Communication arrangement for a robotic-assisted surgical platform

Abstract

The present invention discloses various surgical systems. A surgical system includes: a hub, the hub including a generator; a robot, the robot including a tool holder; an energy tool, the energy tool can be releasably mounted to the tool holder and can be operably connected to the generator; a console; and a wireless communication path, the wireless communication path extending between the energy tool and the console. A wired communication path extends between the energy tool and the console. The wireless communication path is configured to transmit data indicating a detected tissue parameter to the console.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This patent application claims priority under 35 U.S.C. § 119(e) to U.S. Provisional Patent Application No. 62 / 649,320, filed on March 28, 2018, entitled “DRIVE ARRANGEMENTS 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-BASED MEDICAL 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 one or more 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 surgical system is provided. The surgical system includes a hub including a generator; a robot including a tool holder; an energy tool that can be releasably mounted to the tool holder and can be operably coupled to the generator; a console; and a wireless communication path extending between the energy tool and the console. The wired communication path extends between the energy tool and the console. The wireless communication path is configured to transmit data indicating a detected tissue parameter to the console.

[0006] In another general aspect, a surgical system is provided. The surgical system includes a wireless communication module; a robot; and a flexible circuit. The robot includes a tool holder and an energy tool that can be releasably mounted to the tool holder. The flexible circuit is positioned between the tool holder and the energy tool and is positioned to intercept a communication path between the tool holder and the energy tool. The flexible circuit is coupled to a wireless transmitter configured to communicate with the wireless communication module.

[0007] In yet another aspect, a surgical system is provided. The surgical system includes: a hub including a wireless communication module; a robot including a tool holder configured to interface with a releasable surgical tool; and a console. A primary communication path extends between the robot and the console via a wired connection. A first wireless communication path extends between the robot and the wireless communication module. A second wireless communication path extends between the console and the wireless communication module. The first wireless communication path and the second wireless communication path form at least a portion of an additional communication path between the robot and the console, the additional communication path being different from the primary communication path.

[0008] In another aspect, a system is provided. The system includes a wireless communication module configured to transmit a signal. The system also includes a robotic surgical tool, the robotic surgical tool including a tool interface, wherein the tool interface includes: a mechanical connector configured to receive a drive motion from a robotic tool driver; and an electrical connector configured to transmit the signal. The system also includes a flexible circuit configured to intercept the signal when the flexible circuit is engaged with the tool interface. BRIEF DESCRIPTION OF THE DRAWINGS

[0009] 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.

[0010] Figure 1 is a block diagram of a computer-implemented interactive surgical system according to at least one aspect of the present disclosure.

[0011] Figure 2 A surgical system for performing a surgical procedure in an operating room according to at least one aspect of the present disclosure.

[0012] 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.

[0013] 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.

[0014] Figure 5 is a perspective view of a combination generator module having bipolar, ultrasonic and monopolar contacts and a smoke evacuation device according to at least one aspect of the present disclosure.

[0015] 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.

[0016] 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.

[0017] 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.

[0018] Fig. 9 A computer-implemented interactive surgical system according to at least one aspect of the present disclosure.

[0019] 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.

[0020] 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.

[0021] 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.

[0022] 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.

[0023] 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.

[0024] 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.

[0025] 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.

[0026] 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.

[0027] 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.

[0028] 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.

[0029] Fig. 20 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.

[0030] Fig.21 According to at least one aspect of the present disclosure, Fig. 20 An example of a generator of one form of a generator.

[0031] Fig. 22 is a schematic diagram of a robotic surgical system according to one aspect of the present disclosure.

[0032] Fig.23 is a plan view of a minimally invasive telerobotic surgical system for performing a surgical procedure according to one aspect of the present disclosure.

[0033] Fig.24 According to one aspect of the present disclosure Fig.23 Perspective view of a surgeon's console of a surgical system.

[0034] Fig.25 According to at least one aspect of the present disclosure Fig.23 A perspective view of the electronics cart for a surgical system.

[0035] Fig.26 is an illustration of a teleoperated surgical system according to one aspect of the present disclosure.

[0036] Fig. 27 According to one aspect of the present disclosure Fig.23 Partial view of the patient side cart of the surgical system.

[0037] Fig.28 According to one aspect of the present disclosure Fig.23Front view of a remote surgical tool of a surgical system.

[0038] Fig.29 FIG. 1 is a control schematic diagram of a teleoperated surgical system according to one aspect of the present disclosure.

[0039] Fig.30 is a front view of a robotic surgical system and its various communication pathways according to one aspect of the present disclosure.

[0040] Fig.31 for Fig.30 An exploded perspective view of the interface between a robotic tool and a tool mounting portion of a robotic surgical system.

[0041] Fig.32 According to one aspect of the present disclosure Fig.31 Detailed drawing of the interface.

[0042] Fig.33 is a perspective view of a bipolar radio frequency (RF) robotic tool having a smoke evacuation pump for use with a robotic surgical system according to one aspect of the present disclosure.

[0043] Fig.34 An end effector for clamping and manipulating tissue is depicted according to one aspect of the present disclosure. Fig.33 A perspective view of the end effector of a bipolar radiofrequency robotic tool.

[0044] Fig.35 According to one aspect of the present disclosure Fig.33 A plan view of the tool drive interface of a bipolar RF robotic tool with components removed for clarity.

[0045] Fig.36 is a plan view of an ultrasonic robotic tool having cooling and insufflation features for use with a robotic surgical system according to one aspect of the present disclosure.

[0046] Fig.37 Flowchart of a control algorithm for a robotic tool for use with a robotic surgical system according to one aspect of the present disclosure.

[0047] Fig.38 is a perspective view of a drive system for a robotic surgical tool according to one aspect of the present disclosure.

[0048] Fig.39 According to at least one aspect of the present disclosure Fig.38 Exploded perspective view of the drive system.

[0049] Fig.40 According to at least one aspect of the present disclosure Fig.38A perspective, partially cut-away view of a proximal housing of a robotic surgical tool depicting the arrangement of a transmission within the proximal housing.

[0050] Fig.41 According to one aspect of the present disclosure Fig.40 An exploded perspective view of the transmission arrangement.

[0051] Fig.42 for Fig.40 An exploded perspective view of a transmission arrangement with various components removed for clarity; depicts a transmission arrangement in a first configuration according to one aspect of the present disclosure, wherein a first cooperating drive is drivingly coupled to a first output shaft and a second cooperating drive is drivingly coupled to a second output shaft.

[0052] Fig.43 According to one aspect of the present disclosure Fig.40 0026] An exploded perspective view of a transmission arrangement with various components removed for clarity; depicts the transmission arrangement in a second configuration according to one aspect of the present disclosure, with a first cooperating drive and a second cooperating drive drivingly coupled to a third output shaft.

[0053] Fig.44 According to one aspect of the present disclosure Fig.40 0026] An exploded perspective view of a transmission arrangement with various components removed for clarity; depicts the transmission arrangement in a third configuration according to one aspect of the present disclosure, with a first cooperating drive and a second cooperating drive drivingly coupled to a fourth output shaft.

[0054] Fig.45 According to at least one aspect of the present disclosure Fig.40 A cross-sectional front view of the transmission arrangement.

[0055] Fig.46 According to at least one aspect of the present disclosure Fig.38 Graphical display of the output torque of a robotic surgical tool for different surgical functions.

[0056] Fig.47 According to one aspect of the present disclosure, the Fig.38 Perspective view of a robotic surgical tool.

[0057] Fig.48 According to one aspect of the present disclosure, the Fig.38 Perspective view of a robotic surgical tool.

[0058] Fig.49 According to one aspect of the present disclosure, the Fig.38 Perspective view of a robotic surgical tool.

[0059] Fig.50 According to one aspect of the present disclosure, the Fig.38 Perspective view of a robotic surgical tool.

[0060] Fig.51 is an illustration of a robotically controlled end effector at a surgical site according to one aspect of the present disclosure.

[0061] Fig.52 According to one aspect of the present disclosure Fig.51 View of the robot-controlled end effector.

[0062] Fig.53 According to one aspect of the present disclosure Fig.51 A graphical display of the force and displacement over time of one of the end effectors of the robot controlled end effector.

[0063] Fig.54 is a flow chart of a control algorithm for a surgical tool for use with a robotic surgical system according to one aspect of the present disclosure.

[0064] Fig.55 is an elevation view of a surgical procedure involving a robotic surgical system and a handheld surgical instrument according to one aspect of the present disclosure and depicts multiple displays in a surgical operating room.

[0065] Fig.56 A timeline depicting situational awareness of a surgical hub according to one aspect of the present disclosure. DETAILED DESCRIPTION

[0066] 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:

[0067] U.S. Provisional Patent Application Serial No. 62 / 649,302, entitled “INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES”;

[0068] U.S. Provisional Patent Application Serial No. 62 / 649,294, entitled “DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD”;

[0069] U.S. Patent Application Serial No. 62 / 649,300, entitled “SURGICAL HUB SITUATIONAL AWARENESS”;

[0070] U.S. Provisional Patent Application Serial No. 62 / 649,309, entitled “SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES INOPERATING THEATER”;

[0071] U.S. Provisional Patent Application Serial No. 62 / 649,310, entitled “COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS”;

[0072] 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”;

[0073] U.S. Patent Application Serial No. 62 / 649,296, entitled “ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES”;

[0074] U.S. Provisional Patent Application Serial No. 62 / 649,333, entitled “CLOUD-BASED MEDICALANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER”;

[0075] U.S. Provisional Patent Application Serial No. 62 / 649,327, entitled “CLOUD-BASED MEDICALANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES”;

[0076] U.S. Provisional Patent Application Serial No. 62 / 649,315, entitled “DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK”;

[0077] U.S. Patent Application Serial No. 62 / 649,313, entitled “CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES”;

[0078] U.S. Provisional Patent Application Serial No. 62 / 649,320, entitled “DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”;

[0079] U.S. Provisional Patent Application Serial No. 62 / 649,307, entitled “AUTOMATIC TOOLADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”; and

[0080] U.S. Provisional Patent Application Serial No. 62 / 649,323, entitled “SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.”

[0081] The applicant of the present application owns the following U.S. patent applications filed on March 29, 2018, each of which is incorporated herein by reference in its entirety:

[0082] U.S. Patent Application Serial No. ____________, entitled “INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES”; Attorney Docket No. END8499USNP / 170766;

[0083] U.S. Patent Application Serial No. ____________, entitled “INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICES AND DATA CAPABILITIES”; Attorney Docket No. END8499USNP1 / 170766-1;

[0084] U.S. Patent Application Serial No. ____________, entitled “Surgical hub coordination of control and communication of operating room devices”; Attorney Docket No. END8499USNP2 / 170766-2;

[0085] U.S. Patent Application Serial No. ____________, entitled “Spatial awareness of surgical hubs in operating rooms; Attorney Docket No. END8499USNP3 / 170766-3;

[0086] U.S. patent application entitled “Cooperative utilization of data derived from secondary sources by intelligent surgical hubs” Serial No. ____________; Attorney Docket No. END8499USNP4 / 170766-4;

[0087] U.S. Patent Application Serial No. ____________, entitled “Surgical hub control arrangements”; Attorney Docket No. END8499USNP5 / 170766-5;

[0088] U.S. Patent Application Serial No. ____________ entitled “DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD”; Attorney Docket No. END8500USNP / 170767;

[0089] 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;

[0090] U.S. Patent Application Serial No. ____________, entitled “SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT”; Attorney Docket No. END8500USNP2 / 170767-2;

[0091] U.S. Patent Application Serial No. ____________, entitled “DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETERWITH AN OUTCOME”; Attorney Docket No. END8500USNP3 / 170767-3;

[0092] U.S. Patent Application entitled “SURGICAL HUB SITUATIONAL AWARENESS,” Serial No. ____________; Attorney Docket No. END8501USNP / 170768;

[0093] U.S. Patent Application entitled “SURGICAL SYSTEM DISTRIBUTED PROCESSING” Serial No. ____________; Attorney Docket No. END8501USNP1 / 170768-1;

[0094] U.S. Patent Application entitled “AGGREGATION AND REPORTING OF SURGICAL HUB DATA” Serial No. ____________; Attorney Docket No. END8501USNP2 / 170768-2;

[0095] U.S. Patent Application Serial No. ____________, entitled “SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES INOPERATING THEATER”; Attorney Docket No. END8502USNP / 170769;

[0096] U.S. Patent Application entitled “DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE” Serial No. ____________; Attorney Docket No. END8502USNP1 / 170769-1;

[0097] U.S. Patent Application Serial No. ____________, entitled “STERILE FIELD INTERACTIVE CONTROL DISPLAYS”; Attorney Docket No. END8502USNP2 / 170769-2;

[0098] U.S. Patent Application Serial No. ____________, entitled “COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS”; Attorney Docket No. END8503USNP / 170770;

[0099] 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;

[0100] 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

[0101] U.S. Patent Application Serial No. ____________, entitled “DUAL CMOS ARRAY IMAGING”; Attorney Docket No. END8504USNP2 / 170771-2.

[0102] The applicant of the present application owns the following U.S. patent applications filed on March 29, 2018, each of which is incorporated herein by reference in its entirety:

[0103] U.S. Patent Application Serial No. ____________, entitled “ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES”; Attorney Docket No. END8506USNP / 170773;

[0104] U.S. Patent Application Serial No. ____________, entitled “ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS”; Attorney Docket No. END8506USNP1 / 170773-1;

[0105] U.S. Patent Application entitled “CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER” Serial No. ____________; Attorney Docket No. END8507USNP / 170774;

[0106] U.S. Patent Application Serial No. ____________ entitled “CLOUD-BASED MEDICAL ANALYTICS FOR LINKING OF LOCAL USAGETRENDS WITH THE RESOURCE ACQUISITION BEHAVIORS OF LARGER DATA SET”; Attorney Docket No. END8507USNP1 / 170774-1;

[0107] 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;

[0108] U.S. Patent Application Serial No. ____________, entitled “CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES”; Attorney Docket No. END8508USNP / 170775;

[0109] U.S. Patent Application Serial No. ____________, entitled “DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK”; Attorney Docket No. END8509USNP / 170776; and

[0110] U.S. Patent Application Serial No. ____________, entitled “CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES”; Attorney Docket No. END8510USNP / 170777.

[0111] The applicant of the present application owns the following U.S. patent applications filed on March 29, 2018, each of which is incorporated herein by reference in its entirety:

[0112] U.S. Patent Application Serial No. ____________, entitled “DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMs”; Attorney Docket No. END8511USNP / 170778;

[0113] U.S. Patent Application Serial No. ____________, entitled “CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”; Attorney Docket No. END8511USNP2 / 170778-2;

[0114] U.S. Patent Application Serial No. ____________, entitled “AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICALPLATFORMS”; Attorney Docket No. END8512USNP / 170779;

[0115] U.S. Patent Application Serial No. ____________, entitled “CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”; Attorney Docket No. END8512USNP1 / 170779-1;

[0116] U.S. Patent Application Serial No. ____________, entitled “COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICALPLATFORMS”; Attorney Docket No. END8512USNP2 / 170779-2;

[0117] U.S. Patent Application Serial No. ____________, entitled “DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”; Attorney Docket No. END8512USNP3 / 170779-3; and

[0118] U.S. Patent Application Serial No. ____________, entitled “SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”; Attorney Docket No. END8513USNP / 170780.

[0119] 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 illustrative examples 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.

[0120] See also Figure 1 , a 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.

[0121] Figure 3An 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's body. 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.

[0122] 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.

[0123] Various examples of cloud-based analytics performed by the cloud 104 and suitable for use in the present disclosure are described in U.S. Provisional Patent Application Serial No. 62 / 611,340, entitled “CLOUD-BASED MEDICAL ANALYTICS,” filed on December 28, 2017, the disclosure of which is incorporated herein by reference in its entirety.

[0124] 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.

[0125] 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.

[0126] 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.

[0127] 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.

[0128] In various aspects, the imaging device 124 is configured for use in minimally invasive surgery. 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.

[0129] In one aspect, the imaging device employs multispectral monitoring to discern topography and underlying structure. A multispectral image is an image that captures image data within a specific wavelength range across the electromagnetic spectrum. The wavelengths may be separated by filters or by using instruments that are sensitive to specific wavelengths, including light from frequencies outside the visible range, such as IR and ultraviolet. Spectral imaging may allow for 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” in 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. Multispectral monitoring may be a useful tool for repositioning the surgical field after completing the surgical task to perform one or more of the previously described tests on the treated tissue.

[0130] 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 devices. 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 the area around the patient that has been prepared for surgical procedures. The sterile field can include a scrubbed team member that is appropriately dressed, as well as all furniture and fixtures in the area.

[0131] 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 in U.S. Provisional Patent Application Serial No. 62 / 611,341, entitled “INTERACTIVE SURGICAL PLATFORM,” filed on December 28, 2017, under the title “Advanced Imaging Acquisition Module,” the disclosure of which is incorporated herein by reference in its entirety.

[0132] 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.

[0133] 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.

[0134] 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 the surgical system 102 are described under the title “Surgical Instrument Hardware” in 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.

[0135] 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.

[0136] During surgery, energy application to tissue for sealing and / or cutting is usually associated with smoke evacuation, suction of excess fluid and / or flushing of tissue. Fluid lines, power lines and / or data lines from different sources are usually tangled during surgery. Valuable time can be lost in solving this problem during surgery. 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.

[0137] Various aspects of the present disclosure provide a surgical hub for use in a surgical procedure 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 and power contacts. The combination generator module includes two or more of an ultrasonic energy generator device, a bipolar RF energy generator device, and a monopolar RF energy generator device seated in a single unit. In one aspect, the combination generator module also includes a smoke evacuation device for connecting the combination generator module to at least one energy delivery cable of a surgical instrument, at least one smoke evacuation device configured to evacuate 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 evacuation device.

[0138] 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.

[0139] 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.

[0140] 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.

[0141] 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 includes second data and power contacts, wherein the second energy generator module is slidably movable to electrically engage with the power and data contacts, and wherein the second energy generator is capable of being slidably movable to not electrically engage with the second power and data contacts.

[0142] 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.

[0143] 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 devices, bipolar devices, and ultrasonic devices 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.

[0144] 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.

[0145] 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 a power and data contact of a corresponding docking station 151 of the hub modular housing 136 when the combination generator module 145 is slid into place within a 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 .

[0146] 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.

[0147] 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.

[0148] 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, an aspiration tube, and an irrigation tube. The aspiration tube may have an inlet at its distal end, and the aspiration tube extends through the shaft. Similarly, the aspiration 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.

[0149] 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.

[0150] 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.

[0151] 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.

[0152] 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.

[0153] 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.

[0154] 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.

[0155] 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.

[0156] 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 connected 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.

[0157] 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.

[0158] 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.

[0159] 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.

[0160] Various image processors and imaging devices suitable for use with the present disclosure are described in U.S. Patent 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. Patent No. 7,982,776, entitled “SBI MOTION ARTIFACTREMOVAL 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 No. 2011 / 0306840, entitled “CONTROLLABLE MAGNETIC SOURCE TO FIXTUREINTRACORPOREAL APPARATUS,” published on December 15, 2011, and U.S. Patent Application Publication No. 2014 / 0243597, entitled “SYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCEDURE,” published on August 28, 2014, each of which is incorporated herein by reference in its entirety.

[0161] 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 connected 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 connected 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.

[0162] Modular devices 1a-1n located in an operating room may be connected to a modular communication hub 203. A network hub 207 and / or a network switch 209 may be connected 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 connected to a network switch 209. A network switch 209 may be connected 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.

[0163] 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 connected to an endoscope, a generator module 140 connected 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.

[0164] 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 connected 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.

[0165] 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 (including image data) collected by the devices 1a-1n / 2a-2m 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 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.

[0166] 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) to transmit the 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.

[0167] 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.

[0168] 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.

[0169] 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.

[0170] 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.

[0171] 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.

[0172] 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.

[0173] 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 connected to the following modules: an imaging module 238 connected to an endoscope 239, a generator module 240 connected 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 connected to a display 237, and a non-contact sensor module 242. The operating room devices are connected 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 connected to the modular control tower 236 via wired or wireless communication standards or protocols, as described herein. The modular control tower 236 can be connected to the 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.

[0174] 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.

[0175] 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 transmitting 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, entitled “INTERACTIVE SURGICAL PLATFORM,” filed on December 28, 2017, under the title “Surgical Hub Spatial Awareness Within an Operating Room,” 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 transmitting laser pulses, receiving laser pulses that bounce off the walls of the operating room, and comparing the phase of the transmitted pulses with the received pulses to determine the size of the operating room and adjust the Bluetooth pairing distance limit.

[0176] 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.

[0177] The 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 LM4F230H5QR ARM Cortex-M4F processor core, such as 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 sequential random access memory (SRAM), a 32KB MCU loaded with 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.

[0178] In one aspect, the processor 244 may include a safety controller including two families of controllers such as the TMS570 and RM4x, known under the trade name Hercules ARMCortex 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 advanced integrated safety features while delivering scalable performance, connectivity, and memory options.

[0179] 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).

[0180] 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.

[0181] 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 use 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 devices described herein can be implemented with various operating systems or combinations of operating systems.

[0182] The user inputs commands or information into the computer system 210 through (one or more) input devices connected 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.

[0183] 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).

[0184] In various aspects, Fig.10 computer system 210, imaging module 238 and / or visualization system 208, and / or Figures 9 and 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.

[0185] 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.

[0186] Fig.11A functional block diagram of one aspect of a USB network hub 300 device according to one aspect of the present disclosure is illustrated. In the illustrated aspect, the USB network hub device 300 employs the TUSB2036 integrated circuit hub of 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.

[0187] 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.

[0188] 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 connected to the pause / resume logic and frame timer 316 circuits and the 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 circuits 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 .

[0189] 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.

[0190] Surgical Instrument Hardware

[0191] 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. The motor 482 driven by the motor driver 492 can be operably connected to the longitudinally movable displacement member to drive the 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 the I-beam firing, the closure tube travel, the shaft rotation and the joint movement. The display 473 displays a variety of operating conditions of the instrument and may 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.

[0192] In one aspect, the 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, the 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 CPU loaded with 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.

[0193] 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 ARMCortex 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 advanced integrated safety features while delivering scalable performance, connectivity, and memory options.

[0194] Controller 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, microcontroller 461 includes processor 462 and memory 468. Electric motor 482 can be a brushed DC (DC) motor having a gear box and a mechanical link to the articulation or knife system. In one aspect, motor driver 492 can be an A3941 available from Allegro Microsystems, Inc. Other motor drivers can be easily replaced for use in 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 SURGICALSTAPLING AND CUTTING INSTRUMENT," published on October 19, 2017, which is incorporated herein by reference in its entirety.

[0195] 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.

[0196] 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, which may include a plurality of battery cells connected in series and 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.

[0197] 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.

[0198] The tracking system 480 includes a controlled motor drive circuit arrangement including a position sensor 472 according to one aspect of the present disclosure. The position sensor 472 for the absolute positioning system provides a unique position signal corresponding to the position of the displacement member. In one aspect, the displacement member represents a longitudinally movable drive member, which includes a rack of drive teeth for meshing engagement with a corresponding drive gear of the gear reducer assembly. In other aspects, the displacement member represents a firing member, which can be adapted and configured to include a rack of drive teeth. In yet another aspect, the displacement member represents a firing rod or 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 or tool, such as a drive member, a firing member, a firing rod, an I-beam, or any element that can be displaced. In one aspect, the longitudinally movable drive member is connected 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, a 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.

[0199] The electric motor 482 may include a rotatable shaft that can be operably interfaced 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 can be operably connected 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 can be connected to a linear actuator via a rack and pinion arrangement, or connected 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 can display the output of the absolute positioning system. The displacement member represents a longitudinally movable drive member, which includes a rack of drive teeth formed thereon for meshing engagement with a corresponding drive gear of the gear reducer assembly. The displacement member represents a longitudinally movable firing member, a firing rod, an I-beam, or a combination thereof.

[0200] 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.

[0201] 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.

[0202] 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.

[0203] 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 device 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-lead 4×4×0.85 mm package.

[0204] 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, other sensors may include sensor arrangements such as those described in U.S. Patent No. 9,345,481, entitled “STAPLE CARTRIDGE TISSUE THICKNESS,” issued May 24, 2016, which is incorporated herein by reference in its entirety; U.S. Patent Application Publication No. 2014 / 0263552, entitled “STAPLE CARTRIDGE TISSUE THICKNESS,” issued 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 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, wherein 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 algorithms (such as weighted averages and theoretical control loops) that drive the calculated response toward the measured response. The calculated response of the physical system takes into account properties such as mass, inertia, viscous friction, inductance and resistance to predict the state and output of the physical system by knowing the input.

[0205] 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.

[0206] Sensor 474 (such as, for example, a strain gauge or 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 sensor 474, sensor 476 (such as a load sensor) can measure the closing force applied to the anvil by the closed drive system. 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 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.

[0207] 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.

[0208] 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.

[0209] 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 .

[0210] 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 circuit 500 may include a microcontroller, which includes one or more processors 502 (e.g., microprocessors, microcontrollers) connected 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.

[0211] 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.

[0212] 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.

[0213] 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.

[0214] In some cases, the surgical instrument system or tool may include a firing motor 602. The firing motor 602 can be operably coupled to a firing motor drive assembly 604, which can 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 can cause, for example, a nail to be deployed from a nail magazine 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 can be retracted by reversing the direction of the motor 602.

[0215] 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.

[0216] 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.

[0217] 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.

[0218] 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 connected 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.

[0219] In at least one example, the common control module 610 can selectively switch between being able to operably engage the articulation motors 606a, 606b and being able to operably engage 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 connect the common control module 610 to the firing motor 602; in the second position 617, the switch 614 can electrically connect the common control module 610 to the closing motor 603; in the third position 618a, the switch 614 can electrically connect the common control module 610 to the first joint motion motor 606a; and in the fourth position 618b, the switch 614 can electrically connect 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 connected 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.

[0220] 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.

[0221] 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.

[0222] 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 memory units in memory unit 624 may be coupled to processor 622, for example.

[0223] 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.

[0224] In various cases, the processor 622 may control the motor driver 626 to control the position, rotation direction, and / or speed of the motor connected to the common controller 610. In some cases, the processor 622 may signal the motor driver 626 to stop and / or deactivate the motor connected 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 an 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.

[0225] 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, Texas Instruments LM4F230H5QR is an ARM Cortex-M4F processor core that 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 32-bit MCU loaded with 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.

[0226] 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.

[0227] In some cases, one or more mechanisms and / or sensors (such as 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.

[0228] 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 closure 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 closure member, an axis member, and / or one or more articulation members.

[0229] 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 individually operated by the control circuit 710 in open-loop or closed-loop feedback control.

[0230] 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 circuit 731 provides an output signal to the control circuit 710, such as an elapsed time or a digital count, 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.

[0231] 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.

[0232] 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.

[0233] 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.

[0234] 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 separate 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 linkage devices 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.

[0235] 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 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 actuator 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 actuator 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 nail magazine 718 and the anvil 716.

[0236] 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 a motor control 708b, which provides a drive signal to the motor 704b. The output shaft of the motor 704b is coupled to a torque sensor 744b. The torque sensor 744b is coupled to a transmission 706b 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 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 hold the tissue between the anvil 716 and the staple cartridge 718.

[0237] In one aspect, the control circuit 710 is configured to rotate an axis member such as a shaft 740 to rotate the end effector 702. The control circuit 710 provides a motor set point to a 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, which is coupled to the shaft 740. The transmission 706c includes a movable mechanical element such as a rotating element to control the shaft 740 to rotate clockwise or counterclockwise more than 360°. In one aspect, the motor 704c is coupled to a rotary 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 rotary gear assembly that can be operably supported on a 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 shaft 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.

[0238] In one aspect, the control circuit 710 is configured to cause the end effector 702 to articulate. The control circuit 710 provides a motor set point to a motor control 708d, which provides a drive signal to the motor 704d. The output of the motor 704d is connected to a torque sensor 744d. The torque sensor 744d is connected to a transmission 706d, which is connected to the joint motion 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 connected to an articulation nut that is rotatably journaled on the 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 .

[0239] 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 joint motion components 742a, 742b are driven by a separate disk driven by two motors 708d, 708e on the robot interface (rack). 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.

[0240] 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.

[0241] 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, which can be 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 connected to a CORDIC processor, which is also known as a bit-by-bit 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, digital shift operations, and table lookup operations.

[0242] 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 ultrasonic blade 718 having tissue thereon, and (4) the loads and positions on the two articulation rods.

[0243] 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 completeness of the tissue located therebetween.

[0244] 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.

[0245] 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.

[0246] 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 processing 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, entitled “CLOSED LOOP VELOCITY CONTROLTECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT,” filed on June 29, 2017, which is incorporated herein by reference in its entirety.

[0247] 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.

[0248] 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 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 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 the starting position. The timer / counter 781 can be configured to measure elapsed time, count external events, or time external events.

[0249] 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 voltage of 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.

[0250] 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 linkage 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 translates toward the distal side and toward the proximal side. The control circuit 760 may track these 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.

[0251] 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 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.

[0252] One or more sensors 788 may include a strain gauge, such as a micro strain gauge, 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 completeness of the tissue located therebetween.

[0253] 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 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.

[0254] A current sensor 786 may be employed to measure the current consumed by the motor 754. The force required to advance the I-beam 764 corresponds to the current consumed by the motor 754. The force is converted into a digital signal and provided to the control circuit 760.

[0255] 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.

[0256] 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 mechanical connection 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 can be referred to as drag acting relative to the electric motor 754. External influences such as drag can cause the operation of the physical system to deviate from the desired operation of the physical system.

[0257] Various exemplary aspects relate to a surgical instrument 750 that includes an end effector 752 having a motor-driven surgical sealing 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 opposite the anvil 766. The clinician can hold 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 with a cutting element positioned at the distal end can cut tissue between the staple cartridge 768 and the anvil 766.

[0258] 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. 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.

[0259] In some examples, the control circuit 760 may 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 may select a firing control program. The response of the instrument may 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 may 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 may adjust the motor 754 in a closed-loop manner based on the translation data describing the position of the displacement member so that the displacement member translates 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.

[0260] 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 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).

[0261] 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-electric conductor switch, an ultrasonic switch, an accelerometer, an inertial sensor, and the like.

[0262] In one aspect, the position sensor 784 can be implemented as an absolute positioning system including a monolithic magnetic rotary position sensor implemented as an AS5055EQFT, available from Austria Microsystems, AG. The position sensor 784 interfaces 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, 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.

[0263] 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 foot. 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 the co-owned U.S. patent application serial number 15 / 628,175 filed on June 20, 2017 entitled "TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT," which is incorporated herein by reference in its entirety.

[0264] 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 a 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 the starting position. The timer / counter 781 can be configured to measure elapsed time, count external events, or time external events.

[0265] 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 voltage of 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.

[0266] 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 linkage 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 translates toward the distal side and toward the proximal side. The control circuit 760 may track these 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 may 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.

[0267] 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 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.

[0268] One or more sensors 788 may include a strain gauge, such as a micro strain gauge, 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 completeness of the tissue located therebetween.

[0269] 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.

[0270] A current sensor 786 may be employed to measure the current consumed by the motor 754. The force required to advance the I-beam 764 corresponds to the current consumed by the motor 754. The force is converted into a digital signal and provided to the control circuit 760.

[0271] 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.

[0272] 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.

[0273] Generator Hardware

[0274] Fig. 208 is a simplified block diagram of a generator 800 configured to provide, among other benefits, inductor-free tuning. Additional details of the generator 800 are described in U.S. Pat. No. 9,060,775, entitled “SURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES,” issued on June 23, 2015, 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. A secondary winding 808 of the power transformer 806 is contained in the isolation stage 802 and may include a tapped configuration (e.g., a center-tapped or non-center-tapped configuration) to define drive signal outputs 810a, 810b, 810c for delivering drive signals to different surgical instruments, such as 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 an ultrasonic surgical instrument, and the drive signal outputs 810b, 810c can output RF electrosurgical drive signals (e.g., 100V RMS drive signals) to an electrosurgical instrument, where the drive signal output 810b corresponds to the center tap of the power transformer 806.

[0275] 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 deliver 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 provided to a combined multifunctional ultrasonic / electrosurgical instrument can be a therapeutic level signal or a 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.

[0276] 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 certain 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 certain forms, the logic device 816 may include a programmable gate array (PGA), an FPGA, a programmable logic device (PLD), among other logic circuits, for example. Thus, by controlling the input of the power amplifier 812 via the DAC circuit 818, the logic device 816 may control any 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 discussed 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.

[0277] The power rail of the power amplifier 812 may be powered by a switch-mode regulator 820 (e.g., a power converter). In certain forms, the switch-mode regulator 820 may include, for example, an adjustable buck regulator. The non-isolated stage 804 may also include a first processor 822, for example, in one form, the first processor may include a DSP processor, such as an Analog Devices ADSP-21469 SHARC DSP available from Analog Devices, Norwood, MA, although any suitable processor may be employed 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., a radio frequency 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 supplied 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.

[0278] 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 calling 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 for 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, which 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.

[0279] 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 per 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 an 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, among other things, calculations of complex currents flowing through the motional 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. 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 and 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.

[0280] 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. Subsequently, the frequency of the drive signal may 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 supplied as an input to a DDS control algorithm implemented by the logic device 816.

[0281] 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 forms, control of the current amplitude may be achieved, for example, by a control algorithm in the DSP processor 822, such as a proportional integral derivative (PID) control algorithm. Variables controlled by the control algorithm to appropriately control the current amplitude of the drive signal may include, for example, the scale of the LUT waveform samples stored in the logic device 816 and / or the full-scale output voltage of the DAC circuit 818 (which supplies input to the power amplifier 812) via the DAC circuit 834.

[0282] The non-isolated stage 804 may also include a second processor 836, which is used to provide, among other things, user interface (UI) functions. 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). Examples of UI functions supported by the UI processor 836 may include auditory 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, the UI processor may also coordinate 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.

[0283] In certain forms, for example, both the DSP processor 822 and the UI processor 836 can determine and monitor the operating state of the generator 800. For the DSP processor 822, the operating state of the generator 800 can indicate, for example, which control and / or diagnostic processes are implemented by the DSP processor 822. For the UI processor 836, the operating state of the generator 800 can indicate, for example, which elements of the UI (e.g., display screen, sound) are presented to the user. The respective DSP processor 822 and UI processor 836 can 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 can act as the principal in this relationship and determine when a transition between operating states will occur. The UI processor 836 can note valid transitions between operating states and can confirm 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 can 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 can cause the generator 800 to enter a fault mode.

[0284] 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 controller 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.

[0285] 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 discussed below). As such, 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) for turning the generator 800 on and off. When the generator 800 is in the power off state, if activation of the user "on / off" input device is detected, the controller 838 may activate 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 for transitioning the generator 800 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 for transitioning the generator 800 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 for transitioning the generator 800 to the powered-off state. In such forms, the controller 838 may not have an independent ability to remove power from the generator 800 after the powered-on state of the generator 800 is established.

[0286] 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 been initiated. Such an alert may be provided at the start of a power-on or power-off sequence and before other processes associated with the sequence begin.

[0287] In certain forms, the isolated stage 802 may include an instrument interface circuit 840 to provide a communication interface, for example, between control circuitry of a surgical instrument (e.g., control circuitry including a handpiece switch) and components of the non-isolated stage 804, such as 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 connection, such as an IR-based communication connection, that maintains a suitable degree of electrical isolation between the isolated stage 802 and the non-isolated stage 804. For example, the instrument interface circuit 840 may be powered using a low-dropout voltage regulator powered by an isolation transformer, which is driven from the non-isolated stage 804.

[0288] 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 conductor 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.

[0289] 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 disposed 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 be communicated 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 separately from the logic circuit 842 and include suitable circuits (e.g., discrete logic devices, processors) 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 circuit 842.

[0290] In some forms, the first data circuit may store information related to a specific surgical instrument associated therewith. 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. Such information may be read by the instrument interface circuit 840 (e.g., by the logic circuit 842), transmitted to the components of the non-isolated station 804 (e.g., to the logic device 816, the DSP processor 822, and / or the UI processor 836) to be presented to the user via an output device and / or to 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) to be stored therein. Such information may include, for example, an updated number of operations in which the surgical instrument is used and / or the date and / or time of its use.

[0291] As previously described, surgical instruments may be detachable from handpieces (e.g., multifunctional surgical instruments may be detachable from handpieces) to facilitate instrument interchangeability and / or disposableity. 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 issue 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 data circuits 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.

[0292] 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.

[0293] 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. Additionally 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).

[0294] 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 for a cable connecting the hand piece to the generator 800). In one form, information may be communicated to and from the second data circuit using, for example, a single bus communication scheme implemented on an existing cable (such as one of the conductors used to transmit the interrogation signal from the signal conditioning circuit 844 to the control circuit in the hand piece). 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.

[0295] In some forms, the isolation stage 802 may include at least one blocking capacitor 850-1 connected to the drive signal output 810b to prevent direct 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, for example, by the logic circuit 842. Based on changes in the leakage current (as indicated by the voltage samples), the generator 800 can determine when at least one of the blocking capacitors 850-1 and 850-2 fails, thereby providing a benefit over a single capacitor design with a single point of failure.

[0296] In certain forms, the non-isolated stage 804 may include a power supply 854 for delivering DC power at an appropriate voltage and current. The power supply may include, for example, a 400W power supply for delivering a system voltage of 48V DC. The power supply 854 may also include one or more DC / DC voltage converters 856 for receiving the output of the power supply 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 these DC / DC voltage converters may receive input from the controller 838 when the controller 838 detects that a user has initiated an "on / off" input device to enable operation of the DC / DC voltage converter 856 or to wake up the DC / DC voltage converter 856.

[0297] 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.

[0298] 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 on 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.

[0299] The first voltage sensing circuit 912 connects the two ends of the terminals marked as ENERGY1 and RETURN paths to measure the output voltage between the two terminals. The second voltage sensing circuit 924 connects the two ends of the terminals marked as ENERGY2 and RETURN paths to measure the output voltage between the two terminals. 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.

[0300] In one aspect, the impedance may be determined by the processor 902 by dividing the output of a first voltage sensing circuit 912 connected across terminals labeled ENERGY1 / RETURN or a second voltage sensing circuit 924 connected across terminals labeled ENERGY2 / RETURN by the output of a current sensing circuit 914 arranged in series with the RETURN branch of 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.

[0301] 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 pencil or other probe) to the ENERGY2 output and a suitable return pad to the RETURN output.

[0302] Additional details are disclosed in U.S. Patent Application Publication No. 2017 / 0086914, entitled “TECHNIQUES FOR OPERATING GENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICALINSTRUMENTS,” published on March 30, 2017, which is incorporated herein by reference in its entirety.

[0303] 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.

[0304] 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".

[0305] 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.

[0306] 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 devices. 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.

[0307] 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).

[0308] 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 ARM Cortex-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 32-bit MCU loaded with 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.

[0309] In one example, the processor may include a safety controller including two families based on controllers such as the TMS570 and RM4x under the trade name Hercules ARM Cortex R4, also offered by Texas Instruments Inc. The safety controllers may be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while delivering scalable performance, connectivity, and memory options.

[0310] 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 to be connected or paired with a corresponding surgical hub. The modular device includes, for example, an intelligent surgical instrument, a medical imaging device, a suction / irrigation device, a smoke evacuator, an energy generator, a ventilator, an insufflator, and a display. 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 a sensor 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 the 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.

[0311] Situational Awareness

[0312] Situational awareness is the ability of some aspects of a surgical system to determine or infer information related to a surgical procedure based on data received from a database and / or instrument. This information may include the type of surgery being performed, the type of tissue being operated on, or the body cavity being the subject of the surgery. Using contextual information related to the surgical procedure, a surgical system can, for example, improve the way the surgical system controls modular devices (e.g., robotic arms and / or robotic surgical tools) connected thereto, and provide background information or suggestions to the surgeon during the course of the surgical procedure.

[0313] See now Fig.56 , depicts a timeline 5200 depicting situational awareness of a hub, such as surgical hub 106 or 206. Timeline 5200 is an illustrative surgical procedure and contextual information that the surgical hub 106, 206 can derive from data received from data sources at each step in the surgical procedure. Timeline 5200 depicts typical steps that nurses, surgeons, and other medical personnel would take during a segmentectomy procedure, starting with setting up the operating room and ending with transferring the patient to a postoperative recovery room.

[0314] The situational awareness surgical hub 106, 206 receives data from data sources throughout the surgical procedure, including data generated each time medical personnel utilize 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 about the ongoing surgery (i.e., contextual information) as new data is received, such as which step of the surgery 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 medical personnel, providing data or prompts that may be related to a particular procedure step (e.g., via a display screen), adjusting modular devices 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.

[0315] As a first step 5202 in this exemplary operation, hospital staff retrieves the patient's EMR from the hospital's electronic medical record (EMR) database. Based on the selected patient data in the EMR, the surgical hub 106, 206 determines that the operation to be performed is a thoracic operation.

[0316] 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 surgeries and confirms that the mix of supplies corresponds to a thoracic procedure. Additionally, the surgical hub 106, 206 can also determine that the procedure is not a wedge procedure (because the incoming supplies lack certain supplies required for a thoracic wedge procedure or otherwise do not correspond to a thoracic wedge procedure).

[0317] 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.

[0318] In the 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 smoke evacuators, insufflators, and medical imaging devices. 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 surgery, and the type of modular device connected to the hub, the surgical hub 106, 206 can generally infer the specific surgery 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.

[0319] 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.

[0320] In step 5212, the medical staff 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 step 5212, the preoperative portion of the lung segmentectomy surgery is completed and the surgical portion begins.

[0321] 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 surgery has begun because it may compare the detection of the patient's lung collapsing to the expected steps of the surgery (which may have been previously accessed or retrieved) to determine that collapsing the lung is a surgical step in this particular surgery.

[0322] 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 ruled out 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 surgery 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 the 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 surgery being performed and / or the techniques used for a particular type of surgery.

[0323] In step 5218, the surgical team begins the dissection step of the procedure. 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 intersect the received data with the retrieval step of the surgical procedure to determine that the energy instrument fired at this point in the process (i.e., after the previously discussed surgical 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.

[0324] 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.

[0325] Eleventh step 5222, perform the segmentectomy portion of the surgery. 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 segmentectomy portion of the surgery is in progress.

[0326] 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 operation, 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 the surgeon regularly switches back and forth between surgical suturing / cutting instruments and surgical energy (i.e., RF or ultrasonic) instruments according to the specific steps in the operation because different instruments are better suited for specific tasks. Therefore, a specific sequence in which the suturing / cutting instruments and surgical energy instruments are used can indicate the steps of the operation being performed by the surgeon. In addition, in some cases, a robotic tool can be used for one or more steps in the surgical operation, and / or a handheld surgical instrument can be used for one or more steps in the surgical operation. (One or more) surgeons can, for example, alternate between robotic tools and handheld surgical instruments and / or can use the device simultaneously. When the twelfth step 5224 is completed, the incision is closed and the postoperative portion of the operation begins.

[0327] 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 (ie, the patient's breathing rate begins to increase).

[0328] 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 surgery, 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.

[0329] Situational awareness is further described in 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. 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.

[0330] Robotic system

[0331] The robotic surgical system can be used for minimally invasive medical procedures. During such medical procedures, a patient can be placed on a platform adjacent to the robotic surgical system, and a surgeon can be positioned at a console remote from the platform and / or remote from the robot. For example, the surgeon can be positioned outside a sterile field surrounding a surgical site. The surgeon provides input to a user interface via an input device at the console to manipulate surgical tools coupled to an arm of the robotic system. For example, the input device can be a mechanical input device such as a control handle or joystick, or a contactless input device such as an optical gesture sensor.

[0332] 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 articulated 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's body, 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. Additionally or alternatively, in some cases, the robotic surgical system may be used in open surgery.

[0333] Fig. 22A schematic diagram of a robotic surgical system 15000 is depicted. The 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 will appreciate that additional and alternative input devices may be employed.

[0334] The central control unit 15002 includes a processor 15004 that can be operably connected to a memory 15006. The controller 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 (e.g., one or more motors, sensors, and / or displays) of the robotic surgical system 15000. 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 at a console 15012) and / or may interact with a remote system. The memory 15006 may be directly and / or indirectly connected to the processor 15004 to store instructions and / or databases.

[0335] The robot 15022 includes one or more robot arms 15024. Each robot 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 housed in a bracket assembly or housing. In some cases, a transmission between the motor 15026 and one or more drivers 15028 can allow the motor 15026 to be coupled and uncoupled 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 robot arm 15024 by rotating the robot arm 15024 and / or its links and / or joints. In addition, one or more drivers 15028 can be coupled to a surgical tool 15030 and can, for example, achieve joint motion, rotation, clamping, sealing, suturing, energizing, firing, cutting and / or opening. In some cases, the surgical tool 15030 can be interchangeable and / or replaceable. Examples of robotic surgical systems and surgical tools are further described herein.

[0336] 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 ) may be combined with the robotic surgical system 15000. Additionally or alternatively, the robotic surgical system 15000 may include various features and / or components of the computer-implemented interactive surgical system 100 and the computer-implemented interactive surgical system 200.

[0337] In one example, the robotic surgical system 15000 may include the 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 embodiment, 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 such cases, the robotic surgical system 15000 may 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 may include a central control unit 15002 and / or the central control unit 15002 may communicate with the cloud. In other cases, the surgical hub may be implemented as a separate unit that is separate from the central control unit 15002 and can communicate with the central control unit 15002.

[0338] Another surgical robotic system is the da Surgical robotic systems. Figure 23 to Figure 29 An example of a system is depicted. Fig.23A minimally invasive robotic surgery (MIRS) system 12010 is depicted, which is typically used to perform minimally invasive diagnostic or surgical procedures on a patient 12012 lying on an operating table 12014. The system 12010 includes a surgeon's console 12016 for use by a surgeon 12018 during surgery. One or more assistants 12020 may also participate in the surgery. The MIRS system 12010 may also include a patient-side cart 12022, i.e., a surgical robot and electronics cart 12024. When the surgeon 12018 observes the surgical site through the console 12016, the surgical robot 12022 can manipulate at least one removably connected tool assembly 12026 (hereinafter referred to as "tool") through a minimally invasive incision in the patient 12012. An image of the surgical site can be obtained by an imaging device such as a stereo endoscope 12028, which can be manipulated by the surgical robot 12022 to orient the endoscope 12028. Various alternative imaging devices are further described herein.

[0339] The electronics cart 12024 may be used to process images of the surgical site for subsequent display to the surgeon 12018 via the surgeon's console 12016. The number of disposable robotic tools 12026 will generally depend on factors such as the diagnosis or surgical procedure and the space limitations in the operating room. If it is necessary to change one or more of the robotic tools 12026 used during surgery, the assistant 12020 may remove the robotic tool 12026 from the surgical robot 12022 and replace it with another tool 12026 from the tray 12030 in the operating room.

[0340] Main references Fig.24 The surgeon's console 12016 includes a left-eye display 12032 and a right-eye display 12034 for presenting a coordinated stereoscopic view of the surgical site to the surgeon 12018 to enable depth perception. The console 12016 also includes one or more input control devices 12036, which in turn cause the surgical robot 12022 ( Fig.23 ) manipulate one or more tools 12026 ( Fig.23 ). Input control device 12036 may provide tools 12026 ( Fig.23) the same degrees of freedom to provide the surgeon with a sense of remote presence or input control device 12036 being integrated with the robotic tool 12026, so that the surgeon has a strong sense of direct control of the robotic tool 12026. To this end, position sensors, force sensors, and tactile feedback sensors can be used to transmit the position, force, and touch from the robotic tool 12026 back to the surgeon's hand through the input control device 12036. The surgeon's console 12016 is usually located in the same room as the patient 12012 so that the surgeon 12018 can directly monitor the operation, be present in person if necessary, and can directly communicate with the assistant 12020, rather than through a telephone or other communication medium. However, the surgeon 12018 can be located in a different room, a completely different building, or other remote location from the patient 12012, thereby allowing remote surgery. The sterile field can be defined around the surgical site. In various cases, the surgeon 12018 can be positioned outside the sterile field. The sterile adapter can define part of the boundary of the sterile field. An example of a sterile adapter for a robotic arm is described in U.S. patent application publication 2015 / 0257842, entitled “BACKUP LATCH RELEASE FOR SURGICAL INSTRUMENT,” filed on March 17, 2015, which was published as U.S. Patent Serial No. 9,839,487 on December 12, 2017, the entirety of which is incorporated herein by reference.

[0341] Now mainly see Fig.25 , the electronics cart 12024 may be coupled to the endoscope 12028 and may include a processor to process the captured images for subsequent display, such as on the surgeon's console or on another suitable display located locally and / or remotely to the surgeon. For example, where a stereoscopic endoscope 12028 is used, the electronics cart 12024 may process the captured images to present the surgeon with a coordinated stereoscopic image of the surgical site. Such coordination may include alignment between opposing images and may include adjusting the stereoscopic working distance of the stereoscopic endoscope. As another example, the image processing may include using previously determined camera calibration parameters to compensate for imaging errors of the image capture device, such as optical aberrations.

[0342] Fig.26 A robotic surgical system 12050 is schematically shown, such as Fig.23 MIRS system 12010. As discussed herein, the surgeon's console 12052 (such as Fig.23 The surgeon's console 12016 in FIG. 1200 may be used by the surgeon to control a surgical robot 12054 (such as a Fig.23The surgical robot 12054 may use an imaging device (such as a stereo endoscope) to capture images of the surgical site and output the captured images to an electronics cart 12056 (such as a Fig.23 Electronics cart 12024). As described herein, the electronics cart 12056 can process the captured images in various ways prior to any subsequent display. For example, the electronics cart 12056 can overlay the captured images with a virtual control interface before displaying the combined images to the surgeon via the surgeon's console 12052. The surgical robot 12054 can output the captured images for processing outside the electronics cart 12056. For example, the surgical robot 12054 can output the captured images to a processor 12058, which can be used to process the captured images. The images can also be processed by a combination of the electronics cart 12056 and the processor 12058, which can be coupled together to process the captured images jointly, sequentially, and / or in combination thereof. One or more separate displays 12060 can also be coupled to the processor 12058 and / or the electronics cart 12056 for local and / or remote display of images (such as images of the surgical site or other related images).

[0343] Fig. 27 and 28 The surgical robot 12022 and the robotic tool 12062 are shown separately. The robotic tool 12062 is a Fig.23 ). The reader will understand that alternative robotic tools may be used with the surgical robot 12022, and exemplary robotic tools are described herein. The surgical robot 12022 shown provides manipulation of three robotic tools 12026 and an imaging device 12028 (such as a stereo endoscope for capturing images of the surgical site). Manipulation is provided by a robotic mechanism having a plurality of robotic joints. The imaging device 12028 and the robotic tool 12026 may be positioned and manipulated through an incision in the patient's body so as to maintain a remote center of motion or a virtual pivot at the incision to minimize the size of the incision. The image of the surgical site may include an image when the distal end of the robotic tool 12026 is within the field of view (FOV) of the imaging device 12028. Each tool 12026 may be detachable from and carried by a corresponding surgical manipulator 12031, which is located at the distal end of one or more of these robotic joints. The surgical manipulator 12031 provides a movable platform for moving the entire tool 12026 relative to the surgical robot 12022 via movement of the robotic joints. The surgical manipulator 12031 also provides power to operate the robotic tool 12026 using one or more mechanical interfaces and / or electrical interfaces.

[0344] Fig.29 12100 is a schematic diagram of a remotely operated surgical system 12100. The surgical system 12100 includes a surgeon's console 12102, which may be, for example, the surgeon's console 12052 ( Fig.26 ). The surgeon console 12102 drives the surgical robot 12104, which may be, for example, the surgical robot 12022 ( Fig.23 ). The surgical robot 12104 includes a surgical manipulator 12106, which may be, for example, the surgical manipulator 12031 ( Fig. 27 ). The surgical manipulator 12106 includes a motor unit 12108 and a robotic tool 12110. The motor unit 12108 is a bracket assembly that holds five motors, which can be assigned to different mechanisms. In some examples, only five motors are used, while in other examples, more or less than five motors can be used. The motor unit 12108 includes a power motor 12112, a camshaft motor 12140, a pitch motor 12116, a yaw motor 12118, and a low-force grip motor 12120, but these motors can be used for different purposes depending on the attached instrument. Generally speaking, each motor is an electric motor that is mechanically and electrically coupled to a corresponding input of the robotic tool 12110. In some examples, the motor unit 12108 may be located at the proximal end of the robotic tool 12110 in a chassis shared with the robotic tool, such as Fig.28 The motor housing is further described in U.S. Patent Application Publication No. 2012 / 0150192, entitled "METHOD FOR PASSIVELY DECOUPLING TORQUE APPLIED BY A REMOTEACTUATOR INTO AN INDEPENDENTLY ROTATING MEMBER," filed on November 15, 2011, which was published as U.S. Patent Serial No. 9,095,362 on August 4, 2015, which is incorporated herein by reference in its entirety.

[0345] The robotic tool 12110 may be, for example, the robotic tool 12026 ( Fig.23). The robotic tool 12110 includes an elongated actuator unit 12122 including three discrete inputs each mechanically coupled to a pitch motor 12116, a yaw motor 12118, and a low-force grip motor 12120 through a surgical manipulator 12106. The robotic tool 12110 also includes a transmission 12124 mechanically coupled to the power motor 12112 and the camshaft motor 12140. Examples of tools are further described in International Patent Application Publication No. WO 2015 / 153642, filed on March 31, 2015, entitled “SURGICAL INSTRUMENT WITH SHIFTABLE TRANSMISSION,” and International Patent Application Publication No. WO 2015 / 153636, filed on March 31, 2015, entitled “CONTROL INPUT ACCURACY FOR TELEOPERATED SURGICAL INSTRUMENT,” the entirety of each of these provisional patent applications being incorporated herein by reference.

[0346] The surgical end effector 12126 is located at the distal end of the effector unit 12122. The surgical end effector 12126 and the effector unit 12122 are connected by a movable wrist. Examples of such wrists are shown in U.S. Patent Application Publication No. 2011 / 0118708, filed on November 12, 2010, entitled "DOUBLE UNIVERSAL JOINT" and U.S. Patent Serial No. 9,216,062, filed on February 15, 2012, entitled "SEALS AND SEALING METHODS FOR A SURGICAL INSTRUMENT HAVING ANARTICULATED END EFFECTOR ACTUATED BY A DRIVE SHAFT", each of which is incorporated herein by reference in its entirety. In short, the surgical end effector can be characterized by a plurality of discrete but interrelated mechanisms, each of which provides a degree of freedom (DOF) for the surgical end effector 12126. As used herein with respect to the surgical system 12100, DOF is one or more interrelated mechanisms for affecting corresponding motions. These DOFs provide the surgical end effector 12126 with different operating modes that can be operated simultaneously or separately. For example, the wrist enables the surgical end effector 12126 to pitch and yaw relative to the surgical manipulator 12106, and therefore includes a pitch DOF 12128 and a yaw DOF 12130. The surgical end effector 12126 also includes a roll DOF 12132 that rotates the surgical end effector 12126 around an elongated axis. Different robotic tools may have different DOFs, as further described herein.

[0347] The surgical end effector 12126 may include a clamping and cutting mechanism, such as a surgical stapler. Examples of such instruments (including their staple cartridges) are further described in U.S. Patent Application Publication Serial No. 2013 / 0105552, filed on October 26, 2012, entitled "CARTRIDGE STATUS AND PRESENCEDETECTION" and U.S. Patent Application Publication 2013 / 0105545, filed on October 26, 2012, entitled "SURGICAL INSTRUMENT WITH INTEGRAL KNIFE BLADE", both of which are incorporated herein by reference in their entirety. The clamping mechanism may be held according to two modes, and therefore includes two DOFs. A low-force DOF 12134 (e.g., a cable actuation mechanism) is used to pull the clamp with low force to gently manipulate tissue. The low-force DOF 12134 may be used to prepare the surgical end effector for cutting or suturing operations. High force DOF 12136 (e.g., a lead screw actuation mechanism) is used to further open the clamp or close the clamp on the tissue with relatively high force, for example, to bind the tissue in preparation for a cutting or suturing operation. Once clamped, the surgical end effector 12126 uses tool actuation DOF 12138 to further affect the tissue, for example, by suturing, cutting and / or cauterizing the tissue. The clamping system for a surgical end effector is further described in the following patents: U.S. Patent Serial No. 9,393,017, entitled “METHODS AND SYSTEMS FOR DETECTING STAPLE CARTRIDGE MISFIRE OR FAILURE,” filed on May 15, 2012, which was published on July 19, 2016; U.S. Patent Serial No. 8,989,903, entitled “METHODS AND SYSTEMS FOR INDICATING A CLAMPING PREDICTION,” filed on January 13, 2012, which was published on March 2, 2015; and U.S. Patent Serial No. 9,662,177, entitled “METHODS AND SYSTEMS FOR INDICATING A CLAMPING PREDICTION,” filed on March 2, 2015, which was published on May 30, 2017, all of which are incorporated herein by reference.

[0348] like Fig.29As shown in FIG. 1 , the pitch motor 12116, the yaw motor 12118, and the low-force grip motor 12120 drive the pitch DOF 12128, the yaw DOF 12130, and the low-force grip DOF 12134, respectively. Thus, each of the pitch DOF 12128, the yaw DOF 12130, and the low-force grip DOF 12134 is separately paired with a motor and can be operated independently and simultaneously with respect to the other DOFs. However, the high-force grip DOF 12136, the roll DOF 12132, and the tool actuation DOF 12138 share a single input with the power motor 12112 via the transmission 12124. Thus, since the connection with the power motor 12112 occurs separately, only one of the high-force grip DOF 12136, the roll DOF 12132, and the tool actuation DOF 12138 can be operated at a time. The camshaft motor 12140 is actuated to switch the output of the power motor 12112 between the high force holding DOF 12136, the rolling DOF 12132, and the tool actuation DOF 12138. Thus, the transmission 12124 advantageously allows for a greater number of DOFs than an arrangement in which each motor is dedicated to a single DOF.

[0349] Surgical robotic systems (such as Figure 23 to Figure 29 Additional features and operation of the robotic surgical system are further described in the following references, each of which is incorporated herein by reference in its entirety:

[0350] U.S. Patent Application Publication No. 2011 / 0118708, filed on November 12, 2010, entitled “DOUBLE UNIVERSAL JOINT”;

[0351] U.S. Patent No. 9,095,362, entitled “METHOD FOR PASSIVELY DECOUPLING TORQUE APPLIED BY A REMOTE ACTUATOR INTO AN INDEPENDENTLY ROTATING MEMBER,” filed on November 15, 2011 and published on August 4, 2015;

[0352] U.S. Patent No. 8,989,903, entitled “METHODS AND SYSTEMS FOR INDICATING ACLAMPING PREDICTION,” filed on January 13, 2012 and published on March 24, 2015;

[0353] U.S. Patent No. 9,216,062, entitled “SEALS AND SEALING METHODS FOR A SURGICALINSTRUMENT HAVING AN ARTICULATED END EFFECTOR ACTUATED BY A DRIVE SHAFT,” filed on February 15, 2012 and published on December 22, 2015;

[0354] U.S. Patent No. 9,393,017, entitled “METHODS AND SYSTEMS FOR DETECTING STAPLECARTRIDGE MISFIRE OR FAILURE,” filed on May 15, 2012 and published on July 19, 2016;

[0355] U.S. Patent Application Publication No. 2013 / 0105552, entitled “CARTRIDGE STATUS AND PRESENCE DETECTION,” filed on October 26, 2012;

[0356] U.S. Patent Application Publication No. 2013 / 0105545, filed on October 26, 2012, entitled “SURGICAL INSTRUMENT WITH INTEGRAL KNIFEBLADE”;

[0357] International patent application publication WO 2015 / 142814, entitled “SURGICAL CANNULA MOUNTS AND RELATED SYSTEMS AND METHODS,” filed on March 17, 2015;

[0358] U.S. Patent Application Publication No. 2015 / 0257842, filed on March 17, 2015, entitled “BACKUP LATCH RELEASE FOR SURGICALINSTRUMENT”;

[0359] U.S. Patent Application Publication No. 2015 / 0257841, entitled “LATCH RELEASE FOR SURGICAL INSTRUMENT,” filed on March 17, 2015;

[0360] International patent application WO 2015 / 153642, entitled “SURGICAL INSTRUMENT WITH SHIFTABLE TRANSMISSION,” filed on March 31, 2015;

[0361] International patent application published as WO 2015 / 153636, entitled “CONTROL INPUT ACCURACY FOR TELEOPERATED SURGICAL INSTRUMENT,” filed on March 31, 2015; and

[0362] U.S. Patent Serial No. 9,662,177, entitled “METHODS AND SYSTEMS FOR INDICATING ACLAMPING PREDICTION,” filed on March 2, 2015 and published on May 30, 2017

[0363] The robotic surgical systems and features disclosed herein may be used in conjunction with the da Surgical robotic systems and / or Figure 23 to Figure 29 The reader will also understand 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 processor 12058 ( Fig.26 ) may be housed in a robot control tower. For example, a 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 connecting to 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 based on the synthesized data. In various cases, a sensor system comprising 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 accessed, for example, by the processor 12058. In various cases, the situational awareness module may receive information from a non-robotic surgical hub and / or the cloud (such as the 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 described herein and in U.S. Provisional Patent Application Serial No. 62 / 611,341, filed on December 28, 2017, entitled “INTERACTIVESURGICALPLATFORM,” and Provisional Patent Application Serial No. 62 / 611,340, filed on December 28, 2017, entitled “CLOUD-BASED MEDICAL ANALYTICS,” the disclosures of which are incorporated herein by reference in their entirety.

[0366] A surgical system including a robot, a visualization system (such as visualization system 108 or visualization system 208), and one or more hubs (such as hub 106, robot hub 122, hub 206, and / or robot hub 222) may benefit from a robust communication system for data collection and dissemination. For example, various parameters regarding a surgical site, surgical instrument, and / or surgical procedure may be important information to the robot, visualization system, and hub. In addition, the robot may include one or more subcomponents, such as a console, which may require information regarding, for example, a surgical site, surgical instrument, and / or surgical procedure. For example, it may be helpful to collect and disseminate information in real time or near real time and disseminate it to appropriate components and / or subcomponents to inform machine learning and / or decision-making processes. In some cases, data collection and dissemination may inform situational awareness of a surgical system including one or more robotic systems.

[0367] In one aspect, the robotic surgical system may include additional communication paths. For example, the robotic surgical system may include a main wired communication path and an auxiliary wireless communication path. In some cases, the two communication paths may be independent, so that the auxiliary path is redundant and / or parallel to the main path. In various cases, a first type and / or amount of data may be transmitted along the main path, and a second type and / or amount of data may be transmitted along the auxiliary path. Multiple communication paths can improve the connectivity of the robot and / or robotic surgical tools to one or more displays in the operating room, console, and / or control unit. The communication path can connect the surgical robot to, for example, a central control unit (e.g., a hub) and / or a visualization system (e.g., a display). In various cases, the additional communication path can provide additional data to the robot and / or the generator module and / or a processor communicating with the generator module.

[0368] Main references Fig.30 , depicts a robotic surgical system 12200 including a console 12216 and a robot 12222. Console 12216 can be similar in many respects to console 12016 ( Fig.23 and Fig.24 ), and robot 12222 may be similar in many respects to robot 12022 ( Fig.23 and Fig. 27 ). For example, the robot tool 12026 ( Fig.23 ) is positioned at the distal end of one of the arms of the robot 12222. The robotic tool 12226 is an energy device. For example, energy can be supplied to the robotic tool 12226 by a generator connected to the robotic tool 12226.

[0369] The robotic surgical system 12200 also includes a hub 12224, which can be similar in many respects to the robotic hub 122 ( Figure 2 ) and / or Robot Hub 222 ( Fig. 9 ). Hub 12224 includes a generator module 12230, which is similar in many respects to generator module 140 ( Figure 3 ); and wireless communication module 12238, which is similar in many respects to communication module 130 ( Figure 3 ). The generator module 12230 is configured to supply energy to the robotic tool 12226 via a first wired connection 12244.

[0370] In one instance, the first wired connection 12244 can be a bidirectional communication path between the robotic tool 12226 and the surgical hub 12224. The first wired connection 12244 can transmit high-level energy parameters or other electrical data between the robotic tool 12226 and the surgical hub 12224. For example, the surgical hub 12224 can supply the robotic tool 12226 with information about the power level supplied thereto (e.g., the current for RF devices and the amplitude and / or frequency for ultrasonic devices). Additionally, the robotic tool 12226 can provide the robot 12222 with information about the conductivity and / or impedance detected at the tissue interface, which corresponds to the characteristics of the tissue and / or the effectiveness of the energy device.

[0371] In addition, a second wired connection 12240 between the console 12216 and the robotic tool 12226 mounted to the robot 12222 provides a communication path for control signals from the robotic console 12216 to the robotic tool 12226. In one instance, the second wired connection 12240 may be a one-way communication path from the robot 12222 to the console 12216 with respect to control parameters or other mechanical data collected by the robot 12222 and / or the robotic tool 12226. For example, the robot 12222 may provide information about surgical actuation of the robotic tool, such as a closing motion and / or a firing motion, to the console 12216. More specifically, the robot may, for example, transmit a clamping force parameter (e.g., clamping pressure of the robotic tool 12226 against tissue) and / or a firing force parameter from the robotic tool 12226 to the console 12216.

[0372] Still see Fig.30 , in the absence of the wireless communication paths 12242 and 12246, the robot hub 12224 may not be able to communicate with the console 12216, and vice versa. Additionally, the robotic tool 12226 may not be able to communicate with the hub 12224. In the absence of a communication path between the hub 12224 and the robot 12222 and / or the robotic tool 12226, mechanical control parameters (e.g., gripping force) from the robotic tool 12226 may not be transmitted to the robot hub 12224 and its generator module 12230. Additionally, electrical high-level energy parameters may not be transmitted from the robot 12222 to the robot hub 12224 and / or the console 12216. In such cases, the system 12200 would include an open-loop control.

[0373] Different energy parameters and different clamping pressures may be better suited for certain types of tissue and / or certain applications. For example, ultrasonic welding is typically a function of transducer amplitude and clamping pressure over time. Similarly, RF welding is typically a function of current and clamping pressure over time. However, in the absence of the above-mentioned wireless communication paths 12242 and 12246, the generator module 12230 may not know the clamping pressure. Similarly, the console 12216 may not know the energy parameters.

[0374] To optimize the control of the robotic tool 12226, the robotic tool 12226 may transmit one or more mechanical control parameters to the robotic hub 12224. Additionally, the hub 12224 may transmit one or more advanced energy parameters to the console 12216. The data transmission may provide closed-loop control for the system 12200. In one instance, the mechanical control parameters and advanced energy parameters may be balanced for different types of tissue and / or specific applications. For example, the clamping pressure may be reduced and the power to the robotic tool 12226 may be increased, or vice versa.

[0375] Still see Fig.30 , the robotic tool 12226 includes a wireless communication module 12228, as further described herein. The wireless communication module 12228 communicates signals with the wireless communication module 12238 of the robotic hub 12224 via a wireless communication path 12242. For example, the wireless communication module 12238 may include a first receiver 12232 configured to receive wireless signals from the robotic tool 12226. The wireless communication module 12238 also includes a second receiver 12234 that can receive signals from the console 12216 via a second wireless communication path 12246. In such cases, for example, the first wireless communication path 12242 and the second wireless communication path 12246 can respectively complete a communication circuit from the robotic tool 12226 back to the console 12216 via the surgical hub 12224.

[0376] In other cases, the wireless communication module 12228 may be located on the robot 12222. For example, the wireless communication module 12228 may be positioned on the arm of the robot and / or on the tool mounting portion of the robot 12222.

[0377] Additionally or alternatively, a wireless communication pathway may be provided between the robotic tool 12226 and the console 12216 .

[0378] The wireless pathways described herein can provide data transmission without hindering the mobility of the robotic tool 12226 and / or creating additional opportunities for tangling or cords and / or wires. In other cases, one or more wireless communication pathways described herein can be replaced with one or more wired connections.

[0379] In one aspect, the robotic tool 12226 and / or the hub 12224 may share information regarding sensed tissue parameters (e.g., conductivity or inductance corresponding to characteristics of the tissue) and / or control algorithms for energizing the tissue (e.g., power levels), which may be based on the sensed tissue parameters. For example, the robotic tool 12226 may provide information regarding status, activation status, identification information, and / or smart data to the hub 12224. The data provided to the hub 12224 may be stored, analyzed, and / or further disseminated by the hub 12224, such as to its display screen 12236. In such cases, the hub 12224 is a catheter or relay station for transmitting data to an additional location via a wired or wireless connection.

[0380] In some cases, the hub 12224 includes a situational awareness module, as further described herein. The situational awareness module can be configured to determine and / or confirm the steps in the surgical procedure and / or recommend specific surgical actions based on information received from various sources (including the robot 12222 and the console 12216). The wireless communication paths 12242 and 12246 that connect the hub 12224 to the robot 12222 and the console 12216, respectively, can be configured to notify the situational awareness module. For example, mechanical control parameters for clamping and / or firing can be transmitted to the hub 12224 and its situational awareness module via the second wireless communication path 12246. Additionally or alternatively, energy parameters for activation of energy tools and / or sensed tissue parameters can be transmitted to the hub 12224 and its situational awareness module via the first wireless communication path 12242.

[0381] In some cases, the data wirelessly transmitted to the hub 12224 may inform its situational awareness module. For example, based on the sensed tissue parameters detected by the robotic tool 12226 and transmitted along the first wireless communication pathway 12242, the situational awareness module may determine and / or confirm the type of tissue involved in the surgical procedure, and in some cases, may recommend a treatment response based on the type of tissue encountered.

[0382] Still see Fig.30, a second wired connection 12240 from the robot 12222 to the console 12216 provides a first communication path. In addition, the wired or wireless connection between the robot 12222 and the hub 12224 in combination with the wireless communication path 12246 between the hub 12224 and the console 12216 forms a second parallel communication path from the robot 12222 to the console 12212. Because the second communication path communicates via the hub 12224 and its wireless communication module 12238, the second communication path is different from the first communication path. However, such a path provides a parallel and alternative path to the second wired connection 12240 between the robot 12222 and the console 12216. Similarly, parallel and / or redundant paths are also provided via the wireless path 12242 and the wired path 12244 between the robot 12222 and the hub 12224. The alternative parallel communication path can reinforce the integrity of the communication system and enable robotic communication between various components of the surgical system.

[0383] Additionally or alternatively, the information may be transmitted directly to a device or system having wireless capabilities, such as a visualization system or display, such as visualization system 108 or visualization system 208, for example. Fig.55 The surgical system 12300 depicted in the figure includes a console 12216 for a surgeon S, a robot 12222 including a robotic tool 12226 mounted thereon, and a surgical hub 12224. The surgical system 12300 also includes a monitor 12350 positioned in a surgical operating room. Additional clinicians may be in the operating room, including nurses N, medical assistants MA, and anesthesiologists A. Some clinicians may be positioned in a sterile field. For example, a nurse N standing at a table 12352 supporting multiple medical instruments and robotic tools may be sterile. Medical assistants MA and anesthesiologists A holding handheld surgical instruments may be positioned outside the sterile field. Clinicians may see the monitor 12350 in and outside the sterile field. An additional display 12354 may be positioned in the sterile field. The additional display 12354 may be, for example, a mobile computer with wireless, cellular, and / or Bluetooth capabilities. In one embodiment, the additional display 12354 can be a tablet computer positionable on the patient P or patient table 12358, such as Tablet computer. In such cases, the display 12354 is positioned within the sterile field.

[0384] The wireless communication module 12228 on the robot tool 12226 ( Fig.30) can communicate signals with monitor 12350 and / or display 12354. In such cases, data and / or information obtained at the surgical site and / or by the robotic tool 12226 can be transmitted directly to a screen within the surgical operating room and can be immediately viewed by various clinicians in the surgical operating room (including clinicians in or outside the sterile field). In such cases, data can be provided in real time or near real time to inform clinician decisions during surgery. In addition, certain information can be transmitted to the hub 12224 for further storage, analysis, and / or dissemination, as further described herein.

[0385] Due to the wireless communication path, in some cases, the monitor 12350 and / or the display 12354 can also display information from the hub, including energy parameters. For example, the hub 12224 can obtain an indication generator module 12230 ( Fig.30 ) and / or data indicative of a sensed tissue parameter may be received from the robotic tool 12226, as further described herein. In such instances, the activation information and / or tissue information may be displayed on the monitor 12350 and / or display 12354, making the information readily available to operators both within and outside the sterile field.

[0386] In one aspect, the hub 12224 may ultimately communicate with a cloud, such as the cloud 104 or the cloud 204, to further inform machine learning and decision-making processes related to high-level energy parameters and / or mechanical control parameters of the robotic tool 12226. For example, the cloud may determine appropriate surgical actions and / or treatment responses for specific tissue parameters, surgical procedures, and / or patient demographics based on the aggregated data stored therein. To protect patient confidentiality, the hub 12224 may, for example, send a redacted and / or confidential version of the data.

[0387] As this article is relative to Fig.30 As described above, the robotic tool 12226 includes a wireless communication module 12228 . Fig.31 Also shown is a wireless communication module 12228. Specifically, Fig.31 A proximal portion of a robotic tool 12226 is depicted including a wireless communication module 12228 , and a tool mounting portion or attachment portion 12250 of the robot 12222 for releasably attaching a proximal housing of the robotic tool 12226 . Fig.32 A detailed view of the mechanical and electrical interfaces between the robotic tool 12226 and the tool mounting portion 12250 is depicted.

[0388] The robotic tool 12226 includes a first drive interface 12252 drivingly coupled to a second drive interface 12254 on a tool mounting portion 12250. The tool mounting portion 12250 includes a bracket or motor housing that houses a plurality of motors that may be similar in many respects to, for example, motors 12112, 12116, 12118, 12120, and 12140 ( Fig.29 ). These motors are drivingly coupled to a rotational output 12256 at a second drive interface 12254, which engages a rotational input 12258 on the robotic tool 12226. For example, the rotational input 12258 is positioned and configured to mechanically cooperate with the rotational output 12256 on the tool mounting portion 12250.

[0389] Fig.31 12260 for supplying power to the motor. The plug 12260 is also coupled to the wireless communication module 12228. In such cases, the wireless communication module 12228 can be powered via the current supplied by the plug 12260. The plug 12260 can ultimately be wired to the generator module 12230 in the hub 12224 to complete the wired connection 12244 between the robotic tool 12226 and the hub 12224 (see Fig.30 ).

[0390] Now mainly see Fig.31 , the tool mounting portion 12250 also includes an electrical contact 12262, and the robotic tool 12226 includes an electrical contact 12264 positioned and configured to mate with the electrical contact 12262 on the tool mounting portion 12250. Electrical signals can be transmitted between the robotic tool 12226 and the robot 12222 ( Fig.30 ) between the robot tool 12262 and the robot tool 12226. In some cases, mechanical control parameters from the robot tool 12262 may be transmitted to the robot 12222 via the electrical contacts 12262, 12264, as further described herein. Additionally or alternatively, high-level energy parameters may be transmitted to the robot 12222 and / or the robotic tool 12226, or vice versa, via the mating electrical contacts 12262, 12264, as further described herein.

[0391] like Fig.32As depicted, when the robotic tool 12226 is mounted to the tool mounting portion 12250, the flexible circuit 12270 is positioned between the mating electrical contacts 12264 of the robotic tool 12226 and the electrical contacts 12262 of the tool mounting portion 12250 to facilitate data transmission. The flexible circuit 12270 is positioned to intercept communication signals between the robotic tool 12262 and the tool mounting portion 12250. In such cases, the flexible circuit 12270 is configured to capture signals transmitted between those contacts 12262, 12264. In some cases, the flexible circuit 12270 may provide smart features to the robotic tool 12226.

[0392] In various embodiments, the flexible circuit 12270 can comprise a feedback pigtail connector. The pigtail connector can intercept the connection between the robotic tool 12226 and the tool mounting portion 12250.

[0393] In various cases, Fig.31 The flexible circuit 12270 may also include a device configured to communicate with the hub 12224 ( Fig.30 ) wireless transmitter for communication. In other cases, the flexible circuit 12270 can be connected to a wireless communication module (such as Fig.30 and Fig.31 Module 12228 in the wireless communication module may include a wireless transmitter and / or a wireless receiver.

[0394] The flexible circuit 12270 occupies a small footprint between the tool mounting portion 12250 and the robotic tool 12226. In one aspect, existing robotic systems can be retrofitted with such flexible circuits. In other words, existing robotic tools and tool mounting portions can utilize the robust communication system described herein without modifying the current robotic tools and / or tool mounting portions.

[0395] In various cases, the flexible circuit 12270 or another intermediate pigtail connector can be configured to acquire an external controller (e.g., hub 106 ( Figure 3 ) and one or more signals between the energy generator of the generator module 140 in the robot tool 12226. In addition, such circuits or connectors can be used to deliver signals to the robot tool 12226 via an intercepting connection.

[0396] In one aspect, the robotic hub includes a processor and a memory communicatively coupled to the processor, as described herein. The memory stores instructions executable by the processor to relay wireless signals between the robot and the console, as described herein. In some cases, the memory stores instructions executable by the processor to adjust a control parameter (e.g., power level) of the generator based on a signal intercepted by the flexible circuit and / or transmitted along the wireless communication path. Additionally or alternatively, the memory stores instructions executable by the processor to adjust a control parameter (e.g., clamping pressure) of the energy tool based on a signal indicative of a tissue characteristic intercepted by the flexible circuit and / or transmitted along the wireless communication path.

[0397] In various aspects, the present disclosure provides a control circuit to relay wireless signals between a robot and a control console, adjust control parameters of a generator, and / or adjust control parameters of an energy 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 relay wireless signals between a robot and a control console, adjust control parameters of a generator, and / or adjust control parameters of an energy tool, as described herein.

[0398] In one aspect, one or more features and / or effects of a robotically controlled surgical tool and its end effector can be controlled by a control algorithm. For example, the intensity of the end effector effect can be controlled by a control algorithm stored in a memory of the robot and executable by a processor. In one case, the end effector effect can be smoke evacuation, blowing, and / or cooling. In another case, the end effector effect can be articulation and / or retraction. For example, the robot can implement a load control hold algorithm for the articulation of the robotic tool that generates a predefined lateral load on the tissue and is limited by a displacement limit, as further described herein.

[0399] In some cases, it may be desirable to incorporate a pump into a robotically controlled surgical tool, such as an energy tool including an RF electrode and / or an ultrasonic scalpel. The pump may provide insufflation gas or air to the surgical site. In some cases, the pump may provide a coolant to the surgical site and / or may extract smoke and / or steam from the surgical site.

[0400] The robotically controlled surgical tool includes a drive system for releasably engaging with the robot and transmitting drive motion from the robot to the robotic tool. For example, the robotically controlled surgical tool may include an interface including one or more rotary drives configured to receive a rotational input from one or more motors in a motor housing or tool mounting portion. Exemplary drive systems and their interfaces are further described herein.

[0401] For example, the rotary drive in the robotic tool is configured to actuate various surgical functions, such as rotation of the shaft, closing of the end effector jaws, and articulation of the end effector. Examples of interface configurations are further described herein and in International Patent Application Publication No. WO 2015 / 153642, filed on March 31, 2015, entitled "SURGICAL INSTRUMENT WITH SHIFTABLE TRANSMISSION," International Patent Application Publication No. WO 2015 / 153636, filed on March 31, 2015, entitled "CONTROL INPUT ACCURACY FORTELEOPERATED SURGICAL INSTRUMENT," and U.S. Patent No. 9,095,362, filed on November 15, 2011, entitled "METHOD FOR PASSIVELY DECOUPLING TORQUE APPLIED BY A REMOTEACTUATOR INTO AN INDEPENDENTLY ROTATING MEMBER," each of which is incorporated herein by reference in its entirety.

[0402] In some cases, the number of motors, the number of rotary drives, and / or the arrangement of motors and / or rotary drives may be limited or constrained by the footprint of the drive system and / or the connection between the robotic tool and the tool mounting portion. In one aspect, it may be desirable for new and / or improved robotically controlled surgical tools to be compatible with existing robotic platforms. For example, it may be desirable to change functionality and / or increase functionality of robotic tools for use with existing motor housings and tool mounting portions without expanding the motor housing or tool mounting portion. In such cases, it may be challenging to incorporate certain features, such as pumps, into robotic tools that are compatible with existing surgical robots. In addition, it may be desirable to include controls and / or control algorithms for such pumps within the existing architecture of the surgical robot.

[0403] In one aspect, a pump for a robotic tool may be powered by a rotary drive of the robotic tool interface. Thus, the rotary drive and pump may be driven at variable rates, which may depend on the needs of the robotic tool and / or the surgical procedure. For example, the speed of the rotary drive coupled to the pump may be related to the volume of smoke being extracted from the surgical site and / or the energy applied to the tissue by the robotic tool. In one instance, the robotic tool may be an intelligent tool comprising a processor configured to determine an appropriate rate for the pump based on sensors on the robotic tool and / or other inputs to the robotic tool. In other instances, a processor in the control unit of the robot may be configured to determine an appropriate rate for the pump based on sensors on the robot and / or its modules (such as a smoke evacuation module in a robotic hub).

[0404] Energy devices use energy to affect tissue. In energy devices, energy is supplied by a generator. Energy devices include devices with tissue contact electrodes (such as electrosurgical devices with one or more radio frequency (RF) electrodes), and devices with vibrating surfaces (such as ultrasonic devices with ultrasonic blades). For electrosurgical devices, the generator is configured to generate an oscillating current to energize the electrodes. For ultrasonic devices, the generator is configured to generate ultrasonic vibrations to energize the ultrasonic blade.

[0405] As provided herein, an energy device delivers mechanical or electrical energy to a target tissue in order to treat the tissue (e.g., cutting tissue and / or cauterizing blood vessels in and / or near the target tissue). The cutting and / or cauterization of tissue may result in fluids and / or particles being released into the air. Such fluids and / or particles discharged during a surgical procedure may constitute smoke, which may include carbon and / or other particles suspended in the air.

[0406] In various cases, an energy tool for use with a robotic system may include a suction port coupled to a pump that is powered by a motor on the tool driver. The energy tool of the surgical robotic system may include a suction port coupled to a pump powered by a motor on the tool driver. The pump may be configured to extract smoke from the surgical site via the suction port. In such cases, the energy tool may include a smoke evacuation system. In one aspect, the robotic tool may include a pump. Alternatively, the robotic tool may be coupled to a pump.

[0407] The reader will understand that such an exhaust system may be referred to as a "smoke exhaust system", but such a system may be configured to be more than just exhausting smoke from a surgical site. Throughout this disclosure, the "smoke" exhausted by an exhaust system is not limited to smoke. On the contrary, the exhaust system disclosed herein can be used to exhaust various fluids, including liquids, gases, vapors, smoke, steam, or combinations thereof. These fluids may be of biological origin and / or may be introduced into a surgical site from an external source during surgery. For example, these fluids may include water, saline, lymph, blood, effluent, and / or purulent discharge. In addition, the fluid may include particles or other substances (e.g., cellular matter or debris) exhausted by the exhaust system. For example, such particles may be suspended in a fluid.

[0408] Main references Figure 33 to Figure 35 , depicting a robotic tool 12426 for use with a surgical end effector. The robotic tool 12426 can be used with, for example, a robotic surgical system 12010 ( Fig.23 ) is used together. The robotic tool 12426 is a bipolar radio frequency (RF) robotic tool. For example, the tool can be similar in many aspects to the tool disclosed in U.S. Patent Serial No. 8,771,270, entitled "BIPOLAR CAUTERY INSTRUMENT", filed on July 16, 2008, which is incorporated herein by reference in its entirety.

[0409] In other cases, the robotic tool 12426 can be a monopolar RF tool, an ultrasonic tool, or an ultrasonic-RF combination tool. For example, the robotic tool 12426 can be similar in many respects to the tool disclosed in U.S. Patent Serial No. 9,314,308, entitled "ROBOTICULTRASONIC SURGICAL DEVICE WITH ARTICULATING END EFFECTOR," filed on March 13, 2013, which is incorporated herein by reference in its entirety.

[0410] The robotic tool 12426 includes a proximal housing 12437, a shaft 12438 extending from the proximal housing 12437, and an end effector 12428 extending from a distal end of the shaft 12438. Fig.34 , the end effector 12428 includes opposing jaws 12430a, 12430b. Each jaw 12430a, 12430b includes a tissue contacting surface having an electrode. For example, jaw 12430a may include a supply electrode and jaw 12430b may include a return electrode, or vice versa. The end effector 12428 is Fig.3412428 is shown in a clamping configuration and generating RF welding. In such cases, smoke S from RF welding can accumulate around the end effector 12428. For example, in some cases, smoke S may accumulate in the abdominal cavity of the patient.

[0411] The robotic tool 12426 may include an exhaust system 12436. For example, to improve visibility and efficiency of the robotic tool 12426, smoke S at the surgical site may be exhausted along an exhaust channel or suction conduit 12440 extending proximally from the end effector 12428. The exhaust channel 12440 may extend through the shaft 12438 of the robotic tool 12426 to the proximal housing 12437. The exhaust conduit 12440 terminates at a suction port 12442 adjacent to the end effector 12428. During operation of the exhaust system 12436, smoke S at the surgical site is sucked into the suction port 12442 and through the exhaust conduit 12440.

[0412] In various cases, the robotic tool 12426 may also include insufflation, cooling, and / or irrigation capabilities. For example, the exhaust system 12436 may be configured to selectively pump fluid (such as saline or CO2) toward the end effector 12428 and pump it into the surgical site.

[0413] In various cases, the exhaust passage 12440 can be coupled to a pump for exhausting smoke S along the exhaust passage 12440 within the shaft 12438 of the robotic tool 12426. Fig.35 , the exhaust system 12436 includes a pump 12446. The pump 12446 is housed in a proximal housing 12437 of the robotic tool 12426. The pump 12446 is a cam pump that has been incorporated into a drive interface 12448 of the robotic tool 12426. The drive interface 12448 includes a rotary drive 12450 that is driven by a rotary output from a motor in a tool mounting portion of the robot, as described herein (see, e.g., rotary output 12256 ( Fig.31 ) and rotated outputs 12824a-12824e ( Fig.39 )).

[0414] The cam pump can be low volume and quiet or noiseless, and therefore desirable in some cases. For example, the cam pump can ensure that the noise generated by the exhaust system 12436 does not distract the clinician and / or allow communication between clinicians in the surgical operating room. The reader will readily appreciate that in other cases, the exhaust system 12436 can use a different pump.

[0415] Fig.33 and Fig.35A passage 12452 in the pump 12446 that terminates in a connector 12454 extends from the pump 12446. The connector 12454 is a Luer connector, however, the reader will readily appreciate that alternative connectors are contemplated. The Luer connector can be selectively coupled to a reservoir that is configured to receive smoke S, for example, from a surgical site. Additionally or alternatively, the Luer connector can supply exhaust from the pump 12446 to a filter.

[0416] Still see Fig.35 , depicting the internal components of the drive interface 12448, however, certain components are excluded for clarity. The exhaust channel 12440 extends through the shaft 12438 to the cam pump 12446 in the proximal housing 12437. The pump 12446 is driven by the rotary drive 12450 of the interface 12448. In various cases, the interface 12448 may include four rotary drives 12450. In one example, the first rotary drive 12450 is configured to drive joint motion, the second rotary drive 12450 is configured to drive jaw closing motion, the third rotary drive 12450 is configured to drive shaft rotation, and the fourth rotary drive 12450 is configured to drive the pump 12446. The reader will understand that alternative interface arrangements may include more or less than four rotary drives 12450. In addition, the drive motion generated by the rotary drive 12450 may vary depending on the desired function of the robotic tool 12426. Additionally, in some cases, the drive interface 12448 may include a transmission or switch so that the rotational drive 12450 can be switched between multiple surgical functions, as further described herein (e.g., see Fig.29 Transmission 12124 and Figures 40 to 45 In one embodiment, the rotary drive 12450 coupled to the pump 12446 can also actuate a clamping motion of the end effector 12428, for example.

[0417] In one aspect, activation of the pump 12446 of the robotic tool 12426 can be coordinated with the application of energy to the robotic tool 12426. In various cases, the control algorithm for the rotary drive 12450 of the pump 12446 can be related to the rate at which smoke S is extracted from the surgical site. In such cases, the robot (e.g., Fig.23 and Fig. 27 The robot 12022) can directly control the volume discharged and / or extracted from the surgical site.

[0418] In one embodiment, based on images from a camera (such as an endoscope-like imaging device 124 ( Figure 2) camera) to control the on / off control of the pump 12446. The imaging device 124 can be configured to detect the presence of smoke S in the field of view at the surgical site. On the other hand, based on the input from the smoke sensor 12453 ( Fig.34 ) is connected in series with the fluid pumped out of the patient. For example, the pump 12446 can remain on as long as the smoke sensor 12453 detects a threshold amount of smoke S, and can be disconnected or paused when the volume of the detected smoke S drops below the threshold amount. In another aspect, the pump 12446 is turned on when the energy is activated, and in some cases can remain on for a period of time after the energy stops. For example, the duration that the pump 12446 can remain on after the energy stops can be fixed, or can be proportional to the length of time the energy is activated.

[0419] Main references Fig.37 , a flowchart depicting logical steps for operating a pump such as pump 12446 is shown. A processor of a robot (e.g., robot 12022) and / or a processor of a hub (e.g., hub 106, hub 206, robot hub 122, and robot hub 222) in signal communication with the robot can determine or estimate the rate at which smoke is exhausted from the surgical site. At step 12510, the smoke evacuation rate can be determined by one or more factors or inputs, including activation of energy by a robotic tool (first input 12502), a smoke sensor in series with a smoke evacuation channel (second input 12504), and / or an imaging device configured to view the surgical site (third input 12506). The first input 12502 can correspond to, for example, a duration and / or power level of energy application. Based on the one or more factors, the pump can be adjusted at step 12512. For example, the rate at which the rotary drive drives the pump can be adjusted. In other cases, when the detected smoke evacuation rate is below a threshold volume, the rotary drive can stop or pause the operation of the pump. Fig.37 The flowchart in can continue throughout the operation of the robotic tool. In some cases, steps 12510 and 12512 can be repeated at predefined intervals during the surgical procedure and / or when requested by the clinician and / or recommended by the hub.

[0420] See now Fig.36 , depicting a robotic tool 12526 for use with a robotic surgical system. The robotic tool 12526 can be used with, for example, the robotic surgical system 12010 ( Fig.23). The robotic tool 12526 is an ultrasonic robotic tool with cooling and blowing capabilities. For example, the robotic tool 12526 can be similar in many respects to the robotic tool disclosed in U.S. Patent Serial No. 9,314,308, entitled “ROBOTIC ULTRASONIC SURGICAL DEVICE WITH ARTICULATING ENDEFFECTOR,” filed on March 13, 2013, which is incorporated herein by reference in its entirety.

[0421] The robotic tool 12526 includes a proximal housing 12537, a shaft 12538 extending from the proximal housing 12537, and an end effector 12528 extending from the distal end of the shaft 12538. The end effector 12528 includes an ultrasonic blade 12530a and an opposing clamping arm 12530b. The robotic tool 12526 also includes an irrigation system 12536 configured to provide a coolant, such as saline or cold CO2, to the surgical site. Irrigation can be configured to cool tissue and / or the ultrasonic blade 12530a, for example. The irrigation system 12536 includes an irrigation channel 12540 extending through the shaft 12538 to the proximal housing 12537. The irrigation channel 12540 terminates at an irrigation port adjacent to the end effector 12528.

[0422] In various cases, the irrigation channel 12540 can be coupled to a blower that is configured to direct fluid along the irrigation channel 12540 within the shaft 12538 of the robotic tool 12526. The irrigation system 12536 includes a blower 12546. The blower 12546 is housed in a proximal housing 12537 of the robotic tool 12526. The blower 12546 is a regenerative blower that has been incorporated into a drive interface 12548 of the robotic tool 12526. The drive interface 12548 includes a rotary drive 12550 that is driven by a rotary output from a motor in a tool mounting portion of the robot, as described herein (see, e.g., rotary output 12556 ( Fig.31 ) and rotated outputs 12824a-12824e ( Fig.39 )).

[0423] A channel 12552 terminating in a connector 12554 extends from the blower 12546. The connector 12554 is a Luer connector, however, the reader will readily appreciate that alternative connectors are contemplated. The Luer connector can be selectively coupled to a reservoir configured to provide irrigation fluid to the blower 12546. In operation, coolant can enter the insufflation line through the connector 12554, and the blower 12546 can draw the coolant toward the blower 12546 at the drive interface 12548, and then blow the coolant toward the end effector 12528 distally along the shaft 12538 of the robotic tool 12526. The coolant can be discharged at or near the end effector 12528, which can cool the ultrasonic blade and / or maintain insufflation of the surgical site, such as abdominal insufflation.

[0424] exist Fig.36 , the internal components of the drive interface 12548 are depicted, however, certain components are excluded for clarity. The flushing channel 12540 extends through the shaft 12538 to the blower 12546 in the proximal housing 12537. The blower 12546 is driven by the rotary drive 12550 of the drive interface 12548. Similar to the interface 12448 ( Fig.35 ), the interface 12548 includes four rotary drives 12550. In one example, the first rotary drive 12550 is configured to drive joint motion, the second rotary drive 12550 is configured to drive jaw closing motion, the third rotary drive 12550 is configured to drive shaft rotation, and the fourth rotary drive 12550 is configured to drive the irrigation system 12536. The reader will understand that alternative interface arrangements may include more or less than four rotary drives 12550. In addition, the drive motion generated by the rotary drive 12550 may vary depending on the desired function of the robotic tool. Furthermore, in some cases, the drive interface 12548 may include a transmission or switch so that the rotary drive 12550 can switch between multiple surgical functions, as further described herein (e.g., see Fig.29 Transmission 12124 and Figures 40 to 45 In one embodiment, the rotary drive 12550 coupled to the blower 12546 can also actuate a clamping motion of the end effector 12528, for example.

[0425] As this article is relative to Fig.35 Pump 12446 as described in, Fig.36The operation of the blower 12546 in the robot tool 12526 can be coordinated with the energy applied by the robot tool 12526. For example, the blower 12546 can be turned on when the energy is activated, and in some cases, the blower 12546 can remain on for a period of time after the energy stops. For example, the duration that the blower 12546 can remain on after the energy stops can be fixed, or can be proportional to the length of time the energy is activated. Additionally or alternatively, the power level of the blower 12546 can be proportional to or otherwise related to the activation level of the robot tool 12526. For example, a high power level can correspond to a first rate, and a lower power level can correspond to a second rate. In one example, the second rate can be different from the first rate.

[0426] In one aspect, the robotic tool 12526 may further include an insufflation pump located upstream of the regeneration blower 12546. The insufflation pump may direct a first volume of fluid into the trocar and direct a second volume of fluid into the regeneration blower 12546. The fluid provided to the trocar may be configured to insufflate a surgical site, such as the abdominal cavity of a patient. The fluid provided by the regeneration blower 12546 may be configured to cool an ultrasonic scalpel, for example.

[0427] The robotic surgical tools 12426 and 12526 may be used in conjunction with a hub, such as the robotic hub 122 or the robotic hub 222. In one aspect, the robotic hub may include a situational awareness module, as described herein. The situational awareness module may be configured to determine and / or confirm steps in a surgical procedure and / or recommend specific surgical actions based on information received from various sources, including one or more robotic surgical tools and / or generator modules. In one instance, actuation of a pump on a robotic surgical tool may notify the situational awareness module that drainage and / or flushing has been employed, which may lead to conclusions about a particular surgical procedure or a group of surgical procedures. Similarly, data from the situational awareness module may be supplied to a processor. In some cases, a processor may be communicatively coupled to a memory storing instructions that may be executed by the processor to adjust the pumping rate of the pump based on data from the situational awareness module, which may indicate, for example, the type of surgical procedure and / or the steps in the surgical procedure. For example, situational awareness may indicate that insufflation is necessary for at least a portion of a particular surgical procedure. In such instances, a pump such as a blower 12546 ( Fig.36 ) can be activated and / or maintained at a certain level to maintain adequate blowing.

[0428] 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 cause a drive in a robotic tool to rotate at a variable rate to provide an adjustable power level to a pump in the robotic tool, as described herein.

[0429] In various aspects, the present disclosure provides control circuitry for rotating a rotary drive in a robotic tool at a variable rate, 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 rotate a rotary drive in a robotic tool at a variable rate to provide an adjustable power level to a pump in the robotic tool, as described herein.

[0430] See now Fig.51 and Fig.52 , depicting a surgical procedure utilizing two robotic tools. Fig.51 In the example, the first tool is a flexible robotic retractor 12902 that applies a retraction force to a portion of the patient's liver L. Fig.52 , the flexible robotic retractor 12902 can move in direction A along the longitudinal axis of the tool shaft and / or can move laterally in direction B (e.g., pivoting at a joint between two rigid links in the robotic retractor).

[0431] In this example, the second tool is an articulated bipolar tool 12904 that is being clamped on tissue. For example, the articulated bipolar tool 12904 can be configured to move the liver attachment A to the liver using bipolar RF current. The articulated bipolar tool 12904 can be articulated laterally in direction C (e.g., pivoting at an articulation joint proximal to the bipolar jaws of the robotic tool 12904). Fig.52 Directions A, B and C are indicated by arrows.

[0432] In the depicted example, the flexible robotic retractor 12902 attempts to block the organ liver L while the bipolar jaws of the articulated bipolar tool 12904 attempt to cut and / or seal the clamped tissue to move the liver attachment A. In one aspect, the movement of the liver L by the flexible robotic retractor 12902 can be configured to maintain a constant retraction force as the bipolar tool 12904 moves the liver attachment A to the liver L. The load control algorithm can be configured to maintain a constant retraction force on the tissue. In some cases, the load control algorithm can be an articulation control algorithm that provides a set or predetermined torque at the articulation joints of the articulated bipolar tool 12904 and / or the flexible robotic retractor 12902. For example, the set torque at the articulation joint can be approximated based on the current supplied to the articulation motor.

[0433] In some cases, the flexible robotic retractor 12902 may present a risk of excessive retraction of the liver L or otherwise endanger excessive retraction of the liver L. For example, if the displacement of the flexible robotic retractor 12902 approaches a set displacement limit, the flexible robotic retractor 12902 may present a risk of tearing a portion of the tissue. To prevent such excessive retraction, the force generated by the flexible robotic retractor 12902 may be reduced by a load control algorithm when the displacement of the flexible robotic retractor 12902 approaches a displacement limit. For example, when the displacement limit has been met, the force may be reduced to below a constant or substantially constant retraction force.

[0434] See now Fig.53 The graphical display 12910 in FIG. 1 plots the retraction force F applied to an organ and the displacement δ of the robotic tool by extending the organ over time. The reader will appreciate that the robotic tools 12902 and 12904 (eg, Fig.51 and Fig.52 12910. Alternative surgical tools and surgical procedures are also contemplated. In one aspect, an operator can set a retraction force threshold Y and a displacement limit X, such as Fig.53 In other cases, the retraction force threshold Y and / or displacement limit X may be determined and / or calculated based on information from the surgical hub and / or the cloud. In some cases, a specific retraction force threshold Y and / or displacement limit X may be recommended to a clinician based on data stored in a memory of the robot, surgical hub, and / or the cloud. The retraction force threshold Y and / or displacement limit X may depend on, for example, patient information.

[0435] During the surgical procedure, if the retraction force F drops below the constant retraction force threshold Y, or drops by a predefined percentage or amount relative to the constant retraction force threshold Y, such as at times t1, t2, and t3, the flexible robotic retractor 12902 can be further displaced to displace the organ and the retraction force F can be increased toward the threshold Y. Similarly, if the displacement δ approaches the displacement limit X, such as at time t4, the retraction force can be reduced to limit the displacement from further exceeding the displacement limit X. For example, see again Fig.51 , the liver L is depicted as being in a second position indicated as L'. The position of the liver L' may correspond to the displacement limit X of the flexible robotic retractor 12902.

[0436] See now Fig.54 , showing a diagram depicting a method for operating a robotic tool such as tool 12902 ( Fig.51 and Fig.52) is a flowchart of the logical steps of the robot (e.g., robot 12022). At step 12920, a processor for a robot (e.g., robot 12022) and / or a processor of a hub (e.g., hub 106, hub 206, robot hub 122, and robot hub 222) that communicates signals with the robot may set displacement limits. In addition, the processor may set force limits at step 12922. The displacement limits and force limits may be selected based on inputs from one or more sources, including clinician input 12930, robot input 12932, hub input 12934, and / or cloud input 12936, as further described herein. In some cases, the hub may suggest specific limits based on data collected by the robot, provided to the hub, and / or stored in the cloud. For example, the situational awareness module may suggest specific limits based on a surgical procedure or steps thereof detected by the situational awareness module. Additionally or alternatively, the clinician may provide input and / or select limits from the hub's suggestions. In other cases, the clinician may override the hub's suggestions. For example, the limits may correspond to ranges of values, such as limits of ±1%, ±5%, or ±10%.

[0437] The robotic tool may initially operate in a constant force mode. At step 12924, in the constant force mode, the force applied by the robotic tool may be maintained at a force limit. The processor may monitor the force to ensure that the force remains below the force limit Y. If the force exceeds the force limit Y, the displacement value may be increased at step 12926 until the force reaches or is sufficiently close to the force limit Y. When the force is within a range of values ​​corresponding to the force limit, the force may be sufficiently close to the force limit. The processor may monitor the displacement to ensure that the displacement remains below the displacement limit X.

[0438] If the displacement approaches the displacement limit X (or enters a range of values ​​corresponding to the displacement limit), the robotic tool may switch to a displacement limit mode. In the displacement limit mode, the force value may be reduced at step 12928 to ensure that the robotic tool remains within the displacement limit. A new force limit may be set at step 12922 to ensure that the displacement remains within the displacement limit. In such a case, the robotic tool may switch back to the constant force mode (with the new reduced force limit), and steps 12924, 12926, and 12928 may be repeated.

[0439] In some cases, the stiffness of one or more axes of the robotic tools may be incorporated into the load control algorithm in order to achieve a desired amount of lateral force on an organ, such as the liver L. For example, the flexible robotic retractor 12902 may define a stiffness that affects the lateral load applied to the tissue by the end effector of the flexible robotic retractor.

[0440] In some cases, a drive housing for a robotic tool may include multiple rotary drives that are operably driven by one or more motors. The motors may be positioned in a motor bracket that may be located at the distal end of the robotic arm. In other cases, the motors may be incorporated into the robotic tool. In some cases, the motor may be operably driven by multiple rotary drives, and the transmission may be configured to switch between the multiple rotary drives. In such cases, the robotic tool cannot simultaneously actuate two or more rotary drives associated with a single drive motor. For example, as described herein with respect to Fig.29 As described above, the motor 12112 can selectively power one of the rolling DOF 12132, the high-force grip DOF 12136, or the tool actuation DOF 12138. The transmission 12124 can selectively couple the motor 12112 to the appropriate DOF.

[0441] In some cases, it may be desirable to increase the torque delivered to the output of the robotic tool. For example, in some cases (such as when the tissue to be cut and / or sutured is particularly thick or tough), the clamping and / or firing of the surgical stapler may benefit from additional torque. Especially for a longer end effector and / or a longer firing stroke, additional torque may be required to complete the firing stroke. In some cases, an I-beam firing structure may be utilized, especially for a longer end effector and / or a longer firing stroke. The I-beam may limit the flexibility at the distal end of the firing stroke, for example. However, the I-beam may require increased torque.

[0442] Additionally, some robotic tools may require additional flexibility with respect to operating multiple DOFs or surgical end effector functions simultaneously. To increase the power, torque, and flexibility of the robotic system, additional motors and / or larger motors may be incorporated into the motor bracket. However, the addition of motors and / or the use of larger motors may increase the size of the motor bracket and drive housing.

[0443] In some cases, a robotic surgical tool may include a compact drive housing. A compact drive housing may improve the entry envelope of a robotic arm. In addition, a compact drive housing may minimize the risk of arm collision and entanglement. Although the drive housing is compact, it may still provide sufficient power, torque, and flexibility for the robotic tool.

[0444] In some cases, one of the drive shafts may be utilized to effect switching between end effector functions. Switching and locking of the rotary drive may occur only when, for example, the robotic surgical system is in a stationary mode. In one aspect, it may be feasible to have three rotary drives operate as many end effector functions as desired based on a cam structure for the switching drives. In one aspect, by using three rotary drives in combination, the robotic surgical tool may switch between four different possible functions instead of three different functions. For example, the three rotary drives may affect shaft rotation, independent head rotation, firing, closing, and auxiliary closing devices. In other cases, the rotary drives may selectively power a pump, such as in Fig.35 and Fig.36 Surgical tools 12426 and 12526.

[0445] Additionally or alternatively, in some cases, multiple rotary drive devices may cooperatively drive a single output shaft. For example, in order to increase the torque delivered to the surgical tool, multiple motors may be configured to deliver torque to the same output shaft at a given time. For example, in some cases, two drive motors may drive a single output. The switcher drive device may be configured to engage and disengage the two drive motors independently from the single output member. In such cases, the increased torque can be delivered to the output through a compact drive housing associated with multiple rotary drives and end effector functions. Therefore, the load capacity of the surgical tool can be increased. In addition, the drive housing can accommodate surgical tools that require different surgical functions (including the operation of multiple DOF or surgical functions).

[0446] See now Figure 38 to Figure 45 , depicts a drive system 12800 for a robotic surgical tool 12830. Drive system 12800 includes a housing 12832 and a motor bracket 12828. A shaft 12834 of surgical tool 12830 extends from housing 12832. Motor bracket 12828 is similar to motor bracket 12108 ( Fig.29 ) can accommodate five motors 12826. In other cases, the motor bracket 12828 can accommodate fewer than five motors or more than five motors. In other cases, the motor 12826 can be accommodated in the robotic surgical tool 12830.

[0447] Each motor 12826 is coupled to a rotation output 12824, and each rotation output 12824 is coupled to a rotation input 12836 in the housing 12832 at the drive interface 12822. The rotational motion from the motor 12826 and the corresponding rotation output 12824 is transmitted to the corresponding rotation input 12836. The rotation input 12836 corresponds to a rotation driver or a rotation drive shaft in the housing 12832. In one example, the first motor 12826a can be a left / right joint motion (or yaw) motor, the second motor 12826b can be an up / down joint motion (or pitch) motor, the third motor 12826c can be a switcher motor, the fourth motor 12826d can be a first cooperative motor, and the fifth motor 12826e can be a second cooperative motor. Similarly, the first rotational output 12824a can be a left / right joint motion (or yaw) output, the second rotational output 12824b can be an up / down joint motion (or pitch) output, the third rotational output 12824c can be a switcher output, the fourth rotational output 12824d can be a first cooperative output, and the fifth rotational output 12824e can be a second cooperative output. In addition, the first rotational input 12836a can be a left / right joint motion (or yaw) drive shaft, the second rotational input 12836b can be an up / down joint motion (or pitch) drive shaft, the third rotational input 12836c can be a switcher drive shaft, the fourth rotational input 12836d can be a first cooperative drive shaft, and the fifth rotational input 12836e can be a second cooperative drive shaft. In other cases, the drive shafts 12836a-12836e can be operably positioned in different orientations to achieve different gear train configurations to transmit the desired rotational output.

[0448] Figures 47 to 50 The surgical tool 12830 is depicted in a variety of different configurations. Fig.47 The surgical tool 12830 is in an unactuated configuration. Fig.48 , shaft 12834 has been articulated about the yaw axis and the pitch axis (in the directions of arrows A and B). The rotation of the first rotation input 12836a and the second rotation input 12836b are configured to cause the shaft 12834 to be articulated about the yaw axis and the pitch axis, respectively. Fig.49 , the shaft 12834 has been rotated in the direction of arrow C about the longitudinal axis of the shaft 12834, and the jaws of the end effector 12835 have been closed using low force actuation in the direction of arrow D. Rotation of the fourth rotational output 12836d is configured to selectively affect rotation of the shaft 12834, and rotation of the fifth rotational output 12836e is configured to selectively affect low force closure of the end effector 12835. Fig.50, the jaws of the end effector 12835 have been clamped by high force actuation in the direction of arrow E, and the firing member has been advanced in the direction of arrow F. Rotation of the fourth rotational output 12836d and the fifth rotational output 12836e are configured to selectively and cooperatively affect high force closure of the end effector 12835 and firing of the firing component therein, respectively.

[0449] Now mainly see Figures 40 to 45 , the housing 12832 includes multiple layers of gear train assemblies. Specifically, the housing 12832 includes a first gear train assembly 12838a stacked below a second gear train assembly 12838b, which is stacked below a third gear train assembly 12838c, which is stacked below a fourth gear train assembly 12838d. For example, the first gear train assembly 12838a corresponds to a first DOF, such as rotation of the shaft 12834. For example, the second gear train assembly 12838b corresponds to a second DOF, such as closing the end effector 12835 with a low closing force (i.e., fast closing). For example, the third gear train assembly 12838c corresponds to a third DOF, such as clamping the end effector 12835 with a high closing force (i.e., slow closing). For example, the fourth gear train assembly 12838d corresponds to a fourth DOF, such as firing a firing element in the end effector 12835. Five rotational inputs 12836a-12836e extend through four levels of gear train assemblies 12838a-12838d.

[0450] The first motor 12826a is drivingly coupled to the first rotational input 12836a. In such cases, the first motor 12826a is specifically configured to drive the first rotational input 12836a that affects the first DOF. For example, see mainly Fig.41 , the articulation wire 12842 can extend from the first rotational input 12836a through the shaft 12834 of the robotic tool 12830 toward the end effector 12835. The rotation of the first rotational input 12836a is configured to actuate the articulation wire 12842 to achieve left / right articulation of the end effector 12835. Similarly, the second motor 12826b is drivingly coupled to the second rotational input 12836b. In such a case, the second motor 12826b is specifically configured to drive the second rotational input 12836b that affects the second DOF. Still referring to Fig.41, the articulation wire 12844 can extend from the second rotational input 12836b through the shaft 12834 of the robotic tool 12830 toward the end effector 12835. Rotation of the second rotational input 12836b is configured to actuate the articulation wire 12844 to affect up / down articulation of the end effector 12835. In other cases, at least one of the first rotational input 12836a and the second rotational input 12836b can correspond to a different DOF or a different surgical function.

[0451] The housing 12832 also includes a transmission assembly 12840. For example, the third rotation input portion 12836c is a switch drive shaft of the transmission assembly 12840. Figures 40 to 45 As depicted, the third rotational input 12836c can be a camshaft that includes a plurality of cam lobes. The arrangement of the cam lobes 12839 can correspond to each gear train assembly 12838a-12838d stacked in the housing 12832. In addition, each gear train assembly 12838a-12838d includes a corresponding shuttle 12846a-12846d that can be operatively engaged by the third rotational input 12836c. For example, the thi...

Claims

1. A surgical system comprising: a hub, the hub comprising a generator; A robot, the robot comprising a tool holder; an energy tool releasably mounted to the tool holder and operably coupled to the generator; Console; a first wired communication path extending between the energy tool and the console; a primary communication path extending directly between the energy tool and the console through the first wired communication path; a second wired communication path extending between the energy tool and the hub; a wireless communication pathway extending between the hub and the console, wherein the wireless communication pathway is configured to transmit data indicative of the detected tissue parameter to the console; and An auxiliary communication path extends between the energy tool and the console through a combination of the second wired communication path and the wireless communication path.

2. The surgical system of claim 1, wherein: The hub also includes a situational awareness module configured to determine a step in a surgical procedure based on one or more signals from the console and one or more signals from the energy tool.

3. The surgical system of claim 1, wherein: The hub further includes a wireless communication module, and wherein the wireless communication path further includes the wireless communication module.

4. The surgical system of claim 1, wherein: The wireless communication path is configured to communicate machine control parameters to the hub.

5. The surgical system of claim 1, wherein: The robot also includes a flex circuit positioned to intercept a communication path between the tool holder and the energy tool.

6. The surgical system of claim 1, wherein: Data of a first type is transmitted along the primary communication path, wherein data of a second type is transmitted along the secondary communication path, and wherein the data of the first type is different from the data of the second type.

7. A surgical system comprising: a hub, the hub comprising a wireless communication module and a generator module; a robot comprising a tool holder configured to interface with a releasable surgical tool, wherein a first wired connection extends between the robot and the hub; a console, wherein a primary communication path extends directly between the robot and the console via a second wired connection; a first wireless communication path extending between the robot and the wireless communication module; a second wireless communication pathway extending between the control console and the wireless communication module, wherein the first wireless communication pathway and the second wireless communication pathway form at least a portion of an additional communication pathway between the robot and the control console, the additional communication pathway being different from the primary communication pathway; and A flexible circuit is positioned to intercept a communication path between the tool holder and the releasable surgical tool.

8. The surgical system of claim 7, wherein: The first wireless communication pathway is configured to transmit data indicative of a clamping force to the hub.

9. The surgical system of claim 7, wherein: The second wired connection is configured to transmit data indicative of an energy parameter from the robot to the console.

10. The surgical system of claim 7, further comprising an energy tool releasably mounted to the tool holder.

11. The surgical system of claim 10, wherein: The hub also includes a processor and a memory communicatively coupled to the processor, and wherein the memory stores instructions executable by the processor to adjust a control parameter of the energy tool based on a signal transmitted along the first wireless communication path.

12. The surgical system of claim 7, wherein: The hub also includes a situational awareness module configured to determine a step in a surgical procedure based on one or more signals transmitted along the first wireless communication pathway.

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