Adaptive retraction force control

Abstract

A surgical system can be associated with the cutting and retraction of tissue. The system can include a processor configured to work with a surgical cutting instrument and a retraction instrument. The processor can identify a current surgical task, determine a proximity of nearby structures, and calculate a retraction force direction and strength. Based on the retraction force direction and strength, the system can generate a control signal that directs the retraction instrument to apply the calculated force, which can allow a first tissue to be retracted and a second tissue to be cut by the surgical cutting instrument.

Description

Cross-reference to related applications

[0001] The content of each of the following submitted at the same time is incorporated into this article by reference: • Case file number END9638USNP1, entitled “Progresses Advancement of Authorized Level Based on Learned Complimentary Assistance”. • Case number END9638USNP2, titled "ADJUSTING AUTOMATED COOPERATIVE OPERATIONS BASED ONSITUATIONALLY DERIVED CONSTRAINTS". • Case file number END9638USNP3, entitled “ASSISTANCE ADVANCEMENT MULTI-SYSTEM INTERACTION”. • Case No. END9638USNP4 concerning the agent's case titled "MONITORING AND IDENTIFYING SURGEON CONTROL AND SUGGESTING ATASK THAT MAY BE DONE AUTONOMOUSLY". • Case No. END9638USNP5, entitled “CONTROL OF INFORMATION FLOW, PRIORITIZATION AND MANIFESTATION OF DATA ASSOCIATED WITH AN ACTIVE HCP INTERACTION SPACE”. • The agent's case file number END9638USNP7, entitled "ADJUSTMENT OR DISPLAY OF OPTIONS OF POSITIONAL ORORIENTATION IMPLICATIONS ON SURGICAL TOOL USAGE", and • Case number END9638USNP8, concerning the agent's case titled "ADJUSTMENT OF PHYSIOLOGIC FUNCTION SUPPLEMENTATION CONTROL".

[0002] The following are all cited and incorporated into this article: • U.S. Patent Application No. 18 / 810,323, filed on August 20, 2024, entitled “METHOD FOR MULTI-SYSTEM INTERACTION”; • U.S. Patent Application No. 18 / 960,006, filed November 26, 2024, entitled “METHOD FOR SMART SURGICAL SYSTEMS”; and • U.S. Patent Application No. 18 / 954,186, filed on November 20, 2024, entitled “METHOD FOR MULTI-SYSTEM INTERACTION”. Background Technology

[0003] Surgical procedures are typically performed in the operating room or surgical chamber of a medical facility, such as a hospital. Various surgical devices and systems are utilized in the performance of surgical procedures. In the digital and information age, due to patient safety and the general expectation of maintaining traditional practices, medical systems and facilities are often slower to adopt systems or procedures utilizing newer and more advanced technologies. Summary of the Invention

[0004] A surgical system can be associated with the cutting and retraction of tissue. The system may include a processor configured to work in conjunction with surgical cutting and retraction instruments. The processor can identify the current surgical task, determine the proximity of nearby structures, and calculate the direction and intensity of the retraction force. Based on the direction and intensity of the retraction force, the system can generate a control signal that guides the retraction instrument to apply the calculated force, which allows the first tissue to be retracted and the second tissue to be cut by the surgical cutting instrument.

[0005] The surgical system calculates the direction and speed of movement of the cutting instrument and predicts how tissue might respond to the movement. By taking into account the proximity of nearby structures, the system can adjust the retraction force to avoid causing injury. The system allows the cutting instrument's movement to be modified based on the calculated retraction force or direction, which indicates the likelihood (e.g., high probability) of damage to surrounding tissue.

[0006] The system can determine the tension range and retraction force of the tissue being manipulated. Based on the tension range and retraction force, the system can prevent tissue damage, such as tearing. The system can also incorporate pre-selected force strength limits, ensuring that the retraction device does not exceed a force threshold.

[0007] The system can use imaging to identify tissue planes and key structures. The identified tissue planes and key structures allow the system to adjust the forces applied during retraction and dissection to minimize the risk of injury, for example, when dealing with scars or remodeling tissue. The system can modify control signals based on the identified tissue planes and key structures to enable surgical instruments to move across the target area. Attached Figure Description

[0008] Figure 1 This is a block diagram of a computer-implemented surgical system.

[0009] Figure 2 An example surgical system in an operating room is shown.

[0010] Figure 3 Example surgical hubs paired with various systems are shown.

[0011] Figure 4 An example situational awareness surgical system is shown.

[0012] Figure 5 An example surgical system that may include surgical instruments is shown.

[0013] Figure 6A An example stage of a surgical procedure is illustrated, in which retraction instruments pull the first target tissue away from the surgical site to provide visibility.

[0014] Figure 6B An example stage of the surgical procedure is illustrated, in which connective tissue is partially cut by a laparoscopic bipolar dissecting device and a retraction instrument that applies force to retract the gastric tissue.

[0015] Figure 6C This illustrates how the stomach continues to be stretched open as more connective tissue is dissected.

[0016] Figure 7 An example flowchart illustrating a surgical system procedure is provided.

[0017] Figure 8 An example machine learning-based graph is shown that is associated with a surgical system. Detailed Implementation

[0018] A more detailed understanding can be obtained by referring to the following description, which is given by way of example in conjunction with the accompanying drawings.

[0019] Figure 1An example computer-implemented surgical system 20000 is illustrated. The example surgical system 20000 may include one or more surgical systems (e.g., surgical subsystems) 20002, 20003, and 20004. For example, surgical system 20002 may include a computer-implemented interactive surgical system. For example, surgical system 20002 may include a surgical hub 20006 and / or a computing device 20016 communicating with a cloud computing system 20008, such as... Figure 2 The cloud computing system 20008 may include at least one remote cloud server 20009 and at least one remote cloud storage unit 20010. Example surgical systems 20002, 20003, or 20004 may include one or more wearable sensing systems 20011, one or more environmental sensing systems 20015, one or more robotic systems 20013, one or more intelligent devices 20014, one or more human-machine interface systems 20012, etc. Human-machine interface systems are also referred to herein as human-machine interface devices. Wearable sensing system 20011 may include one or more healthcare professional (HCP) sensing systems and / or one or more patient sensing systems. Environmental sensing system 20015 may include one or more devices, for example, for measuring one or more environmental properties, such as... Figure 2 Further described. The robotic system 20013 may include multiple devices for performing surgical procedures, such as... Figure 2 Further described.

[0020] Surgical system 20002 can communicate with remote server 20009, which may be part of cloud computing system 20008. In one example, surgical system 20002 can communicate with remote server 20009 via a cable / FIOS networking node of an Internet service provider. In one example, patient sensing system can communicate directly with remote server 20009. Surgical system 20002 (and / or the various subsystems, intelligent surgical instruments, robots, sensing systems, and other computerized devices described herein) can collect data in real time and transmit the data to a cloud computer for data processing and manipulation. It should be understood that cloud computing may rely on shared computing resources rather than using local servers or personal devices to process software applications.

[0021] Surgical system 20002 and / or components thereof may communicate with remote server 20009 via a cellular transmit / receive point (TRP) or base station using one or more of the following cellular protocols: GSM / GPRS / EDGE (2G), UMTS / HSPA (3G), Long Term Evolution (LTE) or 4G, LTE-Advanced (LTE-A), New Radio (NR) or 5G, and / or other wired or wireless communication protocols. Various examples of cloud-based analytics performed by cloud computing system 20008 and applicable to use with this disclosure are described in U.S. Patent Application Publication No. US 2019-0206569 A1 (U.S. Patent Application No. 16 / 209,403), filed December 4, 2018, entitled “METHOD OF CLOUD BASED DATA ANALYTICS FOR USE WITH THE HUB,” the entire disclosure of which is incorporated herein by reference.

[0022] The surgical hub 20006 can collaboratively interact with one of a plurality of devices displaying images from a laparoscopy and information from one or more other intelligent devices and one or more sensing systems 20011. The surgical hub 20006 can interact with one or more sensing systems 20011, one or more intelligent devices, and multiple displays. The surgical hub 20006 can be configured to collect measurement data from the sensing systems and transmit notification or control messages to the one or more sensing systems 20011. The surgical hub 20006 can transmit and / or receive information including notification information to and / or from a human-machine interface system 20012. The human-machine interface system 20012 may include one or more human-machine interface devices (HIDs). The surgical hub 20006 can transmit and / or receive notification or control information to be converted into audio, display, and / or control information for various devices communicating with the surgical hub.

[0023] For example, the sensing system may include a wearable sensing system 20011 (which may include one or more HCP sensing systems and / or one or more patient sensing systems) and / or an environmental sensing system 20015, such as Figure 1 As shown. The sensing system can measure data associated with various biomarkers. The sensing system can use one or more sensors, such as optical sensors (e.g., photodiodes, photoresistors), mechanical sensors (e.g., motion sensors), acoustic sensors, electrical sensors, electrochemical sensors, thermoelectric sensors, infrared sensors, etc., to measure biomarkers. The sensor can use one or more of the following sensing techniques to measure biomarkers as described herein: photoplethysmography, electrocardiography, electroencephalography, colorimetry, impedance spectroscopy, potentiometry, current measurement, etc.

[0024] Biomarkers measured by the sensing system may include, but are not limited to, sleep, core body temperature, maximum oxygen uptake, physical activity, alcohol consumption, respiratory rate, oxygen saturation, blood pressure, blood glucose, heart rate variability, blood pH, hydration status, heart rate, skin conductance, peripheral temperature, tissue perfusion pressure, cough and sneezing, gastrointestinal motility, gastrointestinal imaging, respiratory bacteria, edema, psychological factors, sweat, circulating tumor cells, autonomic tone, circadian rhythm and / or menstrual cycle.

[0025] Biomarkers can relate to physiological systems, including but not limited to behavioral and psychological systems, cardiovascular systems, renal systems, dermal systems, nervous systems, gastrointestinal systems, respiratory systems, endocrine systems, immune systems, tumors, musculoskeletal systems, and / or reproductive systems. For example, information from biomarkers can be determined and / or used by a computer-implemented patient and surgical system 20000. This information from biomarkers can be determined and / or used by the computer-implemented patient and surgical system 20000 to improve said systems and / or improve patient outcomes.

[0026] The sensing system can transmit data to the surgical hub 20006. The sensing system can communicate with the surgical hub 20006 using one or more of the following RF protocols: Bluetooth, Bluetooth Low Energy (BLE), Bluetooth Smart, Zigbee, Z-Wave, IPv6 Low Power Wireless Personal Area Network (6LoWPAN), and Wi-Fi.

[0027] The sensing system, biomarkers, and physiological system are described in more detail in U.S. Application No. 17 / 156,287 (Attorney’s File No. END9290USNP1), filed on January 22, 2021, entitled “METHOD OF ADJUSTING A SURGICAL PARAMETERBASED ON BIOMARKER MEASUREMENTS”, the entire disclosure of which is incorporated herein by reference.

[0028] The sensing system described herein can be used to assess the physiological condition of a surgeon performing surgery on a patient, a patient preparing for surgery, or a patient recovering after surgery. The cloud-based computing system 20008 can be used to monitor biomarkers associated with the surgeon or patient in real time, and can be used to generate surgical plans based at least on measurement data collected prior to surgery, provide control signals to surgical instruments during surgery, and notify the patient of complications during the postoperative period.

[0029] A cloud-based computing system 20008 can be used to analyze surgical data. Surgical data can be obtained via one or more intelligent instruments 20014, wearable sensing systems 20011, environmental sensing systems 20015, robotic systems 20013, etc., within the surgical system 20002. Surgical data may include tissue status to assess leakage or perfusion of sealed tissue following tissue sealing and surgical pathology data, including images of samples of body tissue, anatomical structures of the body using various sensors integrated with imaging devices, and techniques such as overlaying images captured by multiple imaging devices, image data, etc. Surgical data can be analyzed to improve surgical outcomes by determining whether further treatment can proceed (such as endoscopic interventions, emerging technologies, targeted radiation, targeted interventions, and the application of precision robotics to tissue-specific sites and conditions). Such data analysis can employ outcome analysis processing, and using standardized methods can provide beneficial feedback to validate surgical treatment and surgeon behavior, or to suggest modifications to surgical treatment and surgeon behavior.

[0030] Figure 2 An example surgical system 20002 in an operating room is shown. Figure 2 As illustrated, the patient undergoes surgery performed by one or more healthcare professionals (HCPs). The HCP is monitored by one or more HCP sensing systems 20020 worn by the HCP. The HCP and the environment surrounding the HCP may also be monitored by one or more environmental sensing systems, including, for example, a collection of cameras 20021, a collection of microphones 20022, and other sensors that can be deployed in the operating room. The HCP sensing systems 20020 and the environmental sensing systems may communicate with a surgical hub 20006, which in turn may communicate with one or more cloud servers 20009 of a cloud computing system 20008, such as... Figure 1 As shown. Environmental sensing systems can be used to measure one or more environmental properties, such as the location of the HCP in the surgical room, HCP movement, environmental noise in the surgical room, temperature / humidity in the surgical room, etc.

[0031] like Figure 2As illustrated, a main display 20023 and one or more audio output devices (e.g., speakers 20019) are positioned within a sterile area to be visible to the operator at the operating table 20024. Furthermore, a visualization / notification tower 20026 is positioned outside the sterile area. The visualization / notification tower 20026 may include a first non-sterile human-machine interface (HID) 20027 and a second non-sterile HID 20029 that are mutually exclusive. The HID may be a display or a display with a touchscreen that allows direct human-machine interface with the HID. The HID system guided by the surgical hub 20006 can be configured to utilize HIDs 20027, 20029, and 20023 to coordinate information flow to the operator both inside and outside the sterile area. In one example, the surgical hub 20006 may enable the HID (e.g., the main HID 20023) to display notifications and / or information about the patient and / or surgical procedures. In one example, the surgical hub 20006 may prompt and / or receive input from personnel in a sterile or non-sterile area. In another example, the surgical hub 20006 may enable the HID to display a snapshot of the surgical site recorded by the imaging device 20030 on a non-sterile HID 20027 or 20029, while maintaining a real-time feed of the surgical site on the main HID 20023. For example, the snapshot on the non-sterile display 20027 or 20029 may allow a non-sterile operator to perform diagnostic steps related to the surgical procedure.

[0032] The surgical hub 20006 can be configured to route diagnostic inputs or feedback entered by a non-sterile operator at the visualization tower 20026 to the main display 20023 within the sterile area, where a sterile operator at the operating table can view the diagnostic inputs or feedback. In one example, the input may be a modified form of a snapshot displayed on a non-sterile display 20027 or 20029, which can be routed to the main display 20023 via the surgical hub 20006.

[0033] See Figure 2Surgical instrument 20031 is used in surgical procedures as part of surgical system 20002. Hub 20006 can be configured to coordinate the flow of information to the display of surgical instrument 20031. For example, it is described in U.S. Patent Application Publication No. US 2019-0200844 A1 (U.S. Patent Application No. 16 / 209,385), filed December 4, 2018, entitled “METHOD OF HUB COMMUNICATION, PROCESSING, STORAGE AND DISPLAY,” the entire disclosure of which is incorporated herein by reference. Diagnostic inputs or feedback entered by a non-aseptic operator at visualization tower 20026 can be routed by hub 20006 to the surgical instrument display within the aseptic area, where the operator of surgical instrument 20031 can view the diagnostic inputs or feedback. For example, an example surgical instrument suitable for use with the surgical system 20002 is described in U.S. Patent Application Publication No. US 2019-0200844 A1 (U.S. Patent Application No. 16 / 209,385), filed December 4, 2018, entitled “METHOD OF HUB COMMUNICATION, PROCESSING, STORAGE AND DISPLAY,” under the heading “Surgical Instrument Hardware,” the entire disclosure of which is incorporated herein by reference.

[0034] like Figure 2 As shown, surgical system 20002 can be used to perform surgery on a patient lying supine on operating table 20024 in operating room 20035. Robotic system 20034 can be used as part of surgical system 20002 during surgery. Robotic system 20034 may include surgeon's console 20036, patient-side trolley 20032 (surgical robot), and surgical robot hub 20033. While the surgeon views the surgical site through surgeon's console 20036, patient-side trolley 20032 can manipulate at least one removably attached surgical tool 20037 through a minimally invasive incision within the patient's body. Images of the surgical site can be obtained via medical imaging device 20030, which can be manipulated by patient-side trolley 20032 to orient the imaging device 20030. Robotic hub 20033 can be used to process images of the surgical site for subsequent display to the surgeon via surgeon's console 20036.

[0035] Other types of robotic systems can be readily adapted for use with surgical system 20002. Various examples of robotic systems and surgical tools applicable to this disclosure are described herein and in U.S. Patent Application No. US 2019-0201137 A1 (U.S. Patent Application No. 16 / 209,407), filed December 4, 2018, entitled “METHOD OF ROBOTIC HUB COMMUNICATION, DETECTION, AND CONTROL,” the entire disclosure of which is incorporated herein by reference.

[0036] In various aspects, the imaging device 20030 may include at least one image sensor and one or more optical components. Suitable image sensors may include, but are not limited to, charge-coupled device (CCD) sensors and complementary metal-oxide-semiconductor (CMOS) sensors.

[0037] The optical components of the imaging device 20030 may include one or more illumination sources and / or one or more lenses. The one or more illumination sources may be directed to illuminate multiple portions of the surgical site. One or more image sensors may receive light reflected or refracted from the surgical site, including light reflected or refracted from tissue and / or surgical instruments.

[0038] Light sources can be configured to radiate electromagnetic energy in both the visible and invisible spectra. The visible spectrum (sometimes referred to as the optical spectrum or emission spectrum) is the portion of the electromagnetic spectrum that is visible to the human eye (e.g., detectable by it) and can be referred to as "visible light" or simply "light." The typical human eye responds to wavelengths in the range of approximately 380 nm to approximately 750 nm in air.

[0039] The invisible spectrum (e.g., the non-luminescent spectrum) is the portion of the electromagnetic spectrum that lies below and above the visible spectrum (i.e., wavelengths below about 380 nm and above about 750 nm). The invisible spectrum is undetectable to the human eye. Wavelengths greater than about 750 nm are longer than the red visible spectrum and become invisible infrared (IR), microwave, and radio electromagnetic radiation. Wavelengths less than about 380 nm are shorter than the violet spectrum and become invisible ultraviolet, X-ray, and gamma-ray electromagnetic radiation.

[0040] In various respects, the imaging device 20030 is configured to be used in minimally invasive surgery. Examples of imaging devices suitable for use in this disclosure include, but are not limited to, arthroscopy, angioscopy, bronchoscopy, cholangioscopy, colonoscopy, cytology endoscopy, duodenoscope, colonoscope, esophagoduodenoscope (gastroscopy), endoscope, laryngoscope, nasopharyngeal-renal endoscopy, sigmoidoscopy, thoracoscopy, and ureteroscopy.

[0041] Imaging devices can employ multispectral monitoring to distinguish morphology and underlying structures. A multispectral image is an image that captures image data across a specific wavelength range of the electromagnetic spectrum. Wavelengths can be separated by filters or by using instruments sensitive to specific wavelengths, including light from frequencies outside the visible light range, such as IR and ultraviolet. Spectral imaging allows the extraction of additional information that the human eye fails to capture with its red, green, and blue receptors. The use of multispectral imaging is described in more detail under the title “Advanced Imaging Acquisition Module” in U.S. Patent Application No. US 2019-0200844 A1 (U.S. Patent Application No. 16 / 209,385), filed December 4, 2018, entitled “METHOD OF HUB COMMUNICATION, PROCESSING, STORAGE ANDDISPLAY,” the entire disclosure of which is incorporated herein by reference. After completing a surgical task to perform one or more of the previously described tests on the treated tissue, multispectral monitoring can be a useful tool for repositioning the surgical site. It goes without saying that rigorous sterilization of the operating room and surgical equipment is required during any surgical procedure. The stringent hygienic and sterilization conditions required in a “surgical room” (e.g., operating room or treatment room) necessitate the highest possible sterility for all medical devices and apparatus. Part of this sterilization process requires the sterilization of any material that comes into contact with the patient or penetrates the sterile area, including the imaging device 20030 and its attachments and components. It should be understood that a sterile area can be considered a designated area deemed free of microorganisms, such as within a tray or sterile towel, or can be considered the area surrounding the patient prepared for surgical procedures. A sterile area may include properly dressed scrubbed team members, as well as all equipment and fixtures within that area.

[0042] Figure 1 The illustrated wearable sensing system 20011 may include, for example: Figure 2One or more HCP sensing systems 20020 are shown. The HCP sensing system 20020 may include sensing systems for monitoring and detecting a set of physical and / or physiological states of a healthcare professional (HCP). An HCP may typically be a surgeon or one or more healthcare professionals or other healthcare providers assisting a surgeon. In one example, the HCP sensing system 20020 may measure a set of biomarkers to monitor the HCP's heart rate. In one example, the HCP sensing system 20020 worn on the surgeon's wrist (e.g., a watch or wristband) may use an accelerometer to detect hand movements and / or tremors and determine the amplitude and frequency of the tremors. The sensing system 20020 may transmit measurement data associated with the set of biomarkers and data associated with the surgeon's physical state to a surgical hub 20006 for further processing.

[0043] Figure 1 The illustrated environmental sensing system 20015 can transmit environmental information to the surgical hub 20006. For example, the environmental sensing system 20015 may include a camera 20021 for detecting the hand / body position of the HCP. The environmental sensing system 20015 may include a microphone 20022 for measuring ambient noise in the surgical room. Other environmental sensing systems 20015 may include devices such as a thermometer for measuring temperature and a hygrometer for measuring the humidity of the surrounding environment in the surgical room. Surgeon biomarkers may include one or more of the following: pressure, heart rate, etc. Environmental measurements from the surgical room may include ambient noise levels associated with the surgeon or patient, surgeon and / or staff movement, surgeon and / or staff attention levels, etc. The surgical hub 20006 (either independently or in communication with a cloud computing system) can use surgeon biomarker measurement data and / or environmental sensing information to modify the control algorithms of handheld instruments or the average latency of robot interfaces, for example, to minimize tremors.

[0044] The surgical hub 20006 can use surgeon biomarker measurements associated with HCP to adaptively control one or more surgical instruments 20031. For example, the surgical hub 20006 can transmit control programs to the surgical instrument 20031 to control its actuators to limit or compensate for fatigue and the use of fine motor skills. The surgical hub 20006 can transmit control programs based on situational awareness and / or context regarding the importance or criticality of the task. When control is needed, the control program can instruct the instrument to change its operation to provide more control.

[0045] Figure 3An example surgical system 20002 with a surgical hub 20006 is shown. The surgical hub 20006 can be paired with a wearable sensing system 20011, an environmental sensing system 20015, a human-machine interface system 20012, a robotic system 20013, and a smart instrument 20014 via modular controls. The hub 20006 includes a display 20048, an imaging module 20049, a generator module 20050 (e.g., an energy generator), a communication module 20056, a processor module 20057, a storage array 20058, and an operating room mapping module 20059. In some aspects, such as Figure 3 As illustrated, hub 20006 also includes smoke extraction module 20054 and / or suction / flushing module 20055. Various modules and systems can be connected directly to the modular control via a router or via communication module 20056. The operating room device can be coupled to cloud computing resources and data storage devices via the modular control. Human-machine interface system 20012 may include a display subsystem and a notification subsystem.

[0046] Modular controls can be coupled to a non-contact sensor module. The non-contact sensor module can use ultrasonic, laser-based, and / or similar non-contact measuring devices to measure the size of the operating room and generate a mapping of the surgical room. Other distance sensors can be used to determine the boundaries of the operating room. An ultrasonic-based non-contact sensor module can scan the operating room by emitting a burst of ultrasound and receiving the echo as it bounces back from the walls of the operating room, as described under the title “Surgical Hub Spatial Awareness Within an Operating Room” in U.S. Provisional Patent Application Serial No. 62 / 611,341, filed December 28, 2017, entitled “INTERACTIVE SURGICAL PLATFORM”, the entire contents of which are incorporated herein by reference. The sensor module can be configured to determine the size of the operating room and adjust Bluetooth pairing distance limits. A laser-based non-contact sensor module can scan the operating room by emitting laser pulses, receiving laser pulses bouncing back from the walls of the operating room, and comparing the phase of the emitted pulse with the received pulse to determine the size of the operating room and adjust Bluetooth pairing distance limits.

[0047] During surgery, the application of energy to tissue for sealing and / or cutting can be associated with fumigation, aspiration of excess fluid, and / or tissue flushing. Fluid lines, power lines, and / or data lines from different sources can become entangled during surgery. Resolving this issue during surgery wastes valuable time. Disconnecting lines may require disconnecting them from their respective modules, which may necessitate module resets. The Hub Modular Housing 20060 provides a unified environment for managing power lines, data lines, and fluid lines, reducing the frequency of entanglement between such lines.

[0048] Energy can be applied to tissue at a surgical site. The surgical hub 20006 may include a hub housing 20060 and a combined generator module slidably received in a docking base within the hub housing 20060. The docking base includes data and power contacts. The combined generator module may include two or more of an ultrasonic energy generator component, a bipolar RF energy generator component, or a monopolar RF energy generator component housed in a single unit. The combined generator module may include a smoke extraction component, at least one energy delivery cable for connecting the combined generator module to a surgical instrument, at least one smoke extraction component configured to extract smoke, fluid, and / or particles generated by applying therapeutic energy to tissue, and a fluid line extending from a remote surgical site to the smoke extraction component. The fluid line may be a first fluid line, and a second fluid line may extend from a remote surgical site to a suction and flushing module 20055 slidably housed in the hub housing 20060. The hub housing 20060 may include a fluid interface.

[0049] The combined generator module can generate multiple energy types for application to tissue. One energy type may be more advantageous for cutting tissue, while another different energy type may be more advantageous for sealing tissue. For example, a bipolar generator can be used to seal tissue, while an ultrasonic generator can be used to cut sealed tissue. Aspects of this disclosure present a solution in which the hub modular housing 20060 is configured to accommodate different generators and facilitate interactive communication between them. The hub modular housing 20060 allows for the rapid removal and / or replacement of various modules.

[0050] The modular surgical housing may include: a first energy generator module configured to generate a first energy for application to tissue; and a first docking base including a first docking port including first data and power contacts, wherein the first energy generator module is slidably movable to electrically engage with the power and data contacts, and wherein the first energy generator module is slidably movable to no longer electrically engage with the first power and data contacts. The modular surgical housing may also include: a second energy generator module configured to generate a second energy, different from the first energy, for application to tissue; and a second docking base including a second docking port including second data and power contacts, wherein the second energy generator module is slidably movable to electrically engage with the power and data contacts, and wherein the second energy generator module is slidably movable to no longer electrically engage with the second power and data contacts. Furthermore, the modular surgical housing also includes a communication bus between the first and second docking ports, configured to facilitate communication between the first and second energy generator modules.

[0051] See Figure 3 The hub modular housing 20060 allows for modular integration of the generator module 20050, the smoke extraction module 20054, and the suction / flushing module 20055. The hub modular housing 20060 facilitates interactive communication between modules 20059, 20054, and 20055. The generator module 20050 may have integrated monopolar, bipolar, and ultrasonic components supported in a single housing unit slidably inserted into the hub modular housing 20060. The generator module 20050 can be connected to the monopolar device 20051, the bipolar device 20052, and the ultrasonic device 20053. The generator module 20050 may include a series of monopolar generator modules, bipolar generator modules, and / or ultrasonic generator modules that interact through the hub modular housing 20060. The hub modular housing 20060 facilitates the insertion of multiple generators and interactive communication between generators connected to the hub modular housing 20060, allowing the generator to function as a single generator.

[0052] A surgical data network with a set of communication hubs can connect sensing systems and modular devices located in one or more operating rooms, patient recovery rooms, or rooms in a medical facility specifically equipped for surgical procedures to a cloud computing system 20008.

[0053] Figure 4A diagram illustrating a situation-aware surgical system 5100 is provided. Data source 5126 may include, for example, a modular device 5102, a database 5122 (e.g., an EMR database containing patient records), a patient monitoring device 5124 (e.g., a blood pressure (BP) monitor and an electrocardiogram (EKG) monitor), an HCP monitoring device 35510, and / or an environmental monitoring device 35512. Modular device 5102 may include sensors configured to detect parameters associated with the patient, HCP, and environment, and / or the modular device itself. Modular device 5102 may include one or more intelligent instruments 20014. Surgical hub 5104 may derive surgical context information from the data, for example, based on a specific combination of received data or a specific order in which data is received from data source 5126. The context information inferred from the received data may include, for example, the type of surgical procedure being performed, the specific steps of the surgical procedure being performed by the surgeon, the type of tissue being operated on, or the body cavity of the surgical object. The ability of the surgical hub 5104 to derive or infer surgical-related information from received data can be termed "situational awareness." For example, the surgical hub 5104 may incorporate a situational awareness system, which could be hardware and / or programming associated with the surgical hub 5104 that derives surgical-related background information from received data, and / or surgical planning information received from the edge computing system 35514 or the enterprise cloud server 35516. The background information derived from the data source 5126 may include, for example, the steps of the surgical procedure being performed, whether and how a specific modular device 5102 is being used, and the patient's condition.

[0054] Surgical hub 5104 can connect to various databases 5122 to retrieve data from them regarding surgical procedures being performed or to be performed. In one example of surgical system 5100, database 5122 may include a hospital's EMR database. Data that can be received from database 5122 by the situational awareness system of surgical hub 5104 may include, for example, start (or setup) time or operational information about a procedure (e.g., a segmental resection in the upper right thoracic region). Surgical hub 5104 can derive background information about the surgical procedure from this data alone or from this data in combination with data from other data sources 5126.

[0055] The surgical hub 5104 can be connected to (e.g., paired with) various patient monitoring devices 5124. In one example of the surgical system 5100, the patient monitoring devices 5124 that can be paired with the surgical hub 5104 may include a pulse oximeter (SpO2 monitor) 5114, a BP monitor 5116, and an EKG monitor 5120. Perioperative data that can be received by the situational awareness system of the surgical hub 5104 from the patient monitoring devices 5124 may include, for example, the patient's oxygen saturation, blood pressure, heart rate, and other physiological parameters. Background information that can be derived by the surgical hub 5104 from the perioperative data sent by the patient monitoring devices 5124 may include, for example, whether the patient is in the operating room or under anesthesia. The surgical hub 5104 may derive these inferences individually from data from the patient monitoring devices 5124 or in combination with data from other data sources 5126 (e.g., a ventilator 5118).

[0056] The surgical hub 5104 can be connected to (e.g., paired with) various modular devices 5102. In one example of the surgical system 5100, the modular device 5102 paired with the surgical hub 5104 may include a fume extractor, medical imaging devices (such as...) Figure 2 The imaging device 20030 shown includes an insufflator, a combined energy generator (for providing power to ultrasound surgical instruments and / or RF electrosurgical instruments), and a ventilator.

[0057] Perioperative data received by the surgical hub 5104 from the medical imaging device may include, for example, whether the medical imaging device is activated and video or image feeds. Background information derived by the surgical hub 5104 from the perioperative data transmitted by the medical imaging device may include, for example, whether the surgery is a VATS procedure (based on whether the medical imaging device is activated or paired with the surgical hub 5104 at the start of the surgery or during the procedure). Image or video data (or a data stream representing video for a digital medical imaging device) from the medical imaging device may be processed by a pattern recognition system or a machine learning system to, for example, identify features (e.g., organ or tissue type) in the field of view (FOY) of the medical imaging device. Background information derived by the surgical hub 5104 from the identified features may include, for example, the type of surgical procedure (or its steps) being performed, the organ being operated on, or the body cavity in which the operation is being performed.

[0058] The situational awareness system of the surgical hub 5104 can derive contextual information from data received from the data source 5126 in a variety of different ways. For example, the situational awareness system may include a pattern recognition system or a machine learning system (e.g., an artificial neural network) trained on training data to associate various inputs (e.g., data from the database 5122, patient monitoring device 5124, modular device 5102, HCP monitoring device 35510, and / or environmental monitoring device 35512) with corresponding contextual information about the surgical procedure. For example, the machine learning system can accurately derive contextual information about the surgical procedure from the provided inputs. In an example, the situational awareness system may include a lookup table that stores pre-represented environmental information about the surgical procedure associated with one or more inputs (or ranges of inputs) corresponding to environmental information. In response to a query using one or more inputs, the lookup table can return corresponding contextual information used by the situational awareness system to control the modular device 5102. In the example, the contextual information received by the situational awareness system of the surgical hub 5104 may be associated with a specific control adjustment or a set of control adjustments for one or more modular devices 5102. In the example, the situational awareness system may include a machine learning system, lookup table, or other such system that can generate or retrieve one or more control adjustments for one or more modular devices 5102 when provided with contextual information as input.

[0059] For example, based on data source 5126, the situational-aware surgical hub 5104 can determine the type of tissue being operated on. The situational-aware surgical hub 5104 can infer whether the surgery being performed is thoracic or abdominal, thus allowing the surgical hub 5104 to determine whether the tissue held by the end effector of the surgical suture and cutting instruments is lung tissue (for thoracic surgery) or stomach tissue (for abdominal surgery). The situational-aware surgical hub 5104 can determine whether the surgical site is under pressure (by determining that the surgery is utilizing airflow) and determine the type of surgery to achieve a consistent amount of smoke extraction for both thoracic and abdominal surgeries. Based on data source 5126, the situational-aware surgical hub 5104 can determine which step of the surgery is being performed or will be performed subsequently.

[0060] The situation-aware surgical hub 5104 can determine the type of surgical procedure being performed and customize energy levels based on the expected tissue profile of the procedure. The situation-aware surgical hub 5104 can adjust the energy levels of ultrasonic surgical instruments or RF electrosurgical instruments throughout the entire surgical procedure, rather than just on a per-procedure basis.

[0061] In the example, data can be extracted from an additional data source 5126 to improve the conclusions drawn by the surgical hub 5104 from one data source 5126. The situation-aware surgical hub 5104 can supplement the data received from the modular device 5102 with the background information about the surgery that it has built from other data sources 5126.

[0062] The situational awareness system of the surgical hub 5104 can take physiological measurement data into account to provide additional contextual information when analyzing visualization data. This additional context can be useful when the visualization data itself may be uncertain or incomplete.

[0063] The situational awareness surgical hub 5104 can determine whether a surgeon (or other HCP) is making an error or otherwise deviating from the intended procedure during surgery. For example, the surgical hub 5104 can determine the type of surgery being performed, retrieve a corresponding list of steps or the order of equipment use (e.g., from memory), and compare the steps being performed or the equipment being used during the surgical procedure with the expected steps or equipment determined by the surgical hub 5104 for that type of surgery. The surgical hub 5104 can provide alerts indicating that a particular step in the surgery is performing an unexpected action or utilizing an unexpected device.

[0064] Surgical instruments (and other modular devices 5102) can be adapted to the specific context of each surgical procedure (such as adaptation to different tissue types) and verification actions during the surgical procedure. Subsequent steps, data, and display adjustments can be provided to the surgical instruments (and other modular devices 5102) in the operating room according to the specific context of the surgery.

[0065] Figure 5An example surgical system 20280 is illustrated, which may include a surgical instrument 20282. The surgical instrument 20282 may communicate with a console 20294 and / or a portable device 20296 via a wired and / or wireless connection through a local area network 20292 and / or a cloud network 20293. The console 20294 and the portable device 20296 may be any suitable computing device. The surgical instrument 20282 may include a handle 20297, an adapter 20285, and a loading unit 20287. The adapter 20285 is releasably coupled to the handle 20297, and the loading unit 20287 is releasably coupled to the adapter 20285, such that the adapter 20285 transmits force from a drive shaft to the loading unit 20287. The adapter 20285 or the loading unit 20287 may include a force gauge (not explicitly shown) disposed therein to measure the force applied to the loading unit 20287. The loading unit 20287 may include an end effector 20289 having a first jaw 20291 and a second jaw 20290. The loading unit 20287 may be an in-situ loading or multiple-fire loading unit (MFLU), which allows clinicians to fire multiple fasteners multiple times without removing the loading unit 20287 from the surgical site to reload it.

[0066] The first jaw 20291 and the second jaw 20290 may be configured to clamp tissue therebetween, fire a fastener through the clamped tissue, and cut the clamped tissue. The first jaw 20291 may be configured to fire at least one fastener multiple times, or may be configured to include a replaceable multiple-fire fastener cartridge containing multiple fasteners (e.g., nails, clamps, etc.) that can be fired more than once before being replaced. The second jaw 20290 may include an anvil that deforms or otherwise secures the fastener when it is ejected from the multiple-fire fastener cartridge.

[0067] The handle 20297 may include a motor coupled to a drive shaft to influence its rotation. The handle 20297 may include a control interface for selectively activating the motor. The control interface may include buttons, switches, levers, sliders, touchscreens, and any other suitable input mechanisms or user interfaces that can be engaged by a clinician to activate the motor.

[0068] The control interface of the handle 20297 can communicate with the controller 20298 of the handle 20297 to selectively activate the motor to affect the rotation of the drive shaft. The controller 20298 may be located within the handle 20297 and is configured to receive input from the control interface and adapter data from the adapter 20285 or loading unit data from the loading unit 20287. The controller 20298 can analyze the input from the control interface and the data received from the adapter 20285 and / or the loading unit 20287 to selectively activate the motor. The handle 20297 may also include a display that a clinician can view during use of the handle 20297. The display may be configured to show portions of the adapter or loading unit data before, during, or after the firing instrument 20282.

[0069] Adapter 20285 may include an adapter identification device 20284 disposed therein, and loading unit 20287 may include a loading unit identification device 20288 disposed therein. Adapter identification device 20284 may communicate with controller 20298, and loading unit identification device 20288 may communicate with controller 20298. It should be understood that loading unit identification device 20288 may communicate with adapter identification device 20284, and the adapter identification device relays or transmits communications from loading unit identification device 20288 to controller 20298.

[0070] The adapter 20285 may also include a plurality of sensors 20286 (one shown) disposed around it to detect various conditions of the adapter 20285 or the environment (e.g., whether the adapter 20285 is connected to the loading unit, whether the adapter 20285 is connected to the handle, whether the drive shaft rotates, the torque of the drive shaft, the strain of the drive shaft, the temperature within the adapter 20285, the number of times the adapter 20285 is fired, the peak force of the adapter 20285 during firing, the total force applied to the adapter 20285, the peak retraction force of the adapter 20285, the number of pauses of the adapter 20285 during firing, etc.). The plurality of sensors 20286 may provide input to the adapter identification device 20284 in the form of data signals. The data signals of the plurality of sensors 20286 may be stored in the adapter identification device 20284 or may be used to update adapter data stored in the adapter identification device. The data signals of the plurality of sensors 20286 may be analog or digital. Multiple sensors 20286 may include force gauges to measure the force applied to the loading unit 20287 during firing.

[0071] The handle 20297 and adapter 20285 can be configured to interconnect the adapter identification device 20284 and the loading unit identification device 20288 with the controller 20298 via an electrical interface. The electrical interface can be a direct electrical interface (i.e., including electrical contacts that engage with each other to transmit energy and signals therebetween). Additionally or alternatively, the electrical interface can be a contactless electrical interface for wirelessly transmitting energy and signals therebetween (e.g., inductive transmission). It is also conceivable that the adapter identification device 20284 and the controller 20298 can wirelessly communicate with each other via a wireless connection separate from the electrical interface.

[0072] The handle 20297 may include a transceiver 20283 configured to transmit instrument data from the controller 20298 to other components of the system 20280 (e.g., LAN 20292, cloud 20293, console 20294, or portable device 20296). The controller 20298 may also transmit instrument data and / or measurement data associated with one or more sensors 20286 to the surgical hub. The transceiver 20283 may receive data (e.g., pod data, loading unit data, adapter data, or other notifications) from the surgical hub 20270. The transceiver 20283 may also receive data (e.g., pod data, loading unit data, or adapter data) from other components of the system 20280. For example, controller 20298 can send instrument data to console 20294, including the serial number of the attachment adapter (e.g., adapter 20285) attached to handle 20297, the serial number of the loading unit (e.g., loading unit 20287) attached to adapter 20285, and the serial number of the multi-fire fastener cartridge loaded onto the loading unit. Console 20294 can then send data associated with the attached cartridge, loading unit, and adapter (e.g., cartridge data, loading unit data, or adapter data), respectively, back to controller 20298. Controller 20298 can display the message on a local instrument display or send the message via transceiver 20283 to console 20294 or portable device 20296 for display on display 20295 or portable device screen, respectively.

[0073] Figure 6A , Figure 6B and Figure 6C An example is illustrated of a surgical system configured for manipulating tissue during laparoscopic surgery. The features described herein can be associated with the interaction between a laparoscopic bipolar dissection device 56700 and a laparoscopic gripper 20289, which work together to perform tissue retraction and cutting near the stomach and diaphragm during surgery.

[0074] Surgical systems can be used as one or more central hubs or as example systems for controlling retraction instruments. For example, as a hub, the system can coordinate multiple instruments, such as cutting and retraction tools. The system can focus on managing retraction forces, directions, and tissue displacement to protect surrounding structures. The system can be adjusted based on real-time feedback.

[0075] exist Figure 6A In this surgical system, steps during the surgical procedure may include, for example, a laparoscopic grasper 20289 retracting gastric tissue while a laparoscopic bipolar dissecting device 56700 cooperatively releases connective tissue surrounding the stomach 56706 and diaphragm 56712. The laparoscopic instruments can act together near adjacent structures (e.g., the stomach wall 56706 and connective tissue 56710), thereby avoiding damage to surrounding anatomical structures. For example, the system can identify the current task, determine the proximity of adjacent structures, and calculate the retraction force associated with cutting (e.g., surrounding tissue / connective tissue) without causing damage.

[0076] Current tasks may include surgical procedures such as mobilization, ossification, and dissection. Mobilization may involve the controlled movement and positioning of tissue to provide access to the surgical site. Ossification may involve the separation of tissue to expose vital anatomical structures, such as blood vessels or organs, while minimizing damage to the surrounding area. Dissection may involve cutting and removing target tissue. In one or more surgical procedures, the system may monitor tissue tension and proximity to adjacent structures, for example, dynamically adjusting retraction forces and cutting movements to achieve precision and reduce the risk of injury.

[0077] Figure 6B An example of a step in the surgical procedure is illustrated, where connective tissue 56710 is partially cut, and the laparoscopic gripper 20289 continues to apply a retraction force F2. As the force pulls the gastric tissue 56706 apart, the system can calculate the movement of the gripper, determine the proximity of adjacent structures, and generate control signals to adjust the retraction force in real time. The forces can be balanced so that the tissue is moved to maintain tension and is allowed to be cut in a controlled manner by the laparoscopic bipolar dissection device 56700.

[0078] Figure 6C This illustrates a step in the surgical procedure, where a laparoscopic grasper 20289 maintains a retraction force F2 on the stomach 56706 as more connective tissue 56710 is released. The surgical system can monitor the displacement of the target tissue and determine whether the applied force may cause potential damage to adjacent structures. The system can respond to control signals to modify the retraction or cutting movement based on the likelihood of damage.

[0079] Figure 7An example diagram illustrating the operation of a surgical system is shown. At 56714, the system can identify the current task associated with surgical cutting instruments configured to cooperate with retraction instruments. For example, the system can analyze the surgical procedure and consider the surgical objectives and the interaction between the cutting and retraction instruments.

[0080] When identifying the current task associated with a surgical cutting instrument, the system can use the following information: The system can analyze surgical background information, which may include the type of surgery being performed, the target tissue involved, and surrounding anatomical structures. The system can determine the task based on whether the surgical cutting instrument is energized, as the energization status of the instrument indicates whether it is ready to perform cutting, cauterization, or other actions. The system can consider the movement of the surgical cutting instrument, such as its orientation, speed, or position relative to the retractor, to identify the current task and coordinate the movements of the surgical cutting instrument and the retractor.

[0081] For example, during laparoscopic surgery, such as Figures 6A to 6C As shown, surgical cutting instrument 56700 can be positioned to cut tissue surrounding stomach 56706 and diaphragm 56712, and retraction instrument 20289 can pull apart stomach tissue. The system can analyze target tissue and surgical sites and determine the role of the instruments in the context of surgical procedures. The system can determine proximity to adjacent structures and tasks, such as cutting connective tissue, while minimizing damage to nearby structures (e.g., organs / unrelated tissues).

[0082] In the example, the surgical cutting instrument 56700 may include a smart energy device. The example energy device may be configured to perform cutting, dissection, or coagulation tasks. The example energy device may use electrosurgical techniques to cut tissue. The example energy device may use ultrasound techniques for tissue dissection. The example energy device may be used for, and associated with, purposes of reducing bleeding or improving tissue healing.

[0083] The features described herein can be associated with imaging or recognition in intelligent devices used for tissue separation and energy modulation. Imaging or recognition intelligent devices can show the path of a previous tissue plane. Based on data from the recognition system, the device can adjust the magnitude of tissue separation forces, motion, or energy used in energy-assisted dissection. Adjustments can be based on the proximity of the device to critical structures or the distance of the device from the intended path. The system can use such data to adapt the force application or generator power level based on the proximity to the previous tissue plane.

[0084] The force or generator power level can be adjusted based on the proximity of the occluded tissue plane. The system can also adjust the force or generator power level based on how tissue scarring affects tissue properties. For example, tougher, scarred tissue may be associated with a higher power level for incision. As the power level increases, the risk of making an overly deep cut may increase, potentially puncturing underlying critical structures. The system can adjust its response based on tissue scarring, applying greater energy power the closer the energizer is to the original tissue plane, and reducing the energy level when operating near critical structures.

[0085] The applied energy can be limited based on the device pressure at the initial anatomical point. The energy applied by the device can also be limited based on the pressure applied during the procedure. An energized device can create an initial anatomical point, which reduces the corresponding forces associated with mechanical instruments during tissue dissection. For example, during colorectal surgery, a surgeon can extend a circular suture cannula to tent the tissue before forming an anastomosis. The surgeon can manually assist the cannula using a monopolar pencil, thereby limiting the forces associated with the surgical procedure. Collaborative systems can utilize monopolar devices or (e.g., other) energy tools to establish anatomical points and reduce the mechanical forces associated with further dissection.

[0086] Abrasive dissection (e.g., performed with a peanut dissecter) can be based on the abrasive properties of the instrument head and the force mechanically applied to the dissected tissue. The applied force can be proportional to the depth of dissection per pass. As the direction of passage becomes more invasive, the depth of dissection can become greater, and the risk of damaging underlying critical structures may increase. When dissection approaches the original (e.g., lost tissue pathways), the surgeon may be more decisive without increasing the risk of unintended damage. Critical structures may not cross the tissue plane, and if they could, they would cross the tissue plane in predictable locations.

[0087] In examples of performing blunt dissection, such as using a peanut or grinding dissection system, the force applied may depend on the amount of lateral movement relative to the applied force. The system may utilize energy electrical parameters (such as tissue impedance) as a representative of the mechanical force. This representative parameter can limit the application of mechanical force, preventing excessive pressure from being applied.

[0088] Electrical impedance can be used as a representative of tissue compression. For example, in an example associated with a bipolar device, the system can use impedance to inform tissue characteristics and determine the mechanical force associated with suture firing, allowing the surgeon to adjust the applied force based on how easily the tissue can be dissected once the jaws are inserted. The applied force, the rate of dissection, and the ease with which the jaws open and dissect the tissue can be associated with determining how to configure the anatomical procedure, such as when tissue characteristics have changed due to scarring or other abnormalities.

[0089] Retraction instrument 20289 may include a retraction device and, for example, a retraction gripper. The retraction gripper may be configured to manipulate and retract tissue to expose the target area of ​​the surgical cutting instrument. Based on control signals generated by the system, the retraction device may be used to adjust tissue positioning in real time. Instruments 56700 and 20289 may work in conjunction with the surgical cutting device during various stages of surgical procedures.

[0090] At point 56716, the system can determine the proximity of adjacent structures relative to the retraction device. The proximity of structures can be monitored by the system to ensure that the calculated forces applied during retraction and cutting do not cause unintended harm. For example, in... Figure 6A In this system, connective tissue 56710 and the stomach wall 56706 can be located close to the surgical site being operated on by the laparoscopic instruments. The system can determine the distance between adjacent tissues and the retraction instruments to avoid excessive stretching or tearing when retracting the stomach tissue. Real-time assessment allows the retraction force applied to the target tissue (e.g., the stomach) to be controlled. The system can update its calculations as the cutting instruments perform the surgical task.

[0091] At 56718, the system can calculate the direction and intensity of the retraction force associated with the retraction instrument used to retract the first target tissue, in order to facilitate the cutting of the second target tissue by surgical instruments (e.g., based on the identified task and proximity of adjacent structures).

[0092] In this example, the system can be configured to manipulate a first target tissue and a second target tissue during surgery. The first target tissue may include a loosened organ, such as the stomach, liver, or another anatomical structure. The second target tissue may include tissue surrounding an organ intended to be cut or dissected during the loosening process. For example, during the loosening of the stomach, the second target tissue may include connective tissue or ligaments to be cut to safely reposition the organ. The system can be designed to apply a precise retraction force to the first target tissue (organ) to expose the second target tissue for cutting, thereby manipulating (e.g., effectively manipulating) the organ while dissecting the surrounding tissue.

[0093] For example, in Figure 6B In this system, the laparoscopic gripper 20289 applies a retraction force F2 to the gastric tissue 56706 while partially cutting the connective tissue 56710. The system calculates the direction in which the gastric tissue should be pulled, and the appropriate strength of the force associated with maintaining tissue tautness without causing excessive tension that could lead to injury. This calculation takes into account the proximity of the structure, the movement of the cutting instrument, and the rate of tissue displacement. The system provides force to the cutting instrument to continue the operation while avoiding excessive pressure on surrounding tissues.

[0094] At position 56720, the system can generate a control signal to instruct the retraction device to apply a retraction force in the calculated retraction direction based on the calculated retraction force intensity. Figure 6C For example, as more connective tissue 56710 is released, the laparoscopic gripper 20289 can maintain a retraction force F2 on the gastric tissue 56706. The generated control signal can guide the retraction instrument to continue pulling the gastric tissue with the calculated force, keeping the tissue in place so that the cutting instrument can be operated safely and effectively.

[0095] The system can adjust control signals in response to changes in the surgical environment, such as tissue displacement or proximity to adjacent structures. For example, if the system detects a shift in the position of the stomach or nearby tissue, it can recalibrate the retraction force in real time to maintain effective retraction.

[0096] In the example, when a surgical instrument cuts a second target tissue at a first time instance, the surgical system can determine the direction and velocity of movement associated with the surgical instrument. Based on the direction and velocity of movement associated with the surgical instrument, the system can calculate the target displacement of the first target tissue at the second time instance. Based on the target displacement of the first target tissue and the proximity of adjacent structures to the retraction instrument, the system can calculate the probability that retracting the first target tissue to the target displacement will damage adjacent structures. Based on the calculated probability, the system can generate a second control signal to modify the retraction force.

[0097] In the example, the surgical system may generate a third control signal to instruct the surgical cutting instrument to modify at least one of its direction of movement or speed of movement.

[0098] In the example, the surgical system can generate an indication that is configured to indicate the likelihood of damage to adjacent structures caused by the retraction instrument while the surgical cutting instrument maintains its current direction and speed of movement.

[0099] In the example, the surgical system can determine the target tissue tension range associated with the second target tissue based on the identified current task associated with the surgical cutting instruments.

[0100] Return to reference Figures 6A to 6C The second target tissue is exemplified as connective tissue 56710, and the dissecting device 56700 is configured to dissect this connective tissue. Tissue retraction may be related to clinical purposes. Figure 6AAs shown, the example clinical objective is that the retraction instrument 20289 can pull the gastric tissue 56706 away from the surgical site, thereby removing the organ from the visualization path to provide the surgeon with a clear view of the surgical area. Removing the organ from the visualization path facilitates the surgeon's visibility of connective tissue anatomy. In examples of gradual retraction, or in examples of using additional retraction as the organ is gradually released from its appendages, the system can apply minimal retraction force or perform stepwise displacement to ensure that the organ remains firmly retracted when its fixation is released.

[0101] Tissue retraction can generate a stable grounding force that surgical instruments (such as the laparoscopic bipolar dissection device 56700) can resist. For example... Figure 6B As illustrated, when the retraction instrument applies force F2 to the stomach, tension is generated in the surrounding tissue, thereby providing a reaction force for the dissecting instrument to separate and cut the connective tissue 56710. For example... Figure 6C As shown, grounding force allows the retraction instrument to generate tension to support the dissection and support the accuracy of separating the second target tissue (e.g., connective tissue) from the first target tissue (e.g., organ).

[0102] The system can determine the maximum retraction force intensity to avoid tearing of the second target tissue based on a defined target tension range associated with the second tissue, wherein the retraction force intensity associated with the retraction device is calculated based on the defined maximum retraction force intensity.

[0103] In the example, the surgical system can determine a target displacement associated with a first target tissue based on the identified current task associated with the surgical cutting instrument, making a second target tissue visible for cutting by the surgical cutting instrument. The system can determine a minimum retraction force intensity based on the determined target displacement associated with the first target tissue, wherein the retraction force intensity associated with the retraction instrument is calculated based on the determined minimum retraction force intensity.

[0104] In the example, the surgical system can perform clinical tasks related to tissue retraction. Organ retraction can be associated with removing an organ or a portion of an organ from a visual path, thus providing the surgeon with a clear view of the surgical site. This retraction can be gradual and associated with the retraction force on the attachments as the organ is gradually released from its attachments. In the example, the system can calculate a minimum retraction force or perform stepwise displacement to allow the organ to be retracted in a controlled manner, thereby minimizing the risk of damage when the organ's fixation is released. Example clinical tasks may include generating grounding forces that the retraction instrument resists, allowing the instrument to separate a second target tissue (such as connective tissue) from a first target tissue (e.g., an organ). By calculating the target displacement of the first target tissue, the system can enable the second target tissue to be correctly positioned for cutting. The system can determine the minimum retraction force intensity associated with achieving the displacement.

[0105] In the example, the surgical system can obtain a preselected force strength limit associated with the retraction instrument, wherein the retraction force strength associated with the retraction instrument is further calculated based on the preselected force strength limit.

[0106] In this example, the surgical system can adapt instrument loading based on the system's perception of the identified task, user control actions, and pre-selected force intensity limits. The system can obtain the pre-selected force intensity limits associated with the retraction instruments and calculate the retraction force intensity accordingly. By monitoring the surgical task (such as cutting or dissecting a second target tissue) and recognizing the user's control input, the system can adjust the applied force so that it remains within defined limits. This dynamic adaptation of the retraction force allows the instruments to minimize the risk of tissue damage while maintaining the force required to manipulate the primary target tissue. Additionally, the system can utilize the pre-selected force intensity limits to create controlled interactions between the instruments.

[0107] The features described herein can be associated with controlled constraints on forces applied to tissue to achieve desired tissue interactions. The system described herein can provide controlled constraints on forces applied to tissue during surgical procedures to achieve desired tissue interactions. Control can be based on adjustments to instrument loading, taking into account factors including awareness of the current task, user-controlled actions, and pre-selected force limits or coupled displacements. The system can adjust force limits. The system can use contextual awareness of the operation and consider how the user manipulates the instrument relative to surrounding tissue. The system can display the applied current force or force threshold relative to predefined input limits and provide feedback to the user to prevent excessive force during surgery. The system can display directional information about the applied force. Future movements can be guided, and forces can be displayed in a manner conducive to sequential surgical procedures.

[0108] The features described herein can be associated with tissue retraction and control to provide access to the surgical intervention site. The retraction device can adaptively control both the direction and intensity of the reaction force. This system can hold tissue in a static position or apply retraction force to facilitate interaction with other surgical devices.

[0109] Clinical work may be associated with tissue retraction. Tissue retraction during surgery serves a clinical function. Organ retraction can be associated with removing an organ or a portion of an organ from the surgical field, thus providing the surgeon with a clear view of the surgical area. As organ attachments are released, the system can control retraction to achieve gradual or stepwise displacement of the organ. The system can calculate and apply the minimum necessary force for retraction, thus avoiding unnecessary tension or injury. Tissue retraction provides the retraction instrument with grounding force against which it functions, which facilitates tissue separation. The system can balance the retraction force within an acceptable window of values, ensuring that the retraction force is sufficient to move the organ without causing damage and allowing the user to know the proximity of adjacent tissue structures.

[0110] The features described herein can be associated with progressive visualization and reverse retraction. The system can account for the reaction forces and displacements during tissue reverse retraction, in which the force applied by the retraction tool is proportional to the displacement force applied by the reverse retraction device. The application of proportional forces allows the tissue to move in one direction without unintentional separation. The system can continuously monitor the retraction force and the reverse retraction force, ensuring that the reverse retraction force remains within safe limits and does not interfere with critical adjacent structures. For example, if adjacent organs or critical tissues are very close, the system can restrict the movement of the retraction device to avoid accidental contact or injury.

[0111] This system incorporates situational awareness of the retraction instrument's operation relative to the surgical cutting instrument. When the surgical cutting instrument cuts a second target tissue, the system determines the instrument's direction and speed of movement. Based on the identified task, the system determines the coupling displacement between the cutting and retraction instruments and adjusts the retraction force threshold. The adjustment of the force threshold or control can be based on an understanding of how the instruments interact during surgery. The system can display the force or its threshold relative to predefined input limits.

[0112] The features described herein can be associated with tissue dissection and / or separation capabilities. This system enables tissue dissection and separation during surgical procedures. Tissue dissection and separation can facilitate the identification and navigation of tissue planes while minimizing damage to critical structures. The system can allow tissue separation to expose important surgical sites without applying excessive force. Tissue dissection and separation can be associated with complex tissue structures and / or situations where tissue planes cannot be (e.g., are not easily) distinguished, such as, for example, tissue remodeling or scarring. The system can guide the surgeon in tissue dissection (e.g., while maintaining the structural integrity of the tissue being operated on) by identifying appropriate separation lines.

[0113] The features described herein can be correlated with the identification of tissue planes to improve traversal to the desired surgical site while minimizing accidental damage to critical structures. The system can be configured to identify tissue planes. By detecting tissue planes and distinguishing them from complex planes caused by adhesions, scarring, or remodeling, the system can determine anatomical pathways. The system can provide visual or tactile feedback to help surgeons orient instruments and maintain the appropriate trajectory toward the surgical site.

[0114] The features described herein can be associated with identifying original tissue planes from complex tissue planes. In examples associated with adhesions, disordered remodeling, or scarring, the system can help identify original tissue planes that may have been obscured by adhesions, disordered remodeling, or scarring. The system can use imaging techniques to show surgeons the location of natural separation lines or tissue planes. Once tissue separation begins, the system can provide guidance by indicating the location of key structures, allowing surgeons to avoid critical structures during dissection. The system can suggest the use of energy-based devices rather than force-driven methods to enhance tissue separation.

[0115] This system can navigate situations that complicate tissue separation. For example, when tissue cannot be separated as easily as healthy tissue, the system can guide the surgeon with alternative methods. In examples involving vascularized tissue or an expanded blood supply, the system can assist by providing information on how to proceed without causing unnecessary damage. In examples involving sensitive structures such as liver casings, the system can help maintain the integrity of the casing by identifying how to safely separate surrounding tissue without damaging the structure of the liver itself.

[0116] The features described in this article can be associated with the identification of underlying critical structures. This system can help surgeons identify critical structures located beneath the surface when dissecting along known tissue planes. This may be associated with working along or within planes of adhesions or complex tissues that are obscured by anatomical structures. Imaging can be used to re-establish the location of tissue planes followed during surgical procedures such as ossification or tissue loosening.

[0117] This system can be configured to map angiogenesis, which can be associated with determining the safest anatomical pathway. Vascular structures may not cross tissue planes. If vascular structures do cross tissue planes, such as in remodeled tissue areas, they may be smaller compared to organ tissue (e.g., unremodeled organ tissue). When tissue planes are not readily visible, the system can determine them by the absence of interconnections or variations (e.g., significant variations) in vascular structure, size, or trajectory. Using multispectral imaging, the system can detect tissue planes by identifying differences in fiber bundles, tissue composition, or reflectivity. Detection of tissue planes (e.g., via identifying differences in fiber bundles, tissue composition, or reflectivity) allows surgeons to visually follow or reposition tissue planes after encountering complex tissue remodeling.

[0118] Anatomy can occur in unintended planes and based on surgeon's technical errors. This system can help maintain relative position to anatomical structures during laparoscopic and robotic surgeries, such as when orientation changes occur throughout the procedure. Maintaining relative position can be associated with unintentional tissue damage or reduction of anatomy in unintended tissue planes. For example, if a surgeon mistakenly performs anatomy in an unintended plane, the system can detect the error and maintain a tracking point in the correct tissue type or plane throughout the procedure. The tag can be discarded, and the system can automatically track the point or tissue type, allowing the surgeon to remain on the correct surgical path.

[0119] The features described herein can be associated with limiting localized and residual tissue tension. This system can limit localized and residual tissue tension during surgery by monitoring organs or connective tissue that have not yet been sufficiently moved from surrounding fixations or adhesions. When excessive force is applied, tearing, perforation, or localized bleeding may occur at the fixation or gripping point. The system can adjust the force limits by calculating the tension required for manipulation (e.g., safe manipulation) to avoid such outcomes.

[0120] The features described herein can be associated with the transmission of tissue tension and instrument-applied forces. The system can calculate and communicate the effects of instrument-applied forces on blood flow and tissue tension. Such forces can be displayed to the user or communicated (e.g., algorithmically) to constrain instrument operation. The system can provide surgeons with real-time feedback on tissue tension, forces, and their effects on tissue structure, blood flow, and healing. Communication between intelligent systems within the surgical setup can further constrain forces to avoid unintentional damage to tissue.

[0121] The features described herein can be associated with end effector control using motors and representative measurements. In patent US 9,700,309, four independent motors are used to control the closure, firing, joint movement, and distal head rotation of the end effector. Based on this architecture, the lateral force applied externally to the end effector or during active head movement can be determined using motor current (e.g., force) or reverse drive of the unpowered system (e.g., stroke). The resulting load, or the load required to activate joint movement or axis rotation, can be used as a representative of the amount of external force (e.g., tension) generated after positioning or the amount of residual force. The system can record data and transmit it from the smart endoscopic cutter to a monitoring system, such as a visualization hub, which can compare the data with other system inputs.

[0122] For visualization, laser Doppler flowmetry, intraoperative indocyanine green (ICG) fluorescence angiography, or infrared (IR) thermography can be used to detect real-time blood flow impact. Imaging techniques can use wavelengths of light to stimulate or measure active or passive emission from tissue. The measured blood flow can be compared with forces and strokes recorded by the device. Data exchange can occur bidirectionally, from device to system, from system to device, or between devices.

[0123] The features described herein can be associated with residual arterial pressure due to organ loosening. In the example, insufficient loosening of an organ with connective tissue interconnections and surrounding blood supply (e.g., the colon) can lead to residual arterial tension. This tension can cause occlusion, collapse, or insufficient blood flow when the attachment points are pulled back into the anatomy. When residual tension is present in the tissue covering the organ and surrounding arteries or capillaries, vascular collapse can occur, restricting blood flow to the organ and leading to ischemia or tissue death. Proper loosening can be associated with relieving tension and achieving adequate blood flow during surgical procedures.

[0124] The features described herein can be associated with the inhibitory function of residual organ wall or muscle tone. Residual muscle or organ wall tone, caused by stretching from a fixed point, can inhibit internal processes such as peristalsis or lymphatic flow. Peristalsis refers to the involuntary contraction and relaxation of intestinal muscles, producing a wavy motion that propels the contents forward. Lymphatic vessels, responsible for collecting and draining interstitial fluid, can function similarly to veins, with thin walls and low pressure. This system allows for adequate drainage to prevent excessive fluid accumulation, which could otherwise lead to tissue swelling, vascular compression, and tissue damage.

[0125] Larger lymphatic vessels may be equipped with a muscle, structurally intermediate between smooth muscle and cardiac muscle, which can contract rhythmically (e.g., like peristalsis) to maintain lymphatic movement. Contraction enables the lymph to move continuously to complement body movement and maintain flow when the body is at rest.

[0126] The features described herein can be associated with local tissue tension and suture management. Local tissue tension between layers or fiber bundles can cause direct tissue compression, leading to shear forces, tissue separation, local tearing, or parenchymal compressive separation. Tension can be associated with surgeries (e.g., laparoscopic or robotic colorectal anastomosis) where inappropriate suturing techniques can result in suture leakage. Suturing techniques can reduce the incidence of intraoperative air leakage and postoperative anastomotic leakage.

[0127] The system can use sensors to detect device closure and end-effector stability. Bluetooth communication can transmit data to an external hub or system (e.g., Ottava). External monitoring systems (such as local visualization range or tissue strain optical measurement systems) can notify the user of irregular tissue folds, compression changes, or inhomogeneities between tissue layers or planes. The system can recommend repositioning when the suture device or energy device is clamped but has not yet fired. The device can suggest adjustments to the rate and pauses to handle irregular tissue sections, minimize complications by controlling the advance speed, allow for more local compression, or extend the compression time.

[0128] The features described herein can be associated with the control of microtissue tension arising from the interaction between the jaws and tissue layers. This system controls the microtissue tension generated by the interaction between the jaws of a device (e.g., a dual-jaw RF advanced bipolar device, an endoscopic cutter, or a circular stapler) and the tissue layers they engage. The way tissue is handled in the jaws can affect treatment outcomes when the device resists and compresses the tissue before treatment is applied. For example, when tissue is compressed in the jaws of an endoscopic cutter, overloading the proximal end of the jaws can cause tissue layers to fold over themselves. In an example where the device is designed to compress two layers, overloading may instead result in compression of four layers.

[0129] When the I-beam or progressive pressure deployment mechanism is actuated from the proximal end to the distal end, uneven distribution of tissue within the jaws can produce variable tissue compression during suture deployment. This irregular compression can lead to uneven suture formation, irregular suture height, and uneven residual tissue compression across the suture. Such inconsistencies in tissue remodeling can result in bleeding, tissue leakage, or inadequate healing along the suture, such as in sensitive areas like the stomach or colon.

[0130] The application of a circular suture device can be associated with tissue layer irregularities. In examples associated with a circular suture device, the device fires through one or more temporary sutures. A circular anastomosis can reconnect a portion of a tubular structure (such as the colon) to a circular suture extending above a previously deployed suture. The circular suture may overlap with four layers of tissue, with other portions involving two layers. The result can be uneven tissue thickness, leading to differences in suture height and compression.

[0131] The presence of four layers of tissue and pre-existing suture bends can lead to irregular compression and structural instability. This can accelerate localized tissue death, which can occur before sufficient tissue remodeling takes place. For example, in colon surgery, circular sutures may be designed to dislodge and pass through the body within 12 to 18 days. If tissue death occurs prematurely before adequate colonic remodeling, the result can be postoperative leakage into the abdomen, potentially leading to sepsis.

[0132] The features described herein can be associated with limiting or scaling device control motion to improve end effector end-effector stability. The system can limit or scale device control motion to affect (e.g., improve) the stability of the end effector end, thereby preventing unintended coupled motions, such as tremors. By controlling the precision of the device during surgery, the system can track the movement of circular device components, allowing the user to maintain stable and controlled movements. Tracking the movement reduces errors caused by wobbling or inaccurate movement, which makes it easier for the user to guide the device and perform tasks with greater accuracy.

[0133] The features described herein can be associated with the tracking of movement of circular device components. To facilitate device control, the system can utilize a tracking mechanism to follow the movement of the circular device components. Movement tracking can be associated with simplified guidance during surgery.

[0134] It can detect tissue planes beyond the remodeled tissue plane. When the system encounters areas where tissue remodeling obscures the original tissue plane, it can project previously monitored tissue planes that have been adjusted based on the general anatomical layout of the population. The projection can highlight the possible location of key structures to guide the surgeon. The system can utilize local ultrasound imaging to identify connective tissues connecting organs and tissues on one side of a tissue plane. Ultrasound imaging can allow the identification of tissue planes that are not visible to the naked eye.

[0135] This system can identify scar tissue. It provides functionality for detecting and identifying scar tissue during the preoperative planning phase and during surgery. In preoperative planning, previous surgical procedures can indicate the presence of scar formation in the target area based on external imaging. During surgery, the surgeon can visually identify the scar, and / or the system's instruments can detect electrical properties that distinguish scar tissue from healthy tissue. Furthermore, advanced visualization techniques incorporated into the system can differentiate between scarred and non-scarred tissue.

[0136] In lobectomy, the fissures between lung lobes can be dissected. This system can aid in dissecting these fissures during lobectomy, especially in patients with a history of surgery, pneumonia, interstitial lung disease, or tuberculosis. Chronic tuberculosis can cause continuous tissue remodeling, resulting in layers of scar tissue that obscure the natural tissue plane. Following the plane can prevent damage to critical structures, and scar tissue can affect the ability to locate critical structures. Tuberculosis can increase the likelihood of cancer or require surgical intervention, which can increase the complexity of the procedure.

[0137] Surgeons can navigate downwards to arteries and veins, which can be transversely incised before the solid tissue is delineated. When tissue planes are obscured due to scarring, the system uses multispectral imaging to identify remnants of the plane. Multispectral imaging allows surgeons to proceed more decisively along anatomical pathways without causing collateral damage. By reconstructing the plane, the system helps avoid unintentional damage to vital structures, thus improving accuracy and outcomes in complex cases.

[0138] This system can indicate tissue planes and determine how to re-enter them. It provides indication of tissue planes and methods for re-entering them when they become complex or obstructed. The system can identify minimal or most aligned complex tissue paths for dissection to re-establish access to normal anatomical tissue planes. Determining the absence of underlying blood vessels or critical structures within a complex tissue plane segment can be associated with avoiding damage. The indicated anatomical path can be adjusted based on detected underlying critical or suspicious structures. Adjustments can be made by overlaying a modified preoperative whole-body CT scan with locally identified landmarks and alignment points, providing surgeons with detailed mapping of the likely locations of critical structures.

[0139] When a portion of the tissue plane is obscured, the system can rely on the portion of the tissue plane that has already been navigated or dissected, as well as the portion of the plane that remains deeper within the tissue. The system can virtually define the location where the tissue plane should be, allowing the surgeon to follow this projection route until the tissue plane visually reappears. This type of real-time guidance helps surgeons navigate complex tissue pathways without the risk of damaging critical structures or underlying blood vessels.

[0140] The instrument control force can be adjusted based on the identified task type or surgical task. The system can adjust the instrument control force based on the tissue type and the surgical task being performed. For example, in cases where the tissue does not have a natural dissection plane, such as the liver, the system can mechanically generate a dissection path. The energy device can semi-cauterize the tissue during dissection, thus relying on force-driven techniques to complete the surgery.

[0141] The features described herein can be associated with non-invasive tissue dissection. This system achieves non-invasive tissue dissection by limiting the insertion load of an instrument (e.g., a double-jaw dissecter). The amount of force applied during insertion can be carefully controlled to ensure no tissue damage. The system monitors tissue displacement relative to the applied force, allowing the surgeon to assess whether a significant amount of force has been applied to a known displacement.

[0142] Force limits within an anatomical context can be based on the use and anatomical structure. The system can adjust tissue interaction forces based on both the type of tissue being operated on and the specific surgical task. For example, during dissection or retraction, the forces applied by the instruments can be adjusted to suit the tissue type. In this example, fragile tissue may require a lower force threshold to avoid tearing or trauma. Tougher or more fibrous tissue may require higher forces to achieve the desired separation. The system can use force limits tailored to the specific tissue and surgical task, taking the anatomical context into account.

[0143] Robotic surgery force adjustment can be based on tissue type. In robotic surgery, the robotic arm can be used to push aside solid organs to allow for anatomical visibility. Because solid organs do not pose an immediate risk of damage, greater force can be applied. When the gripper is used on cancerous or fragile tissues, such as cancerous tissue, the applied force can be limited to a lower level to minimize the risk of further tissue damage. The system can automatically adjust the force limits according to the tissue type.

[0144] The force limit can be adjusted based on tissue type. The system can adjust the force limit based on the specific tissue type involved in the surgery. For example, thin and tearable mesenteric tissue with a diffuse vascular distribution may require a low force level to prevent tearing or damage. In examples of solid organs, such as during liver dissection or bifurcation of a solid organ, a greater amount of force may be allowed. For tissues such as the small intestine or colon, or in colorectal surgery, the system can apply different force limits.

[0145] For tissues including repeating cartilaginous rings that provide radial expansion forces and interconnected connective tissue (e.g., like the esophagus), compression and puncture characteristics may exist. In the example, the system can adjust the force limits using a multispectral or visible spectral visualization system or via impedance readings. Inputs (e.g., multispectral or visible spectral visualization system / impedance readings) allow the system to distinguish tissue types and adjust the force parameters accordingly.

[0146] Power actuation and energy application can be tailored based on tissue structure. The system can adjust power actuation and advanced energy application based on the tissue type and configuration detected during surgery. The system can monitor the device's performance during tissue dissection and adjust accordingly to maintain safety. For example, softer or vascular tissue may require (e.g., a lower) force threshold, while tougher tissue may allow (e.g., more) force or energy application.

[0147] In the example, when a surgical instrument cuts a second target tissue, the surgical system can determine the direction and velocity of movement associated with the surgical instrument. The system can determine the coupled displacement associated with the surgical instrument and the retraction device based on the identified current task. The system can determine the motion associated with the retraction device based on the direction of movement associated with the surgical instrument, the velocity associated with the surgical instrument, and the coupled displacement. The system can generate a control signal configured to instruct the retraction device to move according to the determined motion.

[0148] In the example, when the surgical cutting instrument cuts a second target tissue, the surgical system can determine the direction of movement associated with the surgical cutting instrument. The system can generate control signals configured to indicate, on a surgical site display, the determined direction of movement associated with the surgical cutting instrument and the calculated direction of the retraction force associated with the retraction instrument.

[0149] In the example, when a surgical instrument cuts a second target tissue, the surgical system can determine the current direction and speed of movement associated with the surgical instrument. Based on the current direction and speed of movement associated with the surgical instrument, the system can predict the cutting position of the surgical instrument at a future time instance. Based on the cutting position of the surgical instrument at the future time instance, the system can calculate the target motion and target retraction force of the retraction instrument at the future time instance. The system can generate control signals configured to indicate the determined target motion and target retraction force of the retraction instrument at the future time instance on a surgical site display.

[0150] Figure 8 An example of a machine learning-based system is illustrated, which manages surgical procedures by processing input data, AI / ML processing, and outputs in the output phase, thereby facilitating real-time adjustments and decisions during surgery. The system can influence the precision and safety of tissue retraction and cutting by analyzing input data, applying machine learning models, and generating interventions in the surgical environment. The system can adjust instrument movement and force based on real-time physiological feedback and predictive modeling.

[0151] At point 56722, the system can collect input data from various sources, including user objectives, patient demographics, physiological data determined prior to surgery, imaging data, instrument and sensor input data from surgical instruments, and real-time user engagement information. Data may include information about the surgical environment, such as tissue type, instrument location, and user preferences. Sensor data can monitor physiological signals or the status of surgical instruments.

[0152] At point 56724, the system can use a machine learning model to process the input data. The system can perform real-time physiological adjustments, predictive modeling of surgical outcomes, and use feedback loops to retract and cut tissue. Machine learning algorithms can be applied to detect patterns and assess risk, predicting potential tissue damage and recommending adjustments to the direction, speed, and force of surgical instruments.

[0153] At point 56726, the system can generate output data to guide interventions during surgical procedures. Based on the insights generated at point 56724, the system can suggest real-time adjustments to instrument movement, cutting forces, and retraction forces. The system can provide predictive metrics about potential risks and possible outcomes.

Claims

1. A surgical system comprising: Processor, the processor being configured to: Identify the current task associated with a surgical cutting instrument, which is configured to cooperate with a retraction instrument; Determine the proximity of adjacent structures relative to the retraction device; Based on the identified current task and the determined proximity of the adjacent structures, the direction and intensity of the retraction force associated with the retraction instrument are calculated, the retraction instrument being used to retract the first target tissue to facilitate the cutting of the second target tissue by the surgical cutting instrument; as well as A control signal is generated, which is configured to instruct the retraction device to apply a retraction force in the calculated retraction direction with a calculated retraction force intensity.

2. The surgical system according to claim 1, wherein, The processor is also configured to: When the surgical cutting instrument cuts the second target tissue at the first instance, the direction of movement and speed of movement associated with the surgical cutting instrument are determined; The target displacement of the first target tissue at the second time instance is calculated based on the direction of movement and the speed of movement associated with the surgical cutting instrument. Based on the target displacement of the first target tissue and the proximity of the adjacent structure to the retraction device, calculate the probability that retracting the first target tissue to the target displacement will damage the adjacent structure; as well as A second control signal is generated based on the calculated probability to modify the pulling force.

3. The surgical system according to claim 2, wherein, The processor is also configured to: A third control signal is generated to instruct the surgical cutting instrument to modify at least one of the movement direction or the movement speed.

4. The surgical system according to claim 2, wherein, The processor is also configured to: A generation instruction is configured to indicate the likelihood of damage to the adjacent structure caused by the retraction instrument while the surgical cutting instrument maintains the current direction of movement and the current speed of movement.

5. The surgical system according to claim 1, wherein, The processor is also configured to: Based on the identified current task associated with the surgical cutting instrument, determine the target tissue tension range associated with the second target tissue; as well as The maximum retraction force is determined based on the identified target tension range associated with the second tissue to avoid tearing the second target tissue, wherein the retraction force associated with the retraction device is calculated based on the identified maximum retraction force.

6. The surgical system of claim 1, wherein, The processor is also configured to: Based on the identified current task associated with the surgical cutting instrument, a target displacement associated with the first target tissue is determined, making the second target tissue visible for cutting by the surgical cutting instrument. as well as The minimum retraction force is determined based on the target displacement associated with the first target tissue, wherein the retraction force associated with the retraction device is calculated based on the determined minimum retraction force.

7. The surgical system according to claim 1, wherein, The processor is also configured to: A preselected force strength limit associated with the retraction device is obtained, wherein the retraction force strength associated with the retraction device is further calculated based on the preselected force strength limit.

8. The surgical system according to claim 1, wherein, The processor is also configured to: When the surgical cutting instrument cuts the second target tissue, the direction of movement and speed of movement associated with the surgical cutting instrument are determined; The coupling displacement associated with the surgical cutting instrument and the retraction instrument is determined based on the identified current task. The motion associated with the retraction device is determined based on the direction of movement associated with the surgical cutting instrument, the speed of movement associated with the surgical cutting instrument, and the coupling displacement. as well as A control signal is generated, which is configured to instruct the retraction device to move according to a determined motion.

9. The surgical system according to claim 1, wherein, The processor is also configured to: When the surgical cutting instrument cuts the second target tissue, a direction of movement associated with the surgical cutting instrument is determined; as well as A control signal is generated, which is configured to indicate on a surgical site display the determined direction of movement associated with the surgical cutting instrument and the calculated direction of the retraction force associated with the retraction instrument.

10. The surgical system according to claim 1, wherein, The processor is also configured to: When the surgical cutting instrument cuts the second target tissue, the current direction of movement and current speed of movement associated with the surgical cutting instrument are determined; Based on the current direction of movement and the current speed of movement associated with the surgical cutting instrument, predict the cutting position of the surgical cutting instrument at a future time instance; Based on the cutting position of the surgical cutting instrument at a future time instance, calculate the target motion and target retraction force of the retraction instrument at the future time instance; as well as A control signal is generated, which is configured to indicate the target movement of the retraction instrument and the target retraction force at the determined future time instance on a surgical site display.

11. A method for use in a surgical system, the method comprising: Identify the current task associated with a surgical cutting instrument, which is configured to cooperate with a retraction instrument; Determine the proximity of adjacent structures relative to the retraction device; Based on the identified current task and the determined proximity of the adjacent structures, the direction and intensity of the retraction force associated with the retraction instrument are calculated, the retraction instrument being used to retract the first target tissue to facilitate the cutting of the second target tissue by the surgical cutting instrument; as well as A control signal is generated, which is configured to instruct the retraction device to apply a retraction force in the calculated retraction direction with a calculated retraction force intensity.

12. The method according to claim 11, wherein, The method further includes: When the surgical cutting instrument cuts the second target tissue at the first instance, the direction of movement and speed of movement associated with the surgical cutting instrument are determined; The target displacement of the first target tissue at the second time instance is calculated based on the direction of movement and the speed of movement associated with the surgical cutting instrument. Based on the target displacement of the first target tissue and the proximity of the adjacent structure to the retraction device, calculate the probability that retracting the first target tissue to the target displacement will damage the adjacent structure; and A second control signal is generated based on the calculated probability to modify the pulling force.

13. The method according to claim 12, wherein, The method further includes: A third control signal is generated to instruct the surgical cutting instrument to modify at least one of the movement direction or the movement speed.

14. The method according to claim 12, wherein, The method further includes: A generation instruction is configured to indicate the likelihood of damage to the adjacent structure caused by the retraction instrument while the surgical cutting instrument maintains the current direction of movement and the current speed of movement.

15. The method of claim 11, wherein, The method further includes: Based on the identified current task associated with the surgical cutting instrument, determine the target tissue tension range associated with the second target tissue; and The maximum retraction force is determined based on the identified target tension range associated with the second tissue to avoid tearing the second target tissue, wherein the retraction force associated with the retraction device is calculated based on the identified maximum retraction force.

16. The method of claim 11, wherein, The method further includes: Based on the identified current task associated with the surgical cutting instrument, a target displacement associated with the first target tissue is determined, making the second target tissue visible for cutting by the surgical cutting instrument; and The minimum retraction force is determined based on the target displacement associated with the first target tissue, wherein the retraction force associated with the retraction device is calculated based on the determined minimum retraction force.

17. The method according to claim 11, wherein, The method further includes: A preselected force strength limit associated with the retraction device is obtained, wherein the retraction force strength associated with the retraction device is further calculated based on the preselected force strength limit.

18. The method according to claim 11, wherein, The method further includes: When the surgical cutting instrument cuts the second target tissue, the direction of movement and speed of movement associated with the surgical cutting instrument are determined; The coupling displacement associated with the surgical cutting instrument and the retraction instrument is determined based on the identified current task. The motion associated with the retraction instrument is determined based on the direction of movement associated with the surgical cutting instrument, the speed of movement associated with the surgical cutting instrument, and the coupling displacement; and A control signal is generated, which is configured to instruct the retraction device to move according to a determined motion.

19. The method of claim 11, wherein, The method further includes: When the surgical cutting instrument cuts the second target tissue, the direction of movement associated with the surgical cutting instrument is determined; and A control signal is generated, which is configured to indicate on a surgical site display the determined direction of movement associated with the surgical cutting instrument and the calculated direction of the retraction force associated with the retraction instrument.

20. The method according to claim 11, wherein, The method further includes: When the surgical cutting instrument cuts the second target tissue, the current direction of movement and current speed of movement associated with the surgical cutting instrument are determined; Based on the current direction of movement and the current speed of movement associated with the surgical cutting instrument, predict the cutting position of the surgical cutting instrument at a future time instance; Based on the cutting position of the surgical cutting instrument at a future time instance, calculate the target motion and target retraction force of the retraction instrument at that future time instance; and A control signal is generated, which is configured to indicate the target movement of the retraction instrument and the target retraction force at the determined future time instance on a surgical site display.

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