Surgical system communication path

Abstract

A surgical system includes a surgical hub, a surgical instrument, a generator configured to power an end effector, and a smoke evacuation system configured to remove smoke from a surgical site. The surgical instrument includes the end effector. Control commands are passed directly from the surgical hub to the surgical instrument. The surgical instrument is configured to pass the control commands received from the surgical hub to the generator and the smoke evacuation system in a daisy chain fashion.

Description

Surgical system communication path

[0001] Cross-references to related applications

[0002] This non-provisional application claims the benefit of U.S. Provisional Patent Application Serial No. 62 / 955,299, entitled “DEVICES AND SYSTEMS FOR ELECTROSURGERY,” filed December 30, 2019, pursuant to 35 U.S.C., Section 119(e), the disclosure of which is incorporated herein by reference in its entirety. Background Technology

[0003] This invention relates to surgical instruments designed to process tissue, including but not limited to surgical instruments configured to cut and fasten tissue. Surgical instruments may include electrosurgical instruments powered by a generator to achieve tissue dissection, cutting, and / or coagulation during surgical procedures. Surgical instruments may include instruments configured to cut tissue and suture it using surgical staples and / or fasteners. Surgical instruments may be configured for use in open surgery, but may also be used in other types of surgery such as laparoscopic, endoscopic, and robot-assisted procedures, and may include end effectors capable of articulating relative to an axial portion of the instrument to facilitate precise positioning within the patient. Summary of the Invention

[0004] In various embodiments, a surgical system is disclosed, comprising a surgical hub, surgical instruments, a generator configured to power an end effector, and a smoke extraction system configured to remove smoke from a surgical site. The surgical instruments include the end effector. Control commands are transmitted directly from the surgical hub to the surgical instruments. The surgical instruments are configured to daisy-chain the control commands received from the surgical hub to the generator and the smoke extraction system.

[0005] In various embodiments, a surgical system is disclosed, comprising a surgical hub, surgical instruments, a generator configured to power an end effector, and a smoke extraction system configured to remove smoke from a surgical site. The surgical instruments include the end effector. Control commands are transmitted directly from the surgical hub to the surgical instruments. The surgical instruments are configured to transmit the control commands received from the surgical hub to the generator and the smoke extraction system.

[0006] In various embodiments, a surgical system is disclosed, comprising a surgical hub, a first surgical instrument, a first generator configured to power a first end effector, and a second surgical instrument. The first surgical instrument includes the first end effector. Control commands are transmitted directly from the surgical hub to the first surgical instrument. The first surgical instrument is configured to daisy-chain the control commands received from the surgical hub to the first generator and the second surgical instrument. Attached Figure Description

[0007] The novel features of various aspects are specifically set forth in the appended claims. However, the described aspects relating to both the organization and the method of operation are best understood by referring to the following description in conjunction with the accompanying drawings, wherein:

[0008] Figure 1 shows an example of a generator used with a surgical system according to at least one aspect of this disclosure;

[0009] Figure 2 illustrates one form of a surgical system according to at least one aspect of the present disclosure, the surgical system comprising a generator and an electrosurgical instrument that can be used with the generator.

[0010] Figure 3 shows a block diagram of a surgical instrument or tool according to at least one aspect of the present disclosure;

[0011] Figure 4 is a perspective view of a surgical system according to at least one embodiment, the surgical system including surgical instruments and a display monitor, wherein the surgical instruments include a display screen.

[0012] Figure 5 is a schematic diagram of the corresponding views of the display screen and display monitor of the surgical instrument of Figure 4 according to at least one embodiment;

[0013] Figure 6 is a schematic diagram of the corresponding views of the display screen and display monitor of the surgical instrument of Figure 4 according to at least one embodiment;

[0014] Figure 7 is a schematic diagram of the corresponding views of the display screen and display monitor of the surgical instrument of Figure 4 according to at least one embodiment;

[0015] Figure 8 is a schematic diagram of the corresponding views of the display screen and display monitor of the surgical instrument of Figure 4 according to at least one embodiment;

[0016] Figure 9 is a schematic diagram of the corresponding views of the display screen and display monitor of the surgical instrument of Figure 4 according to at least one embodiment;

[0017] Figure 10 is a graphical representation of the relationship between the total effective energy delivered by one or more generators of the surgical system and the duty cycle of the motor from the smoke exhaust system, according to at least one embodiment.

[0018] Figure 11 is a schematic diagram of a surgical system according to at least one embodiment, the surgical system including a surgical hub, a combined electrosurgical instrument powered by multiple generators, a smoke extraction system and a display.

[0019] Figure 12 is an image depicting the relationship between the power supplied by one or more generators of a surgical system over time and the impedance of the treated tissue over time, according to at least one embodiment.

[0020] Figure 13 is a schematic diagram of a communication path with a surgical system according to at least one embodiment, wherein the surgical system includes a surgical hub, a smoke extraction device, surgical instruments, a first generator configured to supply power to a first operation of the surgical instruments, and a second generator configured to supply power to a second operation of the surgical instruments.

[0021] Figure 14 is a schematic diagram of a surgical system according to at least one embodiment, the surgical system including a surgical hub and a plurality of robotic arms configured to receive tools thereon, wherein the surgical system includes an authentication module configured to allow the tools to be attached to and / or used with the surgical system.

[0022] Figure 15 is a schematic diagram of a surgical system located in a treatment room according to at least one embodiment;

[0023] Figure 16 is a diagram depicting various operating parameters and / or specifications of surgical instruments at various stages of a surgical procedure according to at least one embodiment.

[0024] Figure 17 is a front view of the surgical instrument shown in Figure 16, which is intended to deliver bipolar energy to the patient's tissue in the first moment.

[0025] Figure 18 is a front view of the surgical instrument shown in Figure 16, which is used to deliver bipolar and monopolar energy to patient tissue at a second time.

[0026] Figure 19 is a front view of the surgical instrument shown in Figure 16, which is used to deliver monopolar energy to the patient's tissue at the fourth time.

[0027] Figure 20 is a graphical representation of the various operating parameters and / or specifications of the surgical instruments in Figure 16 at different stages of surgical procedures.

[0028] Figure 21 is a graphical representation of tissue impedance measured during the duration of a surgical procedure according to at least one embodiment;

[0029] Figure 22 is a schematic diagram representing strain calculation according to at least one embodiment, wherein the applied strain is calculated using the gap defined between the jaws of the end effector when the end effector is in the open configuration;

[0030] Figure 23 is a schematic diagram illustrating the strain calculation in Figure 22, where the calculated applied strain exceeds the actual applied strain when the patient tissue is not in contact with or between the jaws of the end effector.

[0031] Figure 24 is a schematic diagram representing the calculation of tissue impedance according to at least one embodiment, wherein tissue impedance is calculated using the gap defined between the jaws of the end effector when the jaws of the end effector contact the patient tissue located therebetween.

[0032] Figure 25 is a graphical representation of the relationship between motor current and jaw gap over time according to at least one embodiment;

[0033] Figure 26 is a schematic diagram of a network according to at least one embodiment, the network being formed by surgical instruments and cloud-based storage media;

[0034] Figure 27 is a graphical representation of the relationship between the change in jaw gap determined by the network in Figure 26 and the clamping current of the jaw motor.

[0035] Figure 28 is a graphical representation of the relationship between generator power and time determined based on the network in Figure 26;

[0036] Figure 29 is a graphical representation of the relationship between the activation cycle of a surgical instrument according to at least one embodiment and the impedance measured when the end effector of the surgical instrument is in a closed configuration and no patient tissue is present therebetween.

[0037] Figure 30 is a graphical representation of the relationship between electrical conductivity, jaw bore size, and jaw motor force during the jaw clamping stroke, according to at least one embodiment; and

[0038] Figure 31 is a graphical representation of the jaw closing speed based on user input and the jaw closing speed based on the user input and monitored parameters according to at least one embodiment. Detailed Implementation

[0039] The applicant of this application owns the following U.S. patent applications filed on the same date as this application, each of which is incorporated herein by reference in its entirety:

[0040] • The agent's case file number, END9234USNP1 / 190717-1M, entitled "METHOD FOR AN ELECTROSURGICAL PROCEDURE";

[0041] • The agent's case file number for the "ARTICULATABLE SURGICAL INSTRUMENT" is END9234USNP2 / 190717-2;

[0042] • The agent's case file number for the title "SURGICAL INSTRUMENT WITH JAW ALIGNMENT FEATURES" is END9234USNP3 / 190717-3;

[0043] • The case file number for the agent whose title is “SURGICAL INSTRUMENT WITH ROTATABLE AND ARTICULATABLESURGICAL END EFFECTOR” is END9234USNP4 / 190717-4;

[0044] • The agent's case file number for the title "ELECTROSURGICAL INSTRUMENT WITH ASYNCHRONOUS ENERGIZING ELECTRODES" is END9234USNP5 / 190717-5;

[0045] • The agent's case file number END9234USNP6 / 190717-6, titled "ELECTROSURGICAL INSTRUMENT WITH ELECTRODES BIASING SUPPORT";

[0046] • The agent's case file number for the title "ELECTROSURGICAL INSTRUMENT WITH FLEXIBLE WIRING ASSEMBLIES" is END9234USNP7 / 190717-7;

[0047] • The agent's case file number, END9234USNP8 / 190717-8, entitled "ELECTROSURGICAL INSTRUMENT WITH VARIABLE CONTROL MECHANISMS";

[0048] • The agent's case file number for the title "ELECTROSURGICAL SYSTEMS WITH INTEGRATED AND EXTERNAL POWERSOURCES" is END9234USNP9 / 190717-9;

[0049] • The agent's case file number is END9234USNP10 / 190717-10, and the title is "ELECTROSURGICALINSTRUMENTS WITH ELECTRODES HAVING ENERGY FOCUSING FEATURES";

[0050] • The agent's case file number END9234USNP11 / 190717-11, titled "ELECTROSURGICAL INSTRUMENTS WITH ELECTRODES HAVING VARIABLEENERGY DENSITIES";

[0051] • The agent's case file number for the titled "ELECTROSURGICAL INSTRUMENT WITH MONOPOLAR AND BIPOLAR ENERGYCAPABILITIES" is END9234USNP12 / 190717-12;

[0052] • The case file number for the agent named “ELECTROSURGICAL END EFFECTORS WITH THERMALLY INSULATIVE AND THERMALLY CONDUCTIVE PORTIONS” is END9234USNP13 / 190717-13.

[0053] • The agent's case file number END9234USNP14 / 190717-14, entitled "ELECTROSURGICAL INSTRUMENT WITH ELECTRODES OPERABLE INBIPOLAR AND MONOPOLAR MODES";

[0054] • The agent's case file number for the title "ELECTROSURGICAL INSTRUMENT FOR DELIVERING BLENDED ENERGY MODALITIES TO TISSUE" is END9234USNP15 / 190717-15;

[0055] • The agent's case file number END9234USNP16 / 190717-16, entitled "CONTROL PROGRAM ADAPTATION BASED ON DEVICE STATUS AND USERINPUT"; and

[0056] • The agent's case file number is END9234USNP17 / 190717-17, with the title "CONTROL PROGRAM FOR MODULAR COMBINATION ENERGY DEVICE".

[0057] The applicant of this application owns the following U.S. provisional patent applications filed on December 30, 2019, the full disclosure of each of which is incorporated herein by reference:

[0058] • U.S. Provisional Patent Application Serial No. 62 / 955,294, entitled “USER INTERFACE FORSURGICAL INSTRUMENT WITH COMBINATION ENERGY MODALITY END-EFFECTOR”;

[0059] • U.S. Provisional Patent Application Serial No. 62 / 955,292, entitled “COMBINATION ENERGY MODALITY END-EFFECTOR”; and

[0060] • U.S. Provisional Patent Application Serial No. 62 / 955,306, entitled “SURGICAL INSTRUMENT SYSTEMS”.

[0061] The applicant of this application holds the following U.S. patent applications, the full disclosure of each of which is incorporated herein by reference:

[0062] • U.S. Patent Application Serial No. 16 / 209,395, entitled “METHOD OF HUB COMMUNICATION”, now U.S. Patent Application Publication No. 2019 / 0201136;

[0063] • U.S. Patent Application Serial No. 16 / 209,403, entitled “METHOD OF CLOUD BASED DATAANALYTICS FOR USE WITH THE HUB”, now U.S. Patent Application Publication No. 2019 / 0206569;

[0064] • U.S. Patent Application Serial No. 16 / 209,407, entitled “METHOD OF ROBOTIC HUBCOMMUNICATION, DETECTION, AND CONTROL”, now U.S. Patent Application Publication No. 2019 / 0201137;

[0065] • U.S. Patent Application Serial No. 16 / 209,416, entitled “METHOD OF HUB COMMUNICATION, PROCESSING, DISPLAY, AND CLOUD ANALYTICS”, now U.S. Patent Application Publication No. 2019 / 0206562;

[0066] • U.S. Patent Application Serial No. 16 / 209,423, entitled “METHOD OF COMPRESSING TISSUE WITHIN A STAPLING DEVICE AND SIMULTANEOUSLY DISPLAYING THE LOCATION OF THETISSUE WITHIN THE JAWS”, now U.S. Patent Application Publication No. 2019 / 0200981;

[0067] • U.S. Patent Application Serial No. 16 / 209,427, entitled “METHOD OF USING REINFORCEDFLEXIBLE CIRCUITS WITH MULTIPLE SENSORS TO OPTIMIZE PERFORMANCE OF RADIOFREQUENCY DEVICES”, now U.S. Patent Application Publication No. 2019 / 0208641;

[0068] • U.S. Patent Application Serial No. 16 / 209,433, entitled “METHOD OF SENSING PARTICULATE FROM SMOKE EVACUATED FROM A PATIENT, ADJUSTING THE PUMP SPEED BASED ON THESENSED INFORMATION, AND COMMUNICATING THE FUNCTIONAL PARAMETERS OF THE SYSTEM TO THE HUB”, now U.S. Patent Application Publication No. 2019 / 0201594;

[0069] • U.S. Patent Application Serial No. 16 / 209,447, entitled “METHOD FOR SMOKE EVACUATION FOR SURGICAL HUB”, now U.S. Patent Application Publication No. 2019 / 0201045;

[0070] • U.S. Patent Application Serial No. 16 / 209,453, entitled “METHOD FOR CONTROLLING SMARTENERGY DEVICES”, now U.S. Patent Application Publication No. 2019 / 0201046;

[0071] • U.S. Patent Application Serial No. 16 / 209,458, entitled “METHOD FOR SMART ENERGYDEVICE INFRASTRUCTURE”, now U.S. Patent Application Publication No. 2019 / 0201047;

[0072] • U.S. Patent Application Serial No. 16 / 209,465, entitled “METHOD FOR ADAPTIVE CONTROLSCHEMES FOR SURGICAL NETWORK CONTROL AND INTERACTION”, now U.S. Patent Application Publication No. 2019 / 0206563;

[0073] • U.S. Patent Application Serial No. 16 / 209,478, entitled “METHOD FOR SITUATIONAL AWARENESS FOR SURGICAL NETWORK OR SURGICAL NETWORK CONNECTED DEVICE CAPABLE OF ADJUSTING FUNCTION BASED ON A SENSED SITUATION OR USAGE”, now U.S. Patent Application Publication No. 2019 / 0104919;

[0074] • U.S. Patent Application Serial No. 16 / 209,490, entitled “METHOD FOR FACILITY DATACOLLECTION AND INTERPRETATION”, now U.S. Patent Application Publication No. 2019 / 0206564;

[0075] • U.S. Patent Application Serial No. 16 / 209,491, entitled “METHOD FOR CIRCULAR STAPLERCONTROL ALGORITHM ADJUSTMENT BASED ON SITUATIONAL AWARENESS”, now U.S. Patent Application Publication No. 2019 / 0200998;

[0076] • U.S. Patent Application Serial No. 16 / 562,123, entitled “METHOD FOR CONSTRUCTING ANDUSING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLE DEVICES”;

[0077] • U.S. Patent Application Serial No. 16 / 562,135, entitled “METHOD FOR CONTROLLING ANENERGY MODULE OUTPUT”;

[0078] • U.S. Patent Application Serial No. 16 / 562,144, entitled “METHOD FOR CONTROLLING AMODULAR ENERGY SYSTEM USER INTERFACE”; and

[0079] • U.S. Patent Application Serial No. 16 / 562,125, entitled “METHOD FOR COMMUNICATING BETWEEN MODULES AND DEVICES IN A MODULAR SURGICAL SYSTEM”.

[0080] Before detailing the various aspects of the electrosurgical system, it should be noted that the illustrative examples are not limited in application or use to the details of the construction and arrangement of the components shown in the drawings and specifications. The illustrative examples may be implemented or incorporated in other aspects, variations, and modifications, and may be practiced or performed in various ways. Furthermore, unless otherwise specified, the terminology and expressions used herein are chosen for the convenience of the reader in describing the illustrative examples and are not intended to be restrictive. Moreover, it should be understood that one or more of the aspects, expressions, and / or examples described below may be combined with any one or more of the other aspects, expressions, and / or examples described below.

[0081] Various aspects involve electrosurgical systems, which include electrosurgical instruments powered by a generator to achieve tissue dissection, cutting, and / or coagulation during surgical procedures. In one aspect, these electrosurgical instruments can be configured for use in open surgery, but can also be applied to other types of surgery, such as laparoscopic, endoscopic, and robot-assisted procedures.

[0082] As described in more detail below, electrosurgical instruments typically include a shaft with a distally mounted end effector (e.g., one or more electrodes). This end effector is positioned against tissue so that current is introduced into the tissue. Electrosurgical instruments can be configured for bipolar or monopolar operation. During bipolar operation, current is introduced into and returns to the tissue via the active electrode and return electrode of the end effector, respectively. During monopolar operation, current is introduced into the tissue via the active electrode of the end effector and returns via a return electrode (e.g., a grounding pad) separately positioned on the patient's body. The heat generated by the current flowing through the tissue can create a hemostatic seal within and / or between tissues, and is therefore particularly suitable for, for example, sealing blood vessels.

[0083] Figure 1 illustrates an example of a generator 900 configured to deliver multiple energy modes to a surgical instrument. The generator 900 provides RF signals and / or ultrasound signals for delivering energy to the surgical instrument. The generator 900 includes at least one generator output that can deliver multiple energy modes (e.g., ultrasound, bipolar or monopolar RF, irreversible and / or reversible electroporation and / or microwave energy, etc.) through a single port, and these signals can be delivered individually or simultaneously to an end effector to process tissue. 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 multiple signal waveforms based on information stored in a memory coupled to the processor 902 (not shown for clarity in this disclosure). Digital information associated with the waveforms is provided to the waveform generator 904, which includes one or more DAC circuits to convert the digital inputs into analog outputs. The analog outputs are fed to an amplifier 906 for signal conditioning and amplification. The regulated and amplified output of amplifier 906 is coupled to power transformer 908. The signal is coupled to the secondary side in the patient isolation area via power transformer 908. A first signal of the first energy mode is provided to a surgical instrument between terminals labeled ENERGY1 and RETURN. A second signal of the second energy mode is coupled across capacitor 910 and provided to a surgical instrument between terminals labeled ENERGY2 and RETURN. It should be understood that more than two energy modes can be output, and therefore the subscript "n" can be used to specify that up to n ENERGY signals can be provided. n Terminals, where n is a positive integer greater than 1. It should also be understood that, without departing from the scope of this disclosure, up to "n" return paths can be provided. n .

[0084] A first voltage sensing circuit 912 is coupled to both ends of a terminal labeled ENERGY1 and RETURN path to measure the output voltage between them. A second voltage sensing circuit 924 is coupled to both ends of a terminal labeled ENERGY2 and RETURN path to measure the output voltage between them. As shown, a current sensing circuit 914 is connected 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 different return paths are 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 corresponding isolation transformers 928, 922, and the output of the current sensing circuit 914 is provided to another isolation transformer 916. 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 current supplied to surgical instruments can be adjusted using output voltage and current feedback information, and parameters such as output impedance can be calculated. Input / output communication between the processor 902 and the patient isolation circuit is provided through interface circuit 920. Sensors can also communicate electrically with the processor 902 through interface circuit 920.

[0085] In one aspect, impedance can be determined by processor 902 by dividing the output of a first voltage sensing circuit 912 coupled to the terminals labeled ENERGY1 / RETURN or a second voltage sensing circuit 924 coupled to the terminals labeled ENERGY2 / RETURN by the output of a current sensing circuit 914 connected in series with the RETURN branch on the secondary side of 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 928, 922, and the output of the current sensing circuit 914 is provided to another isolation transformer 916. Digital voltage and current sensing measurements from ADC circuit 926 are provided to processor 902 for impedance calculation. For example, the first energy mode ENERGY1 may be RF unipolar energy, and the second energy mode ENERGY2 may be RF bipolar energy. However, in addition to bipolar and unipolar RF energy modes, other energy modes include ultrasonic energy, irreversible and / or reversible electroporation and / or microwave energy, etc. Furthermore, although the example shown in Figure 1 illustrates that a single return path RETURN can be provided for two or more energy modes, in other respects, ENERGY can be provided for each energy mode. n Provide multiple return paths RETURN n .

[0086] As shown in Figure 1, a generator 900, including at least one output port, may include a power transformer 908 with a single output and multiple taps to provide power to the end effector in one or more energy modes (such as ultrasound, bipolar or monopolar RF, irreversible and / or reversible electroporation and / or microwave energy, etc.) depending on the type of tissue treatment being performed. For example, the generator 900 may deliver energy with higher voltage and lower current to drive an ultrasound transducer, with lower voltage and higher current to drive an RF electrode for sealing tissue, or with a coagulation waveform for point coagulation using 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. In one example, the connection between the RF bipolar electrode and the output of the generator 900 would preferably be located between the outputs labeled ENERGY2 and RETURN. In the case of unipolar 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 connected to the RETURN output.

[0087] Additional details are disclosed in U.S. Patent Application Publication 2017 / 0086914, entitled “TECHNIQUES FOR OPERATING GENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICALINSTRUMENTS”, published on March 30, 2017, the entire contents of which are incorporated herein by reference.

[0088] Figure 2 illustrates one form of a surgical system 1000, which includes a generator 1100 and various surgical instruments 1104, 1106, and 1108 that can be used with the generator. Surgical instrument 1104 is an ultrasonic surgical instrument, surgical instrument 1106 is an RF electrosurgical instrument, and multifunctional surgical instrument 1108 is a combined ultrasonic / RF electrosurgical instrument. The generator 1100 can be configured for use with a variety of surgical devices. Depending on the form, the generator 1100 can be configured for use with different types of surgical instruments, including, for example, ultrasonic surgical instruments 1104, RF electrosurgical instruments 1106, and multifunctional surgical instruments 1108 that integrate RF energy and ultrasonic energy simultaneously delivered from the generator 1100. Although generator 1100 is shown as independent of surgical instruments 1104, 1106, and 1108 in the form of Figure 2, in one embodiment, generator 1100 may be integrally formed with any of surgical instruments 1104, 1106, and 1108 to form an integrated surgical system. Generator 1100 includes an input device 1110 located on the front panel of generator 1100 control console. Input device 1110 may include any suitable means for generating signals suitable for programming the operation of generator 1100. Generator 1100 may be configured for wired or wireless communication.

[0089] Generator 1100 is configured to drive multiple surgical instruments 1104, 1106, and 1108. The first surgical instrument is an ultrasonic surgical instrument 1104 and includes a handheld device 1105 (HP), an ultrasonic transducer 1120, a shaft 1126, and an end effector 1122. The end effector 1122 includes an ultrasonic scalpel 1128 acoustically coupled to the ultrasonic transducer 1120 and a clamping arm 1140. Handheld device 1105 includes a trigger 1143 for operating the clamping arm 1140 and a combination of toggle buttons 1137, 1134b, and 1134c for powering and driving the ultrasonic scalpel 1128 or other functions. Toggle buttons 1137, 1134b, and 1134c can be configured to power the ultrasonic transducer 1120 using generator 1100.

[0090] The generator 1100 is also configured to drive a second surgical instrument 1106. The second surgical instrument 1106 is an RF electrosurgical instrument and includes a handheld device 1107 (HP), a shaft 1127, and an end effector 1124. The end effector 1124 includes electrodes in gripping arms 1145, 1142b and returns through an electrically conductive portion of the shaft 1127. These electrodes are coupled to and powered by a bipolar energy source within the generator 1100. The handheld device 1107 includes a trigger 1145 for operating the gripping arms 1145, 1142b and an energy button 1135 for actuating an energy switch to power the electrodes in the end effector 1124. The second surgical instrument 1106 can also be used with a return pad to deliver monopolar energy to tissue.

[0091] The generator 1100 is also configured to drive a multi-functional surgical instrument 1108. The multi-functional surgical instrument 1108 includes a handheld component 1109 (HP), a shaft 1129, and an end effector 1125. The end effector 1125 includes an ultrasonic scalpel 1149 and a clamping arm 1146. The ultrasonic scalpel 1149 is acoustically coupled to an ultrasonic transducer 1120. The handheld component 1109 includes a combination of a trigger 1147 for operating the clamping arm 1146 and switching buttons 11310, 1137b, 1137c for powering and driving the ultrasonic scalpel 1149 or other functions. The switching buttons 11310, 1137b, 1137c can be configured to power the ultrasonic transducer 1120 using the generator 1100 and the ultrasonic scalpel 1149 using a bipolar energy source also included in the generator 1100. Monopolar energy can be delivered to tissues in combination with bipolar energy or separately.

[0092] Generator 1100 is configurable for use with a variety of surgical instruments. Depending on the form, generator 1100 may be configurable for use with different types of surgical instruments, including, for example, ultrasonic surgical instruments 1104, RF electrosurgical instruments 1106, and multifunctional surgical instruments 1108 that integrate RF energy and ultrasonic energy delivered simultaneously from generator 1100. Although generator 1100 is shown as independent of surgical instruments 1104, 1106, and 1108 in the form of FIG. 2, in another form, generator 1100 may be integrally formed with any of surgical instruments 1104, 1106, and 1108 to form an integrated surgical system. As discussed above, generator 1100 includes an input device 1110 located on the front panel of generator 1100 control console. Input device 1110 may include any suitable means for generating signals suitable for programming the operation of generator 1100. Generator 1100 may also include one or more output devices 1112. Further aspects of generators for digitally generating electrical signal waveforms and surgical instruments are described in U.S. Patent Application Publication US-2017-0086914-A1, the entire contents of which are incorporated herein by reference.

[0093] Figure 3 illustrates a schematic diagram of a surgical instrument or tool 600 comprising multiple motor assemblies that can be activated to perform various functions. In the illustrated example, the closing motor assembly 610 is operable to switch the end effector between an open and closed configuration, and the articulation motor assembly 620 is operable to articulate the end effector relative to the shaft assembly. In some cases, the multiple motor assemblies can be activated individually to induce firing motion, closing motion, and / or articulation in the end effector. The firing motion, closing motion, and / or articulation can be transmitted to the end effector, for example, via the shaft assembly.

[0094] In some cases, the closing motor assembly 610 includes a closing motor. The closing motor 603 may be operatively coupled to a closing motor drive assembly 612, which may be configured to transmit closing motions generated by the motor to an end effector, specifically displacing the closing member into a closed position to transform the end effector into a closed configuration. These closing motions can, for example, transform the end effector from an open configuration to a closed configuration to capture tissue. The end effector can be transformed to an open position by reversing the direction of the motor.

[0095] In some cases, the articulated motion motor assembly 620 includes an articulated motion motor operatively coupled to the articulated motion drive assembly 622, which can be configured to transmit articulated motion generated by the motor to an end effector. In some cases, the articulated motion can cause the end effector to articulate relative to an axis, for example.

[0096] One or more motors in the surgical instrument 600 may include a torque sensor to measure the output torque on the motor shaft. Forces on the end effector can 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.

[0097] In various cases, motor assemblies 610, 620 include one or more motor drivers, which may include one or more H-bridge FETs. These motor drivers can regulate the power delivered from power source 630 to the motor based on inputs from, for example, a microcontroller 640 (“controller”) from control circuitry 601. In some cases, the microcontroller 640 can be used to determine, for example, the current consumed by the motor.

[0098] In some cases, microcontroller 640 may include microprocessor 642 (“processor”) and one or more non-transitory computer-readable media or storage units 644 (“memory”). In some cases, memory 644 may store various program instructions that, when executed, cause processor 642 to perform the various functions and / or calculations described herein. In some cases, one or more memory units in memory unit 644 may be coupled to processor 642, for example. In various aspects, microcontroller 640 may communicate via wired or wireless channels or combinations thereof.

[0099] In some cases, power source 630 may be used, for example, to supply power to microcontroller 640. In some cases, power source 630 may include, for example, a battery (or “battery pack” or “power pack”), such as a lithium-ion battery. In some cases, the battery pack may be configured to be releasably mounted to the handle for supplying power to surgical instrument 600. Multiple battery cells connected in series may be used as power source 630. In some cases, power source 630 may be, for example, replaceable and / or rechargeable.

[0100] In various situations, processor 642 can control the motor driver to control the position, direction of rotation, and / or speed of the motors in components 610 and 620. In some cases, processor 642 can signal the motor driver to stop and / or deactivate the motor. It should be understood that the term "processor" as used herein includes any suitable microprocessor, microcontroller, or other basic computing device that combines the functionality of a computer's central processing unit (CPU) on one or at most a few integrated circuits. Processor 642 is a versatile programmable device that receives digital data as input, processes that 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 processor operates on numbers and symbols represented in a binary number system.

[0101] In one instance, processor 642 can be any single-core or multi-core processor, such as those marketed as ARM Cortex by Texas Instruments. In some cases, microcontroller 620 can be, for example, an LM4F230H5QR available from Texas Instruments. In at least one example, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4F processor chip that includes: 256KB of single-cycle flash memory or other non-volatile memory (up to 40MHz) on-chip memory, a prefetch buffer for improving performance above 40MHz, 32KB of single-cycle SRAM, and a... The software includes an internal ROM, a 2KB EEPROM, one or more PWM modules, one or more QEI emulations, one or more 12-bit ADCs with 12 analog input channels, and other readily available features. Other microcontrollers can be easily substituted for use with the surgical instrument 600. Therefore, this disclosure should not be limited to this context.

[0102] In some cases, memory 644 may include program instructions for controlling each motor in the motors of surgical instrument 600. For example, memory 644 may include program instructions for controlling the closure motor and the joint movement motor. Such program instructions can enable processor 642 to control the closure and joint movement functions based on input from an algorithm or control program from surgical instrument 600.

[0103] In some cases, one or more mechanisms and / or sensors, such as sensor 645, can be used to alert processor 642 to program instructions that should be used in a particular setting. For example, sensor 645 can alert processor 642 to use program instructions associated with closing the end effector and performing joint movements on the end effector. In some cases, sensor 645 may include, for example, a position sensor that can be used to sense the position of the closing actuator. Thus, if processor 642 receives a signal from sensor 630 indicating actuation of the closing actuator, processor 642 can use program instructions associated with closing the end effector to activate the motor of the closing drive assembly 620.

[0104] In some examples, these motors may be brushless DC electric motors, and the corresponding motor drive signals may include PWM signals provided to one or more stator windings of these motors. Furthermore, in some examples, these motor drivers may be omitted, and the control circuit 601 may directly generate the motor drive signals.

[0105] During various laparoscopic surgical procedures, it is common practice to insert the surgical end effector portion of a surgical instrument through a cannula already embedded in the patient's abdominal wall to access the surgical site located inside the patient's abdomen. In its simplest form, the cannula is a pen-shaped instrument with a sharp triangular dot at one end, typically used within a hollow tube called a cannula or sleeve to form an opening into the body through which the surgical end effector can be introduced. This arrangement forms an entrance into the body cavity through which the surgical end effector can be inserted. The cannula's inner diameter necessarily limits the size of the end effector and drive support shaft of the surgical instrument that can be inserted through the cannula.

[0106] Regardless of the specific type of surgical procedure being performed, once a surgical end effector has been inserted into the patient through the cannula, it is generally necessary to move the surgical end effector relative to the shaft assembly located within the cannula in order to properly position the surgical end effector relative to the tissue or organ to be treated. This movement or positioning of the surgical end effector relative to the portion of the shaft retained within the cannula is commonly referred to as the "articular movement" of the surgical end effector. Various articulation joints have been developed to attach the surgical end effector to the associated shaft to facilitate this articulation. As expected, in many surgical procedures, it is desirable to use a surgical end effector with the largest possible range of articulation.

[0107] Due to the dimensional constraints imposed by the size of the cannula, the dimensions of the articulation joint components must be configured to allow free insertion through the cannula. These dimensional constraints also limit the size and composition of various drive elements and components that operatively engage with a motor and / or other control system supported within a housing, which may be handheld or part of a larger automated system. In many cases, these drive elements must operatively pass through the articulation joint to operatively couple to or engage with a surgical end effector. For example, one such drive element is often used to apply articulated motion control actions to a surgical end effector. During use, the articulation drive element can be left unacted to position the surgical end effector in a non-articular position to facilitate cannula insertion, and the articulation drive element can be subsequently actuated to articulate the surgical end effector to the desired position once it is inside the patient.

[0108] Therefore, the aforementioned size limitations pose numerous challenges to developing articulation systems capable of achieving the desired range of motion while still accommodating the various drive systems necessary for manipulating the diverse features of a surgical end effector. Furthermore, once the surgical end effector is in the desired articulation position, the articulation system and articulation joint must be able to hold the surgical end effector in that position during actuation and completion of the surgical procedure. Such articulation joint arrangements must also be able to withstand the external forces experienced by the end effector during use.

[0109] Throughout a particular surgical procedure, various modes of using one or more surgical devices are typically employed. For example, a communication path extending between a surgical device and a centralized surgical hub can improve the efficiency and success rate of the procedure. In various cases, each surgical device within the surgical system includes a display that transmits the presence and / or operational status of other surgical devices within the system. The surgical hub can use the information received through the communication path to assess the compatibility of surgical devices used with each other, evaluate the compatibility of surgical devices used during a particular surgical procedure, and / or optimize the operating parameters of the surgical devices. As described in more detail herein, the operating parameters of the one or more surgical devices can be optimized based on, for example, patient demographics, the specific surgical procedure, and / or detected environmental conditions such as tissue thickness.

[0110] Figures 4 through 9 illustrate the partitioned display system. The partitioned display transmits various generator and / or surgical device parameters between the display 27010 of the handheld surgical instrument 27000 and the main monitor display 27100. Figure 4 depicts an example of the display 27010 of the handheld surgical instrument 27000. In various cases, the display 27010 includes a touch-sensitive graphical user interface capable of receiving user input. The display 27010 includes various settings and / or modes that allow users to customize the information and / or images displayed on the display 27010 at any given time.

[0111] Surgical instrument 27000 communicates with main display monitor 27100. Main display monitor 27100 includes a screen larger than the display 27010 of surgical instrument 27000. In various cases, main display monitor 27100 displays the same information and / or images as the display 27010 of surgical instrument 27000. In other cases, main display monitor 27100 displays different information and / or images than the display 27010 of surgical instrument 27000. In various cases, main display monitor 27100 includes a touch-sensitive graphical user interface capable of receiving user input. Similar to the display 27010 of surgical instrument 27000, main display monitor 27100 includes various settings and / or modes that allow users to customize the information and / or images displayed on main display monitor 27100 at any given time. As described in more detail herein, a selected mode on main display monitor 27100 can change the mode of display 27010 on surgical instrument 27000, and vice versa. In other words, the main display monitor 27100 and the surgical instrument display 27010 work together to transmit selected operating parameters to the user in the most efficient way.

[0112] The depicted handheld surgical instrument 27000 includes combined electrosurgical functionality, wherein the surgical instrument 27000 includes an end effector comprising a first jaw and a second jaw. The first jaw and the second jaw include electrodes disposed thereon. The electrosurgical instrument 27000 includes one or more power generators configured to supply power to the electrodes to power them. More specifically, energy delivery to patient tissue supported between the first jaw and the second jaw is achieved by powering electrodes configured to deliver energy in monopolar, bipolar, and / or combined modes. The combined mode is configured to deliver alternating or mixed bipolar and monopolar energy. In at least one embodiment, the at least one power generator includes a battery, a rechargeable battery, a disposable battery, and / or combinations thereof. The various details concerning the operation of the first and second generators are described in more detail in the following patent application: U.S. Patent Application Serial No. 16 / 562,123, filed September 5, 2019, entitled “METHOD FOR CONSTRUCTING AND USING A MODULAR SURGICAL ENERGYSYSTEM WITH MULTIPLE DEVICES”, which is incorporated herein by reference in its entirety.

[0113] The display 27010 of the surgical instrument 27000 and the main display monitor 27100 include partitioned displays to convey a variety of operating parameters to the user. The partitioned displays are configured to be selectively segmented. In other words, the user can select the operating parameters to be displayed and / or the display location of the selected operating parameters. This customization minimizes distraction by eliminating unwanted and / or unnecessary information, while allowing the user to efficiently observe the information needed and / or desired for controlling the surgical instrument 27000 and / or performing surgery. The display 27010 of the surgical instrument 27000 includes a first section 27012 in which the power level of a specific mode is displayed. The display 27010 of the surgical instrument 27000 also includes a second section 27014 in which the mode in which the surgical instrument 27000 is operating and / or the type of energy being delivered by the surgical instrument 27000 is identified or otherwise conveyed.

[0114] Similarly, the main display monitor 27100 includes a segmented display; however, in various cases, the images displayed on the main display monitor 27100 may overlap each other. The central portion 27110 of the main display monitor 27100 streams real-time feeds and / or still images of the surgical site to the operating room. The real-time feeds and / or images of the surgical site are captured by a suitably positioned camera, such as an endoscope. The menu selection portion 27130 of the main display monitor 27100 prompts and / or otherwise allows the user to select the mode currently in which the main display monitor 27100 is located and / or the information the user wishes to see on the main display monitor 27100. The device status portion 27120 of the main display monitor 27100 transmits information similar to the first portion 27012 of the surgical instrument display 27010. In various cases, the device status portion 27120 is further divided into multiple sections. For example, the first portion 27122 is configured to transmit operating parameters reflecting a bipolar mode. These operating parameters may be specific and / or general. Specific operating parameters may, for example, reflect the power level of the bipolar mode. General operating parameters may, for example, indicate whether the bipolar mode is active or inactive. Part 27124 is configured to transmit operating parameters reflecting the unipolar mode. Such operating parameters may be specific and / or general. Specific operating parameters may, for example, reflect the power level of the unipolar mode. General operating parameters may, for example, indicate whether the unipolar mode is active or inactive. Part 37126 is configured to transmit operating parameters reflecting the smoke extraction system. Such operating parameters may be specific and / or general. Specific operating parameters may, for example, reflect the power level of the smoke extraction system. General operating parameters may, for example, indicate whether the smoke extraction system is active or inactive.

[0115] Referring now to Figures 5 through 9, the display 27010 of the surgical instrument 27000 is shown next to the corresponding display on the main display monitor 27100. As described in more detail herein, when the user changes the power level on the handheld surgical instrument 27000, this change in power level is reflected on the main display monitor 27100. For example, as shown in Figure 5, the generator operating in bipolar mode is currently operating at a power level of 80 watts, as indicated in the device status section 27120 of the main display monitor 27100 and the first section 27012 and the second section 27014 of the surgical instrument display 27010. More specifically, the first section 27012 of the surgical instrument display 27010 indicates the output of the generator, while the second section 27014 of the surgical instrument display 27010 indicates the mode and / or type of energy. Similarly, the device status section 27120 of the main display monitor 27100 indicates that the generator is operating in bipolar energy mode at a power level of 80 watts and in unipolar energy mode at a power level of zero watts. Upon receiving a command to increase the power output of the generator operating in bipolar mode to 100 watts, the surgical instrument display 27010 and the main display monitor 27100 change accordingly, as shown in FIG6. More specifically, the first section 27012 of the surgical instrument display 27010 now indicates a power level of 100 watts, and the device status section 27120 of the main display monitor 27100 now indicates that the generator is operating in bipolar mode at a power level of 100 watts. The main display monitor 27100 continues to indicate that the unipolar energy mode is operating at a power level of zero watts; however, the main display monitor 27100 also indicates that the smoke detection system has been activated to 20% 27126 due to the detection of smoke and / or an increase in the power level of surgical instruments within the surgical site.

[0116] Figures 7 through 9 depict the display 27010 of the surgical instrument 27000 and the corresponding main display monitor 27100 when a combination of bipolar and monopolar energy is delivered to patient tissue. Figure 7 shows a first portion 27012' of the surgical instrument display 27010 in total power mode. As shown on the main display monitor 27100, the bipolar energy mode 27122 is operating at a power level of 60 watts, and the monopolar energy mode 27124 is operating at a power level of 60 watts. However, a combined and / or total power level of 120 watts is represented on the first portion 27012' of the surgical instrument display 27010. The main display monitor 27100 also indicates that the smoke detection system has been activated to 50% 27126 due to the detection of smoke and / or an increase in the power level of the surgical instrument within the surgical site. As shown in Figure 8, the user may want to see the individual power levels of the bipolar and unipolar modes on the first portion 27012” of the surgical instrument display 27010, and the total power level on the device status portion 27122’ of the main display monitor 27100. In other words, the information shown on the display in Figure 8 is the reverse of that shown on the display in Figure 7. The main display monitor 27100 also indicates that the smoke detection system has been activated to 73% 27126 due to the detection of smoke and / or changes in the power levels of the bipolar and / or unipolar modes within the surgical site. The pair of displays shown in Figure 9 are similar in many respects to the pair of displays shown in Figure 8; however, the user has opted to remove the indication of the operating level of the smoke detection system from the main display monitor 27100.

[0117] As discussed in more detail herein, the surgical instrument display 27010 and / or the main display monitor 27100 may include a touch-sensitive graphical user interface. In various cases, the surgical instrument display 27010 is used to control the content displayed on the surgical instrument display 27010, rather than the content displayed on the main display monitor 27100. In other cases, the main display monitor 27100 is used to control the content displayed on the surgical instrument display 27010, rather than the content displayed on the main display monitor 27100. In various cases, each display is configured to control the content displayed on its own display. In various cases, each display within the surgical system is configured to collaboratively control the content displayed on other displays within the surgical system.

[0118] In various cases, the surgical system includes an electrosurgical device and a smoke extraction system. As discussed in more detail herein, the electrosurgical device is configured to deliver energy to patient tissue supported between the jaws of an end effector by energizing electrodes. These electrodes are configured to deliver energy in a monopolar mode, a bipolar mode, and / or a combination of alternating or mixed bipolar and monopolar energies. In various cases, a first generator is configured to control the bipolar energy mode, and a second generator is configured to control the monopolar energy mode. A third generator is configured to control the smoke extraction system. Various details regarding the operation of the first and second generators are described in more detail in the following patent application: U.S. Patent Application Serial No. 16 / 562,123, filed September 5, 2019, entitled “METHOD FOR CONSTRUCTING AND USING A MODULAR SURGICALENERGY SYSTEM WITH MULTIPLE DEVICES,” which is incorporated herein by reference in its entirety.

[0119] Figure 10 is a graphical representation 27200 depicting the proportional relationship between the duty cycle of the smoke extraction system and the total effective energy delivered to the patient tissue. Time 27210 is represented along the x-axis, while power (W) 27220a and the duty cycle (%) of the smoke extraction system 27220b are represented along the y-axis. The total effective energy is represented in three aspects: (1) bipolar therapy 27230; (2) unipolar therapy 27240; and (3) combined energy 27250. The percentage of the smoke extractor duty cycle is represented in two aspects: (1) in response to combined energy 27260; and (2) in response only to bipolar therapy 27270. For example, at time t0, no power is delivered to the patient tissue and the smoke extraction system is inactive. At time t1, bipolar therapy 27230 is delivered at a first power level P1. At time t1, bipolar therapy 27230 is the only energy delivered to the patient tissue. As the power increases to P1 during the time period t0 to t1, the smoke extraction system is activated. At time t1, the first percentage S1 of the smoke extraction duty cycle is utilized.

[0120] At time t2, the power level of bipolar therapy 27230 increases, and monopolar therapy 27240 begins to be delivered. At time t3, bipolar therapy 27230 decreases, while monopolar therapy 27240 increases. Overall, the combined energy 27250 remains essentially the same from t2 to t3. At time t3, the combined energy 27250 is delivered at a third power level P3, which is higher than the first power level P1 delivered at time t1. As the power increases to P3 during the time period t1 to t3, the percentage of the smoke extraction system duty cycle also increases. At time t3, a third percentage S3 of the smoke extraction duty cycle is utilized. The third percentage S3 is greater than the first percentage S1. At time t4, delivery of bipolar therapy 27230 has ceased, and the only energy delivered to the patient tissue is obtained through monopolar therapy 27240. Notably, at time t4, monopolar therapy 27240 delivers energy to the patient tissue at the highest level P4 of monopolar therapy delivered throughout the surgical procedure. Therefore, since the delivered energy P4 at time t4 is greater than the delivered energy P3 at time t3, the percentage of the exhaust duty cycle also increases. At time t4, a fourth percentage S4 of the exhaust duty cycle is utilized. The fourth percentage S4 is greater than the third percentage S3 and the first percentage S1.

[0121] Figure 10 graphically illustrates the delivery of bipolar energy 27230 at different levels at various time points during a surgical procedure. These time points may correspond to a tissue sealing cycle in which the surgical hub commands the fume extraction system to increase or decrease its operating level in response to the current bipolar power level. After the tissue sealing cycle is completed, unipolar energy can be applied for a defined time period to cut the patient tissue. When cutting the patient tissue, the surgical hub may, for example, command the fume extraction system to increase its operating level based on an increase in the energy applied to cut the tissue, since such an increase in applied energy typically corresponds to an increase in smoke generated from burning the tissue. During a particular surgical procedure, the surgical hub is aware of predefined time points for energy delivery and power level changes. These predefined time points may vary, for example, based on the type of specific surgical procedure to be performed. These predefined time points may also vary, for example, based on patient demographic data identified by the surgical hub. Any detected change in the type and / or level of applied energy can trigger responses in different components of the surgical system.

[0122] Similar to the surgical system described relative to Figure 10, the surgical system 27700 depicted in Figure 11 includes an electrosurgical instrument 27710 in communication with a surgical hub. The electrosurgical instrument 27710 is configured to deliver energy to patient tissue supported between the jaws of an end effector via electrodes configured to deliver energy in monopolar, bipolar, and / or combined modes. The electrosurgical instrument 27710 is configured to apply alternating or mixed bipolar and monopolar energy to the patient tissue in combined mode. The surgical system 27700 also includes a first generator 27720 configured to control monopolar energy modes and a second generator 27730 configured to control bipolar energy modes. A display 27750 is located within the operating room and in the user's field of vision. In various cases, the electrosurgical instrument 27710 includes a display located thereon. When the second generator 27730 delivers bipolar energy to the patient tissue, the instrument display and / or display 27750 in the operating room indicates the applied power level. In various situations, the smoke extraction level of the smoke extraction system is indicated on the display, where the smoke extraction level is based on the applied energy level and / or energy type. As discussed in more detail herein, when the first generator 27720 delivers unipolar energy to the patient tissue and / or the second generator 27730 delivers a reduced amount of bipolar energy to the patient tissue, the display is configured to update the displayed or otherwise transmitted operating parameters. As the power level changes during surgical procedures, such changes are transmitted to the surgical hub. In response, the surgical hub is configured to automatically or without external prompting change the smoke extraction level to compensate for changes in the energy level and / or energy type applied to the patient tissue.

[0123] At least one of the instrument display and display screen 27750 includes a touch-sensitive graphical user interface configured to receive user input. The user can select information to be displayed, the display position of the selected information on a particular display, and / or a display within the surgical system to display desired information. In various cases, the surgical system 27700 also includes one or more cameras located in the operating room. These cameras are configured to monitor movement of the user and / or the surgical system apparatus. The cameras can transmit any detected movement to a surgical hub, which identifies that the detected movement corresponds to a predetermined command. For example, a camera can detect when a user swings their arm. A memory within the surgical hub associates the arm swing with a display that the user expects to clear all operating parameters, such that only real-time feeds and / or images of the surgical site remain on the display. Exemplary commands that can be associated with specific user and / or instrument movements include: adjusting the position of the display, adjusting the view of the display, adjusting the information presented on the display, adjusting the position of the displayed information on a particular display, adjusting the size of the displayed information, controlling the power level of a generator, and / or controlling the operating parameters of various surgical instruments of the surgical system.

[0124] As discussed with respect to surgical system 27700, electrosurgical instrument 27710 includes combined electrical modes. The monopolar mode of the electrosurgical instrument is operated by a first generator 27720, while the bipolar mode is operated by a second generator 27730. Monopolar energy is delivered to patient tissue to create an incision or otherwise cut treated tissue. Bipolar energy is delivered to the patient tissue prior to cutting it to seal and / or cauterize the target tissue. Figure 12 shows a graphical representation 27300 of the power levels (watts) of the first and second generators 27320a relative to time (t) 27310. The power levels are represented in two ways: (1) the first generator 27340; and (2) the second generator 27330. Graphical representation 27300 also depicts the relationship between tissue impedance (Ω) 27320b and time (t) 27310. Tissue impedance is represented in two ways: (1) in response to delivered unipolar energy 27345; and (2) in response to delivered bipolar energy 27335.

[0125] As the power level of the second generator 27330 increases from zero, bipolar energy is delivered to the patient tissue. The impedance of the patient tissue increases in response to the application of bipolar energy 27335. Notably, even after the power level of the second generator 27330 begins to decrease, the impedance of the patient tissue continues to increase for a certain period of time. In other words, without the delivery of monopolar energy to cut the patient tissue, the impedance of the tissue sealed by the bipolar energy 27335 will eventually decrease after the power level of the second generator 27330 decreases; however, in such cases, the impedance of the tissue does not necessarily decrease immediately. At time t1, the power level of the first generator 27340 increases, thereby cutting the tissue by delivering monopolar energy to the patient tissue. The impedance of the patient tissue also increases in response to the application of monopolar energy 27345. Notably, as the tissue is cut and the power level of the first generator 27340 decreases, the impedance of the patient tissue increases exponentially.

[0126] Figure 13 illustrates algorithm 27400 for controlling various components of a surgical system. The surgical system includes surgical instruments configured to perform intended surgical functions. In various cases, the surgical instruments are handheld and include a handle. The user is configured to operate the surgical instruments in various modes via input elements on the handle. As described in more detail herein, the surgical instruments include a first generator configured to supply power to a unipolar mode and a second generator configured to supply power to a bipolar mode. The surgical system also includes a smoke extraction system configured to remove smoke and / or other unwanted particles from the surgical site. The surgical instruments and / or the smoke extraction system communicate signalically with a surgical hub, which is configured to coordinate appropriate responses of the components of the surgical system in response to user input on the surgical instruments, the smoke extraction system, and / or another component within the surgical system.

[0127] As shown in Figure 13, control algorithm 27400 begins when the user changes the mode of the surgical instrument 27410. For example, the user may wish to increase the power level of the first generator to cut patient tissue. Alternatively, the user may wish the surgical instrument to seal and / or cut patient tissue. In either case, the surgical instrument then transmits user input 27412, 27414 to the first and second generators, respectively. The surgical instrument also transmits user input 27415 to the surgical hub. After the surgical hub is informed of the desired increase in unipolar energy 27420, it is configured to command the second generator 27425 to supply and / or apply a suitable power level. Upon receiving communication 27412 from the surgical instrument, the first generator increases waveform 27440 to prepare for cutting patient tissue. Upon receiving communication 27414 from the surgical instrument and command 27425 from the surgical hub, the second generator increases the power level 27450 associated with the bipolar mode to prepare for sealing patient tissue after cutting. The second generator can then transmit its ready status (27455) to the first generator. The first generator can then begin cutting the patient tissue (27442). In other words, the surgical hub prevents the monopolar electrode from being powered until the bipolar electrode has been powered to prevent cutting tissue that has not yet been cauterized and / or sealed. The surgical hub is further configured to command the smoke extraction system (27426) to increase its motor rate in response to an increase in the power levels of the first and second generators. After the smoke extraction system increases its motor rate (27430), it is configured to maintain communication with the surgical hub, surgical instruments, and / or the first and second generators throughout the entire duration of the surgical procedure. For example, the smoke extraction system is configured to continuously transmit the current motor rate (27435) to the surgical hub. In such cases, the smoke extraction system transmits its current motor rate to the surgical hub every minute or every two minutes; however, the smoke extraction system can transmit its current motor rate at any suitable frequency. Once the surgical instrument has completed the desired tissue cut, the user can again provide input on the instrument handle to reduce the power level of the first generator and / or terminate the control algorithm 27400. In various cases, the control algorithm 27400 is configured to automatically reduce the power level of the first generator after a predetermined time period corresponding to the completion of the tissue cut. Using the control algorithm 27400, the surgical hub can, for example, coordinate the operating parameters of the components of the surgical system to facilitate efficient and / or effective surgical procedures.

[0128] Many surgical devices, tools, and / or replaceable parts are typically used during a particular surgical procedure. This document discloses various systems designed, among others, to streamline devices and / or parts stored in the operating room for use during a particular procedure, minimizing operator error, and / or minimizing delays during surgery. The systems described herein, among others, utilize artificial intelligence and machine learning developed during one or more surgical procedures to increase the efficiency of the procedure.

[0129] Figure 14 illustrates various components of an exemplary surgical system 27500. During a particular surgical procedure, the patient lies on an operating table or any suitable surgical surface 27510. In various cases, a surgical robot is used at least in part to perform the specific procedure. The surgical robot includes one or more robotic arms 27520. Each robotic arm 27520 is configured to receive tool components 27590. The tool components 27590 are configured to cooperate with each other to perform and / or assist a clinician in performing a specific surgical procedure. Tool components may include, for example, surgical suturing and / or tissue cutting tool components, tissue grasping tool components, and / or electrosurgical tool components. Tool components may include other distinguishing features such as, for example, size, manufacturer, manufacturing date, number of previous uses, and / or expiration date.

[0130] Surgical system 27500 also includes a surgical hub 27530. Various surgical hubs are described in U.S. Patent Application Serial No. 16 / 209,395, filed December 4, 2018, entitled “METHOD OF HUB COMMUNICATION,” which is incorporated herein by reference in its entirety. Surgical hub 27530 includes a memory 27535 that stores combinations of various suitable or otherwise appropriate tool components 27590 to be used during a particular surgical procedure. In other words, the memory 27535 of surgical hub 27530 includes a stored database that can be used to indicate which tool components 27590 are suitable for use during a selected surgical procedure.

[0131] Prior to performing the desired surgical procedure, the clinician may inform or otherwise transmit details related to the desired surgical procedure and / or the patient to the surgical hub 27530. Such details may include, for example, an identifier of the surgical procedure, an identifier of the clinician performing the procedure, and / or a biometric profile of the patient. The surgical hub 27530 is then configured to use one or more of the transmitted details to evaluate and / or determine which tool components 27950 are necessary and / or suitable for performing the desired surgical procedure. In various cases, the surgical hub 27530 is configured to evaluate which modes of each tool component 27950 are suitable for performing the desired surgical procedure on a particular patient.

[0132] As shown in Figure 14, four robotic arms 27250 are attached to the operating table 27510 around or otherwise. Three tool components 27590 are connected to three corresponding robotic arms 27250, allowing one robotic arm to freely receive additional tool components. Multiple unique tool components 27560, 27570, and 27580 are shown stored on a mobile support 27550 within the operating room. As mentioned above, the type and / or function of tool components 27560, 27570, and 27580 can be different. In such cases, the surgical hub 27530 evaluates the available tool components 27560, 27570, and 27580 and identifies suitable tool components for attachment to the surgical robot. For example, suitable tool components are identified based on one or more factors, such as what type and / or function the surgical robot still requires and / or which tool component completes a predetermined tool component pairing, for example, associated with the desired surgical procedure. In various cases, such as surgical robots, a memory is included that stores pre-determined tool-part pairings based on specific surgical procedures and / or specific patient demographics. In such cases, the surgical robot is able to identify suitable tool parts for attachment to the surgical robot based on the identifiers of already attached tool parts.

[0133] In other cases, tool parts 27560, 27570, and 27580 include the same type and / or function; however, tool parts 27560, 27570, and 27580 include at least one other distinguishing feature, such as differences in size, manufacturer, expiration date, and / or number of previous uses. Surgical hub 27530 evaluates the profile of each available tool part 27560, 27570, and 27580 and identifies suitable tool parts based on which features are compatible with the profiles of other selected and / or attached tool parts 27590.

[0134] As shown in Figure 14, each tool component 27560, 27570, 27580 includes a QR code 27565, 27575, 27585 located at any suitable position thereon, wherein each QR code contains an informational profile indicating the tool component to which the QR code is associated. A user uses any suitable scanning tool 27540 to scan and / or read the QR codes 27565, 27575, 27585. The scanning tool 27540 then transmits the QR code and / or the information contained within the QR code to the surgical hub 27530. When the QR code itself is transmitted by the scanning tool 27540 to the surgical hub 27530, the processor of the surgical hub 27530 is configured to decrypt the informational profile contained in the received QR code. While the depicted embodiment includes QR codes, the tool components may include, for example, any suitable memory device, such as a barcode, RFID tag, and / or memory chip.

[0135] The surgical hub 27530 is configured to alert the user during surgical procedures when a tool component is unacceptable and / or undesirable for use. This alert can be delivered through various forms of feedback, including, for example, tactile feedback, auditory feedback, and / or visual feedback. In at least one instance, the feedback includes audio feedback, and the surgical system 27500 may include a speaker that emits a sound, such as a beep, when an error is detected. In some cases, the feedback includes visual feedback, and the tool component may include a light-emitting diode (LED), for example, which flashes when an error is detected. In some cases, visual feedback can be delivered to the user through an alert presented on a display monitor within the clinician's field of vision. In various instances, the feedback includes tactile feedback, and components of the surgical system 27500 may include an electric motor that includes an eccentric element that vibrates when an error is detected. The alert can be specific or general. For example, the alert may specifically indicate that a QR code on the tool component cannot be detected, or the alert may specifically indicate that the QR code includes information indicating an incompatible and / or defective tool component.

[0136] For example, a user attempts to attach a first tool component 27560 to an available robotic arm 27590 of a surgical robot. Before attaching the first tool component 27560 to the robotic arm 27590, a scanning tool 27540 scans a QR code 27565 displayed on the first tool component 27560. The scanning tool 27540 transmits the QR code 27565 and / or the information contained within the QR code 27565 to a surgical hub 27530. The surgical hub 27530 compares the information contained in the QR code 27565 with a stored list of acceptable tool components associated with a specific surgical procedure and / or a stored list of acceptable tool components compatible with the tool component currently attached to the surgical robot. In this case, the surgical hub 27530 cannot identify and / or locate the first tool component 27560 within its memory 27535. Therefore, the use of the first tool component 27560 with the surgical robot is not recommended and / or the first tool component is not suitable for use with the surgical robot. As discussed above, the surgical hub 27530 is configured to alert the clinician that the first tool component 27560 is incompatible with the surgical robot and / or a specific surgical procedure. In various situations, such as surgical system 27500, the first tool component 27560 can be prevented from being attached to the surgical system via mechanical and / or electrical locking. This attachment locking prevents the clinician from missing and / or simply ignoring alerts issued by surgical system 27500. In other words, the attachment locking requires the clinician to take affirmative steps to override errors transmitted by surgical system 27500. In such cases, overriding can be activated to allow the clinician to override any system locking and utilize the operational functions of the first tool component 27560. In various situations, when the first tool component 27560 is identified as incompatible with the surgical robot and cannot be used with it, overriding is unavailable to prevent the clinician from utilizing the functions of the first tool component 27560.

[0137] Similarly, the user attempts to attach the second tool component 27570 to the available robotic arm 27590 of the surgical robot. Before attaching the second tool component 27570 to the robotic arm 27590, a scanning tool 27540 scans the QR code 27575 displayed on the second tool component 27570. The scanning tool 27540 transmits the QR code 27575 and / or the information contained within the QR code 27575 to the surgical hub 27530. The surgical hub 27530 compares the information contained in the QR code 27575 with a stored list of acceptable tool components associated with a specific surgical procedure and / or a stored list of acceptable tool components compatible with the tool component currently attached to the surgical robot. In this case, the surgical hub 27530 is unable to identify and / or locate the second tool component 27570 within its memory 27535. Therefore, the use of the second tool component 27570 with the surgical robot is not recommended and / or the second tool component is not suitable for use with the surgical robot. As discussed above, the surgical hub 27530 is configured to alert the clinician that the second tool component 27570 is incompatible with the surgical robot and / or a specific surgical procedure. In various situations, the surgical system 27500 can prevent the second tool component 27570 from attaching to the surgical system. This attachment lock prevents the clinician from missing and / or simply ignoring alerts issued by the surgical system 27500. In other words, the attachment lock requires the clinician to take affirmative steps to override errors transmitted by the surgical system 27500. In such cases, overriding can be activated to allow the clinician to override any system lock and utilize the operational functions of the second tool component 27570. In various situations, when the second tool component 27570 is identified as incompatible with the surgical robot and cannot be used with it, overriding is unavailable to prevent the clinician from utilizing the functions of the second tool component 27570.

[0138] The user attempts to attach a third tool component 27580 to an available robotic arm 27590 of the surgical robot. Before attaching the third tool component 27580 to the robotic arm 27590, a scanning tool 27540 scans a QR code 27585 displayed on the third tool component 27580. The scanning tool 27540 transmits the QR code 27585 and / or the information contained within the QR code 27585 to a surgical hub 27530. The surgical hub 27530 compares the information contained in the QR code 27585 with a stored list of acceptable tool components associated with a specific surgical procedure and / or a stored list of acceptable tool components compatible with the tool component currently attached to the surgical robot. In this case, the surgical hub 27530 successfully identifies and / or locates the third tool component 27580 in its memory 27535. The third tool component 27580 is then determined to be suitable for use with the surgical robot and / or with other attached tool components during a specific surgical procedure. In various scenarios, the surgical hub 27530 is configured to alert clinicians that the third tool component 27580 is compatible with the surgical robot. In other scenarios, the surgical system 27500 simply does not prevent the third tool component 27580 from being attached to the available robotic arm 27590.

[0139] In various scenarios, the memory 27535 of the surgical hub 27530 is configured to store QR codes associated with each tool component used during a specific surgical procedure. The surgical hub 27530 can then analyze the collected information to form observations and / or conclusions regarding factors such as, for example, the efficiency and / or effectiveness of a particular tool component and / or multiple tool components during the surgical procedure. The surgical hub 27530 can then use these observations and / or conclusions to select and / or recommend which tool components to use during future surgical procedures.

[0140] Figure 15 depicts a surgical system 27600 including one or more cameras configured to assist clinicians in performing efficient and / or successful surgical procedures. Similar to surgical system 27500, surgical system 27600 includes an operating table 27610 or any suitable surgical surface. Surgical system 27600 also includes a surgical hub 27650 and a device tower 27660. Various surgical hubs are described in U.S. Patent Application Serial No. 16 / 209,395, filed December 4, 2018, entitled “METHOD OF HUBCOMMUNICATION,” which is incorporated herein by reference in its entirety.

[0141] The surgical system 27600 also includes a camera system comprising one or more cameras 27640 located at various locations throughout the operating room. In the depicted embodiment, two cameras 27640 are located in opposite corners of the operating room; however, the cameras 27640 can be positioned and / or oriented to allow the cameras 27640 to collaboratively capture the operating room in an unobstructed manner at any suitable location. Artificial intelligence protocols detect and / or identify various devices, equipment, and / or personnel within the operating room and their corresponding locations and / or orientations.

[0142] Camera 27640 of the camera system communicates with surgical hub 27650. In other words, real-time feeds from camera 27640 can be transmitted to surgical hub 27650 for processing and analysis. Through analysis of the material collected by camera 27640, surgical hub 27650 is able to maintain a real-time inventory of devices, equipment, and / or personnel in the operating room, and / or monitor and / or control interactions between detected devices, equipment, and / or personnel. Using the images and / or data collected by the camera system, surgical hub 27650 is configured to: be informed of the identification of detected devices, alert clinicians about compatibility issues with detected devices, and / or control various components of surgical system 27600 based on the presence and / or operation of detected devices. Surgical hub 27650 is configured to: compare any detected devices to determine compatibility between devices during a particular surgical procedure, facilitate collaboration between two devices that tend to work together, and / or facilitate collaboration between two devices based on their sensing and / or control operations.

[0143] As shown in Figure 15, anesthesia cart 27670 and preparation table 27620 are located in the operating room. Preparation table 27620 is configured to support various surgical instruments and / or devices in a manner that makes them easily accessible for use during surgery. For example, such surgical instruments and / or devices may include replaceable staple cartridges or shaft assemblies of different sizes, which include end effectors of different sizes and / or functions. In the depicted embodiment, preparation table 27620 supports first device 27630a, second device 27630b, and third device 27630c.

[0144] Camera 27640 is configured to detect identification information about devices, equipment, and / or personnel located in the operating room. For example, camera 27640 may capture serial numbers printed on a visible portion of each device 27630a, 27630b, 27630c (such as on the device's packaging). In various cases, the packaging includes a QR code printed thereon containing information about the device contained within the packaging. The QR code is captured by camera 27640 and transmitted to surgical hub 27650 for analysis and identification of the staple cartridge.

[0145] This identification system can function, for example, during surgical procedures where the surgical suture instrument includes an end effector, with a 60mm staple cartridge configured to be housed within the end effector. For instance, a camera 27640 in the operating room is configured to capture the presence of the surgical suture instrument in the form of real-time video feeds and / or still images. The camera 27640 then transmits the captured images to a surgical hub 27650. The surgical hub 27650 is configured to identify the surgical suture instrument based on the images received from the camera 27640. If the surgical hub 27650 knows the surgical procedure to be performed, it can alert the clinician whether the identified surgical suture instrument is suitable. For example, knowing that a 45mm staple cartridge is associated with a specific surgical procedure, the surgical hub 27650 can alert the clinician that the detected surgical suture instrument is unsuitable because its end effector is configured to receive a 60mm staple cartridge.

[0146] The surgical hub 27650 includes a memory 27655 therein storing technical requirements and / or specifications associated with various devices. For example, the memory 27655 of the surgical hub 27650 identifies that the aforementioned surgical suture instrument is configured to receive a 60mm staple cartridge. In various cases, the memory 27655 may also identify a specific brand of 60mm staple cartridges compatible with the surgical suture instrument. In various cases, for example, a camera 27640 may capture the presence of a replaceable staple cartridge in the form of real-time video feed and / or still images. The camera 27640 then transmits the captured images to the surgical hub 27650. The surgical hub 27650 is configured to identify characteristics of the replaceable staple cartridge based on the images received from the camera 27640. Such characteristics include, for example, size, brand, and / or manufacturing batch. As discussed in more detail herein, warnings may be specific or general. When camera 27640 captures the presence of packaging containing a replaceable 45mm staple cartridge, surgical hub 27650 is configured to alert clinicians that an incompatible staple cartridge has been mistakenly stored in the room. This alert, for example, can prevent surgical instrument malfunction, patient injury, and / or wasted time during surgical procedures.

[0147] As discussed above, the camera system is configured to facilitate coordination of devices detected within the operating room by the surgical hub 27650. In various situations, the camera system detects the combined energy device and the smoke extraction system. The combined energy device is configured to apply bipolar and monopolar energy to patient tissue. For example, when the camera system and / or the surgical hub 27650 detects activation of the combined energy device, the presence of the combined energy device in a location near the patient, and / or the presence of smoke in the operating room, the surgical hub 27650 is configured to direct the generator to activate the smoke extraction system.

[0148] Surgical instruments can utilize measurable or otherwise detectable features of end effectors to confirm specific stages of surgical procedures and / or control various operational parameters of the surgical instruments. Such features may include, for example, the distance between the jaws of the end effector. The memory of the surgical instruments and / or surgical hubs includes stored information that associates a specific jaw gap distance with a specific stage of surgical procedure. For example, when the distance between the jaws is measured to be between 0.030 inches and 0.500 inches, the surgical instruments and / or surgical hubs confirm that the end effector is delivering bipolar energy to the patient tissue. In other cases, when the distance between the jaws is measured to be between 0.030 inches and 0.500 inches, the surgical instruments and / or surgical hubs activate a generator, thereby initiating the delivery of bipolar energy to the patient tissue. In other words, the detection of the characteristics of the surgical instruments and / or the patient tissue they contact can be used by the surgical instruments and / or surgical hubs to confirm and / or adjust the operation of the surgical instruments.

[0149] Figure 16 includes a diagram depicting various operating parameters and / or specifications of surgical instruments corresponding to different stages of a surgical procedure. Similar to the surgical instruments described in more detail herein, the surgical instrument 27000 depicted in Figures 17 through 19 includes combined electrosurgical functions, wherein the surgical instrument includes an end effector comprising a first jaw 27810 and a second jaw 27820. At least one of the first jaw 27810 and the second jaw 27820 is movable relative to each other, and the end effector is configurable between an open configuration and a closed configuration. The first jaw 27810 includes a first tissue support and / or tissue contact surface 27815, and the second jaw 27820 includes a second tissue support and / or tissue contact surface 27825. The first jaw 27810 and the second jaw 27820 include electrodes disposed thereon. The electrosurgical instrument 27000 includes one or more power generators configured to supply power to the electrodes to energize them. More specifically, energy delivery to patient tissue supported between a first and a second clamp is achieved through electrodes configured to deliver energy in unipolar, bipolar, and / or combined modes. Alternating or mixed bipolar and unipolar energy is configured to be delivered in combined mode. In at least one embodiment, the at least one power generator includes a battery, a rechargeable battery, a disposable battery, and / or combinations thereof.

[0150] The end effector 27800 is used to perform various end effector functions during surgical procedures. At the initial time t0, the end effector 27800 does not contact the patient tissue T. t0 Contact. Therefore, the electrodes of the end effector 27800 do not deliver any energy. At the initial time t0, the patient tissue T t0 The end effector 27800 is shown in an open configuration, in a relaxed, uncompressed state. In the open configuration, the distance d0 between the first tissue support surface 27815 and the second tissue support surface 27825 spans any distance from 0.500 inches to 0.700 inches. In other words, when the end effector 27800 is in the open configuration, the tissue support surfaces 27815 and 27825 are separated from each other by a maximum distance d0 of 0.500 inches to 0.700 inches.

[0151] At the first time t1, the jaws 27810 and 27820 of the end effector 27800 begin to engage with the patient tissue T. t1 Contact. When the end effector 27800 moves from the open configuration to the closed configuration, the patient tissue T... t1 At least a portion of it is located between the jaws 27810 and 27820 of the end effector 27800. As the jaws 27810 and 27820 move toward the closed configuration, the tissue T is compressed between these two jaws.t1 At time t1, the end effector 27800 is configured to deliver a pulse to the patient tissue T. t1 Bipolar energy is delivered. For example, the application of bipolar energy allows the end effector 27800 to feather through parenchymal cells. At time T1, the end effector 27800 is in a partially closed configuration. At time t1, a first distance d1 between the first tissue support surface 27815 and the second tissue support surface 27825 spans any distance between 0.030 inches and 0.500 inches. In other words, when the end effector delivers bipolar energy to the patient tissue at time t1... t1 When delivering bipolar energy, the tissue support surfaces 27815 and 27825 are separated by a maximum first distance d1 of 0.030 inches to 0.500 inches. Figure 17 shows the jaws 27810 and 27820 of the end effector 27800 extending into the patient tissue T at the first time t1. t1 A detailed description of the delivery of bipolar energy.

[0152] At the second time t2, the jaws 27810 and 27820 of the end effector 27800 remain in contact with the patient tissue T. t2 Contact. Patient tissue T t2 At least a portion of it is located between the jaws 27810 and 27820 of the end effector 27800. At time t2, the end effector 27800 is configured to deliver a force to the patient tissue T. t2 Delivering a combination of bipolar and monopolar energy. The application of bipolar and monopolar energy allows the end effector 27800 to deliver T-cell energy to the patient tissue. t2 Heating occurs. At time t2, the end effector 27800 is in a partially closed configuration; however, compared to the end effector 27800 at time t1, the distal end effector 27800 at time t2 is closer to a fully closed configuration. More specifically, at time t2, the second distance d2 between the first tissue support surface 27815 and the second tissue support surface 27825 spans any distance between 0.010 inches and 0.030 inches. In other words, when the end effector propels the patient tissue T at time t2... t2 When delivering bipolar and monopolar energy, the tissue support surfaces 27815 and 27825 are separated by a maximum second distance d2 of 0.010 inches to 0.030 inches. Figure 18 shows the jaws 27810 and 27820 of the end effector 27800 extending towards the patient tissue T at the second time t2. t2 Detailed description of the delivery of bipolar and unipolar energy.

[0153] At the third time t3, the jaws 27810 and 27820 of the end effector 27800 remain in contact with the patient tissue T. t3 Contact. Patient tissue T t3At least a portion of it is located between the jaws 27810 and 27820 of the end effector 27800. At time t3, the end effector 27800 is configured to continue pushing the material into the patient tissue T. t3 Delivery of a combination of bipolar and monopolar energy. Continued application of bipolar and monopolar energy allows the end effector 27800 to seal the patient tissue T. t3 At time t3, the end effector 27800 is in a partially closed and / or fully closed configuration. In other words, compared to the end effector 27800 at time t2, the distal end effector 27800 at time t3 is in a fully closed configuration and / or closer to a fully closed configuration. More specifically, at time t3, the third distance d3 between the first tissue support surface 27815 and the second tissue support surface 27825 spans any distance between 0.003 inches and 0.010 inches. In other words, when the end effector is at time t3, it is moving towards the patient tissue T... t3 When delivering bipolar and monopolar energy, the tissue support surfaces 27815 and 27825 are separated by a maximum third distance d3 of 0.003 inches to 0.100 inches. Figure 18 also shows a detailed depiction of the delivery of bipolar and monopolar energy to the patient tissue by the jaws 27810 and 27820 of the end effector 27800 at the third time t3.

[0154] At the fourth time t4, the jaws 27810 and 27820 of the end effector 27800 remain in contact with the patient tissue T. t4 Contact. Patient tissue T t4 At least a portion of it is located between the jaws 27810 and 27820 of the end effector 27800. At time t4, the end effector 27800 is configured to deliver a force to the patient tissue T. t4 Delivery of monopolar energy. The application of monopolar energy allows the end effector 27800 to cut the patient tissue T. t4 At time t4, the end effector 27800 is in a partially closed and / or fully closed configuration. In other words, compared to the end effector 27800 at time t2, the distal end effector 27800 at time t4 is in a fully closed configuration and / or closer to a fully closed configuration. More specifically, at time t4, the fourth distance d4 between the first tissue support surface 27815 and the second tissue support surface 27825 spans any distance between 0.003 inches and 0.010 inches. In other words, when the end effector is at time t4, it is moving towards the patient tissue T... t4 When delivering monopolar energy, the tissue support surfaces 27815 and 27825 are separated by a maximum fourth distance d4 of 0.003 inches to 0.010 inches. Figure 19 shows the jaws 27810 and 27820 of the end effector 27800 at the fourth time t4 towards the patient tissue T. t4A detailed description of the delivery of unipolar energy.

[0155] Figure 20, plot 27900, illustrates the relationship between various operating parameters and / or specifications of the surgical instruments of Figures 16 to 19 and time. The surgical instruments and / or surgical hubs can utilize the depicted relationships to confirm the correct functioning of the surgical instruments during surgical procedures and / or to operate and / or adjust various functions of the surgical instruments in response to one or more measured parameters. The graph shows: (1) the power (W) 27920a of the generator controlling the surgical instrument in the bipolar mode as a function of time 27910 27930; (2) the power (W) 27920a of the generator controlling the surgical instrument in the unipolar mode as a function of time 27910 27935; (3) the distance between the jaws of the end effector 27920b as a function of time 27910 27940; (4) the force (F) 27920c of the jaw motor as a function of time 27910 27950; and (5) the speed (V) 27920d of the jaw motor as a function of time 27910 27960.

[0156] At time t0, the electrodes of the end effector are not delivering energy to the patient tissue, and the end effector is not yet in contact with the patient tissue. Since the end effector is in the open configuration, the distance 27920b between the jaws of the end effector is maximum at time t0. The clamping force 27950 of the jaws is minimum from time t0 to time t1 because the end effector experiences almost no resistance from the patient tissue as it moves from the open configuration to the closed configuration. From time t1 to time t2, the jaws of the end effector continue to approach the patient tissue, during which time the end effector begins to deliver bipolar energy 27930. The distance between the jaws of the end effector is shorter at time t1 than at time t0. From time t1 to time t2, the jaw motor speed 27960 begins to decrease as the clamping force of the end effector jaws 27950 begins to increase.

[0157] As illustrated relative to Figures 16 through 29, a combination of monopolar energy 27935 and bipolar energy 27930 is delivered to the patient tissue from time t2 to time t3. During this time period, the jaws of the end effector continue to approach the patient tissue. The distance between the jaws of the end effector is shorter at time t2 than at time t1. The specific distance between the jaws of the end effector at time t2 indicates to the surgical instrument and / or surgical hub that the tissue warming phase of the surgery has been reached and that a combination of monopolar and bipolar energy should and / or is being delivered to the patient tissue. From time t2 to time t3, the jaw motor speed continues to decrease and is less than the jaw motor speed at t1. The force required to clamp the jaws increases abruptly between time t2 and time t3, thereby confirming to the surgical instrument and / or surgical hub that a combination of monopolar and bipolar energy is being delivered to the patient tissue.

[0158] Monopolar and bipolar energy continued to be delivered to the patient tissue, and the patient tissue was sealed from time t3 to time t4. As the end effector reached its fully closed configuration at time t3, the clamping force also reached its maximum; however, the clamping force remained stable between time t3 and time t4. The power level of the generator delivering monopolar energy increased between time t3 and time t4, while the power level of the generator delivering bipolar energy decreased between time t3 and time t4. Finally, between time t4 and time t5, monopolar energy was the only energy delivered for cutting the patient tissue. The force of the clamping jaws of the end effector can vary when cutting the patient tissue. Efficient and / or effective tissue cutting is identified by surgical instruments and / or surgical hubs when the clamping force decreases by 27952 from its steady-state level maintained between time t3 and time t4. When the force of the clamping jaws increases by 27954 from its steady-state level maintained between time t3 and time t4, inefficient and / or ineffective tissue cutting is identified by surgical instruments and / or surgical hubs. In such cases, an error may be transmitted to the user.

[0159] In various situations, the clamping operation of the end effector jaws can be adjusted based on detected characteristics of the contacting patient tissue. These detected characteristics include tissue thickness and / or tissue type. For example, the operation can be adjusted based on the detected patient tissue thickness, such as the range of the gap distance between the jaws during the jaw closure stroke, the load threshold, the jaw closure rate, the current limit applied during the jaw closure stroke, and / or the waiting time between the jaw closure stroke and energy delivery. In various situations, the detected characteristics of the contacting patient tissue can be used to adjust tissue weld parameters. More specifically, for example, the detected characteristics can be used to adjust impedance sensing multi-frequency scanning, energy mode balancing and / or sequencing, energy delivery level, impedance shut-off level, and / or the waiting time between two energy level adjustments.

[0160] As discussed in more detail above, surgical instruments and / or surgical hubs can utilize measured tissue characteristics to control and / or adjust the operating parameters of the surgical instruments. For example, tissue impedance can be detected when patient tissue is located between the jaws of an end effector. The detection of tissue impedance alerts the surgical instruments and / or surgical hub to the end effector jaws being in contact with and / or near the patient tissue. Referring now to Figure 21, graph 28000 shows the tissue impedance 28020 calculated over time 28010. When the jaws of the end effector are not in contact with the patient tissue, the tissue impedance 28030a is infinite. When the jaws of the end effector clamp around the patient tissue located between them, the patient tissue is in contact with both jaws. In such cases, the tissue impedance 28030b is measurable. The ability to measure tissue impedance indicates to the surgical instruments and / or surgical hub that the patient tissue is properly positioned between the jaws of the end effector. For example, surgical instruments and / or surgical hubs can then initiate operations such as applying bipolar and / or monopolar energy to patient tissue.

[0161] In various situations, surgical instruments and / or surgical hubs can utilize the detected magnitude of tissue impedance to determine the stage of a surgical procedure. For example, as shown in Figure 21, after initial contact between the jaws of the end effector and the patient tissue, tissue impedance 28030b is measured to be at a first level. The surgical instrument can then begin delivering bipolar energy to the patient tissue. As the detected tissue impedance 28030b increases to and / or exceeds a first predetermined level, the surgical instrument begins delivering a combination of bipolar and monopolar energy to the patient tissue to warm and / or form a seal. As the detected tissue impedance 28030b continues to increase, reaching and / or exceeding a second predetermined level, the surgical instrument stops delivering bipolar energy while continuing to deliver monopolar energy to cut the patient tissue. Finally, when the patient tissue is no longer located between the jaws of the end effector after the cutting is complete, the tissue impedance reaches infinity. In such cases, the surgical instrument and / or surgical hub can stop delivering monopolar energy.

[0162] In various situations, strain can be a measure used to regulate the operating parameters of surgical instruments such as clamping mechanisms. However, for accurate estimation of compressive strain, contact between the jaws of the end effector and the patient tissue is desirable. As discussed in more detail with reference to Figure 21, surgical instruments and / or surgical hubs can determine the presence of contact between the jaws of the end effector and the patient tissue by detecting tissue impedance. Figure 22 shows an end effector 28100 including a first jaw 28110 and a second jaw 28120, wherein the end effector is in an open configuration. In the open configuration, a gap is defined between the first jaw 28110 and the second jaw 28120. The jaws 28110 and 28120 of the end effector 28100 are configured to receive patient tissue therebetween. At an initial time t0, the patient tissue T A,0 Located between the first jaw 28110 and the second jaw 28120. It is noteworthy that the patient tissue T... A,0 It contacts the first jaw 28110 and the second jaw 28120. In other words, the patient tissue T... A,0 The thickness is greater than or equal to the gap. When at least one of the first jaws 28110 and the second jaws 28120 moves toward each other, the patient tissue is compressed and a gap is defined between the first jaws 28110 and the second jaws 28120. Decrease. Patient tissue T A,1 It is shown as being compressed between the first jaw 28110 and the second jaw 28120 at time t1. The compressive strain can be calculated using the equation shown in Figure 22. Because the patient tissue T A,0 At time t0, the jaws 28110 and 28120 of the end effector 28100 come into contact, so the applied strain is accurately calculated.

[0163] Figure 23 shows the end effector 28100 of Figure 22 in an open configuration. In the open configuration, a gap is defined between the first jaw 28110 and the second jaw 28120. The jaws 28110 and 28120 of the end effector 28100 are configured to receive patient tissue therebetween. At an initial time t0, the patient tissue T B,0 Located between the first jaw 28110 and the second jaw 28120. However, unlike patient tissue T... A,0 Patient tissue T B,0 It does not contact either the first jaw 28110 or the second jaw 28120. In other words, the patient tissue T... B,0 The thickness is less than or equal to the gap. When at least one of the first jaws 28110 and the second jaws 28120 moves toward each other, the gap defined between the first jaws 28110 and the second jaws 28120 decreases. Patient tissue T B,1 It is shown as being compressed and / or in contact with the first and second jaws between time t1 and the first jaw 28110 and the second jaw 28120. The compressive strain can be calculated using the equation shown in Figure 23; however, the calculated compressive strain will be overestimated because the patient tissue T... B,0 At time t0, the jaws 28110 and 28120 of the end effector 28100 are not in contact.

[0164] As described above, calculating compressive strain using the gap defined between the first and second jaws of the end effector when it is in the open configuration yields accurate results only if the patient tissue is in contact with both jaws of the end effector at the initial time t0. Therefore, using the standard gap defined between the first and second jaws of the end effector when it is in the open configuration is undesirable. Instead, when calculating compressive strain, the gap defined between the first and second jaws of the end effector when the patient tissue initially contacts both jaws should be used. In Figure 24, the end effector is shown in the open configuration 28150. It is noteworthy that the patient tissue is not in contact with either of the end effector jaws 28110 or 28120. Therefore, the dimensions and / or specifications of the end effector in this configuration 28150 should not be used to calculate compressive strain. As at least one of the first jaws 28110 and the second jaws 28120 continues to move toward each other, a gap is defined between the first jaws 28110 and the second jaws 28120. At the initial time t0, the patient tissue T C,0 Located between the first jaw 28110 and the second jaw 28120. It is noteworthy that the patient tissue T... C,0 It contacts the first jaw 28110 and the second jaw 28120. In other words, the patient tissue T... C,0 The thickness is greater than or equal to the gap. As at least one of the first jaws 28110 and the second jaws 28120 continues to move toward each other, the patient tissue is compressed and a gap is defined between the first jaws 28110 and the second jaws 28120. Decrease. Patient tissue T C,1 It is shown as being compressed between time t1 and the first jaw 28110 and the second jaw 28120. The compressive strain can be calculated using the equation shown in Figure 24. When the patient tissue T C,0At time t0, the jaws 28110 and 28120 of the end effector 28100 come into contact, and the gap defined between the first jaw 28110 and the second jaw 28120 is at the point of initial tissue contact. When implemented, the applied strain is calculated accurately.

[0165] The motor control program for a combined electrosurgical instrument can utilize detected tissue stability as input. The surgical instrument can determine tissue stability by detecting the compression rate and / or measuring the creep of patient tissue compressed between the end effector jaws. The control program can be modified to adjust the waiting time between end effector functions, define when additional tissue stability determinations are performed, and / or adjust the jaw clamping rate based on the determined tissue stability.

[0166] As shown in Figure 25, the end effector 28250 includes a first jaw 28254 and a second jaw 28256, wherein at least one of the first jaw 28254 and the second jaw 28256 is configured to move toward each other, and the patient tissue T is configured to be positioned between the first jaw and the second jaw. Figure 25 provides a schematic diagram of various positions of the first jaw 28254 and the second jaw 28256 relative to the patient tissue T during the jaw clamping stroke. The gap 28220a defined between the jaws of the end effector and the motor current 28220b required to clamp the jaws of the end effector vary with time 28210, at least in part, due to tissue stability measurements. The initial slope S0 corresponds to the change in the jaw gap 28230 from the time when the jaws are fully open to the time point when there is initial contact between the jaws and the patient tissue T. The resulting motor current 28240 remains low in the absence of tissue contact until the end effector jaws contact the patient tissue T. The surgical system is configured to monitor the current 28220b over time 28210 to identify when the current slope flattens, i.e., when the tissue stabilizes. When the current slope flattens, the surgical system is configured to acquire the difference between the peak current at the time of initial contact between the end effector and the tissue and the time when the current flattens. In other words, when the waiting time expires, the jaws can continue to clamp the tissue located therein, where the waiting time is defined by the time it takes for tissue compression to stabilize. Creep in the motor current drives the next stage of motor current and speed to achieve the desired jaw gap or level of tissue compression. The creep measurement is repeated to drive the next stage of motor current and speed until the final jaw gap or level of tissue compression is achieved.

[0167] In addition to sensing parameters associated with the clamping stroke of the jaws, surgical systems can monitor other functions to adjust and / or refine the operating parameters of surgical instruments. For example, a surgical system can monitor the orientation of the surgical instrument relative to the user and / or patient, the impedance of tissue located between the jaws of the end effector to determine tissue location and / or tissue composition, the patient's grounding level, and / or leakage current. Leakage current can be monitored to determine secondary leakage from other devices and / or to generate parasitic energy output via capacitive coupling.

[0168] In various scenarios, surgical instruments are configured to modify instrument and / or generator settings and / or control procedures using local unsupervised machine learning. In such scenarios, the surgical instrument can update and / or modulate local functional behavior based on aggregated and / or collected data from various surgical procedures performed using the same surgical instrument. Such functional behavior can be modulated based on previous use cases and / or specific user and / or hospital preferences. In such scenarios, the surgical instrument's control procedure identifies the same user and automatically modifies the default procedure using the identified user's preferences. The surgical instrument can be updated by receiving regional and / or global updates and / or improvements to the digitally enabled control procedure and / or displayed information via interaction with a non-local server.

[0169] In various scenarios, surgical instruments are configured to modify instrument and / or generator settings and / or control programs using a global set of instrument operating parameters and / or surgical outcomes. The global surgical system is configured to collect data on relevant and / or influential instrument parameters, such as outcomes, complications, comorbidities, surgical instrument costs, instrument utilization, operation duration, surgical data, and / or patient data. The global surgical system is further configured to collect data on generator operating data, such as impedance profiles, power levels, energy modes, event labeling, and / or adverse events. The global surgical system is further configured to collect data on intelligent device operating parameters, such as clamping time, tissue pressure, waiting time, number of uses, patient time on the operating table, battery level, motor current, and / or actuation stroke. The global surgical system is configured to adjust default control programs and / or update existing control programs based on detected operating parameters. In this way, each surgical instrument within the global surgical system can perform the most effective and / or efficient surgical procedures possible.

[0170] Figure 26 illustrates a network 28300 of surgical instruments 28310 communicating with a cloud-based storage medium 28320. The cloud-based storage medium 28320 is configured to receive data related to operating parameters from the surgical instruments 28310, collected during numerous surgical procedures. This data is used by the cloud-based storage medium 28320 to optimize control procedures for efficient and / or desired results. The cloud-based storage medium 28320 is further configured to analyze all collected data from a random batch 28340. The analysis results from the random batch 28340 can be further used to re-qualify the control procedures. For example, data collected within batch A may represent significantly different wear profiles. It may then be possible to conclude from this data that, for example, adjusting the power instead of the clamping current, the instrument wears out faster. The cloud-based storage medium 28320 is configured to communicate this finding and / or conclusion to the surgical instruments. The surgical instruments can then maximize their lifespan by adjusting the clamping current instead of the power, and / or the surgical system can alert clinicians to this finding.

[0171] Figure 26 illustrates a network 28300 of surgical instruments 28310 communicating with a cloud-based storage medium 28320. The cloud-based storage medium 28320 is configured to receive data related to operating parameters from the surgical instruments 28310, collected during numerous surgical procedures. This data is used by the cloud-based storage medium 28320 to optimize control procedures for efficient and / or desired results. The cloud-based storage medium 28320 is further configured to analyze all collected data from a random batch 28340. The analysis results from the random batch 28340 can be further used to re-qualify the control procedures. For example, data collected within batch A may represent significantly different wear profiles. It may then be possible to conclude from this data that, for example, adjusting the power instead of the clamping current, the instrument wears out faster. The cloud-based storage medium 28320 is configured to communicate this finding and / or conclusion to the surgical instruments. The surgical instruments can then maximize their lifespan by adjusting the clamping current instead of the power, and / or the surgical system can alert clinicians to this finding.

[0172] Information collected from the network 28300 of the surgical instrument 28310 by the cloud-based storage medium 28320 is graphically presented in Figures 27 and 28. More specifically, Figure 27 illustrates the relationship between the gap 28430 defined between the jaws of the end effector (which varies over time from the point of initial tissue contact during surgery) and the clamping current 28440 of the jaw motor. The number of times a particular end effector has reached full clamping during the jaw clamping stroke affects the amount of force required to clamp tissue of the same thickness. For example, compared to 10 to 10 full clamping cycles 28430a, the jaws of the end effector can clamp to a greater extent using less current than the instrument clamping to a greater extent using 10 to 15 full clamping cycles 28430b. Furthermore, compared to 16 to 20 full clamping cycles 28430c, the jaws of the end effector can clamp to a greater extent using less current than the instrument clamping to a greater extent using 10 to 15 full clamping cycles 28430b. Finally, as surgical instruments continue to be used, clamping tissue of the same thickness to the same full clamping gap requires more force and therefore more current. Information collected from the surgical instrument 28310 and the cloud-based storage medium 28320 can be used to modify the control program to perform more efficient and / or time-sensitive jaw clamping strokes.

[0173] The current required to clamp tissue of the same thickness by achieving the same full clamping gap between the jaws of the end effector is used to set the motor current threshold for the generator. As shown in Figure 28, the motor current threshold is lower for end effectors that have achieved full clamping less than 10 times because less current is required to achieve full clamping. Therefore, the control program sets the threshold generator power of the newer end effector lower compared to the older end effector. If the same generator power is used in the older end effector as in the newer end effector, the tissue may not be adequately clamped and / or compressed between the jaws of the end effector. If the same generator power is used in the newer end effector as in the older end effector, the tissue and / or instrument may be damaged because the tissue may be over-compressed by the jaws of the end effector.

[0174] In various cases, surgical systems include modular components. For example, a surgical system may include a surgical robot comprising robotic arms configured to receive tools with varying capabilities. The control program of the surgical system may be modified, for instance, based on the type of modular attachments, such as the tools attached to the surgical robotic arms. In other cases, surgical systems may include handheld surgical instruments configured to receive different and / or replaceable end effectors. Before performing the intended surgical function, the handheld surgical instrument may be configured to identify the attached end effector and modify the control program based on the identified identifier of the end effector.

[0175] The surgical system is configured to identify attached modular components using adaptive and / or intelligent query techniques. In various cases, the surgical system uses a combination of electrical and mechanical actuation queries to determine the capacity and / or capability of the attached component. The response to the query may be recorded, and / or compared with information stored in the surgical system's memory to establish baseline operating parameters associated with the identified modular attachment. In various cases, the established baseline parameters are stored in the surgical system's memory for use in future identification of the same or similar modular attachments.

[0176] In various situations, an electrical query signal is transmitted from the handle of the surgical instrument to the attached modular component, wherein the purpose of transmitting the electrical query signal is to determine the identification, operating parameters, and / or status of the attached modular component. The attached modular component is configured to send a response signal containing identification information. In various situations, no response is received to the query signal, and / or the response signal includes unidentifiable information. In such cases, the surgical instrument may perform a default function to assess the capabilities of the attached modular component. This default function is limited by conservative operating parameters. In other words, the default operating parameters used during the execution of the default function are limited to a specific level to avoid damage to the surgical instrument and / or the attached modular component, harm to the patient, and / or harm to the user. The surgical instrument is configured to utilize the results of the default function to set an operating procedure specific to the attached modular component.

[0177] For example, a surgical instrument can perform a tissue cutting stroke, wherein a cutting member traverses an attached end effector from a proximal position to a distal position. In cases where the surgical instrument cannot recognize the attached end effector, the instrument is configured to perform the tissue cutting stroke using default operating parameters. Using the position of the cutting member within the end effector at the end of the tissue cutting stroke, the instrument can determine the length of the tissue cutting stroke associated with and / or suitable for completion using the attached end effector. The instrument is configured to record the most distal position of the cutting member to set additional operating parameters associated with the attached end effector. Such additional operating parameters include, for example, the speed of the cutting element and / or the length of the end effector during the tissue cutting stroke.

[0178] The default function can also be used to determine one or more current states of the attached modular components. For example, the default function can be executed to determine whether the attached end effector is articulating and / or the degree to which the attached end effector is articulating. The surgical instrument is then configured to adjust the control program accordingly. The length of the cutting stroke changes as the end effector articulates across a series of joint angles. In other words, the length of the cutting stroke is different when the end effector is articulated compared to when the end effector is in a non-articular state. The surgical instrument is configured to update the control program to execute a cutting stroke spanning the length associated with the last detected full stroke. The surgical instrument is further configured to use the length of the last completed cutting stroke to determine whether the full length of the cutting stroke was achieved and / or completed using the current control program compared to when the end effector is articulated.

[0179] In various situations, the surgical system can perform intelligent assessments of the characteristics of the attached components. These characteristics include, for example, tissue pad wear, the degree of accessory use, and / or the operational condition of the accessories. In other words, the surgical system is configured to assess the function and / or condition of the attached components. Upon detecting the characteristics of the attached modular components, the control procedures for operating the surgical system are adjusted accordingly.

[0180] Surgical instruments include one or more tissue pads located on the jaws of an end effector. Tissue pads are known to be prone to wear and tear over time, for example, due to frictional engagement with the blade when no tissue is present between them. Surgical instruments are configured to determine the degree of tissue pad wear by analyzing the remaining tissue pad thickness and / or stiffness. Using the determined state of the tissue pad, the surgical instrument adjusts its control program accordingly. For example, the control program may change the applied pressure and / or power level of the surgical instrument based on the determined state of the tissue pad. In various cases, in response to a detected thickness of the tissue pad (which is less than a threshold thickness), the processor of the surgical instrument may automatically reduce the power level of the surgical instrument.

[0181] The surgical instrument includes combined electrosurgical functions, wherein the surgical instrument includes an end effector comprising a first jaw and a second jaw. At least one of the first jaw and the second jaw is configured to move toward each other to switch the end effector between an open configuration and a closed configuration. The first jaw and the second jaw include electrodes disposed thereon. The electrosurgical instrument includes one or more power generators configured to supply power to the electrodes to power them. The surgical instrument can assess the degree of charring and / or tissue contamination on one or more end effector jaws by measuring impedance when the end effector is in a closed configuration and no patient tissue is present therebetween. A predetermined impedance can be stored in the memory of the surgical instrument, wherein if the impedance exceeds a predetermined threshold, the jaw includes an undesirable level of charring and / or tissue contamination thereon. As discussed in more detail herein, an alert can be issued to the user upon detection of an undesirable level of charring. In various cases, the processor of the surgical instrument and / or surgical hub can automatically adjust operating parameters in response to the detected closed jaw impedance. For example, such operating parameters include power level, applied pressure level, and / or advanced tissue cutting parameters.

[0182] As shown in Figure 29, the graphical representation 28500 illustrates the relationship 28530 between the measured impedance 28250 and multiple activation cycles 28510. Before any energy activation (n=0 activation), the baseline impedance is measured and recorded in memory. As discussed above, the impedance is measured when the end effector of the surgical instrument is in a closed configuration and no patient tissue is present therein. The surgical instrument and / or surgical hub prompts the user to change the end effector to a closed configuration in order to measure the closed jaw impedance. For example, such prompts can be delivered at predefined activation intervals (such as n=5, 10, 15, etc.). As carbonization and / or tissue contamination accumulates on the jaws of the end effector, the impedance increases. At a level equal to and / or higher than a first predetermined level 28540, the surgical instrument and / or surgical hub is configured to alert the user to this carbonization accumulation and suggest that the user clean the end effector. At a level equal to and / or higher than a second predetermined level 28550, surgical instruments and / or surgical hubs can prevent the user from using various operational functions of the surgical instruments before the end effector is cleaned. Assuming the measured impedance has been reduced to an acceptable level, the operational lock can be removed after cleaning the end effector.

[0183] As discussed above, surgical hubs and / or surgical instruments are configured to alert a user when a predetermined impedance is met and / or exceeded. This alert can be delivered through various forms of feedback, including, for example, tactile feedback, auditory feedback, and / or visual feedback. In at least one case, the feedback includes audio feedback, and the surgical instrument may include a speaker that emits a sound, such as a beep, when an error is detected. In some cases, the feedback includes visual feedback, and the surgical instrument may include a light-emitting diode (LED), for example, which flashes when an error is detected. In some cases, visual feedback can be delivered to the user through an alert presented on a display monitor within the user's field of vision. In various cases, the feedback includes tactile feedback, and the surgical instrument may include an electric motor that includes an eccentric element that vibrates when an error is detected. The alert can be specific or general. For example, the alert may specifically indicate that the clamping jaw impedance exceeds a predetermined level, or the alert may specifically indicate the measured impedance.

[0184] In various situations, surgical instruments and / or surgical hubs are configured to detect parameters such as integrated shaft tension, damage, and / or tolerance stacking to compensate for the functional parameter operation of the motor actuator. Surgical instruments are configured to alert the user when detected parameters of the attached end effector and / or shaft approach and / or fall outside the desired operating range specific to the attached component. In addition to alerting the user, in various situations, operation of the surgical instrument is prevented when it is detected that the surgical instrument cannot operate within a predefined envelope of adjustment. Surgical instruments and / or surgical hubs include over-control devices, allowing the user to over-control lock under certain predefined conditions. Such predefined conditions include: emergency situations, the surgical instrument being in use during surgery where its use would harm the patient, and one-time over-control allowing the user to decide to reuse the surgical instrument. In various situations, over-control is also used to allow the user to perform secondary end effector functions unrelated to the primary end effector function. For example, if the surgical instrument prevents the jaws of the end effector from jointing, the user can activate over-control to allow the surgical instrument to joint the end effector.

[0185] The surgical system can adjust control programs configured to operate surgical instruments in response to detected instrument actuation parameters, energy generator parameters, and / or user input. The control program is adjusted by combining the defined state of the surgical instrument with user input. For example, the defined state of the surgical instrument may include whether the end effector is in its open configuration, whether the end effector is in its closed configuration, and / or whether tissue impedance is detectable. The defined state of the surgical instrument may include more than one detected feature. For example, the defined state of the surgical instrument may be assessed using a combination of two or more measurements, a series of ordered operations, and / or an interpretation of familiar user input based on a scenario of familiar user input. For example, the control program is configured to adjust various functions of the surgical instrument, such as power levels, gradual increases or decreases in power, and / or various motor control parameters.

[0186] The surgical system includes a surgical instrument comprising combined electrosurgical functions, wherein the surgical instrument includes an end effector having a first jaw and a second jaw on which electrodes are disposed. The electrosurgical instrument includes one or more power generators configured to supply power to the electrodes to power them. More specifically, energy delivery to patient tissue supported between the first and second jaws is achieved through electrodes configured to deliver energy in monopolar, bipolar, and / or combined modes of alternating or mixed bipolar and monopolar energies. As described in more detail herein, the surgical system can adjust the energy power activation level of the one or more generators based on various monitoring parameters of the surgical instrument.

[0187] The surgical system is configured to adjust energy power activation based on instrument monitoring parameters. In various situations, the surgical system can monitor sequences of activation of various surgical instrument functions. The system can then automatically adjust various operating parameters based on the activation of these instrument functions. For example, the system can monitor the activation of rotational and / or joint motion controls and prevent surgical instruments from delivering energy to patient tissue while such secondary non-clamping controls are in use.

[0188] In various situations, such as surgical systems, the instrument power level can be adjusted to compensate for detected operating parameters, such as insufficient battery and / or motor drive power levels. For example, detecting insufficient battery and / or motor drive power levels can indicate to the surgical system that the clamping strength of the end effector is affected and / or impaired, resulting in undesirable control of the patient tissue located therebetween.

[0189] A surgical system can record operating parameters of surgical instruments during use that are associated with a specific intended function. The surgical system can then use these recorded operating parameters to adjust the energy power level and / or the surgical instrument mode, for example, when it recognizes that a specific intended function is being performed. In other words, the surgical system can automatically adjust the energy power level and / or the surgical instrument mode using stored preferred operating parameters when the desired function of the surgical instrument is recognized, and / or the surgical instrument can adjust the energy power level and / or the surgical instrument mode to support and complement the desired function. For example, the surgical system can supplement a detected lateral load on an axis by applying monopolar power, since the detected lateral load on the axis is typically due to grinding anatomy with the end effector in its closed configuration. The surgical system decides to apply monopolar power because it knows, through prior procedures and / or through information stored in memory, that monopolar power results in improved anatomy. In various cases, the surgical system is configured to apply monopolar power proportionally to the increase in detected lateral load.

[0190] The surgical system can adjust a control program configured to operate surgical instruments in response to detected end effector parameters. As shown in Figure 30, the surgical instruments can automatically modify the gap clamping control program using measured tissue conductivity. For example, tissue conductivity is measured at two frequencies, such as 50 kHz and 5 MHz. Low-frequency conductivity (GE) is driven by extracellular fluid, while high-frequency conductivity (GI) is driven by intracellular fluid. For example, intracellular fluid levels change when cells are damaged. The end effector can be configured in both open and closed configurations. Therefore, when the end effector is actuated from its open configuration toward its closed configuration, the jaws of the end effector compress the tissue located therebetween. During tissue compression, changes in conductivity between the two frequencies can be detected and / or recorded. The surgical system is configured to adjust the control program based on the ratio of low-frequency conductivity (GE) to high-frequency conductivity (GI) to control the clamping compression of the end effector. The surgical system adjusts the control program until it approaches discrete, predetermined points and / or inflection points, thereby indicating that cell damage may be nearby.

[0191] More specifically, Figure 30 is a graphical representation 29000 of the relationship between the measured tissue conductivity 29100, the ratio of low-frequency conductivity to high-frequency conductivity 29200, the jaw orifice size 29300, and the jaw motor force 29400 during the jaw clamping stroke duration 29010. At the beginning of the jaw clamping stroke, the measured tissue conductivity is lowest due to the initial contact between the end effector jaws and the patient tissue, and the jaw orifice 29300 is at its maximum when the end effector is in its open configuration. The jaw motor force is lower at the beginning of the jaw clamping stroke, at least in part due to the small amount of resistance supplied to the jaws from the tissue located between them. Before compression, but after contact exists between the patient tissue and the end effector jaws, the low-frequency conductivity 29110 increases, indicating the presence of extracellular fluid within the captured tissue. Similarly, before compression, but after contact between the patient tissue and the jaws of the end effector, the high-energy conductivity 29120 increased, indicating the presence of intracellular fluid.

[0192] As the end effector begins to move toward its closed configuration, the jaws of the end effector begin to clamp the tissue located therebetween, and thus the jaw orifice 29300 continues to decrease. The jaws begin to compress the tissue; however, it is undesirable for the patient's tissue to be sealed by the surgical instrument before fluid begins to drain from the compressed tissue. The jaw motor force continues to increase during the jaw clamping stroke as the captured tissue removes the increased resistance to the end effector jaws.

[0193] After the initial expulsion of extracellular fluid causes a decrease in low-frequency conductivity (GE) 29110, GE 29110 remains relatively constant during the jaw clamping stroke. High-frequency conductivity (GI) 29120 remains relatively constant during the jaw clamping stroke until the patient tissue is sealed. When tissue compression continues after sealing, intracellular tissue damage occurs and intracellular fluid is expelled. At this point, GI 29120 decreases, causing the ratio of low-frequency conductivity to high-frequency conductivity 29210 to reach a peak. A tissue damage threshold 29220 is pre-defined to alert the user and / or automatically prompt the surgical system to modify operating parameters when the peak value of the ratio of low-frequency conductivity to high-frequency conductivity 29210 reaches and / or exceeds the tissue damage threshold 29220. At this time, the surgical system is configured to modify the control program to stop actuating the jaws of the end effector in the closed configuration toward the end effector and / or begin actuating the jaws of the end effector in the open configuration toward the end effector. In various situations, the surgical system is configured to modify the control program to reduce the clamping force of the jaws. This adjustment to the control program prevents further tissue damage.

[0194] The surgical system is configured to modify the control program based on collaborative dual inputs. More specifically, the surgical system can change the motor actuation rate based on user input and predefined settings. For example, the greater the force applied by the user to the handle control, the faster the motor is actuated to trigger the system. In various cases, the handle control can be used to transmit different commands to the surgical system depending on the context of the surgical system. More specifically, the surgical system can monitor and / or record specific user inputs. Specific user inputs can be analyzed for their length, duration, and / or any suitable characteristics that can be used to distinguish the input. For example, the handle of a surgical instrument may include a trigger configured to control shaft rotation. In various cases, faster actuation of the trigger corresponds to an increase in the rate of shaft rotation; however, the maximum force (current) threshold of the motor remains constant. In other cases, faster actuation of the trigger corresponds to an increase in the applied force, while the rotational speed threshold remains unchanged. This control can be further differentiated by the shaft rotational speed, which increases based on the duration of user-actuated trigger actuation, while the force is based on the rate at which the trigger is actuated.

[0195] In various cases, motor actuation control is based on a combination of predefined settings and detection of instrument operating parameters and / or user control parameters. Figure 31 is a graphical representation 29500 of the relationship between the actual jaw closing speed 29520 and the trigger speed 29510 indicated by the user input. The jaw closing speed 29520, generated solely by the corresponding user input 29510, is represented by the first line 29530. As the user input trigger speed 29510 increases, the jaw closing speed 29520 also increases. This relationship 29530 is determined without considering any other parameters. The jaw closing speed 29520, generated by the corresponding user input 29510 and the determination of the thick tissue located between the jaws of the end effector, is represented by the second line 29540. As the user input trigger speed 29510 increases, the jaw closing speed 29520 also increases; however, the jaw closing speed 29520 is less than the jaw closing speed considering only the user input trigger speed. Another consideration is that tissue thickness slows down the jaw closure speed in order to prevent damage to, for example, patient tissue and / or surgical instruments.

[0196] A surgical system comprises numerous components. For example, a surgical system may include numerous handheld surgical instruments, surgical hubs, and surgical robots. In various scenarios, each component of a surgical system communicates with other components and can issue commands, and / or can modify the control program based on at least one monitored parameter and / or user input. The surgical system includes means for determining which system is in charge and which system makes partial operational decisions. This designation can be altered based on context awareness, the occurrence of predetermined events, and / or exceeding thresholds. In various scenarios, command protocols can be established within the surgical system to indicate the types of commands each component can issue and / or which components within the surgical system the issuing component can direct the commands to.

[0197] Command protocols can use predefined thresholds to determine when to authorize a transfer of control. For example, a surgical system includes a generator and handheld surgical instruments, comprising various controls within them. At the start of surgery, the generator is initially in control, adjusting its power based on detected impedance. The generator uses the detected impedance and / or the current power level to command a pressure control within the handle of the surgical instrument to follow a specific pressure requirement. At some point during surgery, a lower impedance threshold is exceeded, indicating that the generator algorithm has detected an electrical short circuit. The generator then transfers control to the pressure control within the handle by instructing it to determine whether tissue is still within the jaws of the end effector. The pressure control is then able to determine the appropriate tissue compression and can convey information—which power level and / or energy mode is best suited for the detected tissue.

[0198] Control protocols can be determined based on consensus reached by multiple components within a surgical system. For example, three components within the surgical system detect a first value associated with a monitored parameter, while two components detect a second value associated with the same monitored parameter, where the first and second values ​​are different. A group of three components includes more components than a group of two components, and therefore controls more first values ​​for the monitored parameter. Each component within the surgical system can be assigned a position within a hierarchy. The hierarchy can be established based on the reliability and / or capabilities of specific components. A first component detects a first value associated with a monitored parameter, and a second component detects a second value associated with the same monitored parameter, where the first and second values ​​are different. Within the hierarchy of the surgical system, the second component is "higher level" than the first component, and therefore the second value of the monitored parameter detected by the second component is of a higher level.

[0199] Various aspects of the subject matter described herein are illustrated in the following embodiments:

[0200] Example Set 1

[0201] Example 1—A surgical system comprising surgical instruments, a generator configured to supply power to an end effector, and a processor configured to run a control program to operate the surgical system. The surgical instruments include the end effector, which includes a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable relative to each other between an open position and a closed position. Tissue is configured to be positioned between the first jaw and the second jaw. The processor is configured to: detect the first parameter of the surgical system, detect at least one user input, and modify the control program in response to the detected first parameter and the at least one user input.

[0202] Example 2—A surgical system according to Example 1, wherein the control program is configured to control the power level of the generator.

[0203] Example 3—A surgical system according to Example 1 or 2, wherein the control program is configured to control a motor, wherein the motor is configured to move the end effector between the open configuration and the closed configuration.

[0204] Example 4—A surgical system according to Example 3, wherein the control program is configured to control the motor via motor control parameters, and wherein the control program is configured to adjust the motor control parameters in response to the detected first parameter and the detected user input.

[0205] Example 5—A surgical system according to Example 1, 2, 3 or 4, wherein the first parameter includes instrument actuation parameters.

[0206] Example 6—A surgical system according to Example 1, 2, 3, 4 or 5, wherein the first parameter includes generator operating parameters.

[0207] Example 7—A surgical system according to Examples 1, 2, 3, 4, 5 or 6, wherein the first parameter includes the state of the end effector.

[0208] Example 8—A surgical system according to Example 1, 2, 3, 4, 5, 6 or 7, wherein the first parameter indicates whether the end effector is in the open configuration or the closed configuration.

[0209] Example 9—A surgical system according to Examples 1, 2, 3, 4, 5, 6 or 7, wherein the first parameter indicates whether the tissue is located between the first jaw and the second jaw.

[0210] Example 10—A surgical system according to Examples 1, 2, 3, 4, 5, 6, 7, 8 or 9, wherein the surgical instruments are under operational control, and wherein the generator is by default a subordinate control system.

[0211] Example 11—A surgical system according to Examples 1, 2, 3, 4, 5, 6, 7, 8 or 9, wherein the control program is configured to enable the generator to operate and the surgical instruments to be subordinate to the control system in response to the detected first parameter and the detected user input.

[0212] Example 12—A surgical system according to Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 or 11, wherein the first parameter comprises a combination of two measurements.

[0213] Example 13—A surgical system according to Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 or 12, wherein the surgical system further includes a trigger configured to receive the user input, wherein the processor is configured to interpret a plurality of user inputs received by the trigger, wherein each user input includes a different meaning based on context usage.

[0214] Example 14—A surgical system comprising surgical instruments, a generator configured to supply power to the surgical instruments, and a processor configured to run a control program to operate the surgical system. The processor is configured to: detect the state of the surgical instruments, detect at least one user input, and adjust the control program in response to the detected state of the surgical instruments and the at least one user input.

[0215] Example 15—A surgical system according to Example 14, wherein the surgical instrument includes an end effector, wherein the end effector is configurable in an open configuration and a closed configuration, and wherein the state of the surgical instrument corresponds to whether the end effector is in the open configuration or the closed configuration.

[0216] Example 16—A surgical system according to Example 14 or 15, wherein the surgical instrument includes an end effector, wherein the end effector is configurable in an open configuration and a closed configuration, and wherein the state of the surgical instrument corresponds to whether patient tissue is located between the first jaw and the second jaw.

[0217] Example 17—A surgical system according to Example 14, 15 or 16, wherein the surgical system further includes an input component configured to receive the user input, wherein the processor is configured to interpret a plurality of user inputs received by the input component, wherein each received user input includes a different meaning based on the context of the surgical system.

[0218] Example 18—A surgical system comprising a surgical instrument, a generator configured to supply power to an end effector, and a processor configured to run a control program to operate the surgical system. The surgical instrument includes the end effector, which includes a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable relative to each other between an open position and a closed position. Tissue is configured to be positioned between the first jaw and the second jaw. The processor is configured to: detect a first parameter of the surgical instrument, detect a second parameter of the generator, detect at least one user input, and modify the control program in response to the detected first parameter, the detected second parameter, and the at least one user input.

[0219] Example 19—A surgical system according to Example 18, wherein the first parameter of the surgical instrument corresponds to whether the end effector is in the open configuration or the closed configuration and whether the patient tissue is located between the first jaw and the second jaw.

[0220] Example 20—A surgical system according to Example 18 or 19, wherein the surgical instrument further includes an input member configured to receive the user input, wherein the processor is configured to interpret a plurality of user inputs received by the input member, wherein each received user input includes a different meaning based on the contextual use of the surgical instrument within the surgical system.

[0221] Example Set 2

[0222] Example 1—A surgical instrument comprising a housing, a shaft assembly, a processor, and a memory. The shaft assembly is alternatively connected to the housing. The surgical assembly includes an end effector. The memory is configured to store program instructions that, when executed from the memory, cause the processor to: send an electrical query signal to the attached shaft assembly; receive a response signal from the attached shaft assembly; when the attached shaft assembly does not receive a response signal, cause the processor to execute a default function; determine an identification feature of the attached shaft assembly due to the execution of the default function; and modify a control program based on the identification feature of the attached shaft assembly.

[0223] Example 2—A surgical instrument according to Example 1, wherein the identification feature includes the remaining capacity of the attached shaft assembly.

[0224] Example 3—A surgical instrument according to Example 1 or 2, wherein the identifying features include the performance level of the attached shaft assembly.

[0225] Example 4—A surgical instrument according to Example 1, 2 or 3, wherein the identification features are different for attached shaft assemblies with different capabilities.

[0226] Example 5—A surgical instrument according to Example 1, 2, 3 or 4, wherein the memory includes a lookup table that includes operating parameters corresponding to a specific shaft assembly, wherein the processor uses a received response signal to identify the attached shaft assembly within the lookup table, and wherein the control program modifies using the stored operating parameters of the identified shaft assembly.

[0227] Example 6—A surgical instrument according to Example 1, 2, 3, 4 or 5, wherein the memory further includes program instructions that, when executed, cause the processor to store the modified control program in the memory.

[0228] Example 7—A surgical instrument comprising a housing, a shaft assembly, a processor, and a memory. The shaft assembly is alternatively connected to the housing. The surgical assembly includes an end effector. The memory is configured to store program instructions that, when executed from the memory, cause the processor to: send a variable polling communication to the attached shaft assembly; determine the capabilities of the attached shaft assembly based on a response to the variable polling communication; and modify a control program based on the determined capabilities of the attached shaft assembly.

[0229] Example 8—A surgical instrument according to Example 7, wherein the variable query communication includes an electrical query signal and physical actuation of the surgical instrument.

[0230] Example 9—A surgical instrument according to Example 7 or 8, wherein the physical actuation of the surgical instrument is monitored to determine the functional capability of the attached shaft assembly.

[0231] Example 10—A surgical instrument according to Example 7, 8 or 9, wherein the determined capacity relates to the remaining capacity of the shaft assembly.

[0232] Example 11—A surgical instrument according to Examples 7, 8, 9 or 10, wherein the determined capability relates to the performance level of the shaft assembly.

[0233] Example 12—A surgical instrument according to Examples 7, 8, 9, 10 or 11, wherein the capability to be determined varies based on the shaft assembly of the connection.

[0234] Example 13—A surgical instrument according to Examples 7, 8, 9, 10, 11 or 12, wherein the memory further includes program instructions that, when executed, cause the processor to store the modified control program and the determined axis assembly capabilities in the memory.

[0235] Example 14—A surgical instrument comprising a housing, a shaft assembly, a processor, and a memory. The shaft assembly is interchangeably coupled to the housing. The surgical assembly includes an end effector. The memory is configured to store program instructions that, when executed from the memory, cause the processor to: send a query signal to the shaft assembly coupled to the housing; receive a response signal from the shaft assembly coupled to the housing; if no response signal is identified, cause the processor to execute a default end effector function; determine an identification feature of the shaft assembly coupled to the housing due to the execution of the default end effector function; and modify a control program based on the identification feature of the shaft assembly coupled to the housing.

[0236] Example 15—A surgical instrument according to Example 14, wherein the processor does not recognize the response signal because the processor does not receive the response signal.

[0237] Example 16—A surgical instrument according to Example 14 or 15, wherein the identifying feature includes the remaining capacity of the shaft assembly coupled to the housing.

[0238] Example 17—A surgical instrument according to Example 14, 15 or 16, wherein the identifying features include the performance level of the shaft assembly coupled to the housing.

[0239] Example 18—A surgical instrument according to Examples 14, 15, 16 or 17, wherein the defined features can differ based on the shaft assembly interchangeably coupled to the housing.

[0240] Example 19—A surgical instrument according to Examples 14, 15, 16, 17 or 18, wherein the memory includes a lookup table that includes operating parameters corresponding to a specific shaft assembly, wherein the processor uses a received response signal to identify the shaft assembly coupled to the housing within the lookup table, and wherein the control program modifies using the stored operating parameters of the identified shaft assembly.

[0241] Example 20—A surgical instrument according to Examples 14, 15, 16, 17, 18 or 19, wherein the memory further includes program instructions that, when executed, cause the processor to store the modified control program in the memory.

[0242] Example Set 3

[0243] Example 1—A surgical system comprising a surgical hub, surgical instruments, a generator configured to power an end effector, and a smoke extraction system configured to remove smoke from a surgical site. The surgical instruments include the end effector. Control commands are transmitted directly from the surgical hub to the surgical instruments. The surgical instruments are configured to daisy-chain the control commands received from the surgical hub to the generator and the smoke extraction system.

[0244] Example 2—A surgical system according to Example 1, wherein the surgical instruments are configured to modify the control commands using parameters detected by the surgical instruments.

[0245] Example 3—A surgical system according to Example 2, wherein the surgical instruments are configured to transmit the modified control commands to the generator.

[0246] Example 4—A surgical system according to Example 2 or 3, wherein the operating parameters of the generator are controlled by the modified control commands.

[0247] Example 5—A surgical system according to Example 2, 3 or 4, wherein the generator is configured to modify the modified control command using a second parameter detected by the generator.

[0248] Example 6—A surgical system according to Example 2, 3, 4 or 5, wherein the surgical instruments are configured to transmit the modified control commands to the surgical hub, and wherein the surgical hub is configured to transmit the modified control commands to the generator.

[0249] Example 7—A surgical system according to Example 1, wherein the surgical instrument detects a first parameter of the surgical instrument, wherein the surgical instrument is configured to transmit the detected first parameter to the generator, and wherein the generator is configured to use the first parameter to modify the control command.

[0250] Example 8—A surgical system according to Example 1, wherein the surgical instrument detects a first parameter of the surgical instrument, wherein the surgical instrument is configured to transmit the detected first parameter to the generator, wherein the generator detects a second parameter, and wherein the generator is configured to modify the control command using the first parameter and the second parameter.

[0251] Example 9—The surgical system according to Examples 1, 2, 3, 4, 5, 6, 7 or 8 further includes a display screen configured to display real-time feeds of the surgical site and first operating parameters of the surgical instruments.

[0252] Example 10—A surgical system according to Example 9, wherein the surgical instrument further includes an instrument display configured to display a second operating parameter of the surgical instrument, and wherein the first operating parameter is the same as the second operating parameter.

[0253] Example 11—A surgical system according to Example 9, wherein the surgical instrument further includes an instrument display configured to display a second operating parameter of the surgical instrument, and wherein the first operating parameter is different from the second operating parameter.

[0254] Example 12—A surgical system according to Example 9, 10 or 11, wherein the display screen is further configured to display operating parameters of the generator.

[0255] Example 13—A surgical system comprising a surgical hub, surgical instruments, a generator configured to power an end effector, and a smoke extraction system configured to remove smoke from a surgical site. The surgical instruments include the end effector. Control commands are transmitted directly from the surgical hub to the surgical instruments. The surgical instruments are configured to transmit the control commands received from the surgical hub to the generator and the smoke extraction system.

[0256] Example 14—A surgical system according to Example 13, wherein the surgical instruments are configured to transmit control commands received from the surgical hub to the generator and the smoke extraction system in a daisy-chain manner.

[0257] Example 15—A surgical system comprising a surgical hub, a first surgical instrument, a first generator configured to power a first end effector, and a second surgical instrument. The first surgical instrument includes the first end effector. Control commands are transmitted directly from the surgical hub to the first surgical instrument. The first surgical instrument is configured to daisy-chain the control commands received from the surgical hub to the first generator and the second surgical instrument.

[0258] Example 16—A surgical system according to Example 15, wherein the first surgical instrument is configured to modify the control command using a first parameter detected by the first surgical instrument.

[0259] Example 17—A surgical system according to Example 16, wherein the first surgical instrument is configured to transmit the modified control command to the second surgical instrument.

[0260] Example 18—A surgical system according to Example 17, wherein the second surgical instrument is configured to modify the modified control command using a second parameter detected by the second surgical instrument, and wherein the second surgical instrument is configured to transmit the modified control command to the first surgical instrument.

[0261] Example 19—A surgical system according to Example 15, wherein the first surgical instrument is configured to detect a first parameter, wherein the second surgical instrument is configured to detect a second parameter, wherein the second surgical instrument is configured to transmit the detected second parameter to the first surgical instrument, and wherein the first surgical instrument is configured to modify the control command using the first parameter detected by the first surgical instrument and the second parameter detected by the second surgical instrument.

[0262] Example 20—A surgical system according to Examples 15, 16, 17, 18 or 19, wherein the second surgical instrument includes a smoke extraction system configured to remove smoke from the surgical site.

[0263] Although several forms have been illustrated and described, the applicant does not intend to limit or restrict the scope of the appended claims to such details. Many modifications, variations, alterations, substitutions, combinations, and equivalents of these forms can be made without departing from the scope of this disclosure, and those skilled in the art will recognize such modifications, variations, alterations, substitutions, combinations, and equivalents. Furthermore, alternatively, the structure of each element associated with a described form can be described as a device for providing the function performed by said element. Additionally, where materials for certain components are disclosed, other materials may also be used. Therefore, it should be understood that the foregoing detailed descriptions and the appended claims are intended to cover all such modifications, combinations, and variations falling within the scope of the forms disclosed in this invention. The appended claims are intended to cover all such modifications, variations, alterations, substitutions, modifications, and equivalents.

[0264] The specific embodiments described above have illustrated various forms of apparatus and / or methods using block diagrams, flowcharts, and / or examples. Wherever such block diagrams, flowcharts, and / or examples contain one or more functions and / or operations, those skilled in the art will understand that each function and / or operation in such block diagrams, flowcharts, and / or examples can be implemented individually and / or collectively by various hardware, software, firmware, or virtually any combination thereof. Those skilled in the art will recognize that some aspects of the forms disclosed herein can be equivalently implemented in an integrated circuit, wholly or partially, as one or more computer programs running on one or more computers (e.g., as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (e.g., as one or more programs running on one or more microprocessors), as firmware, or as any combination thereof, and that designing circuit systems and / or writing software and / or hardware code according to this disclosure will be within the skill of those skilled in the art. Furthermore, those skilled in the art will recognize that the mechanisms of the subject matter described herein can be distributed as one or more program products in various forms, and that the exemplary forms of the subject matter described herein apply regardless of the specific type of signal-bearing medium used for actual distribution.

[0265] Instructions used for programming logic to execute various disclosed aspects may be stored in the system's memory, such as dynamic random access memory (DRAM), cache, flash memory, or other memory. Furthermore, the instructions may be distributed via a network or through other computer-readable media. Therefore, machine-readable media may include any means for storing or transmitting information in a machine-readable (e.g., computer-readable) form, but are not limited to floppy disks, optical disks, optical disc read-only memory (CD-ROM), and magneto-optical disks, read-only memory (ROM), random access memory (RAM), erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), magnetic cards or optical cards, flash memory, or tangible machine-readable storage devices used for transmitting information over the Internet via electrical signals, optical signals, acoustic signals, or other forms of propagation signals (e.g., carrier waves, infrared signals, digital signals, etc.). Therefore, non-transitory computer-readable media include any type of tangible machine-readable medium suitable for storing or transmitting electronic instructions or information in a machine-readable (e.g., computer-readable) form.

[0266] As used in any aspect of this document, the term "control circuitry" may refer to, for example, hardwired circuitry systems, programmable circuitry systems (e.g., computer processors including one or more individual instruction processing cores, processing units, processors, microcontrollers, microcontroller units, controllers, digital signal processors (DSPs), programmable logic devices (PLDs), programmable logic arrays (PLAs), field-programmable gate arrays (FPGAs)), state machine circuitry systems, firmware storing instructions executed by the programmable circuitry system, and any combination thereof. Control circuitry can be implemented collectively or individually as part of a larger system, such as integrated circuits (ICs), application-specific integrated circuits (ASICs), system-on-a-chip (SoCs), desktop computers, laptop computers, tablet computers, servers, smartphones, etc. Therefore, as used herein, "control circuit" includes, but is not limited to, electronic circuits having at least one discrete circuit, electronic circuits having at least one integrated circuit, electronic circuits having at least one application-specific integrated circuit, electronic circuits forming a general-purpose computing device configured by a computer program (e.g., a general-purpose computer configured by a computer program that at least partially implements the methods and / or devices described herein, or a microprocessor configured by a computer program that at least partially implements the methods and / or devices described herein), electronic circuits forming a memory device (e.g., forming a random access memory), and / or electronic circuits forming a communication device (e.g., a modem, a communication switch, or an optoelectronic device). Those skilled in the art will recognize that the subject matter described herein can be implemented in analog or digital modes, or some combination thereof.

[0267] As used in any aspect of this document, the term "logic" can refer to an application, software, firmware, and / or circuit system configured to perform any of the foregoing operations. Software can be embodied as a software package, code, instructions, instruction sets, and / or data recorded on a non-transitory computer-readable storage medium. Firmware can be embodied as hard-coded (e.g., non-volatile) code, instructions, or instruction sets and / or data in a memory device.

[0268] As used in any part of this document, the terms “component,” “system,” “module,” etc., can refer to computer-related entities, hardware, combinations of hardware and software, software, or software in execution.

[0269] As used in any aspect of this document, "algorithm" refers to a systematic sequence of steps that leads to a desired result, where "step" refers to the manipulation of physical quantities and / or logical states, which may (but not necessarily) take the form of electrical or magnetic signals that can be stored, transferred, combined, compared, and otherwise manipulated. These signals are commonly referred to as bits, values, elements, symbols, characters, terms, numbers, etc. These and similar terms may be associated with appropriate physical quantities and are merely convenient labels applied to these quantities and / or states.

[0270] The network may include a packet-switched network. Communication devices may be able to communicate with each other using a selected packet-switched network communication protocol. An exemplary communication protocol may include an Ethernet communication protocol that may allow communication using Transmission Control Protocol / Internet Protocol (TCP / IP). The Ethernet protocol may conform to or be compatible with the Ethernet standard entitled "IEEE 802.3 Standard" published by the Institute of Electrical and Electronics Engineers (IEEE) in December 2008 and / or a higher version of this standard. Alternatively or additionally, communication devices may be able to communicate with each other using the X.25 communication protocol. The X.25 communication protocol may conform to or be compatible with standards published by the International Telecommunication Union Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, communication devices may be able to communicate with each other using the Frame Relay communication protocol. The Frame Relay communication protocol may conform to or be compatible with standards published by the International Telegraph and Telephone Consultative Committee (CCITT) and / or the American National Standards Institute (ANSI). Alternatively or additionally, transceivers may be able to communicate with each other using the Asynchronous Transfer Mode (ATM) communication protocol. The ATM communication protocol may conform to or be compatible with the ATM standard entitled "ATM-MPLS Network Interworking 2.0" and / or a higher version of that standard, published by the ATM Forum in August 2001. Of course, this document also envisions different and / or subsequently developed connectivity-oriented network communication protocols.

[0271] Unless otherwise expressly stated in the foregoing disclosure, it is understood that in the foregoing disclosure, discussions using terms such as “processing,” “estimating,” “calculating,” “determining,” and “displaying” refer to the actions and processes of a computer system or similar electronic computing device that manipulate data represented as physical (electronic) quantities in the registers and memories of the computer system and convert them into other data similarly represented as physical quantities in the memory or registers of the computer system or other such information storage, transmission, or display devices.

[0272] One or more components may be referred to herein as “configured to be,” “configurable to be,” “operable / operationally,” “suitable / adaptable,” “capable,” “adaptable / fittable,” etc. Those skilled in the art will recognize that, unless the context otherwise requires, “configured to be” generally encompasses components in an active state and / or in an inactive state and / or in a standby state.

[0273] The terms "proximal" and "distal" are used herein in relation to the clinician manipulating the handle portion of the surgical instrument. "Proximal" refers to the portion closest to the clinician, and "distal" refers to the portion furthest from the clinician's position. It should also be understood that, for brevity and clarity, spatial terms such as "vertical," "horizontal," "upper," and "lower" may be used in conjunction with accompanying drawings. However, surgical instruments are used in many orientations and locations, and these terms are not restrictive and / or absolute.

[0274] Those skilled in the art will recognize that, in general, the terminology used herein, and particularly in the appended claims (e.g., the text of the appended claims), is typically intended to be “open” terms (e.g., the term “comprising” should be interpreted as “including but not limited to,” the term “having” should be interpreted as “at least having,” the term “including” should be interpreted as “comprising but not limited to,” etc.). Those skilled in the art will also understand that if a specific number of statements in the introduced claims is intended, such an intention will be explicitly stated in the claims, and if no such statement is present, such an intention does not exist. For example, to aid understanding, the appended claims below may contain the use of the introductory phrases “at least one” and “one or more” to introduce the claims. However, the use of such phrases should not be construed as implying that introducing a claim statement with the indefinite article "a" or "an" limits any particular claim containing such an introductory claim statement to a claim containing only one such statement, even when the same claim includes the introductory phrase "one or more" or "at least one" and indefinite articles such as "a" or "an" (e.g., "a" and / or "an" should generally be interpreted as meaning "at least one" or "one or more"); this also applies to the use of definite articles used to introduce a claim statement.

[0275] Furthermore, even when a specific number of claims is explicitly stated, those skilled in the art should recognize that such a statement should generally be interpreted as referring to at least the number stated (e.g., in the absence of other modifiers, a bare statement of "two statements" generally means at least two statements, or two or more statements). Moreover, in cases where conventions such as "at least one of A, B, and C" are used, such constructions are generally intended to have a meaning that those skilled in the art will understand (e.g., "a system having at least one of A, B, and C" will include, but is not limited to, systems having only A, only B, only C, A and B together, A and C together, B and C together, and / or A, B, and C together, etc.). In cases where conventions such as "at least one of A, B, or C" are used, such constructions are generally intended to have a meaning that those skilled in the art will understand (e.g., "a system having at least one of A, B, or C" should include, but is not limited to, systems having only A, only B, only C, A and B together, A and C together, B and C together, and / or A, B, and C together, etc.). Those skilled in the art should also understand that, generally, unless the context otherwise indicates, any transitional words and / or phrases presenting two or more alternative terms in the detailed description, claims, or drawings should be understood to cover the possibility of including one of the terms, any one of the terms, or both of the terms. For example, the phrase "A or B" will generally be understood to include the possibility of "A" or "B" or "A and B".

[0276] With respect to the appended claims, those skilled in the art will understand that the operations described herein can generally be performed in any order. Furthermore, although various operation flowcharts are shown in one or more sequences, it should be understood that the various operations may be performed in other orders than those shown, or may be performed simultaneously. Unless the context otherwise requires, examples of such alternative orderings may include overlapping, interleaving, interruption, reordering, incremental, preparatory, supplementary, simultaneous, reverse, or other altered orderings. Moreover, unless the context otherwise requires, terms such as “in response to,” “related,” or other past tense adjectives are generally not intended to exclude such variations.

[0277] It is worth noting that any reference to "one aspect," "one aspect," "one example," or "one example" means that the specific feature, structure, or characteristic described in connection with said aspect is included in at least one aspect. Therefore, the phrases "in one aspect," "in one aspect," "in one example," and "in one example" appearing in various places throughout the specification do not necessarily refer to the same aspect. Furthermore, specific features, structures, or characteristics may be combined in one or more aspects in any suitable manner.

[0278] In this specification, unless otherwise stated, the terms "about" or "approximately" as used herein refer to an acceptable error in a particular value as determined by one of ordinary skill in the art, depending in part on how the value is measured or determined. In some embodiments, the terms "about" or "approximately" mean within 1, 2, 3, or 4 standard deviations. In some embodiments, the terms "about" or "approximately" mean within 50%, 20%, 15%, 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%, 0.5%, or 0.05% of a given value or range.

[0279] In this specification, unless otherwise specified, all numerical parameters should in all cases be understood to be referred to by or modified by the term "about," whereby the numerical parameters have inherent differences in the underlying measurement techniques used to determine the parameter values. To a minimum, and without attempting to limit the application of the doctrine of equivalents to the scope of the claims, each numerical parameter described herein should be interpreted at least according to the significant digits of the reported value and by applying customary rounding methods.

[0280] Any numerical ranges listed herein include all subranges covered by the listed range. For example, the range “1 to 10” includes all subranges between the listed minimum value 1 and the listed maximum value 10 (inclusive), that is, a minimum value equal to or greater than 1 and a maximum value equal to or less than 10. Furthermore, all ranges listed herein include the endpoints of the listed range. For example, the range “1 to 10” includes the endpoints 1 and 10. Any upper limit value listed in this specification is intended to include all smaller limits covered therein, and any lower limit value listed in this specification is intended to include all larger limits covered therein. Therefore, the applicant reserves the right to amend this specification (including the claims) to expressly list any subranges covered by the expressly listed ranges. All such ranges are inherently described in this specification.

[0281] Any patent application, patent, non-patent publication, or other public material mentioned in this specification and / or listed in any application data sheet is incorporated herein by reference, provided that the incorporated material is inconsistent with this specification. Therefore, and to the extent necessary, the disclosures expressly listed herein replace any conflicting material incorporated herein by reference. Any material or portion thereof allegedly incorporated herein by reference that conflicts with existing definitions, statements, or other public materials listed herein will be incorporated only to the extent that the incorporated material does not conflict with existing public materials.

[0282] In summary, many beneficial effects resulting from employing the concepts described herein have been described. For illustrative and descriptive purposes, one or more of the specific embodiments described above have been provided. These embodiments are not intended to be exhaustive or limited to the precise forms disclosed in the invention. Modifications or variations may be made to the invention in accordance with the teachings above. The one or more forms chosen and described are intended to illustrate the principles and practical applications, thereby enabling those skilled in the art to utilize various forms and modifications suitable for the intended particular use. The claims filed herein are intended to define the full scope.

Claims

1. A surgical system comprising: A surgical hub, the surgical hub including a hub processor configured to provide a first signal; A surgical instrument, the surgical instrument including an end effector, a sensor and an instrument processor, wherein the instrument processor receives a first signal from the surgical hub; an electrosurgical generator, the electrosurgical generator including a generator processor, wherein the electrosurgical generator is configured to power the end effector, wherein the instrument processor is configured to transmit a second signal to the electrosurgical generator. The device includes a smoke extraction system configured to remove smoke from the surgical site, wherein the generator processor is configured to transmit a third signal to the smoke extraction system; and wherein the surgical hub, the surgical instruments, the electrosurgical generator, and the smoke extraction system are configured to communicate in a daisy-chain manner.

2. The surgical system of claim 1, wherein the surgical instrument is configured to modify the second signal based on parameters of the end effector detected by the sensor of the surgical instrument.

3. The surgical system of claim 2, wherein the surgical instruments are configured to transmit the modified second signal to the electrosurgical generator.

4. The surgical system of claim 3, wherein the operating parameters of the electrosurgical generator are controlled by the modified second signal.

5. The surgical system of claim 3, wherein the electrosurgical generator is configured to modify the modified second signal using a second parameter detected by the electrosurgical generator.

6. The surgical system of claim 2, wherein the surgical instruments are configured to transmit the modified second signal to the surgical hub, and wherein the surgical hub is configured to transmit the modified second signal to the electrosurgical generator.

7. The surgical system of claim 1, wherein the sensor of the surgical instrument is configured to detect a first parameter of the end effector, wherein the instrument processor is configured to transmit the detected first parameter to the electrosurgical generator, and wherein the generator processor is configured to modify the first signal based on the first parameter.

8. The surgical system of claim 1, wherein the sensor of the surgical instrument is configured to detect a first parameter of the end effector of the surgical instrument, wherein the instrument processor is configured to transmit the detected first parameter to the electrosurgical generator, wherein the electrosurgical generator detects a second parameter, and wherein the electrosurgical generator is configured to modify the third signal using the first parameter and the second parameter.

9. The surgical system of claim 1 further includes a display screen configured to display real-time feeds of the surgical site and first operating parameters of the surgical instruments.

10. The surgical system of claim 9, wherein the surgical instrument further comprises an instrument display configured to display a second operating parameter of the surgical instrument, and wherein the first operating parameter is the same as the second operating parameter.

11. The surgical system of claim 9, wherein the surgical instrument further comprises an instrument display configured to display a second operating parameter of the surgical instrument, and wherein the first operating parameter is different from the second operating parameter.

12. The surgical system of claim 9, wherein the display screen is further configured to display operating parameters of the electrosurgical generator.

13. A surgical system comprising: A surgical hub, the surgical hub including a hub processor configured to provide a first signal; A surgical instrument, the surgical instrument including an end effector, a sensor and an instrument processor, wherein the instrument processor receives a first signal from the surgical hub; an electrosurgical generator, the electrosurgical generator including a generator processor, wherein the electrosurgical generator powers the end effector, wherein the instrument processor is configured to transmit a second signal to the electrosurgical generator. and a smoke extraction system configured to remove smoke from the surgical site, wherein the generator processor is configured to transmit a third signal to the smoke extraction system.

14. The surgical system of claim 13, wherein the first signal, the second signal, and the third signal communicate in a daisy-chain manner.

15. A surgical system comprising: A surgical hub includes a hub processor configured to provide a first signal; a first surgical instrument including a first end effector and a first processor, wherein the first processor receives the first signal from the surgical hub; a first electrosurgical generator including a first generator processor, wherein the first electrosurgical generator powers the first end effector, wherein the first processor of the first surgical instrument transmits a second signal to the first electrosurgical generator; and a second surgical instrument, wherein the first generator processor is configured to transmit a third signal to the second surgical instrument; wherein the surgical hub, the first surgical instrument, the first electrosurgical generator, and the second surgical instrument are configured to communicate in a daisy-chain manner.

16. The surgical system of claim 15, wherein the first surgical instrument is configured to modify the second signal using a first parameter detected by the first surgical instrument.

17. The surgical system of claim 16, wherein the first surgical instrument is configured to transmit the modified second signal to the second surgical instrument.

18. The surgical system of claim 17, wherein the second surgical instrument is configured to modify the modified second signal using a second parameter detected by the second surgical instrument, and wherein the second surgical instrument is configured to transmit the modified second signal to the first surgical instrument.

19. The surgical system of claim 15, wherein the first surgical instrument is configured to detect a first parameter, wherein the second surgical instrument is configured to detect a second parameter, wherein the second surgical instrument is configured to transmit the detected second parameter to the first surgical instrument, and wherein the first surgical instrument is configured to modify the second signal using the first parameter detected by the first surgical instrument and the second parameter detected by the second surgical instrument.

20. The surgical system of claim 15, wherein the second surgical instrument includes a smoke extraction system configured to remove smoke from the surgical site.

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