Adjusting the functionality of a surgical device based on situational awareness

Abstract

To provide a surgical device capable of adjusting a function.SOLUTION: A surgical device comprises: an end effector having a first jaw and a second jaw which can be mutually opened and closed; a closure trigger which is operated so as to move at least either of the first jaw and the second jaw that are in an open state to a closed state; a control circuit which controls a power level applied to the end effector according to an operation amount of the closure trigger or a movement amount in a closed direction of the at least either of the first jaw and the second jaw; and an actuation button which actuates power supply to the end effector. In the surgical device, the power level applied to the end effector is changed according to the operation amount of the closure trigger or the movement amount in the closed direction of the at least either of the first jaw and the second jaw when the operation button is actuated.SELECTED DRAWING: Figure 16

Description

[Technical field]

[0001] (CROSS REFERENCE TO RELATED APPLICATIONS) This application claims the benefit of U.S. Nonprovisional Patent Application No. 16 / 182,256, filed November 6, 2018, entitled “ADJUSTMENT OF A SURGICAL DEVICE FUNCTION BASED ON SITUATIONAL AWARENESS,” the disclosure of which is incorporated herein by reference in its entirety.

[0002] This application claims priority under 35 U.S.C. §119(e) to U.S. Provisional Application No. 62 / 729,183, filed September 10, 2018, entitled "A CONTROL FOR A SURGICAL NETWORK OR SURGICAL NETWORK CONNECTED DEVICE THAT ADJUSTS ITS FUNCTION BASED ON A SENSED SITUATION OR USAGE," the disclosure of which is incorporated herein by reference in its entirety.

[0003] This application further claims priority under 35 U.S.C. §119(e) to U.S. Provisional Patent Application No. 62 / 692,747, entitled "SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE," filed June 30, 2018, U.S. Provisional Patent Application No. 62 / 692,748, entitled "SMART ENERGY ARCHITECTURE," filed June 30, 2018, and U.S. Provisional Patent Application No. 62 / 692,768, entitled "SMART ENERGY DEVICES," filed June 30, 2018, the disclosures of each of which are incorporated herein by reference in their entirety.

[0004] This application further claims priority under 35 U.S.C. §119(e) to U.S. Provisional Patent Application No. 62 / 659,900, filed April 19, 2018, entitled "METHOD OF HUB COMMUNICATION," the disclosure of which is incorporated herein by reference in its entirety.

[0005] This application is further incorporated by reference under 35 U.S.C. §119(e) in its entirety with respect to U.S. Provisional Patent Application No. 62 / 650,898, filed March 30, 2018, entitled "CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS," U.S. Provisional Patent Application No. 62 / 650,887, filed March 30, 2018, entitled "SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES," U.S. Provisional Patent Application No. 62 / 650,882, filed March 30, 2018, entitled "SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM," and U.S. Provisional Patent Application No. 62 / 650,883, filed March 30, 2018, entitled "SURGICAL SMOKE EVACUATION SENSING AND METHOD FOR INTERACTIVE SURGICAL PLATFORM," each of which is hereby incorporated by reference in its entirety. This application claims priority to U.S. Provisional Patent Application No. 62 / 650,877, filed March 30, 2018, entitled "METHOD CONTROLS."

[0006] This application further claims priority under 35 U.S.C. §119(e) to U.S. Provisional Patent Application No. 62 / 640,417, filed March 8, 2018, entitled "TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR," and U.S. Provisional Patent Application No. 62 / 640,415, filed March 8, 2018, entitled "ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR," the disclosures of each of which are incorporated herein by reference in their entirety.

[0007] This application further claims priority under 35 U.S.C. §119(e) to U.S. Provisional Patent Application No. 62 / 611,341, entitled "INTERACTIVE SURGICAL PLATFORM," filed December 28, 2017; U.S. Provisional Patent Application No. 62 / 611,340, entitled "CLOUD-BASED MEDICAL ANALYTICS," filed December 28, 2017; and U.S. Provisional Patent Application No. 62 / 611,339, entitled "ROBOT ASSISTED SURGICAL PLATFORM," filed December 28, 2017, the disclosures of each of which are incorporated herein by reference in their entireties. [Background technology]

[0008] The present disclosure relates to surgical systems and devices. Clinical information can be collected and / or stored in a variety of different surgical devices before, during, and / or after surgery. Certain information can be useful to a clinician in making one or more clinical decisions before, during, and / or after surgery. [Brief description of the drawings]

[0009] The various aspects described herein, both as to organization and method of operation, together with further objects and advantages thereof, can best be understood by reference to the following description taken in conjunction with the accompanying drawings, in which: [Figure 1] FIG. 1 is a block diagram of a computer-implemented interactive surgical system according to at least one aspect of the present disclosure. [Diagram 2] FIG. 1 is a diagram of a surgical system used to perform a surgical procedure in an operating room, according to at least one embodiment of the present disclosure. [Diagram 3] FIG. 1 illustrates a surgical hub paired with a visualization system, a robotic system, and an intelligent instrument, in accordance with at least one aspect of the present disclosure. [Figure 4] FIG. 13 is a partial perspective view of a surgical hub housing and of a combination generator module slidably receivable within a drawer of the surgical hub housing, in accordance with at least one embodiment of the present disclosure. [Diagram 5] FIG. 1 is a perspective view of a combination generator module including bipolar, ultrasonic, and monopolar contacts and smoke evacuation components in accordance with at least one embodiment of the present disclosure. [Figure 6] FIG. 13 illustrates individual power bus attachments for multiple lateral docking ports of a lateral modular housing configured to receive multiple modules, in accordance with at least one embodiment of the present disclosure. [Figure 7] FIG. 1 illustrates a vertical modular housing configured to receive multiple modules, in accordance with at least one embodiment of the present disclosure. [Figure 8] FIG. 1 illustrates a surgical data network comprising a modular communications hub configured to connect modular devices located at one or more surgical sites of a medical facility, or any room within a medical facility equipped with specialized equipment for surgical procedures, to a cloud, in accordance with at least one embodiment of the present disclosure. [Figure 9] FIG. 1 illustrates a computer-implemented interactive surgical system in accordance with at least one aspect of the present disclosure. [Figure 10] FIG. 1 illustrates a surgical hub including multiple modules coupled to a modular control tower, in accordance with at least one embodiment of the present disclosure. [Figure 11] FIG. 2 illustrates an embodiment of a Universal Serial Bus (USB) network hub device in accordance with at least one embodiment of the present disclosure. [Figure 12] FIG. 1 is a block diagram of a cloud computing system including a plurality of smart surgical instruments coupled to a surgical hub that can be connected to a cloud component of the cloud computing system in accordance with at least one aspect of the present disclosure. [Figure 13] FIG. 2 is a diagram of a functional module architecture of a cloud computing system in accordance with at least one aspect of the present disclosure. [Figure 14] FIG. 1 is a diagram of a situationally aware surgical system, according to at least one aspect of the present disclosure. [Figure 15] 1 is a timeline illustrating situational awareness of a surgical hub, in accordance with at least one embodiment of the present disclosure. [Figure 16] FIG. 1 is an elevational view of a surgical instrument including an end effector and a trigger, where the degree to which the end effector is closed is controlled by the degree to which the trigger is actuated, in accordance with at least one aspect of the present disclosure. [Figure 17] 17 is a pair of graphs illustrating end effector closure and transducer amplitude versus trigger angle for the surgical instrument of FIG. 16 in accordance with at least one embodiment of the present disclosure. [Figure 18] FIG. 1 is a schematic diagram of a surgical procedure involving multiple devices in a surgical field, including a combination energy instrument, a surgical stapler, and an aspirating / irrigation device, in accordance with at least one embodiment of the present disclosure, further showing a detailed elevational view of the combination energy instrument and a detailed top view of a sterile field display including touch screen controls for adjusting the surgical functions of the multiple devices within the sterile field. [Figure 19A] FIG. 13 is a diagram of a display screen including clinician suggestions based on input from a context-aware surgical hub, in accordance with at least one embodiment of the present disclosure. [Figure 19B] FIG. 19B is a diagram of the display screen of FIG. 19A with suggestions shown at a high priority level based on predicted surgical actions and input from a situation-aware surgical hub, in accordance with at least one embodiment of the present disclosure. [Figure 20] FIG. 13 is a block diagram illustrating intra-operative data correlated with predicted outcomes and further showing corresponding suggestions based on the predicted outcomes, in accordance with at least one aspect of the present disclosure. [Figure 21] FIG. 1 is a schematic diagram of a surgical drainage system, according to at least one embodiment of the present disclosure. [Figure 22] FIG. 1 is a perspective view of a surgical system including a surgical evacuation system, according to at least one embodiment of the present disclosure. [Figure 23] FIG. 2 is a schematic diagram of an ejector housing of an ejection system according to at least one embodiment of the present disclosure. [Figure 24]1 is a series of graphs illustrating particulate concentration, fan rotation speed, and energy device power versus time in accordance with at least one embodiment of the present disclosure. [Diagram 25] FIG. 1 is a diagram of an ultrasound through particle detection system in accordance with at least one embodiment of the present disclosure. [Figure 26] FIG. 1 is a diagram of an ultrasound reflective particle detection system in accordance with at least one embodiment of the present disclosure. [Figure 27] 27 is a flow chart for detecting tissue surface information using the ultrasound reflective particle detection system of FIG. 26 in accordance with at least one embodiment of the present disclosure. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0010] The applicant of this application owns the following U.S. patent applications, filed November 6, 2018, the disclosures of each of which are incorporated by reference in their entirety herein: No. 16 / 182,224, entitled "SURGICAL NETWORK, INSTRUMENT, AND CLOUD RESPONSES BASED ON VALIDATION OF RECEIVED DATASET AND AUTHENTICATION OF ITS SOURCE AND INTEGRITY"; U.S. Patent Application No. 16 / 182,230, entitled "SURGICAL SYSTEM FOR PRESENTING INFORMATION INTERPRETED FROM EXTERNAL DATA"; U.S. Patent Application Serial No. 16 / 182,233, entitled "MODIFICATION OF SURGICAL SYSTEMS CONTROL PROGRAMS BASED ON MACHINE LEARNING"; U.S. Patent Application Serial No. 16 / 182,239, entitled “ADJUSTMENT OF DEVICE CONTROL PROGRAMS BASED ON STRATIFIED CONTEXTUAL DATA IN ADDITION TO THE DATA”; U.S. Patent Application No. 16 / 182,243, entitled "SURGICAL HUB AND MODULAR DEVICE RESPONSE ADJUSTMENT BASED ON SITUATIONAL AWARENESS"; U.S. patent application Ser. No. 16 / 182,248, entitled "DETECTION AND ESCALATION OF SECURITY RESPONSES OF SURGICAL INSTRUMENTS TO INCREASING SEVERITY THREATS"; · U.S. Patent Application Serial No. 16 / 182,251, entitled "INTERACTIVE SURGICAL SYSTEM"; U.S. Patent Application Serial No. 16 / 182,260, entitled “AUTOMATED DATA SCALING, ALIGNMENT, AND ORGANIZING BASED ON PREDEFINED PARAMETERS WITHIN SURGICAL NETWORKS”; U.S. patent application Ser. No. 16 / 182,267, entitled “SENSING THE PATIENT POSITION AND CONTACT UTILIZING THE MONO-POLAR RETURN PAD ELECTRODE TO PROVIDE SITUATIONAL AWARENESS TO A SURGICAL NETWORK”; U.S. Patent Application Serial No. 16 / 182,249, entitled “POWERED SURGICAL TOOL WITH PREDEFINED ADJUSTABLE CONTROL ALGORITHM FOR CONTROLLING END EFFECTOR PARAMETER”; U.S. Patent Application Serial No. 16 / 182,246, entitled "ADJUSTMENTS BASED ON AIRBORNE PARTICLE PROPERTIES"; U.S. Patent Application Serial No. 16 / 182,242, entitled “REAL-TIME ANALYSIS OF COMPREHENSIVE COST OF ALL INSTRUMENTATION USED IN SURGERY UTILIZING DATA FLUIDITY TO TRACK INSTRUMENTS THROUGH STOCKING AND IN-HOUSE PROCESSES”; U.S. patent application Ser. No. 16 / 182,255, entitled “USAGE AND TECHNIQUE ANALYSIS OF SURGEON / STAFF PERFORMANCE AGAINST A BASELINE TO OPTIMIZE DEVICE UTILIZATION AND PERFORMANCE FOR BOTH CURRENT AND FUTURE PROCEDURES”; U.S. Patent Application Serial No. 16 / 182,269, entitled “IMAGE CAPTURING OF THE AREAS OUTSIDE THE ABDOMEN TO IMPROVE PLACEMENT AND CONTROL OF A SURGICAL DEVICE IN USE”; No. 16 / 182,278, entitled “COMMUNICATION OF DATA WHERE A SURGICAL NETWORK IS USING CONTEXT OF THE DATA AND REQUIREMENTS OF A RECEIVING SYSTEM / USER TO INFLUENCE INCLUSION OR LINKAGE OF DATA AND METADATA TO ESTABLISH CONTINUITY”; U.S. Patent Application Serial No. 16 / 182,290, entitled "SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THE OPTIMAL SOLUTION"; U.S. Patent Application Serial No. 16 / 182,232, entitled "CONTROL OF A SURGICAL SYSTEM THROUGH A SURGICAL BARRIER"; U.S. patent application Ser. No. 16 / 182,227, entitled "SURGICAL NETWORK DETERMINATION OF PRIORITIZATION OF COMMUNICATION, INTERACTION, OR PROCESSING BASED ON SYSTEM OR DEVICE NEEDS"; U.S. Patent Application Serial No. 16 / 182,231, entitled "WIRELESS PAIRING OF A SURGICAL DEVICE WITH ANOTHER DEVICE WITHIN A STERILE SURGICAL FIELD BASED ON THE USAGE AND SITUATIONAL AWARENESS OF DEVICES"; U.S. Patent Application Serial No. 16 / 182,229, entitled “ADJUSTMENT OF STAPLE HEIGHT OF AT LEAST ONE ROW OF STAPLES BASED ON THE SENSED TISSUE THICKNESS OR FORCE IN CLOSING”; U.S. patent application Ser. No. 16 / 182,234, entitled "STAPLING DEVICE WITH BOTH COMPULSORY AND DISCRETIONARY LOCKOUTS BASED ON SENSED PARAMETERS"; U.S. Patent Application Serial No. 16 / 182,240, entitled “POWERED STAPLING DEVICE CONFIGURED TO ADJUST FORCE, ADVANCEMENT SPEED, AND OVERALL STROKE OF CUTTING MEMBER BASED ON SENSED PARAMETER OF FIRING OR CLAMPING”; U.S. Patent Application Serial No. 16 / 182,235, entitled "VARIATION OF RADIO FREQUENCY AND ULTRASONIC POWER LEVEL IN COOPERATION WITH VARYING CLAMP ARM PRESSURE TO ACHIEVE PREDEFINED HEAT FLUX OR POWER APPLIED TO TISSUE," and U.S. Patent Application No. 16 / 182,238, entitled “ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSURE APPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE AT A CUT PROGRESSION LOCATION.”

[0011] The applicant of the present application owns the following U.S. patent applications, filed September 10, 2018, the disclosures of each of which are incorporated by reference in their entirety herein: U.S. Provisional Patent Application No. 62 / 729,183, entitled “A CONTROL FOR A SURGICAL NETWORK OR SURGICAL NETWORK CONNECTED DEVICE THAT ADJUSTS ITS FUNCTION BASED ON A SENSED SITUATION OR USAGE”; No. 62 / 729,177, entitled “AUTOMATED DATA SCALING, ALIGNMENT, AND ORGANIZING BASED ON PREDEFINED PARAMETERS WITHIN A SURGICAL NETWORK BEFORE TRANSMISSION”; No. 62 / 729,176, entitled “INDIRECT COMMAND AND CONTROL OF A FIRST OPERATING ROOM SYSTEM THROUGH THE USE OF A SECOND OPERATING ROOM SYSTEM WITHIN A STERILE FIELD WHERE THE SECOND OPERATING ROOM SYSTEM HAS PRIMARY AND SECONDARY OPERATING MODES”; U.S. Provisional Patent Application No. 62 / 729,185, entitled “POWERED STAPLING DEVICE THAT IS CAPABLE OF ADJUSTING FORCE, ADVANCEMENT SPEED, AND OVERALL STROKE OF CUTTING MEMBER OF THE DEVICE BASED ON SENSED PARAMETER OF FIRING OR CLAMPING”; U.S. Provisional Patent Application No. 62 / 729,184, entitled “POWERED SURGICAL TOOL WITH A PREDEFINED ADJUSTABLE CONTROL ALGORITHM FOR CONTROLLING AT LEAST ONE END EFFECTOR PARAMETER AND A MEANS FOR LIMITING THE ADJUSTMENT”; U.S. Provisional Patent Application No. 62 / 729,182, entitled “SENSING THE PATIENT POSITION AND CONTACT UTILIZING THE MONO POLAR RETURN PAD ELECTRODE TO PROVIDE SITUATIONAL AWARENESS TO THE HUB”; U.S. Provisional Patent Application No. 62 / 729,191, entitled “SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THE OPTIMAL SOLUTION”; U.S. Provisional Patent Application No. 62 / 729,195, entitled “ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSURE APPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE AT A CUT PROGRESSION LOCATION”; and Provisional U.S. Patent Application No. 62 / 729,186, entitled “WIRELESS PAIRING OF A SURGICAL DEVICE WITH ANOTHER DEVICE WITHIN A STERILE SURGICAL FIELD BASED ON THE USAGE AND SITUATIONAL AWARENESS OF DEVICES.”

[0012] The applicant of this application owns the following U.S. patent applications, filed August 28, 2018, the disclosures of each of which are incorporated by reference in their entirety herein: U.S. Patent Application Serial No. 16 / 115,214, entitled "ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR"; · U.S. Patent Application Serial No. 16 / 115,205, entitled “TEMPERATURE CONTROL OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR”; U.S. Patent Application No. 16 / 115,233, entitled "RADIO FREQUENCY ENERGY DEVICE FOR DELIVERING COMBINED ELECTRICAL SIGNALS"; U.S. Patent Application Serial No. 16 / 115,208, entitled “CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION”; U.S. Patent Application Serial No. 16 / 115,220, entitled “CONTROLLING ACTIVATION OF AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO THE PRESENCE OF TISSUE”; · U.S. Patent Application Serial No. 16 / 115,232, entitled “DETERMINING TISSUE COMPOSITION VIA AN ULTRASONIC SYSTEM”; U.S. Patent Application Serial No. 16 / 115,239, entitled “DETERMINING THE STATE OF AN ULTRASONIC ELECTROMECHANICAL SYSTEM ACCORDING TO FREQUENCY SHIFT”; · U.S. Patent Application Serial No. 16 / 115,247, entitled "DETERMINING THE STATE OF AN ULTRASONIC END EFFECTOR"; · U.S. Patent Application Serial No. 16 / 115,211, entitled "SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS"; U.S. Patent Application Serial No. 16 / 115,226, entitled "MECHANISMS FOR CONTROLLING DIFFERENT ELECTROMECHANICAL SYSTEMS OF AN ELECTROSURGICAL INSTRUMENT"; U.S. Patent Application Serial No. 16 / 115,240, entitled “DETECTION OF END EFFECTOR IMMERSION IN LIQUID”; U.S. Patent Application No. 16 / 115,249, entitled "INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING"; U.S. Patent Application Serial No. 16 / 115,256, entitled “INCREASING RADIO FREQUENCY TO CREATE PAD-LESS MONOPOLAR LOOP”; U.S. Patent Application Serial No. 16 / 115,223, entitled "BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS PRESSURE BASED ON ENERGY MODALITY," and · U.S. Patent Application No. 16 / 115,238, entitled “ACTIVATION OF ENERGY DEVICES.”

[0013] The applicant of this application owns the following U.S. patent applications, filed August 23, 2018, the disclosures of each of which are incorporated by reference in their entirety herein: · U.S. Provisional Patent Application No. 62 / 721,995, entitled “CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION”; · U.S. Provisional Patent Application No. 62 / 721,998, entitled "SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS"; U.S. Provisional Patent Application No. 62 / 721,999, entitled "INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING"; U.S. Provisional Patent Application No. 62 / 721,994, entitled "BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS PRESSURE BASED ON ENERGY MODALITY"; and · U.S. Provisional Patent Application No. 62 / 721,996, entitled “RADIO FREQUENCY ENERGY DEVICE FOR DELIVERING COMBINED ELECTRICAL SIGNALS.”

[0014] The applicant of this application owns the following U.S. patent applications, filed June 30, 2018, the disclosures of each of which are incorporated by reference in their entirety herein: · U.S. Provisional Patent Application No. 62 / 692,747, entitled "SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE"; · U.S. Provisional Patent Application No. 62 / 692,748, entitled "SMART ENERGY ARCHITECTURE"; and · U.S. Provisional Patent Application No. 62 / 692,768, entitled “SMART ENERGY DEVICES.”

[0015] The applicant of this application owns the following U.S. patent applications, filed June 29, 2018, the disclosures of each of which are incorporated by reference in their entirety herein: U.S. Patent Application Serial No. 16 / 024,090, entitled "CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS"; U.S. Patent Application Serial No. 16 / 024,057, entitled “CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS”; U.S. Patent Application Serial No. 16 / 024,067, entitled "SYSTEMS FOR ADJUSTING END EFFECTOR PARAMETERS BASED ON PERIOPERATIVE INFORMATION"; · U.S. Patent Application Serial No. 16 / 024,075, entitled "SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING"; · U.S. Patent Application Serial No. 16 / 024,083, entitled "SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING"; U.S. Patent Application No. 16 / 024,094, entitled "SURGICAL SYSTEMS FOR DETECTING END EFFECTOR TISSUE DISTRIBUTION IRREGULARITIES"; U.S. Patent Application No. 16 / 024,138, entitled "SYSTEMS FOR DETECTING PROXIMITY OF SURGICAL END EFFECTOR TO CANCEROUS TISSUE"; · U.S. Patent Application Serial No. 16 / 024,150, entitled "SURGICAL INSTRUMENT CARTRIDGE SENSOR ASSEMBLIES"; · U.S. Patent Application Serial No. 16 / 024,160, entitled "VARIABLE OUTPUT CARTRIDGE SENSOR ASSEMBLY"; · U.S. Patent Application Serial No. 16 / 024,124, entitled "SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE"; · U.S. Patent Application Serial No. 16 / 024,132, entitled "SURGICAL INSTRUMENT HAVING A FLEXIBLE CIRCUIT"; U.S. Patent Application Serial No. 16 / 024,141, entitled "SURGICAL INSTRUMENT WITH A TISSUE MARKING ASSEMBLY"; U.S. Patent Application Serial No. 16 / 024,162, entitled "SURGICAL SYSTEMS WITH PRIORITIZED DATA TRANSMISSION CAPABILITIES"; · U.S. Patent Application Serial No. 16 / 024,066, entitled “SURGICAL EVACUATION SENSING AND MOTOR CONTROL”; · U.S. Patent Application Serial No. 16 / 024,096, entitled "SURGICAL EVACUATION SENSOR ARRANGEMENTS"; · U.S. Patent Application Serial No. 16 / 024,116, entitled "SURGICAL EVACUATION FLOW PATHS"; · U.S. Patent Application Serial No. 16 / 024,149, entitled “SURGICAL EVACUATION SENSING AND GENERATOR CONTROL”; · U.S. Patent Application Serial No. 16 / 024,180, entitled “SURGICAL EVACUATION SENSING AND DISPLAY”; U.S. Patent Application No. 16 / 024,245, entitled “COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM”; U.S. Patent Application No. 16 / 024,258, entitled "SMOKE EVACUATION SYSTEM INCLUDING A SEGMENTED CONTROL CIRCUIT FOR INTERACTIVE SURGICAL PLATFORM"; U.S. Patent Application Serial No. 16 / 024,265, entitled "SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION CIRCUIT FOR COMMUNICATION BETWEEN A FILTER AND A SMOKE EVACUATION DEVICE," and · U.S. Patent Application No. 16 / 024,273, entitled “DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS.”

[0016] The applicant of this application owns the following U.S. provisional patent applications, filed June 28, 2018, the disclosures of each of which are incorporated by reference in their entirety herein: U.S. Provisional Patent Application No. 62 / 691,228, entitled "A METHOD OF USING REINFORCED FLEX CIRCUITS WITH MULTIPLE SENSORS WITH ELECTROSURGICAL DEVICES"; U.S. Provisional Patent Application No. 62 / 691,227, entitled “CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS”; · U.S. Provisional Patent Application No. 62 / 691,230, entitled “SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE”; · U.S. Provisional Patent Application No. 62 / 691,219, entitled “SURGICAL EVACUATION SENSING AND MOTOR CONTROL”; U.S. Provisional Patent Application No. 62 / 691,257, entitled “COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM”; U.S. Provisional Patent Application No. 62 / 691,262, entitled "SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION CIRCUIT FOR COMMUNICATION BETWEEN A FILTER AND A SMOKE EVACUATION DEVICE," and · U.S. Provisional Patent Application No. 62 / 691,251, entitled “DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS.”

[0017] The applicant of the present application owns the following U.S. provisional patent applications, filed April 19, 2018, the disclosures of which are incorporated herein by reference in their entireties: · U.S. Provisional Patent Application No. 62 / 659,900, entitled “METHOD OF HUB COMMUNICATION.”

[0018] The applicant of the present application owns the following U.S. provisional patent applications, filed March 30, 2018, the disclosures of each of which are incorporated by reference in their entirety herein: U.S. Provisional Patent Application No. 62 / 650,898, filed March 30, 2018, entitled “CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS”; · U.S. Provisional Patent Application No. 62 / 650,887, entitled “SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES”; U.S. Provisional Patent Application No. 62 / 650,882, entitled "SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM," and · U.S. Provisional Patent Application No. 62 / 650,877, entitled “SURGICAL SMOKE EVACUATION SENSING AND CONTROLS.”

[0019] The applicant of this application owns the following U.S. patent applications, filed March 29, 2018, the disclosures of each of which are incorporated by reference in their entirety herein: · U.S. Patent Application Serial No. 15 / 940,641, entitled "INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES"; U.S. Patent Application No. 15 / 940,648, entitled "INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICES AND DATA CAPABILITIES"; U.S. Patent Application No. 15 / 940,656, entitled "SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATING ROOM DEVICES"; · U.S. Patent Application Serial No. 15 / 940,666, entitled "SPATIAL AWARENESS OF SURGICAL HUBS IN OPERATING ROOMS"; U.S. Patent Application No. 15 / 940,670, entitled "COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECONDARY SOURCES BY INTELLIGENT SURGICAL HUBS"; · U.S. Patent Application Serial No. 15 / 940,677, entitled "SURGICAL HUB CONTROL ARRANGEMENTS"; U.S. Patent Application No. 15 / 940,632, entitled "DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD"; U.S. Patent Application Serial No. 15 / 940,640, entitled "COMMUNICATION HUB AND STORAGE DEVICE FOR STORING PARAMETERS AND STATUS OF A SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED ANALYTICS SYSTEMS"; U.S. Patent Application Serial No. 15 / 940,645, entitled "SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT"; U.S. patent application Ser. No. 15 / 940,649, entitled “DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETER WITH AN OUTCOME”; · U.S. Patent Application No. 15 / 940,654, entitled "SURGICAL HUB SITUATIONAL AWARENESS"; · U.S. Patent Application Serial No. 15 / 940,663, entitled "SURGICAL SYSTEM DISTRIBUTED PROCESSING"; · U.S. Patent Application No. 15 / 940,668, entitled “AGGREGATION AND REPORTING OF SURGICAL HUB DATA”; · U.S. Patent Application No. 15 / 940,671, entitled "SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER"; U.S. Patent Application Serial No. 15 / 940,686, entitled "DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE"; · U.S. Patent Application No. 15 / 940,700, entitled "STERILE FIELD INTERACTIVE CONTROL DISPLAYS"; U.S. Patent Application No. 15 / 940,629, entitled "COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS"; U.S. Patent Application No. 15 / 940,704, entitled "USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT"; U.S. Patent Application No. 15 / 940,722, entitled "CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY"; U.S. patent application Ser. No. 15 / 940,742, entitled "DUAL CMOS ARRAY IMAGING"; U.S. Patent Application No. 15 / 940,636, entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES"; · U.S. Patent Application No. 15 / 940,653, entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS"; U.S. Patent Application No. 15 / 940,660, entitled "CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER"; U.S. Patent Application No. 15 / 940,679, entitled "CLOUD-BASED MEDICAL ANALYTICS FOR LINKING OF LOCAL USAGE TRENDS WITH THE RESOURCE ACQUISITION BEHAVIORS OF LARGER DATA SET"; U.S. Patent Application No. 15 / 940,694, entitled "CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTED INDIVIDUALIZATION OF INSTRUMENT FUNCTION"; U.S. Patent Application No. 15 / 940,634, entitled "CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES"; U.S. Patent Application No. 15 / 940,706, entitled "DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK"; U.S. Patent Application No. 15 / 940,675, entitled "CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES"; U.S. Patent Application No. 15 / 940,627, entitled "DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS"; · U.S. Patent Application No. 15 / 940,637, entitled "COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS"; · U.S. Patent Application Serial No. 15 / 940,642, entitled "CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS"; · U.S. Patent Application No. 15 / 940,676, entitled "AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS"; U.S. Patent Application No. 15 / 940,680, entitled "CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS"; · U.S. Patent Application Serial No. 15 / 940,683, entitled "COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS"; U.S. Patent Application No. 15 / 940,690, entitled "DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS," and · U.S. Patent Application No. 15 / 940,711, entitled “SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.”

[0020] The applicant of this application owns the following U.S. provisional patent applications, filed March 28, 2018, the disclosures of each of which are incorporated by reference in their entirety herein: · U.S. Provisional Patent Application No. 62 / 649,302, entitled "INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES"; · U.S. Provisional Patent Application No. 62 / 649,294, entitled "DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD"; · U.S. Provisional Patent Application No. 62 / 649,300, entitled “SURGICAL HUB SITUATIONAL AWARENESS”; · U.S. Provisional Patent Application No. 62 / 649,309, entitled “SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER”; · U.S. Provisional Patent Application No. 62 / 649,310, entitled “COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS”; U.S. Provisional Patent Application No. 62 / 649,291, entitled “USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT”; U.S. Provisional Patent Application No. 62 / 649,296, entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES"; · U.S. Provisional Patent Application No. 62 / 649,333, entitled "CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER"; U.S. Provisional Patent Application No. 62 / 649,327, entitled "CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES"; · U.S. Provisional Patent Application No. 62 / 649,315, entitled "DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK"; U.S. Provisional Patent Application No. 62 / 649,313, entitled "CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES"; · U.S. Provisional Patent Application No. 62 / 649,320, entitled "DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS"; U.S. Provisional Patent Application No. 62 / 649,307, entitled "AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS," and · U.S. Provisional Patent Application No. 62 / 649,323, entitled “SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.”

[0021] The applicant of this application owns the following U.S. provisional patent applications, filed March 8, 2018, the disclosures of each of which are incorporated by reference in their entirety herein: U.S. Provisional Patent Application No. 62 / 640,417, entitled “TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR”; and · U.S. Provisional Patent Application No. 62 / 640,415, entitled “ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR.”

[0022] The applicant of this application owns the following U.S. provisional patent applications, filed December 28, 2017, the disclosures of each of which are incorporated by reference in their entirety herein: · U.S. Provisional Patent Application No. U.S. Provisional Patent Application No. 62 / 611,341 entitled “INTERACTIVE SURGICAL PLATFORM”; U.S. Provisional Patent Application No. 62 / 611,340, entitled "CLOUD-BASED MEDICAL ANALYTICS," and · U.S. Provisional Patent Application No. 62 / 611,339, entitled “ROBOT ASSISTED SURGICAL PLATFORM.”

[0023] Before describing the various aspects of the surgical device and generator in detail, it should be noted that the illustrated embodiments are not limited in application or use to the details of construction and arrangement of parts shown in the accompanying drawings and description. The illustrative embodiments may be embodied or incorporated in other aspects, variations, and modifications and may be practiced or carried out in various ways. Moreover, unless otherwise specified, the terms and phrases used herein have been selected for the purpose of describing the illustrative embodiments for the convenience of the reader and not for the purpose of limiting them. Furthermore, it should be understood that one or more of the aspects, embodiment of the aspects, and / or embodiments described below can be combined with any one or more of the other aspects, embodiment of the aspects, and / or embodiments described below.

[0024] Surgical Hub 1, a computer-implemented interactive surgical system 100 includes one or more surgical systems 102 and a cloud-based system (e.g., cloud 104, which may include a remote server 113 coupled to a storage device 105). Each surgical system 102 includes at least one surgical hub 106 in communication with the cloud 104, which may include the remote server 113. In one embodiment, as shown in FIG. 1, the surgical system 102 includes a visualization system 108, a robotic system 110, and a handheld intelligent surgical instrument 112 configured to communicate with each other and / or with the hub 106. In some aspects, the surgical system 102 may include M hubs 106, N visualization systems 108, O robotic systems 110, and P handheld intelligent surgical instruments 112, where M, N, O, and P are integers equal to or greater than 1.

[0025] In various aspects, the intelligent instrument 112 described herein with reference to Figures 1-7 can be implemented as an energy device 213000 (Figure 16), a combination energy instrument 213100 (Figure 18), a surgical stapler 213102 (Figure 18), an suction / irrigation device 213104 (Figure 18), a sterile field display 213108 (Figure 18), a surgical device 213204 (Figures 19A and 19B), a surgical evacuation system 50400 (Figure 21), an electrosurgical instrument 50630 (Figure 22), an evacuation system 50600 (Figure 22), an evacuation system 50900 (Figure 23), a scope 213501 (Figure 25), and a surgical device 213608 (Figure 26). In such examples, intelligent instruments 112 (e.g., device 1), such as combination energy instrument 213100 ( FIG. 18 ), surgical stapler 213102 ( FIG. 18 ), suction / irrigation device 213104 ( FIG. 18 ), sterile field display 213108 ( FIG. 18 ), surgical device 213204 ( FIG. 19A and FIG. 19B ), surgical evacuation system 50400 ( FIG. 21 ), electrosurgical instrument 50630 ( FIG. 22 ), evacuation system 50600 ( FIG. 22 ), evacuation system 50900 ( FIG. 23 ), scope 213501 ( FIG. 25 ), and surgical device 213608 ( FIG. 26 ). a ~1 n ) are configured to operate within a surgical data network 201, as described with reference to FIG.

[0026] FIG. 2 illustrates an example of a surgical system 102 used to perform a surgical procedure on a patient lying on an operating table 114 in a surgical operating room 116. A robotic system 110 is used as part of the surgical system 102 in the surgical procedure. The robotic system 110 includes a surgeon's console 118, a patient side cart 120 (surgical robot), and a surgical robot hub 122. The patient side cart 120 can manipulate at least one detachably coupled surgical tool 117 during minimally invasive incision of the patient's body while the surgeon views the surgical site via the surgeon's console 118. Images of the surgical site can be obtained by a medical imaging device 124, which can be manipulated by the patient side cart 120 to orient the imaging device 124. The robotic hub 122 can be used to process images of the surgical site for subsequent display to the surgeon via the surgeon's console 118.

[0027] Other types of robotic systems can be readily adapted for use with the surgical system 102. Various examples of robotic systems and surgical tools suitable for use with the present disclosure are described in U.S. Provisional Patent Application No. 62 / 611,339, filed December 28, 2017, entitled "ROBOT ASSISTED SURGICAL PLATFORM," the disclosure of which is incorporated herein by reference in its entirety.

[0028] Various examples of cloud-based analytics performed by cloud 104 and suitable for use with the present disclosure are described in U.S. Provisional Patent Application No. 62 / 611,340, entitled "CLOUD-BASED MEDICAL ANALYTICS," filed December 28, 2017, the disclosure of which is incorporated by reference in its entirety herein.

[0029] In various embodiments, the imaging device 124 includes at least one image sensor and one or more optical components. Suitable image sensors include, but are not limited to, Charge-Coupled Device (CCD) sensors and Complementary Metal-Oxide Semiconductor (CMOS) sensors.

[0030] The optical components of the imaging device 124 may include one or more illumination sources and / or one or more lenses. The one or more illumination sources may be directed to illuminate portions of the surgical field. The one or more image sensors may receive light reflected or refracted from the surgical field, including light reflected or refracted from tissue and / or surgical instruments.

[0031] The one or more illumination sources may be configured to emit electromagnetic energy in the visible and invisible spectrum. The visible spectrum, sometimes referred to as the optical spectrum or luminescence spectrum, is the portion of the electromagnetic spectrum that is visible to (i.e., detectable by) the human eye, and is sometimes referred to as visible light, or simply light. A typical human eye responds to wavelengths in air between about 380 nm and about 750 nm.

[0032] The invisible spectrum (i.e., the non-radiative spectrum) is the portion of the electromagnetic spectrum that lies below and above the visible spectrum (i.e., wavelengths below about 380 nm and above about 750 nm). The invisible spectrum is not detectable by the human eye. Wavelengths above about 750 nm are longer than the red visible spectrum, which constitutes invisible infrared (IR), microwave, and wireless electromagnetic radiation. Wavelengths below about 380 nm are shorter than the violet spectrum, which constitutes invisible ultraviolet, X-ray, and gamma ray electromagnetic radiation.

[0033] In various aspects, the imaging device 124 is configured for use in minimally invasive surgery. Examples of imaging devices suitable for use with the present disclosure include, but are not limited to, arthroscopes, angioscopes, bronchoscopes, cholangioscopes, colonoscopes, cytoscopes, duodenoscopes, enteroscopes, esophagogastroduodenoscopes (gastroscopes), endoscopes, laryngoscopes, nasopharyngo-neproscopes, sigmoidoscopes, thoracoscopes, and ureteroscopes.

[0034] In one aspect, the imaging device uses multispectral monitoring to distinguish between topography and underlying structures. Multispectral imaging captures image data within a specific wavelength range across the electromagnetic spectrum. The wavelengths can be separated by filters or by using instruments sensitive to light from specific wavelengths including frequencies beyond the visible light range, for example, IR and ultraviolet light. Spectral imaging can allow for the extraction of additional information that the human eye cannot capture with its red, green, and blue receptors. The use of multispectral imaging is described in detail in the "Advanced Imaging Acquisition Module" section of U.S. Provisional Patent Application No. 62 / 611,341, entitled "INTERACTIVE SURGICAL PLATFORM," filed December 28, 2017, the disclosure of which is incorporated herein by reference in its entirety. Multispectral monitoring can be a useful tool to reposition the surgical field to perform one or more of the above-mentioned tests on the treated tissue after the surgical procedure is completed.

[0035] It is self-evident that any surgical procedure requires rigorous sterilization of the operating room and surgical equipment. The strict sanitary and sterile conditions required in the "surgical theater", i.e., operating room or procedure room, require the utmost sterility of all medical devices and equipment. Part of that sterilization process is the need to sterilize everything that comes into contact with the patient or enters the sterile field, including the imaging device 124 and its accessories and components. It will be understood that the sterile field may be considered a specific area that is deemed free of microorganisms, such as in a tray or on a sterile towel, or the sterile field may be considered the area immediately surrounding the patient who is prepared for the surgical procedure. The sterile field may include cleaned team members in appropriate clothing, as well as all the equipment and fixtures in the area.

[0036] In various aspects, the visualization system 108 includes one or more imaging sensors strategically positioned relative to the sterile field, one or more image processing units, one or more storage arrays, and one or more displays, as shown in Figure 2. In one aspect, the visualization system 108 includes HL7, PACS, and EMR interfaces. The various components of the visualization system 108 are described in the "Advanced Imaging Acquisition Module" section of U.S. Provisional Patent Application No. 62 / 611,341, entitled "INTERACTIVE SURGICAL PLATFORM," filed December 28, 2017, the disclosure of which is incorporated herein by reference in its entirety.

[0037] As shown in FIG. 2, the primary display 119 is positioned within the sterile field so as to be visible to an operator at the operating table 114. In addition, a visualization tower 111 is positioned outside the sterile field. The visualization tower 111 includes a first non-sterile display 107 and a second non-sterile display 109 facing away from each other. A visualization system 108 guided by the hub 106 is configured to utilize the displays 107, 109, and 119 to regulate information flow to the operator in and outside the sterile field. For example, the hub 106 can cause the visualization system 108 to maintain a live view of the surgical site on the primary display 119 while displaying snapshots of the surgical site recorded by the imaging device 124 on the non-sterile displays 107 or 109. The snapshots on the non-sterile displays 107 or 109 can, for example, enable the non-sterile operator to perform diagnostic steps related to the surgical procedure.

[0038] In one aspect, the hub 106 is also configured to send diagnostic input or feedback entered by a non-sterile operator at the visualization tower 111 in the sterile field to a primary display 119 in the sterile field for viewing by a sterile operator at the operating table. In one example, the input may be in the form of a correction to a snapshot displayed on the non-sterile display 107 or 109 that can be sent by the hub 106 to the primary display 119.

[0039] 2, a surgical instrument 112 is used as part of the surgical system 102 in a surgical procedure. The hub 106 is also configured to regulate information flow to the display of the surgical instrument 112. For example, coordinate information flow is further described in U.S. Provisional Patent Application No. 62 / 611,341, entitled "INTERACTIVE SURGICAL PLATFORM," filed December 28, 2017, the disclosure of which is incorporated herein by reference in its entirety. Diagnostic input or feedback entered by a non-sterile operator at the visualization tower 111 may be sent by the hub 106 to the surgical instrument display 115 in the sterile field, where the diagnostic input or feedback may be viewed by the operator of the surgical instrument 112. Exemplary surgical instruments suitable for use with the surgical system 102 are described, for example, under the heading "Surgical Instrument Hardware" in U.S. Provisional Patent Application No. 62 / 611,341, entitled "INTERACTIVE SURGICAL PLATFORM," filed December 28, 2017, the disclosure of which is incorporated by reference in its entirety into this specification.

[0040] 3, the hub 106 is shown in communication with a visualization system 108, a robotic system 110, and a handheld intelligent surgical instrument 112. The hub 106 includes a hub display 135, an imaging module 138, a generator module 140 (which may include a monopolar generator 142, a bipolar generator 144, and / or an ultrasound generator 143), a communications module 130, a processor module 132, and a storage array 134. In certain aspects, as shown in FIG. 3, the hub 106 further includes a smoke evacuation module 126, a suction / irrigation module 128, and / or a procedure room mapping module 133.

[0041] During a surgical procedure, the application of energy to tissue for sealing and / or cutting is typically accompanied by smoke evacuation, aspiration of excess fluid, and / or irrigation of tissue. Fluid, power, and / or data lines from different sources often become entangled during a surgical procedure. Valuable time may be lost addressing this issue during a surgical procedure. Untangling the lines may require unplugging the lines from their corresponding modules, which may require resetting the modules. The modular housing 136 of the hub provides a unified environment for managing the power, data, and fluid lines, reducing the frequency of such tangling between the lines.

[0042] Aspects of the present disclosure present a surgical hub for use in a surgical procedure involving application of energy to tissue at a surgical site. The surgical hub includes a hub housing and a combination generator module slidably receivable within a docking station of the hub housing. The docking station includes data and power contacts. The combination generator module includes two or more of an ultrasonic energy generator component, a bipolar RF energy generator component, and a monopolar RF energy generator component housed within a single unit. In one aspect, the combination generator module further includes a smoke evacuation component, at least one energy supply cable for connecting the combination generator module to a surgical instrument, at least one smoke evacuation component configured to evacuate smoke, fluid, and / or particulates generated by application of therapeutic energy to tissue, and a fluid line extending from a remote surgical site to the smoke evacuation component.

[0043] In one aspect, the fluid line is a first fluid line and a second fluid line extends from a remote surgical site to an aspiration and irrigation module that is slidably received within the hub housing. In one aspect, the hub housing includes a fluid interface.

[0044] Certain surgical procedures may require the application of more than one energy type to tissue. One energy type may be more beneficial for cutting tissue, while another different energy type may be more beneficial for sealing tissue. For example, a bipolar generator may be used to seal tissue, while an ultrasonic generator may be used to cut the sealed tissue. Aspects of the present disclosure present a solution in which the modular housing 136 of the hub is configured to house different generators and facilitate bidirectional communication between them. One advantage of the modular housing 136 of the hub is that it allows for quick removal and / or replacement of various modules.

[0045] Aspects of the present disclosure present a modular surgical housing for use in a surgical procedure involving application of energy to tissue, the modular surgical housing including a first energy generator module configured to generate a first energy for application to tissue, and a first docking station including a first docking port including first data and power contacts, the first energy generator module slidably movable into electrical engagement with the power and data contacts, and the first energy generator module slidably movable out of electrical engagement with the first power and data contacts.

[0046] In addition to the above, the modular surgical housing further includes a second energy generator module configured to generate a second energy for application to tissue, different from the first energy, and a second docking station including a second docking port including second data and power contacts, wherein the second energy generator module is slidably movable into electrical engagement with the power and data contacts, and the second energy generator module is slidably movable out of electrical engagement with the second power and data contacts.

[0047] Additionally, the modular surgical housing further includes a communication bus between the first docking port and the second docking port configured to facilitate communication between the first energy generator module and the second energy generator module.

[0048] 3-7, aspects of the disclosure are presented with respect to a hub modular housing 136 that allows for modular integration of a generator module 140, a smoke evacuation module 126, and an aspiration / irrigation module 128. The hub modular housing 136 further facilitates bidirectional communication between the modules 140, 126, 128. As shown in FIG. 5, the generator module 140 may be a generator module that includes integrated monopolar, bipolar, and ultrasonic components supported within a single housing unit 139 that is slidably insertable into the hub modular housing 136. As shown in FIG. 5, the generator module 140 may be configured to connect to a monopolar device 146, a bipolar device 147, and an ultrasonic device 148. Alternatively, the generator module 140 may include a series of monopolar, bipolar, and / or ultrasonic generator modules that interact via the hub modular housing 136. The hub modular housing 136 may be configured to facilitate the insertion of multiple generators and bidirectional communication between generators docked to the hub modular housing 136 such that the multiple generators function as a single generator.

[0049] In one aspect, the hub modular housing 136 includes a modular power and communications backplane 149 with external and wireless communication headers to allow removable attachment of the modules 140, 126, 128 and bidirectional communication therebetween.

[0050] In one aspect, the hub modular housing 136 includes a docking station or drawer 151, also referred to herein as a drawer, configured to slidably receive the modules 140, 126, 128. FIG. 4 shows a partial perspective view of the surgical hub housing 136 and a combination generator module 145 slidably receivable in the docking station 151 of the surgical hub housing 136. A docking port 152 having power and data contacts on the rear side of the combination generator module 145 is configured to engage a corresponding docking port 150 with the power and data contacts of the corresponding docking station 151 of the hub modular housing 136 when the combination generator module 145 is slid into position within the corresponding docking station 151 of the hub modular housing 136. In one aspect, the combination generator module 145 includes bipolar, ultrasonic, and monopolar modules and a smoke evacuation module integrated together with a single housing unit 139, as shown in FIG.

[0051] In various aspects, the smoke evacuation module 126 includes fluid lines 154 that transport captured / collected smoke and / or fluids away from the surgical site, for example, to the smoke evacuation module 126. Vacuum suction generated from the smoke evacuation module 126 can draw smoke into openings in utility conduits at the surgical site. Utility conduits coupled to the fluid lines may be in the form of flexible tubing that terminates at the smoke evacuation module 126. The utility conduits and fluid lines define a fluid pathway that extends toward the smoke evacuation module 126, which is received within the hub housing 136.

[0052] In various aspects, the aspiration / irrigation module 128 is coupled to a surgical tool that includes aspiration and suction fluid lines. In one embodiment, the aspiration and suction fluid lines are in the form of flexible tubing that extends from the surgical site towards the aspiration / irrigation module 128. One or more drive systems can be configured to effect irrigation and suction of fluids to and from the surgical site.

[0053] In one aspect, the surgical tool includes a shaft having an end effector at its distal end, at least one energy treatment portion associated with the end effector, a suction tube, and an irrigation tube. The suction tube can have an inlet port at its distal end, and the suction tube extends through the shaft. Similarly, the irrigation tube can extend through the shaft and have an inlet port proximate to the energy delivery instrument. The energy delivery instrument is configured to deliver ultrasonic and / or RF energy to the surgical site and is initially coupled to the generator module 140 by a cable extending through the shaft.

[0054] The irrigation tube can be in fluid communication with a fluid source and the suction tube can be in fluid communication with a vacuum source. The fluid source and / or vacuum source can be housed within the aspiration / irrigation module 128. In one embodiment, the fluid source and / or vacuum source can be housed within the hub housing 136 separate from the aspiration / irrigation module 128. In such an embodiment, the fluid interface can be configured to connect the aspiration / irrigation module 128 to the fluid source and / or vacuum source.

[0055] In one aspect, the modules 140, 126, 128 and / or their corresponding docking stations on the hub modular housing 136 may include alignment features configured to align the docking ports of the modules to engage with their counterparts in the docking stations of the hub modular housing 136. For example, as shown in FIG. 4 , the combination generator module 145 includes side brackets 155 configured to slidably engage with corresponding brackets 156 of the corresponding docking stations 151 of the hub modular housing 136. The brackets cooperate to guide the docking port contacts of the combination generator module 145 into electrical engagement with the docking port contacts of the hub modular housing 136.

[0056] In some aspects, the drawers 151 of the hub's modular housing 136 are the same or substantially the same size, and the modules are sized to be received within the drawers 151. For example, the side brackets 155 and / or 156 may be larger or smaller depending on the size of the module. In other aspects, the drawers 151 are different sizes, each designed to accommodate a particular module.

[0057] Additionally, to prevent inserting a module into a drawer with incompatible contacts, the contacts of a particular module may be keyed to engage with the contacts of a particular drawer.

[0058] 4, the docking port 150 of one drawer 151 may be coupled to the docking port 150 of another drawer 151 via a communication link 157 to facilitate two-way communication between the modules housed within the hub modular housing 136. Alternatively, or in addition, the docking port 150 of the hub modular housing 136 may facilitate wireless two-way communication between the modules housed within the hub modular housing 136. Any suitable wireless communication may be used, such as, for example, Air Titan-Bluetooth.

[0059] 6 illustrates individual power bus attachments of multiple lateral docking ports of a lateral modular housing 160 configured to receive multiple modules of a surgical hub 206. The lateral modular housing 160 is configured to laterally receive and interconnect modules 161. The modules 161 are slidably inserted into a docking station 162 of the lateral modular housing 160 that includes a backplane for interconnecting the modules 161. As shown in FIG. 6, the modules 161 are disposed laterally within the lateral modular housing 160. Alternatively, the modules 161 may be disposed vertically within the lateral modular housing.

[0060] FIG. 7 illustrates a vertical modular housing 164 configured to receive a plurality of modules 165 of the surgical hub 106. The modules 165 are slidably inserted into a docking station or drawer 167 of the vertical modular housing 164 that includes a backplane for interconnecting the modules 165. Although the drawers 167 of the vertical modular housing 164 are vertically oriented, in certain cases the vertical modular housing 164 may include horizontally oriented drawers. Additionally, the modules 165 may interact with each other via docking ports of the vertical modular housing 164. In the embodiment of FIG. 7, a display 177 is provided for displaying data related to the operation of the modules 165. Additionally, the vertical modular housing 164 includes a master module 178 that houses a plurality of sub-modules that are slidably received within the master module 178.

[0061] In various aspects, the imaging module 138 includes an integrated video processor and a modular light source and is adapted for use with various imaging devices. In one aspect, the imaging device is configured with a modular housing that can be assembled with a light source module and a camera module. The housing can be a disposable housing. In at least one embodiment, the disposable housing is removably coupled with a reusable controller, a light source module, and a camera module. The light source module and / or the camera module can be selectively selected depending on the type of surgical procedure. In one aspect, the camera module includes a CCD sensor. In another aspect, the camera module includes a CMOS sensor. In another aspect, the camera module is configured for imaging of the scanned beam. Similarly, the light source module can be configured to deliver white light or a different light depending on the surgical procedure.

[0062] During a surgical procedure, it may be inefficient to remove a surgical device from the surgical field and replace it with another surgical device including a different camera or a different light source. Temporary loss of view of the surgical field may result in undesirable results. The modular imaging device of the present disclosure is configured to allow replacement of a light source module or a camera module midstream during a surgical procedure without the need to remove the imaging device from the surgical field.

[0063] In one aspect, the imaging device comprises a tubular housing including a plurality of channels. A first channel is configured to slidably receive a camera module that may be configured for snap-fit ​​engagement with the first channel. A second channel is configured to slidably receive a light source module that may be configured for snap-fit ​​engagement with the second channel. In another embodiment, the camera module and / or the light source module may be rotated into a final position within their corresponding channels. A threaded engagement may be employed instead of a snap-fit ​​engagement.

[0064] In various embodiments, multiple imaging devices are positioned at different locations within the surgical field to provide multiple fields of view. The imaging module 138 can be configured to switch between the imaging devices to provide an optimal field of view. In various aspects, the imaging module 138 can be configured to integrate images from the different imaging devices.

[0065] Various image processors and imaging devices suitable for use with the present disclosure are described in U.S. Patent No. 7,995,045, issued Aug. 9, 2011, entitled "COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR," which is incorporated herein by reference in its entirety. Additionally, U.S. Patent No. 7,982,776, issued Jul. 19, 2011, entitled "SBI MOTION ARTIFACT REMOVAL APPARATUS AND METHOD," which is incorporated herein by reference in its entirety, describes various systems for removing motion artifacts from image data. Such systems may be integrated with the imaging module 138. Additionally, U.S. Patent Application Publication No. 2011 / 0306840, published December 15, 2011, entitled "CONTROLLABLE MAGNETIC SOURCE TO FIXTURE INTRACORPOREAL APPARATUS," and U.S. Patent Application Publication No. 2014 / 0243597, published August 28, 2014, entitled "SYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCEDURE," each of which is incorporated herein by reference in its entirety.

[0066] FIG. 8 illustrates a surgical data network 201 comprising a modular communication hub 203 configured to connect modular devices located at one or more surgical sites of a medical facility, or any room in a medical facility with specialized equipment for surgical procedures, to a cloud-based system (e.g., cloud 204, which may include a remote server 213 coupled to storage device 205). In one aspect, the modular communication hub 203 comprises a network hub 207 and / or a network switch 209 in communication with a network router. The modular communication hub 203 can further be coupled to a local computer system 210 to provide local computer processing and data manipulation. The surgical data network 201 may be configured as passive, intelligent, or switched. A passive surgical data network acts as a conduit for data, allowing data to go from one device (or segment) to another and to cloud computing resources. An intelligent surgical data network includes additional functionality that allows traffic to pass through the monitored surgical data network, configuring each port in the network hub 207 or network switch 209. An intelligent surgical data network can be referred to as a manageable hub or switch. A switching hub reads the destination address of each packet and then forwards the packet to the correct port.

[0067] Modular devices 1a-1n deployed at the surgical site may be coupled to the modular communication hub 203. A network hub 207 and / or a network switch 209 may be coupled to a network router 211 to connect the devices 1a-1n to the cloud 204 or a local computer system 210. Data associated with the devices 1a-1n may be transferred to a cloud-based computer via the router for remote data processing and manipulation. Data associated with the devices 1a-1n may also be transferred to the local computer system 210 for local data processing and manipulation. Modular devices 2a-2m deployed at the same surgical site may also be coupled to the network switch 209. The network switch 209 may be coupled to the network hub 207 and / or a network router 211 to connect the devices 2a-2m to the cloud 204. Data associated with the devices 2a-2n may be transferred to the cloud 204 via the network router 211 for data processing and manipulation. Data associated with the devices 2a-2m may also be transferred to the local computer system 210 for local data processing and manipulation.

[0068] It will be appreciated that the surgical data network 201 may be expanded by interconnecting multiple network hubs 207 and / or multiple network switches 209 with multiple network routers 211. The modular communications hub 203 may be housed in a modular control tower configured to receive multiple devices 1a-1n / 2a-2m. A local computer system 210 may also be housed in the modular control tower. The modular communications hub 203 is connected to a display 212 to display images acquired by some of the devices 1a-1n / 2a-2m, for example, during a surgical procedure. In various aspects, devices 1a-1n / 2a-2m may include various modules such as, for example, an imaging module 138 coupled to an endoscope, a generator module 140 coupled to an energy-based surgical device, a smoke evacuation module 126, a suction / irrigation module 128, a communications module 130, a processor module 132, a storage array 134, a surgical device coupled to a display, and / or a non-contact sensor module, among other modular devices that may be connected to the modular communications hub 203 of the surgical data network 201.

[0069] In one aspect, the surgical data network 201 may include a combination of network hubs, network switches, and network routers that connect the devices 1a-1n / 2a-2m to the cloud. Any one or all of the devices 1a-1n / 2a-2m coupled to the network hub or network switch may collect data in real time and transfer the data to a cloud computer for data processing and manipulation. It will be understood that cloud computing relies on shared computing resources rather than having local servers or personal devices to handle software applications. The term "cloud" may be used as a metaphor for the "internet," but the term is not so limited. Thus, the term "cloud computing" may be used herein to refer to "a type of internet-based computing," where various services such as servers, storage devices, and applications are delivered to a modular communications hub 203 and / or computer system 210 located at the surgical site (e.g., a fixed, mobile, temporary, or on-site operating room or space) and to devices connected to the modular communications hub 203 and / or computer system 210 via the internet. The cloud infrastructure may be maintained by a cloud service provider. In this context, the cloud service provider may be an entity that coordinates the use and control of devices 1a-1n / 2a-2m located within one or more surgical sites. The cloud computing services may perform numerous calculations based on data collected by smart surgical instruments, robots, and other computerized devices located within the surgical sites. The hub hardware allows multiple devices or connections to connect to a computer that communicates with cloud computing resources and storage devices.

[0070] By applying cloud computer data processing techniques to data collected by the devices 1a-1n / 2a-2m, the surgical data network provides improved surgical outcomes, reduced costs, and improved patient satisfaction. At least some of the devices 1a-1n / 2a-2m can be used to observe tissue status and evaluate leakage or perfusion of the sealed tissue after tissue sealing and cutting procedures. At least some of the devices 1a-1n / 2a-2m can be used to diagnostically inspect data including images of samples of body tissue to identify pathologies such as disease effects using cloud-based computing. This includes tissue and phenotypic localization and margin confirmation. At least some of the devices 1a-1n / 2a-2m can be used to identify anatomical structures of the body using techniques such as various sensors integrated with imaging devices and overlaying images captured by multiple imaging devices. Data collected by the devices 1a-1n / 2a-2m, including image data, may be transferred to the cloud 204 or a local computer system 210, or both, for data processing and manipulation, including image processing and manipulation. The data can be analyzed to improve the outcome of the surgical procedure by determining whether further treatments can be pursued, such as endoscopic interventions, emerging technologies, targeted radiation, targeted interventions, and application of precision robotics to tissue-specific sites and conditions. Such data analysis may further employ prognostic analysis processes, and using a standardized approach can provide useful feedback to either confirm or suggest modifications to surgical treatments and surgeon performance.

[0071] In one implementation, the surgical field devices 1a-1n may be connected to the modular communication hub 203 via wired or wireless channels depending on the configuration of the devices 1a-1n relative to the network hub. The network hub 207 may be implemented in one embodiment as a local network broadcast device that operates on the physical layer of the Open System Interconnection (OSI) model. The network hub provides connectivity to the devices 1a-1n located in the same surgical field network. The network hub 207 collects data in the form of packets and sends them to the router in half-duplex mode. The network hub 207 does not store any media access control / Internet Protocol (MAC / IP) for forwarding device data. Only one of the devices 1a-1n can send data at a time through the network hub 207. The network hub 207 does not have a routing table or intelligence on where to send the information and broadcasts all network data across each connection and to the remote server 213 (FIG. 9) on the cloud 204. Although network hub 207 can detect basic network errors such as collisions, broadcasting all information to multiple ports can pose security risks and cause bottlenecks.

[0072] In another implementation, the surgical site devices 2a-2m may be connected to the network switch 209 via wired or wireless channels. The network switch 209 functions within the data link layer of the OSI model. The network switch 209 is a multicast device for connecting the devices 2a-2m located within the same surgical site to the network. The network switch 209 transmits data in the form of frames to the network router 211 and functions in full duplex mode. Multiple devices 2a-2m can transmit data simultaneously through the network switch 209. The network switch 209 stores and uses the MAC addresses of the devices 2a-2m to forward data.

[0073] The network hub 207 and / or the network switch 209 are coupled to a network router 211 to connect to the cloud 204. The network router 211 functions within the network layer of the OSI model. The network router 211 creates a path for sending data packets received from the network hub 207 and / or the network switch 211 to cloud-based computer resources for further processing and manipulation of data collected by any one or all of the devices 1a-1n / 2a-2m. The network router 211 may be used to connect two or more different networks located at different locations, such as different networks located at different operating sites in the same medical facility, or different operating sites in different medical facilities. The network router 211 transmits data in the form of packets to the cloud 204 and functions in full-duplex mode. Multiple devices can transmit data simultaneously. The network router 211 uses IP addresses to forward data.

[0074] In one embodiment, the network hub 207 may be implemented as a USB hub that allows multiple USB devices to be connected to a host computer. The USB hub may expand a single USB port into several tiers so that more ports are available for connecting devices to the host system computer. The network hub 207 may include wired or wireless capabilities for receiving information over a wired or wireless channel. In one aspect, a wireless USB short-range, high-bandwidth wireless communication protocol may be used for communication between the devices 1a-1n and 2a-2m located within the surgical field.

[0075] In another embodiment, the surgical field devices 1a-1n / 2a-2m can communicate with the modular communications hub 203 via the Bluetooth wireless technology standard to exchange data over short distances from fixed and mobile devices (using short wavelength UHF radio waves in the 2.4-2.485 GHz ISM band) and to create a personal area network (PAN). In other aspects, the surgical field devices 1a-1n / 2a-2m can communicate with the modular communications hub 203 via numerous wireless or wired communications standards or protocols, including but not limited to Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20, long-term evolution (LTE), and Ev-DO, HSPA+, HSDPA+, HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT, and Ethernet derivatives thereof, as well as any other wireless and wired protocols designated 3G, 4G, 5G, and beyond. The computing module may include multiple communications modules. For example, a first communications module may be dedicated to short-range wireless communications, such as Wi-Fi and Bluetooth, and a second communications module may be dedicated to long-range wireless communications, such as GPS, EDGE, GPRS, CDMA, WiMAX, LTE, Ev-DO, and the like.

[0076] The modular communications hub 203 can act as a central connection for one or all of the surgical field devices 1a-1n / 2a-2m and handles data types known as frames. Frames carry data generated by the devices 1a-1n / 2a-2m. Once the frames are received by the modular communications hub 203, they are amplified and transmitted to the network router 211, which forwards this data to cloud computing resources by using any number of wireless or wired communications standards or protocols described herein.

[0077] The modular communications hub 203 may be used as a stand-alone device or may be connected to compatible network hubs and network switches to form a larger network. The modular communications hub 203 is generally easy to install, configure, and maintain, making the modular communications hub 203 a good choice for networking the surgical field devices 1a-1n / 2a-2m.

[0078] FIG. 9 illustrates a computer-implemented interactive surgical system 200. The computer-implemented interactive surgical system 200 is similar in many respects to the computer-implemented interactive surgical system 100. For example, the computer-implemented interactive surgical system 200 includes one or more surgical systems 202 that are similar in many respects to the surgical system 102. Each surgical system 202 includes at least one surgical hub 206 that communicates with a cloud 204 that may include a remote server 213. In one aspect, the computer-implemented interactive surgical system 200 includes a modular control tower 236 connected to a plurality of surgical field devices, such as, for example, intelligent surgical instruments, robots, and other computerized devices located within the surgical field. As shown in FIG. 10, the modular control tower 236 includes a modular communication hub 203 coupled to a computer system 210. As illustrated in the embodiment of FIG. 9, the modular control tower 236 is coupled to an imaging module 238 coupled to an endoscope 239, a generator module 240 coupled to an energy device 241, a smoke evacuator module 226, a suction / irrigation module 228, a communication module 230, a processor module 232, a storage array 234, a smart device / instrument 235 optionally coupled to a display 237, and a non-contact sensor module 242. The surgical field devices are coupled to cloud computing resources and data storage devices via the modular control tower 236. The robot hub 222 may also be connected to the modular control tower 236 and cloud computing resources. Among other things, the device / instrument 235, visualization system 208 may be coupled to the modular control tower 236 via wired or wireless communication standards or protocols described herein. The modular control tower 236 may be coupled to a hub display 215 (e.g., monitor, screen) for displaying and overlaying images received from the imaging module, device / instrument display, and / or other visualization systems 208. The hub display may also display data received from devices connected to the modular control tower along with images and overlay images.

[0079] FIG. 10 illustrates a surgical hub 206 comprising a number of modules coupled to a modular control tower 236. The modular control tower 236 comprises a modular communication hub 203, e.g., a network-connected device, and a computer system 210, e.g., for providing local processing, visualization, and imaging. As shown in FIG. 10, the modular communication hub 203 can be connected in a hierarchical configuration to expand the number of modules (e.g., devices) that can be connected to the modular communication hub 203 and transfer data associated with the modules to the computer system 210, cloud computing resources, or both. As shown in FIG. 10, each of the network hubs / switches in the modular communication hub 203 includes three downstream ports and one upstream port. The upstream network hub / switch is connected to a processor to provide communication connections to cloud computing resources and a local display 217. Communication to the cloud 204 can be via either wired or wireless communication channels.

[0080] The surgical hub 206 uses the non-contact sensor module 242 to measure the dimensions of the surgical field and generate a map of the surgical field using either an ultrasound or laser-based non-contact measurement device. As described in U.S. Provisional Patent Application No. 62 / 611,341, filed December 28, 2017, entitled "INTERACTIVE SURGICAL PLATFORM," section "Surgical Hub Spatial Awareness Within an Operating Room," which is incorporated herein by reference in its entirety, the ultrasound-based non-contact sensor module scans the surgical field by transmitting bursts of ultrasound and receiving echoes as the bursts of ultrasound reflect off the surrounding walls of the surgical field, where the sensor module is configured to determine the size of the surgical field and adjust the distance limit for Bluetooth pairing. The laser-based non-contact sensor module scans the surgical field by, for example, transmitting laser light pulses and receiving laser light pulses that reflect off the surrounding walls of the surgical field, comparing the phase of the transmitted pulses to the received pulses to determine the size of the surgical field and adjust the distance limit for Bluetooth pairing.

[0081] The computer system 210 includes a processor 244 and a network interface 245. The processor 244 is coupled to a communication module 247, a storage device 248, a memory 249, a non-volatile memory 250, and an input / output interface 251 via a system bus. The system bus may be any of several types of bus structures including a memory bus or memory controller, a peripheral or external bus, and / or a local bus using any of a variety of bus architectures, including, but not limited to, a 9-bit bus, an Industrial Standard Architecture (ISA), a Micro-Channel Architecture (MSA), an Extended ISA (EISA), an Intelligent Drive Electronics (IDE), a VESA Local Bus (VLB), a Peripheral Component Interconnect (PCI), a USB, an Advanced Graphics Port (AGP), a Personal Computer Memory Card International Association bus (PCMCIA), a Small Computer Systems Interface (SCSI), or any other proprietary bus.

[0082] Processor 244 may be any single-core or multi-core processor, such as those known under the trade name ARM Cortex manufactured by Texas Instruments. In one aspect, the processor may be an LM4F230H5QR ARM Cortex-M4F processor core available from Texas Instruments, including, for example, 256 KB of on-chip memory of single-cycle flash memory or other non-volatile memory up to 40 MHz, a pre-fetch buffer to improve performance beyond 40 MHz, 32 KB of single-cycle serial random access memory (SRAM), internal read-only memory (ROM) loaded with StellarisWare® software, 2 KB of electrically erasable programmable read-only memory (EEPROM), and / or one or more pulse width modulation (PWM) or one or more quadrature encoder input (QEI) analog, one or more 12-bit analog-to-digital converters (ADCs) with 12 analog input channels, details of which are available in the product data sheet.

[0083] In one aspect, the processor 244 may include a safety controller, including two controller families such as the TMS570 and RM4x, also known under the trade name Hercules ARM Cortex R4 from Texas Instruments. The safety controller may be configured specifically for IEC 61508 and ISO 26262 safety-critical applications, among others, to provide advanced integrated safety features while offering scalable performance, connectivity, and memory options.

[0084] System memory may include both volatile and nonvolatile memory. The basic input / output system (BIOS), containing the basic routines for transferring information between elements within the computer system, such as during start-up, is stored in the nonvolatile memory. For example, nonvolatile memory may include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), EEPROM, or flash memory. Volatile memory includes random-access memory (RAM), which acts as external cache memory. In addition, RAM is available in many forms, such as SRAM, dynamic RAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDR SDRAM), enhanced SDRAM (ESDRAM), Synchlink DRAM (SLDRAM), and direct Rambus RAM (DRRAM).

[0085] The computer system 210 also includes removable / non-removable, volatile / non-volatile computer storage media, such as disk storage devices. Disk storage devices include, but are not limited to, devices such as magnetic disk drives, floppy disk drives, tape drives, Jaz drives, Zip drives, LS-60 drives, flash memory cards, or memory sticks. In addition, disk storage devices can include storage media, either independently or in combination with other storage media, including, but not limited to, optical disk drives, such as compact disc ROM drives (CD-ROM), compact disc recordable drives (CD-R Drives), compact disc rewritable drives (CD-RW Drives), or digital versatile disc ROM drives (DVD-ROMs). Removable or non-removable interfaces may be used to facilitate connection of disk storage devices to the system bus.

[0086] It should be appreciated that the computer system 210 includes software that acts as an intermediary between users and the basic computer resources described in a preferred operating environment. Such software includes an operating system. The operating system, which may be stored on a disk storage device, functions to control and allocate resources of the computer system. System applications take advantage of resource management by the operating system through program modules and program data stored either in system memory or on the disk storage devices. It should be appreciated that the various components described herein may be implemented with various operating systems or combinations of operating systems.

[0087] A user inputs commands or information into the computer system 210 through input devices coupled to the I / O interface 251. Input devices include, but are not limited to, pointing devices such as a mouse, trackball, stylus, touchpad, keyboard, microphone, joystick, gamepad, satellite dish, scanner, TV tuner card, digital camera, digital video camera, webcam, and the like. These and other input devices connect to the processor through the system bus via interface ports. Interface ports include, for example, serial ports, parallel ports, game ports, and USB. Output devices use some of the same types of ports as the input devices. Thus, for example, a USB port may be used to provide input to the computer system and also to output information from the computer system to an output device. Output adapters are provided to illustrate that there are some output devices such as monitors, displays, speakers, and printers, among other output devices that require special adapters. Output adapters include, by way of example and not limitation, video and sound cards that provide a means of connection between an output device and the system bus. It should be noted that other devices, such as remote computers, and / or systems of devices, provide both input and output capabilities.

[0088] The computer system 210 can operate in a networked environment using logical connections to one or more remote or local computers, such as a cloud computer. The remote cloud computer can be a personal computer, a server, a router, a network PC, a workstation, a microprocessor-based appliance, a peer device, or other general network node, and typically includes many or all of the elements described with respect to a computer system. For simplicity, only memory storage devices are shown with the remote computer. The remote computer is logically connected to the computer system through a network interface, which is then physically connected through a communication connection. The network interface encompasses communication networks such as local area networks (LANs) and wide area networks (WANs). LAN technologies include Fiber Distributed Data Interface (FDDI), Copper Distributed Data Interface (CDDI), Ethernet / IEEE802.3, Token Ring / IEEE802.5, and the like. WAN technologies include, but are not limited to, point-to-point links, circuit-switched networks such as Integrated Services Digital Networks (ISDN) and variations thereon, packet-switched networks, and Digital Subscriber Lines (DSL).

[0089] In various aspects, the computer system 210 of FIG. 10, the imaging module 238 of FIGS. 9-10, and / or the visualization system 208, and / or the processor module 232 may include an image processor, an image processing engine, a media processor, or any dedicated digital signal processor (DSP) used to process digital images. The image processor may use parallel computing using single instruction multiple data (SIMD) or multiple instruction multiple data (MIMD) techniques to increase speed and efficiency. The digital image processing engine may perform a variety of tasks. The image processor may be a system on a chip with a multi-core processor architecture.

[0090] The communications connection refers to the hardware / software used to connect the network interface to the bus. Although the communications connection is shown internal to the computer system for clarity of illustration, the communications connection may be external to computer system 210. By way of example only, the hardware / software required to connect to the network interface includes internal and external technologies such as modems, including ordinary telephone grade modems, cable modems, and DSL modems, ISDN adapters, and Ethernet cards.

[0091] In various aspects, the device / instrument 235 described with reference to Figures 9 and 10 can be implemented as a combination energy instrument 213100 (Figure 18), a surgical stapler 213102 (Figure 18), an suction / irrigation device 213104 (Figure 18), a sterile field display 213108 (Figure 18), a surgical device 213204 (Figures 19A and 19B), a surgical evacuation system 50400 (Figure 21), an electrosurgical instrument 50630 (Figure 22), an evacuation system 50600 (Figure 22), an evacuation system 50900 (Figure 23), a scope 213501 (Figure 25), and a surgical device 213608 (Figure 26). Thus, the combination energy instrument 213100 (FIG. 18), the surgical stapler 213102 (FIG. 18), the suction / irrigation device 213104 (FIG. 18), the sterile field display 213108 (FIG. 18), the surgical device 213204 (FIGS. 19A and 19B), the surgical exhaust system 50400 (FIG. 21), the electrosurgical instrument 50630 (FIG. 22), the exhaust system 50600 (FIG. 22), the exhaust system 50900 (FIG. 23), the scope 213501 (FIG. 25), and the surgical device 213608 (FIG. 26) are configured to interface with the modular control tower 236 and the surgical hub 206. Once connected to the surgical hub 206, the combination energy instrument 213100 (FIG. 18), the surgical stapler 213102 (FIG. 18), the suction / irrigation device 213104 (FIG. 18), the sterile field display 213108 (FIG. 18), the surgical devices 213204 (FIGS. 19A and 19B), the surgical exhaust system 50400 (FIG. 21), the electrosurgical instrument 50630 (FIG. 22), the exhaust system 50600 (FIG. 22), the exhaust system 50900 (FIG. 23), the scope 213501 (FIG. 25), and the surgical devices 213608 (FIG. 26) are configured to interface with the cloud 204, the server 213, other instruments connected to the hub, the hub display 215, or the visualization system 209, or a combination thereof.Additionally, when connected to the hub 206, the combination energy instrument 213100 (FIG. 18), the surgical stapler 213102 (FIG. 18), the suction / irrigation device 213104 (FIG. 18), the sterile field display 213108 (FIG. 18), the surgical device 213204 (FIGS. 19A and 19B), the surgical evacuation system 50400 (FIG. 21), the electrosurgical instrument 50630 (FIG. 22), the evacuation system 50600 (FIG. 22), the evacuation system 50900 (FIG. 23), the scope 213501 (FIG. 25), and the surgical device 213608 (FIG. 26) may utilize processing circuitry available in the hub local computer system 210.

[0092] FIG. 11 illustrates a functional block diagram of one embodiment of a USB network hub 300 device in accordance with at least one embodiment of the present disclosure. In the illustrated embodiment, the USB network hub device 300 employs a Texas Instruments TUSB2036 integrated circuit hub. The USB network hub 300 is a CMOS device that provides an upstream USB transmit / receive port 302 and up to three downstream USB transmit / receive ports 304, 306, 308 that conform to the USB 2.0 standard. The upstream USB transmit / receive port 302 is a differential rooted data port that includes a differential data minus (DM0) input paired with a differential data plus (DP0) input. The three downstream USB transmit / receive ports 304, 306, 308 are differential data ports, with each port including a differential data plus (DP1-DP3) output paired with a differential data minus (DM1-DM3) output.

[0093] The USB network hub 300 device is implemented with a digital state machine instead of a microcontroller and does not require firmware programming. A fully compliant USB transceiver is integrated into the circuitry of the upstream USB transmit / receive port 302 and all downstream USB transmit / receive ports 304, 306, 308. The downstream USB transmit / receive ports 304, 306, 308 support both full speed and low speed devices by automatically setting the slew rate depending on the speed of the device attached to the port. The USB network hub 300 device may be configured in either bus-powered or self-powered mode and includes hub power logic 312 to manage power.

[0094] The USB network hub 300 device includes a serial interface engine 310 (SIE). The SIE 310 is the front end of the USB network hub 300 hardware and handles most of the protocol described in Chapter 8 of the USB specification. The SIE 310 typically understands signaling down to the transaction level. Functions it handles may include packet recognition, transaction reordering, detection / generation of SOP, EOP, RESET, and RESUME signals, clock / data separation, non-return to zero inverted (NRZI) data encoding / decoding and bit stuffing, CRC generation and checking (token and data), Packet ID (PID) generation and checking / decoding, and / or serial-parallel-to-parallel-serial conversion. 310 receives a clock input 314 and is coupled to suspend / resume logic and frame timer 316 circuitry and hub repeater circuitry 318 via port logic circuits 320, 322, 324 to control communication between the upstream USB transmit / receive port 302 and the downstream USB transmit / receive ports 304, 306, 308. The SIE 310 is coupled to a command decoder 326 via interface logic 328 to control commands from a serial EEPROM via a serial EEPROM interface 330 .

[0095] In various aspects, the USB network hub 300 can connect up to 127 functions organized in up to six logical layers to a single computer. Additionally, the USB network hub 300 can connect to all peripherals using a standardized four-wire cable that provides both communication and power distribution. The power configurations are bus-powered and self-powered. The USB network hub 300 may be configured to support four modes of power management: bus-powered hub with either individual or ganged port power management, and self-powered hub with either individual or ganged port power management. In one aspect, using a USB cable, the USB network hub 300, the upstream USB transmit / receive port 302 is plugged into a USB host controller, and the downstream USB transmit / receive ports 304, 306, 308 are exposed for connecting USB compatible devices, and so on.

[0096] Further details regarding the structure and function of surgical hubs and / or surgical hub networks can be found in U.S. Provisional Patent Application No. 62 / 659,900, filed April 19, 2018, entitled "METHOD OF HUB COMMUNICATION," which is incorporated by reference in its entirety.

[0097] Cloud system hardware and function modules FIG. 12 is a block diagram of a computer-implemented interactive surgical system according to at least one aspect of the present disclosure. In one aspect, the computer-implemented interactive surgical system is configured to monitor and analyze data related to the operation of various surgical systems, including surgical hubs, surgical instruments, robotic devices, and surgical sites or medical facilities. The computer-implemented interactive surgical system includes a cloud-based analysis system. Although the cloud-based analysis system is described as a surgical system, it is not necessarily limited to such and may be a cloud-based medical system in general. As shown in FIG. 12, the cloud-based analysis system includes a plurality of surgical instruments 7012 (which may be the same as or similar to the instruments 112), a plurality of surgical hubs 7006 (which may be the same as or similar to the hubs 106), and a surgical data network 7001 (which may be the same as or similar to the network 201) for coupling the surgical hubs 7006 to a cloud 7004 (which may be the same as or similar to the cloud 204). Each of the plurality of surgical hubs 7006 is communicatively coupled to one or more surgical instruments 7012. The hub 7006 is also communicatively coupled to a cloud 7004 of computer-implemented interactive surgical systems via a network 7001. The cloud 7004 is a remote, centralized source of hardware and software for storing, manipulating, and communicating data generated based on the operation of various surgical systems. As shown in FIG. 12, access to the cloud 7004 is achieved via a network 7001, which may be the Internet or any other suitable computer network. The surgical hub 7006 coupled to the cloud 7004 may be considered the client side of a cloud computing system (i.e., a cloud-based analysis system). A surgical instrument 7012 is paired with the surgical hub 7006 for control and performance of various surgical procedures or operations described herein.

[0098] In addition, the surgical instrument 7012 may include a transceiver for data transmission to and from the corresponding surgical hub 7006 (which may also include a transceiver). The combination of the surgical instrument 7012 and the corresponding hub 7006 may indicate a particular location, such as a surgical site within a medical facility (e.g., a hospital) for providing a medical procedure. For example, the memory of the surgical hub 7006 may store the location data. As shown in FIG. 12, the cloud 7004 includes a central server 7013 (which may be the same as or similar to the remote server 113 of FIG. 1 and / or the remote server 213 of FIG. 9), a hub application server 7002, a data analysis module 7034, and an input / output ("I / O") interface 7007. The central server 7013 of the cloud 7004 collectively manages the cloud computing system, which includes monitoring requests by the client surgical hubs 7006 and managing the processing power of the cloud 7004 to execute the requests. Each of the central servers 7013 includes one or more processors 7008 coupled to a suitable memory device 7010, which may include volatile memory such as random access memory (RAM) and non-volatile memory such as magnetic storage devices. The memory device 7010 may include machine-executable instructions that, when executed, cause the processor 7008 to execute a data analysis module 7034 for cloud-based data analysis, actions, recommendations, and other operations described below. Additionally, the processor 7008 may execute the data analysis module 7034 independently of or in conjunction with a hub application executed independently by the hub 7006. The central server 7013 also includes an aggregated medical data database 2212, which may reside in the memory 2210.

[0099] Based on the connection to the various surgical hubs 7006 via the network 7001, the cloud 7004 can aggregate data from the various surgical instruments 7012 and the particular data generated by their corresponding hubs 7006. Such aggregated data may be stored in the cloud 7004's database of aggregated medical data 7011. In particular, the cloud 7004 may advantageously perform data analysis and operations on the aggregated data to gain insights and / or perform functions that an individual hub 7006 cannot achieve by itself. To this end, as shown in FIG. 12, the cloud 7004 and the surgical hubs 7006 are communicatively coupled to send and receive information. An I / O interface 7007 is connected to the multiple surgical hubs 7006 via the network 7001. In this manner, the I / O interface 7007 can be configured to transfer information between the surgical hubs 7006 and the aggregated medical data database 7011. The I / O interface 7007 can thus facilitate read / write operations of the cloud-based analysis system. Such read / write operations may be performed in response to requests from the hub 7006. These requests may be sent to the hub 7006 via a hub application. The I / O interface 7007 may include one or more high speed data ports, which may include a Universal Serial Bus (USB) port, an IEEE 1394 port, and Wi-Fi and Bluetooth I / O interfaces for connecting the cloud 7004 to the hub 7006. The hub application server 7002 of the cloud 7004 is configured to host and provide shared functionality to software applications (e.g., hub applications) executed by the surgical hub 7006. For example, the hub application server 7002 may manage requests made by the hub 7006 for the hub application to control access to the aggregated medical data database 7011 and perform load balancing. The data analysis module 7034 is described in further detail with reference to FIG. 13.

[0100] The particular cloud computing system configuration described in this disclosure is specifically designed to address various problems that arise in the context of medical operations and procedures performed using medical devices such as surgical instruments 7012, 112. In particular, the surgical instruments 7012 may be digital surgical devices configured to interact with the cloud 7004 to implement techniques to improve surgical outcomes. The various surgical instruments 7012 and / or the surgical hub 7006 may include touch-controlled user interfaces such that a clinician may control aspects of the interaction between the surgical instruments 7012 and the cloud 7004. Other suitable user interfaces for control, such as an audibly controlled user interface, may also be used.

[0101] FIG. 13 is a block diagram illustrating a functional architecture of a computer-implemented interactive surgical system according to at least one aspect of the present disclosure. The cloud-based analysis system includes a number of data analysis modules 7034 that may be executed by a processor 7008 of the cloud 7004 to provide data analysis solutions to problems specifically arising in the medical field. As shown in FIG. 13, the functionality of the cloud-based data analysis module 7034 may be supported via a hub application 7014 hosted by a hub application server 7002 that may be accessed on the surgical hub 7006. The cloud processor 7008 and the hub application 7014 may work in conjunction to execute the data analysis module 7034. An application program interface (API) 7016 defines a set of protocols and routines corresponding to the hub application 7014. In addition, the API 7016 manages the storage and retrieval of data in and from a database 7011 of aggregated medical data for the operation of the application 7014. A cache 7018 also stores data (e.g., temporarily) and is coupled to the API 7016 for more efficient retrieval of data used by the application 7014. 13 includes modules for resource optimization 7020, data collection and aggregation 7022, authorization and security 7024, control program updates 7026, patient outcome analysis 7028, recommendations 7030, and data classification and prioritization 7032. Other suitable data analysis modules may be implemented by the cloud 7004, according to some aspects. In one aspect, a data analysis module is used to make certain recommendations based on an analysis of trends, outcomes, and other data.

[0102] For example, the data collection and aggregation module 7022 may be used to generate self-describing data (e.g., metadata) including identifying salient features or configurations (e.g., trends), managing redundant data sets, and storing data into paired data sets that may be grouped by procedure but not necessarily tied to actual surgical procedure dates and surgeons. In particular, paired data sets generated from the operation of the surgical instruments 7012 may include applying a binary classification, such as bleeding or non-bleeding events. More generally, the binary classification may be characterized as either a desired event (e.g., a successful surgical procedure) or an undesired event (e.g., a misfired or misused surgical instrument 7012). The aggregated self-describing data may represent individual data received from various groups or subgroups of the surgical hub 7006. Thus, the data collection and aggregation module 7022 may generate aggregated metadata or other organized data based on the raw data received from the surgical hub 7006. To this end, the processor 7008 may be operatively coupled to the hub application 7014 and the aggregated medical data database 7011 to execute the data analysis module 7034. The data collection and aggregation module 7022 may store the aggregated, organized data in the aggregated medical data database 2212.

[0103] The resource optimization module 7020 can be configured to analyze this aggregated data to determine optimal use of resources for a particular medical facility or group of medical facilities. For example, the resource optimization module 7020 may determine optimal ordering points for surgical staplers 7012 for a group of medical facilities based on corresponding projected demand for such instruments 7012. The resource optimization module 7020 could also evaluate resource usage or other operating configurations of various medical facilities to determine whether resource usage can be improved. Similarly, the recommendation module 7030 can be configured to analyze the organized data aggregated from the data collection and aggregation module 7022 to provide recommendations. For example, the recommendation module 7030 may be able to recommend to a medical facility (e.g., a medical service provider such as a hospital) that a particular surgical instrument 7012 should be upgraded to an improved version based, for example, on a higher than expected error rate. In addition, the recommendation module 7030 and / or resource optimization module 7020 may be able to suggest better supply chain parameters such as product reorder points, provide suggestions for different surgical instruments 7012, their uses, or procedure steps that would improve surgical outcomes, etc. The medical facility may receive such suggestions via the corresponding surgical hub 7006. More specific suggestions regarding parameters or configurations of various surgical instruments 7012 may also be provided. The hub 7006 and / or surgical instruments 7012 may each have a display screen that displays the data or suggestions provided by the cloud 7004.

[0104] The patient outcome analysis module 7028 may analyze surgical outcomes associated with the currently used operating parameters of the surgical instrument 7012. The patient outcome analysis module 7028 may also analyze and evaluate other potential operating parameters. In this regard, the suggestion module 7030 may be able to make suggestions using these other potential operating parameters based on resulting in a better surgical outcome, such as a better seal or less bleeding. For example, the suggestion module 7030 may send suggestions to the surgical hub 7006 regarding when to use a particular cartridge for a corresponding stapling surgical instrument 7012. Thus, the cloud-based analysis system may be configured to analyze large collections of raw data and provide centralized suggestions (advantageously determined based on the aggregated data) across multiple medical facilities while controlling for common variables. For example, the cloud-based analysis system may be able to analyze, evaluate, and / or aggregate data based on type of medical procedure, type of patient, number of patients, geographic similarity between medical providers / facilities using similar types of instruments, etc., in a manner that cannot be analyzed independently by a single medical facility alone.

[0105] The control program update module 7026 may be configured to implement various surgical instrument 7012 suggestions when the corresponding control program is updated. For example, the patient outcome analysis module 7028 may be able to identify correlations linking certain control parameters with successful (or unsuccessful) outcomes. Such correlations may be addressed when an updated control program is transmitted to the surgical instrument 7012 via the control program update module 7026. Updates to the instrument 7012 transmitted via the corresponding hub 7006 may incorporate aggregated performance data collected and analyzed by the data collection and aggregation module 7022 of the cloud 7004. Additionally, the patient outcome analysis module 7028 and suggestions module 7030 may be able to identify improved ways to use the instrument 7012 based on the aggregated performance data.

[0106] The cloud-based analysis system may include security features implemented by the cloud 7004. These security features may be managed by the authorization and security module 7024. Each surgical hub 7006 may have associated unique credentials, such as a username, password, and other suitable security credentials. These credentials may be stored in memory 7010 and may be associated with an authorized cloud access level. For example, based on providing accurate credentials, the surgical hub 7006 may be granted access to communicate with the cloud to a predetermined extent (e.g., send or receive certain defined types of information). To this end, the aggregated medical data database 7011 of the cloud 7004 may include a database of credentials to verify the accuracy of the provided credentials. Different credentials may be associated with various levels of permission for interaction with the cloud 7004, such as a predetermined level of access to receive data analytics generated by the cloud 7004.

[0107] Additionally, for security purposes, the cloud may maintain a database of hubs 7006, instruments 7012, and other devices, which may include a "blacklist" of prohibited devices. Specifically, a blacklisted surgical hub 7006 may not be allowed to interact with the cloud, while a blacklisted surgical instrument 7012 may not have functional access to the corresponding hub 7006 and / or may be prevented from fully functioning when paired with its corresponding hub 7006. Additionally or alternatively, the cloud 7004 may flag instruments 7012 based on incompatibility or other specified criteria. In this manner, counterfeit medical devices and inappropriate reuse of such devices across the cloud-based analysis system may be identified and addressed.

[0108] The surgical instrument 7012 may use a wireless transceiver to transmit a wireless signal that may represent, for example, authorization credentials for access to the corresponding hub 7006 and cloud 7004. A wired transceiver may also be used to transmit the signal. Such authorization credentials may be stored in a memory device of each of the surgical instruments 7012. The authorization and security module 7024 may determine whether the authorization credentials are accurate or counterfeit. The authorization and security module 7024 may also dynamically generate authorization credentials for enhanced security. The credentials may also be encrypted, such as by using hash-based encryption. Upon transmitting the appropriate authorization, the surgical instrument 7012 may transmit a signal to the corresponding hub 7006 and ultimately the cloud 7004 to indicate that the instrument 7012 is ready to acquire and transmit medical data. In response, the cloud 7004 may transition to a state capable of receiving medical data for storage in the aggregated medical data database 7011. This data transmission readiness may also be indicated by, for example, a light indicator on the instrument 7012. The cloud 7004 may also send signals to the surgical instruments 7012 to update their associated control programs. The cloud 7004 may send signals directed to a particular class of surgical instruments 7012 (e.g., electrosurgical instruments) so that software updates to the control programs are sent only to the appropriate surgical instruments 7012. Additionally, the cloud 7004 may be used to implement system-wide solutions to address local or global issues based on selective data transmission and authorization credentials. For example, if a group of surgical instruments 7012 are identified as having a common manufacturing defect, the cloud 7004 may change the authorization credentials corresponding to this group to implement an operational lockout of this group.

[0109] The cloud-based analytics system may enable monitoring of multiple healthcare facilities (e.g., healthcare facilities such as hospitals) to determine improved practices and suggested changes (e.g., via the suggestions module 2030). Thus, the processor 7008 of the cloud 7004 may analyze data associated with an individual healthcare facility to identify the facility and aggregate that data with other data associated with other healthcare facilities. Groups may be defined, for example, based on similar operational actions or geographic locations. In this manner, the cloud 7004 may provide broader analysis and suggestions for groups of healthcare facilities. The cloud-based analytics system may also be used for enhanced situational awareness. For example, the processor 7008 may predictively model the effect of suggestions on costs and effectiveness for a particular facility (for overall operations and / or various medical procedures). The costs and effectiveness associated with that particular facility may also be compared to the corresponding local area of ​​other facilities or any other comparable facilities.

[0110] The data classification and prioritization module 7032 may prioritize and classify data based on criticality (e.g., severity, surprise, suspiciousness of the medical event associated with the data). This classification and prioritization may be used in conjunction with other data analysis module 7034 functions described above to improve the cloud-based analysis and operations described herein. For example, the data classification and prioritization module 7032 may assign priorities to the data analysis performed by the data collection and aggregation module 7022 and the patient outcome analysis module 7028. Different priority levels may result in a specific response from the cloud 7004 (corresponding to the level of urgency), such as elevation for rapid response, special handling, exclusion from the aggregated medical data database 7011, or other suitable response. Additionally, if necessary, the cloud 7004 may send a request (e.g., push message) via the hub application server for additional data from the corresponding surgical instrument 7012. The push message may result in a notification being displayed on the corresponding hub 7006 to request assistance or additional data. This push message may be required in situations where the cloud detects significant irregularities or outliers and the cloud is unable to determine the cause of the irregularity. The central server 7013 may be programmed to trigger this push message in certain critical situations, such as, for example, when the data is determined to differ from expected values ​​by more than a predetermined threshold, or if security is deemed to be involved.

[0111] In various aspects, the surgical instrument 7012 described above with reference to Figures 12 and 13 can be implemented as a combination energy instrument 213100 (Figure 18), a surgical stapler 213102 (Figure 18), an aspiration / irrigation device 213104 (Figure 18), a sterile field display 213108 (Figure 18), a surgical device 213204 (Figures 19A and 19B), a surgical evacuation system 50400 (Figure 21), an electrosurgical instrument 50630 (Figure 22), an evacuation system 50600 (Figure 22), an evacuation system 50900 (Figure 23), a scope 213501 (Figure 25), and a surgical device 213608 (Figure 26). Thus, the combination energy instrument 213100 (FIG. 18), the surgical stapler 213102 (FIG. 18), the suction / irrigation device 213104 (FIG. 18), the sterile field display 213108 (FIG. 18), the surgical devices 213204 (FIGS. 19A and 19B), the surgical evacuation system 50400 (FIG. 21), the electrosurgical instrument 50630 (FIG. 22), the evacuation system 50600 (FIG. 22), the evacuation system 50900 (FIG. 23), the scope 213501 (FIG. 25), and the surgical devices 213608 (FIG. 26) are configured to interface with a network 2001 configured to interface with the surgical hub 7006 and the cloud 7004. Thus, the processing capabilities provided by the central server 7013 and the data analysis module 7034 are configured to process information (e.g., data and control) from the combination energy instrument 213100 (FIG. 18), the surgical stapler 213102 (FIG. 18), the suction / irrigation device 213104 (FIG. 18), the sterile field display 213108 (FIG. 18), the surgical device 213204 (FIGS. 19A and 19B), the surgical evacuation system 50400 (FIG. 21), the electrosurgical instrument 50630 (FIG. 22), the evacuation system 50600 (FIG. 22), the evacuation system 50900 (FIG. 23), the scope 213501 (FIG. 25), and the surgical device 213608 (FIG. 26).

[0112] Further details regarding the cloud analytics system can be found in U.S. Provisional Patent Application No. 62 / 659,900, filed April 19, 2018, entitled "METHOD OF HUB COMMUNICATION," which is incorporated by reference in its entirety.

[0113] Situational Awareness Although an "intelligent" device that includes a control algorithm that responds to sensed data may be an improvement over a "dumb" device that operates without considering the sensed data, some sensed data may be incomplete or inconclusive when considered alone, i.e., without the context of the type of surgical procedure being performed or the type of tissue being operated on. Without knowing the procedure context (e.g., knowing the type of tissue being operated on or the type of procedure being performed), the control algorithm may inaccurately or suboptimally control the modular device when given sensed data that does not include the specific context. For example, the optimal method of the control algorithm to control the surgical instrument in response to a particular sensed parameter may vary according to the particular type of tissue being operated on. This is due to the fact that different tissue types have different properties (e.g., resistance to tearing) that cause them to respond differently to actions taken by the surgical instrument. Thus, it may be desirable for the surgical instrument to take different actions even when the same measurement is sensed for a particular parameter. As one specific example, the optimal way to control a surgical stapling and severing instrument in response to the instrument sensing an unexpectedly high force to close its end effector depends on whether the type of tissue is susceptible to tearing or resistant to this. For tissue susceptible to tearing, such as lung tissue, the instrument's control algorithm optimally ramps down the motor in response to an unexpectedly high force to close to avoid tearing the tissue. For tissue resistant to tearing, such as stomach tissue, the instrument's control algorithm optimally ramps up the motor in response to an unexpectedly high force to close to ensure that the end effector is properly clamped to the tissue. Without knowing whether lung tissue or stomach tissue is being clamped, the control algorithm may make suboptimal decisions.

[0114] One solution utilizes a surgical hub that includes a system configured to derive information regarding the surgical procedure to be performed based on data received from various data sources and then control the paired modular devices accordingly. In other words, the surgical hub is configured to infer information regarding the surgical procedure from the received data and then control the modular devices paired with the surgical hub based on the inferred context of the surgical procedure. FIG. 14 shows a diagram of a situation-aware surgical system 5100 according to at least one embodiment of the present disclosure. In some examples, the data sources 5126 include, for example, the modular devices 5102 (which may include sensors configured to detect parameters associated with the patient and / or the modular devices themselves), databases 5122 (e.g., an EMR database including patient records), and patient monitoring devices 5124 (e.g., blood pressure (BP) monitors and electrocardiogram (EKG) monitors).

[0115] The surgical hub 5104, which may be similar in many respects to the hub 106, may be configured to derive contextual information regarding the surgical procedure from the data based, for example, on a particular combination of received data or a particular order in which data is received from the data sources 5126. The contextual information inferred from the received data may include, for example, the type of surgical procedure being performed, the particular step of the surgical procedure the surgeon is performing, the type of tissue being operated on, or the body cavity that is the subject of the procedure. This ability, according to some aspects of the surgical hub 5104, to derive or infer information related to the surgical procedure from the received data may be referred to as "situational awareness." In one example, the surgical hub 5104 may incorporate a situational awareness system, which is hardware and / or programming associated with the surgical hub 5104 that derives contextual information related to the surgical procedure from the received data.

[0116] The situational awareness system of the surgical hub 5104 may be configured to derive contextual information from data received from the data sources 5126 in a variety of different ways. In one example, the situational awareness system includes a pattern recognition system or a machine learning system (e.g., an artificial neural network) trained with training data to correlate various inputs (e.g., data from the database 5122, the patient monitoring devices 5124, and / or the modular devices 5102) with corresponding contextual information regarding the surgical procedure. In other words, the machine learning system may be trained to accurately derive contextual information regarding the surgical procedure from the inputs provided. In another example, the situational awareness system may include a lookup table that stores pre-characterized contextual information regarding the surgical procedure in correspondence with one or more inputs (or ranges of inputs) that correspond to the contextual information. In response to being queried with one or more inputs, the lookup table may return corresponding contextual information for the situational awareness system to control the modular devices 5102. In one example, the contextual information received by the situational awareness system of the surgical hub 5104 is associated with a particular control adjustment or set of control adjustments of one or more modular devices 5102. In another example, the situational awareness system includes an additional machine learning system, lookup table, or other such system that generates or retrieves one or more control adjustments of the one or more modular devices 5102 when provided with the contextual information as input.

[0117] A surgical hub 5104 incorporating a situational awareness system provides many benefits to the surgical system 5100. One benefit includes improved interpretation of sensed and collected data, which improves processing accuracy and / or use of the data during the course of a surgical procedure. Returning to the previous example, the situational aware surgical hub 5104 can determine what type of tissue is being operated on, and thus, when an unexpectedly high force is detected to close the end effector of the surgical instrument, the situational aware surgical hub 5104 can properly ramp up or down the motor of the surgical instrument to match the type of tissue.

[0118] As another example, the type of tissue being operated on can affect adjustments made to the compression speed and load threshold of the surgical stapling and severing instrument for a particular tissue gap measurement. The context-aware surgical hub 5104 can estimate whether the surgical procedure being performed is a thoracic or abdominal procedure, which allows the context-aware surgical hub 5104 to determine whether the tissue being clamped by the end effector of the surgical stapling and severing instrument is pulmonary (in the case of thoracic surgery) or stomach (in the case of abdominal surgery). The surgical hub 5104 can then adjust the compression speed and load threshold of the surgical stapling and severing instrument appropriately for the type of tissue.

[0119] As yet another example, the type of body cavity being operated on during an insufflation procedure may affect the functionality of the smoke evacuator. The situationally aware surgical hub 5104 can determine if the surgical site is under pressure (by determining that a surgical procedure is utilizing insufflation) and determine the procedure type. As the procedure type is typically performed within a particular body cavity, the surgical hub 5104 can control the smoke evacuator motor speed appropriately for the body cavity being operated on. Thus, the situationally aware surgical hub 5104 can provide a consistent amount of smoke evacuation for both thoracic and abdominal procedures.

[0120] As yet another example, the type of procedure being performed may affect the optimal energy level at which an ultrasonic surgical instrument or a radio frequency (RF) electrosurgical instrument operates. An arthroscopic procedure, for example, requires a higher energy level because the end effector of the ultrasonic surgical instrument or RF electrosurgical instrument is submerged in fluid. The situation-aware surgical hub 5104 may determine whether the surgical procedure is an arthroscopic procedure. The surgical hub 5104 may then adjust the RF power level or ultrasonic amplitude (i.e., "energy level") of the generator to compensate for the fluid-filled environment. Relatedly, the type of tissue being operated on may affect the optimal energy level at which an ultrasonic surgical instrument or a RF electrosurgical instrument operates. The situation-aware surgical hub 5104 may determine what type of surgical procedure is being performed according to the expected tissue profile of the surgical procedure and then customize the energy level of the ultrasonic surgical instrument or the RF electrosurgical instrument, respectively. Additionally, the situationally aware surgical hub 5104 can be configured to adjust the energy level of the ultrasonic surgical instrument or RF electrosurgical instrument throughout the course of a surgical procedure, rather than just on a procedure basis. The situationally aware surgical hub 5104 can determine which step of the surgical procedure is being performed or will be performed thereafter, and then update the generator and / or the control algorithms of the ultrasonic surgical instrument or RF electrosurgical instrument to set the energy level to a value appropriate for the tissue type expected according to the step of the surgical procedure.

[0121] As yet another example, data can be drawn from additional data sources 5126 to improve conclusions that the surgical hub 5104 draws from one data source 5126. The situation-aware surgical hub 5104 can augment data received from the modular device 5102 with contextual information it builds on the surgical procedure from other data sources 5126. For example, the situation-aware surgical hub 5104 can be configured to determine whether hemostasis has occurred (i.e., whether bleeding at the surgical site has stopped) according to video or image data received from a medical imaging device. However, in some cases, the video or image data may not be conclusive. Thus, in one example, the surgical hub 5104 can be further configured to compare a physiological measurement (e.g., blood pressure sensed by a BP monitor communicatively connected to the surgical hub 5104) with visual or image data of hemostasis (e.g., from a medical imaging device 124 (FIG. 2) communicatively coupled to the surgical hub 5104) to make a determination about the integrity of a staple line or tissue weld. In other words, the situational awareness system of the surgical hub 5104 can take into account the physiological measurement data to provide additional context when analyzing the visualization data. The additional context can be useful in cases where the visualization data may not be conclusive or incomplete by itself.

[0122] Another benefit includes actively and automatically controlling the paired modular devices 5102 according to the particular step of the surgical procedure being performed to reduce the number of times a medical professional is required to interact with or control the surgical system 5100 during the course of a surgical procedure. For example, the situation-aware surgical hub 5104 can actively activate a generator to which an RF electrosurgical instrument is connected if it determines that a subsequent step of the procedure requires the use of the instrument. By actively activating the energy source, the instrument can be ready for use as soon as the preceding step of the procedure is completed.

[0123] As another example, the situation-aware surgical hub 5104 can determine whether a current or subsequent step in a surgical procedure requires a different view or degree of magnification on the display according to features at the surgical site that the surgeon is expected to need to see. The surgical hub 5104 can then actively change the displayed view (e.g., provided by a medical imaging device for the visualization system 108) accordingly, causing the display to automatically adjust throughout the surgical procedure.

[0124] As yet another example, the context-aware surgical hub 5104 can determine what step of the surgical procedure is being performed or will be performed subsequently, and whether specific data or comparisons between data are required for that step of the surgical procedure. The surgical hub 5104 can be configured to automatically call up data screens based on the step of the surgical procedure being performed, without waiting for the surgeon to ask for specific information.

[0125] Another benefit includes checking for errors during the setup of a surgical procedure or during the course of a surgical procedure. For example, the situation-aware surgical hub 5104 can determine whether the surgical field is properly or optimally set up for the surgical procedure being performed. The surgical hub 5104 can be configured to determine the type of surgical procedure being performed, retrieve (e.g., from memory) the corresponding checklist, product location, or setup needs, and then compare the current surgical field layout to a standard layout for the type of surgical procedure the surgical hub 5104 has determined is being performed. In one example, the surgical hub 5104 can be configured to compare a list of items for the procedure, scanned, for example, by an appropriate scanner, and / or a list of devices paired with the surgical hub 5104, to a proposed or expected manifest of items and / or devices for a given surgical procedure. If any discontinuities exist between the lists, the surgical hub 5104 can be configured to provide a warning indicating that a particular modular device 5102, patient monitoring device 5124, and / or other surgical item is missing. In one example, the surgical hub 5104 can be configured to determine the relative distance or position of the modular device 5102 and the patient monitoring device 5124, for example, by a proximity sensor. The surgical hub 5104 can compare the relative positions of the devices to a proposed or expected layout for a particular surgical procedure. If a discontinuity exists between the layouts, the surgical hub 5104 can be configured to provide a warning indicating that the current layout of the surgical procedure deviates from the proposed layout.

[0126] As another example, the situation-aware surgical hub 5104 can determine whether a surgeon (or other medical personnel) is making an error or otherwise deviating from an expected course of action during the course of a surgical procedure. For example, the surgical hub 5104 can be configured to determine the type of surgical procedure being performed, retrieve (e.g., from a memory) a corresponding list of steps or sequences of equipment use, and then compare the steps being performed, or the equipment being used, during the course of the surgical procedure to the expected steps or equipment for the type of surgical procedure that the surgical hub 5104 has determined is being performed. In one example, the surgical hub 5104 can be configured to provide a warning indicating that an unexpected action is being performed at a particular step in the surgical procedure or that an unexpected device is being utilized at a particular step in the surgical procedure.

[0127] Overall, the situational awareness system for the surgical hub 5104 improves the outcome of surgical procedures by adjusting the surgical instruments (and other modular devices 5102) for the specific context of each surgical procedure (e.g., adjusting for different tissue types) and validating operations during the surgical procedure. The situational awareness system also improves the efficiency of the surgeon in performing the surgical procedure by automatically suggesting next steps, providing data, and adjusting displays and other modular devices 5102 within the surgical field according to the specific context of the procedure.

[0128] In one aspect, as described below with reference to Figures 24-40, the modular device 5102 can be implemented as a combination energy instrument 213100 (Figure 18), a surgical stapler 213102 (Figure 18), an suction / irrigation device 213104 (Figure 18), a sterile field display 213108 (Figure 18), a surgical device 213204 (Figures 19A and 19B), a surgical evacuation system 50400 (Figure 21), an electrosurgical instrument 50630 (Figure 22), an evacuation system 50600 (Figure 22), an evacuation system 50900 (Figure 23), a scope 213501 (Figure 25), and a surgical device 213608 (Figure 26). Thus, the modular devices 5102 implemented as the combination energy instrument 213100 (FIG. 18), the surgical stapler 213102 (FIG. 18), the suction / irrigation device 213104 (FIG. 18), the sterile field display 213108 (FIG. 18), the surgical device 213204 (FIGS. 19A and 19B), the surgical evacuation system 50400 (FIG. 21), the electrosurgical instrument 50630 (FIG. 22), the evacuation system 50600 (FIG. 22), the evacuation system 50900 (FIG. 23), the scope 213501 (FIG. 25), and the surgical device 213608 (FIG. 26) are configured to operate as a data source 5126 and interact with the database 5122 and the patient monitoring device 5124. The modular devices 5102 implemented as the combination energy instrument 213100 (FIG. 18), the surgical stapler 213102 (FIG. 18), the suction / irrigation device 213104 (FIG. 18), the sterile field display 213108 (FIG. 18), the surgical devices 213204 (FIGS. 19A and 19B), the surgical evacuation system 50400 (FIG. 21), the electrosurgical instrument 50630 (FIG. 22), the evacuation system 50600 (FIG. 22), the evacuation system 50900 (FIG. 23), the scope 213501 (FIG. 25), and the surgical devices 213608 (FIG. 26) are further configured to interact with the surgical hub 5104 to provide information (e.g., data and control) to and receive information (e.g., data and control) from the surgical hub 5104.

[0129] 15, there is shown a timeline 5200 illustrating the situational awareness of a hub, such as the surgical hub 106 or 206 (FIGS. 1-11). The timeline 5200 is an exemplary surgical procedure and the contextual information that the surgical hub 106, 206 may derive from data received from data sources at each step of the surgical procedure. The timeline 5200 illustrates typical steps that may be taken by nurses, surgeons, and other medical personnel during the course of a lung segmentectomy surgery, beginning with setting up the surgical site and ending with transporting the patient to a post-operative recovery room.

[0130] The situationally aware surgical hub 106, 206 receives data from data sources throughout the course of a surgical procedure, including data generated each time medical personnel utilize a modular device paired with the surgical hub 106, 206. The surgical hub 106, 206 receives this data from the paired modular devices and other data sources to continually derive inferences (i.e., contextual information) regarding the ongoing procedure as new data is received, such as which step of the procedure is being performed at any given time. The situationally aware system of the surgical hub 106, 206 can, for example, record data regarding the procedure to generate reports, verify steps being taken by medical personnel, provide data or prompts (e.g., via a display screen) that may be relevant to a particular procedure step, adjust the modular device based on the context (e.g., activate a monitor, adjust the field of view (FOV) of a medical imaging device, or change the energy level of an ultrasonic surgical instrument or RF electrosurgical instrument), and take any other such action described above.

[0131] As a first step 5202 in this exemplary procedure, hospital personnel retrieve the patient's EMR from the hospital's EMR database. Based on selected patient data in the EMR, the surgical hub 106, 206 determines that the procedure to be performed is a thoracic procedure.

[0132] In a second step 5204, personnel scan the incoming medical supplies for the procedure. The surgical hub 106, 206 cross-references the scanned supplies with a list of supplies utilized in various types of procedures to verify that the mix of supplies is compatible with the thoracic procedure. Additionally, the surgical hub 106, 206 may also determine that the procedure is not a wedge procedure (either because the incoming supplies do not include certain supplies required for a thoracic wedge procedure or are not otherwise compatible with a thoracic wedge procedure).

[0133] In a third step 5206, medical personnel scan the patient's band via a scanner communicatively connected to the surgical hub 106, 206. The surgical hub 106, 206 can then verify the patient's identity based on the scanned data.

[0134] In a fourth step 5208, the medical staff turns on the auxiliary devices. The auxiliary equipment utilized may vary depending on the type of surgical procedure and the technology used by the surgeon, but in this exemplary case includes a smoke evacuator, an aspirator, and a medical imaging device. Once activated, the auxiliary equipment, which is a modular device, may automatically pair with the surgical hub 106, 206 located within a certain proximity of the modular device as part of its initialization process. The surgical hub 106, 206 may then derive contextual information regarding the surgical procedure by detecting the type of modular device that is paired with it during this pre-operative or initialization phase. In this particular example, the surgical hub 106, 206 determines that the surgical procedure is a VATS procedure based on this particular combination of paired modular devices. Based on a combination of data from the patient's EMR, a list of medical supplies used in the procedure, and the types of modular devices that connect to the hub, the surgical hub 106, 206 may roughly estimate the particular procedure that the surgical team will perform. Once the surgical hub 106, 206 knows what particular procedure is being performed, the surgical hub 106, 206 can then retrieve the steps of that procedure from memory or from the cloud and then cross-reference data subsequently received from connected data sources (e.g., modular devices and patient monitoring devices) to estimate which steps of the surgical procedure the surgical team is performing.

[0135] In a fifth step 5210, personnel attach EKG electrodes and other patient monitoring devices to the patient. The EKG electrodes and other patient monitoring devices may be paired with the surgical hub 106, 206. Once the surgical hub 106, 206 begins receiving data from the patient monitoring devices, the surgical hub 106, 206 confirms that the patient is at the surgical site.

[0136] In a sixth step 5212, medical personnel induce anesthesia in the patient. The surgical hub 106, 206 may estimate that the patient is under anesthesia based on data from the modular devices and / or patient monitoring devices, including, for example, EKG data, blood pressure data, ventilator data, or a combination thereof. Once the sixth step 5212 is completed, the pre-operative portion of the lung segmentectomy surgery is complete and the operative portion begins.

[0137] In a seventh step 5214, the patient's lung being operated on is collapsed (while ventilation is switched to the contralateral lung). The surgical hub 106, 206 can, for example, infer that the patient's lung has been collapsed from ventilator data. Because the surgical hub 106, 206 can compare the detection of the patient's lung being collapsed to the expected steps of the procedure (which may be accessed or read in advance), it can infer that the surgical portion of the procedure has begun, thereby determining that collapsing the lung is the first surgical step in this particular procedure.

[0138] In an eighth step 5216, a medical imaging device (e.g., a scope) is inserted and video footage from the medical imaging device is initiated. The surgical hub 106, 206 receives the medical imaging device data (i.e., video or image data) through a connection to the medical imaging device. Upon receiving the medical imaging device data, the surgical hub 106, 206 may determine that the laparoscopic portion of the surgical procedure has begun. Additionally, the surgical hub 106, 206 may determine that the particular procedure being performed is a segmentectomy as opposed to a lobectomy (note that the wedge procedure has already been discounted by the surgical hub 106, 206 based on the data received in the second step 5204 of the procedure). Data from the medical imaging device 124 (FIG. 2) may be used to determine contextual information regarding the type of procedure being performed among many different methods, including by determining the angle at which the medical imaging device is oriented with respect to visualization of the patient's anatomy, by monitoring the number or medical imaging devices being used (i.e., activated and paired with the surgical hub 106, 206), and by monitoring the type of visualization device being used. For example, one technique for performing a VATS lobectomy places the camera above the diaphragm in the anterior inferior corner of the patient's thoracic cavity, while one technique for performing a VATS segmentectomy places the camera in an anterior intercostal position relative to the segmental fissure. For example, using pattern recognition or machine learning techniques, a situational awareness system may be trained to recognize the location of the medical imaging device based on visualization of the patient's anatomy. As another example, one technique for performing a VATS lobectomy utilizes a single medical imaging device, while another technique for performing a VATS segmentectomy utilizes multiple cameras. As yet another example, one technique for performing a VATS segmentectomy utilizes an infrared light source (which may be communicatively coupled to a surgical hub as part of the visualization system) to visualize the segmental fissure, which is not utilized in a VATS lobectomy.By tracking any or all of this data from the medical imaging devices, the surgical hub 106, 206 can determine the particular type of surgical procedure being performed and / or the technique being used for the particular type of surgical procedure.

[0139] In a ninth step 5218, the surgical team begins the dissection step of the procedure. Because the surgical hub 106, 206 receives data from the RF or ultrasonic generator indicating that an energy instrument is being fired, it can infer that the surgeon is in the process of dissecting and separating the patient's lungs. The surgical hub 106, 206 can cross-reference the received data with the retrieved step of the surgical procedure to determine that the energy instrument being fired at this point in the process (i.e., after the previously discussed steps of the procedure have been completed) corresponds to the dissection step. In a particular example, the energy instrument can be an energy tool attached to a robotic arm of a robotic surgical system.

[0140] In a tenth step 5220, the surgical team proceeds to the ligation step of the procedure. Because the surgical hub 106, 206 receives data from the surgical stapling and severing instrument indicating the instrument is being fired, the surgical hub 106, 206 can infer that the surgeon is ligating the artery and vein. As in the previous step, the surgical hub 106, 206 can derive this inference by cross-referencing the receipt of data from the surgical stapling and severing instrument with the step in the retrieved process. In a particular example, the surgical instrument may be a surgical tool attached to a robotic arm of a robotic surgical system.

[0141] In an eleventh step 5222, the segmental resection portion of the procedure is performed. The surgical hub 106, 206 can infer that the surgeon is transecting parenchymal tissue based on data from the surgical stapling and cutting instrument, including data from its cartridge. The cartridge data can correspond to, for example, the size or type of staples fired by the instrument. Because different types of staples are applied to different types of tissue, the cartridge data can indicate the type of tissue being stapled and / or transected. In this case, the type of staples fired is applied to parenchymal tissue (or other similar tissue type), which allows the surgical hub 106, 206 to infer that the segmental resection portion of the procedure is being performed.

[0142] Then, in a twelfth step 5224, a node dissection step is performed. The surgical hub 106, 206 may infer that the surgical team is dissecting the node and performing a leak test based on data received from the generator indicating that an RF or ultrasonic instrument is being fired. For this particular procedure, the RF or ultrasonic instrument utilized after the parenchymal tissue is transected corresponds to the node dissection step, which allows the surgical hub 106, 206 to make this inference. It is noted that the surgeon periodically alternates between the surgical stapling / cutting instrument and the surgical energy (i.e., RF or ultrasonic) instrument depending on the particular step of the procedure, as different instruments are better suited for certain tasks. Thus, the particular sequence in which the stapling / cutting instrument and the surgical energy instrument are used may indicate which step of the procedure the surgeon is performing. Additionally, in certain instances, a robotic tool may be used for one or more steps during the surgical procedure, and / or a handheld surgical instrument may be used for one or more steps during the surgical procedure. The surgeon can, for example, alternate between the robotic tool and the handheld surgical instrument and / or can use the devices simultaneously, for example. Once the twelfth step 5224 is completed, the incision is closed and the post-operative portion of the procedure begins.

[0143] In a thirteenth step 5226, the patient's anesthesia is reversed. The surgical hub 106, 206 may estimate that the patient is emerging from anesthesia based on, for example, ventilator data (i.e., the patient's breathing rate begins to increase).

[0144] Finally, a fourteenth step 5228 is for the medical personnel to remove the various patient monitoring devices from the patient. Thus, the surgical hub 106, 206 can presume that the patient is being transferred to a recovery room when the hub loses EKG, BP, and other data from the patient monitoring devices. As can be seen from the description of this exemplary procedure, based on data received from various data sources communicatively coupled to the surgical hub 106, 206, the surgical hub 106, 206 can determine or presume that each step of a given surgical procedure is currently being performed.

[0145] In various aspects, the combination energy instrument 213100 (FIG. 18), the surgical stapler 213102 (FIG. 18), the suction / irrigation device 213104 (FIG. 18), the sterile field display 213108 (FIG. 18), the surgical devices 213204 (FIGS. 19A and 19B), the surgical evacuation system 50400 (FIG. 21), the electrosurgical instrument 50630 (FIG. 22), the evacuation system 50600 (FIG. 22), the evacuation system 50900 (FIG. 23), the scope 213501 (FIG. 25), and the surgical devices 213608 (FIG. 26) are configured to operate with situational awareness in a hub environment, such as the surgical hub 106 or 206 (FIGS. 1-11), as shown by the time line 5200. Situational awareness is further described in U.S. Provisional Patent Application No. 62 / 659,900, filed April 19, 2018, entitled "METHOD OF HUB COMMUNICATION," which is incorporated by reference in its entirety. In certain examples, the operation of a robotic surgical system, including, for example, the various robotic surgical systems disclosed herein, can be controlled by the hub 106, 206 based on its situational awareness and / or feedback from its components and / or based on information from the cloud 104.

[0146] Adaptive control schemes and interactive system control In various aspects, a computer system, such as a surgical hub computer system, can be configured to extract deeper context around the captured data, for example, and then utilize this deeper context to improve the adaptability of actionable items for the operator. The deeper context can include a combination of metadata and data, synthesizing data from different sources and / or data obtained at different times (e.g., pre-op, intra-op, post-op) to determine relationships and / or correlations. In one example, the context of the data can be informed by the surgical hub's situational awareness during the surgical procedure, which can indicate actionable items such as step-specific or temporal adjustments and / or suggestions to the clinician. The system can be configured to implement an adjustable control scheme having interdependent control aspects. For example, the system can be configured to provide an adaptive control scheme having interactive system control based on the captured data.

[0147] In one aspect, the controls of the surgical hub or devices connected to the hub can be configured to adjust its function (or cause its function to be adjusted) based on sensed conditions or usage conditions. The function can be adjusted, for example, by adjusting the scale or extent of the surgical function (e.g., power level or clamping force), adjusting one or more thresholds of the surgical function (e.g., maximum and minimum power level limits), adjusting the resulting action of the surgical function (e.g., changing the energy modality), adjusting the type of measurement affecting the surgical function (e.g., from on-off activation to operator-controlled variable activation), and / or adjusting the complementary action of the surgical function (e.g., adjusting the clamping force based on the selected energy modality). Further examples of adjustments of surgical functions are described herein.

[0148] In one aspect, the type of measurement can vary between on-off activation detection and degree measurement, such as with strain gauges or Hall effect sensors. For example, an actuator for a surgical function can operate as an on-off actuator in a first mode corresponding to a first surgical condition and as a degree-based actuator in a second mode corresponding to a second surgical condition. The degree-based actuator can be configured to adjust, for example, the firing stroke length and / or force, the end effector closure amount and / or clamping force, and / or the energy activation type and / or level. In one aspect, activation and / or deactivation thresholds can be adjusted based on time in the procedure and / or whether it is a fine or coarse use surgical step, which can be informed by the situational awareness of the system, for example.

[0149] In one aspect, the surgical hub can be configured to prioritize visual display on a display within the operating room or surgical field of actionable contextual secondary information gleaned from data available during a procedure. Prioritization can be based, for example, on the reliability and / or importance of the actionable information. In one aspect, activation or toggle icons for the actionable information can include highlighting where the normal graphical interface is not highlighted. The display can be, for example, on the surgical device or on the main display (e.g., a display connected to the surgical hub).

[0150] In certain instances, a clinician may desire to use a surgical device for multiple surgical functions. For example, a surgical device may be used to coagulate blood vessels, cut tissue, and / or seal tissue. To accomplish these different functions, the control scheme of the surgical device may be adjusted. For example, different power levels or thresholds may be utilized. Additionally or alternatively, different energy modalities (e.g., ultrasonic, bipolar, and monopolar) may be utilized. It may be desirable to quickly switch between different surgical functions without resorting to complex controls on the surgical device and / or on a remote console. In certain instances, it may be desirable to perform such control scheme adjustments and adaptations with existing surgical devices and / or with surgical devices that have minimal input controls, i.e., actuators.

[0151] In certain aspects, the surgical system can be configured to implement automatic changes in control based on monitored conditions within the procedure. A single input control or actuator can be utilized to achieve different surgical functions. The available surgical functions operable with the input control can depend on the surgical step or state of the surgical procedure. In various embodiments, a situationally aware surgical hub or a surgical device connected to the hub can determine the surgical step and / or state from its situational awareness. Thus, the system can be configured to adjust the control scheme of the device based on the situational awareness of the user's intent. In one example, in a first surgical state (determined by the situational awareness of the surgical hub), the power level of the transducer can be defined by a first range, and in a second surgical state (determined by the situational awareness of the surgical hub), the power level of the transducer can be defined by a second, different range. Additionally or alternatively, in a first surgical condition (determined by the situational awareness of the surgical hub) the combined energy device may operate in a combination mode and in a second surgical condition (determined by the situational awareness of the surgical hub) the combined energy device may operate in an ultrasonic mode without applying electrosurgical energy. The different surgical functions may be performed by a single actuator, which may comprise a smart or intelligent actuator that is informed by the situational awareness of the surgical hub.

[0152] In one aspect, the surgical device can include an actuator configured to receive an input. The surgical device can further include control circuitry configured to receive a signal from the situation-aware surgical hub indicative of a surgical condition, receive an actuation signal from the actuator in response to the input, and perform a surgical function in response to the actuation signal. The surgical function can include a first surgical function when the surgical condition corresponds to a first surgical condition and a second surgical function when the surgical condition corresponds to a second surgical condition. The second surgical condition can be different from the first surgical condition and the second surgical function can be different from the first surgical function. In another aspect, computer readable instructions stored on a non-transitory medium, when executed, can cause a machine, such as an intelligent surgical device, to receive a signal from the situation-aware surgical hub indicative of a surgical condition, receive an actuation signal in response to an input applied to the actuator of the surgical device, and perform a surgical function in response to the actuation signal. The surgical function may include a first surgical function when the surgical condition corresponds to a first surgical condition and a second surgical function when the surgical condition corresponds to a second surgical condition. The second surgical condition may be different from the first surgical condition and the second surgical function may be different from the first surgical function. Adjustment and adaptation of alternative control schemes are further described herein.

[0153] As described further herein, the function of a control, e.g., an actuator, can be adjusted based on one or more factors, including other instruments currently being used in the surgical field, the steps of the surgical procedure, and / or inputs to secondary controls of the surgical device. Such factors can be determined at least in part from situational awareness, as described further herein.

[0154] In some applications, the degree of displacement of the actuator and / or input force on the actuator of the surgical device may affect the power (e.g., amplitude) limits of the surgical device. Referring now to FIG. 16, the energy device 213000 may include a first activation button 213002 and a second activation button 213004. In various examples, the first activation button 213002 may correspond to a first power level and the second activation button 213004 may correspond to a second power level. For example, the first activation button 213002 may include a higher or maximum power level that may correspond to a cut mode and the second activation button 213004 may include a lower or minimum power level that may correspond to a coagulation mode. In such examples, the first activation button 213002 may be referred to as a "cut button" and the second activation button 213004 may be referred to as a "coagulation button."

[0155] The activation buttons 213002, 213004 may have a spring biased aspect that allows the activation buttons 213002, 213004 to function as an on-off switch and also detect the force applied by the operator to it. In one aspect, the activation buttons 213002, 213004 may have a first or normal activation that occupies a certain portion of the button's range of travel and a second or modified activation that occupies another portion of the button's range of travel. For example, the first 70-80% of the button's range of travel may result in an activation of energy and the remaining portion of the button's range of travel may adjust the energy level. In such an example, if the clinician further compresses either the activation button 213002, 213004 by overcoming a higher bias force, the button may change function and apply a cutting or coagulation energy level as well as increase the power level from the level set on the generator. For example, the power level may be increased one level when the activation button is moved to the remaining portion of the button's range of travel. In this operation, high force actuation serves to both activate the energy and increase the power level of the energy.

[0156] In one aspect, the surgical function controlled by the actuation buttons 213002, 213004 may be subject to the position of the end effector 213006 and / or the closure trigger 213008. For example, still referring to FIG. 16, across a first range of motion (i.e., a first angle θ 1 Movement of the closure trigger 213008 over a second range of motion (i.e., a second angle θ 2 Movement of the closure trigger 213008 (over a second distance b) can affect closure of the end effector 213006 a second amount, a second distance b. In certain embodiments, the first amount can correspond to closing movement of the jaws 213010, 213012 and the second amount can correspond to clamping movement of the jaws 213010, 213012. The first jaw 213010 can be a clamp arm that can move relative to the second jaw 213012 in certain examples. In other examples, only the second jaw 213012 and / or both the jaws 213010, 213012 can be moved by the closure trigger 213008 to close and / or clamp the end effector 213006.

[0157] The first actuation button 213002 and / or the second actuation button 213004 can perform different surgical functions based on the position of the closure trigger 213008 and / or the clamp arm 213010. For example, if the actuation buttons 213002, 213004 are activated when the jaws 213010, 213012 of the end effector 213006 are between a fully open threshold and a partially closed threshold (e.g., closed 2 / 3 of the way through the closure range), the actuation buttons 213002, 213004 can have a respective first energy level. Additionally, if the jaws 213010, 213012 are moved beyond a partially closed threshold (e.g., more than 2 / 3 closed), the first actuation button 213002 and the second actuation button 213004 can have a respective second energy level. The second energy level of each button 213002, 213004 can be higher than the corresponding first energy level of the respective actuation button 213002, 213004. For example, the energy level can be higher when the jaws 213010, 213012 are more closed, such as when the jaws 213010, 213012 actively clamp tissue therebetween.

[0158] A pair of graphs 213020, 213022 illustrating jaw closure and transducer amplitude versus trigger angle (θ) of the energy device 213000 are shown in Figure 17. With reference to graph 213020, the control algorithm of the energy device 213000 is configured to adjust the amplitude of the ultrasonic transducer according to the trigger angle (θ), i.e., the degree to which the closure trigger 213008 (Figure 16) is depressed. The amplitude can be adjusted at one or more thresholds, such as the trigger angle threshold 213024 shown in Figure 17.

[0159] More specifically, during a first range of travel of the closure trigger 213008 (e.g., a first trigger displacement angle θ 1 ), the first actuation button 213002 is a first maximum threshold Max a The second activation button 213004 activates the energy at a first minimum threshold Mina During the second range of travel of the closure trigger 213008 (e.g., the second trigger displacement angle θ 2 ), the first actuation button 213002 is actuated to a second maximum threshold value Max b and a second activation button 213004 activates energy at a second minimum threshold Min b In the illustrated graph 213022, the first minimum threshold Min a is the second minimum threshold Min b Unlike the first maximum threshold Max a is the second maximum threshold Max b More specifically, the first minimum threshold Min a is the second minimum threshold Min b is less than the first maximum threshold Max a is the second maximum threshold Max b is less than.

[0160] As shown in FIG. 17, the first minimum threshold Min a is 30% of the transducer amplitude limit, and the second minimum threshold Min b is 75% of the transducer amplitude limit. In addition, a second maximum threshold Max b is 100% of the transducer amplitude limit, while the first maximum threshold Max a is only 40% of the transducer amplitude limit. Other thresholds are contemplated. For example, a second minimum threshold Min b is the first maximum threshold Max a It may be less than.

[0161] In yet another example, the first minimum threshold Min a is the second minimum threshold Min b and / or a first maximum threshold Max a is the second maximum threshold Max b In yet another example, only one of the limits can be adjusted when the trigger displacement angle exceeds the trigger angle threshold 213024. For example, the second actuation button 213004 can be adjusted to an angle θ1 and θ 2 The first minimum threshold Min during the entire movement range of the closure trigger 213008 including a In other words, the transducer amplitude can be maintained at 30% when the second actuation button 213004 is pressed regardless of the position of the first jaw 213010 and / or the closure trigger 213008. Additionally or alternatively, one or more of the limits can be adjusted with additional trigger angle thresholds.

[0162] Now referring to the graph 213020, the rate of closure of the closure trigger 213008 may also be adjusted based on the detected surgical condition and / or surgical step. For example, the closure trigger 213008 may be adjusted to a first trigger displacement range θ 1 , and the closure trigger 213008 can close at a first rate during a first range of travel over a second trigger displacement range θ 2 The closure trigger 213008 may close at a second rate during a second range of travel spanning a first rate corresponding to slope A / area A. More specifically, the first rate corresponding to slope A / area A may continue until the closure trigger 213008 meets the trigger angle threshold 213024. In the illustrated configuration, the trigger angle threshold 213024 corresponds to 75% end effector closure. In other examples, the trigger angle threshold 213024 may define end effector closure less than or greater than 75%, such as, for example, two-thirds closed and / or 90% closed. Once the trigger angle threshold 213024 is reached, the closure rate may be increased to a second rate in zone B until the closure trigger 213008 is 100% closed. In other examples, the closure rate may be decreased once the trigger angle threshold 213024 is reached. Additionally or alternatively, the closure rate may be adjusted with additional trigger angle thresholds.

[0163] In various examples, the position of the closure trigger 213008 can indicate a surgical condition of the surgical procedure. For example, the closure trigger 213008 can remain open during a first surgical step, can close to a first degree during a second surgical step, and can close to a second degree during a third surgical step. For example, an open jaw can be used to cauterize a blood vessel, a partially closed jaw can be used to coagulate tissue, and / or a fully closed jaw can be used to cut tissue. By monitoring the position of the closure trigger 213008, the control circuitry is configured to determine a surgical condition and / or step and adjust the surgical function, i.e., power level, of the device connected to the hub based on the detected condition and / or step. Situational awareness can further inform the determination. For example, during a particular type of surgical procedure and / or when treating a particular type of tissue, the maximum and / or minimum thresholds and / or trigger angle thresholds can be adjusted in a first manner, and during another type of surgical procedure and / or when treating another type of tissue, the maximum and / or minimum thresholds and / or trigger angle thresholds can be adjusted in a second manner. For example, lung tissue and stomach tissue may require different responses. Additionally or alternatively, arteries and veins may require different thresholds. Situational awareness can determine the type of surgical procedure and / or tissue.

[0164] In various examples, one or more controls and / or actuators of a surgical device can be adjusted based on another control / actuator on the surgical device. Activating a first control / actuator can cause a second control / actuator to have an adjusted function. Referring back to FIG. 16, for example, if the jaws 213010, 213012 of the energy device 213000 are wide open and energy is activated via one of the activation buttons 213002, 213004, the surgical system can sense or otherwise determine that the surgeon is about to use the instrument for a first surgical function, such as a back cut. Thus, the minimum and maximum power levels (e.g., amplitude) can be set to normal levels for the first surgical function. If the jaws 213010, 213012 of the energy device 213000 are more than halfway open, the energy activation buttons 213002, 213004 can drive only an ultrasonic response. However, if the jaws 213010, 213012 are more than half closed, the energy device 213000 can function in a standard combination ultrasonic-electrosurgical mode. As yet another example, if the jaws 213010, 213012 of the energy device 213000 are fully clamped at the highest compression level when ultrasonic energy is applied and the user requests more pressure via the closure trigger 213008 but still actuates the maximum energy activation button 213002, the energy modality can automatically transition from ultrasonic to electrosurgical RF and the energy device 213000 can further increase the pressure applied by the clamping jaws 213010.

[0165] In one aspect, the controls can be adjusted according to other instruments currently being used at the same surgical site. For example, if a secondary energy device is in the field of view (e.g., the field of view of the scope) and a predetermined sequence of keys and / or control actuators are actuated, the surgical hub can adjust the control of the primary energy device, also in the field of view. If a closure trigger and energy button are actuated on the primary energy device and the secondary device is in the field of view, the scalable adjustment control on the secondary energy device can be used to control the power level for the primary energy device. In such an example, the generator powering the primary energy device can be raised or lowered using the control on the secondary energy device. Such remote control of surgical functions can, in various examples, be enabled only when a predetermined sequence of surgical operations has been performed and / or during certain steps in the surgical procedure.

[0166] In another example, touching or contact between the surgical devices can allow one of the surgical devices to adjust the control of the other surgical device. For example, when a second surgical device contacts a first surgical device, then a particular action or combination of actions performed by or on the second surgical device can cause the control algorithm to adjust the function of the first surgical device. For example, when the jaws of the second surgical device are in a fully open configuration, the jaws can press an actuation button on the first surgical device, and then an adjustment control on the second surgical device can be used to change the power level of the first surgical device, such as the power provided by the generator. Once the desired level is set, the second surgical device can be removed from contact with the first surgical device. The first and second surgical devices can then operate as normal devices at the newly set power level. In one example, a continuity sensor can be configured to detect contact between the surgical devices.

[0167] In one aspect, the control of the surgical device can be adjusted according to the step of the surgical procedure being performed. Contextual awareness can inform the surgical hub of the current and / or next step of the surgical procedure. For example, based on previous surgical actions and / or the sequence of use of the surgical devices and / or generators, the surgical hub can determine which particular step of a particular surgical procedure is being performed, such as whether the surgical procedure is currently in a node dissection step, a vessel resection step, etc. If the surgical hub determines that the energy device being used is in a micro-dissection mode, the system can automatically adjust the functionality of the energy device's button to a different setting, for example, a lower power setting for use in this procedure step. In one implementation, the surgical hub and / or generator can determine the particular step or context of the procedure.

[0168] In another implementation, the system can learn and predict procedure-specific steps or contexts by analyzing a particular clinician's most common usage at each stage of a surgical procedure and / or after a particular number or type of surgical instrument changeover. In such a learning mode, in one aspect, the generator does not initially perform any automatic adjustments to the control device. Rather, after monitoring the behavior of the same clinician over a predetermined number of procedures involving the same steps, the surgical device can automatically modify the use of buttons based on the monitoring and past usage by the clinician. In various examples, the surgical device can provide notifications to the clinician when the functionality of a control is adjusted. For example, the surgical device can provide an audio notification (e.g., a beep or audio description), a visual cue (e.g., a flashing light and / or wording on a screen), and / or a tactile alert (e.g., vibration and / or movement of the surgical device or a portion thereof, such as the actuator button itself). In other examples, the surgical hub can suggest adjustments to the controls. Suggestions from the surgical hub are further described herein.

[0169] In various aspects, controls of the surgical hub, surgical instruments, and other devices can be adjusted based on a screen running on the sterile field display. Controls of the surgical devices can be adjusted based on the displayed information. In one aspect, a control that normally controls moving or adjusting the focus of a visualization device (e.g., a scope) can be configured to adjust magnification, for example, when a hyperspectral imaging overlay is active. Hyperspectral imaging is further described in U.S. Patent Application Serial No. 15 / 940,722, filed March 29, 2018, entitled "CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY," which is incorporated herein by reference in its entirety.

[0170] As another example, controls on the handle for a surgical instrument within the field of view of the sterile field display can be adjusted by a selection on the sterile field display. Additionally, adjustments can be based on situational awareness in various examples. For example, the system can determine that a particular surgical device is being utilized and can allow the functionality of that surgical device to be controlled from a second device, such as a display screen in the sterile field. Referring now to FIG. 18, a surgical procedure is shown that includes a combination energy instrument 213100, a surgical stapler 213102, an aspirating / irrigation device 213104, and a sterile field display 213108. The combination energy device 213100 includes a single energy button 213110 configured to implement different energy modalities. For example, the combination energy device 213100 can operate in a bipolar mode, a monopolar mode, an ultrasonic mode, and / or various combinations thereof (e.g., a mixed mode). In one example, the combination energy device 213100 can operate in a monopolar-bipolar mode. In another example, the combination energy device 213100 can operate in an ultrasonic-bipolar mode, and in yet another example, the combination energy device can operate in an ultrasonic-monopolar mode. The various energy modalities can be applied sequentially and / or mixed simultaneously.

[0171] In one aspect, controls on the handles of surgical instruments within the field of view of the sterile field display 213108 can be adjusted by selections on the sterile field display 213108. For example, the combination energy instrument 213100 includes a single button 213110 that can be configured to apply energy to selectively cut and coagulate tissue. The energy modality activated by the button 213110 can be adjusted by selections on the sterile field display 213108.

[0172] In one aspect, the energy activation button 213110 can have an indicator that changes or otherwise indicates when the sterile field display 213108 is being used to change the function of the button 213110 and / or when the sterile field display 213108 is sharing control of the button 213110. For example, the combined energy device 213100 can include an LED on the handle and / or the energy activation button 213110 itself that can change color and / or otherwise change appearance (e.g., changing color of the energy activation button 213110 and / or being illuminated with a flashing and / or pulsing light) when adjusted from a secondary device such as the sterile field display 213108. In one example, the button 213110 can have a normal red hue that is projected through a light channel from a multi-colored LED for the cut function, while a blue hue can be projected through a light channel from a multi-colored LED for the coagulation function. For example, when the sterile field display 213108 changes the surgical function to a mixed energy modality, the button 213110 that was red may change to purple. In various examples, the interface area on the sterile field display 213108 may also include a corresponding color indicator (e.g., purple wording and / or highlighting when the button 213110 is illuminated in a purple hue) to indicate that the functionality between the displayed controls on the surgical field display 213108 and the mixed energy device 213100 is linked.

[0173] Various surgical instruments can be controlled in different ways depending on the number and type of buttons / actuators thereon and the desired surgical function of the surgical instrument. For example, if a surgical instrument includes two buttons (e.g., a first button corresponding to a first power level suitable for coagulation and a second button corresponding to a second power level suitable for cutting), the sterile field display 213108 can be configured to adjust the function of the first and second buttons. For example, one of the buttons can be utilized to activate monopolar energy and the other button can be configured to activate mixed energy. In such an example, the button can include an indicator (e.g., a color LED) that changes when the sterile field display 213108 is being used to change the function of the button and / or to indicate that the sterile field display 213108 is sharing control of the button. The indicator can communicate the selected energy modality and / or how the energy modality was selected. For example, the first button can include a red hue LED and the second button can include a blue hue LED. When the first button is configured to activate a mixed energy modality, the red hue LED can become a purple hue. Additionally, the interface area on the sterile field display 213108 can include a purple indicator.

[0174] In various examples, the sterile field display 213108 may allow the clinician to switch the function of the buttons on the handle of the combination energy device 213100. In such a case, the colors of the two buttons may be inverted. In another example, the functions of the buttons may be changed. For example, the second button (e.g., previously corresponding to a power level suitable for cutting tissue) may be changed to an energy activation button and the first button (e.g., previously corresponding to a power level suitable for coagulating tissue) may be changed to a power level adjustment control. In such an example, each time the power level adjustment control is activated, the sterile field display 213108 may indicate the newly selected power level. For example, the sterile field display 213108 may utilize a flashing icon to indicate the change to the generator power level. Thereafter, activation of the second button (currently functioning as the energy activation button) may be used to activate and deactivate energy at the newly set power level.

[0175] In yet another example, the button 213110 and / or other buttons on the combined energy device 213100 can be changed from an on-off activation function to a pressure-sensitive activation function. For example, a higher level of force applied to the button 213110 can be configured to increase the intensity of the energy activation, such as by increasing the power level based on the force on the button 213110. Additionally, the sterile field display 213108 can be used to change the separate on / off function of the button 213110 to a pressure-sensitive adjustment function. Additionally, the sterile field display 213108 and the button 213110 can utilize different indications when the power level is changed. For example, the light emitted from the button can change intensity as the pressure-sensitive activation adjusts the power level of the combined energy device 213100. Additionally, the sterile field display 213108 can show a color synchronized with the color of the button 213110 to indicate the current function and pairing.

[0176] In various examples, the surgical hub can be configured to provide suggestions to the clinician during the surgical procedure. For example, the surgical hub can aggregate data from multiple sources to determine suggested surgical actions. In various examples, the suggestions can be based on the situational awareness of the surgical hub. The relevance or importance of the suggestions may depend on the surgical context or scenario. For example, general suggestions can be elevated to a higher level based on data acquired by various data sources and / or sensors. Because the surgical hub can aggregate a significant amount of information, it can be useful to prioritize suggestions to the clinician to avoid overwhelming the clinician with too much data at a given time. For example, if the clinician is constantly interrupted by suggestions, some or many of which are not relevant and / or useful, the clinician can ignore the hub's suggestions entirely and / or disable the suggestions setting on the surgical hub. Prioritizing suggestions based on situational awareness allows the clinician to be well informed regarding actionable and / or time-sensitive items.

[0177] In various examples, the importance of a suggestion may depend on the location of the surgical device. For example, actionable aspects may be highlighted or emphasized to the clinician. Additionally, non-actionable and / or non-important aspects may be displayed discretely and / or selectively hidden from view. If the location of the surgical device indicates that the suggestion is actionable by the clinician, the surgical hub may highlight the suggestion, while non-actionable suggestions may be displayed more discretely and / or selectively hidden from view. In such examples, actionable suggestions are selectively communicated to the clinician, which allows the clinician to consider the value of such suggestions in a timely manner.

[0178] In various examples, for example, the surgical system can include a screen configured to selectively display suggestions to a clinician in an operating room. The surgical system can also include a control circuit and a context-aware surgical hub communicatively coupled to the screen, the control circuit configured to receive a signal from the context-aware surgical hub indicative of a surgical condition, determine a priority level of the suggestions based on the surgical condition, and communicate the priority level of the suggestions via the display. In various examples, the control circuit comprises a processor and a memory communicatively coupled to the processor, the memory storing instructions executable by the processor to receive a signal from the context-aware surgical hub indicative of a surgical condition, determine a priority level of the suggestions based on the surgical condition, and communicate the priority level of the suggestions via the display. In various examples, a non-transitory computer readable medium stores computer readable instructions that, when executed, cause a machine, such as an intelligent surgical device, to receive a signal from the context-aware surgical hub indicative of a surgical condition, determine a priority level of the suggestions based on the surgical condition, and communicate the priority level of the suggestions via the display.

[0179] In various aspects, the surgical system can be configured to provide notifications to the clinician when certain aspects of the context information are actionable. For example, FIGS. 19A and 19B show a display screen 213200 that includes suggestions 213202, 213202′ to the clinician based on input from a context-aware surgical hub, such as surgical hub 106 (FIGS. 1-3) or surgical hub 206 (FIG. 10) or surgical hub 7006 (FIG. 12). In various examples, the display screen 213200 includes a user interface overlay on the display screen 213200 that provides context-dependent suggestions. For example, the surgical system can highlight a data feed that has an actionable icon to indicate that the underlying context has an actionable aspect. In various examples, the suggestion feed can always be present. However, the suggestion is only highlighted if the suggestion is actionable. The suggestion can be highlighted, for example, with highlighting, blinking, and / or marking. In other examples, the suggestion feed is only displayed if it includes an actionable item.

[0180] As shown in FIG. 19B, the suggestion 213202′ is highlighted to indicate a high priority level based on the expected surgical action and input from the situation-aware surgical hub. More specifically, in FIG. 19A, the surgical device 213204 is shown in a first position generally proximate to the lesion area 213206 of the lung 213208. In FIG. 19B, the surgical device 213204 is moving toward the lesion area 213206. Based on the trajectory of the surgical device 213204 and / or the position of the surgical device 213204, the surgical system can determine that the suggestion 213202 from FIG. 19A is now feasible and thus can highlight the suggestion 213202′ as shown in FIG. 19B. In other words, the position change of the surgical device 213204 changes the confidence of the context-based suggestion. An increase in confidence corresponds to a high priority level for the suggestion 213202′.

[0181] The actionable aspect or actionable item can be, in certain examples, a user-selected change in an instrument function parameter. For example, if friable tissue is detected by the system, the system can suggest adjustments to protect the tissue. In one example, the surgical system can suggest reducing the target clamp load of the stapler. Additionally or alternatively, the surgical system can suggest the use of a surgical auxiliary material, such as, for example, a buttress or tissue thickness compensator. As another example, if the system detects a complication, such as, for example, a patient and mendicant complication that affects healing, the system can be configured to prompt or suggest the user to adjust compression wait time, utilize an auxiliary material, and / or utilize a reduced staple size.

[0182] In one aspect, an executable embodiment can automatically overlay procedurally important information during device placement. For example, referring again to FIG. 19A and FIG. 19B, the display screen 213200 is configured to label and / or call out lesion areas 213206 and / or nodules in the vicinity of the surgical device. In various aspects, the automatic feature can be toggled between on and off depending on the user's preferences. Similarly, the suggestion feed can be toggled between on and off. In various examples, suggestions can only be displayed if they are executable and / or if they rise to a priority level above a predefined threshold that is preprogrammed and / or adjusted by the operator.

[0183] In one aspect, the system can be configured to highlight data feeds that have direct relevance to the current surgical step or execution. Relevant data in a surgical context can affect how the clinician performs one or more of the subsequent functional tasks. For example, a data feed related to a blood pressure measurement can be highlighted in certain instances, such as when the blood pressure measurement is abnormally high or low. Abnormally high or low blood pressure can affect how the clinician performs a cut of a large blood vessel with an energy device. Thus, in various examples, blood pressure data can be highlighted when situational awareness indicates that the clinician is preparing to perform a cut. As another example, the system can be configured to monitor the return path linkage to the patient. For example, return path linkage data can be highlighted for the clinician when the return path linkage is limited and a monopolar electrosurgical instrument is utilized for dissection or mobilization.

[0184] In yet another example, near-infrared (NIR) fluorescence of indocyanine green (ICG) imaging can be highlighted based on actionable items determined by situational awareness and / or context clues detected by one or more sensors at the surgical site. NIR fluorescence can be used to visualize, for example, anatomical structures, perfusion and perfusion defects, and the lymphatic system. The high penetration depth of NIR light allows the distribution of ICG to be visualized to a depth of 10 mm below the tissue surface. In liver surgery, the system can be used to visualize liver metastases or primary tumors in the liver. Exemplary applications include: visualization of perfusion, where ischemic areas can be more easily and efficiently displayed in real time and / or perfusion can be examined, for example, at the anastomosis, thereby enabling the surgeon to take intraoperative actions such as for perfusion assessment of the planned resection area and of subsequent anastomoses in colonic or esophageal resections and gastric bypass, for example flap plasty in open surgery, visualization of liver segments, rapid perfusion assessment for multidisciplinary use in laparoscopic, endoscopic and open surgery; visualization of the anatomical structures of the biliary system, thereby allowing rapid and reliable identification of the bile duct anatomy, for example in cholecystectomy to reduce the duration of the operation and facilitate the differentiation between the cystic duct and the common bile duct, and allowing the visualization of bile leaks during surgery with ICG, for example following partial hepatectomy; visualization of hepatocellular carcinoma and metastases, including, for example, intraoperative visualization of metastases and hepatocellular carcinoma at or below the liver surface, diagnosis of superficial or near-surface micrometastases down to the millimeter range, easier definition of resection borders, and visualization of liver segments; and Visualization of the lymphatic system, which allows for example to visualize the entire lymphatic system draining a tumor in real time, visualizing lymph nodes, localizing lymphatic leaks and avoiding nuclear medicine imaging with a detection rate comparable to established methods in multidisciplinary use, for example in gynecology, urology and general surgery.

[0185] NIR / ICG visualization can be provided, for example, by OPAL1® technology from KARL STORZ, described at www.karlstorz.com / ie / en / nir-icg-near-infrared-fluorescence.htm. The NIR / ICG data can be emphasized or highlighted to the clinician when visualization is important for situational awareness and how the surgeon will perform subsequent steps based on the anticipated surgical steps.

[0186] In another example, the surgical system can be configured to highlight an alternative imaging or analysis system when the surgical system detects that the imaging or analysis system detects something relevant to the current step or current task of the surgical device. For example, the system can highlight a laser Doppler scanning array feature when the dissection instrument is about to cross a significant vessel or infrastructure. As another example, the system can highlight computed tomography (CT) imaging when the stapler appears to be placed within the limits of the surrounding tissue area. Various suggestions to the clinician can be communicated on a display screen within the sterile field. In various examples, one or more suggestions can be further highlighted by an audible and / or tactile indication within the sterile area, such as an audio warning and / or a beep if the suggestion is actionable and / or time sensitive.

[0187] In various examples, a suggestion is actionable if the suggestion can be implemented within a predetermined time and / or number of surgical steps. For example, a suggestion can be actionable if it should be implemented within the next few minutes (e.g., 1-2 minutes) of the procedure. In certain examples, a suggestion can be actionable if it should be implemented within the next 5, 10, or 30 seconds of the procedure. The time frame can be determined, for example, by the reaction skill of the clinician. In certain examples, a first type of emphasis for the suggestion can be provided at a first time point and a second type of emphasis can be provided at a later time point if the suggestion is more time-sensitive / urgent. In still other examples, a suggestion can be provided if it is related to a predicted next surgical step based on the clinician's situational awareness. In other examples, the suggestion can be provided two steps prior to the step it should be implemented. The reader will appreciate that various time-based and step-based settings for the actionable suggestions can be pre-determined and / or adjusted by the clinician and / or operator. In certain examples, the actionable suggestions can be needed, for example, during a surgical training session. In other examples, the actionable suggestions may be optional and / or customizable by the clinician.

[0188] In various aspects, the surgical system can be configured to implement a data bridge for clinicians. Various techniques are described herein for interfacing the data in the surgical hub to a display for use by the clinician. For example, intraoperative surgical data can contribute to the implementation and tracking of post-operative care metrics.

[0189] FIG. 20 shows a block diagram 213300 illustrating intraoperative surgical data 213302 being correlated with predicted outcomes 213304 and corresponding recommendations 213306 being provided. For example, intraoperative surgical data 213302 can be correlated with prior outcomes to determine predicted outcomes 213304 based on intraoperative surgical data 213302 to inform clinicians of key concerns, recommendations, and potential best practices. Additionally, intraoperative surgical data 213302 can be correlated with prior case history to predict outcomes of care metrics flagged by an operator or organization, such as a hospital or health system. Predicted outcomes 213304 based on data correlation can include, for example, patient length of stay, readmission rates, reoperation rates, time to chest tube removal, time to colonic motility, and number, type, and severity of insurance or other clinically coded events (e.g., ICD-9 or ICD-10 codes for bleeding-related complications, blood transfusions, etc.). Additionally, the intra-operative dataset may in some aspects be comprehensive of all available primary and secondary data sources from the procedure (e.g., EMR, situational awareness learning, video, etc.).

[0190] Block diagram 213300 refers to a lower anterior resection (LAR) procedure where the tumor is located deep in the patient's pelvis. For example, firing information, which may be obtained from video and / or various sensors, indicates that the margins are suboptimal, which corresponds to an increased chance of cancer recurrence. The firing information also indicates that the colon is under significant strain, which corresponds to an increased risk of leakage. Additionally, the firing information indicates that the firing line is not vertical, which corresponds to an increased time to colonic motility. Intraoperative surgical data 213302 also monitors procedure time. In the example of FIG. 20, the procedure time is characterized as "very long" due to extensive dissection and significant colonic manipulation. In combination, these factors also correspond to an increased likelihood of cancer recurrence. The data bridge may also obtain additional data, such as, for example, medications delivered and / or patient demographics, which may further correspond to various predicted outcomes and / or comorbidities. Based on the various predicted outcomes 213304, the surgical hub can provide various suggestions for post-operative care, including aggressive oncological follow-up treatment, placement of a rectal drain, increased dietary restrictions, hospital cost analysis, and predicted length of stay (LOS), which can inform hospital bed allocation and / or requirements.

[0191] In various aspects, the surgical system can be configured to detect the movement, velocity, acceleration, and / or orientation of elements, such as particulate matter and / or aerosol particles, within the field of view (FOV) of the scope. By detecting one or more of these characteristics, the surgical system can increase the depth of data that can be extracted during a surgical procedure and / or elucidate aspects of the clinician's surgical procedure. For example, the system can be configured to determine active actionable events to bring to the clinician's attention.

[0192] The characteristics of the fluid flow at the surgical site can be indicators of actionable items or adjustments for the surgical hub and / or clinician. The fluid flow includes, for example, smoke, insufflation, blood, contrast, and / or dye flow. In various examples, the characteristics of the fluid flow can correspond to different surgical events, such as, for example, increased smoke generation during energy treatment, detection of bleeding, perfusion assessment, and / or detection of a leaking anastomosis. Recommendations can be provided based on the actionable items determined by a characteristic or characteristics of the detected fluid flow. However, without detection and / or monitoring of one or more characteristics of the fluid flow, it can be difficult to determine the various actionable items and corresponding recommendations.

[0193] In various examples, by detecting and / or monitoring one or more characteristics of the fluid flow, deeper data details can be extracted for analysis by the surgical hub. As a result, actionable items can be identified and / or more quickly identified, and corresponding suggestions can be provided and / or implemented in a timely manner. In certain examples, the surgical hub can automatically implement adjustments and / or alert the clinician of actionable items.

[0194] In one aspect, a surgical system includes a sensor configured to detect a characteristic of suspended particles in a fluid in a patient's abdominal cavity, a surgical device configured to implement a surgical function, and a control circuit including a processor and a memory communicatively coupled to the processor, the control circuit being communicatively coupled to the sensor and the surgical device. The control circuit can be configured to receive an input signal from the sensor indicative of a characteristic of suspended particles in the fluid and provide an output signal to the surgical device indicative of an adjustment to the surgical function in response to the input signal. The surgical system can be configured to detect suspended particulates and aerosols in an insufflation gas in the body (e.g., abdomen), for example. In one aspect, the detection method includes, for example, optical, laser refraction, ultrasound, and / or magnetic resonance. In one aspect, the functional adjustment can include, for example, affecting the generator power level, the ventilation of the space, the degree of smoke evacuation, the degree of filtration, and / or the application of a secondary condenser to induce condensation. In one aspect, the adjustment can result in a proportional increase of an already operating system, the addition of a second effect or function to an already operating system, or the complete replacement of one operation or function with another system. The various adjustments are further described herein.

[0195] Detecting one or more characteristics of the fluid flow at the surgical site can include one or more measurement systems and / or methods as further described herein. For example, optical and / or ultrasonic measurement systems can be used. Optical measurement systems include, for example, laser Doppler velocimeters (LDV) or laser Doppler flowmeters (LDF), particle image velocimeters (PIV), and / or near infrared (NIR) fluorescence of indocyanine green (ICG), which are further described herein. Ultrasonic measurement systems include, for example, non-contact pass-through ultrasonic detection and non-contact reflection ultrasonic detection, which are also further described herein. Various techniques for detecting and / or imaging particle flow can be used in many surgical applications, including, for example, smoke detection and control of evacuation, aerosol and particulate differentiation, hemorrhage detection, perfusion assessment to identify anatomical structures, dye differentiation, differentiation of surface reflectance of disrupted surfaces, and differentiation of fluids that flow, leak, and / or seep over a surface, for example. Various surgical applications are further described herein.

[0196] LDV, often referred to as LDF in clinical or medical applications, is a technique in which the Doppler shift of a laser beam is used to measure the velocity in a transparent or translucent fluid flow, and / or the linear or vibrational motion of an opaque reflective surface. In one embodiment, two beams of collimated, monochromatic, coherent laser light intersect in the fluid flow to be measured. The two beams are usually obtained by splitting a single beam, thus ensuring coherence between the two beams. Lasers with wavelengths in the visible spectrum (390-750 nm), e.g., He-Ne, argon ion, and / or laser diodes, can be used, allowing the beam path to be observed. In other examples, wavelengths outside the visible spectrum can be utilized, which can, for example, avoid distracting the clinician and / or interfering with other imaging / visualization systems. Transmissive optics focuses the two beams to intersect at the beam focus. The intersecting beams can, for example, interfere and generate a set of linear fringes. As particles entrained in the fluid pass the fringes, they reflect light that is then collected by the receiving optics and focused onto a photodetector. The reflected light fluctuates in intensity, with a frequency equal to the Doppler shift between the incident and scattered light, and thus proportional to the component of the particle velocity that lies in the plane of the two beams. If the LDV sensor is aligned with the flow such that the fringes are perpendicular to the flow direction, the electrical signal from the photodetector is proportional to the total particle velocity. By combining three devices (e.g., He-Ne, Argon-ion, and Laser Diode lasers) at different wavelengths, all three flow velocity components can be measured simultaneously in various examples.

[0197] In various examples, PIV systems can be utilized to determine the two- or three-dimensional vector field of a fluid flow. PIV is an optical method of flow visualization that can be used to obtain instantaneous velocity measurements and related properties in a fluid. The fluid contains tracer particles that are assumed to closely follow the flow dynamics of the fluid. The fluid, including the entrained particles, is illuminated to make the particles visible, and the motion of the particles is used to calculate the velocity and direction of the flow (the velocity field). PIV sensors can include a camera, such as a digital camera with a charge-coupled device (CCD) chip, a strobe or laser with an optical arrangement to limit the physical area illuminated, such as a cylindrical lens used to convert the light beam into a line or sheet, a synchronizer that acts as an external trigger to control the camera and laser, and seed or tracer particles within the fluid under investigation. Fiber optic cables or liquid light guides can connect the laser to the lens setup, and PIV software can be used to post-process the optical images, for example.

[0198] In 2D PIV applications, a laser light sheet of light scattering particles is illuminated through two consecutive frames, which are captured to generate a two-dimensional map of the particle's movement and its vector of movement. For stereo or 3D PIV, two or more cameras can be utilized at an angle to each other to capture two consecutive frames, and another camera can be configured to allow out-of-plane measurements. In one aspect, time-resolved particle tracking can allow evaluation of particle trajectories or paths, as well as determination of particle volume and velocity.

[0199] Surgical applications for the optical particle detection and tracking techniques and systems described herein can include, for example, smoke detection applications, bleeding detection applications, perfusion assessment applications, and dye discrimination applications. Various exemplary applications are further described herein.

[0200] In one application, detection of the presence and / or concentration of smoke within an internal cavity, such as the abdominal cavity, can utilize air supply rate control, smoke evacuation rate control or activation, and / or generator algorithm parameter adaptation to minimize smoke generation. Smoke evacuation systems are further described herein.

[0201] In various examples, the surgical hub can be communicatively coupled to a smoke evacuation system. Smoke is often generated during surgical procedures utilizing one or more energy devices. The energy devices use energy to affect tissue. In the energy devices, the energy is provided by a generator, as described further herein. Energy devices include devices with tissue-contacting electrodes, such as electrosurgical devices with one or more radio frequency (RF) electrodes, and devices with a vibrating surface, such as ultrasonic devices with ultrasonic blades. In electrosurgical devices, the generator is configured to generate an oscillating current to power the electrode. In ultrasonic devices, the generator is configured to generate ultrasonic vibrations to power the ultrasonic blade.

[0202] Many surgical systems employ surgical exhaust systems that capture smoke resulting from a surgical procedure and direct the captured smoke away from the clinician and / or patient through filters and exhaust ports. For example, the exhaust system may be configured to exhaust smoke generated during an electrosurgical procedure. Although such exhaust systems may be referred to as "smoke exhaust systems," the reader will understand that such exhaust systems may be configured to exhaust more than just smoke from a surgical site. Throughout this disclosure, the "smoke" exhausted by the exhaust system is not limited to smoke. Rather, the smoke exhaust systems disclosed herein may be used to exhaust a variety of fluids, including liquids, gases, vapors, smoke, steam, or combinations thereof. The fluids may be of biological origin and / or may be introduced to the surgical site from an external source during a procedure. Fluids may include, for example, water, saline, lymph, blood, exudate, and / or purulent discharge. Additionally, the fluids may include particulates or other matter (e.g., cellular matter or debris) that are exhausted by the exhaust system. For example, such particulates may be suspended in the fluid. An exemplary smoke evacuation system, and various subassemblies and / or components thereof, are shown in Figures 21-23. The smoke evacuation system is further described in U.S. Patent Application Serial No. 16 / 024,066, entitled "SURGICAL EVACUATION SENSING AND MOTOR CONTROL," filed June 29, 2018, which is incorporated herein by reference in its entirety.

[0203] In certain examples, the processor can be located in the ejector housing of the surgical evacuation system. For example, referring to FIG. 21, the processor 50408 and memory 50410 therefor are disposed in the ejector housing 50440 of the surgical evacuation system 50400. The processor 50408 is in signal communication with the motor driver 50428, various internal sensors 50430, the display 50442, the memory 50410, and the communication device 50418. The communication device 50418 can include a transceiver configured to communicate physically wired or wirelessly. The communication device 50418 can further include one or more additional transceivers. The transceiver can include, but is not limited to, a cellular modem, a wireless mesh network transceiver, a Wi-Fi transceiver, a low power wide area (LPWA) transceiver, and / or a near field communication transceiver (NFC). The communications device 50418 may include or be configured to communicate with mobile phones, sensor systems (e.g., environmental, location, motion, etc.) and / or sensor networks (wired and / or wireless), computing systems (e.g., servers, workstation computers, desktop computers, laptop computers, tablet computers (e.g., iPad® and Galaxy Tab®, etc.), ultraportable computers, ultramobile computers, netbook computers, and / or sub-notebook computers, etc. In at least one aspect of the present disclosure, one of the devices may be a coordinator node.

[0204] The transceivers may be configured to receive serial transmit data from the processor 50408 via respective universal asynchronous receiver-transmitters (UARTs), modulate the serial transmit data onto an RF carrier to generate a transmit RF signal, and transmit the transmit RF signal via respective antennas. The transceivers are further configured to receive a receive RF signal including an RF carrier modulated with the serial receive data via respective antennas, demodulate the receive RF signal to extract the serial receive data, and provide the serial receive data to respective UARTs to provide to the processor 50408. Each RF signal has an associated carrier frequency and an associated channel bandwidth. The channel bandwidth is associated with the carrier frequency, the transmit data, and / or the receive data. Each RF carrier frequency and channel bandwidth is associated with an operating frequency range of the transceiver. Each channel bandwidth is further associated with a wireless communication standard and / or protocol with which the transceiver may comply. In other words, each transceiver may support a selected wireless communication standard and / or protocol, e.g., an implementation of IEEE 802.11a / b / g / n for Wi-Fi and / or IEEE 802.15.4 for wireless mesh networking using Zigbee routing.

[0205] The communication device 50418 can enable the processor 50408 in the surgical evacuation system 50400 to communicate with other devices in the surgical system. For example, the communication device 50418 can enable wired and / or wireless communication to one or more external sensors 50432, one or more surgical devices 50444, one or more hubs 50448, one or more clouds 50446, and / or one or more additional surgical systems and / or tools. The reader will readily appreciate that the surgical evacuation system 50400 of FIG. 21 can be incorporated into an electrosurgical system in certain instances. The surgical evacuation system 50400 also includes a pump 50450 including its pump motor 50451, an evacuation conduit 50436, and an exhaust 50452. The various pumps, exhaust conduits, and exhausts are further described herein. The surgical evacuation system 50400 can also include sensing and intelligent control devices. The sensing and intelligent control devices contain sensor and communication algorithms that facilitate communication between the smoke evacuation system and other devices and adapt their control programs.

[0206] The surgical evacuation system 50400 can be programmed to monitor one or more parameters of the surgical system and can affect surgical functions based on one or more algorithms stored in memory in signal communication with the processor of the surgical hub and / or the surgical device connected to the hub in the surgical evacuation system 50400 and / or the processor 50408. Various exemplary aspects disclosed herein can be implemented, for example, by such algorithms. For example, intelligent surgical evacuation systems and adjustment algorithms are further described in U.S. Patent Application Serial No. 16 / 024,066, filed June 29, 2018, entitled "SURGICAL EVACUATION SENSING AND MOTOR CONTROL," which is incorporated herein by reference in its entirety.

[0207] The electrosurgical system may include a signal generator, an electrosurgical instrument, a return electrode, and a surgical evacuation system. The generator may be an RF wave generator that generates RF electrical energy. Connected to the electrosurgical instrument is a utility conduit. The utility conduit includes a cable that transmits electrical energy from the signal generator to the electrosurgical instrument. The utility conduit also includes a vacuum hose that conveys captured and / or collected smoke and / or fluid away from the surgical site. Such an exemplary electrosurgical system 50601 is shown in FIG. 22. More specifically, the electrosurgical system 50601 includes a generator 50640, an electrosurgical instrument 50630, a return electrode 50646, and an evacuation system 50600. The electrosurgical instrument 50630 includes a handle 50632 and a distal conduit opening 50634 that is fluidly connected to a suction hose 50636 of the evacuation system 50600. The electrosurgical instrument 50630 also includes an electrode powered by the generator 50640. A first electrical connection 50642, e.g., a wire, extends from the electrosurgical instrument 50630 to the generator 50640. A second electrical connection 50644, e.g., a wire, extends from the generator 50646 to an electrode, i.e., a return electrode 50646. In other examples, the electrosurgical instrument 50630 may be a bipolar electrosurgical instrument. A distal conduit opening 50634 on the electrosurgical instrument 50630 is fluidly connected to a suction hose 50636 that extends to a filter end cap 50603 of a filter located within the ejector housing 50618 of the evacuation system 50600.

[0208] In other examples, the distal conduit opening 50634 of the evacuation system 50600 may be on a handpiece or tool that is separate from the electrosurgical instrument 50630. For example, the evacuation system 50600 may include a surgical tool that is not coupled to the generator 50640 and / or does not include a tissue-conducting surface. In certain examples, the distal conduit opening 50634 of the evacuation system 50600 may be releasably attached to the electrosurgical tool. For example, the evacuation system 50600 may include a clip-on or snap-on conduit that terminates in a distal conduit opening, which may be releasably attached to the surgical tool.

[0209] The electrosurgical instrument 50630 is configured to deliver electrical energy to a target tissue of a patient to cut the tissue and / or cauterize blood vessels in and / or near the target tissue, as described herein. Specifically, an electrical discharge is delivered to the patient by the electrode tip to cause heating of the patient's cellular material in close contact with or adjacent to the electrode tip. The heating of the tissue occurs to a suitably high temperature such that electrosurgical procedures can be performed using the electrosurgical instrument 50630. A return electrode 50646, or return pad, can be placed under the patient during a surgical procedure to complete the circuit and provide a return electrical path to the generator 50640 for the energy passing through the patient's body.

[0210] Heating of a patient's cellular material by the electrode tip, or cauterization of blood vessels to prevent bleeding, often results in the emission of smoke at the location where the cauterization is performed, as described further herein. In such instances, the evacuation system 50600 is configured to capture smoke emitted during a surgical procedure, as the evacuation conduit opening 50634 is near the electrode tip. Vacuum suction can draw smoke through the electrosurgical instrument 50630, into the conduit opening 50634, and into the suction hose 50636 toward the evacuation housing 50618 of the smoke evacuation system 50600. In various instances, the electrosurgical system 50601 and / or the evacuation system 50600 can include control circuitry including a processor and memory, as described herein with respect to the control schematic of FIG.

[0211] 23, another ejector housing 50918 for the ejection system 50900 is shown. For example, the ejector housing 50918 defines a flow path 50904 between an inlet 50922 to the ejector housing 50918 and an outlet 50924 to the ejector housing 50918. Intermediate the inlet 50922 and the outlet 50924, a fluid trap 50960, a filter 50970, and a pump 50906 are sequentially disposed. The ejector housing 50918 may include a socket or receptacle 50971 sized to receive a modular fluid trap and / or a replaceable filter 50970. At the diverter valve 50934, the fluid may be directed into a condenser 50935 of the fluid trap 50960 and the smoke may be directed directly to the filter 50970. In certain examples, the fluid trap 50960 can include a baffle, such as baffle 50964, and / or a splatter screen, such as screen 50962, to prevent trapped fluid from splashing out of the fluid trap 50960. The filter 50970 includes a pleated ultra-low permeation air (ULPA) filter 50942 and a charcoal filter 50944. Sealed conduits or tubes 50905 extend between the various in-line components. The ejector housing 50918 also includes sensors 50830, 50832, 50836, 50838, 50840, 50846, 50848, 50850, 50852, and 50854, which are further described herein and in U.S. patent application Ser. No. 16 / 024,066, filed Jun. 29, 2018, entitled "SURGICAL EVACUATION SENSING AND MOTOR CONTOL," which is incorporated herein by reference in its entirety.

[0212] 23, the ejector housing 50918 also includes a centrifugal blower mechanism 50980 and a recirculation valve 50990. The recirculation valve 50990 can be selectively opened and closed to recirculate fluid through the fluid trap 50960. For example, if the fluid detection sensor 50836 detects fluid, the recirculation valve 50990 can be opened such that the fluid is directed away from the filter 50970 and back into the fluid trap 50960. If the fluid detection sensor 50836 does not detect fluid, the valve 50990 can be closed such that the smoke is directed towards the filter 50970. As the fluid is recirculated through the recirculation valve 50990, the fluid can be drawn through a recirculation conduit 50982. The centrifugal blower mechanism 50980 engages the recirculation conduit 50982 to generate a recirculation suction force within the recirculation conduit 50982. More specifically, when the recirculation valve 50990 is opened and the pump 50906 is activated, the suction force generated by the pump 50906 downstream of the filter 50970 can cause a rotation of a first centrifugal blower, or first tumbling basket 50984, which is transmitted into a second centrifugal blower, or second tumbling basket 50986, drawing the recirculating fluid through the recirculation valve 50990 and into the fluid trap 50960.

[0213] In various aspects of the present disclosure, the control schematic of FIG. 21 may be utilized with the various surgical systems, evacuation systems, sensor systems, and ejector housings of FIGS.

[0214] Smoke exhausted from a surgical site may include liquids, aerosols, and / or gases, and / or may include materials of different chemical and / or physical properties, such as, for example, particulate matter and particles of different sizes and / or densities. Different types of materials exhausted from a surgical site may affect the efficiency of a surgical evacuation system and its pump. Additionally, certain types of materials may require the pump to draw excessive power and / or may pose a risk of damaging the motor for the pump.

[0215] The power supplied to the pump can be modulated to control the smoke flow rate through the exhaust system based on input from one or more sensors along the flow path. The output from the sensors can indicate, for example, the condition or quality of the smoke exhaust system and / or one or more characteristics of the exhausted smoke, such as the type and ratio of materials, chemical properties, density, and / or particulate size. In one aspect of the disclosure, a pressure difference between two pressure sensors in the exhaust system can indicate the condition of the area between them, such as, for example, the condition of a filter, a fluid trap, and / or the overall system. Based on the sensor input, the operating parameters of the motor for the pump can be adjusted by changing the current supplied to the motor and / or a duty cycle configured to change the motor speed.

[0216] In one aspect of the present disclosure, by regulating the flow rate of smoke through the exhaust system, the efficiency of the filters can be improved and / or the motor can be protected from burning out.

[0217] The surgical exhaust system may include one or more particle counters or sensors to detect the size and / or concentration of particulates in the smoke. Referring again to FIG. 23, particle sensors 50838 and 50848 are shown. The reader will readily appreciate that a variety of particle measurement means are possible. For example, the particle sensor can be an optical sensor, a laser sensor, a photoelectric sensor, an ionization sensor, an electrostatic sensor, and / or combinations thereof. Various particle sensors are further described herein.

[0218] In various examples, the speed of the motor, and therefore the speed of the pump, can be adjusted based on particulate concentration detected by one or more particulate sensors in the surgical evacuation system. For example, if the particle sensor detects an increase in the concentration of particulates in the flow path, which may correspond to an increase in the amount of smoke in the flow path, the rotational speed of the motor can be increased to speed up the pump to draw more fluid from the surgical site into the smoke evacuation system. Similarly, if the particle sensor detects a decrease in the concentration of particulates in the flow path, which may correspond to a decrease in the amount of smoke in the flow path, the rotational speed of the motor can be decreased to decrease the speed of the pump to reduce suction from the surgical site. Additional and alternative adjustment algorithms for the surgical evacuation system are further described herein. Furthermore, in certain examples, based on sensor data from the smoke evacuation system, a generator in the surgical system can be controlled to adjust the amount of smoke generated at the surgical site, as further described herein.

[0219] In addition to the particle sensor located along the flow path of the surgical exhaust system, the system can include one or more sensors for detecting particulate concentrations in the surrounding room, such as an operating room or surgical field. Referring again to FIG. 23, the air quality particle sensor 50852 is mounted on an exterior surface of the exhaust housing 50918. Alternative locations for the air quality particle sensor 50852 are also envisioned.

[0220] In at least one example, the particle sensor can be located downstream of the filter, and in certain examples, can be located at or near the outlet of the filter. For example, the particle sensor 50848 is located downstream of the filter 50970 and the pump 50906 in the smoke evacuation system 50900. Because the particle sensor 50848 is located downstream of the filter 50970, the particle sensor is configured to verify that the filter 50970 has removed sufficient particulates from the smoke. In various examples, such a sensor can be adjacent to the exhaust outlet 50924 of the evacuation housing 50918. In one aspect of the present disclosure, an electrostatic particle sensor can be utilized. For example, the exhaust outlet 50924 can include an electrostatic particulate sensor downstream of the filtration system through which the exhaust flow passes before being exhausted to the surgical site.

[0221] The particulate concentration detected by one or more sensors of the surgical evacuation system can be communicated to the clinician in a number of different ways. For example, the ejector housing 50918 and / or the evacuation device can include an indicator, such as one or more lights and / or a display screen. For example, an LED on the ejector housing 50918 can change color (e.g., from blue to red) depending on the amount of particulate detected by the sensor. In other examples, the indicator can include an alarm or warning, which can be, for example, tactile, audible, and / or visual. In such an example, an indicator can notify a clinician in the surgical site when the particulate concentration in the ambient air detected by an air quality sensor (e.g., particle sensor 50852) exceeds a threshold amount.

[0222] In certain examples, the surgical evacuation system can include an optical sensor. The optical sensor can include an electronic sensor that converts light or changes in light into an electronic signal. The optical sensor can utilize light scattering to detect and count particles in the smoke to determine the concentration of particles in the smoke. In various examples, the light is laser-based. For example, in one example, a laser light source is configured to illuminate the particles as they move through the detection chamber. As the particles pass through the beam of the laser, the light source is refracted, obscured, redirected, and / or absorbed. The scattered light is recorded by a photodetector, and the recorded light is analyzed. For example, the recorded light can be converted into an electrical signal indicative of the size and amount of particles, which corresponds to the particulate concentration in the smoke. The particulate concentration in the smoke can be calculated in real time, for example, by a laser light sensor. In one aspect of the present disclosure, at least one of the particle sensors 50838, 50848, 50852 is a laser light sensor. Various alternative sensing techniques and sensor configurations are further described herein and in U.S. patent application Ser. No. 16 / 024,066, filed Jun. 29, 2018, entitled "SURGICAL EVACUATION SENSING AND MOTOR CONTROL," which is incorporated by reference in its entirety.

[0223] Based on the presence and concentration of smoke in the abdominal cavity, a generator algorithm for minimizing or controlling smoke generation can be adapted. For example, information and / or knowledge gained from previous surgical events, such as previous firings and / or energy activations, can be used to adjust one or more parameters of the generator control algorithm. Referring now to FIG. 24, a series of graphs 213400, 213402, and 213404 are shown in which particle count 213406, fan rotation speed 213408, and energy device power 213410 are shown versus time (t). The particle count 213406 can be detected using various sensors and / or detection techniques disclosed herein. One or more surgical functions and / or one or more devices can be adjusted in response to the detected particle count 213406, which corresponds to the smoke concentration at the surgical site (e.g., within the patient's internal cavity). Furthermore, the type and / or degree of adjustment can depend on knowledge gained during previous firings and / or activations.

[0224] The energy device power 213410 is 0 From time t 2 During the first start 213412 until time t 5 From time t 7 21. Knowledge gained during the first activation 213412 can be utilized to adjust a control algorithm of the control circuitry applied during the second activation 213414. The control circuitry can be contained in the surgical hub and / or smoke evacuator, for example, as shown in the control schematic of FIG.

[0225] 24 , when the energy device is activated for a first activation 213412, the power 213410 of the energy device is set to a default power level 213430 and the particle count 213406 begins to increase towards a first threshold 213416. The default power level 213430 can be a power level selected by the clinician. For example, the default power level 213430 can be pre-programmed into the surgical device and / or surgical hub. In certain examples, the surgical device can be configured to operate at different pre-defined power levels depending on which actuators and / or control buttons are activated by the clinician.

[0226] time t 1 In this case, if the first start 213412 continues, the number of particles 213406 will be increased by t 2 At time t 1 In response to exceeding the first threshold 213416 at , a control circuit in signal communication with the smoke evacuation device is configured to perform a first adjustment 213420. For example, the control circuit is configured to increase the fan rotational speed 213408 from a low setting 213426 to a high setting 213428.

[0227] The first start 213412 occurs at time t 2 After the end of the process, the particle count 213406 may begin to decrease from the peak value 213418. However, the smoke evacuator may not start until time t 3 In response to the particle count 213406 decreasing below the first threshold 213416, the fan speed 213408 can be decreased to a low setting 213426, in various examples, until the particle count 213406 decreases below a time t 4The fan speed 213408 can be turned off when the particle count drops to zero at 213406. In other examples, the smoke evacuator can correspond to additional particle count thresholds and / or include additional speeds that can be scaled proportionally to the particle count 213406, for example. In various examples, the smoke evacuator can operate at an ultra-low setting and / or cycle on and off when in sleep or hibernation mode when the particle count is below zero and / or a minimum threshold.

[0228] The second invocation 213414 begins at time t 5 At time t , the particle count 213406 begins to increase again and the fan speed 213408 can be set to a low setting 213426 to extract the smoke from the surgical site. In various examples, the smoke evacuation device can be activated in response to activation of the energy device before any smoke is detected. As shown in FIG. 24 , in a particular example, the particle count 213406 can continue to increase during the second activation 213414 while the fan speed 213408 is set to the low setting 213426, and at time t 6 At time t t 213414, as the second activation 213414 continues, the particle count 213406 again increases above the first threshold 213416. When the control circuit again performs the first adjustment 213420, the particle count 213406 increases again at time t 7 At time t 6 In response to exceeding the first threshold 213416 at , the control circuit is configured to adapt the control algorithm and perform a second adjustment 213422 that is different from the first adjustment 213420.

[0229] For example, at time t 6In addition to increasing the fan rotation speed 213408 from a low setting 213426 to a high setting 213428, the control circuitry is configured to decrease the energy device power 213410 below a predetermined power level 213430. For example, a clinician actuated control may correspond to the predetermined power level 213430. However, the surgical hub control circuitry may adjust the energy device power 213430 to an adjusted power level 213432. The adjusted power level 213432 in FIG. 24 is less than the predetermined power level 213430. In other examples, the hub controlled adjustment may increase the energy device power 213410 and / or otherwise adjust the energy device power, for example, by applying pulses of varying duration and / or frequency (e.g., pulse width modulation and / or pulse frequency modulation) and / or by adjusting the energy modality.

[0230] The second adjustment 213422 can be learned or developed based on the system's response to the first adjustment 213420. For example, if the peak value 213418 obtained when performing the first adjustment 213420 is still considered to be too high and / or associated with an undesirable result, such as obstructing the clinician's view and / or interfering with the application of energy to the tissue, the control circuitry can call for a different adjustment, for example. As described herein, the second adjustment 213422 includes the first adjustment 213422 (i.e., adjusting the fan rotation speed 213408 from a low setting 213426 to a high setting 213428) and an additional adjustment to the energy device power 213410. In other examples, the second adjustment 213422 can replace the first adjustment 213420.

[0231] In certain examples, the second adjustment 213422 can adjust the threshold and / or degree of the first adjustment 213420. For example, the second adjustment 213422 can include increasing the fan speed 213408 to a level greater than the high setting 213428. In various examples, the second adjustment 213422 can include a modification to the first adjustment 213420 proportional to the desired effect. For example, if the first adjustment 213410 increased the fan speed 213408 by 10% to obtain a 10% reduction in smoke density, the second adjustment 213422 can result in a 15% reduction in the fan speed 213408 to obtain the desired 15% reduction in smoke density.

[0232] The first and second adjustments described herein are exemplary adjustments that may include, for example, changing the generator power level, the smoke evacuator power level, the ventilation of the space, and the degree and / or type of filtration and / or condensation induction in the smoke evacuation system.

[0233] As described herein, the improved techniques for particle identification and tracking, which can determine, for example, fluid directionality and velocity, can be utilized in a variety of surgical applications. For example, the improved techniques can be used in smoke detection applications, as described further herein. Additionally or alternatively, based on the smoke directionality and / or velocity, the surgical system can be configured to adjust smoke evacuation motor control to clear the smoke more quickly and then slow down to minimize noise in the operating room (OR). As another example, the system can increase insufflation recirculation to evacuate particulates from the active operating area. For example, if a sensor detects smoke moving toward a treatment area where a clinician is actively working and / or treating, it may be preferable to increase circulation within the cavity to move interfering particulates (i.e., smoke) away from the treatment area more quickly.

[0234] In one application, the improved techniques for particle identification and tracking can be utilized for hemorrhage detection. Based on the directionality and velocity of the flow, the control circuitry and / or the surgical hub can make decisions and / or suggest subsequent steps to address the hemorrhage. In another application, the improved techniques for particle identification and tracking can be utilized for tissue perfusion assessment. Perfusion assessment can be utilized, for example, to identify anatomical structures. In one example, NIR illumination of ICG can be used to image perfusion within a lung segment. Such perfusion visualization can be used, for example, to identify / define an inter-segment plane for a segment resection procedure. The control circuitry and / or the surgical hub can then make decisions and / or suggest subsequent steps. For example, the control circuitry and / or the surgical hub can suggest a particular surgical device and / or location. In a particular example, the control circuitry and / or the surgical hub can guide a surgical device to a desired location.

[0235] In one application, improved techniques for particle identification and detection can be used in conjunction with dye migration, thereby enabling the system to highlight leak paths. For example, the magnitude and location of the leak can be determined. In one example, when leak testing an anastomosis, a leak path from the colon to the abdomen can be identified. In various examples, identification of the leak path can inform the clinician's decision-making process. For example, suggestions can be provided to the clinician regarding how and / or when to address the leak path. In certain examples, contextual information provided by the hub can influence the suggestions provided to the clinician. The contextual information can indicate the probability of a functional leak given the current pressure in the colon dye fluid, tissue viability from computed tomography (CT) imaging and / or instrumentation forces, and / or patient-specific aggravating factors, which can be identified, for example, in an electronic health record (EHR). The suggestions can include suggestions of viable products to reinforce the anastomosis based on identification of detected related matters (e.g., leak size, location of the leak relative to the "dog ear" or lateral cross margins / stapled corners, and / or compressive loads detected with a circular stapler). Additionally or alternatively, suggestions may include proposals for overlaying reinforcing agents such as fibrin, thrombin, and / or oxidized regenerated cellulose (ORC). Additionally or alternatively, suggestions may include proposals to sew or restap portions of the line, for example, due to tissue tension or collateral blood supply issues.

[0236] In various examples, the detection of one or more characteristics of the fluid flow at the surgical site can include one or more of various measurement systems and / or techniques further described herein. For example, optical measurement systems such as laser Doppler velocimetry (LDV) or laser Doppler flowmeter (LDF), particle image velocimetry (PIV), and / or near infrared (NIR) fluorescence of indocyanine green (ICG) can be utilized. In other examples, instead of a camera / optical measurement system, the detection and / or measurement can utilize alternative sensing arrays to track particles. For example, ultrasonic measurement systems such as non-contact through-type ultrasonic detection and non-contact reflective ultrasonic detection can be utilized, for example.

[0237] In one embodiment, non-contact pass-through ultrasound can be utilized for particle detection. Referring to the ultrasound pass-through particle detection system 213500 of FIG. 25, an ultrasound emitter 213502 can be placed inside the patient's body (e.g., in the abdominal cavity) similar to an optical scope. In various examples, the emitter 213502 can be placed at the distal end of a scope 213501 for an imaging system. The scope can include a camera that views the surgical site and transmits the view to a display that can be viewed by the physician. Scopes include, but are not limited to, arthroscopes, angioscopes, bronchoscopes, cholangioscopes, colonoscopes, cytoscopes, duodenoscopes, enteroscopes, esophagogastroduodenoscopes (gastroscopes), endoscopes, laryngoscopes, nasopharyngeal-neproscopes, sigmoidoscopes, thoracoscopes, ureteroscopes, and extracorporeal endoscopes. In other examples, the emitter 213502 can be a separate and distinct device from the scope. The ultrasonic emitter 213502 is configured to transmit a homogenous curtain of sound that passes through the fluid 213504 (e.g., moving particles such as smoke particulates and / or vapor aerosols) and is received by the receiver 213506 on the other side of the fluid 213504. The receiver 213506 can be disposed on a surgical device, such as, for example, an end effector and / or a distal nose of a staple cartridge 213508 received within an elongated channel of the end effector. In other examples, the receiver 213506 can be disposed on a separate and distinct surgical tool. As various sound waves pass from the emitter 213502 through the fluid 213504, certain waves can be blocked by the fluid 213504. Based on the sound waves received by the receiver 213506, the ultrasonic through particle detection system 213500 is configured to determine a Doppler shift, i.e., an acceleration or deceleration of the sound waves that corresponds to a characteristic of the fluid flow.

[0238] Surgical applications of the ultrasound through particle detection system 213500 include smoke detection applications and control of evacuation, including, for example, detection of velocity, directionality, and concentration of particulates in a flow, as well as detection of flow patterns and / or dispersion rates. Surgical uses also include differentiation between aerosol particles and particulates (e.g., smoke from vapor). Such differentiation may be useful, for example, in adjusting a smoke evacuation system, such as altering the fluid flow path to address aerosols in the flow path that may damage particulate matter filters if not properly extracted. Additional surgical applications for particle detection and monitoring, such as ultrasonic techniques utilizing the ultrasound through particle detection system 213500, for particle detection and monitoring are further described herein. Additionally, surgical systems and / or control circuits may be configured to utilize information from such ultrasound through particle detection systems to adjust and / or suggest surgical functions during a surgical procedure.

[0239] In one aspect, non-contact reflective sound detection can be utilized for particle detection. Referring now to FIG. 26, an ultrasonic reflective particle detection system 213600 is shown. Similar to the ultrasonic through-sound technology described above with respect to FIG. 25, the ultrasonic reflective particle detection system 213600 includes an emitter, i.e., a transmitter / sound source 213602, and a receiver 213606. However, this ultrasonic reflective particle detection system 213600 differs from the ultrasonic through-sound particle detection system 213500 in that the emitter 213602 and receiver 213606 are co-located on the same surgical device 213608. In other examples, the emitter 213602 and receiver 213606 can be located adjacent to each other, although they are located on separate devices. In various examples, the surgical device 213608 can be a scope, such as, for example, the device 213502 (FIG. 25).

[0240] The ultrasound reflective particle detection system 213600 is configured to detect reflected acoustic waves. The reflection and refraction of the acoustic waves depends on the surface characteristics of the tissue T targeted by the surgical device 213608. Because the surgical device 213608 is not in contact with the tissue T, it is configured not to sense superficial aspects of the tissue T, such as the surface features of the tissue T, and the properties / characteristics of the depth within the tissue T. For example, referring to the flowchart 213650 of FIG. 27, in block 213652, data from the emitter 213602 and receiver 213606 regarding acoustic wave characteristics is obtained and provided to a control circuit for analysis in block 213654. The control circuit is configured to determine tissue surface information in block 213656. Various control circuits for receiving input signals, calculating tissue surface information, and providing an output can be incorporated into various control circuits described herein. For example, an algorithm for determining tissue surface information from an input signal can be stored in a memory of various control circuits described herein.

[0241] Surgical applications of ultrasound reflective particle detection systems include, for example, differentiation of surface reflections of broken surfaces and detection of flowing or exuding fluids on tissue surfaces. For example, sound reflections indicative of broken or interrupted surface tissue features can be used to detect unhealthy tissue features such as infection, adhesions, scarring, remodeling, and cancer. Such tissue features can correspond to more interrupted tissue surfaces, thus causing increased refraction and attenuation of ultrasound waves compared to healthy tissue, which typically defines a continuous uninterrupted surface. Fluids flowing or exuding on the surface of tissue can also cause different Doppler effects on sound waves directed at the surface and generate sound reflections that differ from the reflections of solid tissue surfaces. Furthermore, the more fluid present, the more sound absorption the fluid can induce to absorb a portion of the energy of the sound waves. Furthermore, the Doppler effect on sound waves results in a shift in the Doppler waves of the sound waves depending on whether the fluid is moving toward or away from the transmitter and receiver. The directionality of the fluid flow can be detected. In various examples, by varying the range of frequencies emitted by the transmitter, the system can further refine, for example, the surface tension, elastic modulus, and / or viscosity of the detected fluid. The surgical system or its control circuitry can thus be configured to utilize information from such ultrasound reflective particle detection systems to adjust and / or suggest surgical functions during a surgical procedure.

[0242] In various aspects, the system can be configured to monitor materials in a flow, for example, that is removed / evacuated from the abdomen by a smoke evacuation system or filtered and replaced by an irrigation / insufflation system, using various techniques described herein for particle identification and detection along the flow path. In a particular example, the system can be configured to detect particles in the extracted gases and measure their flow rates directly. In one aspect, an ultrasonically penetrating array can be placed, for example, at the intersection between the passages extracting the insufflation gases or the passages filtering the insufflation gases. Such an array can be configured to detect particles passing through and can thus be used to determine the type and concentration of particles passing through. An alternative to an ultrasonically penetrating array is a laser counter array, which can be placed in a similar manner. The laser counter array can measure the interrupted laser light waves passing from one side of the passage to the other, or the refraction of light from the particles.

[0243] In various examples, vortex shedding can be used in combination with either the ultrasonic through array or the laser counter array described above. The vortex shedding is configured to detect the size of particles and their flow rate, rather than simply using the presence or concentration of particles given a given flow rate. When utilizing a vortex flowmeter, there are no moving parts or elements in the flow required to measure the flow. Advantageously, this can improve the ability to clean and reuse the detection system and / or minimize the accumulation of bodily fluids, for example, in the detection system. EXAMPLES

[0244] Various aspects of the subject matter described herein are illustrated in the following numbered examples. Example 1 - A surgical system comprising a sensor configured to detect a characteristic of suspended particles in a fluid within a patient's abdominal cavity, a surgical device configured to perform a surgical function, and a control circuit comprising a processor and a memory storing instructions executable by the processor to receive an input signal from the sensor indicative of a characteristic of suspended particles in the fluid and to provide an output signal to the surgical device indicative of an adjustment to the surgical function in response to the input signal.

[0245] Example 2 - A surgical system as described in Example 1, wherein the sensor includes at least one of an optical sensor, a laser sensor, an ultrasonic sensor, a magnetic resonance sensor, and a vortex shedding sensor.

[0246] Example 3 - A surgical system described in any one of Examples 1 and 2, wherein the characteristics of particles suspended in the fluid include at least one of particle type, particle size, particle concentration, particle velocity, and particle direction.

[0247] Example 4 - A surgical system described in any one of Examples 1 to 3, wherein the adjustment to the surgical function includes at least one of proportionally increasing the surgical function based on the characteristics of suspended particles in the fluid, adding an auxiliary surgical function to the surgical function, and replacing the surgical function with an alternative surgical function.

[0248] Example 5 - A surgical system described in any one of Examples 1 to 4, wherein the surgical device comprises a generator configured to supply power to the energy device at a power level, and the adjustment to the surgical function includes adjusting the power level supplied from the generator to the energy device.

[0249] Example 6 - A surgical system described in any one of Examples 1 to 4, wherein the surgical device comprises a smoke evacuator comprising a pump configured to operate at a certain speed, and the adjustment to the surgical function comprises adjusting the speed of the pump.

[0250] Example 7 - A surgical system described in any one of Examples 1 to 4, wherein the surgical device comprises a smoke evacuator with a filtration system, and the adjustment to the surgical function includes adjusting the flow path through the filtration system of the smoke evacuator.

[0251] Example 8 - The surgical system of Example 7, wherein the filtration system includes a particulate filter, and when the input signal indicates an increase in a particulate concentration of suspended particles in the fluid, the flow path is diverted through the particulate filter.

[0252] Example 9 - A surgical system described in any one of Examples 7 and 8, wherein the filtration system includes a condenser and when the input signal indicates an increase in the aerosol concentration of suspended particles in the fluid, the flow path is diverted through the condenser.

[0253] Example 10 - A surgical system described in any one of Examples 1-4, wherein the surgical device comprises an operating room vent and the adjustment to the surgical function includes adjusting the operating room vent to thereby increase ventilation.

[0254] Example 11 - A surgical system described in any one of Examples 1 to 10, wherein the control circuit is further configured to receive a plurality of input signals indicative of a plurality of characteristics of suspended particles in the fluid, the plurality of input signals including an input signal, and in response to the plurality of input signals, to provide an output signal to the surgical device indicative of an adjustment to the surgical function.

[0255] Example 12 - A non-transitory medium storing computer-readable instructions that, when executed, cause a surgical device to receive an input signal from a sensor indicative of a characteristic of suspended particles in a fluid within a patient's abdominal cavity, and in response to the input signal, provide an output signal to the surgical device indicative of an adjustment to a surgical function.

[0256] Example 13 - The non-transitory medium of Example 12, wherein the computer-readable instructions, when executed, cause the surgical device to provide an output signal to the generator to adjust a power level of the generator.

[0257] Example 14 - The non-transitory medium of Example 12, wherein the computer readable instructions, when executed, cause the surgical device to provide an output signal to the smoke evacuator to adjust the speed of the smoke evacuator pump.

[0258] Example 15 - A non-transitory medium as described in Example 12, wherein the computer-readable instructions, when executed, cause the surgical device to provide an output signal to the smoke evacuator to adjust the flow path through the smoke evacuator.

[0259] Example 16 - A non-transitory medium described in any one of Examples 12 to 15, wherein the computer readable instructions, when executed, cause the surgical device to regulate a surgical function by altering the surgical function in proportion to changes in the characteristics of suspended particles in a fluid.

[0260] Example 17 - A non-transitory medium described in any one of Examples 12 to 16, wherein the computer readable instructions, when executed, cause the surgical device to adjust a surgical function by adding an auxiliary surgical function in combination with the surgical function.

[0261] Example 18 - A non-transitory medium described in any one of Examples 12 to 17, wherein the computer-readable instructions, when executed, cause the surgical device to adjust a surgical function by replacing the surgical function with an alternative surgical function.

[0262] Example 19 - A method comprising: receiving an input signal from a sensor indicative of a characteristic of suspended particles in a fluid within a patient's abdominal cavity; and, in response to the input signal, automatically providing an output signal to a surgical device indicative of an adjustment to a surgical function of the surgical device.

[0263] Example 20 - The method of Example 19, further comprising receiving a second input signal from the sensor indicative of a characteristic of suspended particles in the fluid at a time after receiving the input signal, and automatically providing a second output signal to a second surgical device indicative of an adjustment to a surgical function of the second surgical device in response to the second input signal, wherein the second surgical device is different from the first surgical device.

[0264] Example 21 - A surgical device comprising: an actuator configured to receive an input; and a control circuit configured to receive a signal from a situation-aware surgical hub indicative of a surgical condition, receive an actuation signal from the actuator in response to the input, and implement a surgical function in response to the actuation signal, wherein the surgical function includes a first surgical function when the surgical condition corresponds to a first surgical condition, and wherein the surgical function includes a second surgical function when the surgical condition corresponds to a second surgical condition, the second surgical condition being different from the first surgical condition, and the second surgical function being different from the first surgical function.

[0265] Example 22 - A surgical device as described in Example 21, wherein the situational awareness surgical hub comprises a situational awareness module and the surgical condition comprises a step in a surgical procedure.

[0266] Example 23 - A surgical device described in any one of Examples 21 and 22, wherein the surgical condition includes identification of a set of surgical devices currently in use in the surgical field.

[0267] Example 24 - A surgical device described in any one of Examples 21-23, wherein the surgical condition includes the location of a portion of the surgical device.

[0268] Example 25 - A surgical device described in any one of Examples 21 to 24, wherein the surgical condition includes the position of the jaws of an end effector of the surgical device.

[0269] Example 26 - A surgical device described in any one of Examples 21 to 25, wherein the actuator is movable through a first range of movement from a first position to a second position and through a second range of movement from the second position to a third position, movement of the actuator in the first range of movement being configured to activate a surgical function, and movement of the actuator in the second range of movement being configured to measure the extent of the surgical function.

[0270] Example 27 - A surgical device described in any one of Examples 21 to 26, further comprising a Hall effect sensor configured to determine the position of the actuator, wherein the first surgical function includes activation and the second surgical function includes adjusting the degree of activation based on the position of the actuator detected by the Hall effect sensor.

[0271] Example 28 - A surgical device described in any one of Examples 21 to 26, further comprising a strain gauge operably connected to the actuator, the strain gauge configured to determine an input force on the actuator, the first surgical function includes activation, and the second surgical function includes adjusting the degree of activation based on the input force detected by the strain gauge.

[0272] Example 29 - A surgical device described in any one of Examples 21 to 28, wherein the first surgical function is limited by a first maximum threshold and a first minimum threshold, and the second surgical function includes a second maximum threshold and a second minimum threshold, the first maximum threshold being different from the second maximum threshold and the first minimum threshold being different from the second minimum threshold.

[0273] Example 30 - A surgical device described in any one of Examples 21 to 29, wherein the first surgical condition corresponds to a surgical step of coarse use and the second surgical condition corresponds to a surgical step of precision use.

[0274] Example 31 - A surgical device described in any one of Examples 21 to 30, wherein the actuator comprises at least one of a button, a switch, a toggle, a trigger, a lever, a dial, and a knob.

[0275] Example 32 - A surgical device described in any one of Examples 21 to 31, wherein the control circuit comprises a processor and a memory communicatively coupled to the processor.

[0276] Example 33 - A non-transitory medium storing computer readable instructions that, when executed, cause a surgical device to receive a signal from a situationally aware surgical hub indicative of a surgical condition, receive an actuation signal in response to an input applied to an actuator of the surgical device, and implement a surgical function in response to the actuation signal, the surgical function including a first surgical function when the surgical condition corresponds to a first surgical condition, and the surgical function including a second surgical function when the surgical condition corresponds to a second surgical condition, the second surgical condition being different from the first surgical condition, and the second surgical function being different from the first surgical function.

[0277] Example 34 - A system comprising: a screen configured to selectively display suggestions to a clinician in an operating room; and a control circuit comprising a processor and a memory in signal communication with the processor, the memory storing instructions executable by the processor for receiving a signal from a situational awareness surgical hub indicating a surgical condition, determining a priority level of the suggestion based on the surgical condition, and communicating the priority level of the suggestion via the screen.

[0278] Example 35 - A system as described in Example 34, wherein the control circuit is further configured to select one or more suggestions from a plurality of possible suggestions based on the surgical condition.

[0279] Example 36 - A system as described in Example 35, wherein the control circuit is further configured to adjust the priority level of the suggestions based on a predicted surgical action, the predicted surgical action being based on a surgical condition.

[0280] Example 37 - A system described in Example 36, wherein the predicted surgical action is based on the position of the surgical device at the surgical site.

[0281] Example 38 - A system described in any one of Examples 34 to 37, wherein a high priority level is conveyed by at least one of marking, emphasis, highlighting, and blinking.

[0282] Example 39 - A system described in any one of Examples 34 to 38, wherein the screen is disposed on a surgical device.

[0283] Example 40 - The system of any one of Examples 34 to 39, further comprising an imaging system having a video monitor that can be placed in the operating room, the screen being positioned on the video monitor.

[0284] Although several embodiments have been illustrated and described, it is not the applicant's intention to restrict or limit the scope of the appended "claims" to such details. Numerous modifications, variations, changes, substitutions, combinations, and equivalents of these embodiments can be implemented and will occur to those skilled in the art without departing from the scope of the present disclosure. Moreover, the structure of each element associated with the described embodiments can be alternatively described as a means for providing the function performed by the element. Also, although materials are disclosed with respect to specific components, other materials may be used. It is therefore to be understood that the above description and the appended claims are intended to cover all such modifications, combinations, and variations as falling within the scope of the disclosed embodiments. The appended claims are intended to cover all such modifications, variations, changes, substitutions, modifications, and equivalents.

[0285] The above detailed description has described various aspects of devices and / or processes via block diagrams, flow charts, and / or examples. To the extent that such block diagrams, flow charts, and / or examples include one or more functions and / or operations, it should be understood by one of ordinary skill in the art that each function and / or operation included in such block diagrams, flow charts, and / or examples can be individually and / or collectively implemented by a variety of hardware, software, firmware, or virtually any combination thereof. It should be understood by one of ordinary skill in the art that all or a portion of some aspects of the embodiments disclosed herein can be equivalently implemented on an integrated circuit as one or more computer programs running on one or more computers (e.g., as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (e.g., as one or more programs running on one or more microprocessors), as firmware, or virtually any combination thereof, and that designing circuitry and / or writing software and / or firmware code is within the skill of one of ordinary skill in the art in view of the present disclosure. Moreover, those skilled in the art will appreciate that the subject matter described herein may be distributed as one or more program products in a variety of forms, and that the illustrative forms of the subject matter described herein apply regardless of the particular type of signal-bearing medium used to actually effect the distribution.

[0286] The instructions used to program the logic to perform the various disclosed aspects may be stored in a system memory such as dynamic random access memory (DRAM), cache, flash memory, or other storage device. Additionally, the instructions may be distributed over a network or by other computer-readable media. Thus, a machine-readable medium may include any mechanism for storing or transmitting information in a form readable by a machine (e.g., a computer), including but not limited to floppy diskettes, optical disks, compact disks, read-only memories (CD-ROMs), as well as magneto-optical disks, read-only memories (ROMs), random access memories (RAMs), erasable programmable read-only memories (EPROMs), electrically erasable programmable read-only memories (EEPROMs), magnetic or optical cards, flash memories, or tangible machine-readable storage devices used to transmit information over the Internet via electrical, optical, acoustical, or other forms of propagated signals (e.g., carrier waves, infrared signals, digital signals, etc.). Accordingly, non-transitory computer-readable media includes any type of tangible machine-readable medium suitable for storing or transmitting electronic instructions or information in a form readable by a machine (eg, a computer).

[0287] The term "control circuitry" as used in any aspect of the present specification can refer to, for example, hardwired circuitry, programmable circuitry (e.g., a computer processor including one or more individual instruction processing cores, a processing unit, a processor, a microcontroller, a microcontroller unit, a controller, a digital signal processor (DSP), a programmable logic device (PLD), a programmable logic array (PLA), or a field programmable gate array (FPGA)), a state machine circuit, firmware that stores instructions executed by the programmable circuit, and any combination thereof. The control circuitry, collectively or individually, can be embodied as circuits that form part of a larger system, such as, for example, an integrated circuit (IC), an application specific integrated circuit (ASIC), a system on a chip (SoC), a desktop computer, a laptop computer, a tablet computer, a server, a smartphone, etc. Thus, as used herein, "control circuitry" includes, but is not limited to, electrical circuitry having at least one discrete electrical circuit, electrical circuitry having at least one integrated circuit, electrical circuitry having at least one application specific integrated circuit, electrical circuitry forming a general purpose computing device configured by a computer program (e.g., a general purpose computer configured by a computer program that at least partially executes the processes and / or devices described herein, or a microprocessor configured by a computer program that at least partially executes the processes and / or devices described herein), electrical circuitry forming a memory device (e.g., a form of random access memory), and / or electrical circuitry forming a communications device (e.g., a modem, a communications switch, or an opto-electronic device). Those skilled in the art will recognize that the subject matter described herein may be implemented in analog or digital form, or some combination thereof.

[0288] As used in any aspect herein, the term "logic" may refer to an application, software, firmware, and / or circuitry configured to perform any of the operations described above. Software may be embodied as a software package, code, instructions, instruction sets, and / or data recorded on a non-transitory computer-readable storage medium. Firmware may be embodied as code, instructions, or instruction sets, and / or hard-coded (e.g., non-volatile) data in a memory device.

[0289] As used in any aspect of this specification, the terms "component," "system," "module," etc. may refer to a computer-related entity that is either hardware, a combination of hardware and software, software, or software in execution.

[0290] As used in any aspect of the present specification, an "algorithm" refers to a self-consistent sequence of steps leading to a desired result, and the "steps" refer to the manipulation of physical quantities and / or logical states, which may, but need not, be in the form of electrical or magnetic signals capable of being stored, transferred, combined, compared, and otherwise manipulated. It is common practice to refer to these signals as bits, values, elements, symbols, characters, terms, numbers, or the like. These and similar terms may be associated with the appropriate physical quantities or are merely convenient labels applied to these quantities and / or states.

[0291] The network may include a packet-switched network. The communication devices may communicate with each other using a selected packet-switched network communication protocol. One exemplary communication protocol may include an Ethernet communication protocol that may enable communication using Transmission Control Protocol / Internet Protocol (TCP / IP). The Ethernet protocol may conform to or be compatible with the Ethernet standard entitled "IEEE 802.3 Standard" published in December 2008 by the Institute of Electrical and Electronics Engineers (IEEE), and / or later versions of this standard. Alternatively or additionally, the communication devices may communicate with each other using an X.25 communication protocol. The X.25 communication protocol may conform to or be compatible with standards promulgated by the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, the communication devices may communicate with each other using a Frame Relay communication protocol. The frame relay communication protocol may conform to or be compatible with standards promulgated by the Consultative Committee for International Telegraph and Telephone (CCITT) and / or the American National Standards Institute (ANSI). Alternatively or additionally, the transceivers may be capable of communicating with each other using an Asynchronous Transfer Mode (ATM) communication protocol. The ATM communication protocol may conform to or be compatible with the ATM standard published in August 2001 by the ATM Forum entitled "ATM-MPLS Network Interworking 2.0" and / or later versions of this standard.Of course, different and / or later developed connection-oriented network communication protocols are equally contemplated herein.

[0292] Unless expressly specified otherwise, as will be apparent from the foregoing disclosure, discussions throughout the foregoing disclosure using terms such as "processing," "computing," "calculating," "determining," "displaying," and the like will be understood to refer to the operations and processing of a computer system or similar electronic computing device that manipulates and transforms data represented as physical (electronic) quantities in the registers and memory of the computer system into other data similarly represented as physical quantities in the memory or registers of the computer system or such information storage, transmission, or display device.

[0293] One or more components may be referred to herein as being "configured to," "configurable to," "operable / operative to," "adapted / adaptable," "able to," "conformable / conformed to," etc. Those skilled in the art will understand that "configured to" may generally encompass active and / or inactive and / or standby components, unless the context requires otherwise.

[0294] The terms "proximal" and "distal" are used herein with reference to a clinician manipulating a handle portion of a surgical instrument. The term "proximal" refers to the portion closest to the clinician and the term "distal" refers to the portion located away from the clinician. It will be further understood that for convenience and clarity, spatial terms such as "vertical," "horizontal," "up," and "down" may be used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and / or absolute.

[0295] Those of skill in the art will understand that the terms used herein generally, and in the appended claims in particular (e.g., the body of the appended claims), are generally intended as "open" terms (e.g., the term "including" should be interpreted as "including but not limited to," the term "having" should be interpreted as "having at least," the term "includes" should be interpreted as "includes but is not limited to," etc.). Moreover, those of skill in the art will understand that where a specific number is intended in an introduced claim recitation, such intention will be clearly recited in the claim, and in the absence of such recitation, no such intention exists. For example, as an aid to understanding, the appended claims which follow may include the introductory phrases "at least one" and "one or more" to introduce the claim recitation. However, the use of such phrases should not be construed as implying that when a claim recitation is introduced by the indefinite article "a" or "an," any particular claim containing such an introduced claim recitation is limited to claims containing only one such recitation, even if the same claim contains an introductory phrase such as "one or more" or "at least one" and the indefinite article "a" or "an" (e.g., "a" and / or "an" should normally be construed to mean "at least one" or "one or more"). The same applies when a definite article is used to introduce a claim recitation.

[0296] Further, even when a particular number is specified in an introduced claim recitation, one of ordinary skill in the art will recognize that such recitation should typically be interpreted to mean at least the recited number (e.g., a recitation of simply "two items" without other qualifiers generally means at least two items, or more than two items). Furthermore, when a notation similar to "at least one of A, B, and C, etc." is used, such syntax is generally intended in the sense that one of ordinary skill in the art would understand the notation (e.g., "a system having at least one of A, B, and C" includes, but is not limited to, systems having only A, only B, only C, both A and B, both A and C, both B and C, and / or all of A, B, and C, etc.). When a notation similar to "at least one of A, B, or C, etc." is used, such syntax is generally intended in the sense that one of ordinary skill in the art would understand the notation (e.g., "a system having at least one of A, B, or C" includes, but is not limited to, systems having only A, only B, only C, both A and B, both A and C, both B and C, and / or all of A, B, and C, etc.). Furthermore, one of ordinary skill in the art will understand that any disjunctive word and / or phrase expressing two or more alternative terms should typically be understood to contemplate the possibility of including one of those terms, either of those terms, or both of those terms, whether in the specification, claims, or drawings, unless the context requires otherwise. For example, the phrase "A or B" will typically be understood to include the possibilities of "A" or "B" or "A and B."

[0297] With respect to the appended claims, one of ordinary skill in the art will appreciate that the recited operations herein may generally be performed in any order. Also, while flow diagrams of various operations are shown in a sequence, it should be understood that the various operations may be performed in orders other than those illustrated, or may be performed simultaneously. Examples of such alternative orderings may include overlapping, interleaving, interrupting, reordering, incremental, preliminary, additional, simultaneous, reverse, or other different orderings, unless the context requires otherwise. Moreover, terms such as "responsive to," "related to," or other past tense adjectives are generally not intended to exclude such variations, unless the context requires otherwise.

[0298] It is worth noting that any reference to "one embodiment," "an embodiment," "an example," "an example," or the like means that a particular feature, structure, or characteristic described in connection with that embodiment is included in at least one embodiment. Thus, the phrases "in one embodiment," "in an embodiment," "in an example," and "in one example" appearing in various places throughout this specification do not necessarily all refer to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments.

[0299] Any patent application, patent, non-patent publication, or other disclosure material referenced herein and / or listed in any Application Data Sheet is incorporated herein by reference to the extent that the incorporated material is not inconsistent with this specification. As such, and to the extent necessary, the disclosure material explicitly set forth in this specification shall take precedence over any conflicting statements incorporated herein by reference. Any content, or portions thereof, that conflicts with current definitions, opinions, or other disclosure material set forth herein shall be incorporated herein by reference, but only to the extent that no conflict arises between the reference material and the current disclosure material.

[0300] In summary, many benefits have been described that result from using the concepts described herein. The foregoing description of one or more embodiments has been presented for purposes of illustration and description. It is not intended to be exhaustive or to be limited to the precise form disclosed. Modifications or variations are possible in light of the above teachings. The one or more embodiments have been selected and described in order to illustrate the principles and practical applications, thereby enabling those skilled in the art to utilize various embodiments, with various modifications, as suitable for the particular use contemplated. It is intended that the claims presented herewith define the overall scope.

[0301] [Embodiment] (1) an actuator configured to receive an input; A control circuit comprising: Receives a signal from the situational awareness surgical hub indicating a surgical condition; receiving an actuation signal from the actuator in response to the input; and a control circuit configured to implement a surgical function in response to the actuation signal, the surgical function including a first surgical function when the surgical condition corresponds to a first surgical condition, and the surgical function including a second surgical function when the surgical condition corresponds to a second surgical condition, the second surgical condition being different from the first surgical condition, and the second surgical function being different from the first surgical function. (2) The surgical device of claim 1, wherein the situationally aware surgical hub comprises a situationally aware module and the surgical condition comprises a step in a surgical procedure. (3) The surgical device of embodiment 1, wherein the surgical condition includes an identification of a set of surgical devices currently in use in the surgical field. (4) The surgical device of embodiment 1, wherein the surgical condition includes the location of a portion of the surgical device. (5) The surgical device of embodiment 4, wherein the surgical condition includes a position of a jaw of an end effector of the surgical device.

[0302] (6) The surgical device of embodiment 1, wherein the actuator is movable through a first range of movement from a first position to a second position and through a second range of movement from the second position to a third position, movement of the actuator in the first range of movement configured to activate the surgical function, and movement of the actuator in the second range of movement configured to measure an extent of the surgical function. (7) The surgical device of embodiment 1, further comprising a Hall effect sensor configured to determine the position of the actuator, wherein the first surgical function includes activation and the second surgical function includes adjusting the degree of activation based on the position of the actuator detected by the Hall effect sensor. (8) The surgical device of embodiment 1, further comprising a strain gauge operably connected to the actuator, the strain gauge configured to determine the input force on the actuator, the first surgical function including actuation, and the second surgical function including adjusting the degree of actuation based on the input force detected by the strain gauge. (9) The surgical device of embodiment 1, wherein the first surgical function is limited by a first maximum threshold and a first minimum threshold, and the second surgical function includes a second maximum threshold and a second minimum threshold, the first maximum threshold being different from the second maximum threshold and the first minimum threshold being different from the second minimum threshold. (10) The surgical device of embodiment 9, wherein the first surgical condition corresponds to a gross usage surgical step and the second surgical condition corresponds to a precision usage surgical step.

[0303] (11) The surgical device of embodiment 1, wherein the actuator comprises at least one of a button, a switch, a toggle, a trigger, a lever, a dial, and a knob. (12) The surgical device of embodiment 1, wherein the control circuit comprises a processor and a memory communicatively coupled to the processor. (13) A non-transitory medium storing computer readable instructions that, when executed, cause a surgical device to: receiving a signal from a situational awareness surgical hub indicative of a surgical condition; receiving an actuation signal in response to an input applied to an actuator of the surgical device; A non-transitory medium that implements surgical functions in response to the actuation signal, the surgical functions including a first surgical function when the surgical condition corresponds to a first surgical condition, and a second surgical function when the surgical condition corresponds to a second surgical condition, the second surgical condition being different from the first surgical condition, and the second surgical function being different from the first surgical function. (14) a screen configured to selectively display suggestions to a clinician in the operating room; a control circuit comprising a processor and a memory in signal communication with the processor, the memory comprising: Receives a signal from the situational awareness surgical hub indicating a surgical condition; determining a priority level of the suggestion based on the surgical condition; storing instructions executable by said processor for communicating said priority level of said suggestions via said screen. (15) The system of embodiment 14, wherein the control circuitry is further configured to select one or more suggestions from a plurality of possible suggestions based on the surgical condition.

[0304] (16) The system of claim 15, wherein the control circuitry is further configured to adjust the priority level of the suggestions based on a predicted surgical action, the predicted surgical action being based on the surgical condition. (17) The system of embodiment 16, wherein the predicted surgical movement is based on a position of a surgical device at a surgical site. (18) The system of embodiment 14, wherein a high priority level is conveyed by at least one of marking, emphasis, highlighting, and blinking. (19) The system of embodiment 14, wherein the screen is disposed on a surgical device. (20) The system of claim 14, further comprising an imaging system having a video monitor positionable in the operating room, the screen being positioned on the video monitor.

Claims

1. an end effector having a first jaw and a second jaw that can be opened and closed relative to one another; a closure trigger that is operated to move at least one of the first jaw and the second jaw from an open state to a closed state; a control circuit that controls a power level applied to the end effector in response to an amount of operation of the closure trigger or an amount of movement of the at least one of the first jaw and the second jaw in a closing direction; an actuation button for activating power to the end effector; when the actuation button is activated, the power level applied to the end effector is varied in response to the amount of actuation of the closure trigger or the amount of movement of the at least one of the first jaw and the second jaw in the closure direction; a second actuation button for activating power to the end effector; a level of power delivered to the end effector when the actuator button is activated is greater than a level of power delivered to the end effector when the second actuator button is activated; a first power level is applied to the end effector when the first and second jaws are in a range from a fully open position to a predetermined partially closed position and the actuator button is activated, and a second power level is applied to the end effector when the first and second jaws are closed beyond the predetermined partially closed position and the actuator button is activated; a third power level is applied to the end effector when the first and second jaws are in a range from the fully open position to the predetermined partially closed position and the second actuator button is activated, and a fourth power level is applied to the end effector when the first and second jaws are closed beyond the predetermined partially closed position and the second actuator button is activated; the second power level is greater than the first power level, the fourth power level is greater than the third power level, the first power level is greater than the third power level, and the second power level is greater than the fourth power level.

2. 10. The surgical device of claim 1, wherein application of the first power level to the end effector coagulates tissue held by the end effector and application of the second power level to the end effector cuts the tissue held by the end effector.

3. 10. The surgical device of claim 1, wherein application of the third power level to the end effector coagulates tissue held by the end effector and application of the fourth power level to the end effector cuts the tissue held by the end effector.

4. The surgical device of claim 1 , wherein the power level applied to the end effector increases as the actuator button is depressed more.

5. The surgical device of claim 1 , wherein the greater the depression of the second actuator button, the greater the power level applied to the end effector.

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