Graphical interface for a system used to determine tissue characteristics

Abstract

The medical system includes a first jaw and a second opposing jaw each having an inner surface, and at least one light emitting element and at least one optical sensor respectively disposed on the inner surface of one of the first jaw and the second jaw. At least one of the first jaw and the second jaw has an outer surface on the side opposite to the inner surface, and the outer surface includes at least one marking aligned with and disposed thereon with respect to the at least one optical sensor. The medical system also includes at least one visual display and a controller coupled to the optical sensor and the visual display. The controller is configured to determine the position of the tissue relative to the optical sensor and control the visual display to display a graphical interface including at least one marking corresponding to the marking on the outer surface in combination with an image corresponding to the tissue.

Description

Technical Field

[0001] The present invention relates to a graphical interface for a system used to determine the characteristics of a tissue, and more particularly, to a graphical interface for a system used to determine the characteristics of a tissue, the graphical interface including a surgical instrument marked with at least one marking and at least one visual display. 。

Background Art

[0002] Systems and methods for identifying tissues such as blood vessels in the surgical field during a surgical procedure provide valuable information to the surgeon or surgical team. In hospitals in the United States, billions of dollars in out-of-pocket expenses are incurred annually due to accidental blood vessel injuries during surgery. In addition, patients face a mortality rate of up to 32%, may require corrective treatment, and may be hospitalized for an additional nine days, resulting in additional treatment costs reaching tens of thousands of dollars, and in some cases hundreds of thousands of dollars. Therefore, the value obtained from methods and systems that can accurately determine the presence of tissues such as blood vessels in the surgical field is significant, and these costs can be reduced or avoided.

[0003] Furthermore, systems and methods for providing information regarding the presence of tissue within a surgical field are particularly important during minimally invasive surgical procedures. Conventionally, surgeons have relied on direct vision and touch to identify tissues such as blood vessels during surgery and to avoid inadvertent damage to these tissues. Due to the shift towards minimally invasive surgery, including laparoscopic and robotic surgery, surgeons have lost their direct visualization and tactile ability to determine the tissues present within the surgical field. As a result, surgeons must primarily rely on convention and experience to determine whether tissue is present within the surgical field. Unfortunately, anatomical irregularities often occur due to congenital abnormalities, scars from past surgeries, body type (such as obesity), etc. Under such conditions, a system and method that enables a surgeon to determine the presence and / or characteristics of tissue within the surgical field during surgery (potentially in real-time or near real-time) would be of great advantage.

[0004] On the other hand, while it is advantageous to include systems and methods for providing information regarding the presence of tissue within a surgical field, the adoption of such systems and methods may be hindered if they make the surgical procedure more complex. As described above, surgeons often determine the presence and / or characteristics of tissue (e.g., blood vessels) within the surgical field by direct visualization and / or palpation. Therefore, surgeons were able to perform multiple tasks simultaneously by relying on different senses to obtain different information: some information may be obtained visually, while other information may be obtained by touch. In minimally invasive surgery, since surgeons cannot directly visualize or touch the surgical field, not only can surgeons not use touch to identify, for example, the location of blood vessels within the surgical field, but this information also competes with all other visual tasks that surgeons must perform to successfully complete the surgery, to the extent that this information is presented visually to the surgeon. Therefore, if the information is provided visually, it would be advantageous if the information could be provided without the need to add a video display to the already cluttered bank of equipment that surgeons and the surgical team must monitor during the procedure.

[0005] As described in more detail below, the present disclosure describes a graphical interface that embodies an advantageous alternative to existing systems and methods, which can provide improved identification for avoiding or separating tissues such as blood vessels without unduly complicating surgical instruments or procedures.

Summary of the Invention

Means for Solving the Problems

[0006] According to one aspect of the present disclosure, a medical system includes a first jaw having an inner surface, an opposing second jaw having an inner surface, at least one light-emitting element disposed on the inner surface of one of the first jaw and the second jaw, and at least one light sensor disposed on the inner surface of one of the first jaw and the second jaw. At least one of the first jaw and the second jaw has an outer surface facing the inner surface, and the outer surface has at least one marking disposed on the outer surface, and the at least one marking is aligned with the at least one light sensor. The medical system also includes at least one visual display and a controller coupled to the at least one light sensor and the at least one visual display. The controller determines the position of the tissue relative to the at least one light sensor based on a signal from the at least one light sensor, and controls the at least one visual display to display at least one graphical interface including at least one marking corresponding to at least one marking on the outer surface of at least one of the first jaw and the second jaw, in combination with an image corresponding to the tissue disposed between the first jaw and the second jaw.

[0007] This disclosure will be more fully understood from the following description when reference is made to the accompanying drawings. Some of the drawings may be simplified by omitting selected elements for the purpose of more clearly showing other elements. Such omissions of elements in some of the drawings do not necessarily indicate the presence or absence of a particular element in any of the exemplary embodiments, except where explicitly described in the corresponding description. None of the drawings are necessarily to scale.

Brief Description of the Drawings

[0008]

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[0009] The embodiments described herein provide a medical system (e.g., a surgical system according to the illustrated embodiment) having a graphical interface for use with or in a system used to determine tissue characteristics. These graphical interfaces may include visible markings applied to medical or surgical instruments. To explain the position of tissue (e.g., blood vessels) relative to the visible markings on a medical or surgical instrument, a representation of the visible markings can be included in the graphical interface on a visual display.

[0010] The above surgical system can include a medical instrument (e.g., a surgical instrument according to the illustrated embodiment) having at least one light emitting element and at least one light sensor, and a controller coupled to the at least one light sensor. The controller is configured to determine the position of tissue relative to the at least one light sensor based on signals from the at least one light sensor. As will be described in more detail below, various different systems including at least one light emitting element, at least one light sensor, and associated controllers have been proposed by the applicant to make this determination using light transmitted through or reflected from tissue. One or more of these different systems may be included in a medical device.

[0011] The medical instrument has a visible surface (i.e., an outer surface), and at least one marking is disposed on the visible surface. The at least one marking is aligned with the at least one light sensor in a known manner. The controller is coupled to at least one visual display and is configured to control the at least one visual display to display a graphical interface including at least one marking corresponding to the at least one marking on the outer surface of the medical instrument in combination with an image corresponding to tissue disposed between a first jaw and a second jaw.

[0012] According to a series of embodiments, the surgical system includes a medical instrument having a first jaw with an inner surface and a second opposing jaw with an inner surface. Thus, the surgical system can be described as having a first jaw with an inner surface and a second opposing jaw with an inner surface.

[0013] At least one light-emitting element may be disposed on an inner surface of one of the first jaw and the second jaw, and at least one light sensor may be disposed on an inner surface of one of the first jaw and the second jaw. In a series of embodiments, at least one light-emitting element may be disposed in the first jaw and at least one light sensor may be disposed in the second jaw, and determination of the position of the tissue may depend on transmitted light. In another series of embodiments, at least one light-emitting element and at least one light sensor may be disposed in the same jaw (i.e., either the first jaw or the second jaw), and determination of the position of the tissue may depend on reflected light.

[0014] At least one of the first jaw and the second jaw has an outer surface facing the inner surface. At least one marking is disposed on the outer surface, and at least one marking is aligned with at least one light sensor.

[0015] In this way, by combining the image showing the markings on the medical device and the image corresponding to the tissue, the system displays the information obtained from the sensor in a manner that can correlate the information with the markings present in the surgical field where the information was obtained. This allows the surgeon and the surgical team to simplify the processing of this information in one or more of various ways. For example, information regarding the tissue between Joe is not displayed at or near the surgical site. This can avoid the possibility that the fluid (such as blood) present in the surgical field obscures the information regarding the tissue (such as its presence and type). In fact, the markings on the tools and instruments can be optimized to be visible even in the presence of body fluids and other aspects of the surgery. Similarly, the tissue image can be optimized for display on the display device. The combination of the markings in the graphical interface (more precisely, the markings representing the markings on the instrument or tool) and the tissue image provides the possibility of an overall improved interface for communicating this information to the user (such as a surgeon), with an image of the tissue optimized for readability on the visual display and markings optimized for readability in the surgical field. This is beneficial in minimally invasive surgery and robotic surgery, but also beneficial when the surgeon can directly view the surgical field with the naked eye.

[0016] Although the surgical system has been described generally in this way, various embodiments of the surgical system will be described below. These embodiments are provided for illustrative purposes and are not intended to be limiting.

[0017] First, referring to FIGS. 1 - 4, an embodiment of a surgical system 100 is illustrated, which can be used to determine the characteristics of tissue (e.g., presence, diameter, etc.). For example, the system 100 can be used to determine the presence of one tissue, such as a vasculature V, within a region 102 of another tissue T proximate to the working end 104 of a surgical instrument 106. The embodiments of FIGS. 1 - 4 are illustrated with an example where one of the two tissues is vascular tissue, but the usefulness of this system 100 is not limited to such an environment. Further, the environment is not limited to two tissues and may include more than two tissues or may include a single tissue (e.g., a skeletonized blood vessel).

[0018] The vasculature V may be connected to other vasculatures along with the region 102 of tissue T, and furthermore, it will be understood that the vasculature V may extend beyond the region 102 so as to be in fluid communication with other organs (e.g., the heart) present within the patient's body. Further, although tissue T is shown in FIGS. 1 - 4 as completely surrounding the vasculature V to a specific depth (with respect to both circumference and length), this need not be the case in all examples where the system 100 is used. For example, tissue T may only partially surround the vasculature V and / or may only surround a portion of the length of the vasculature V, or tissue T may cover the vasculature V with a very thin layer. As a further non - limiting example, the vasculature V may be a blood vessel, and tissue T may be connective tissue, adipose tissue, and / or liver tissue.

[0019] According to the embodiments shown in FIGS. 1-4, the working end 104 of the surgical instrument 106 is also the distal end of the shaft 108. Thus, the working end and the distal end are referred to as the working end portion 104 or the distal end portion 104. Further, the shaft 108 has a proximal end portion 110, and a grip or handle 112 (referred to as grip 112 herein without distinction) is disposed at the proximal end portion 110 of the shaft 108. The grip 112 is designed according to the nature of the instrument 106. Regarding the thermal ligation device shown in FIG. 1, the grip 112 may be a pistol-shaped grip including a trigger 114. As yet another method, a finger ring generally disposed on a scissor-shaped grip may also be used.

[0020] The working end portion or distal end portion 104 and the proximal end portion 110 having the grip 112 are shown as being disposed at opposite extreme ends of the shaft 108, but it will be appreciated that a given surgical instrument may have a working end (e.g., a tool tip is attached) disposed at an opposite extreme end of the shaft and a grip region disposed intermediate the opposite working ends. In accordance with the terms "distal" and "proximal" used herein, the working end of such an instrument is referred to herein as the distal end portion and the gripping region as the proximal end portion. However, in connection with the illustrated embodiments, the distal end portion and the proximal end portion are located at opposite extreme ends (or simply opposite ends) of the shaft 108.

[0021] Although the surgical instrument 106 is shown as including the shaft 108, it will also be appreciated that embodiments of the system 100 are not limited to only instruments 106 having an elongate shaft as shown. For example, the instrument 106 may be in a form similar to a scissor-type tool (e.g., forceps, hemostatic instrument, sealer / divider, etc.), in which case reference may be made to the distal end or working end portion 104 and the proximal end portion 110 where the grip 112 (in the form of a finger ring or handle) may be disposed. An example of such an embodiment is included in FIG. 17 and is given the same reference numerals as the embodiment shown in FIG. 1. Other embodiments including embodiments where the working end portion 104 is part of a robotic instrument are also within the scope of the present disclosure.

[0022] As described above, according to the illustrated embodiment, the surgical system 100 includes a sensor having at least one light emitting element 120 (or simply the light emitting element 120) and at least one light sensor or detector 122 (or simply the light sensor 122). Refer to FIGS. 2-4. According to the illustrated embodiment, a controller 124 is coupled to the light emitting element 120 and the light sensor 122, and this controller 124 can include a splitter 126 and an analyzer 128, as will be described below. Refer to FIGS. 1 and 17.

[0023] The light emitting element 120 is disposed at the working end 104 of the surgical instrument 106. Also, the light sensor 122 is disposed at the working end 104 of the surgical instrument 106. It can be said that either the light emitting element 120 or the light sensor 122 is disposed at the working end 104, and the light emitting element 120 or the light sensor 122 is physically attached to the working end 104. Alternatively, the light emitting element 120 or the light sensor 122 can be disposed at the working end 104 to which the light emitting element 120 or the light sensor is connected by an optical guide (e.g., an optical fiber), with the first end of the optical guide disposed at the working end 104 and the second end of the optical guide disposed at another location (e.g., the proximal end 110).

[0024] System 100 can operate according to a transmittance-based approach such that the optical sensor 122 is disposed opposite the light-emitting element 120 on the opposing jaws 140, 142 of the surgical instrument 106, as shown, for example, in FIG. 2 (or FIG. 17). More specifically, the first jaw 140 can have an inner surface 144 on which at least one light-emitting element 120 is disposed or mounted, and the second opposing jaw 142 can have an inner surface 146 on which at least one optical sensor 122 is disposed or mounted. Also, system 100 can operate according to a reflectance-based approach, in which case the optical sensor 122 is disposed on the same structure (e.g., a jaw) as the light-emitting element 120 with the optical sensor and the light-emitting elements 122, 120 facing in a common direction, such that a structure exactly similar to the transmittance-based approach shown in FIG. 2 is visible to the user. For example, both the light-emitting element 120 and the optical sensor 122 may be disposed on the inner surface 146 of the second jaw 142.

[0025] It is also possible to operate system 100 according to a reflectance-based approach, in which case the light-emitting element 120 and the optical sensor 122 can face in a common direction and be spaced apart by a certain distance on one of the jaws 140 of a two-jaw device 140, 142, such as, for example, a thermal ligation device (FIG. 3), although the relative angle between the light-emitting element 120 and the optical sensor 122 may be fixed or variable. The light-emitting element 120 and the optical sensor 122 of the reflectance-based system can be configured such that the distance between the light-emitting element 120 and the optical sensor 122 can be adjusted, for example, by positioning the light-emitting element 120 at the tip or end of one jaw 140 of the two-jaw device and the optical sensor 122 at the tip or end of the other jaw 142 of the two-jaw device, as shown in FIG. 4.

[0026] The light-emitting element 120 can be configured to emit light of at least one wavelength. For example, the light-emitting element 120 can emit light having a wavelength of 660 nm. This may be realized by a single element or by a plurality of elements (these elements may be arranged or configured in an array, for example, as will be described in detail below). Similarly, the optical sensor 122 is configured to detect light of at least one wavelength (e.g., 660 nm). According to the embodiments described herein, the optical sensor 122 can also include a plurality of elements, and these elements are arranged or configured in an array.

[0027] According to a particular embodiment, the light-emitting element 120 is configured to emit light of at least two different wavelengths, and the optical sensor 122 is configured to detect light of at least two different wavelengths. As an example, the light-emitting element 120 can emit light of a plurality of wavelengths in the visible range, and the optical sensor 122 can detect light of a plurality of wavelengths in the near-infrared range or the infrared range. According to other embodiments, the light-emitting element 120 and the sensor 122 can radiate and detect light of a plurality of wavelengths.

[0028] According to some embodiments, each individual optical sensor 122 is configured to generate a signal that includes a first pulsating component and a second non-pulsating component. It will be appreciated that the first pulsating component can be the alternating current (AC) component of the signal, and the second non-pulsating component can be the direct current (DC) component. When the optical sensor 122 is in the form of an array, the pulsating information and the non-pulsating information can be generated for each element of the array, or at least for each element of the array that defines at least one column of the array.

[0029] According to such an embodiment, the controller 124 can be coupled to the optical sensor 122 and include a splitter 126 for separating a first pulsating component and a second non-pulsating component for each element of the optical sensor array 122. Further, the controller 124 can also include an analyzer 128 for determining (at least in part) the presence and / or characteristics of tissue, such as a blood vessel V, in the region 102 proximate to the operative end 104 of the surgical instrument 106 based on the pulsating component and / or the non-pulsating component. The pulsating component, the non-pulsating component, or a combination of both components can be used to determine the characteristics (e.g., presence, measurements) of the tissue in the surgical field. Such a system is described in one or more of the following applications, all of which are hereby incorporated by reference in their entirety: U.S. Patent Application Publication Nos. 2021 / 0338260, 2021 / 0068856, 2020 / 0345297, 2020 / 0337633, 2020 / 0268311, 2019 / 0175158, 2019 / 0046220, 2019 / 0038136, 2018 / 0289315, 2018 / 0098705, 2018 / 0042522, 2017 / 0367772, 2017 / 0181701, and 2015 / 0066000.

[0030] In the illustrated embodiment, a light-emitting element and a sensor including an optical sensor are used. However, a surgical system having a graphical interface can be used with other sensors or sensor systems / assemblies. For example, sensors can include other optical sensors or sensing systems, ultrasonic sensors or sensing systems, ultrasonic Doppler sensors or sensing systems, acoustic Doppler sensors or sensing systems, laser Doppler sensors or sensing systems, photoacoustic sensors or sensing systems, magnetic sensors or sensing systems, thermographic sensors or sensing systems, ultrasonic sensors or sensing systems, electrical (e.g., impedance-based) sensors or sensing systems, or any other sensors or sensing systems that can be used to detect or determine the characteristics of tissue. When the sensor or sensing system includes a transmitter (such as a light-emitting element) and a receiver (such as an optical sensor), the transmitter and receiver can be disposed at the working end 104 of a medical (e.g., surgical) instrument or tool 106 (this expression is used herein) as in the embodiments shown in FIGS. 2-4 above. The graphical interface described herein is particularly relevant to the light-emitting element / optical sensor-based system exemplified herein, but is also useful for the other sensors or sensing systems described in this paragraph.

[0031] As described above, the medical system according to the present disclosure provides a graphical interface for transferring or communicating information to a user by combining markings representative of at least one marking on a medical device and an image of tissue determined by a controller. FIGS. 5-14 illustrate different embodiments of such a system. Each of the different embodiments of FIGS. 5-14 can be considered a combination of features illustrated only in that particular embodiment, although embodiments of different figures can also share common or overlapping features. For example, one or more of the embodiments shown in FIGS. 5-14 can include a first marking corresponding to a first end of an optical sensor array, a second marking corresponding to a second end of the optical sensor array, and a third marking corresponding to the center of the array. Thus, the features of the individual embodiments may be combined in additional ways not directly illustrated in FIGS. 5-14, and these additional ways will be consistent with the various embodiments shown and the common or overlapping features among the various embodiments.

[0032] Similarly, the description of an embodiment regarding one surgical instrument or tool is not meant to be limited to use only with such a surgical instrument or tool. For example, the embodiments of FIGS. 5-16 show a graphical interface using a two-joystick instrument or tool where Joe is located at the end of the shaft (similar to the case of an endoscope or robotic tool), but the two-joystick instrument or tool could alternatively be forceps, hemostatic forceps, or a sealer / divider. Thus, any of the embodiments described with reference to the system shown in FIG. 1 incorporating a two-joystick tool with an elongated shaft can also be used with a system as shown in FIG. 17.

[0033] Each of the embodiments shown in FIGS. 5-14 includes a plan view of at least one of the outer surfaces 148, 150 of two jo surgical instruments, particularly the jo 140, 142 of a surgical instrument such as a thermal ligation instrument. Compare FIGS. 2 and 5-14. Further, a jo (e.g., jo 142) having one or more markings disposed thereon (e.g., on the outer surface 150) may also have a light sensor 122 in the form of an array of light sensors disposed on an inner surface (e.g., inner surface 146) facing the illustrated outer surface. According to certain embodiments, one or more markings can cover an area on the outer surface (e.g., 150) that is equal to or substantially equal to the area on the inner surface (e.g., 146) covered by the light sensor 122. According to other embodiments, one or more markings can cover an area on the outer surface that is larger or smaller than the area on the inner surface covered by the light sensor 122.

[0034] According to certain embodiments, one or more markings can be etched onto the surface. According to other embodiments, one or more markings can instead be disposed on the surface by overlaying (e.g., painting) one or more markings onto the surface. It is also possible to combine both etching and overlaying in one embodiment to dispose one or more markings on the surface. Depending on the material used for the jo, another method may be more suitable. For example, if the jo is made of metal, it may be more suitable to etch the markings onto the jo.

[0035] According to certain embodiments, in addition to or instead of etching or overlaying one or more markings, it may be possible to illuminate one or more markings. According to certain embodiments, one or more markings may be defined by a portion (or portions) or region (or regions) of an external surface (such as 150) that is transparent or translucent, and one or more light sources (such as a light emitting diode (LED), the end of an optical fiber, etc.) may be disposed behind the portion of the external surface that is transparent or translucent. In such embodiments, the transparent or translucent portion or region can be defined by removing the material of the joe (such as joe 142) and replacing the removed material with a transparent or translucent material (such as a window). Alternatively, the joe (such as 142) may be composed of a transparent or translucent material, and the portion or region defining one or more markings is distinguished by covering the remaining portion of the external surface with a light-blocking substance (i.e., a substance that is opaque or has a lower translucency than the region forming at least one or more markings), such as a mask, shield, or coating. According to other embodiments, one or more markings can be defined by the light source itself: for example, an LED may be disposed on the external surface or attached to the external surface to define one or more markings.

[0036] Also, each of FIGS. 5-14 also shows a visual display 160 used with the illustrated surgical instrument. The visual display may be, for example, part of a video monitor, but may also be, for example, part of a head-up video display, a video headset, or smart glasses. Further, the present disclosure is not limited to embodiments in which a single visual display 160 is used. A plurality of visual displays can be used, and some of the displays can display only a graphical interface, as will be described in more detail below, while other parts of the displays can display a graphical interface that includes additional information. As another example, the graphical interface may be displayed as a picture-in-picture with other information regarding the patient's vital signs, and vice versa.

[0037] Next, referring to FIG. 5, an embodiment of a surgical system 100 including a surgical instrument 106, such as described in relation to the embodiment of FIG. 2, is shown. In the embodiment of FIG. 2, the surgical instrument 106 has two jaws 140, 142, with at least one light emitting element 120 disposed (or specifically, attached) on jaw 140, and at least one light sensor 122 disposed (or specifically, attached) on jaw 142. Thus, the instrument 106 has an outer surface 150 illustrated in a plan view in the left half of FIG. 5, and markings 170, 172, 174, 176 disposed on the outer surface 150. According to other embodiments, both jaws 140, 142 can instead have one or more markings, such as markings 170, 172, 174, 176, disposed on their respective outer surfaces 148, 150.

[0038] Markings 170, 172, 174, 176 are disposed or formed on the outer surface 150 such that the lateral marking 174 is aligned with at least one optical sensor 122. In particular, when at least one optical sensor 122 is an array of optical sensors 122, the marking 174 disposed on the outer surface 150 corresponds to the center of the array. In fact, when at least one optical sensor 122 is a linear array of optical sensors 122, the marking 174 is disposed on the outer surface 150 at the center of the linear array. This marking 174 is sometimes referred to as the lateral central axis.

[0039] Furthermore, the lateral marking 170 is disposed on the outer surface 150 at the first end of the array of optical sensors 122, and the lateral marking 172 is disposed on the outer surface 150 at the second end of the array of optical sensors 122. Thus, since the marking 174 corresponds to the center or the middle of the array of optical sensors 122, the lateral marking 174 is equidistant from the markings 170, 172. All three of the lateral markings 170, 172, 174 may be lines of different thicknesses, and these lines may appear to be substantially rectangular with respect to the other lines due to their relative thicknesses and may sometimes be referred to as bars without distinction. The different thicknesses can be used to distinguish the markings inside (between the two ends of a set of markings) from the markings outside (the two ends of a set of markings).

[0040] As also shown in the embodiment of FIG. 5, the marking can include a marking 176 that connects the three markings 170, 172, 174. The marking 176 can represent the longitudinal axis of the array of optical sensors 122 and can be arranged along or through the midpoint of each of the markings, i.e., lines 170, 172, 174, as the longitudinal central axis. According to other embodiments, the marking 176 can be arranged at either one end or the other end of the lines 170, 172, or at a position closer to one end than the other end of the lines 170, 172 (i.e., to the left or right of that shown in FIG. 5 with reference to the orientation of the jaws 142 in the plan view of FIG. 5). Since the line 176 in the embodiment of FIG. 5 is arranged inside the end lines 170, 172, it is thinner than the end lines 170, 172, similar to the central line 174.

[0041] The visual display 160 is shown in the right half of FIG. 5 and can include a live image 180 of the surgical field 102 and a graphical interface 182. The controller 124 can combine the live image 180 received from a camera or scope with the graphical interface 182 to provide an integrated image that includes both a visual image of the surgical field and information obtained from the optical sensors 122. In particular, the controller 124 can determine the position of the tissue relative to at least one optical sensor 122 based on signals from at least one optical sensor 122 and then control the visual display to display a graphical interface 182 that provides an image 184 corresponding to the calculated position of the tissue between the jaws 140, 142. More specifically, the controller 124 can control the visual display 160 to display a graphical interface that includes at least one marking 186 corresponding to at least one marking 174 on the outer surface 150 of the second jaw 142, in combination with an image 184 corresponding to the tissue disposed between the first jaw 140 and the second jaw 142.

[0042] In the embodiment shown in FIG. 5, the image 184 includes at least two different regions 188, 190. Region 188 includes the region between the dashed lines, which can represent a first tissue type, such as blood vessels. Region 190 includes the region outside the dashed lines, which can represent a second tissue type, such as adipose tissue. The two regions can be distinguished in the image 184 by using different colors. For example, region 188 can be filled with red and region 190 can be filled with white. Other methods may be used to distinguish the different regions (e.g., different shades of a single color). Regions 188, 190 may include a single region (e.g., corresponding only to the adipose tissue disposed between jaws 140, 142 of the instrument 106) or two or more regions (e.g., ureter, blood vessels, and adipose tissue).

[0043] As can also be seen in the graphical interface 182, the marking 186 can include a line or bar, although other geometric shapes may be used instead. The marking 186 corresponds to the center line 174 of the marking of the instrument 106, particularly the jaw 142. In combination with the image 184, the marking 186 can convey to the user the information that the vasculature (represented by region 188) is between the marking 174 and the marking 170, and the marking 170 has been pre - shown to the user as corresponding to the left end of the graphical interface 182. To remind the user of this correspondence, the interface 182 can have a left end with a rounded shape rather than the flat end shown in FIG. 5. Refer to FIG. 8 described below.

[0044] Other information may be combined with the graphical interface 182. For example, the width of the vasculature can be displayed at one end or the other of the graphical interface 182. Alternatively, numerical scales can be displayed along the image 184 to allow the user to determine the relative distance between the tissue and the central marking 174 or the end markings 170, 172. For example, refer to FIG. 8.

[0045] FIG. 6 shows an embodiment similar to that shown in FIG. 5. Therefore, the reference numerals for the common features are carried over from FIG. 5, and new reference numerals are used for the features specific to the embodiment of FIG. 6.

[0046] The embodiment of FIG. 6 includes an additional marking 178 disposed between the first marking 170 and the third marking 174 and between the second marking 172 and the third marking 174, and the additional marking 178 represents a dimension different from those of the first, second, and third markings 170, 172, 174. For example, the marking 178 can be disposed equidistantly from the first marking 170 and the third marking 174 and from the second marking 172 and the third marking 174, and can represent half of the distance between the main markings 170, 172. These additional markings 178 can also be referred to as quadrant partitions. Since the markings 178 are internal with respect to both ends of a set of markings, they may be thinner than the markings 170, 172 and may also be shorter than the lateral central axis 174 so as to be easily distinguishable from the central axis 174.

[0047] Similarly, the graphical interface 182 includes markings 192 corresponding to the additional markings 178 on the external surface 150 of the joe 142, particularly the joe 142. With these additional markings 192, the user can further associate the information displayed as the image 184 with the tissue disposed between the joes 140, 142. Other information described above with respect to the graphical interface 182 also applies similarly to the embodiment of FIG. 6.

[0048] Also, FIG. 7 shows an embodiment similar to that shown in FIG. 5. Therefore, the reference numerals for the common features are carried over from FIG. 5, and new reference numerals are used for the features specific to the embodiment of FIG. 7.

[0049] The embodiment of FIG. 7 includes a design 200 superimposed on a third marking 174. The design 200 can include a first diagonal line 202 and a second diagonal line 204 joined at a midpoint so as to form an "X" overlapping the lateral central axis. The first and second markings 170, 172 still define the extent of the sensor region (or an array according to the illustrated embodiment), and the longitudinal central axis 176 still refers to the central plane of the sensor array. However, the diagonal lines 202, 204 can provide an angular reference used when associating the information of the image 184 with the jaws 140, 142.

[0050] For this reason, the graphical interface 182 can include data regarding the orientation of the vasculature relative to the horizontal axis. For example, the region 188 can be arranged at an angle of approximately 20 degrees relative to the horizontal axis. The diagonal lines 202, 204 can be used by the user as an additional reference for the information displayed in the image 184 with respect to the jaws 140, 142 of the instrument 106. That is, the angular value of 20 degrees can mean that the vasculature is in the same orientation as the diagonal line 204 and between the jaws 140, 142, but at a shallower inclination relative to the horizontal axis. The other information described above with respect to the graphical interface similarly applies to the embodiment of FIG. 7.

[0051] It will be appreciated that the features of the embodiment of FIG. 7 may be combined with the features of the embodiment of FIG. 6. According to such an embodiment, the user will be able to obtain additional spatial information regarding the position of the tissue relative to the center and both ends of the sensor array, as well as relative angular information regarding the tissue.

[0052] It will also be appreciated that the superimposed design is not used to convey additional information such as angular information. Instead, the superimposed design can be used simply to further emphasize the special nature of the lateral central axis 174. For example, refer to FIGS. 12 and 13.

[0053] FIG. 8 shows an additional embodiment that can be described, for example, with respect to the embodiment of the surgical instrument 106 of FIG. 2. Thus, the instrument 106 has an outer surface 150 illustrated in a plan view in the left half of FIG. 8 and markings disposed on the outer surface 150. According to a particular embodiment, both jaws 140, 142 can have markings such as markings 210, 212, 214, 216 disposed on their respective outer surfaces 148, 150.

[0054] The markings 210, 212, 214, 216 are disposed or formed on the outer surface 150 such that the lateral marking 214 is aligned with at least one light sensor 122. In particular, when at least one light sensor 122 is an array of light sensors 122, the marking 214 corresponds to the center of the array, and when at least one light sensor 122 is a linear array, the marking 214 is disposed at the center of the linear array. The lateral marking 210 is disposed at a first end of the array of light sensors 122, and the lateral marking 212 is disposed at a second end of the array of light sensors 122. All three of the lateral markings 210, 212, 214 can be lines of the same thickness. This is because related information is displayed on each of the lines 210, 212, 214.

[0055] As also shown in the embodiment of FIG. 8, a marking 216 connects the three markings 210, 212, 214. The marking 216 can represent the longitudinal axis of the array of light sensors 122 and can be disposed at one end or side of the first, second, and third markings 210, 212, 214. Similar to the lines 210, 212, 214, this line 216 can have the same line thickness as the other lines 210, 212, 214.

[0056] Each of the markings 210, 212, 214 may be associated with or paired with numerical values 211, 213, 215. These numerical values 211, 213, 215 can correspond to the distances between the markings 210, 212, 214 and one or the other end of the sensor array, as in the case of the embodiment shown in FIG. 8. That is, the marking 210 corresponds to the first end of the array, to which a "0" (zero) value is associated. The second marking 212 is associated with a value of "17.0" and corresponds to 17 mm from the end of the array aligned with the marking 210. Similarly, the third marking 214 is associated with a value of "8.5" and corresponds to 8.5 mm from the end of the array aligned with the marking 210. The numerical displays 211, 213, 215 may assist in associating the information from the display 160 with the displays 210, 212, 214 on the instrument 106.

[0057] It will be seen that starting the numerical markings 211, 213, 215 from a "0" (zero) value corresponding to the marking 210 and incrementing the value for each of the markings 212, 214 is just one possible option. Instead, according to other embodiments, the numerical markings 211, 213, 215 can start from the marking 212 and increment the value for each of the markings 214, 210. As yet another alternative, the numerical markings 211, 213, 215 can indicate the distance from the marking 214, with the marking 214 as a reference. See FIG. 10.

[0058] The visual display 160 is shown in the right half of FIG. 8 and can include a live image 220 of the surgical field 102 and a graphical interface 222. The controller 124 can combine the live image 220 received from a camera or scope and the graphical interface 222 to provide an integrated image that includes both a visual image of the surgical field and information obtained from the optical sensor 122. Similar to the above-described embodiments, the controller 124 can determine the position of the tissue and then control the visual display to display a graphical interface 222 that provides an image 224 corresponding to the position of the tissue between Joe 140, 142. More specifically, the controller 124 can control the visual display 160 to display a graphical interface 222 that includes at least one marking 226.

[0059] In the embodiment shown in FIG. 8, the image 224 includes at least two different regions 228, 230. Region 228 includes the region between the dashed lines, which can represent a first tissue type, such as blood vessels. Region 230 includes the region outside the dashed lines, which can represent a second tissue type, such as adipose tissue. By using different colors, the two regions can be distinguished in the image 224. For example, region 228 can be filled with red and region 230 can be filled with green.

[0060] According to this embodiment, the marking 226 includes a scale disposed on one side of the image 224. The scale 226 includes a plurality of individual markings 227, each of which corresponds to an individual unit of distance from a preceding (or succeeding) marking. In order to be able to compare the scale with the markings of the instrument 106, each of the numerical markings 211, 213, 215 can be included in the scale 226. In combination with the image 224, the scale 226 and its scaled length markings can be used to approximate the widths of the regions 228, 230 of the image 224.

[0061] Furthermore, the graphical interface 222 can include additional information such as, for example, the width of the tissue within region 228. Also, the interface 222 can include information regarding, for example, the relative slope of the tissue within region 228 with respect to the horizontal axis. This information may be conveyed both in numerical form and in the form of an angular indicator (e.g., a line) 232 superimposed on region 228.

[0062] As a further feature, the graphical interface 222 can include a jo indicator 234. In the particular illustrated embodiment, the jo indicator 234 may be a semi-circular region attached to one end or the other end of the tissue image 224. The indicator 234 corresponds to the curved end of the jo 142 and provides a visual reference on the graphical interface 222 to remind the user of the orientation of the image 224 and the scale 226 with respect to the jo 142 of the instrument 106.

[0063] FIG. 9 shows an embodiment similar to that shown in FIG. 8. Therefore, the reference numerals for the common features are carried over from FIG. 8, and new reference numerals are used for the features specific to the embodiment of FIG. 9.

[0064] The markings 210, 212, 214, 216 are arranged or formed on the outer surface 150 such that the lateral marking 214 is aligned with at least one optical sensor 122. In particular, when at least one optical sensor 122 is an array of optical sensors 122, the marking 214 corresponds to the center of the array, and when at least one optical sensor 122 is a linear array, the marking 214 is arranged at the center of the linear array. The lateral marking 210 is arranged at the first end of the array of optical sensors 122, and the lateral marking 212 is arranged at the second end of the array of optical sensors 122. The three lateral markings 210, 212, 214 may all be lines of similar thickness since information related to each of the lines 210, 212, 214 is displayed, but the markings 210, 212 may be longer in the transverse direction than the marking 214 so as to indicate the ends of the corresponding sensor array.

[0065] As also shown in the embodiment of FIG. 8, the marking 216 connects the three markings 210, 212, 214. The marking 216 represents the longitudinal axis of the array of optical sensors 122 and is disposed at one end or side of the first, second, and third markings 210, 212, 214.

[0066] Each of the markings 210, 212, 214 may be associated with or paired with numerical values 211, 213, 215. Different from the embodiment of FIG. 8, each marking corresponds to the distance between the markings 210, 212, 214 and the end or tip of the joe 142. That is, the marking 210 corresponds to the first end of the array, which is associated with the value "6" indicating that the first end of the array (i.e., the marking 210) is 6 mm from the end or tip of the joe 142. The second marking 212 is associated with the value "22" corresponding to 22 mm from the end of the joe 142. Similarly, the third marking 214 is associated with the value "14" corresponding to 14 mm from the end of the joe 142.

[0067] Accordingly, the graphical interface 222 conveys information regarding the position of the tissue relative to the end or tip of the joe, rather than the end of the optical sensor array. Except for this difference, the general structure and operation of the graphical interface are the same as in FIG. 8.

[0068] The features of the embodiments of FIGS. 8 and 9 may be replaced or combined. For example, a longer horizontal line from the embodiment of FIG. 9 may be used with the embodiment of FIG. 8 to represent both ends of the optical sensor array, or may be used in combination with the numerical values of the embodiment of FIG. 8 indicating the distance from one end of the optical sensor array. As another example, the numerical values from the embodiment of FIG. 9 may be used in combination with other markings of the embodiment of FIG. 8 to convey the distance from the end or tip of the joe 142 instead of the distance from the end of the optical sensor array.

[0069] Figure 10 is a further embodiment having aspects common to the embodiments of Figures 8 and 9 and having new features that provide a significantly different overall representation. That is, the markings of the embodiment of Figure 10 also include a number of horizontal markings and at least one vertical marking connecting the horizontal markings at a first end or a first side. A second vertical marking also connects the horizontal markings at a second or opposite end, or a second or opposite side. In this way, the markings constitute a graphic box indicating the ends and sides of the light sensor array with respect to the outer surface 150 of Joe 142.

[0070] Furthermore, as shown in the left half of Figure 10, the numerical markings associated with the horizontal markings are provided in two variations. The first variation, shown as being disposed on the surface 150, includes numerical markings indicating the distance from either end to the horizontal central axis, which are associated with the numerical value of "0" (zero). The second variation, shown immediately to the right of the variation disposed on the surface 150, does not include a numerical display indicating the distance from either end to the horizontal central axis, but the horizontal central axis is marked with a numerical display of "0" (zero).

[0071] In a similar manner, the visual display has a graphical interface marked with graduated distance markings having a central reference position associated with the numerical marking of "0" (zero). In this way, the correspondence between the markings on the outer surface 150 of Joe 142 and the markings of the graphical interface may be conveyed to the user. Furthermore, both ends of the graduations of the graphical interface may include numerical values corresponding to the numerical values disposed on the outer surface 150, or may be omitted if the numerical values are omitted on the outer surface 150 of Joe 142.

[0072] Next, from the left side of FIG. 10, markings 250, 252, 254, 256, 258 are disposed or formed on the outer surface 150 such that at least the lateral marking 254 is aligned with at least one optical sensor 122. In particular, when at least one optical sensor 122 is an array of optical sensors 122, the marking 254 corresponds to the center of the array, and when at least one optical sensor 122 is a linear array, the marking 254 is disposed at the center of the linear array. The first lateral marking 250 is disposed at the first end of the array of optical sensors 122, and the lateral marking 252 is disposed at the second end of the array of optical sensors 122. The three lateral markings 250, 252, 254 can all be lines of the same thickness. This is because related information is displayed on each of the lines 250, 252, 254.

[0073] As also shown in the embodiment of FIG. 10, a first longitudinal marking 256 connects the three markings 250, 252, 254. The marking 256 can be disposed at one end or one side of the first, second, and third markings 250, 252, 254. A second longitudinal marking 258 also connects the three markings 250, 252, 254. The marking 258 can be disposed at the end or side of the first, second, and third markings 250, 252, 254 that is opposite to the first end or side. Similar to the lines 250, 252, 254, the lines 256, 258 may have the same line thickness as the other lines 250, 252, 254.

[0074] As described above, the lines 250, 252, 256, 258 can define a box that indicates the outer boundary of the optical sensor array with respect to the outer surface 150 of Joe. It can be seen that due to the nature of the outer surface 150 of Joe 142, the correspondence may be only approximate in that while the inner surface 146 of Joe 142 is planar, the outer surface 150 of Joe 142 may be curved. However, as a result, useful information can still be conveyed to the user.

[0075] Each of the markings 250, 252, 254 of the first modification of the embodiment of FIG. 10 may be associated with the numerical values 251, 253, 255 or may be in pairs. These numerical values 251, 253, 255 can correspond to the distances between the markings 250, 252, 254 and the center of the optical sensor array. That is, the third marking 254 corresponds to the center of the array, which is associated with a "0" (zero) value. The first marking 250 is associated with a "-8.5" value and corresponds to the end of the joystick 142 or 8.5 mm from the center of the array in the direction of the tip. Similarly, the second marking 254 is associated with an "8.5" value and corresponds to 8.5 mm from the center of the array in the pivot direction between the joysticks 140, 142. Thus, the numerical markings 251, 253, 255 are useful for associating information from the display 160 with the markings 250, 252, 254 on the instrument 106 in that one marking 251 is located closer to one end or tip of the first joystick 140 and the second joystick 142, another marking 253 is located closer to the pivot between the first joystick 140 and the second joystick, and the marking 251 is different from the marking 253.

[0076] It will be appreciated that the embodiment of the first modification having the numerical markings 251, 253, 255 is only one possible option. According to an embodiment of the second modification, the numerical markings 251, 253 can be omitted. Therefore, the box defined by the markings 250, 252, 256, 258 remains, but only the horizontal central axis is indicated by the numerical marking 255. For example, refer to the modification shown in FIG. 10.

[0077] The visual display 160 is shown in the right half of FIG. 10 and can include a live image 260 of the surgical field 102 and a graphical interface 262. The controller 124 can combine the live image 260 received from a camera or scope and the graphical interface 262 to provide an integrated image that includes both a visual image of the surgical field and information obtained from the light sensor 122. Similar to the above-described embodiments, the controller 124 can determine the position of the tissue and then control the visual display to display a graphical interface 262 that provides an image 264 corresponding to the position of the tissue between Joe 140 and 142. More specifically, the controller 124 can control the visual display 160 to display a graphical interface 262 that includes at least one marking 266.

[0078] In the embodiment shown in FIG. 10, the image 264 includes at least two different regions 268, 270. Region 268 includes the region between the dashed lines, which can represent a first tissue type, such as a blood vessel. Region 270 includes the region outside the dashed line, which can represent a second tissue type, such as adipose tissue. The two regions can be distinguished in the image 264 by using different colors, for example, region 268 can be filled with red and region 270 can be filled with white.

[0079] According to this embodiment, the marking 266 includes a scale disposed on one side of the image 264. The scale 266 includes a plurality of individual markings 267, each of which corresponds to an individual unit of distance from a preceding (or succeeding) marking. To enable comparison of the scale with the markings of the instrument 106, at least a numerical marking 255 ("0") can be included in the scale 266. In combination with the image 254, the scale 266 and its scaled length markings can be used to approximate the widths of the regions 268, 270 of the image 264.

[0080] Furthermore, the graphical interface 262 can include additional information such as, for example, the width of the tissue within the region 268. Also, the interface 262 can include information regarding, for example, the relative slope of the tissue within the region 268 with respect to the horizontal axis.

[0081] The embodiments of FIGS. 11 - 14 differ from the embodiments of FIGS. 8 - 10 in that at least the markings on at least the outer surface 150 of the joe 142 do not include markings of numerical values representing distances from a reference point or axis. Instead, similar to the embodiments shown in FIGS. 5 - 7, the embodiments of FIGS. 11 - 14 convey information through the use of geometric structures, figures, and / or designs.

[0082] In the embodiment of FIG. 11, the instrument 106 has markings 290, 292, 294 disposed on the outer surface 150, where the left half of FIG. 11 shows the outer surface 150 in a plan view. According to a particular embodiment, both joes 140, 142 can have markings such as markings 290, 292, 294 disposed on their respective outer surfaces 148, 150.

[0083] The markings 290, 292, 294 are disposed or formed on the outer surface 150 such that at least the marking 294 is aligned with at least one light sensor 122. In particular, when at least one light sensor 122 is an array of light sensors 122, the marking 294 disposed on the outer surface 150 corresponds to the center of the array. In fact, when at least one light sensor 122 is a linear array of light sensors 122, the marking 294 is disposed on the outer surface 150 at the center of the linear array. The marking 290 is disposed on the outer surface 150 at the first end of the array of light sensors 122, and the marking 292 is disposed on the outer surface 150 at the second end of the array of light sensors 122. Since the marking 294 corresponds to the center or middle of the array of light sensors 122, the markings 290, 292 are disposed on either side of the marking 294.

[0084] Any of the three markings 290, 292, and 294 may be of a specific geometric structure, design, or shape. As shown in the illustration, the markings 290, 292, and 294 may be rectangular boxes, and these rectangular boxes may further be approximately square as shown in the illustration. It is not necessary for all three markings to have the same geometric structure, design, or shape. For example, the central marking 294 can be a different marking (e.g., a circle) from the markings 290 and 292 on both sides. Additionally, different structures, designs, or shapes may be carried over to the graphical interface to facilitate the correlation between the markings 290, 292, and 294 on Joe 142 and the graphical interface. The markings 290, 292, and 294 are spaced apart from each other so that each geometric structure, design, or shape is visible separately. However, the markings 290, 292, and 294 may instead be arranged on the surface 150 such that the outer markings 290 and 292 are in contact with the central marking 294 on both sides of the central marking 294.

[0085] As also shown in FIG. 11, each of the markings 290, 292, and 294 can include alphanumeric indicators associated with the markings 290, 292, and 294. For example, the marking 292 can be associated with "A", the marking 294 can be associated with "B", and the marking 292 can be associated with "C". This information can be carried over to the graphical interface to facilitate the correlation between the markings 290, 292, and 294 on Joe 142 and the graphical interface.

[0086] The visual display 160 is shown in the right half of FIG. 11 and can include a live image 300 of the surgical field 102 and a graphical interface 302. The controller 124 can combine the live image 300 received from a camera or scope with the graphical interface 302 to provide an integrated image that includes both a visual image of the surgical field and information obtained from the light sensor 122. In particular, the controller 124 determines the position of the tissue relative to at least one light sensor 122 based on the signal from at least one light sensor 122 and then controls the visual display to display a graphical interface 302 that provides an image 304 corresponding to the position of the tissue between the jaws 140, 142.

[0087] More specifically, the control device 124 can control the visual display 160 to display a graphical interface 302 that includes at least one marking 306, 308, 310 corresponding to at least one marking 290, 292, 294 on the outer surface 150 of the second jaw 142 in combination with an image 300 corresponding to the tissue disposed between the first jaw 140 and the second jaw 142. As described above, each marking 306, 308, 310 may be associated with one of the markings 290, 292, 294 or may have a common structure, design, or shape as the markings 290, 292, 294. In the illustrated embodiment, the regions or zones 306, 308, 310 can appear to be distinguishable from one another by one or more markings that divide the image 304 into three regions even though the regions or zones 306, 308, 310 are not spaced apart as markings 290, 292, 294 such that the regions or zones 306, 308, 310 would be separately visible.

[0088] In the embodiment shown in FIG. 11, the image 304 also includes at least two different regions 312, 314. Region 312 includes the region between the dashed lines, which can represent a first tissue type, such as blood vessels. Region 314 includes the region outside the dashed lines, which can represent a second tissue type, such as adipose tissue. The two regions can be distinguished in the image 304 by using different colors. For example, region 312 can be filled with red and region 314 can be filled with white. Other methods may be used to distinguish the different regions (e.g., different shades of a single color), and the regions can include a single region (e.g., corresponding only to the adipose tissue located between jaws 140, 142 of the instrument 106) or two or more regions (e.g., ureter, blood vessels, and adipose tissue).

[0089] Other information may be combined with the graphical interface 302. For example, the width of the vessel can be displayed at one end or the other of the graphical interface 302. However, according to certain embodiments, it may be sufficient if the user can associate the position of region 312 within the interface 302 with markings 290, 292, 294 so as to be able to identify whether a particular tissue is near or at the center of jaws 140, 142.

[0090] In the embodiment of FIG. 12, a single marking 324 may be disposed or formed on the outer surface 150 such that the marking 324 is aligned with at least one light sensor 122. In particular, when at least one light sensor 122 is an array of light sensors 122, the marking 324 may be disposed on the outer surface 150 corresponding to the center of the array. In fact, when at least one light sensor 122 is a linear array of light sensors 122, the marking 324 is disposed on the outer surface 150 at the center of the linear array. The marking 324 can have a particular geometric structure, design, or shape so as to quickly identify the center of the array, and as a result, quickly correlate the marking 324 on jaw 142 with the display on the graphical interface.

[0091] Markings 326 and 328 can also be provided on the surface 150, one being disposed on one side of the marking 324 and the other being disposed on the opposite side of the marking 324. The lengths of these longitudinally oriented markings 326 and 328 can indicate the length of the sensor array, similar to the markings in the embodiment of FIG. 10. Thereby, the correlation between the markings 324, 326, 328 and the graphical interface can also be facilitated.

[0092] The visual display 160 is shown in the right half of FIG. 12 and can include a live image 330 of the surgical field 102 and a graphical interface 332. The controller 124 can combine the live image 330 received from the camera or scope and the graphical interface 332 to provide an integrated image that includes both the visual image of the surgical field and the information obtained from the optical sensor 122. In particular, the controller 124 determines the position of the tissue relative to at least one optical sensor 122 based on the signal from at least one optical sensor 122 and then controls the visual display to display a graphical interface 332 that provides an image 334 corresponding to the position of the tissue between the jaws 140, 142. Also, a graduated distance section 336 can be provided so that the widths of different regions of the image 334 can be visually estimated.

[0093] In the embodiment shown in FIG. 12, similar to the other embodiments, the image 334 includes at least two different regions 338, 340. Region 338 includes the region between the dashed lines, which can represent a first tissue type, such as the ureter. Region 340 includes the region outside the dashed line, which can represent a second tissue type, such as adipose tissue. The two regions can be distinguished in the image 334 by using different colors. For example, region 338 can be filled with red and region 340 can be filled with white. Other methods may be used to distinguish the different regions (e.g., different shades of a single color), and the regions may include a single region (e.g., corresponding only to the adipose tissue located between jaws 140, 142 of the instrument 106) or two or more regions (e.g., the ureter, blood vessels, and adipose tissue).

[0094] Other information may be combined with the graphical interface 332. For example, the width of the blood vessel can be displayed at one end or the other end of the graphical interface 332. However, according to a particular embodiment, it may be sufficient if the user can correlate the position of region 338 within the interface 332 so as to be able to identify whether a particular tissue is near or within the center of jaws 140, 142.

[0095] To further facilitate the identification and correlation of information on the graphical interface 332 with the markings 324, 326, 328, the graphical interface 332 may include an organizational indicator 342, and the indicator 342 may include one or more markings that move along the image 334 as, for example, the region 338 moves along the image 334 between the two ends of the image 334. As shown, the indicator 342 includes two triangular markings like the heads of arrows that move along the image 334, one above the image 334 and the other below the image 334. Thereby, the user can provide a graphical way to identify the position of a specific region of the tissue 338 on the image 334 and associate that information with Joe 140, 142 via the markings 324, 326, 328. The organizational indicator 342 may even identify a specific sub-region (e.g., approximately the longitudinal center) within the region of the tissue 338 on the image 334.

[0096] As shown, the organizational indicator 342 can be configured to convey not only the position of the region (or sub-region) of the tissue 338 on the image 334 but also the characteristics of the tissue. For example, the organizational indicator 342 can include alphanumeric characters or letters related to the type of tissue. As shown, the organizational indicator 342 includes a "U" arranged horizontally between the heads of two triangular arrows, and the "U" can be associated with the "ureter". In this way, the indicator 342 conveys the position of the ureter but also provides an indicator that distinguishes the ureter from other tissues (e.g., blood vessels). Similarly, blood vessels can be displayed as "BV" (meaning "blood vessel") or "V" (meaning "vascular"), and other tissues can be displayed with letters, numbers, or combinations thereof.

[0097] In the illustration of FIG. 12, alphanumeric characters or letters are used, but it will be appreciated that geometric structures, designs, or shapes may be used instead. For example, a triangle may be used to represent the ureter instead of a "U", and a square may be used to represent a blood vessel. In a preferred embodiment of using geometric structures, designs, or shapes for the tissue indicator 342, geometric structures, designs, or shapes other than the marking 324 are used to avoid confusion regarding the information transmitted by the indicator 342 (i.e., the geometric structure / tissue indicator 342 does not actually indicate only the center of the array associated with the marking 324). However, according to other embodiments, a circle may be used as the marking 324 and for the indicator 342.

[0098] FIG. 13 shows a further embodiment that is similar to the embodiment of FIG. 12. In particular, in the embodiment of FIG. 13, a marking 354 in the form of a geometric structure, design, or shape (e.g., a circle) disposed on the surface 150 of the joe 142 is used to indicate the center of the photosensor array. Different from the embodiment of FIG. 12, in the embodiment of FIG. 13, no longitudinal markings are used on either side of the marking 354. Instead, in the embodiment of FIG. 13, a plurality of transverse markings 356 are used to indicate the length of the photosensor array, and the markings 356 are disposed only in regions on the surface 150 that are substantially coaxial with the photosensor array. As will be described below, the markings 356 can provide additional assistance in correlating the tissue image, which is part of the graphical interface, with the joes 140, 142.

[0099] The visual display 160 is shown in the right half of FIG. 13 and can include a live image 330 of the surgical field 102 and a graphical interface 358. The controller 124 can combine the live image 330 received from a camera or scope with the graphical interface 358 to provide an integrated image including a visual image of the surgical field that includes information obtained from the light sensor 122. In particular, the controller 124 determines the position of the tissue relative to at least one light sensor 122 based on a signal from at least one light sensor 122 and then controls the visual display to display a graphical interface 358 that provides an image 360 corresponding to the position of the tissue between the jaws 140, 142.

[0100] In the embodiment shown in FIG. 13, similar to the other embodiments described above, the image 360 includes at least two different regions 362, 364. Region 362 includes the region between the dashed lines, which can represent a first tissue type, such as a ureter or blood vessel. Region 364 includes the region outside the dashed lines, which can represent a second tissue type, such as adipose tissue. The two regions 362, 364 can be distinguished within the image 360 by using different colors. For example, region 362 can be filled with red and region 364 can be filled with white.

[0101] In addition, the interface 358 can also include geometric markings 366 and other markings 368. These markings 366, 368 correspond to the markings 354, 356 disposed on the surface 150 of the jaw 142 of the instrument or tool 106. The correspondence between the markings 366, 368 and the markings 354, 356 can assist in communicating or relaying information about the tissue disposed between the jaws 140, 142 to the user. In particular, the same geometric structure, design, or shape (i.e., a circle) can be used for the marking 354 and the marking 366, enabling better communication or relay of information to the user. Further, the markings 356, 368 can be used to provide information regarding the relative position and size of the tissue displayed in the tissue image 260 and the tissue between the jaws 140, 142. In embodiments where the spacing between the markings 356 is known, the spacing between the markings 368 can be used to determine or approximate the size of the tissue region displayed in the image 360 (i.e., the interface 358). The markings 366, 368 can also be combined with other markings that indicate the end or tip of the jaw 142 to communicate or relay additional information to the user. See FIGS. 8, 9, or 14.

[0102] Additionally, the above discussion related to the embodiment of FIG. 12 (and the other embodiments above) generally also applies to the embodiment of FIG. 13.

[0103] FIG. 14 shows yet another embodiment that has similarities with the embodiments of FIGS. 12 and 13. In particular, in the embodiment of FIG. 14, markings 374 in the form of a geometric structure, design, or shape (e.g., a circle) are used to indicate the center of the light sensor array. Unlike the embodiments of FIGS. 12 and 13, in the embodiment of FIG. 14, vertical or horizontal markings are not used to indicate the length of the light sensor array. Instead, markings 376 in the form of a further geometric structure (a quadrilateral as shown) are disposed on a surface 150 that is substantially coaxial with the light sensor array. Marking 366 can provide further assistance with respect to the correlation between the tissue image that is part of the graphical interface and Joe 140, 142.

[0104] Visual display 160 is shown in the right half of FIG. 14 and can include a live image 330 of the surgical field 102 and a graphical interface 378. Controller 124 can combine the live image received from the camera or scope with the graphical interface to provide an integrated image that includes both a visual image of the surgical field and information obtained from light sensor 122. In particular, controller 124 can determine the position of the tissue with respect to at least one light sensor 122 based on signals from at least one light sensor 122 and then control the visual display to display a graphical interface that provides an image 380 corresponding to the position of the tissue between Joe 140, 142.

[0105] In the embodiment shown in FIG. 14, similar to the other embodiments, image 380 includes at least two different regions 382, 384. Region 382 includes the region between the dashed lines, which can represent a first tissue type, such as a ureter or blood vessel. Region 384 includes the region outside the dashed lines, which can represent a second tissue type, such as adipose tissue. The two regions 382, 384 can be distinguished within image 380 by using different colors. For example, region 382 can be filled with red and region 384 can be filled with white.

[0106] In addition, interface 378 can also include geometric markings 386 and other markings 388, 390. These markings 386, 388 correspond to the markings 374, 376 disposed on the surface 150 of the jaw 142 of the instrument or tool 106. The correspondence between the markings 386, 388 and the markings 374, 376 can assist in communicating or relaying information about the tissue disposed between the jaws 140, 142 to the user. In particular, the same geometric structure, design, or shape (i.e., a circle) is used for the marking 374 and the marking 386, enabling better communication or relay of information to the user. Further, the markings 376, 388 can be used to provide information regarding the relative position and size of the tissue displayed in the tissue image 280 and the tissue between the jaws 140, 142. The graphical interface can optionally include orientation markings 390, which are similar to those shown in FIGS. 8 and 9 in the form of rounded ends corresponding to the tips of the jaws 140, 142, enabling the user to better associate the markings 374, 376 with the graphical interface 378.

[0107] Otherwise, the above discussion (and the other above embodiments) related to the embodiments of FIGS. 12 and 13 are generally applicable to the embodiment of FIG. 14 as well.

[0108] Figures 5 - 14 show embodiments that are used primarily with a system where markings on an instrument or tool reference the position of tissue between the jaws of the instrument or tool. However, other embodiments may instead include markings on an instrument or tool that are used with a system that references the position of tissue proximate to the jaws of the instrument or tool when the tissue is not between the jaws of the instrument or tool. Such embodiments are particularly useful with the reflectance - based systems shown in FIGS. 3 and 4, where, in contrast to between the jaws, the element and sensor are arranged to detect tissue proximate to the tip or end of the jaw. In such embodiments, markings can also be included on the jaws, but the graphical interface can include a tissue image including a jaw indicator for associating the position of the end or tip of the jaw with information regarding the tissue proximate to (or remote from) the end or tip of the jaw. Further embodiments can include markings that enable correlation of information displayed regarding tissue between the jaws with markings on the outer surface of the jaw, and also markings that enable display of the distance of tissue proximate to the end or tip of the jaw. Such embodiments are also within the scope of the present disclosure.

[0109] Although the various structures and modes of operation of the surgical system have been described, additional detailed descriptions of the sensors, controllers, and other ancillary devices will now be provided.

[0110] The graphical interface described above can be used with the light - emitting element 120 and the light sensor 122 that define the sensor, but it will be appreciated that the graphical interface can also be used with other sensors. As noted above, the graphical interface can be used in combination with, for example, an ultrasonic sensor. However, the most preferred system includes the graphical interface, the light - emitting element 120, and the light sensor 122. Accordingly, further comments regarding the light - emitting element 120 and the light sensor 122 are included below.

[0111] As mentioned above, the light emitting element 120 can include one or more elements. According to the embodiment schematically shown in FIG. 2, the optical sensor 122 can include a first light emitting element 120-1, a second light emitting element 120-2, and a third light emitting element 120-3. All the light emitting elements may be adapted to emit light at a specific wavelength (e.g., 660 nm), or a specific light emitting element may be adapted to emit light at a wavelength different from that of other light emitting elements. Each light emitting element may be, for example, a light emitting diode.

[0112] As shown in FIG. 2, for those embodiments in which the light emitting element 120 is in the form of an array including one or more light emitting diodes, the diodes may be arranged in the form of a one-dimensional, two-dimensional, or three-dimensional array. Examples of a two-dimensional array include arranging diodes in a plurality of rows and columns on a single plane. Further examples of a two-dimensional array include arranging diodes along a line on or within a curved surface. A three-dimensional array can include diodes arranged in a plurality of planes so as to form a plurality of rows and columns on or within a curved surface.

[0113] The optical sensor 122 can also include one or more elements. Here, according to the embodiment shown in FIG. 2, the optical sensor 122 can include a first optical sensor 122-1, a second optical sensor 122-2, an nth optical sensor 122-n, and the like. Similar to the case of the light emitting elements 120-1, 120-2, 120-3, the optical sensors 122-1, 122-2, 122-3 may be arranged in an array, and the above discussion regarding the array also applies here.

[0114] In fact, when the array of optical sensors 122 includes rows of optical sensors (such as in FIG. 2), instead, the array 122 can be referred to as a linear array. The individual optical sensors of the array 122 may be arranged adjacent to each other, or the optical sensors may be arranged spaced apart from each other. It is also possible to separate the individual optical sensors that make up a column of optical sensors from each other by optical sensors that make up different rows or columns of the array. However, according to a particular embodiment, the array can comprise a charge-coupled device (CCD), in particular a linear CCD image sensor consisting of a plurality of pixels. As yet another option, a CMOS sensor array can also be used.

[0115] The arrangements of the light-emitting element 120 and the optical sensor 122 may be different between the transmittance-based embodiment of FIG. 2 and the reflectance-based embodiments of FIGS. 3 and 4, and it is likewise true that the light-emitting element 120 and the optical sensor 122 in the reflectance-based embodiments may include a plurality of elements.

[0116] Comparing the arrangements shown in FIGS. 3 and 4 with the arrangement of FIG. 2, the light-emitting element 120 and the optical sensor 122 are generally arranged facing in a common direction (i.e., the direction of the target tissue sample). Thereby, it is not generally necessary for the light-emitting element 120 and the sensor 122 to be arranged in a common plane, although this is preferred. According to a particular embodiment, the light-emitting element 120 and the sensor 122 can be formed integrally (i.e., as a single unit) with the surgical instrument 106 (see FIGS. 3 and 4), although other options are possible as will be described later. In this way, the light emitted by the light-emitting element 120 and scattered by the target tissue can be captured by the optical sensor 122.

[0117] Furthermore, the distance between the light-emitting element 120 and the sensor 122 is considered likely to affect the light received by the sensor 122. As currently understood, after photons contact tissue and leave the light-emitting element 120, an ensemble of independent photons returns to the surface and reaches the sensor 122. Some of the detected photons travel a short distance from the plane of the light-emitting element and the detector and emerge at the location of the sensor 122, while some photons move further through the tissue before emerging from the surface without being absorbed (absorbed photons cannot contribute to the photocurrent). The path length distribution and penetration depth of the photons reaching the sensor 122 vary according to the distance between the light-emitting element and the sensor, and the maximum effective photon depth penetration value is several times the physical distance between the light-emitting element and the sensor. For example, by setting the distance between the light-emitting element 120 and the sensor 122 to 5 mm, blood vessels from 0 mm to 12 mm below the tissue surface can be detected.

[0118] Changes in blood volume due to the difference between systolic pressure and diastolic pressure in an artery embedded in tissue affect the relative number of long-distance traveling photons that survive and reach the sensor 122. The temporarily observed difference in the number of long-distance traveling photons caused by the presence of an artery in the photon trajectory is the cause of the pulsatile (AC) signal. When the separation between the light source and the detector is small, the detected photons traveling a short distance are less exposed to the circulation of arterial blood deeper below the tissue surface, so they can survive with a more uniform likelihood between systole and diastole. As the separation between the light source and the detector increases, the proportion of long-distance traveling photons among the photons reaching the sensor 122 increases, and the detected pulse amplitude increases. Therefore, it is considered that by increasing the distance between the light-emitting element 120 and the sensor 122, light penetrates deeper into the tissue, enabling detection of blood vessels deeper down.

[0119] Furthermore, it is considered that a similar effect can be obtained by adjusting the angles of the light-emitting element 120 and / or the sensor 122. That is, by changing the linear distance between the light-emitting element 120 and the sensor 122, it becomes possible to sample different proportions of long-distance moving photons at the surface sensor 122. Similarly, by changing the angles of the light-emitting element 120 and / or the sensor 122, it is possible to change the depth and distance that the photons move before being sampled by the sensor 122. As a result, it is considered that by changing the angle of the light-emitting element and / or the sensor, the depth at which the instrument 106 can detect blood vessels can be changed.

[0120] Therefore, according to the embodiments described herein, the light-emitting element 120 and the sensor 122 can be arranged so as to be attached in a fixed relationship with each other, or in a movable or adjustable relationship. In particular, FIG. 3 shows an embodiment in which the light-emitting element 120 and the sensor 122 are at a certain distance from each other and have a certain angular relationship between the light-emitting element 120 and the sensor 122. With such an embodiment, the user can be confident that the detected blood vessel is, for example, within 12 mm from the working end 104 of the instrument 106. In contrast, in the embodiment of FIG. 4, the light-emitting element 120 is attached to the first jaw 140 of the instrument 106, and the sensor 122 is attached to the second jaw 142 of the instrument 106. In such an embodiment, the user can change the detection depth simply by changing the distance between the jaws 140, 142 of the instrument 106: with the jaws 140, 142 closed, the user can probe a shallow blood vessel (i.e., a blood vessel within 12 mm from the tissue surface), while with the jaws 140, 142 open, the user can probe a deep blood vessel (i.e., a blood vessel below 12 mm from the tissue surface). According to the embodiment shown in FIG. 4, the control structure for operating the jaws 140, 142 can be configured to correct the distance between the jaws 140, 142 in a controlled manner (e.g., in discrete increments) so that the user can determine the jaw spacing (and thus the detection depth) without visualizing the jaws 140, 142.

[0121] As described above, the light-emitting elements 120 in FIGS. 3 and 4 can include one or more elements. According to such an embodiment, all of these elements may be adapted to emit light at a specific wavelength (e.g., 660 nm), or a specific element may emit light at a wavelength different from that of other elements. A system having a plurality of light-emitting elements 120 and / or a plurality of sensors 122 is considered to have an improved signal-to-noise ratio and spatial resolution compared to a system including a single light-emitting element 120 and a sensor 122.

[0122] Regarding those embodiments in which the light-emitting element 120 is in the form of an array including one or more light-emitting diodes, the diodes can be arranged in the form of a one-dimensional, two-dimensional, or three-dimensional array. Examples of a two-dimensional array include arranging diodes in a plurality of rows and columns on a single plane. Further examples of a two-dimensional array include arranging diodes along a line on or within a curved surface. A three-dimensional array can include diodes arranged in a plurality of planes so as to form a plurality of rows and columns on or within a curved surface.

[0123] Furthermore, the optical sensor 122 can be provided with a mechanism for physically excluding photons reaching the sensor 122 from various angles. This mechanism can be composed of a mask or a grated layer for physically filtering photons that do not reach the sensor 122 at a substantially perpendicular angle. It has been observed that the average depth transmittance of photons emitted from the light-emitting element 120 is equal to slightly more than half of the distance between the light source and the detector (for a 5 mm interval, a transmittance of about 2.5 mm). This mechanism increases the proportion of long-distance moving and deep-penetrating photons received by the sensor 122 and increases the depth at which blood vessels are detected by the device.

[0124] For all of the above embodiments, system 100 can include hardware and software in addition to light emitting element 120, sensor 122, and controller 124. For example, if a plurality of light emitting elements 120 are used, a drive controller can be provided to control the switching of individual emitter elements. Similarly, if a plurality of sensors 122 are provided, a multiplexer can be provided, which can be coupled to sensors 122 and an amplifier. Further, controller 124 can include a filter and analog-to-digital conversion as needed.

[0125] According to certain embodiments, splitter 126 and analyzer 128 may be constituted by one or more electrical circuit components. According to other embodiments, one or more processors (or simply a processor) can be programmed to perform the operations of splitter 126 and analyzer 128. According to further embodiments, splitter 126 and analyzer 128 may be partly constituted by electrical circuit components and partly by a processor programmed to perform the operations of splitter 126 and analyzer 128.

[0126] For example, splitter 126 can include or be constituted by a processor programmed to separate the pulsating component from the non-pulsating component. Further, analyzer 128 can include or be constituted by a processor programmed to determine (or, for example, quantify the size of) the presence of blood vessel V in region 102 proximate to working end 104 of surgical instrument 106 based on the pulsating component and / or the non-pulsating component. The instructions by which the processor is programmed may be stored on a memory associated with the processor, and this memory may include one or more tangible non-transitory computer-readable memories storing computer-executable instructions that, when executed by the processor, can cause one or more processors to perform one or more actions.

[0127] In addition to the above, FIGS. 15 and 16 show an embodiment of the surgical system 100 in combination with an embodiment of a video system 400 that can be conventionally used, for example, during minimally invasive surgery or laparoscopic surgery. The video system 400 includes a video camera or other image capture device 402, a video or other related processor 404, and a display 406 having a viewing screen 408.

[0128] As shown, the video camera 402 is directed at an area 102 proximate the working ends 104 of the two surgical instruments 106. As shown, both surgical instruments 106 are part of an embodiment of the surgical system 100 as illustrated in and discussed above with respect to FIG. 1. Other elements of the surgical system 100 are omitted for ease of illustration, but it should be noted that elements of the system 100, such as the splitter 126 and the analyzer 128, may be housed in the same physical housing as the video processor 404.

[0129] Signals from the video camera 402 are passed through the video processor 404 to the display 406, and the surgeon or other members of the surgical team can view not only the area 102 but also the working ends 104 of the surgical instruments 106, which are typically inside the patient. Because the markings 140, 142, i.e., on the surface 150 of the area 102, are in proximity, the markings are also visible on the display screen 408. As described above, this advantageously enables the surgeon to receive visual cues via the markings on the same display 406 as the area 102 and the working ends 104, on the same display screen 408. As a result, the surgeon does not have to search for where the information transmitted through the markings is located.

[0130] FIG. 16 shows another embodiment of the video system 400 that can be used in combination with the embodiment of the surgical system 100. According to this embodiment, the video processor 404 is not disposed in a housing separate from the video camera 402', but is disposed in the same housing as the video camera 402'. According to a further embodiment, the video processor 404 may instead be disposed as the display screen 408' within the same housing as the remainder of the display 406'. Otherwise, the above discussion regarding the embodiment of the video system 400 shown in FIG. 15 similarly applies to the embodiment of the video system 400 shown in FIG. 16.

[0131] The combination of the markings on the surface of the surgical instrument and the graphical interface described above advantageously enables the surgeon or surgical team to view the output from the controller 124, but as shown in FIGS. 1, 15, and 16, it is also possible to include other output devices. For example, a warning may be displayed on a video monitor being used in the surgery (e.g., displays 406, 406' in FIGS. 15 and 16), or the image on the monitor can be distorted, blinked, changed in size, or otherwise altered in appearance. Further, one or more light-emitting elements 430 can be disposed at the working end 104 of the surgical instrument 106 (see FIGS. 15 and 16), or at the proximal end 110 of the shaft 108 (including the case where it is disposed on or attached to the grip or handle 112) to provide a visual display or alarm. Also, the auxiliary output may be in the form of, or include, a speaker 502 that provides an audible alarm. Further, the auxiliary output may be in the form of, or incorporate, a safety lockout associated with the surgical instrument 106 that interrupts the use of the surgical instrument 106. For example, the lockout could prevent ligation or cauterization if the surgical instrument 106 is a thermal ligation instrument. As yet another example, the auxiliary output may be in the form of a tactile feedback system such as a vibrator 504 that is attached to or integrally formed with the handle or handpiece of the surgical instrument 106 to provide a tactile display or alarm. Various combinations of these specific forms of auxiliary output can also be used.

[0132] Also, if the surgical system 100 includes one or more light-emitting elements 430 disposed at the working end 103 or proximal end 110 of the surgical instrument, the one or more light-emitting elements 430 may be as disclosed in U.S. Patent Application Publication No. 2017 / 0367772, which is hereby incorporated by reference in its entirety.

[0133] Furthermore, one or more light-emitting elements 430 (similar to the light-emitting element 120 and the optical sensor 122) can be attached to the instrument or tool 106 (either removably / non-removably (e.g., clip-on), or permanently / permanently (e.g., with an adhesive)). Alternatively, the light-emitting element 430 may be integrally formed with the surgical instrument 106 (i.e., as one piece). Also, as described above, the light-emitting element 430 can be attached to a separate instrument or tool that is used in combination with the surgical instrument or tool 106.

[0134] As described above, the surgical instrument 106 may be a thermal ligation device in one embodiment shown in FIG. 1. In another embodiment, the surgical instrument 106 may simply be a grasper or grasping forceps having opposing jaws. According to further embodiments, the surgical instrument may be other surgical instruments such as, for example, forceps, hemostatic instruments, sealers / dividers, irrigators, surgical staplers, clip applicators, and robotic surgical systems. According to still further embodiments, the surgical instrument may carry a graphical interface and sensors and have no other function than to place them within the surgical field. The illustration of a single embodiment is not intended to exclude the use of the system 100 with other surgical instruments or tools 106.

[0135] In conclusion, the above has described detailed descriptions of different embodiments of the present invention, but it should be understood that the legal scope of the present invention is defined by the language of the claims. The detailed description should be construed as illustrative only, and it is not possible, if not unrealistic, to describe all possible embodiments, so it does not describe all possible embodiments of the present invention. It is possible to implement a number of other embodiments using either current technology or technology developed after the filing date of the present application, and they shall still be included within the scope of the claims that define the present invention.

[0136] Also, in this application, unless a term is explicitly defined using the phrase "As used herein, the term "" is defined to mean..." or a similar statement, there is no intention, whether explicit or implicit, to limit the meaning of such term beyond its plain or ordinary meaning, and it should be understood that such terms should not be construed as being limited in scope based on any description made in any section of this application (other than the language of the claims). As long as the terms recited in the claims of this application are referred to as corresponding to a single meaning in this application, this is done only for clarification so as not to confuse the reader, and it is not intended that the terms of such claims be limited to that single meaning in an implied or other manner. Finally, unless the elements of a claim are defined by reciting the term "means" and a function without reciting a structure, it is not intended that the scope of the elements of the claim be construed based on the application of 35 U.S.C. § 112(f).

Claims

1. A medical system comprising: a first jaw having an inner surface and a second opposing jaw having an inner surface; at least one light emitting element disposed on the inner surface of one of the first jaw and the second jaw, and at least one light sensor disposed on the inner surface of one of the first jaw and the second jaw; at least one of the first jaw and the second jaw has an outer surface facing the inner surface, the outer surface has at least one marking disposed thereon, and the at least one marking is aligned with the at least one light sensor; at least one visual display; and a controller coupled to the at least one light sensor and the at least one visual display, determining a position of tissue relative to the at least one light sensor based on a signal from the at least one light sensor, configured to control the at least one visual display to display a graphical interface including at least one marking corresponding to the at least one marking on the outer surface of at least one of the first jaw and the second jaw in combination with an image corresponding to tissue disposed between the first jaw and the second jaw.

2. The medical system according to claim 1, wherein the at least one light sensor includes an array of light sensors, and the at least one marking disposed on the outer surface corresponds to the center of the array.

3. The medical system according to claim 2, wherein the array is a linear array, and the at least one marking disposed on the outer surface corresponds to the center of the linear array.

4. The medical system according to claim 2 or 3, wherein the at least one marking disposed on the outer surface comprises a first marking corresponding to a first end of the array, a second marking corresponding to a second end of the array, and a third marking corresponding to the center of the array.

5. The at least one marking disposed on the outer surface comprises an additional marking disposed between the first marking and the third marking and between the second marking and the third marking, the additional marking being of a different dimension than the first marking, the second marking, and the third marking, the medical system of claim 4.

6. The medical system of claim 4 or 5, wherein the first marking, the second marking, and the third marking are lines.

7. The medical system according to any one of claims 4 to 6, wherein the third marking has a design superimposed on the third marking.

8. The medical system according to any one of claims 4 to 7, wherein the at least one marking includes a longitudinal line disposed on one side of the first marking, the second marking, and the third marking.

9. The medical system according to any one of claims 4 to 7, wherein the at least one marking includes a longitudinal line disposed along the midpoint of each of the first marking, the second marking, and the third marking.

10. The medical system according to any one of claims 4 to 7, wherein the at least one marking includes a pair of longitudinal lines, one longitudinal line being disposed on one side of the first marking, the second marking, and the third marking, and the other longitudinal line being disposed on the opposite side of the first marking, the second marking, and the third marking.

11. The medical system according to any one of claims 4 to 10, wherein the first marking is disposed proximate one end of the first joe and the second joe, the second marking is disposed proximate the pivot between the first joe and the second joe, and the first marking is different from the second marking.

12. The medical system of claim 4, wherein the first marking, the second marking, and the third marking are geometric figures.

13. The medical system according to any one of claims 1 to 12, wherein the at least one visual display includes a video monitor, a head-up video display, a pair of smart glasses, and a video headset.

14. A medical system according to any one of claims 1 to 13, wherein the first joe and the second joe are movably connected, and these joes are movable between a first position where the inner surface of the first joe is close to the inner surface of the second joe and a second position where the inner surface of the first joe is spaced from the inner surface of the second joe.

15. The medical system according to claim 14, wherein the first joe and the second joe are rotatably connected.

16. The medical system according to claim 15, wherein the tissue is a vessel such as a blood vessel.

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