field of view (FOV) of a medical imaging device, or changing the energy level of an ultrasonic surgical instrument or an RF electrosurgical instrument), and taking any other such actions described above.

[0309] As a first step 5202 in this exemplary procedure, hospital staff retrieves the patient's electronic medical record (EMR) from the hospital's EMR database. Based on the selected patient data in the EMR, the surgical hub 106, 206 determines that the procedure to be performed is a thoracic procedure.

[0310] In a second step 5204, the staff scans the incoming medical supplies for the procedure. The surgical hub 106, 206 cross-references the scanned supplies with a list of supplies used in various types of procedures and confirms that the mix supplied corresponds to a thorax protocol. Additionally, the surgical hub 106, 206 can also determine that the procedure is not a wedge protocol (because the incoming supplies lack certain supplies required for a thorax wedge protocol, or otherwise do not correspond to a thorax wedge protocol).

[0311] In a third step 5206, the medical personnel scans the patient belt via a scanner communicatively connected to the surgical hub 106, 206. The surgical hub 106, 206 may then confirm the identity of the patient based on the scanned data.

[0312] In a fourth step 5208, the medical staff turns on the auxiliary equipment. The auxiliary equipment utilized may vary depending on the type of surgical procedure and the technique to be used by the surgeon, but in this exemplary case, they include a smoke evacuator, an insufflator, and a medical imaging device. When activated, as part of its initialization process, the auxiliary equipment, which is a modular device, can be automatically paired with a surgical hub 106, 206 located in a specific vicinity of the modular device. The surgical hub 106, 206 can then derive background information about the surgical procedure by detecting the type of modular device paired with it during this preoperative phase or initialization phase. In this specific example, the surgical hub 106, 206 determines that the surgical procedure is a VATS procedure based on this specific combination of paired modular devices. Based on a combination of data from the patient's EMR, a list of medical supplies used in the procedure, and the type of modular device connected to the hub, the surgical hub 106, 206 can generally infer the specific procedure that the surgical team will perform. Once the surgical hub 106, 206 knows what specific procedure is being performed, the surgical hub 106, 206 can retrieve the steps of that procedure from memory or the cloud and then cross-reference the data it subsequently receives from connected data sources (e.g., modular devices and patient monitoring devices) to infer what steps of the surgical procedure the surgical team is performing.

[0313] In a fifth step 5210, a staff member attaches EKG electrodes and other patient monitoring devices to the patient. The EKG electrodes and other patient monitoring devices can be paired with the surgical hub 106, 206. When the surgical hub 106, 206 begins receiving data from the patient monitoring devices, the surgical hub 106, 206 thus confirms that the patient is in the operating room.

[0314] In a sixth step 5212, the medical personnel induces anesthesia in the patient. The surgical hub 106, 206 may infer that the patient is under anesthesia based on data from the modular device and / or the patient monitoring device (including, for example, EKG data, blood pressure data, ventilator data, or a combination thereof). Upon completion of the sixth step 5212, the preoperative portion of the lung segmental resection procedure is completed and the surgical portion begins.

[0315] In a seventh step 5214, collapse the patient's lung being operated on (while ventilation is switched to the contralateral lung). For example, the surgical hub 106, 206 may infer from the ventilator data that the patient's lung has collapsed. The surgical hub 106, 206 may infer that the surgical portion of the protocol has begun because it may compare the detection of the patient's lung collapsing to the expected steps of the protocol (which may have been previously accessed or retrieved) to determine that collapsing the lung is a surgical step in that particular protocol.

[0316] In an eighth step 5216, a medical imaging device (e.g., an endoscope) is inserted and video from the medical imaging device is initiated. The surgical hub 106, 206 receives medical imaging device data (i.e., video or image data) through its connection to the medical imaging device. After receiving the medical imaging device data, the surgical hub 106, 206 can determine that the laparoscopic portion of the surgical procedure has begun. Additionally, the surgical hub 106, 206 can determine that the particular procedure being performed is a segmentectomy, rather than a lobectomy (note that a wedge procedure has been excluded based on the data received by the surgical hub 106, 206 at the second step 5204 of the procedure). From the medical imaging device 124 ( Figure 2 ) can be used to determine contextual information related to the type of procedure being performed in a variety of different ways, including by determining the angle of the medical imaging device relative to the visualization orientation of the patient's anatomy, monitoring the number of medical imaging devices utilized (i.e., activated and paired with the surgical hub 106, 206), and monitoring the type of visualization device utilized. For example, one technique for performing a VATS lobectomy places a camera in the lower anterior corner of the patient's thorax above the diaphragm, while a technique for performing a VATS segmentectomy places a camera in an anterior intercostal position relative to the segmental fissure. For example, using pattern recognition or machine learning techniques, a situational awareness system can be trained to recognize the positioning of the medical imaging device based on the visualization of the patient's anatomy. As another example, one technique for performing a VATS lobectomy utilizes a single medical imaging device, while another technique for performing a VATS segmentectomy utilizes multiple cameras. As another example, a technique for performing a VATS segmentectomy utilizes an infrared light source (which can be communicatively coupled to the surgical hub as part of the visualization system) to visualize a segmental fissure that is not used in a VATS pulmonary resection. By tracking any or all of this data from the medical imaging device, the surgical hub 106, 206 can therefore determine the specific type of surgical procedure being performed and / or the techniques used for a particular type of surgical procedure.

[0317] In step nine 5218, the surgical team begins the dissection step of the protocol. The surgical hub 106, 206 may infer that the surgeon is dissecting to mobilize the patient's lung because it receives data from the RF generator or ultrasonic generator indicating that an energy instrument is being fired. The surgical hub 106, 206 may interleave the received data with the retrieval step of the surgical protocol to determine that the energy instrument fired at this point in the process (i.e., after the previously discussed protocol steps are completed) corresponds to the dissection step. In some cases, the energy instrument may be an energy tool mounted to a robotic arm of a robotic surgical system.

[0318] In step 10 5220, the surgical team proceeds with the ligation step of the procedure. The surgical hub 106, 206 may infer that the surgeon is ligating the artery and vein because it receives data from the surgical stapling and cutting instrument indicating that the instrument is being fired. Similar to the previous step, the surgical hub 106, 206 may derive this inference by cross-referencing the receipt of data from the surgical stapling and cutting instrument with the retrieval step in the process. In some cases, the surgical instrument may be a surgical tool mounted to a robotic arm of a robotic surgical system.

[0319] Eleventh step 5222, perform the segmentation resection portion of the procedure. The surgical hub 106, 206 may infer that the surgeon is transecting soft tissue based on data from the surgical stapling and cutting instrument (including data from its bin). The bin data may correspond to, for example, the size or type of staples fired by the instrument. Since different types of staples are used for different types of tissue, the bin data may indicate the type of tissue being sutured and / or transected. In this case, the type of staple fired is for soft tissue (or other similar tissue types), which allows the surgical hub 106, 206 to infer that the segmentation resection portion of the procedure is in progress.

[0320] In the twelfth step 5224, a node dissection step is performed. The surgical hub 106, 206 can infer that the surgical team is dissecting the node and performing a leak test based on data received from the generator indicating that the RF or ultrasonic instrument is being fired. For this particular procedure, the RF or ultrasonic instrument used after transecting the soft tissue corresponds to a node dissection step, which allows the surgical hub 106, 206 to make such inferences. It should be noted that surgeons regularly switch back and forth between surgical suturing / cutting instruments and surgical energy (i.e., RF or ultrasonic) instruments according to specific steps in the procedure because different instruments are better suited for specific tasks. Therefore, a specific sequence in which suturing / cutting instruments and surgical energy instruments are used can indicate the steps of the procedure being performed by the surgeon. In addition, in some cases, robotic tools can be used for one or more steps in the surgical procedure, and / or handheld surgical instruments can be used for one or more steps in the surgical procedure. (One or more) surgeons can, for example, alternate between robotic tools and handheld surgical instruments and / or can use the devices simultaneously. When the twelfth step 5224 is completed, the incision is closed and the postoperative portion of the procedure begins.

[0321] Thirteenth step 5226, reverse the patient's anesthesia. For example, the surgical hub 106, 206 can infer that the patient is waking up from anesthesia based on, for example, ventilator data (i.e., the patient's breathing rate begins to increase).

[0322] Finally, the fourteenth step 5228 is for the medical staff to remove the various patient monitoring devices from the patient. Thus, the surgical hub 106, 206 can infer that the patient is being transferred to a recovery room when the hub loses EKG, BP, and other data from the patient monitoring devices. As can be seen from the description of this exemplary procedure, the surgical hub 106, 206 can determine or infer when each step of a given surgical procedure occurs based on data received from various data sources that are communicatively coupled to the surgical hub 106, 206.

[0323] Situational awareness is further described in U.S. Provisional Patent Application Serial No. 62 / 611,341, filed on December 28, 2017, entitled INTERACTIVE SURGICAL PLATFORM, the disclosure of which is incorporated herein by reference in its entirety. In some cases, the operation of a robotic surgical system, including the various robotic surgical systems disclosed herein, may be controlled by the hub 106, 206 based on its situational awareness and / or feedback from its components and / or based on information from the cloud 104.

[0324] Robotic system

[0325] The robotic surgical system may be used for minimally invasive medical procedures. In such medical procedures, a patient may be placed on a platform adjacent to the robotic surgical system, and a surgeon may be positioned at a command console remote from the platform and / or the robot. For example, the surgeon may be positioned outside a sterile field surrounding a surgical site. The surgeon provides input to a user interface via an input device on the command console to manipulate surgical tools coupled to an arm of the robotic system. The input device may be a mechanical input device, such as a control handle or joystick, or a contactless input device, such as an optical gesture sensor.

[0326] A robotic surgical system may include a robotic tower supporting one or more robotic arms. At least one surgical tool (e.g., an end effector and / or an endoscope) may be mounted to the robotic arm. For example, the surgical tool may be configured to articulate relative to a corresponding robotic arm via an articulating wrist assembly and / or translate relative to the robotic arm via a linear slide mechanism. During a surgical procedure, the surgical tool may be inserted into a small incision in a patient, for example, via a cannula or trocar, or into a natural orifice of the patient to position the distal end of the surgical tool at a surgical site in the patient's body. In addition or alternatively, in some cases, the robotic surgical system may be used in open surgical procedures.

[0327] A schematic diagram of the robotic surgical system 15000 is depicted in Fig. 22The robotic surgical system 15000 includes a central control unit 15002, a surgeon's console 15012, a robot 15022 including one or more robotic arms 15024, and a main display 15040 operably coupled to the control unit 15002. The surgeon's console 15012 includes a display 15014 and at least one manual input device 15016 (e.g., switches, buttons, touch screen, joystick, gimbal, etc.) that allows the surgeon to remotely manipulate the robotic arms 15024 of the robot 15022. The reader should understand that additional and alternative input devices may be employed.

[0328] The central control unit 15002 includes a processor 15004 operably coupled to a memory 15006. The processor 15004 includes a plurality of inputs and outputs for interfacing with components of the robotic surgical system 15000. The processor 15004 may be configured to receive input signals and / or generate output signals to control one or more of the various components of the robotic surgical system 15000 (e.g., one or more motors, sensors, and / or displays). The output signals may include and / or may be based on algorithmic instructions that may be pre-programmed and / or input by a surgeon or another clinician. The processor 15004 may be configured to accept a plurality of inputs from a user, such as a surgeon on a console 15012, and / or may interface with a remote system. The memory 15006 may be directly and / or indirectly coupled to the processor 15004 to store instructions and / or databases.

[0329] The robot 15022 includes one or more mechanical arms 15024. Each mechanical arm 15024 includes one or more motors 15026, and each motor 15026 is coupled to one or more motor drivers 15028. For example, motors 15026 that can be assigned to different drivers and / or mechanisms can be seated in a bracket assembly or housing. In some cases, a transmission between the motor 15026 and the one or more drivers 15028 can allow the motor 15026 to be coupled and disengaged from the one or more drivers 15028. The driver 15028 can be configured to achieve one or more surgical functions. For example, one or more drivers 15028 can be responsible for moving the mechanical arm 15024 by rotating the mechanical arm 15024 and / or its connecting rods and / or joints. In addition, one or more drivers 15028 can be coupled to a surgical tool 15030 and can achieve, for example, joint motion, rotation, clamping, sealing, suturing, energizing, firing, cutting and / or opening. In some cases, the surgical tools 15030 can be interchangeable and / or replaceable.Examples of robotic surgical systems and surgical tools are further described herein.

[0330] The reader will readily appreciate that the computer-implemented interactive surgical system 100 ( Figure 1 ) and a computer-implemented interactive surgical system 200 ( Fig. 9 ) can be combined with the robotic surgical system 15000. Additionally or alternatively, the robotic surgical system 15000 can include various features and / or components of the computer-implemented interactive surgical systems 100 and 200.

[0331] In one example, the robotic surgical system 15000 may include a robotic system 110 ( Figure 2 ), the robotic system includes a surgeon's console 118, a surgical robot 120, and a robotic hub 122. Additionally or alternatively, the robotic surgical system 15000 can communicate with another hub, such as the surgical hub 106. In one example, the robotic surgical system 15000 can be incorporated into a surgical system, such as the computer-implemented interactive surgical system 100 ( Figure 1 ) or a computer-implemented interactive surgical system 200 ( Fig. 9 ). In this case, the robotic surgical system 15000 can interact with the cloud 104 or cloud 204 and the surgical hub 106 or surgical hub 206, respectively. In some cases, the robotic hub or surgical hub can include a central control unit 15002 and / or the central control unit 15002 can communicate with the cloud. In other cases, the surgical hub can be embodied as a separate unit that is separate from the central control unit 15002 and can communicate with the central control unit 15002.

[0332] Another robotic surgical system is described in Fig.23 and Fig.24 Reference Fig.23 The robotic surgical system 13000 includes robotic arms 13002 and 13003, a control device 13004, and a console 13005 coupled to the control device 13004. Fig.23As shown, the surgical system 13000 is configured for use with a patient 13013 lying on a patient table 13012 to perform minimally invasive surgery. The console 13005 includes a display device 13006 and input devices 13007, 13008. The display device 13006 is configured to display a three-dimensional image, and the manual input devices 13007, 13008 are configured to allow a clinician to remotely manipulate the robotic arms 13002, 13003. Controls for a console such as the console 13005 for a surgeon are further described in International Patent Publication WO2017 / 075121, entitled HAPTIC FEEDBACK FOR A ROBOTIC SURGICAL SYSTEM INTERFACE, filed on October 27, 2016, which is incorporated herein by reference in its entirety.

[0333] Each of the robotic arms 13002, 13003 is composed of a plurality of components connected by joints and includes a surgical assembly 13010 connected to the distal end of the corresponding robotic arm 13002, 13003. Support for multiple arms is further described in U.S. Patent Application Publication No. 2017 / 0071693, filed on November 11, 2016, entitled SURGICAL ROBOTIC ARMS UPPORT SYSTEMS AND METHODS OF USE, which is incorporated herein by reference in its entirety. Various robotic arm configurations are further described in International Patent Publication No. WO2017 / 044406, filed on September 6, 2016, entitled ROBOTIC SURGICAL CONTROLSCHEME FOR MANIPULATING ROBOTIC END EFFECTORS, which is incorporated herein by reference in its entirety. In one example, the surgical assembly 13010 includes a surgical instrument 13020 supporting an end effector 13023. Although two robotic arms 13002, 13003 are depicted, the surgical system 13000 may include a single robotic arm or more than two robotic arms 13002, 13003. Additional robotic arms are also connected to the control device 13004 and can be remotely manipulated via the console 13005. Thus, one or more additional surgical assemblies 13010 and / or surgical instruments 13020 may also be attached to additional robotic arms.

[0334] The robotic arms 13002, 13003 may be driven by an electric drive connected to the control device 13004. According to one example, the control device 13004 is configured to activate the drive, for example via a computer program, so that the robotic arms 13002, 13003 and the surgical assembly 13010 and / or the surgical instrument 13020 corresponding to the robotic arms 13002, 13003 perform the desired movement received through the manual input devices 13007, 13008. The control device 13004 may also be configured to adjust the movement of the robotic arms 13002, 13003 and / or the drive.

[0335] The control device 13004 can control a plurality of motors (e.g., motors l...n), each of which is configured to drive the pushing or pulling of one or more cables (such as cables coupled to the end effector 13023 of the surgical instrument 13020). In use, as these cables are pushed and / or pulled, the one or more cables affect the operation and / or movement of the end effector 13023. The control device 13004 coordinates the activation of the various motors to coordinate the pushing or pulling motion of the one or more cables, thereby coordinating the operation and / or movement of the one or more end effectors 13023. For example, articulation of an end effector by a robotic assembly such as surgical assembly 13010 is further described in U.S. Patent Application Publication No. 2016 / 0303743, filed on June 6, 2016, entitled WRIST AND JAW ASSEMBLIES FOR ROBOTIC SURGICAL SYSTEMS, and International Patent Publication No. WO2016 / 144937, filed on March 8, 2016, entitled MEASURING HEALTH OF A CONNECTOR MEMBER OF A ROBOTIC SURGICAL SYSTEM, each of which is incorporated herein by reference in its entirety. In one example, in addition to or in lieu of one or more cables, each motor is configured to actuate a drive rod or lever arm to affect operation and / or movement of end effector 13023.

[0336] The drive configuration of surgical instruments such as the drive arrangement of surgical end effectors is disclosed in International Patent Publication No. WO2016 / 183054, filed on May 10, 2016, entitled COUPLING INSTRUMENT DRIVE UNIT AND ROBOTIC SURGICAL INSTRUMENT, International Patent Publication No. WO2016 / 205266, filed on June 15, 2016, entitled ROBOTIC SURGICAL SYSTEM TORQUE TRANSDUCTION SENSING, International Patent Publication No. WO2016 / 205452, filed on June 16, 2016, entitled CONTROLLING ROBOTIC SURGICAL INSTRUMENTS WITH BIDIRECTIONAL COUPLING, and International Patent Publication No. WO2016 / 205452, filed on September 22, 2016, entitled ELASTIC SURGICAL INTERFACE FOR ROBOTIC SURGICAL SYSTEM The invention relates to a method for manufacturing a surgical instrument driver and an interface. The invention relates to a method for manufacturing a surgical instrument driver and an interface. The method of manufacturing a surgical instrument driver and an interface are further described in International Patent Publication WO2017 / 053507 entitled ROBOTIC SURGICAL INTERFACE FOR ROBOTIC SURGICAL SYSTEMS, each of which is incorporated herein by reference in its entirety. The modular attachment of surgical instruments to drivers is further described in International Patent Publication WO2016 / 209769, filed on June 20, 2016, entitled ROBOTIC SURGICAL ASSEMBLIES, which is incorporated herein by reference in its entirety. The housing configuration of the surgical instrument driver and interface is further described in International Patent Publication WO2016 / 144998, filed on March 9, 2016, entitled ROBOTIC SURGICAL SYSTEMS, INSTRUMENT DRIVE UNITS, AND DRIVE ASSEMBLIES, which is incorporated herein by reference in its entirety.Various endoscopic instrument configurations for use with robotic arms 13002, 13003 are further described in international patent publication WO2017 / 053358 filed on September 21, 2016, entitled SURGICAL ROBOTIC ASSEMBLIES AND INSTRUMENT ADAPTERS THEREOF, and international patent publication WO2017 / 053363 filed on September 21, 2016, entitled ROBOTIC SURGICAL ASSEMBLIES AND INSTRUMENT DRIVE CONNECTORS THEREOF, each of which is incorporated herein by reference in its entirety. The bipolar instrument configuration used with the robotic arms 13002, 13003 is further described in International Patent Publication WO2017 / 053698, filed on September 23, 2016, entitled ROBOTIC SURGICAL ASSEMBLIES AND ELECTROMECHANICAL INSTRUMENTS THEREOF, which is incorporated herein by reference in its entirety. The stationary shaft arrangement used with the robotic arms 13002, 13003 is further described in International Patent Publication WO2017 / 116793, filed on December 19, 2016, entitled ROBOTIC SURGICAL SYSTEMS AND INSTRUMENT DRIVE ASSEMBLIES, which is incorporated herein by reference in its entirety.

[0337] The control device 13004 includes any suitable logic control circuitry suitable for performing calculations and / or operating according to a set of instructions. The control device 13004 may be configured to communicate with the remote system "RS" via wireless (e.g., Wi-Fi, Bluetooth, LTE, etc.) and / or wired connections. The remote system "RS" may include data, instructions, and / or information related to various components, algorithms, and / or operations of the system 13000. The remote system "RS" may include any suitable electronic service, database, platform, cloud "C" (see Fig.23 ) etc. The control device 13004 may include a central processing unit operably connected to a memory. The memory may include a transient memory (e.g., RAM) and / or a non-transient memory (e.g., flash media, disk media, etc.). In some examples, the memory is part of the remote system "RS" and / or is operably coupled to the remote system "RS".

[0338] The control device 13004 may include multiple inputs and outputs for interfacing with components of the system 13000, such as through driver circuits. The control device 13004 may be configured to receive input signals and / or generate output signals to control one or more of the various components (e.g., one or more motors) of the system 13000. The output signals may include and / or may be based on algorithmic instructions that may be pre-programmed and / or input by a user. The control device 13004 may be configured to accept multiple user inputs from a user interface (e.g., switches, buttons, touch screen, etc. of an operating console 13005) that may be coupled to the remote system "RS".

[0339] Memory 13014 may be directly and / or indirectly coupled to control device 13004 to store instructions and / or databases including preoperative data from biological and / or anatomical atlases. Memory 13014 may be part of and / or operably coupled to remote system "RS".

[0340] According to one example, the distal end of each robotic arm 13002, 13003 is configured to releasably secure an end effector 13023 (or other surgical tool) therein and may be configured to receive any number of surgical tools or instruments, such as a trocar or retractor.

[0341] A simplified functional block diagram of the system architecture 13400 of the robotic surgical system 13010 is depicted in Fig.24 . The system architecture 13400 includes a core module 13420, a surgeon master module 13430, a robotic arm module 13440, and an instrument module 13450. The core module 13420 serves as the central controller of the robotic surgical system 13000 and coordinates the operation of all other modules 13430, 13440, 13450. For example, the core module 13420 maps the control device to the arms 13002, 13003, determines the current state, performs all kinematics and frame transformations, and forwards the resulting movement commands. In this regard, the core module 13420 receives data from each of the other modules 13430, 13440, 13450 and analyzes it in order to provide instructions or commands to the other modules 13430, 13440, 13450 for execution within the robotic surgical system 13000. Although depicted as separate modules, in other examples, one or more of modules 13420, 13430, 13440, and 13450 are a single component.

[0342] The core module 13420 includes a model 13422, an observer 13424, a collision manager 13426, a controller 13428, and a skeleton 13429. The model 13422 includes units that provide an abstract representation (base class) for controlled components, such as motors (e.g., motor l...n) and / or arms 13002, 13003. The observer 13424 creates state estimates based on input and output signals received from other modules 13430, 13440, 13450. The collision manager 13426 prevents collisions between components that have been registered within the system 13010. The skeleton 13429 tracks the system 13010 from a kinematic and dynamic perspective. For example, in one example, the kinematics project can be implemented as forward kinematics or inverse kinematics. The dynamics project can be implemented as an algorithm for modeling the dynamics of the system components.

[0343] The surgeon master module 13430 communicates with the surgeon control device at the console 13005 and forwards input received from the console 13005 to the core module 13420. According to one example, the surgeon master module 13430 transmits button states and control device positions to the core module 13420 and includes a node controller 13432 that includes a state / mode manager 13434, a failover controller 13436, and an N-degree-of-freedom (“DOF”) actuator 13438.

[0344] The robotic arm module 13440 coordinates the operation of the robotic arm subsystem, the arm cart subsystem, the device arm, and the instrument subsystem to control the movement of the corresponding arms 13002, 13003. Although a single robotic arm module 13440 is included, it should be understood that the robotic arm module 13440 corresponds to and controls a single arm. Therefore, additional robotic arm modules 13440 are included in configurations in which the system 13010 includes multiple arms 13002, 13003. The robotic arm module 13440 includes a node controller 13442, a state / mode manager 13444, a failover controller 13446, and an N degree of freedom ("DOF") actuator 13348.

[0345] The instrument module 13450 controls the movement of the instruments and / or tool components attached to the arms 13002, 13003. The instrument module 13450 is configured to correspond to and control a single instrument. Therefore, in a configuration in which a plurality of instruments are included, an additional instrument module 13450 is also included. In one example, the instrument module 13450 obtains and transmits data related to the position of the end effector or jaw assembly (which may include the pitch and yaw angles of the jaws), the width of the jaws or the angle between the jaws, and the position of the entrance. The instrument module 13450 has a node controller 13452, a state / mode manager 13454, a fail-over controller 13456, and an N-degree-of-freedom ("DOF") actuator 13458.

[0346] The core module 13420 uses the position data collected by the instrument module 13450 to determine when the instrument is within the surgical site, within the cannula, adjacent to the portal, or above the portal in free space. The core module 13420 can determine whether to provide instructions to open or close the jaws based on the position of the jaws of the instrument. For example, when the position of the instrument indicates that the instrument is within the cannula, instructions are provided to maintain the jaw assembly in a closed position. When the position of the instrument indicates that the instrument is outside the portal, instructions are provided to open the jaw assembly.

[0347] Robotic surgical systems such as Fig.23 and Fig.24 Additional features and operation of the illustrated surgical robotic system are further described in the following references, each of which is incorporated herein by reference in its entirety:

[0348] U.S. Patent Application Publication No. 2016 / 0303743, filed on June 6, 2016, entitled WRIST AND JAW ASSEMBLIES FOR ROBOTIC SURGICAL SYSTEMS;

[0349] U.S. Patent Application Publication No. 2017 / 0071693, filed on November 11, 2016, entitled SURGICAL ROBOTIC ARM SUPPORT SYSTEMS AND METHODS OF USE;

[0350] International Patent Publication No. WO2016 / 144937, filed on March 8, 2016, entitled MEASURING HEALTH OF A CONNECTOR MEMBER OF AROBOTIC SURGICAL SYSTEM;

[0351] International patent publication WO2016 / 144998, filed on March 9, 2016, entitled ROBOTIC SURGICAL SYSTEMS, INSTRUMENT DRIVE UNITS, AND DRIVE ASSEMBLIES;

[0352] International Patent Publication No. WO2016 / 183054 filed on May 10, 2016, entitled COUPLING INSTRUMENT DRIVE UNIT AND ROBOTIC SURGICALINSTRUMENT;

[0353] International patent publication WO2016 / 205266, filed on June 15, 2016, entitled ROBOTIC SURGICAL SYSTEM TORQUE TRANSDUCTION SENSING;

[0354] International Patent Publication No. WO2016 / 205452, filed on June 16, 2016, entitled CONTROLLING ROBOTIC SURGICAL INSTRUMENTS WITH BIDIRECTIONAL COUPLING;

[0355] International patent publication WO2016 / 209769, filed on June 20, 2016, entitled ROBOTIC SURGICAL ASSEMBLIES;

[0356] International patent publication WO2017 / 044406, filed on September 6, 2016, entitled ROBOTIC SURGICAL CONTROL SCHEME FOR MANIPULATING ROBOTIC END EFFECTORS;

[0357] International patent publication WO2017 / 053358, filed on September 21, 2016, entitled SURGICAL ROBOTIC ASSEMBLIES AND INSTRUMENT ADAPTERS THEREOF;

[0358] International patent publication WO2017 / 053363, filed on September 21, 2016, entitled ROBOTIC SURGICAL ASSEMBLIES AND INSTRUMENT DRIVE CONNECTORS THEREOF;

[0359] International Patent Publication No. WO2017 / 053507, filed on September 22, 2016, entitled ELASTIC SURGICAL INTERFACE FOR ROBOTIC SURGICAL SYSTEMS;

[0360] International patent publication WO2017 / 053698, filed on September 23, 2016, entitled ROBOTIC SURGICAL ASSEMBLIES AND ELECTROMECHANICAL INSTRUMENTS;

[0361] International patent publication WO 2017 / 075121, filed on October 27, 2016, entitled HAPTIC FEEDBACK CONTROLS FOR A ROBOTIC SURGICAL SYSTEM INTERFACE;

[0362] International patent publication WO 2017 / 116793, filed on December 19, 2016, entitled ROBOTIC SURGICAL SYSTEMS AND INSTRUMENT DRIVE ASSEMBLIES.

[0363] The robotic surgical systems and features disclosed herein may be used with Fig.23 and Fig.24 The reader should also appreciate that the various systems and / or features disclosed herein may also be used with alternative surgical systems including, for example, the computer-implemented interactive surgical system 100, the computer-implemented interactive surgical system 200, the robotic surgical system 110, the robotic hub 122, the robotic hub 222, and / or the robotic surgical system 15000.

[0364] In various embodiments, the robotic surgical system may include a robotic control tower that may house a control unit of the system. For example, the robotic surgical system 13000 ( Fig.23 ) control unit 13004 may be located in a robot control tower. The robot control tower may include a robot hub, such as robot hub 122 ( Figure 2 ) or Robot Hub 222 ( Fig. 9 ). Such a robotic hub may include a modular interface for coupling with one or more generators (such as an ultrasound generator and / or a radio frequency generator) and / or one or more modules (such as an imaging module, a suction module, an irrigation module, a smoke evacuation module and / or a communication module).

[0365] The robotic hub may include a situational awareness module that may be configured to synthesize data from multiple sources to determine an appropriate response to a surgical event. For example, the situational awareness module may determine the type of surgical procedure, the steps in the surgical procedure, the type of tissue, and / or tissue characteristics, as further described herein. In addition, such a module may recommend a specific course of action or possible options to the robotic system based on the synthesized data. In various cases, a sensor system including multiple sensors distributed throughout the robotic system may provide data, images, and / or other information to the situational awareness module. Such a situational awareness module may be incorporated into a control unit, such as control unit 13004. In various cases, the situational awareness module may, for example, receive data from a non-robotic surgical hub and / or the cloud (such as surgical hub 106( Figure 1 ), surgical hub 206 ( Fig.10 )、Cloud 104( Figure 1 ) and / or cloud 204 ( Fig. 9 )) obtain data and / or information. Situational awareness of surgical systems is further disclosed in U.S. Provisional Patent Application Serial No. 62 / 611,341, filed on December 28, 2017, entitled INTERACTIVE SURGICAL PLATFORM, and U.S. Provisional Patent Application Serial No. 62 / 611,340, filed on December 28, 2017, entitled CLOUD-BASED MEDICAL ANALYTICS, the disclosure of each of which is incorporated herein by reference in its entirety.

[0366] In some cases, activating a surgical tool at certain times and / or for certain durations during a surgical procedure may cause tissue trauma and / or may prolong the surgical procedure. For example, a robotic surgical system may utilize an electrosurgical tool with an energy delivery surface that should be energized only when a threshold condition is met. In one example, the energy delivery surface should be activated only when the energy delivery surface is in contact with appropriate tissue or target tissue. As another example, a robotic surgical system may utilize a suction element that should be activated only when a threshold condition is met (such as when there is an appropriate volume of fluid). Due to visibility limitations, evolving situations, and numerous moving parts during robotic surgical procedures, it may be difficult for clinicians to determine and / or monitor certain conditions at the surgical site. For example, it may be difficult to determine whether the energy delivery surface of an electrosurgical tool is in contact with tissue. It may also be difficult to determine whether a specific suction pressure is sufficient for the volume of fluid near the suction port.

[0367] In addition, multiple surgical devices may be used in certain robotic surgical procedures. For example, a robotic surgical system may use one or more surgical tools during a surgical procedure. In addition, one or more handheld instruments may also be used during a surgical procedure. One or more of the surgical devices may include sensors. For example, multiple sensors may be positioned around the surgical site and / or the operating room. A sensor system including one or more sensors may be configured to detect one or more conditions at the surgical site. For example, data from the sensor system may determine whether a surgical tool mounted to a surgical robot is being used and / or whether a feature of the surgical tool should be activated. More specifically, the sensor system may, for example, detect whether an electrosurgical device is positioned in abutting contact with tissue. As another example, the sensor system may detect whether a suction element of a surgical tool is applying sufficient suction force to a fluid at the surgical site.

[0368] When in automatic activation mode, the robotic surgical system can automatically activate one or more features of one or more surgical tools based on data, images, and / or other information received from the sensor system. For example, when it is detected that the electrosurgical tool is in use (e.g., positioned in abutting contact with tissue), the energy delivery surface of the electrosurgical tool can be activated. For another example, when the suction port is moved to contact with the fluid, the suction element on the surgical tool can be activated. In some cases, the surgical tool can be adjusted based on the sensed condition.

[0369] A robotic surgical system incorporating an automatic activation mode can automatically provide scenario-specific results based on conditions detected at the surgical site. Scenario-specific results can be, for example, outcome-based and can simplify the clinician's decision-making process. In some cases, such an automatic activation mode can improve the efficiency and / or effectiveness of the clinician. For example, a robotic surgical system can aggregate data to compile a more complete view of the surgical site and / or surgical procedure in order to determine the best possible course of action. In addition or alternatively, with fewer decisions being made by the clinician, the clinician can better focus on other tasks and / or can more effectively process other information.

[0370] In one example, a robotic surgical system can automatically adjust a surgical tool based on the tool's proximity to a visually detectable need and / or the system's situational awareness. Fig.25A and Fig.25B , depicts an ultrasonic surgical tool of a robotic system 13050 in two different positions. In a first position, as Fig.25A As depicted, the blade 13052 of the ultrasonic surgical tool 13050 is positioned so as not to be in contact with the tissue 13060. In such a position, the sensor on the ultrasonic surgical tool 13050 can detect a high resistance. When the detected resistance is above a threshold, the ultrasonic blade 13052 can be powered off. Now see Fig.25B , the ultrasonic blade 13052 is depicted in a second position in which the distal end of the blade 13052 is positioned in abutting contact with the tissue 13060. In this case, the sensor on the ultrasonic surgical tool 13050 can detect a low resistance. When the detected resistance is below a threshold, the ultrasonic blade 13052 can be activated so that therapeutic energy is delivered to the tissue 13060. Alternative sensor configurations are also contemplated, and various sensors are further described herein.

[0371] See also Fig.26A and Fig.26B , depicts another surgical tool, a monopolar cautery pencil 13055, in two different positions. In the first position, as Fig.26A As depicted, the monopolar cautery pencil 13055 is positioned so as not to be in contact with tissue. In such a position, a sensor on the monopolar cautery pencil 13055 can detect a high resistance. When the detected resistance is above a threshold, the monopolar cautery pencil 13055 can be powered off. Fig.26B, the monopolar cautery pen 13055 is depicted in a second position, in which the distal end of the monopolar cautery pen 13055 is positioned in abutting contact with tissue. In this case, the sensor on the monopolar cautery pen 13055 can detect a low resistance. When the detected resistance is below a threshold, the monopolar cautery pen 13055 can be activated so that therapeutic energy is delivered to the tissue. Alternative sensor configurations are also contemplated, and various sensors are further described herein.

[0372] Fig. 27 Shows Fig.25A and Fig.25B 13070 of continuity C and current I of an ultrasonic surgical tool 13050 over time t. Similarly, in some cases, the monopolar cautery pen 13055 may generate a graphical display that is similar in many respects to graphical display 13070. In graphical display 13070, continuity C is represented by a dashed line and current I is represented by a solid line. When the resistance is high and above a threshold, continuity C may also be high. The threshold may be, for example, between 40 and 400 ohms. At time A', continuity C may drop below the threshold, which may indicate a degree of tissue contact. As a result, the robotic surgical system may automatically activate advanced energy treatment of the tissue. When the continuity parameter indicates a degree of tissue contact, Fig. 27 The ultrasonic transducer current depicted in FIG increases from time A' to B'. In various cases, the current I may be limited to a maximum value indicated at B', which may correspond to an open jaw transducer limit, such as in a case where the jaws are not clamped, as shown in FIG. Fig.25A and Fig.25B In various situations, the situational awareness module of the robotic surgical system may indicate that the jaws are not clamped. See again Fig. 27 As shown in the graph 13070 , energy is applied until time C′, at which time loss of tissue contact is indicated by an increase above a threshold in continuity C. As a result, the ultrasonic transducer current I can be reduced to zero when the ultrasonic blade is powered off.

[0373] In various cases, the sensor system may be configured to detect at least one condition at the surgical site. For example, the sensor of the sensor system may detect tissue contact by measuring continuity along the energy delivery surface of the ultrasonic blade. In addition or alternatively, the sensor system may include one or more additional sensors positioned around the surgical site. For example, one or more surgical tools and / or instruments used in a surgical procedure may be configured to detect conditions at the surgical site. The sensor system may communicate signals with a processor of a robotic surgical system. For example, a robotic surgical system may include a central control tower including a control unit that houses a processor and a memory, as further described herein. The processor may issue commands to the surgical tool based on input from the sensor system. In various cases, situational awareness may also indicate and / or affect commands issued by the processor.

[0374] Now go to Fig.28 , the end effector 196400 includes RF data sensors 196406, 196408a, 196408b located on the jaw member 196402. The end effector 196400 includes a jaw member 196402 and an ultrasonic blade 196404. The jaw member 196402 is shown as clamping tissue 196410 located between the jaw member 196402 and the ultrasonic blade 196404. The first sensor 196406 is located in the central portion of the jaw member 196402. The second sensor 196408a and the third sensor 196408b are respectively located on the lateral portions of the jaw member 196402. The sensors 196406, 196408a, 196408b are connected to the flexible circuit 196412 (more specifically shown in Fig.29 The flexible circuit is configured to be fixedly mounted to the jaw member 196402 and is installed or formed integrally therewith.

[0375] End effector 196400 is an exemplary end effector for various surgical devices described herein. Sensors 196406, 196408a, 196408b are electrically connected to the control circuit via an interface circuit. Sensors 196406, 196408a, 196408b are battery powered, and the signals generated by sensors 196406, 196408a, 196408b are provided to analog and / or digital processing circuits of the control circuit.

[0376] In one aspect, the first sensor 196406 is a force sensor for measuring the normal force F3 applied to the tissue 196410 by the jaw member 196402. The second sensor 196408a and the third sensor 196408b include one or more elements for applying RF energy to the tissue 196410, measuring parameters such as tissue impedance, downward force F1, lateral force F2 and temperature. The electrodes 196409a, 196409b are electrically coupled to an energy source such as a circuit and apply RF energy to the tissue 196410. In one aspect, the first sensor 196406 and the second sensor 196408a and the third sensor 196408b are strain gauges for measuring force or force per unit area. It should be understood that the measurement results of the downward force F1, the lateral force F2 and the normal force F3 can be easily converted into pressure by determining the surface area on which the force sensors 196406, 196408a, 196408b act. Additionally, as described in detail herein, the flexible circuit 196412 can include temperature sensors embedded in one or more layers of the flexible circuit 196412. The one or more temperature sensors can be arranged symmetrically or asymmetrically and provide temperature feedback of the tissue 196410 to the control circuitry of the ultrasound drive circuit and the RF drive circuit.

[0377] One or more sensors such as magnetic field sensors, strain gauges, pressure sensors, force sensors, inductive sensors (such as, for example, eddy current sensors), resistive sensors, capacitive sensors, optical sensors and / or any other suitable sensors may be adapted and configured to measure tissue compression and / or impedance.

[0378] Fig.29 Shows Fig.28 An aspect of the flexible circuit 196412 is shown, wherein the sensors 196406, 196408a, 196408b can be mounted to the flexible circuit or formed integrally therewith. The flexible circuit 196412 is configured to be fixedly attached to the jaw member 196402. Fig.29 Specifically, asymmetric temperature sensors 196414a, 196414b are mounted on a flexible circuit 196412 to measure the temperature of tissue 196410 ( Fig.28 ) temperature.

[0379] The reader should understand that alternative surgical tools may be used in conjunction with the above. FIG. 25A to FIG. 29 Describes the automatic activation mode used.

[0380] Fig.30 13150 is a flow chart depicting an automatic activation mode 13151 of a surgical tool. In various cases, the robotic surgical system and its processor are configured to implement Fig.30The process shown. Initially, the sensor system is configured to detect a condition at step 13152. The detected condition is transmitted to the processor, which compares the detected condition to a threshold parameter at step 13154. The threshold parameter can be a maximum value, a minimum value, or a range of values. If the sensed condition is an out-of-bounds condition, the processor can adjust the surgical function at step 13156, and the processor can repeat the comparison process of steps 13152 and 13154. If the sensed condition is not an out-of-bounds condition, no adjustment is required (13158), and the comparison process of steps 13152 and 13154 can be repeated again.

[0381] In various circumstances, the robotic surgical system may allow for a manual override mode 13153. For example, upon activation of a manual override input 13160, such as by a clinician, the surgical system may Fig.30 The automatic activation mode 13151 is exited at step 13162 as shown. In this case, the processor will not automatically adjust the surgical function even when the sensed condition is an out-of-bounds condition. However, in this case, the processor may issue a warning or recommendation to the clinician to recommend a specific course of action based on the sensed condition.

[0382] In various cases, the automatic activation mode can be used with a robotic surgical system that includes a suction feature. In one example, the robotic surgical system can communicate with a suction and / or irrigation tool. For example, a suction and / or irrigation device (see Figure 3 module 128) can be accessed via the surgical hub 106 ( Figure 1 ) and / or surgical hub 206 ( Fig. 9 ) communicates with a robotic surgical system, and a suction and / or irrigation tool may be mounted to the robotic arm. The suction / irrigation device may include a distal suction port and a sensor. In another example, a robotic surgical tool such as an electrosurgical tool may include a suction feature and a suction port on the end effector of the tool.

[0383] See also Fig.31, when the suction port on the end effector 13210 is moved to contact with the fluid, the processor of the robotic surgical system can automatically activate the suction feature structure. For example, the fluid detection sensor 13230 on the tool 13200 can detect the fluid 13220 near the tool 13200 and / or in contact with the tool 13200. The fluid detection sensor 13230 can be, for example, a continuity sensor. The fluid detection sensor 13230 can communicate signals with the processor so that the processor is configured to receive input and / or feedback from the fluid detection sensor 13230. In some cases, when the suction port is moved to be close to the fluid 13220, the suction feature structure can be automatically activated. For example, when the suction port moves within a predefined spatial range of the fluid 13220, the suction feature structure can be activated by the processor. The fluid 13220 can be, for example, saline, which can be provided to the surgical site to enhance conductivity and / or flush tissue.

[0384] In various cases, the tool can be, for example, a smoke evacuation tool and / or can include a smoke evacuation system. A detailed view of the end effector 13210 of the bipolar RF surgical tool 13200 is shown in Fig.31 . The end effector 13210 is shown in a clamped configuration. In addition, smoke and steam 13220 from RF welding accumulate around the end effector 13210. In various cases, to improve the visibility and efficiency of the tool 13200, the smoke and steam 13220 at the surgical site can be discharged along a smoke exhaust channel 13240 extending proximally from the end effector. The smoke exhaust channel 13240 can extend through the shaft 13205 of the surgical tool 13200 to the interface and robot of the surgical tool 13200. The smoke exhaust channel 13240 can be coupled to a pump to draw smoke and / or steam 13220 along the smoke exhaust channel 13240 within the shaft 13205 of the surgical tool 13200. In various cases, the surgical tool 13200 may also include insufflation, cooling and / or flushing functions.

[0385] In one example, the intensity of the suction pressure can be automatically adjusted based on measured parameters from one or more surgical devices. In this case, the suction pressure can vary according to the sensed parameters. The suction tube can include a sensor for detecting the volume of fluid extracted from the surgical site. When the volume of fluid extracted increases, the power of the suction feature structure can be increased, so that the suction pressure increases. Similarly, when the volume of fluid extracted decreases, the power of the suction feature structure can be reduced, thereby reducing the suction pressure.

[0386] In various cases, the sensing system for the suction tool may include a pressure sensor. The pressure sensor can detect when occlusion blocks or partially blocks fluid flow. The pressure sensor can also detect when the suction port moves to abut against tissue. In this case, the processor can reduce and / or suspend the suction force to release the tissue and / or clear the blockage. In various cases, the processor can compare the detected pressure with a threshold maximum pressure. Exceeding the maximum threshold pressure may cause unexpected tissue trauma caused by the suction tool. Therefore, in order to avoid such trauma, the processor can reduce and / or suspend the suction force to protect the integrity of the tissue near it.

[0387] The user can manually override the automatic adjustments implemented in the automatic activation mode described herein. The manual override can be a one-time adjustment to the surgical tool. In other cases, the manual override can be a global override to turn off the setting of the automatic activation mode for a specific surgical operation, a specific duration, and / or the entire procedure.

[0388] In one aspect, a robotic surgical system includes a processor and a memory communicatively coupled to the processor, as described herein. The processor is communicatively coupled to a sensor system, and the memory stores instructions executable by the processor to determine use of a robotic tool based on input from the sensor system, and upon determining use, automatically energize an energy delivery surface of the robotic tool, as described herein.

[0389] In various aspects, the present disclosure provides a control circuit to automatically power on an energy delivery surface as described herein. In various aspects, the present disclosure provides a non-transitory computer readable medium storing computer readable instructions that, when executed, cause a machine to automatically power on an energy delivery surface of a robotic tool as described herein.

[0390] In one aspect, a robotic surgical system includes a processor and a memory communicatively coupled to the processor, as described herein. The processor is communicatively coupled to a fluid detection sensor, and the memory stores instructions executable by the processor to receive input from the fluid detection sensor and automatically activate a suction mode when fluid is detected, as described herein.

[0391] In various aspects, the present disclosure provides a control circuit to automatically activate a puff mode, as described herein. In various aspects, the present disclosure provides a non-transitory computer readable medium storing computer readable instructions that, when executed, cause a machine to automatically activate a puff mode, as described herein.

[0392] Clinicians can use multiple surgical devices during specific surgical procedures, including robotic surgical systems and various handheld instruments. When manipulating one or more robotic tools of a robotic surgical system, the clinician is usually located at the surgeon's command console or module, which is also referred to as a remote console. In various cases, the remote console is positioned outside the sterile field, so it can be away from the sterile field, and in some cases, it can be away from the patient and even away from the operating room. If the clinician wishes to use a handheld instrument, the clinician may need to leave the remote console. At this point, the clinician may not be able to control the robotic tool. For example, the clinician may not be able to adjust the position or utilize the function of the robotic tool. When leaving the remote console, the clinician may also not be able to see one or more displays on the robotic surgical system. The separation between the control points of the handheld instrument and the robotic surgical system may inhibit the effect that the clinician can utilize the surgical device (robotic tool and surgical instrument) together.

[0393] In various cases, the interactive auxiliary display is configured to communicate signals with the robotic surgical system. In various cases, the interactive auxiliary display includes a control module. In addition, the interactive auxiliary display is configured to be wireless and movable around the operating room. In various cases, the interactive auxiliary display is positioned within the sterile field. In one instance, the interactive auxiliary display allows a clinician to manipulate and control one or more robotic tools of the robotic surgical system without having to be physically present at the remote console. In one instance, the ability of the clinician to operate the robotic surgical system away from the remote console allows multiple devices to be used in a synchronized manner. As a safety measure, in some cases, the remote console includes an override function that is configured to prevent the interactive auxiliary display from controlling the robotic tool.

[0394] Fig.32 A surgical system 13100 is shown for use during a surgical procedure, the surgical system utilizing a surgical instrument 13140 and a robotic surgical system 13110. The surgical instrument 13140 is an electrically powered handheld instrument. For example, the surgical instrument 13140 may be a radio frequency (RF) instrument, an ultrasonic instrument, a surgical stapler, and / or a combination thereof. The surgical instrument 13140 includes a display 13142 and a processor 13144. In some cases, the handheld surgical instrument 13140 may be an intelligent surgical instrument having multiple sensors and a wireless communication module.

[0395] The robotic surgical system 13110 includes a robot 13112 that includes at least one robotic tool 13117 configured to perform a specific surgical function. The robotic surgical system 13110 is similar in many respects to the robotic surgical system 13000 discussed herein. The robotic tool 13117 can move in a space defined by the control range of the robotic surgical system 13110. In various cases, the robotic tool 13117 is controlled by various clinician inputs at a remote control console 13116. In other words, when the clinician applies input at the remote control console 13116, the clinician is away from the patient's body and outside the sterile field 13138. The clinician input of the remote control console 13116 is transmitted to a robot control unit 13114 including a robot display 13113 and a processor 13115. The processor 13115 directs the robotic tool 13117 to perform the desired function.

[0396] In various cases, the surgical system 13100 includes a surgical hub 13120 that is similar in many respects to, for example, the hub 106, the hub 206, the robotic hub 122, or the robotic hub 222. The surgical hub 13120 is configured to enhance the collaborative and / or coordinated use of the robotic surgical system 13110 and the surgical instruments 13140. The surgical hub 13120 is in signal communication with a control unit 13114 of the robotic surgical system 13110 and a processor 13144 of the surgical instrument 13140. In various cases, the signals are transmitted via a wireless connection, but any suitable connection may be used to facilitate communication. The control unit 13114 of the robotic surgical system 13110 is configured to send information about the robotic tools 13117 to the surgical hub 13120. Such information includes, for example, the location of the robotic tool 13117 within the surgical site, the operational state of the robotic tool 13117, the forces detected by the robotic tool, and / or the type of robotic tool 13117 attached to the robotic surgical system 13110, but any relevant information and / or operational parameters may also be transmitted. Examples of surgical hubs are further described herein and in U.S. Provisional Patent Application Serial No. 62 / 611,341, filed on December 28, 2017, entitled INTERACTIVE SURGICAL PLATFORM, the disclosure of which is incorporated herein by reference in its entirety.

[0397] In other cases, the robotic surgical system 13110 may include a surgical hub 13120 and / or the control unit 13114 may be incorporated into the surgical hub 13120. For example, the robotic surgical system 13110 may include a robotic hub that includes a modular control tower that includes a computer system and a modular communication hub. One or more modules may be installed in the modular control tower of the robotic hub. Examples of robotic hubs are further described herein and in U.S. Provisional Patent Application Serial No. 62 / 611,341, filed on December 28, 2017, entitled INTERACTIVE SURGICAL PLATFORM, the disclosure of which is incorporated herein by reference in its entirety.

[0398] The processor 13144 of the surgical instrument 13140 is configured to send information about the surgical instrument 13140 to the surgical hub 13120. Such information includes, for example, the position of the surgical instrument 13140 within the surgical site, the operational state of the surgical instrument 13140, forces detected by the surgical instrument 13140, and / or identification information about the surgical instrument 13140, although any relevant information and / or operating parameters may also be sent to the surgical hub.

[0399] In various embodiments, the hub display 13125 is in signal communication with the surgical hub 13120 and may be incorporated into, for example, a modular control tower. The hub display 13125 is configured to display information received from the robotic surgical system 13110 and the surgical instruments 13140. The hub display 13125 may be similar in many respects to, for example, the visualization system 108 ( Figure 1 ). In one aspect, the hub display 13125 may include an array of displays, such as video monitors and / or heads-up displays around the operating room.

[0400] In various cases, the surgical hub 13120 is configured to recognize when a clinician activates a surgical instrument 13140 via a wireless communication signal. Upon activation, the surgical instrument 13140 is configured to send identification information to the surgical hub 13120. Such identification information may include, for example, the model of the surgical instrument, the operating status of the surgical instrument, and / or the location of the surgical instrument, but other suitable device parameters may also be transmitted. In various cases, the surgical hub 13120 is configured to utilize the transmitted information to evaluate the compatibility of the surgical instrument 13140 with the capabilities of the surgical hub 13120. Examples of the capabilities of a surgical hub with compatible surgical instruments are further discussed herein.

[0401] In various instances, the control unit 13114 of the robotic surgical system 13110 is configured to transmit a video feed to the surgical hub 13120, and the surgical hub 13120 is configured to transmit the information or a portion thereof to the surgical instrument 13140, which can replicate a portion of the robotic display 13113 or other information from the robotic surgical system 13110 on the display 13142 of the surgical instrument 13140. In other instances, such as when the robotic surgical system 13110 includes a robotic hub and / or the surgical tool 13117 includes a wireless communication module, the robotic surgical system 13110 (e.g., the control unit 13114 or the surgical tool 13117) can communicate directly with the surgical instrument 13140. The reproduction of a portion of the robotic display 13113 on the surgical instrument 13140 allows the clinician to use the two surgical devices in coordination by providing, for example, alignment data to achieve integrated positioning of the surgical instrument 13140 relative to the robotic tool 13117. In various circumstances, the clinician can delete any unwanted information displayed on the display 13142 of the surgical instrument 13140.

[0402] Still see Fig.32 In various embodiments, the surgical system 13100 further includes an interactive auxiliary display 13130 ​​within the sterile field 13138. The interactive auxiliary display 13130 ​​is also a local control module within the sterile field 13138. The remote console 13116 or main controls may be located outside the sterile field 13138. For example, the interactive auxiliary display 13130 ​​may be a handheld mobile electronic device such as Tablet computer, the handheld mobile electronic device can be placed on the patient or patient table during the surgical procedure. For example, the interactive auxiliary display 13130 ​​can be placed on the abdomen or leg of the patient during the surgical procedure. In other cases, the interactive auxiliary display 13130 ​​can be incorporated into the surgical instrument 13140 within the sterile field 13138. In various cases, the interactive auxiliary display 13130 ​​is configured to communicate signals with the robotic surgical system 13110 and / or the surgical instrument 13140. In this case, the interactive auxiliary display 13130 ​​is configured to display information received from the robotic tool 13117 (e.g., robotic tool 1, robotic tool 2, ..., robotic tool n) and the surgical instrument 13140 (e.g., surgical instrument 1, surgical instrument 2, ..., surgical instrument n). The interactive auxiliary display 13130 ​​depicts tool information 13133 and instrument information 13135 thereon. In various cases, the user is able to interact with the interactive auxiliary display 13130 ​​to customize the size and / or position of the displayed information.

[0403] Still see Fig.32In various embodiments, the surgical hub 13120 is configured to transmit robot status information of the surgical robotic system 13100 to the surgical instrument 13140, and the surgical instrument 13140 is configured to display the robot status information on the display 13142 of the surgical instrument 13140.

[0404] In various instances, the display 13142 of the surgical instrument 13140 is configured to transmit commands to the control unit 13114 of the robotic surgical system 13110 via the surgical hub 13120. As described herein, after viewing and interpreting the robotic state information displayed on the display 13142 of the surgical instrument 13140, the clinician may wish to utilize one or more functions of the robotic surgical system 13110. Using buttons and / or the touch-sensitive display 13142 on the surgical instrument 13140, the clinician is able to input the desired utilization and / or adjustment of the robotic surgical system 13110. The clinician input is transmitted from the surgical instrument 13140 to the surgical hub 13120. The surgical hub 13120 is then configured to transmit the clinician input to the control unit 13114 of the robotic surgical system 13110 to implement the desired function. In other cases, such as when the robotic surgical system 13110 includes a robotic hub, the handheld surgical instrument 13140 can communicate directly with the control unit 13114 of the robotic surgical system 13110.

[0405] In various cases, the surgical hub 13120 communicates signals with both the robotic surgical system 13110 and the surgical instruments 13140, thereby allowing the surgical system 13100 to regulate multiple surgical devices in a synchronized, coordinated, and / or collaborative manner. Information transmitted between the surgical hub 13120 and the various surgical devices includes, for example, surgical instrument identification information and / or the operating status of the various surgical devices. In various cases, the surgical hub 13120 is configured to detect when the surgical instrument 13140 is activated. In one example, the surgical instrument 13140 is an ultrasonic dissector. Upon activation of the ultrasonic dissector, the surgical hub 13120 is configured to transmit the received activation information to the control unit 13114 of the robotic surgical system 13110.

[0406] In various cases, the surgical hub 13120 automatically transmits information to the control unit 13114 of the robotic surgical system 13110. The reader should understand that the information can be transmitted at any suitable time, rate, interval and / or schedule. Based on the information received from the surgical hub 13120, the control unit 13114 of the robotic surgical system 13110 is configured to decide whether to activate at least one robotic tool 13117 and / or activate a specific operating mode, such as a smoke evacuation mode. For example, when activating a surgical tool such as an ultrasonic dissector that is known to generate or may generate smoke and / or contaminants at the surgical site, the robotic surgical system 13110 can automatically activate the smoke evacuation mode or can prompt the surgeon to activate the smoke evacuation mode. In various cases, the surgical hub 13120 is configured to continuously transmit additional information such as various sensed tissue conditions to the control unit 13114 of the robotic surgical system 13110 in order to adjust, continue and / or pause further movement of the robotic tool 13117 and / or the input operating mode.

[0407] In various cases, the surgical hub 13120 may calculate parameters, such as smoke generation intensity, for example, based on additional information transmitted from the surgical instrument 13140. When the calculated parameters are transmitted to the control unit 13114 of the robotic surgical system 13110, the control unit 13114 is configured to move at least one robotic tool and / or adjust the operating mode to take into account the calculated parameters. For example, when the robotic surgical system 13110 enters the smoke evacuation mode, the control unit 13114 is configured to adjust the smoke evacuation motor speed to be proportional to the calculated smoke evacuation intensity.

[0408] In some cases, the ultrasonic tool mounted to the robot 13112 may include a smoke evacuation feature that can be activated by the control unit 13114 to operate in a smoke evacuation mode. In other cases, a separate smoke evacuation device may be utilized. For example, the smoke evacuation tool may be mounted to another robotic arm and utilized during a surgical procedure. In other cases, a smoke evacuation instrument separate from the robotic surgical system 13110 may be utilized. The surgical hub 13120 may, for example, coordinate communications between the robotically controlled ultrasonic tool and the smoke evacuation instrument.

[0409] exist Figure 33 to Figure 36 In the drawings, various surgical devices and components thereof are described with reference to a colon resection procedure. The reader should understand that the surgical devices, systems, and procedures described in conjunction with these figures are Fig.32 Now see Fig.33 , depicting a handle portion 13202 of a handheld surgical instrument 13300. In some aspects, the handheld surgical instrument 13300 corresponds to Fig.3213140 of the surgical system 13100 in FIG. 13140. In one example, the handheld surgical instrument 13300 is an electric circular stapler and includes a display 13310 on a handle portion 13302 thereof.

[0410] As described herein, in the case of a surgical hub 13320 ( Fig.34 ) to combine the handheld surgical instrument 13300 with a robotic surgical system (e.g., Fig.32 Before pairing with a robotic surgical system 13110 in a handheld surgical instrument 13300, a display 13310 on the handle 13302 of the handheld surgical instrument 13300 may include information about the status of the instrument 13300, such as a clamping load 13212, anvil status 13214, and / or instrument or staple cartridge status 13216. In various cases, the display 13310 of the handheld surgical instrument 13300 includes an alert 13318 of the status of the delivery firing system provided to the user. In various cases, the display 13310 is configured to display information in a manner that conveys the most important information to the user. For example, in various cases, the display 13310 is configured to display warning information in a larger size, in a flashing manner, and / or in a different color. When the handheld surgical instrument 13300 is not paired with a surgical hub, the display 13310 may depict information collected only from the handheld surgical instrument 13300 itself.

[0411] See now Fig.34 After pairing the handheld surgical instrument 13300 with the surgical hub 13320, as described herein Fig.32 As described, for example, information detected and displayed by the handheld surgical instrument 13300 may be transmitted to the surgical hub 13320 and displayed on a hub display (e.g., Fig.32 In addition or alternatively, the information may be displayed on a display of the robotic surgical system. In addition or alternatively, the information may be displayed on a display 13310 on the handle portion 13302 of the handheld surgical instrument 13300. In various circumstances, the clinician may decide what information to display at one or more locations. As described above, in various circumstances, the clinician may be able to delete any undesirable information displayed on the display 13310 of the handheld surgical instrument 13300, the display of the robotic surgical system, and / or the display of the hub.

[0412] Still see Fig.34After pairing the handheld surgical instrument 13300 with the robotic surgical system, the display 13310 on the handle portion 13302 of the handheld surgical instrument 13300 may be different from the display 13310 on the handheld surgical instrument 13300 before pairing with the robotic surgical system. For example, procedure information from the surgical hub 13320 and / or the robotic surgical system may be displayed on the electric circular stapler. For example, Fig.34 As shown, for the convenience of the clinician, robotic status information is displayed on the display 13310 of the handheld surgical instrument 13300, including alignment information 13312 from the surgical hub 13320 and one or more retraction tensions 13316, 13317 applied by the robotic tool on a particular tissue. In various cases, the display 13310 of the handheld surgical instrument 13300 includes an alert 13318 provided to the user that conveys the parameters monitored by the surgical hub 13320 during the surgical procedure. In various cases, the display 13310 is configured to display information in a manner that conveys the most important information to the user. For example, in various cases, the display 13310 is configured to display warning information in a larger size, in a flashing manner, and / or in a different color.

[0413] Still see Fig.34 , the display 13310 of the handheld surgical instrument 13300 is configured to display information about one or more retraction tensions 13316, 13317 applied by one or more devices during a surgical procedure involving one or more robotic tools. For example, the handheld surgical instrument 13300, i.e., an electric circular stapler, involves Fig.35 In this procedure, one device (e.g., a robotic tool) is configured to grasp colon tissue, while another device (e.g., a handheld circular stapler) is configured to grasp rectal tissue. As the devices move apart from each other, the force F that retracts the colon tissue is monitored. RC and the force F that retracts the rectal tissue RR In the example shown, when the force of retracting the colon tissue exceeds a predetermined threshold, an alert notification 13318 is issued to the user. RC 、F RR The predetermined thresholds are represented by horizontal dashed lines on display 13310. The user will be notified when one or both thresholds are exceeded and / or reached to minimize damage and / or trauma to surrounding tissue.

[0414] exist Fig.36 The retraction force F is shown in RC 、F RRIn the case shown in the graphical displays 13330 and 13340, the user is notified when a predetermined threshold is exceeded, as shown in the shaded area 13332 of the graphical display 13330, indicating that the retraction force F of the colon tissue RC Exceeding the predetermined threshold of 0.5 lbs.

[0415] In some cases, it may be difficult to align the end effector of a circular stapler with the target tissue during a colorectal procedure due to limited visibility. Fig.35 During colon resection, the surgical instrument 13300, i.e., a circular stapler, can be positioned adjacent to the transected rectum 13356. In addition, the anvil 13301 of the surgical instrument 13300 can engage the transected colon 13355. The robotic tool 133175 is configured to engage the anvil 13301 and apply a retraction force F RC It may be difficult to confirm the relative position of the surgical instrument 13300 to the target tissue, for example, by passing sutures through the transected colon 13355. In some cases, information from the surgical hub 13320 and the robotic surgical system may facilitate alignment. For example, Fig.34 As shown, the center of the surgical instrument 13300 can be shown relative to the center of the target tissue 13318 on the display screen 13310 of the surgical instrument 13300. In some cases, and as Fig.35 As shown, the sensors and wireless transmitters on the surgical instrument 13300 can be configured to transmit positioning information to a surgical hub 13320, for example.

[0416] Colorectal procedures, their visibility limitations, and alignment tools for a surgical hub are further described herein and in U.S. provisional patent application serial number 62 / 611,341, filed on December 28, 2017, entitled INTERACTIVE SURGICAL PLATFORM, the disclosure of which is incorporated herein by reference in its entirety.

[0417] As described above, the display 13310 on the handheld device 13300 can also be configured to alert the clinician in certain scenarios. For example, Fig.34 The display 13310 in includes an alert 13318 because one or more forces exceed a predefined force threshold. Fig.35 and Fig.36 , during colon resection, the robot arm can apply a first force F on the anvil RC , and the handheld instrument 13300 can apply a second force F on the rectum 13356 RR The tension of the circular stapler on the rectum 13356 can be limited to a first limit (e.g., Fig.36 0.5 lbs) and the tension of the robotic arm on the colon 13355 may be limited to a second limit (e.g., Fig.36 When the tension on the rectum 13356 or colon 13355 exceeds a threshold, the clinician may be advised to intervene.

[0418] Fig.35 and Fig.36 The tension on the colon F RC The resistance to the robotic arm may be determined, and thus may be determined by a control unit, such as the control unit 13114 of the robotic surgical system 13110. Such information may be transmitted to the handheld surgical instrument 13300 and displayed on its display 13310 in the sterile field, such that, for example, the appropriate clinician may readily obtain the information in real time, or near real time, or at any suitable interval, rate, and / or schedule.

[0419] In various cases, surgical systems such as Fig.37 and Fig.38 The surgical system 13360 includes interactive auxiliary displays 13362, 13364 within the sterile field. The interactive auxiliary displays 13362, 13364 are also mobile control modules in some cases and can be similar to, for example, Fig.32 The surgeon's command console or remote control module 13370 is the primary control module and may be located outside the sterile field. In one example, the interactive auxiliary display 13362 may be a mobile device, watch, and / or small tablet computer that may be worn on the user's wrist and / or forearm, and the interactive auxiliary display 13364 may be a handheld mobile electronic device that may be placed on the patient 13361 or patient table during a surgical procedure, such as a Tablet computer. For example, the interactive auxiliary display 13362, 13364 can be placed on the abdomen or leg of the patient 13361 during a surgical procedure. In other cases, the interactive auxiliary display 13362, 13364 can be incorporated into a handheld surgical instrument 13366 within a sterile field.

[0420] In one example, surgical system 13360 is shown during a surgical procedure. For example, a surgical procedure may be described herein in conjunction with Figure 33 to Figure 36The colon resection procedure described. In this case, the surgical system 13360 includes a robot 13372 and a robotic tool 13374 extending into the surgical site. The robotic tool can be, for example, an ultrasonic device including an ultrasonic knife and a clamping arm. The surgical system 13360 also includes a remote command console 13370, which includes a robot hub 13380. The control unit of the robot 13372 is housed in the robot hub 13380. The surgeon 13371 is initially positioned at the remote command console 13370. The assistant 13367 holds a handheld surgical instrument 13366, which is a circular stapler extending into the surgical site. The assistant 13367 also holds an auxiliary display 13364 that communicates with the robot hub 13380. The auxiliary display 13364 is a mobile digital electronic device, which can be fixed on, for example, the forearm of the assistant. The handheld surgical instrument 13366 includes a wireless communication module. The second surgical hub 13382 is also fixed in the operating room. The surgical hub 13382 includes a generator module and may include additional modules as further described herein and in U.S. provisional patent application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the disclosure of which is incorporated herein by reference in its entirety.

[0421] Main references Fig.37 , the hubs 13380, 13382 include wireless communication modules so that a wireless communication link is established between the two hubs 13380, 13382. In addition, the robot hub 13380 communicates signals with the interactive auxiliary displays 13362, 13364 within the sterile field. The hub 13382 communicates signals with the handheld surgical instrument 13366. If the surgeon 13371 moves toward the patient 13361 and within the sterile field (as shown by the reference numeral 13371'), the surgeon 13371 can use one of the wireless interactive displays 13362, 13364 to operate the robot 13372 away from the remote command console 13370. Multiple auxiliary displays 13362, 13364 within the sterile field allow the surgeon 13371 to move away from the remote command console 13370 without losing important surgical procedure information and control of the robotic tools used therein.

[0422] The interactive auxiliary displays 13362, 13364 allow the clinician to leave the remote command console 13370 and enter the sterile field while maintaining control of the robot 13372. For example, the interactive auxiliary displays 13362, 13364 allow the clinician to simultaneously maintain collaborative and / or coordinated control of the powered handheld surgical instrument 13366 and the robotic surgical system. In various instances, information is transmitted between the robotic surgical system, one or more powered handheld surgical instruments 13366, the surgical hub 13380, 13382, and the interactive auxiliary displays 13362, 13364. Such information may include, for example, images on displays of the robotic surgical system and / or powered handheld surgical instruments, parameters of the robotic surgical system and / or powered handheld surgical instruments, and / or control commands for the robotic surgical system and / or powered handheld surgical instruments.

[0423] In various instances, a control unit of the robotic surgical system (e.g., control unit 13113 of the robotic surgical system 13110) is configured to transfer at least one display element from the surgeon's command console (e.g., console 13116) to an interactive auxiliary display (e.g., display 13130). In other words, a portion of the display content at the surgeon's console is copied to the display content of the interactive auxiliary display, thereby integrating the robot display with the interactive auxiliary display. Copying the robot display to the display content of the interactive auxiliary display allows the clinician to leave the remote command console without losing the visual image displayed therein. For example, at least one of the interactive auxiliary displays 13362, 13364 can display information from the robot, such as information from the robot display and / or the surgeon's command console 13370.

[0424] In various cases, the interactive auxiliary displays 13362, 13364 are configured to control and / or adjust at least one operating parameter of the robotic surgical system. Such control can occur automatically and / or in response to clinician input. By interacting with the touch-sensitive screen and / or buttons on the interactive auxiliary displays 13362, 13364, the clinician is able to enter commands to control the movement and / or function of one or more robotic tools. For example, when using the handheld surgical instrument 13366, the clinician may want to move the robotic tool 13374 to a different position. In order to control the robotic tool 13374, the clinician applies the input to the interactive auxiliary displays 13362, 13364, and the corresponding interactive auxiliary displays 13362, 13364 transmit the clinician input to the control unit of the robotic surgical system in the robot hub 13380.

[0425] In various circumstances, a clinician at the remote command console 13370 of the robotic surgical system may manually override any robotic commands initiated by clinician input on one or more interactive auxiliary displays 13362, 13364. For example, when clinician input is received from one or more interactive auxiliary displays 13362, 13364, the clinician at the remote command console 13370 may allow commands to be issued and the desired functions to be performed, or the clinician may override commands by interacting with the remote command console 13370 and prohibiting commands from being issued.

[0426] In some cases, the clinician in the sterile field may need to request permission to control the robot 13372 and / or the robotic tools 13374 mounted thereon. The surgeon 13371 at the remote command console 13370 may approve or deny the clinician's request. For example, the surgeon may receive a pop-up message or other notification indicating that another clinician is requesting permission to operate a handheld surgical instrument and / or interact with an interactive auxiliary display 13362, 13364.

[0427] In various embodiments, a robotic surgical system such as the robotic surgical system 13000 ( Fig.23 )、13400( Fig.24 )、13150( Fig.30 )、13100( Fig.32 ) and / or the surgical hub 13380, 13382 are, for example, programmed with pre-approved functions of the robotic surgical system. For example, if the clinician input from the interactive auxiliary display 13362, 13364 corresponds to the pre-approved function, the robotic surgical system allows the interactive auxiliary display 13362, 13364 to control the robotic surgical system and / or does not prohibit the interactive auxiliary display 13362, 13364 from controlling the robotic surgical system. If the clinician input from the interactive auxiliary display 13362, 13364 does not correspond to the pre-approved function, the interactive auxiliary display 13362, 13364 cannot command the robotic surgical system to perform the desired function. In one instance, the situational awareness module in the robotic hub 13370 and / or the surgical hub 13382 is configured to indicate and / or influence when the interactive auxiliary display can issue a control motion to the robotic surgical system.

[0428] In various cases, the interactive auxiliary display 13362, 13364 can control a portion of the robotic surgical system when in contact with a portion of the robotic surgical system. For example, when the interactive auxiliary display 13362, 13364 is in contact with the robotic tool 13374, the interactive auxiliary display 13362, 13364 will be granted control of the robotic tool 13374 in contact. The clinician can then input commands using the touch-sensitive screen and / or buttons on the interactive auxiliary display 13362, 13364 to control the movement and / or function of the robotic tool 13374 in contact. This control scheme allows the clinician to reposition the robotic arm, reload the robotic tool and / or otherwise reconfigure the robotic surgical system. In a similar manner to that described above, a clinician 13371 at the remote command console 13370 of the robotic surgical system can manually override any robotic command initiated by the interactive auxiliary display 13362, 13364.

[0429] In one aspect, a robotic surgical system includes a processor and a memory communicatively coupled to the processor, as described herein. The memory stores instructions executable by the processor to receive a first user input from a control console and a second user input from a mobile wireless control module to control a function of a robotic surgical tool, as described herein.

[0430] In various aspects, the present disclosure provides a control circuit that receives a first user input from a console and a second user input from a mobile wireless control module to control a function of a robotic surgical tool as described herein. In various aspects, the present disclosure provides a non-transitory computer readable medium storing computer readable instructions that, when executed, cause a machine to receive a first user input from a console and a second user input from a mobile wireless control module to control a function of a robotic surgical tool as described herein.

[0431] A robotic surgical system may include multiple robotic arms configured to assist a clinician during a surgical procedure. Each robotic arm may operate independently of the other robotic arms. Because each robotic arm operates independently, there may be a lack of communication between them, which may increase the risk of tissue trauma. For example, tissue trauma may result in a situation where one robotic arm is configured to apply a force that is stronger and in a different direction than the force configured to be applied by a second robotic arm. For example, tissue trauma and / or tearing may occur when a first robotic arm applies a strong retractive force to tissue and a second robotic arm is configured to rigidly hold the tissue in place.

[0432] In various cases, one or more sensors are attached to each robotic arm of the robotic surgical system. The one or more sensors are configured to sense forces applied to surrounding tissue during operation of the robotic arm. Such forces may include, for example, holding forces, retraction forces, and / or dragging forces. The sensors of each robotic arm are configured to transmit the magnitude and direction of the detected forces to a control unit of the robotic surgical system. The control unit is configured to analyze the transmitted forces and set a limit on the maximum load to avoid trauma to tissue in the surgical site. For example, if the retraction or dragging force applied by the second robotic arm increases, the control unit can minimize the holding force applied by the first robotic arm.

[0433] Fig.39 A robotic surgical system 13800 is depicted that includes a control unit 13820 and a robot 13810. The robotic surgical system 13800 is similar in many respects to, for example, a system that includes a robot 13002 ( Fig.23 ) of the robotic surgical system 13000. The control unit 13820 includes a processor 13822 and a display 13824. The robot 13810 includes two robotic arms 13830, 13840 configured to perform various surgical functions. Each of the robotic arms 13830, 13840 is independently operable and moves freely in a space that defines the control range of the robotic surgical system 13800. One or more robotic arms 13830, 13840 are configured to receive tools, such as staplers, radio frequency (RF) tools, ultrasonic knives, grippers and / or cutting instruments. Other suitable surgical tools may be used. In various cases, the robotic arms 13830, 13840 each include different tools configured to perform different functions. In other cases, all robotic arms 13830, 13840 include the same tools, but any suitable arrangement may also be used.

[0434] The first robotic arm 13830 includes a first driver 13834 and a first motor 13836. When activated by the processor 13822, the first motor 13836 drives the first driver 13834 to actuate the corresponding component of the first robotic arm 13830. The second robotic arm 13840 includes a second driver 13844 and a second motor 13846. When activated by the processor 13822, the second motor 13846 drives the second driver 13844 to actuate the corresponding component of the second robotic arm 13840.

[0435] Each of the robotic arms 13830, 13840 includes a sensor 13832, 13842 in signal communication with the processor 13822 of the control unit 13820. The sensors 13832, 13842 may be located on the drives 13834, 13844, respectively, and / or on the motors 13836, 13846, respectively. In various cases, the sensors 13832, 13842 are configured to detect the position of each individual robotic arm 13830, 13840 within the control range of the robotic surgical system 13800. The sensors 13832, 13842 are configured to transmit the detected position to the processor 13822 of the robotic surgical system 13800. In various cases, the position of the robotic arms 13830, 13840 is displayed on the display 13824 of the control unit 13820. As described in detail below, in various circumstances, the processor 13822 is configured to run an algorithm to implement position limits specific to each robotic arm 13830, 13840, for example, to avoid tissue trauma and damage to the robotic surgical system 13800. Such position limits can improve the ability of a clinician to simultaneously coordinate the operation of multiple robotic arms 13830, 13840 of the robotic surgical system 13800.

[0436] In various cases, the sensors 13832, 13842 are configured to detect the force applied by each robotic arm 13830, 13840. The sensors 13832, 13842 may be torque sensors. As described above, each robotic arm 13830, 13840 of the robotic surgical system 13800 may be independently operable. During a particular surgical procedure, a clinician may wish to use each robotic arm 13830, 13840 to perform a different surgical function. Upon detecting the force applied by each robotic arm 13830, 13840, each sensor 13832, 13842 is configured to transmit the detected force to the processor 13822. The processor 13822 is then configured to analyze the transmitted information and set maximum and / or minimum force limits for each robotic arm 13830, 13840, for example to reduce the risk of causing tissue trauma. In addition, the processor 13822 is configured to continuously monitor the force applied by each robotic arm 13830, 13840 and control each robotic arm 13830, 13840 proportionally relative to each other based on the direction and magnitude of the applied force. For example, the opposing force between the two robotic arms 13830, 13840 can be measured and maintained below a maximum force limit. In order to keep the opposing force below the maximum force limit, at least one force can be reduced, which may result in displacement of the robotic arms 13830, 13840.

[0437] For example, Fig.40A surgical site and a portion of a surgical system 13800 are depicted, the surgical system including three robotic arms, in addition to robotic arms 13830 and 13840, including robotic arm 13850 (third robotic arm), which is also shown in FIG. Fig.39 The first robotic arm 13830 is configured to hold a portion of the stomach connective tissue. To hold the portion of the stomach connective tissue, the first robotic arm 13830 applies an upward force F H1 The second robotic arm 13840 applies a dragging force and / or a cutting force F to the tissue. D2 At the same time, the third robotic arm 13850 retracts a portion of the liver tissue away from the current surgical incision position, thereby further exposing the next surgical incision position. In order to move the portion of the liver tissue out of the path of the advancing second robotic arm 13840, the third robotic arm 13850 applies a retraction force F away from the second robotic arm 13840. R3 In various examples, as the second robotic arm 13840 is further advanced into the surgical site, the control unit of the robotic surgical system directs the third robotic arm 13850 to increase the applied retraction force F R3 To continue to expose the next surgical incision site. Fig.40 A specific surgical procedure and particular robotic arms are depicted, but any suitable surgical procedure may be performed, and any suitable combination of robotic arms may utilize the control algorithms disclosed herein.

[0438] Fig.41 Describes the specific surgical procedures detailed above. Fig.40 Graphical representations 13852 , 13854 of the forces applied by the robotic arms 13830 , 13840 , and 13850 and the relative positions of the robotic arms 13830 , 13840 , and 13850 . Fig.41 The graphical display 13852 in FIG. 1 shows the force applied by each of the robotic arms 13830, 13840, and 13850 during a period of time, while the graphical display 13854 shows the relative position of each of the robotic arms 13830, 13840, and 13850 during the same period of time. As described above, the first robotic arm 13830 is configured to apply a holding force F on a portion of the stomach connective tissue. H1 . Holding force F H1 This is indicated by the solid lines on the graphs 13852 and 13854. The second robotic arm 13840 is configured to apply a dragging force and / or a cutting force F on the stomach connective tissue. D2 . Drag force F D2 This is indicated by the dotted lines on the graphs 13852 and 13854. The third robotic arm 13850 is configured to apply a retraction force F on a portion of the liver tissue. R3 . Retraction force F R3Indicated by the dotted lines on graphs 13852 and 13854.

[0439] In various cases, the control unit of the robotic surgical system applies at least one force threshold, such as a maximum force threshold, as shown in the graphical display 13852. Thus, the third robotic arm 13850 is prevented from applying a retraction force F greater than the maximum retraction force threshold. R3 Such maximum force limits are imposed to avoid, for example, tissue trauma and / or to avoid damage to the various robotic arms 13830 , 13840 , and 13850 .

[0440] Additionally or alternatively, the control unit 13820 of the robotic surgical system 13800 may apply at least one force threshold, such as a minimum force threshold, as depicted in the graphical display 13852. In the depicted example, the first robotic arm 13830 is prevented from applying a holding force F that is less than the minimum holding force threshold. H1 Such minimum force limits may be imposed, for example, to avoid maintaining proper tissue tension and / or visualization of the surgical site.

[0441] In various cases, the control unit 13820 of the robotic surgical system 13800 applies the maximum force difference detected between the various robotic arms during the load control mode. To set the maximum force difference, the control unit 13820 of the robotic surgical system is configured to continuously monitor the difference in magnitude and direction of the opposing forces generated by the robotic arms. As described above, the first robotic arm 13830 is configured to apply a holding force F H1 The second robotic arm 13840 is configured to apply a holding force F that is the same as the holding force F applied by the first robotic arm 13830. H1 The opposite drag force F D2 In various circumstances, the maximum force differential prevents accidental overloading and / or damage to objects clamped between the robotic arms 13830, 13840, and 13850. Such objects include, for example, surrounding tissue and / or surgical components such as buckles, gastric bands, and / or sphincter enhancement devices. 最大反向 Represents the maximum force difference set by the control unit 13820 in this specific example.

[0442] As can be seen from graphical display 13852, at the beginning of the surgical procedure, the force F H1 and drag force F D2 The size of the force F increases. Such an increase in size may i...

Claims

1. A robotic surgical system, comprising: a control unit comprising a processor and a memory communicatively coupled to the processor; A robot comprising a tool mounting frame; a tool comprising an energy delivery surface, wherein the tool is configured to be releasably mounted to the tool mount; and a sensor system configured to detect at least one condition at a surgical site, the at least one condition comprising the energy delivery surface being positioned in abutting contact with tissue, wherein the sensor system is in signal communication with the processor; wherein the memory stores instructions executable by the processor to: determining use of the tool based on input from the sensor system by detecting that the energy delivery surface is positioned in abutting contact with tissue; as well as When it is detected that the energy delivery surface is positioned in abutting contact with tissue, the energy delivery surface is automatically energized.

2. The robotic surgical system of claim 1, wherein the tool comprises a monopolar cautery pencil.

3. The robotic surgical system of claim 1, wherein the tool comprises an ultrasonic scalpel.

4. The robotic surgical system of claim 1 , wherein the sensor system is configured to detect impedance of tissue at the surgical site, and wherein the memory stores instructions executable by the processor to determine the use of the tool when the impedance is within a predefined range.

5. The robotic surgical system of claim 1, wherein the memory stores instructions executable by the processor to determine an activation mode of the tool based on input from the sensor system.

6. The robotic surgical system of claim 1, wherein the processor comprises a situational awareness module configured to recommend surgical functions based on input from the sensor system.

7. The robotic surgical system of claim 1, further comprising a manual override mode in which automatic energization of the energy delivery surface by the processor is prevented.

8. A robotic surgical system comprising: Control unit; A robot comprising a tool mounting frame; a tool comprising an energy delivery surface, wherein the tool is configured to be releasably mounted to the tool mount; and a sensor system configured to detect at least one condition at a surgical site, the at least one condition comprising the energy delivery surface being positioned in abutting contact with tissue, wherein the sensor system is in signal communication with the control unit; The control unit is configured as follows: determining use of the tool based on input from the sensor system by detecting that the energy delivery surface is positioned in abutting contact with tissue; as well as When it is detected that the energy delivery surface is positioned in abutting contact with tissue, the energy delivery surface is automatically energized.

9. The robotic surgical system of claim 8, wherein the sensor system is configured to detect impedance of tissue at the surgical site, and wherein the control unit is configured to determine the use of the tool when the impedance is within a predefined range.

10. The robotic surgical system of claim 8, wherein the control unit is configured to determine an activation mode of the tool based on input from the sensor system.

11. The robotic surgical system of claim 8, wherein the control unit comprises a situational awareness module configured to recommend surgical functions based on input from the sensor system.

12. The robotic surgical system of claim 8, further comprising a manual override mode in which automatic energization of the energy delivery surface by the control unit is prevented.

13. A non-transitory computer readable medium storing computer readable instructions which, when executed, cause a machine to: determining use of the surgical tool based on input from the sensor system by detecting that the energy delivery surface is positioned in abutting contact with tissue; and The energy delivery surface of the surgical tool is automatically energized when it is detected that the energy delivery surface is positioned in abutting contact with tissue.

14. The non-transitory computer readable medium of claim 13, wherein the surgical tool comprises a monopolar cautery pencil.

15. The non-transitory computer readable medium of claim 13, wherein the surgical tool comprises an ultrasonic blade.

16. The non-transitory computer readable medium of claim 13, wherein the sensor system is configured to detect impedance of tissue at a surgical site, and wherein when the impedance is within a predefined range, the computer readable instructions cause the machine to determine the use of the surgical tool.

17. The non-transitory computer readable medium of claim 13, wherein the computer readable instructions cause a machine to determine an activation mode based on input from the sensor system.

18. The non-transitory computer readable medium of claim 13, wherein the non-transitory computer readable medium comprises a situational awareness module configured to recommend a surgical function based on input from the sensor system.

19. The non-transitory computer readable medium of claim 13, further comprising a manual override mode in which automatic powering of the energy delivery surface by the machine is prevented.

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